It was hard to figure out why the far right mob was engorging themselves on the fiction of "death panels" dispensing medical care. It took a while, then there was the flash: Despite calling themselves Christian, they have no faith.
Well, not exactly right. They are actually "totemic" Christians. They have faith in their totems. "The Bible" is one of their totems. "Free markets" are another. "Family" is another.
When there needs to be a rational dialogue, they reach into their bag of superstitions and wave around a totem, as if to ward off the evil spirits of "socialism" or "homosexuality" or "lack of values."
Their shamans, Rush, Palin, O'Reilly, and the others, actually know this is a game. They just want to win, and capture the fame, power and money that comes from selling fear, like their forebears, Jimmy Swagggert, Jim Baker, and the others. These use the totems to communicate in code, to prod their flock into panic, to create the frenzy we see building around us.
But others with more character are faced with the knowledge that the issues we face will not bow to superstitions. That the shoddy system of health care we have eats 16% of our budget and will not run from a totem. That it needs to be fixed by rational effort.
Bank reform, credit card reform, education reform, political reform will not be solved with magical potions. These are issues that need to be looked at squarely, and hard decisions need to be made. Imbalances corrected. Power may shift.
Oh yes, the left has its totems as well. In many ways they mirror that of the right, and usually start with a hatred of other people's money. The difference is that the left doesn't hide behind Christianity, though interestingly, probably has more claim to it.
But why are those on the right so eager to believe the false prophets? Is it they don't really believe that their Reward is Coming? Is that why they are so focused on the lies and politics of the material world?
Or it may be that there is need, now, to stretch our idea of community to include others not like us. They want to exclude more than embrace, and hypocrisy always hides behind anger and fear.
It doesn't matter. There is work to be done. We need to get to it.
Sunday, August 30, 2009
Wednesday, August 19, 2009
It's about power, stupid
The truly strange thing about the war over the "public option" is that it is probably the most market oriented facet of the whole health care reform package. The wrong guys support it, the wrong guys are opposed.
Normally, the left would simply resort to regulation: "Though shalt not charge more than..." and screw up the economics of health care more than they are screwed up.
"At a minimum, there should be very strict regulation of all insurers, on and off the exchange, to promote competition and fair prices and substantial subsidies to help low-income people buy insurance..." editorializes the New York Times, again illustrating how the left doesn't "get" economics. To promote competition you don't regulate insurers, you guard the markets, reduce "barriers to entry," etc.
There are many market forces in place that drive up the cost of health care "as a system." Doctor owned diagnostic centers, for example; lack of competition in any one geographical market; insurance oligopolies; no standardized charting.
The antidote is to introduce forces that can systemically drive down prices, and that is best achieved through competition. That competition is best enhanced with public options, consumer choice, consumer consequences, all of which are lacking in the current environment.
And maybe for that reason alone, the brains of the Republican right are so opposed. The public option might actually work, because it really is a market-based tool. A tool they should favor.
On the other hand, if they can kill the public option and force the left into its comfortable role of law-based decision making, they will be able to point out that the left does want to deny choice, favors government over the individual. It is a long term strategy to get back into power.
The administration needs to grab this process. It can not be left to the right, nor the blue dogs, nor the far left. This administration is in a unique position to take all the good ideas and rework the health care landscape, with or without "compromise." Their plan could be the compromise.
There are many good ideas out there. Public option. Co-operatives. Tort reform. Transportability. Elimination of rules that limit plans to "in-state." Standardized, transferable electronic records. Perhaps they all need to be given a chance.
It is time to get to work.
Normally, the left would simply resort to regulation: "Though shalt not charge more than..." and screw up the economics of health care more than they are screwed up.
"At a minimum, there should be very strict regulation of all insurers, on and off the exchange, to promote competition and fair prices and substantial subsidies to help low-income people buy insurance..." editorializes the New York Times, again illustrating how the left doesn't "get" economics. To promote competition you don't regulate insurers, you guard the markets, reduce "barriers to entry," etc.
