One of the most controversial legislative successes of the current administration is healthcare reform. Some of those provisions — which would prevent insurers from denying children coverage because of preexisting conditions, allow young adults to stay on their parents’ insurance until age 26, and gradually raise the allowable annual caps on coverage — have already begun to take effect, even as Congress expects to revisit the issue before the session is out.
In fact, as a concession for passing a budget last week, the Democrats agreed to allow a vote on a repeal of "Obamacare," after promising such a vote would never happen. As it turns out, it - the repealing legislation - will be attached to the FAA bill. (Makes sense, in lala land . . . or in Washington.)
It's a common refrain among parents carrying private health insurance - they meet those caps, when cancer is involved, lightning-fast. I can only imagine that it's similar for other diseases. Autism is extraordinarily expensive. In my opinion, medical decisions for autism are probably more difficult to make because they are not generally life-and-death and one can question the efficacy of the treatment, giving it a more "optional" flavor than, say, a double needle bone marrow aspiration has. In addition, many autism treatments are not covered by insurance at all, though I've been reading that this is starting to change in some states. (Last I heard, fifteen states were covering ABA therapy. Which means that, last I heard, 35 were not . . . and ABA is but one segment of autism treatment.)
I know that many of you fear socialized medicine. What you really fear, I suspect, is socialism itself. However, I want you to consider momentarily that we already have a number of systems in place that operate socialistically, and all of them, up until recently, were running quite well - and we accepted the idea of paying for them with tax dollars. Today we are seeing a move toward privatizing even these services, services that we all take for granted. Our public schools, fire departments, and police departments are taxpayer-funded: socialist? No one has really objected to that before, unless you consider the school vouchers program, which has remained controversial. No one wants our police departments to be run like Mexico's, where you literally might have to pay the police officer yourself to get any help at all. We benefit from the centralized and state-run aspects of these programs. More importantly, though, we generally accept the idea that they should be centralized and state-run.
I've read again and again that the best healthcare system in the world is considered to be that of France, America's political philosophy soul-sister. In America, we have phenomenal emergency healthcare, but it's hard to argue that emergency rooms can take care of us all, and all of our woes. Preventative care has been the goal, but when most people are trying not to lose their shirts, it's easy to sort of "hope for the best" where your health is concerned and put off your doctor visits. How many adults wait for their Medicare to kick in? And then arrive at the doctor's office with a plethora of interrelated health issues that the doctor can barely sort out? This simply doesn't happen there, except in the case of the rare personality that just doesn't want to go to the doctor. No one avoids medical care because they can't pay. And while there may be some people in France who dislike the idea of paying higher taxes to cover their neighbor - I don't know, I'm just saying that there may be - it's as natural to them as funding police and fire departments and schools is to us.
It's a mindset.
I could go off on some tangent about how the wealthiest 1% in America hold 95% of all of the wealth, how wealth redistribution is the cure, how medical socialism a la Sweden or France could benefit us - but the image conjured up is that of Stalin's prison camps, not Abba. We've been socialized to cringe at the word "socialism." But it's sorta beside the point, when you consider the dilemma faced my millions of people without insurance coverage, people devastated by unforeseen or simply overwhelming medical costs to the extent that they're selling (or losing) their homes and filing for bankruptcy. You hear about people doing without medical care.
One of the biggest flaws in the logic of the average American when asked about universal healthcare coverage is the idea that "I" shouldn't have to pay for the guy who didn't behave responsibly and pay for coverage, like "I" did . . . there are certainly a good number of people who choose not to buy insurance because, well, they're healthy. And then it all falls apart, and they're uninsurable, and they want you, the responsible guy who paid for insurance for all of those years, to pay his way now, too? Obviously, that's unfair. Where's the . . . benefit? . . for doing the right thing? What's an honest guy to do?
But there are two things to consider. First, any business knows how to spread out its losses by "taxing" the paying customers. It's the argument the insurance lobby uses when it argues in favor of "tort reform." So when an uninsured person shows up at the emergency room, do you think the hospital is just going to write it off as charity? As much as possible, it's going to recoup its losses somewhere else. (Many hospitals have to do this to stay afloat - I think most smaller hospitals, at least, are running pretty close to the break-even point. But I don't know statistics on that. Just wanted to say that they're not all big-profit operations unto themselves.) Anyway, back to the losses thing: if the hospital is recouping by charging more to someone else's insurance, you can be sure that you will eventually get stuck with the bill when the insurance company raises everyone's rates to keep profits coming. Insurance companies are among the wealthiest of industries. These folks have long left break-even in the dust. Take a glimpse at the top 10 of the Fortune 500, and you'll see more than a couple of slots filled by insurance companies that are afraid of going broke under the healthcare law.
