07 September 2009
National Health Service This Year!
I wrote the following piece in 2009, yet failed to publish it. I publish it now because it has become relevant to the current discussions about health care given the passage of the Affordable Care Act of 2010. The Republicans of 2017 are attempting to repeal and replace the ACA and the Democrats are trying to salvage the best of the ACA and improve its coverage. We now the problem: the insurance industry and Big Pharma have the American health care system hostage to huge bureaucracies and anti-competitive pricing models. Neither part seems willing to attack the problem! So, I offer the following still relevant commentary--old names intact--to readers awaiting the wisdom of our current leadership in Washington.
In 2009:
In 2009:
Candidate Obama won votes when he and his campaign pledged that, if elected, he would put into place a national health care system equivalent to the one members of Congress have. That plan still sounds very adequate for healing Americans who become ill and for encouraging preventative measures in diet, exercise and living patterns for healthy living. What we, the American public, have not heard from President Obama is the enactment of an equivalent insurance plan available to all Americans.
Why not? The people whose jobs depend on the current, disfunctional system want to continue their jobs, their employers in government and private entities depend on the revenue streams of the current, disfunctional system and do not want changes that might inhibit their options for increasing revenue streams. The supporting network of industries and service providers depend on the current, disfunctional system for their businesses.
Some Americans are quite content with the health care they receive from the current, disfunctional system. Representatives and lobbyists of these groups are hammering individuals and stakeholder groups in the White House and Congress with reasons for not messing with the current, disfunctional system because of their self-interests.
Some Americans are quite content with the health care they receive from the current, disfunctional system. Representatives and lobbyists of these groups are hammering individuals and stakeholder groups in the White House and Congress with reasons for not messing with the current, disfunctional system because of their self-interests.
Those 40+ million Americans who, from conception to death, are not satisfied with or do not have access to the current, disfunctional system, however, have no single voice, no one lobbyist or advocate, to have the access to members of Congress or to the White House as do those groups with vested interests in the status quo. Many of these dissatisfied people are parents, indeed so are children and babies, the elderly without the ability or money to control their lives any longer, the immigrants who have difficulty with learning English or Spanish, the unemployed persons, the unemployable persons and the disabled persons. The working poor and what remains of the middle class pay in the range of 41 percent of their incomes on heath care premiums and for what is not covered. For comparison, the mortgage industry used percent of income amounts for qualifying home loans applicants. In a tight market, the advisory amount of household expense including mortgages was between 30-33 percent. In boom times, the amount increased to 50 percent for qualifying. Now, people are being priced out of their homes, communities and social norms, having never anticipated the crushing power of inflation in health care, investment fraud, recalcitrant and uncooperative banks limiting access to loans, and an economy starved for cash and credit at all levels with which to function.
What do I do about this? When I had some disposable income, I did send small one-time donations. I do not have the time or the disposable funds to contribute money. E-mails from every progressive political group and political party thinks I should fund their efforts, though who knows where that money goes. Much of it is not tax deductible. So, I write letters:
I fax these letters to their Washington offices in hopes that a human must look at them. I sometimes receive a polite, snail mail response with a thanks for writing. (My emails usually elicit nothing or an email response instructing me to go to the addressee's web site and use its form for providing input.) In these letters, which are one page, no big words, I remind them of the Declaration of Independence's declaration of our Rights as humans to Life, Liberty, and the Pursuit of Happiness. I tell them that two of the three depend inextricably on health, so any national health plan for America must include a public option, of which I favor a single payer design.I write letters to Committee heads from both parties in both houses of Congress,I write letters to Special Counsel to the President Nancy-Anne DeParleI write letters to the President and the Vice PresidentI write letters to Speaker Nancy PelosiI write letters to my senators, Barbara Boxer and Dianne FeinsteinI write letters to my Congressional representative, Darrell Issa, 49th Congressional DistrictI write letters to Barbara Lee, head of the House's Black Caucus and 9th Congressional DistrictI write letters to Henry WaxmanI write letters to other senators and representatives
I also inform them that the lack of a public option has cost me over $500,000 in prescription medicines and co-payments, because I was 46 when I became disabled in 1991. No healthcare insurance company would sell me supplemental insurance for Medicare for 18 years because I was not 65 years old. During this period, I paid Medicare co-pays, but also the full professional fees for specialist physicians who did not take Medicare patients and for all medications.
Politicians, news pundits and those individuals with jobs, and those who believe them, are very quick to hoist the "Reduce Cost" flag whenever some issue goes to the legislature for resolving. As a result of years of reporting about government waste and purchasing stupidity by the Defense Department and the military branches, the public rightfully regards our tax burdens as too much. The high costs of government can get a politician elected to office and news and commentary on radio and television can have a sure, audience grabbing, program just by focusing on government waste, especially in the entitlement programs. The absence of concomittant government rule enforcement and corrections because Congress either fails to budget for these agencies meant to discover and report waste and abuse, or, if there is an approved budget item, Congress can withhold appropriating money intended for this activity. The enforcement agencies, the inspector generals and internal auditors make their reports and recommendations, but no one person who reports to the President or Vice President is accountable for resolving issues in those reports. There is no civil service chief of staff, so action depends on a political appointee in the current administration. Nevertheless, market forces have not led to price equilibrium or customer-friedly marketing schemes sufficient to rein in the costs for health care.
During the years following WW II, "the greatest generation" voted into law a series of entitlements for good cause, righting the wrongs of past generations such as racial and gender discrimination in education, housing, job accessibility and retention. That generation also imposed additional costs of production by enacting the OSHA laws for worker and community safety and ADA to recognize the impediments to job, home and living persons with disabilities encounter daily. The resulting list of entitlements, grouped by name as "welfare", raised the expense budgets at every level of government, they cost manufacturers and merchants, restaurants and construction to include many new requirements that increased the cost for providing the final product.
President Clinton cut welfare benefits that he and the Congress believed were creating a permanent class among Americans whose society and culture turned around government entitlement programs. That approach cannot work for health care services because everyone needs health care. There will not be a permanent underclass among Americans without health care services, due to natural attrition--infants, children, adults and old people die off early.
Why must we Americans be 20 years behind the cultures and countries our predecessors left to make a better world in America? Do we have such high incomes that allow us to spend too much money for our health care without realizing the abundance of money involved has enabled inefficient, outdated protocols, facilities and manual data management? Has the abundance of cash float in the health care and private insurance industries fostered the phenomenon of the litigious patient? Has the dispersion of paying for health care among insurance companies, government programs, patient co-payments and institutional write-offs hidden these wasteful and behind-the-times character of health care in America from the American public? I believe it has, just as we solve our other problems with paying out cash.
I do not intend to give up on the current attempt by President Obama to put into place a national, reformed health service this year. I regret that some Progressive groups are already looking at 2010 for creating what we need now.
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