There are many market forces in place that drive up the cost of health care "as a system." Doctor owned diagnostic centers, for example; lack of competition in any one geographical market; insurance oligopolies; no standardized charting.
The antidote is to introduce forces that can systemically drive down prices, and that is best achieved through competition. That competition is best enhanced with public options, consumer choice, consumer consequences, all of which are lacking in the current environment.
And maybe for that reason alone, the brains of the Republican right are so opposed. The public option might actually work, because it really is a market-based tool. A tool they should favor.
On the other hand, if they can kill the public option and force the left into its comfortable role of law-based decision making, they will be able to point out that the left does want to deny choice, favors government over the individual. It is a long term strategy to get back into power.
The administration needs to grab this process. It can not be left to the right, nor the blue dogs, nor the far left. This administration is in a unique position to take all the good ideas and rework the health care landscape, with or without "compromise." Their plan could be the compromise.
There are many good ideas out there. Public option. Co-operatives. Tort reform. Transportability. Elimination of rules that limit plans to "in-state." Standardized, transferable electronic records. Perhaps they all need to be given a chance.
It is time to get to work.
Monday, August 17, 2009
Sunday, August 16, 2009
The public option
On Friday, Sarah Palin joined Republicans nationwide in opposition to public libraries.
Funded by major publishing companies, book store chains and a large seller of books over the Internet, the right wing has declared libraries to be "socialist, communist, and not the American Way."
Libraries, they say, threaten the ability of Americans to buy books, and could lead to government control over what is read, by whom and where.
"If government buys books, government will decide what books to buy. It is clear that this is a threat to democracy," said (former) prescription drug addict Rick Limberger on his radio show.
Will O'Kelly, on his television program and between ads for exotic Swedish sponges, said that people who go to libraries may be affiliated with Al Queda, he didn't know that and wasn't saying that, but librarians should be investigated, and those who publicly deny the fact should be required to prove it isn't true.
Shamus Hennesy said that it is clear that library books are a vehicle for disease, and only pristine, white pages with virginal paper unsullied by unknown hands of other possible color were good enough for his daughters. He compared libraries to crack houses and the sharing of library books to the sharing of needles.
"Tea Baggers," the unfortunately named movement of people afraid of an educated populace, have protested at town hall meetings nationwide. Funded by the book sellers, mobilized by radio entertainers, they shout into microphones provided by the government that people being able to read books purchased by government represents an infringement on their rights.
But it is the darling brunette of the far right who has captured the essence of the debate. Not that her looks matter. If she was a moose with dewlaps and dimples, she would still command attention for the power of her ideas.
"We don't want to pay taxes so other people can read," said Palin, who also said that she would definitely take up arms against public education when she might run for president in 2012, though she said she isn't saying that, nor what she was saying, but said that too with her famous coy smile.
"Government is bad. Taxes are bad. Tax supported 'public' schools are bad. 'Public' libraries are bad. Anything with the word 'public' is bad, because it has most of the same letters as pubic, and will give our young people ideas and lead them down a path of moral decay," Palin said with a wink that instantly drew millions of conservative men down that very same path.
"If I can't afford to pay for my child's education, I should not have an educated child," she added, pointing again with pride to her own family. "Besides, I don't read that much."
Others have not been so direct.
"Libraries threaten the profits of national book store chains. Without profits, they will fail, throwing thousands of sales clerks out of work at a time when the economy can ill afford additional unemployment," said Pewt Heinrichs, former Republican strategist.
Those in favor of libraries have remained for the most part silent. "We just think people should have access to books, even if they can't afford to buy them," said one quietly, asking to remain anonymous, afraid his neighbors would show up to burn down his home.
Funded by major publishing companies, book store chains and a large seller of books over the Internet, the right wing has declared libraries to be "socialist, communist, and not the American Way."
Libraries, they say, threaten the ability of Americans to buy books, and could lead to government control over what is read, by whom and where.
"If government buys books, government will decide what books to buy. It is clear that this is a threat to democracy," said (former) prescription drug addict Rick Limberger on his radio show.
