Wednesday, September 30, 2009

Sold Out

We have been duped. That’s all there is to it. There’s no other way to describe the actions perpetrated on the citizenry by the corrupt and fouled human garbage that passes as governmental leadership in this country. Yesterday, our elected officials voted against creating a government funded health insurance option. Not a “takeover” of the health care system (which by the way, the government already heavily regulates thanks to its Medicare and Medicaid reimbursements), but simply the creation of publicly funded insurance policies that would offer some relief to those of us who pay increasingly handsomely to our insurance companies for ever diminishing coverage.

We were told by our bloviating talking heads and too many congressional members that a government run health insurance option would lead to socialism. We were told that the government would deny care to those who are too young or too old or too sick. We were told that capitalism and free markets are the only true American way to fix anything. Quite simply, we were lied to.

First, there’s that socialism thing. There are many democracies and capitalistic nations that offer a public health insurance option – in fact, the list includes all of them except the U.S. We are the lone wealthy, developed nation that does not provide its citizens this basic service. And why? Well, the insurance companies would be forced to compete with a more efficient, non-profit entity that would put them and their staggering profits to shame. They would be forced to become more efficient (reducing obscene pay and bonuses for the executives), cover more claims (they currently work to pay out as little as possible on all claims – profits are the goal, remember?) and offer more reasonably priced policies. Yeah, that’s a bad idea.

Socialism, as defined by the Merriam-Webster Online Dictionary, is “any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods”. It is not a situation where the government provides a service to its citizens. No one cries socialism when they talk about the public school system or the police or Emergency Medical Services or the military. There are private companies that compete with the government on all of these fronts (private schools, private security services, etc.), and they don’t complain about their businesses being unfairly harmed by publicly funded services. The socialism argument is a red herring.

How about the argument that the government would deny care? The last time I checked, the private insurers were the ones who refused to pay claims. It’s the private insurance companies that pre-screen and deny applicants and pre-approve claims. They are the ones who refuse payment for anything that’s new or expensive. They are the deniers of care, not the government funded programs Medicare or Medicaid.

To be clear, Medicare and Medicaid often don’t reimburse (pay) for all the costs, but no one dies while waiting for pre-approval and they don’t work diligently to deny care so they can make money.

How about that whole free market thing? Well, if the government began a publicly funded insurance option, it would compete in a free market. How much more capitalistic can you get? If one company can offer the same thing as another for a lower price, the other company has to become more efficient, find another niche, or get out of the business, right? What could be more American?

But insurers don’t want competition. They all work together to set prices and extort payments from us to make them wealthy. They tell us we need them. They tell us they will take care of us. The only ones they are interested in are themselves. They want huge profits so they can get large bonuses and make even more money. Competition will reduce their ability to make those staggering profits, so they have spent billions on convincing us and our representatives that somehow competition is not capitalism.

Now, from what I have seen, the insurers are winning. We have no public option that seems imminent and thus, the insurers have no competition. Prices for health care won’t be coming down anytime soon. But rest assured - our noble and fearless leaders are considering MANDATING that every citizen have health insurance. That is, if our employer does not provide it, we will be forced by law to purchase insurance from one of the major insurers. So instead of promoting efficiency by competition, the government has forced us (and our money) into the waiting arms of……you guessed it, the insurance industry. What a country!

Apparently, our government is more interested in representing the insurance industry than those who actually voted them into office. We have been sold off like so much garage sale merchandise – on the cheap and without a care. Until the populace wakes up and becomes outraged, nothing will get better. It will only become worse.

“We do not have to visit a madhouse to find disordered minds; our planet is the mental institution of the universe.” ~Johann Wolfgang von Goethe

Friday, September 18, 2009

On The Fringes By Choice

I couldn’t help but smile when I saw his name on my patient list. I thought, “There must be more than one ______ ________ in the world, but certainly not in this area”. I checked the records, and sure enough, it was him. I won’t use his real name here, as he has a right to his privacy, so I’ll use the pseudonym “Bob”.

I got to know Bob when I was a very young man - both emotionally and chronologically – and we worked together as guides for a whitewater rafting outfitter. He was, I thought until this week, much older than me. It’s funny how years and distance can actually make you seem closer to people, at least in age, than you once were.

His face had not changed much, though it was perhaps a bit more weathered. I couldn’t help but think this was the first time I had seen him without a cigarette in his mouth, sunglasses on his face, and completely sober. The lifestyle of a rafting guide can be as variable as the personality of each individual, but for a large number, it involves excessive alcohol consumption, heavy smoking (tobacco as well as marijuana) and telling stories that are upwards of 10-20% true.

Some guides are college kids who need seasonal work and don’t want to spend four months away from school flipping burgers at fast food joints. Many are near migrant workers, following the transient seasonal work from the rivers to the mountains, working winters as ski instructors or patrollers. These would be the ones who may or may not have dropped out of college, or just have not found or accepted what society has to offer them. Bob embodied the latter group.