Second . . . not every uninsured person is uninsured as a result of irresponsiblility. The classic example is the downsized employee with a pre-existing condition. That's someone who won't be able to buy insurance at any cost. Maybe he worked at the place for twenty years and got laid off. Is that irresponsible? Or is that just how it rolls sometimes? Know any 50-ish guys that got downsized? They're not the top choice for hiring, as most companies are hiring the younger, further-from-retirement, lower-pay range folks. It may be a long way to Medicare, but what's the option when you're unemployed?
There is an attitude that I run across from time to time when I follow comments to articles or posts in which the occasional parent will respond to someone's cry for more generous childhood cancer research spending with something similar to "why should we have to soak up the cost of your situation?" I'm fairly certain that the autism crowd has heard it, too. Maybe we all have. It's an ugly sentiment and I wish I could pull that person aside and explain how cancer is not an inherited disease and most childhood diseases aren't and even if it were in a particular case, that nothing is certain, even the odds of inheriting a disease that your family carries in its genes, especially if you didn't even know that you were carrying it. I would tell that person that most of us are shocked by a diagnosis and that most of us are financially devastated as a result of it, on top of everything else that's been handed to us. I would tell that person that sharing the burden is a karmic appreciation for your child's having been spared; a recognition that, but for the grace of God or dumb luck, it could have been your child. Every birth is a giant leap of faith.
I think that's why people would prefer to think that you must have done something to cause the problem. It lets them off the hook.
Quick survey: how many of you caused your kid's sickness?
But I have to appreciate the point of view. Disgusting as it is, isn't it reflective of most people's opinion of providing universal healthcare coverage? No one wants anything that doesn't benefit them directly. We certainly don't want to pay for it. We seriously do not give two sh*ts about our fellow man. And if we, the lottery winners in the world of childhood disease, can't show compassion to others, then we are worse than those who can't show it to us.
Because we should know better.
Some of us have worked hard all of our lives. Some of us have paid for insurance out of our pockets because it's the right thing to do, only to watch the lifetime caps loom ever closer (and the insured party is only three years old.) Some of us have found ourselves canceled at the earliest opportunity. Some of us have had fantastic insurance coverage through our employment but legitimately worry that our familial obligations, augmented by the sheer labor intensivity of having a sick kid, jeopardize our continuing employment (and hence, insurance.) Sure, you can keep your insurance post-employment . . . but it's typically very expensive to do so. Especially if you're between jobs. Others, "lucky" enough to have seen our kids through their disease and launching them into adulthood, have worried that they'll be uninsurable now, having flown the nest and its attendant insurance policy. I wish I could convince people that these things don't just happen to people who planned poorly.
As long as we have a healthcare system that's driven by huge profits, the wellness of our people will never be the priority in our healthcare system. We may benefit from the advances that the profits motivate at some point. I am not the first to note that once a hospital invests a chunk of money in diagnostic equipment it needs to use the equipment a lot, or that once a hospital purchases state-of-the-art therapeutic instruments it needs to practically run a patient assembly line to maximize its returns. Folks, that's free market economics 101. I can't say that I approve, but it's logical. I know that our medical folks are fond of saying that we have the best there is, and I'm blessed to have some pretty awesome people caring for my family. The international community, however, has not been quite as adoring. I think we rank somewhere in the 30s range (37th or 38th sounds right) as far as healthcare ranking goes, and that's from an international program, I want to say the IMF or maybe the World Health Organization - but I'm guessing there. So clearly we're lacking something in the big scheme of things, when the rest of the industrialized world surpasses us, the most powerful.
Often people want to blame lawyers for skyrocketing medical costs. Having been an attorney, and understanding that no case proceeds to a jury without having been meritorious (and having spent thousands on expert witnesses to say so,) I know that this is somwhat of a myth perpetrated by the insurance companies that want to maximize their profits while canceling the risks (which is not very capitalistic, if you think about it: the profit is moral because the risk is substantial. Take away the risk, spread it amongst the non-profiting public, and suddenly the profit isn't quite so moral.) There's a reason why the Fortune 500 companies' top 10 list is heavily populated with insurance companies. They issue contracts of adhesion to a desperate and trusting public, pocket the profit, and then threaten to raise rates wholesale once they have to pay out anything. They decry the cause of the payout, usually lawyers, and that's a little like threatening to stop buying groceries if your family doesn't stop eating them. It is true, of course, that some manage to file lawsuits that aren't clear winners and walk out with a decent settlement, but by and large, there are hurdles before even filing the suit. (And often it's the insurance company, not the doctor, that agrees to settle.) So the idea that people are just running out and making things up is a bit exaggerrated.
But I digress.