Will O'Kelly, on his television program and between ads for exotic Swedish sponges, said that people who go to libraries may be affiliated with Al Queda, he didn't know that and wasn't saying that, but librarians should be investigated, and those who publicly deny the fact should be required to prove it isn't true.
Shamus Hennesy said that it is clear that library books are a vehicle for disease, and only pristine, white pages with virginal paper unsullied by unknown hands of other possible color were good enough for his daughters. He compared libraries to crack houses and the sharing of library books to the sharing of needles.
"Tea Baggers," the unfortunately named movement of people afraid of an educated populace, have protested at town hall meetings nationwide. Funded by the book sellers, mobilized by radio entertainers, they shout into microphones provided by the government that people being able to read books purchased by government represents an infringement on their rights.
But it is the darling brunette of the far right who has captured the essence of the debate. Not that her looks matter. If she was a moose with dewlaps and dimples, she would still command attention for the power of her ideas.
"We don't want to pay taxes so other people can read," said Palin, who also said that she would definitely take up arms against public education when she might run for president in 2012, though she said she isn't saying that, nor what she was saying, but said that too with her famous coy smile.
"Government is bad. Taxes are bad. Tax supported 'public' schools are bad. 'Public' libraries are bad. Anything with the word 'public' is bad, because it has most of the same letters as pubic, and will give our young people ideas and lead them down a path of moral decay," Palin said with a wink that instantly drew millions of conservative men down that very same path.
"If I can't afford to pay for my child's education, I should not have an educated child," she added, pointing again with pride to her own family. "Besides, I don't read that much."
Others have not been so direct.
"Libraries threaten the profits of national book store chains. Without profits, they will fail, throwing thousands of sales clerks out of work at a time when the economy can ill afford additional unemployment," said Pewt Heinrichs, former Republican strategist.
Those in favor of libraries have remained for the most part silent. "We just think people should have access to books, even if they can't afford to buy them," said one quietly, asking to remain anonymous, afraid his neighbors would show up to burn down his home.
Insurance companies need competition
There have been several health care commentaries from the right with important ideas for the debate on health care. John Mackey of Whole Foods has been unfairly beat up for his ideas (read it here). There have been others.
But they often contain one important flaw. They seem to assume that if something goes wrong, it is the fault of the patient. He or she eats too much or smokes too much or drinks too much.
But not all health events are a matter of choice. Everything that happens to us is not the result of bad habits.
I appear to be healthy, I exercise, I am not overweight. I don't smoke and haven't had a drink in decades. I don't do soft drinks.
But I was refused health insurance because I have high cholesterol. Not heart disease, mind you, but high cholesterol, a condition that could cause heart disease. About the time I decided to address this issue with drugs, unsuccessful with diet, I had to change doctors because of a dispute between the insurance company and my doctor's company over how much money insurance would pay for my visits.
My new doctor ordered a battery of tests. Tests that insurance companies don't like to pay for, because they don't really affect treatment. If you have high cholesterol, the treatment is to take statins, it doesn't really matter why you have high cholesterol. They claim the doctors order the test to make more money.
But my doc wanted to know, because it might dictate how to attack my high cholesterol. It turns out I have a genetically-caused situation. I don't know how to describe it, other than remembering that I had something like three markers for the genetic issue, and if I had the fourth marker, chances are I would already be dead, or face dementia because of plaques in the brain, or worse.
The point is that I have a genetic condition, not modifiable by diet, that could affect my health. And for that reason, I was denied health insurance by private companies. I had to scramble to find a "public option" that would take me.
I am not alone. Many have conditions that allow the insurance industry to decide, after being paid many tens of thousands of dollars, as I paid them, that a patient isn't worth the risk. Heart disease. Broken bones. Family history of cancer. Diabetes. Go away.
The game is rigged in their favor. I know this as a citizen, and having watched them from a chair on the Oregon Board of Medical Examiners. The market mechanism does not work very well when talking about health care, nor insurance.