I have long since given up the life of a guide – spending more than I earned in the company bar, chain smoking and trying desperately (and mostly unsuccessfully) to convince attractive women customers that a fling with a grungy, unshaven man who sported a tan that outlined a lifejacket on his upper body was a good idea. But back then, I thought guys like Bob were the ones who had it together: they had no permanent homes, no wives or children (that they knew of), few bills and worked “real jobs” sporadically at best. At the ripe old age of 20, it was my bohemian dream to follow in their footsteps.

Alas, time moves forward and most of us grow up and become adults – or at least more emotionally mature – and move closer to the center of society. That is, we find regular work, satisfying personal relationships and become more main stream. Bob never did though. He still hangs on to much of the old lifestyle - it has been too hard for him to give it up. He still makes his annual or bi-annual pilgrimage to the canyon so he can row the greatest river in North America; still has no wife or kids (that he knows of); still does not have a “regular” job as it would interfere with his play time; and still smokes like he’s sponsored by Philip Morris.

As a result of his own choices, he is one of our millions of uninsured in America. Not that he minds, or that he wants more from the health care system than he is willing to pay for out of his own pocket. He had a blocked coronary artery several years ago that required the placement of a stent and he paid for it himself – eventually. He now takes bottles of nitroglycerin with him on his canyon trips, because as he told me, “you never know and it’s a long ways away from anywhere”.

The cardiologist in our office who saw him told me Bob needed to stop smoking and make some significant changes if he was going to have a shot at growing old. I told the cardiologist that Bob would do no such thing – it’s just not who he is.

Bob would rather die relatively young doing what he enjoys and without regrets than stop being himself and live longer. He has followed the “live fast, die young and leave a good looking corpse” philosophy to the letter, except that he has made it farther than he likely ever thought he would. He has managed to outlive many of our old comrades and friends despite maintaining the lifestyle. Too many of the people we knew died young as a result of poor choices and bad luck.

I don’t know where people like Bob fit into the health care debate because he’s such a rarity: he’s non-compliant for the most part, but does not hold anyone but himself responsible for his problems. He throws off the curve, if you will. People like Bob will not buy health insurance (even if forced at gunpoint) because they just don’t see a need. He’s self sustaining and uses only the services he needs when he needs them. And he pays for it himself. He’s not our typical member of society by a long shot.

He’s Peter Pan – but older now and all too vulnerable to those things that affect mere mortals. And even though it’s for different reasons now, he still has my respect.

Friday, September 11, 2009

Returning The Hope I Bought

"No, I'm not disillusioned. I'm just not illusioned, either.” – Bob Dylan

In this response to a question posed by an interviewer in 1965, Dylan captures simply and completely my feeling about President Obama and his attempts to rehab the health care system in the U.S. Indeed, after watching the president speak to Congress the other night and witnessing the response from both sides of the chamber, I was left with a feeling that’s significantly less than excited, but not quite apathetic. I do believe that some reforms are on the way, I just don’t think they will be immediately or significantly effective.

My wife watched the speech live, but I was only mostly attentive to it from across the room. She was disappointed with my response and lack of enthusiasm – especially since the topic is discussed almost daily in our house. I listened to Obama talk as I typed an email to a friend about an upcoming backpacking trip. My wife questioned me about my restrained excitement and I replied that I was less than enthralled with what I deemed theater from a president for whom I had much higher hopes. I have seen little of what was promised actually get done and am left, again, feeling jilted by our governmental leaders.

It’s not that I’m cynical enough to think nothing will happen with health care reform – it’s just that I’ve been paying attention to politics and government for too long to think any changes made will be right the first, second or third time around. Reform will be something that’s tinkered with in small increments and over a long period of time. Eventually, it may be done right, but perhaps that won’t happen for the next 20 years.

Sitting there, trying to understand my own sentiments, I couldn’t help but think about the reforms that were enacted on the credit card industry this past spring and summer. They were supposed to help consumers by limiting why and how quickly the card issuers could raise rates. They were touted as a big “win” for regular folks against issuers who had been able to seemingly raise rates and change the rules whenever they wanted. In the end, the unintended consequence of those credit card reforms was that the issuers hiked rates on cardholders before the laws prohibiting the same took effect. As a result of “helping” out the consumer, rates on most cardholders are now 3-4 times what they were previously. This kind of help “fixing” health care we don’t need.

While Obama was getting heckled, I decided to take a quick tour of and peruse their charts detailing money donated by the insurance industry to candidates up for re-election in 2008. It’s an impressive list that includes politicians from both major parties – the largest donations going to the leaders of each party and those with positions of influence over potential reforms. I quickly reminded myself that hope is often sold and seldom redeemed for any value - but campaign contributions almost always pay dividends.

I decided to go to bed and not go over it all again. When my daughter is old enough, I’ll show her how our government, and indeed our country, really works. I’m sure I will almost feel guilty for showing her the things I have learned over time and through repeated frustrations. But she’ll need to learn these things while she’s still young enough to not fall prey to the theatrics that pass for political statesmanship. When I’m done, she’ll be no one’s fool and she’ll be able to spot the Shakespearian influences immediately.

Ultimately, I think health care reform will get close to where we need it to be - but today I am stuck somewhere between hopeful and hopeless. The simple truth is that while most citizens will feel as though they are helped by the reforms that ultimately get enacted, a select few – the wealthiest citizens – will no doubt benefit disproportionately thanks to a government that is only too happy to receive their donations and “support” when it comes to election time.