Oh, wait, this is my soapbox, so I'm going to defend the practice of law for about thirty more seconds. As a former practicing attorney, I believe in the lawsuit, or at least the possibilty of one; it is far more important to our democratic legacy than our love of capitalism, or whatever it is that we have. It is unfortunate that some have learned to exploit the system, and perhaps it too needs an overhaul, but when you've been wronged by someone, shouldn't you have some recompense? It's basic fairness. It's our history. Here's an example of how tort reform hurts the individual. Michigan has no-fault insurance. An insured driver, at fault, destroys your minimally insured but still driveable auto, and you have no recourse but for that which you paid for through your own insurance company, who will fight like hell not to give you a dime. You will have spent hundreds, maybe thousands, on an insurance policy that won't get you another vehicle. In the old days, when you were wronged, you brought a civil suit against the other driver, who was then obligated to make it right with you, assuming that your evidence proved his liability. It was simple: once I proved that you damaged my car, you paid me the amount of money that would repair or replace my car. You put me back in the position I would have occupied, but for your negligence. In some states, drivers buy liability insurance to cover their losses should they be at-fault. The no-fault movement is part of a greater scheme to phase out tort liability completely. It all sounds good until you're the one who's left without wheels, which you will now have to replace, and possibly insure at a higher rate for having been in an accident at all. The insurer spreads its losses out amongst its insured, but the insured takes it in the chin. And I'm still uncertain what benefit the arrangement is to the general insured public. Missed that memo, I guess. Something about lower insurance rates, I think.
If we, as a people, are going to follow this practice for something as atypical as a car accident, why wouldn't we adopt the practice for something as mundane as taking care of one's health? It's entirely possible that significant tort reform will accompany or follow a healthcare reform of any kind, and maybe that's a fair trade, if doctors are going to face increased oversight with diminishing income. It will compromise some individuals' right to recompense. But medical malpractice happens with surprising frequency. Somewhere, a doctor will completely botch someone's care, and there will be no lawsuit. Is that fair? I don't know. But if we're all required to carry auto insurance, what's the holdup in the healthcare field?
Back to health coverage.
When social security was started, people were wary. It's a part of the landscape now, even if some are working overtime to dismantle it; the majority of us have accepted it as part of our societal burden. So will it be with healthcare, one day. If you work in the medical profession, you will probably have a very sophisicated opinion of the healthcare law. But - like my opinion on the right to sue - it will be somewhat biased. Keep in mind that you already have excellent healthcare coverage - unlike most of us that work in other fields. It's the ultimate perq: restaurant workers get meal discounts, retail sales folk get product discounts, lawyers always know who to call; you get great insurance. Most of us don't have this setup. Most of us don't have a clue how to scan a medical bill for error, error that might ultimately impact our lifetime caps. Most of us don't know what to ask for and what to refuse. Most of us with our own insurance pay such a high deductible that we are slowly going broke anyway. What about so-called "experimental" treatments? It's very difficult to get coverage for those. You need someone to advocate for the treatment, someone to work the language for you - great if you have insurance people or lawyers in the family, but better if you have someone who knows how the hospital works.
I'm digressing a little bit here, again, but I keep hearing about the "death option -" people are worried that a government bureaucracy will have the power to decide at what point they'll cut off our care and simply let us die. Sounds a little creepy, yes. It's also a testament to the sophisticated marketing of the political sound byte. I take exception to the characterization of "death by bureaucracy" not necessarily because it's untrue, but because it already exists. Except instead of a government bureaucrat, a low-level individual employed at the good will of the for-profit insurance company is making the decision. Where we decided that this was somehow preferable shows, in my opinion, how deeply ingrained the fear of "big government" is, even when it defies rational argument.
If you review the Preamble of the Constitution, it clearly states that government is supposed to provide for the general welfare. Sure, that's just the preamble, but it's a pretty clear statement.
Where did we go wrong? I hear people say that they want leaders that they can trust. Well . . .that's where we went wrong. Ever heard the phrase "trust, but verify?" We sorta forget to verify. We show up at the polls and wear our little good citizen stickers and think we've fulfilled our civic duty, but there's so much more to it. What if every one of us got daily updates to our inbox regarding our representatives' daily activities? What if every one of us made regular calls to their offices, stating our positions on whatever was on the agenda for the week? What good can we expect to come from our representatives when they are tempted at all times from all sides to make decisions in favor of the moneyed few, when our leaders feel that there is little to lose in giving over to that temptation? We've been lazy.
Trust, in this arena, is a euphemism for laziness, people.
I wonder how many of you know how your legislators voted on the Elizabeth Taylor memorial? While the budget was hanging in the balance and a government shutdown was looming, we're voting on recognizing the life of a movie star? Look, I've got nothing against Liz. But . . . please.
The challenge for this week is to educate yourself on what healthcare reform entails. Some of its provisions are already operating. If it's the term "socialized medicine" that's bothering you, ask yourself . . . why? Why does the idea of basic medical care for all offend you so? Why do you think the quality of care will suffer? Is it sort of like the "no clean air, it will hurt jobs" argument? (Because the only way it can hurt jobs, having clean air, is if we fail to penalize business for ditching us for "greener" pastures.) (Business, especially BIG business, is thoroughly subsidized by the government, so it offends me deeply that there is no imperative that they turn some of that generosity into something for the greater good.)