Our system is broken. We can get great care in America, and I know that, too. I have had exemplary doctors, and I am a demanding patient. But the "system of health care" is broken. There is too much paper work. Doctors face unnecessary lawsuits. Insurance codes are designed to deny payment and coverage, not make it better.
It's time for a change.
But they often contain one important flaw. They seem to assume that if something goes wrong, it is the fault of the patient. He or she eats too much or smokes too much or drinks too much.
But not all health events are a matter of choice. Everything that happens to us is not the result of bad habits.
I appear to be healthy, I exercise, I am not overweight. I don't smoke and haven't had a drink in decades. I don't do soft drinks.
But I was refused health insurance because I have high cholesterol. Not heart disease, mind you, but high cholesterol, a condition that could cause heart disease. About the time I decided to address this issue with drugs, unsuccessful with diet, I had to change doctors because of a dispute between the insurance company and my doctor's company over how much money insurance would pay for my visits.
My new doctor ordered a battery of tests. Tests that insurance companies don't like to pay for, because they don't really affect treatment. If you have high cholesterol, the treatment is to take statins, it doesn't really matter why you have high cholesterol. They claim the doctors order the test to make more money.
But my doc wanted to know, because it might dictate how to attack my high cholesterol. It turns out I have a genetically-caused situation. I don't know how to describe it, other than remembering that I had something like three markers for the genetic issue, and if I had the fourth marker, chances are I would already be dead, or face dementia because of plaques in the brain, or worse.
The point is that I have a genetic condition, not modifiable by diet, that could affect my health. And for that reason, I was denied health insurance by private companies. I had to scramble to find a "public option" that would take me.
I am not alone. Many have conditions that allow the insurance industry to decide, after being paid many tens of thousands of dollars, as I paid them, that a patient isn't worth the risk. Heart disease. Broken bones. Family history of cancer. Diabetes. Go away.
The game is rigged in their favor. I know this as a citizen, and having watched them from a chair on the Oregon Board of Medical Examiners. The market mechanism does not work very well when talking about health care, nor insurance.
Our system is broken. We can get great care in America, and I know that, too. I have had exemplary doctors, and I am a demanding patient. But the "system of health care" is broken. There is too much paper work. Doctors face unnecessary lawsuits. Insurance codes are designed to deny payment and coverage, not make it better.
It's time for a change.
Thursday, August 13, 2009
I want "public option" for health insurance
When I changed employment a couple of years ago, I turned a company over to some very deserving people. We had just a couple employees when we started, about 10 when I left 25 years later. But one of the hallmarks of this small business over those years was that we provided health insurance.
I never wanted to face a situation where one of "my" people got sick and could not afford a doctor.
Leaving the company meant leaving the company health plan. Which also meant, in Oregon, that private insurance was perfectly free to deny me coverage if they didn't want me. And that is what PacificSource said.
Since I had high cholesterol, they didn't want me.
Which meant that I could not get "private insurance." I enrolled instead in the Oregon Medical Insurance Plan, the plan of last resort for people denied coverage for health or financial reasons.
Fortunately I can afford the $500 per month I pay to get the medical care I need. That's before I go to the doctor, by the way. Last year I doubled my cost, and paid more than $12,000, because I had a kidney stone difficult to diagnose.
Now, what is the difference between OMIP, the Veterans Administration, Medicare and Medicaid, and the so-called and much hated "public option" that the Republicans are frothing at the mouth about?
Not that much. Except that it might be able to offer some lower costs, because it would insure more people, not just the sick and older and poorer.
It might actually be an "insurance," which by spreading risk among a general population instead of cherry picking the healthy people to insure, could provide lower cost care to many more people.
I did not like being told that since I might get sick in the future, that I was uninsurable. I don't think it is right. But you know, I am glad Oregon had a "public option" for people the insurance companies don't want to take a risk on.
But I don't want my neighbors or their children to have to either suffer without a doctor's care, I don't want them to have to decide whether to buy milk or pay rent or go to the doctor. This is a natiional issue and it is time for a national solution. We are wasting billions of dollars under the lack of system we have now, under the illusion of free choice and "market" economics. That is just a canard.
