Health care retort

Today, I got the following via email:


Dear Mr. President:

During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.

While glancing over her patient chart, I happened to notice that her payer status was listed as "Medicaid"! During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer.

And, you and our Congress expect me to pay for this woman's health care? I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture", a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that "I can do whatever I want to because someone else will always take care of me".

Once you fix this “culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.

Respectfully,

STARNER JONES, MD

Assuming that there is any truth to this email (and I tend to think that the “facts” are fabricated to make a point), one person’s misplaced priorities are not an indictment of health care reform. (And even people with wacked out priorities deserve medical care.) I agree that Medicaid fraud is an issue that should be addressed, and lord knows that when I worked at Atlanta Legal Aid, I had my share of clients who were on TANF and Medicaid but had nicer cellphones than I did.

This, however, is not what the President’s proposed healthcare reform is about. I can put a face on what it is about for you.

What healthcare reform is about is allowing middle class families like my own, particularly those who have self-employed wage earners or wage earners who work for companies that do not provide health insurance, to afford the health care that their families need. It is about allowing people both to have health insurance that is affordable and to access health care that is affordable, so that families do not have to make a choice between health care and other necessities.

Just as a for example, we have the cheapest health insurance that we can afford with a reputable carrier, yet we currently pay almost $700 a month for health care coverage that has a $5000 family deductible, plus an additional individual deductible for each person in the family, which means that the ACTUAL deductible is closer to $7500 a year. Since we had a child last year, I fully expect that our insurance company will raise that premium come review time in October without providing us any concomitant increase in services.

Health care reform is also about getting rid of pre-existing conditions clauses that force families like ours to pay thousands of dollars to correct a medical condition that our daughter was born with simply because she was so young that ANYTHING wrong with her was a pre-existing condition under our health insurance policy.

Health care reform is about eliminating pre-existing conditions clauses that mean that my mother-in-law can NEVER change insurance companies because she has had breast cancer. (And that also mean she pays a LOT for her coverage.) It is about preventing her insurance company from canceling her simply because she has been sick.

Health care reform is also about putting decisions back into the hands of patients and doctors, rather than allowing insurance companies to call the shots. Because of clauses that insurers are allowed to require in private insurance policies, we had to wait almost two years before having a second child because we could not get insurance to cover anything related to maternity without accepting a one-year waiting period. Our first policy was a piece of crap, and because we switched insurers to get better coverage for our family, we had to wait through not one but two one-year periods.

It’s very easy for people who can rely on group policies provided by employers or for people who have never had to use their insurance policies to think that everything works smoothly with the system. There are, however, great disparities in our health care system that must be addressed. Many families like my own are forced to pay a lot out of pocket for benefits that others get subsidized by employers or to risk bankruptcy by going without health insurance and taking the risk that someone in the family could need expensive, catastrophic care.

Certainly, there are cultural issues to address – Americans actually receive a lot of unnecessary health care services, and some people clearly have wacked out priorities – but the President’s proposed changes for health care reform are just the first step to fixing these problems, not the whole enchilada.

Sticks and stones can break my bones but words can never hurt me…

Unless you are looking to get hurt by them.

Some news coverage here in Atlanta the past few days has focused on MARTA’s choice of names for its renaming of the MARTA lines in an effort to make them more user-friendly. Seems the MARTA folks – following in the footsteps of other major urban centers like NYC and London – chose to go with a basic color scheme of red, green, yellow, and blue as labels for the MARTA lines. Who could have an issue with that?

It’s apparently not as simple as primary colors. See, the yellow line goes into an area that has a large Asian population... And, clearly, MARTA is, at best, ignorant that it is making an allusion to the skin color of the residents of that area or, at worst, making an intentionally snide statement about the residents of that area... (Yes, you can read some sarcasm into that “clearly.”)

It’s just the yellow line creating the brouhaha. No one is asserting any racial association with the red line or political association with the green or blue lines. (Granted, there’s not a large Native American population in Atlanta; but the red line does run north to a pretty Republican area, and the green line runs through some of the most liberal, crunchy areas of Atlanta.)

And it apparently doesn’t matter that the yellow line goes through predominantly white neighborhoods and ends in a predominantly black area and that the same area highly populated by Asians is also highly populated by folks of various other ethnic backgrounds (lots of Spanish-speaking folks from various other Spanish-speaking countries there, too). No, clearly, if the yellow line goes to a neighborhood with a large Asian population, Asians should be offended because someone is pejoratively referencing their skin color. (And you can read some sarcasm into that “clearly,” too.)

Is the word “yellow” so politically loaded in this day and age that a primary color cannot be just a primary color? Seriously, I’m really asking. I mean, the other lines are red, green, and blue, people; they’re not red and yellow, black and white.