As for me, I have no utopian visions for our health care system. I just want to see that something worthwhile gets done so that people get the care they need. I’ve heard enough talking about what, who, how much and why – now I want to see what can be accomplished. It’s time to put up or shut up. Come on Mr. President and Congress – I’m not hard to impress and my expectations are minimal.

Friday, September 4, 2009

A letter to our President and Congressional leaders

Citizens have been listening to all the talking points and arguments thrown back and forth for years now. The debate about health care reform in the U.S. is nothing new – indeed it was only 16 years ago that political leaders last wasted a similarly endless amount of time and energy on the same issue. But the situation in the U.S. this time is different. Many believe the U.S. has entered into what history will call the Greater Depression when this era is compared to the 1930’s. The numbers (GDP, unemployment, housing sales, etc.) that the government agencies report are all suspect and have been shown to be manipulated for political reasons and cover. But they can only becloud for so long, as too many Americans have felt the fiscal crunch of living in the U.S. today. Indeed, it is more difficult than it has been in a very long time (for many different reasons), and as a result, people have learned to doubt what you tell them.

There are the obvious reasons for the pressure citizens feel, of course: unemployment; under-employment; higher costs of living; increased prices on essentials like food and fuel. But these realities are primarily felt by those who are not well-off. And by well-off, let’s qualify that not with numbers, but with this: if a family does not have to choose between essentials each week or pay period (i.e. “How much can we spend on groceries this week because the mortgage payment is due?”) they are better off than most. You, the political leadership in this country, as well as those who would advocate for policies that protect and maintain the status quo, fall into the well-off category.

You, our political leaders, don’t have to adjust your family budgets because essentials have risen in cost. You don’t have to cut back on the weekly grocery bill because your insurance premiums have risen as your employer continues to try and cut costs. You don’t have to worry about co-pays and out-of-pocket minimums that cut into your stagnant or declining wages. You don’t have to think about declining wages or lost hours that allow for you to pay the mortgage. In short, though you represent all citizens, you are not like the vast majority of them because your lives are devoid of the above realities.

The lower and middle classes do not have powerful lobbyists or organized industry groups. They don’t take you out for expensive meals or on trips to play golf in foreign countries. What they are, however, is the largest segment of that group you vowed to represent. Whether you like it or not, you represent the families who have taken up residence in one of the many tent cities that have become increasingly common. You represent the single parent who works more than 1 full-time job to try and make ends meet, yet just can’t seem to get there. You represent the family that struggles, not to move up the ladder, but to hang onto the rung they have called home for years. You represent people who have lost jobs, homes, work hours, take home pay and benefits, retirement and savings portfolio assets, and last but not least, a chance at the American Dream.

Your continued advocacy for a small percentage of the population – the wealthiest ones – who have been so generous to your re-election campaign coffers, is proof enough for a growing number of the rest of Americans that your votes and positions are for sale. While this is nothing new in the political system of the United States, it has become more and more dramatic as the largest corporations and financial firms continue to receive taxpayer dollars despite their contempt for citizens: as customers; as individuals; and as human beings. Simply stated, the populous has had enough. The level of contempt on that side of the fence is growing as fast as their increasing numbers.

You, our leaders, have the opportunity to implement a program that will help millions of people get and stay healthy. You have the opportunity to remove the threat of financial ruin due to medical conditions. You have the opportunity to make sure that some of their tax dollars are spent on programs that help more than just the few. The choice is not really yours – it is theirs. Polls have shown that the majority of Americans want a government funded insurance option or a single-payer system. It is not socialism (unless you consider the U.K., Japan and Germany all socialist countries and not capitalistic ones) to give the populace what it wants and needs. It is not “new” – universal health programs work everywhere else in the world. Indeed, the U.S. should be ashamed that the wealthiest nation on Earth does not provide this basic service to its citizens.

As it stands today, you have given away trillions to banks so that they can remain in business despite their poor decisions and yet demanded nothing of them. You have asked for no reforms that will prevent another disaster, yet the banks have access to unending amounts of cash from the Federal Reserve (at no interest, no less) while charging customers interest rates that approach 30%. Banks get to shed worthless assets at elevated prices because fair accounting standards and practices have been halted and the government backed entities Fannie Mae and Freddy Mac have been green lighted to purchase these worthless debts at close to face value. You have created a welfare system for the wealthiest, and left the rest of your charges to their own devices.

You have provided bailouts to everyone except your represented individual citizens. Don’t you think it’s time you did your jobs and represented the people who actually voted for you? Don’t you think it’s time to help the less fortunate and the rest of those who deserve better than what they have gotten from you and your cohorts? You should all hang your heads in shame for your petty bickering, blatant pandering and political grandstanding. You have had your opportunity to get your faces on T.V. – now go and do something the rest of the citizens of the U.S. deserve and will benefit from. Enact health care reform that will work.

If you need help, there are plenty of us out here with a solid understanding of the system’s real problems and the real solutions that will make it more efficient, more cost-effective and more beneficial. All you have to do now is your job.