This is a great country and we have a great many very smart people. We also have a Republican Party that is trying to scare people on behalf of drug companies and insurance companies that make billions of dollars at the public trough, all the while they gouge the people at the margins.
We need health care reform. We need it now.
I never wanted to face a situation where one of "my" people got sick and could not afford a doctor.
Leaving the company meant leaving the company health plan. Which also meant, in Oregon, that private insurance was perfectly free to deny me coverage if they didn't want me. And that is what PacificSource said.
Since I had high cholesterol, they didn't want me.
Which meant that I could not get "private insurance." I enrolled instead in the Oregon Medical Insurance Plan, the plan of last resort for people denied coverage for health or financial reasons.
Fortunately I can afford the $500 per month I pay to get the medical care I need. That's before I go to the doctor, by the way. Last year I doubled my cost, and paid more than $12,000, because I had a kidney stone difficult to diagnose.
Now, what is the difference between OMIP, the Veterans Administration, Medicare and Medicaid, and the so-called and much hated "public option" that the Republicans are frothing at the mouth about?
Not that much. Except that it might be able to offer some lower costs, because it would insure more people, not just the sick and older and poorer.
It might actually be an "insurance," which by spreading risk among a general population instead of cherry picking the healthy people to insure, could provide lower cost care to many more people.
I did not like being told that since I might get sick in the future, that I was uninsurable. I don't think it is right. But you know, I am glad Oregon had a "public option" for people the insurance companies don't want to take a risk on.
But I don't want my neighbors or their children to have to either suffer without a doctor's care, I don't want them to have to decide whether to buy milk or pay rent or go to the doctor. This is a natiional issue and it is time for a national solution. We are wasting billions of dollars under the lack of system we have now, under the illusion of free choice and "market" economics. That is just a canard.
This is a great country and we have a great many very smart people. We also have a Republican Party that is trying to scare people on behalf of drug companies and insurance companies that make billions of dollars at the public trough, all the while they gouge the people at the margins.
We need health care reform. We need it now.
Wednesday, August 12, 2009
Republican lies about health care
It gets more bizarre by the day. Now the Republicans are telling ugly lies to scare people:
Seniors and the disabled "will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care." -- Sarah Palin, Friday, August 7th, 2009.
There is no such language anywhere in any health care proposal. Republicans are making this stuff up. It is ugly, and the minds that create this crap, especially that of the narcissistic Sarah Palin, are ugly.
We need to make health care better in America. We need to expand insurance coverage to friends and neighbors who have lost their jobs, or can't get insurance because one of their parents had diabetes. We need to create a system that will take care of our children.
It is time Republicans stopped lying about the "public option," which is just another optional insurance program like Medicare, more "private" than V.A. hospitals. It is time Republicans stopped lying about "death panels." It is time Republicans stopped denying that it is immoral to let millions of Americans go without seeing a doctor when they are sick.
We have a problem with health care in America. It is time to find a solution.
Seniors and the disabled "will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care." -- Sarah Palin, Friday, August 7th, 2009.
There is no such language anywhere in any health care proposal. Republicans are making this stuff up. It is ugly, and the minds that create this crap, especially that of the narcissistic Sarah Palin, are ugly.
We need to make health care better in America. We need to expand insurance coverage to friends and neighbors who have lost their jobs, or can't get insurance because one of their parents had diabetes. We need to create a system that will take care of our children.
It is time Republicans stopped lying about the "public option," which is just another optional insurance program like Medicare, more "private" than V.A. hospitals. It is time Republicans stopped lying about "death panels." It is time Republicans stopped denying that it is immoral to let millions of Americans go without seeing a doctor when they are sick.
We have a problem with health care in America. It is time to find a solution.
Tuesday, August 11, 2009
The health care onion
First, there is the debate about fixing this nation's health care. Inside that, there is the debate about the health care debate, whether it is being rigged. Inside that, there is the possibility that Republicans don't care so much about health care, but want to hand Obama a loss. Any loss.
Where to begin?