And what if they were red and yellow, black and white?

Even if there is some racial implication to the word “yellow” (and I will concede that there is), few people now living were around during the time that terms like “yellow peril” were being thrown around. I myself grew up singing Jesus Loves the Little Children, which talks about that particular spiritual leader finding all children “red and yellow, black and white” precious in his sight. And not too long ago, during the inauguration of a certain national leader, the Rev. Joseph E. Lowery, quoting a famous Civil Rights Era mantra, prayed for God to “help us work for that day when black will not be asked to give back, when brown can stick around, when yellow will be mellow, when the red man can get ahead, man, and when white will embrace what is right.”

Nonetheless, Helen Kim, advocacy director for the nonprofit Pan Asian Center commented, “If a line going to the south side of the city was named the black line, I think you’d have a different outcome.”

Helen, Helen, Helen. I am not so sure. First of all, let’s be clear that MARTA is using primary colors, and, to be technically correct, black is not a primary color. Second, of the eight termination points for existing MARTA lines, five are in predominantly black areas, so singling out one line and calling it the “black line” couldn’t reasonably be interpreted as making some statement about the race of the population living at the end point of that line, intentionally or otherwise. Finally, Helen’s so wrapped up in what she views as the pejorative nature of the word “yellow” as a skin tone reference that she forgets that there’s no similar connotation with the word “black.”

I think I’ll side with Gary Gung (who, for the record, is Asian): “What difference does it make if it’s yellow, gold or black. Make the issue about the economy or something else more important.”

In my book, a yellow MARTA line is a yellow MARTA line.

To give credit where credit is due, my quotes from Ms. Kim and Mr. Gung come from this morning’s front-page Atlanta Journal Constitution article by Christian Boone.

Observations On Sarah Palin and the Tea Party Convention

On this, the day following the first (and likely last) Tea Party convention, I find myself once again amazed and perplexed by two not necessarily unrelated phenomena: the popularity of Sarah Palin and the vacuity of the self-proclaimed movement.

First, on Palin. Palin the person is now, for better or worse, one of those “personalities” the doings of whom will from now on be reported to us faithfully by the media, which, upon filing someone in this category, ensures that we will not escape such important details as Palin family dynamics and continuing baby drama involving her daughter or her son who has Down’s. Now, obviously, Palin is a political figure, and when she does political things like making appearances at political conventions, that’s deserving of reporting. But the media certainly does not have to report about how Palin feels about a presidential advisor’s potty mouth. To quote such an unnamed source, that would be “f***ing retarded.”

All right that was a bit of a ramble and a sidetrack. The thing that mystifies me about Palin is just how exceptionally average she is in a lot of ways—average in that she has about the same knowledge concerning foreign affairs and how government works as your average blue collar worker in America. Average in her intellect. Average—or perhaps mundane is the better descriptor—in her pursuit of the crass interpretation of the American dream: riches and power. Where she excels, however, is in connecting with people like her. Thus, the rousing movement that has thrust her to the top, like a rubber ducky on a tsunami. The problem is, she’s still just a rubber ducky.

Now, how about that rousing movement? According to organizers of the convention in Memphis (and granted, many tea party movers and shakers advocated boycotting it, so it is difficult to say what the orthodoxy is of the tea partiers beyond generally being pissed off), the movement stood for the principles of limited government, strong free markets, and a strong national defense. The attack on deficit spending likely is tied to the limited government idea, though that has not been laid out as such.

A few observations on these principles—incidentally, I have to quote the aforesaid presidential advisor once again on another thing he said yesterday (not of the potty-mouthed variety). In reaction to most Republican politicians tenaciously defending pork barrel projects and federal spending in their states and districts immediately following declarations of their outrage and steadfast determination to stand up to the out-of-control tax-and-spend Democratic Congress: “you can be firm on your opinions; it’s your principles you can be flexible on.” So true.

Okay, the observations:

1. Limited government. I think the most obvious interference of government in our lives has to be restrictions imposed on our personal liberty to engage in activities that do not interfere with the lives of others. You all know where I’m going here, right? That’s right! Gay marriage! Find me the heterosexual person whose life has been ruined by the gay couple down the street, and I’ll show you someone who has some severe mental problems. This issue has got to be one of the most obvious and clear examples of minority rights deserving of protection ever, right up there with guaranteeing equal rights to non-white people and women. Counter-arguments essentially come down to either a version of the religious views of a segment of the population being imposed on others (unconstitutional and unfair) or latent feelings of hatred. “I hate you” is not an effective argument and should not be countenanced.