A word on where to get your information: if TV news is your preferred choice, may I suggest that you read their news on the network website rather than watch it? Reading is conducive to reasoning. Watching is a passive activity, and it's more difficult to question the content when it keeps moving. (Did you know that the average person's brain activity slows more during TV watching than during sleep?) There's a reason why the "sound byte" is so important and popular: it's purpose is to encompass a broad, possibly controversial issue from one side's point of view, and present it persuasively and memorably; it's also a "sound" byte because hearing the statement is different from reading it, when the recipient of the information controls the takeup rate. So, read - don't listen. Read. Here's a decent summary from the CBS news website: http://www.cbsnews.com/8301-503544_162-20000846-503544.html . There's also some good info at the following website: www.healthreform.gov/.
I am not "fair and balanced," either, though I'm trying to be. Trying to leave the door open for opposing views. It's the debate that yields the answers. But me, I know I'm very biased. I have a sick kid.
I initially posted this, accidentally, before proofreading (I thought "control P" would print, but instead it posted. Who knew?) So when I realized what had happened, I reread the post and saw a lot of errors but none so important as the omission of the links I refer to here. I am adding them at the end of the post so I don't goof something up again. It's a bummer to be so technologically challenged.
The links include one autism organization, one childhood cancer organization, and one asthma/allergy organization, each stating their respective positions on the Affordable Care Act. I also included links to two PBS programs, entitled "Sick in America" and "Sick Around the World," which are documentaries about an hour long each, as well as a recent PBS news report on the repeal effort. I watched these after I typed this post and decided to add them in here. There are no answers, but a great comparison of healthcare systems in the "world" one. Finally, I included - in the interest of fairness, since healthcare reform is clearly the Democrats' project - a link to the Republican point of view. I was trying to find partisan analyses of the cost related to implementing the healthcare reform, but since I accidentally posted, I'm now just trying to hurry up and fix the errors - I can't delete, and the botched post is out there until I replace it with this slightly more edited version . . . I'll add a link to the comments if I find anything good. Pretty sure we all know that there will be two very different sets of numbers, though.
I urge you to reconsider faithfully following your party's position; consider each issue from your own circumstances. Our legislators worked out their budget disagreement; no one got everything they wanted. That's how it should be. It's not a competition! On that note - one curious thing that I read was about how some Republicans said a proposal by Michigan Sen. Debbie Stabenow to eliminate the 1099 reporting requirement for small businesses to the IRS was "legislative pilferage-" since the idea was originally a Republican's. Some people will even complain when someone agrees with them? I suspect that we'll see some creativity in the days ahead, but again . . . that's how it should be. What's your job, as a citizen and constituent? It's to spell out your very specific preferences. Not just "no to reform" or "reform good," unless that's truly your assessment or you're a caveman. It's an obviously complicated issue, made even more complicated by the fact that campaign donors hold sway and any legislation deemed "job costing" frightens politicians facing elections.
As I often do, I looked up the big campaign spenders for the sponsors of the repeal, and found no surprises: banks, coal, and healthcare. On a whim, though, I looked up Stabenow, who is a healthcare reform proponent; as expected, I found union support, but also . . . healthcare. You can't just go partisan on this. Because the insurance and healthcare profiteers are playing both sides to guarantee the best outcome for themselves. We should do that, too!!!
Sorry to you TV news watchers, but it bears repeating: there's not a network out there that isn't doing someone's bidding. Be skeptical. If anyone really cared about the health of the average American, then insurance would be affordable, and insurance couldn't penalize you for having the very health problems that you purchased health care coverage to treat. Why does "America" really want to repeal healthcare? Because it disgorges those insane profits, that's why! I also want to suggest that the recent move toward privatizing is the wrong path to take. The idea that a program that's run like a business will run more efficiently is deeply flawed. A program that's run like a business will progress toward a single goal, and that is to make a profit. What's needed is less privatizing and more government oversight.
And not just oversight by the government - oversight OF the government, as well.
Me and you.
Accountability.
We are watching you too, Big Brother.
Links: http://www.pbs.org/newshour/rundown/2011/04/in-budget-battles-health-care-is-key-issue.html# and http://www.gop.gov/pledge/healthcare are general info; watch the full programs at http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/ and http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ .
The links re specific disease groups and healthcare reform follow: http://blog.autismspeaks.org/2010/3/23/health-care-reform/ ; http://www.aafa.org/display.cfm?id=7&sub=92&cont.690; and http://www.childrenscause.org/node/156. Hopefully I got them in here right. Anything at all to not have to start over, eh?
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