First off, the lie that we have the best health care system in the world needs to be dismissed. We do not have the best health care system in the world. Look up the statistics on your own. Infant mortality? We rank ninth in the industrial world. Efficiency? Thirty percent of our health care dollars go into the paper work war between doctors and insurers. Etc.
Add to that the power of corporate oligopolies; the drug companies, insurance companies, the physician-owned hospitals and groups of prescribing docs who own radiology centers, etc. We have a recipe for profit, not efficiency nor patient care.
It is important to realize that there is a difference in our "health care system" or lack of it, and the quality of care one might receive from an excellent doctor. That may indeed be world class.
But that is not what we are talking about.
One of the really wrong ideas in this debate is that "the market" will provide health care. It won't. Markets need a tight relationship between money spent and service received. You don' t have a rational market where the payer for service (insurance companies) is not the recipient (patient) of service. Patients want the best care available. Insureres want the lowest cost.
And yet, one of the closest ideas we have to bringing "market" dynamics to the table is being thrown away. Having a "public option" would fit quite well with market economics. If the public option is no good, it will fail. If it is good, it will help bring down costs, while still allowing people to choose.
And we already have "public options." Medicare. Medicaid. Most of the noise about the "pubic option" is based on fear that the gravy train won't stand up to real competition.
Even sending our poor to hospital emergency rooms is a form of "public option." An insanely inefficient option. It slows down "emergency" rooms. It is expensive. It shifts costs, so that those of us with insurance fund the system by paying $6 for a single aspirin. That is a "public option" of irrationality.
It is amazing that Republicans are again able to convince people to scream against their own interests. The men and women working at the gas station and the sporting goods store and driving truck, the retired, and certainly those who have been fired from jobs where they had insurance, should support health care reform. But misinformation, fear mongering and the politics of hate (look at those screaming faces) remain effective weapons.
We can't afford to spend more of our income on health care. It is breaking our finances, draining our future. We can't leave our neighbors without health care: That is immoral.
The time has come to look at alternatives.
Where to begin?
First off, the lie that we have the best health care system in the world needs to be dismissed. We do not have the best health care system in the world. Look up the statistics on your own. Infant mortality? We rank ninth in the industrial world. Efficiency? Thirty percent of our health care dollars go into the paper work war between doctors and insurers. Etc.
Add to that the power of corporate oligopolies; the drug companies, insurance companies, the physician-owned hospitals and groups of prescribing docs who own radiology centers, etc. We have a recipe for profit, not efficiency nor patient care.
It is important to realize that there is a difference in our "health care system" or lack of it, and the quality of care one might receive from an excellent doctor. That may indeed be world class.
But that is not what we are talking about.
One of the really wrong ideas in this debate is that "the market" will provide health care. It won't. Markets need a tight relationship between money spent and service received. You don' t have a rational market where the payer for service (insurance companies) is not the recipient (patient) of service. Patients want the best care available. Insureres want the lowest cost.
And yet, one of the closest ideas we have to bringing "market" dynamics to the table is being thrown away. Having a "public option" would fit quite well with market economics. If the public option is no good, it will fail. If it is good, it will help bring down costs, while still allowing people to choose.
And we already have "public options." Medicare. Medicaid. Most of the noise about the "pubic option" is based on fear that the gravy train won't stand up to real competition.
Even sending our poor to hospital emergency rooms is a form of "public option." An insanely inefficient option. It slows down "emergency" rooms. It is expensive. It shifts costs, so that those of us with insurance fund the system by paying $6 for a single aspirin. That is a "public option" of irrationality.
It is amazing that Republicans are again able to convince people to scream against their own interests. The men and women working at the gas station and the sporting goods store and driving truck, the retired, and certainly those who have been fired from jobs where they had insurance, should support health care reform. But misinformation, fear mongering and the politics of hate (look at those screaming faces) remain effective weapons.
We can't afford to spend more of our income on health care. It is breaking our finances, draining our future. We can't leave our neighbors without health care: That is immoral.
The time has come to look at alternatives.
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