So, how about the tea partiers views on this issue? Surely, with their strong beliefs in limited government, they’re on the forefront, right? Yes, of course I’m being facetious. Mainly—I think, that is, because it is difficult to tell—they’re upset about health care reform requiring a mandate to buy health insurance. Never mind that they already have to buckle their seat belts, buy auto liability insurance, wear hard hats in construction zones, get a permit to build a building, get a driver’s license to drive a car, get a gun permit to own a gun, etc., etc. Having to buy health insurance! Outrageous! By God, people have the right to go about their business uninsured!

You know what? This might work but for the fact that hospitals are required by law to treat people regardless of whether they have insurance or not. Maybe the tea partiers should advocate repealing that law. Then, at least, we would be saving some money. Of course, we’d have some pretty horrid stories about people dying in hospital parking lots. That probably would be pretty nasty. But, hey, they were free to buy or not buy health insurance, right?

Incidentally, I have to bring this up, because I keep hearing it and it’s just wrong: the contention that health care reform would force Americans to pay for the health care costs of illegal immigrants. Folks, we pay for the health care costs of illegal immigrants already when they drop in on our ERs and get treated. Again, if you don’t like it, you can change the law. But I don’t think that would be a good thing—people dying everywhere due to being denied at the hospital. It’s immoral. In fact, I think most doctors would consider it a violation of the Hippocratic oath not to treat someone in such dire circumstances. I’ve said it before and I’ll say it again, we can keep refusing to bring illegal immigrants into the system, but reform of any kind will not work until we do, because there is a huge illegal community out there and it is driving a concomitant huge amount of costs. Unfortunately, it is political suicide to advocate for anything that would benefit illegal immigrants.

2. Strong Free Markets. Generally, when people talk about “strong free markets” or “a vigorous free market system,” they mean removing regulations from free markets. That is, restoration of an unregulated free market system. I say “restoration” because that is what that would be, a return to late 19th century-style capitalism. You know, when we didn’t have things like child labor laws, environmental controls, anti-trust laws, work-safety regulations, food control laws, transparency laws (like financial disclosures), and anti-discriminatory laws.

Look, I think we saw where rolling back some regulations got us—perhaps the worst example of this was the partial repeal of the Glass-Steagall Act in the late 90s, extended further in the early 2000s. (You can read about the Glass-Steagall Act, a bill that was passed in the 1930s to disentangle insurance and bank companies and prohibit certain bank investments here. Suffice to say, it was a pretty good law that I don’t think is a stretch to say probably would have prevented the financial collapse that occurred in 2008). And personally, I’m a fan of laws that prohibit abuses of employees or the accrual of tremendous economic power. In fact, my belief in anti-trust laws lead to my ultimate rejection of a career in economics, which subject at the time was dominated by Chicago school efficient market theory idealists. Not to go into this too much, but when it seemed to me that these brilliant people were assuming away all the hard stuff rather than dealing with it and then placing complex mathematical apparatuses on top of it—lending it, in my opinion, a faux appearance of great detail and accuracy—I had to jump ship.

Anyway, it is interesting and surprising to me that a strong free market tenet can be built into a populist movement in 2010, when it seems so clear that lack of regulation and actions taken to deregulate the financial community directly led to our present economic circumstances. But, hey, I guess people can be irrational sometimes. (Yup, that last sentence was internally referential and ironic, and I’m quite proud of it.)

3. Strong Defense. Well, we’ve got a strong defense, and the Pentagon’s budget went up some more this year. Has it ever gone down? We’ve also got two wars going on that we’re supporting. This is clearly not a controversial position to take—with the exception of people like Dennis Kucinich (he of the “Department of Peace”), it’s rare to find a politician who thinks we should have a “weak” defense or even who would propose reducing the Pentagon’s budget. I personally believe that we spend too much on ways to destroy things and people, but I wouldn’t want us to be taken unawares by a Nazi-like regime.

I have to link this to the budget deficit. I believe that if we crunched the numbers, if we took out the Iraq War—which was prosecuted based on a mistake, whether you support it now or not—and the recent economic collapse, we’d probably have a budget surplus at this point—or maybe we’d be just even. It certainly wouldn’t stand as it does now, over $1 trillion in the red. So, what I would ask the tea baggers is: do you support peremptory military intervention like the Iraq War or do you support deficit reduction, because you can’t have it both ways.

In sum, I think when you dig into the Tea Party movement, you find a lack of original ideas and a shallowness of thought. That is commonly the case with populist movements, I suppose—populist movements by their nature sink to the lowest common denominator of thought, otherwise they couldn’t have such wide appeal. They don’t call ‘em “populist” for nothin’!