The elderly woman tersely stated that her husband had been denied further medical care by the health insurance company with whom the couple had been insured. What were they to do was the question she posed to Oklahoma Senator Tom Coburn. Indeed, what were they supposed to do?
The answer supplied by Senator Coburn was as shocking as it was eye-opening. Rely on your friends and neighbors to help you in your hour of need. No matter that the cost of such help was likely to reach into the hundreds of thousands. By no means, should government be counted on to come to the rescue.
There, in a nutshell, is the sheer bankruptcy of the Republican and lunatic opposition to any change in health care as presently delivered in the United States through a variety of mechanisms. No one should have to appeal to the vagaries of individual circumstances. Alone in Alaska? Appeal to your neighbors, however few and relatively impoverished these might be. Trouble in the Ninth Ward, ask your neighbors for help.
Government exists, if it must, to provide a safety net for its citzenry. Traditionally, this was understood to mean the provision of a common defense. With most people living lives that were short and sometimes brutish, the needs of an elderly population didn't matter. Once industrialization began and life expectancies improved, the needs of the aged and those whose lives suffered from the pollution of industrial society and dangers inherent in an unregulated workplace became of paramount concern. To stave off the growing power of the working class in Imperial Germany, Otto von Bismarck crafted a social pact that sewed the seeds of the modern social welfare state. Other nations followed, and by the 1960s, most Western societies had some form of social welfare state.
The United States remained unique, however. A national health care system never emerged. What developed was an employer based health care system begun during World War II, as employers, unable to raise worker wages, offered supplemental benefits (health care and retirement benefits) as enticements. After World War II, industrial unions sought to extend such employer based health and retirement benefits. The public sector followed suit, and many working Americans enjoyed relative security during their working lives and into retirement.
For those not able to reap the benefits of union action, presidents John F. Kennedy and Lyndon Baines Johnson sought to provide a safety net for elderly citizens. Social security had already provided a modicum of economic safety, but dire health needs always remained a threat to many elderly. Passage of the landmark Medicare Act as part of LBJ's Great Society, gave protection to those elderly not protected through union or public sector agreements.
But, the poor, especially the working poor, who did not have access to unions that could extract excellent health and retirement benefits, were left to fend for themselves. Many went without health insurance and hoped that their relatively youthful age might tip the odds in their favor. Older working poor could rely on whatever care they might receive in emergency rooms at local hospitals.
Those who lost jobs or changed jobs and lost the provision of health insurance might try to cobra their benefits for a while and then seek insurance on their own in the market place. If too expensive, some might choose to forgo continued insurance coverage. Others might hope to land a job in an industry with excellent benefits.
All told, about 46 million people at present do not enjoy health insurance coverage. For some, it is an act of choice. For others, it is a question of necessity. For still others, it is an unfortuate turn of fate. For those with pre-existing medical conditions, private health insurance is well nigh impossible to find and, if available, prohibitively expensive.
The last two countries that rejiggered their health systems were Taiwan and Switzerland. The Swiss managed to rein in private insurance providers and get every one covered. No public option was offered, but restrictions were placed on health providers. Taiwan sought to create a public health system whole cloth. It studied various health care systems and crafted a program that best suited its needs and society.
For the United States, it seems unlikely that Americans could ever accept the intrusiveness of a Taiwanese style health care system where those who "overuse" medical services may be visited by a government agent in order to assess what changes might be required in order to bring medical service usage more into line with societal norms. Still, the United States could try to Swissify the American "system". It could require every American citizen to have health insurance. It could require insurance providers to end recisions and the refusal to provide or continue health care coverage to people with pre-existing conditions. It could place limits on administrative costs for private insurers that now amount to 20% of health care expenses. And, if private insurers refuse to cooperate, then it could use a public option to cover those whom the insurance industry does not want to insure and use its lower administrative costs to push down private sector costs.
The United States COULD do all that. Some of this might even emerge from the U.S. Congress this year. But, most elected Republicans do not want any change that would rein in the private insurance providers or place limits on prescription costs. Instead, as Senator Coburn made all to clear, reliance on the local community is preferable to meaningful change.
As a largely Christian nation, many of whose most outspoken adherents claim allegiance to the Republican party, it is worth asking what Jesus would do. Yes, what would Jesus do? Alas, his first task would be to visit those temples of modern Christianity and expose the hypocrisy espoused by many leading Christians. Turning the other cheek does not mean looking away from the needs of needy. It means to use whatever means necessary to alleviate pain and suffering. If government is the best available means to provide for the needs of the many, then so be it.
I got mine, screw you is nowhere to be found in the Bible - not in the Old or the New Testament. What we are reminded is that the meek shall inherit the earth. By that, I understand that those most in need and unable to fend for themselves shall be blessed because the rest of us who are more fortunate and are able to exercise some measure of control in our lives are COMPELLED to do all that we can to care for others. We are both stewards of the land and compatriots of our fellow citizens. To continue to bow before the god of capital is a violation of the Christian spirit and an invitation to Jesus to throw out the money changers and the money grubbing "Christian" capitalists who use the word to make it what it's not.
Jesus was about change, and change is what is needed now. Shame on you, Mr. Coburn. You just don't get it, do you?
Tuesday, August 25, 2009
Monday, August 17, 2009
LEMMINGMANIA
The dog days of August are usually a slow news period. Leading politicians go on vacation, while Congressional representatives return home to touch base with their constituents. Town halls are often a good venue for representatives to state their positions and receive feedback. Concerned constituents have an opportunity to express their views on issues that matter to them or comment on Congressional action or inaction. Rarely, do town halls get much press coverage. Not this year!
No, for the past several weeks we have witnessed irate constituents berating Democratic representatives in the House and the Senate for betraying the Constitution, taking aim at Grandma and attempting to turn the United States into a 21st century USSR. A few of the participants seemed to be in search of answers. Too often, representatives were treated to boorish individuals rude enough to shout and shove to cut off debate before it began. Many of these were egged on by media bloviators such as Rush Limbaugh. Others, perhaps, read the blogs of former Alaskan governor Sarah Palin or sought inspiration in the musing of Sen. Charles Grassley of Wisconsin who claimed that Americans had every right to be fearful of Obama style health reform. The spectre of "death panels" dooming decrepit granny to a premature death were just the tip of Republican demagogy. At the more extreme wing of the opposition, there was a display of one representative dangling from a noose.
Whew! For the mostly older participants of these angry demonstrations of know-nothingism, it is tempting to give them exactly want they want: no government run health care. Take away Medicare, the primary care vehicle for most retired persons, and let these people insure themselves in the private market. Take that you ignorant old farts!
Where would the many elderly constituents who most prominently savaged Senator Specter of Pennsylvania during not one, but two town halls be without Medicare, the last major contested innovation in the American health delivery system? Destitute. Indeed, even with Medicare, many elderly have had problems coping with infirmity in old age. Prescriptions are expensive and many have fallen through the donut hole created in the Bush era modification of Medicare to include partial government aid for prescription drugs. Medicare, at least, ensures that the elderly will receive health care that would not and could not receive through private insurance.
Lost in all the hyperbole about health care is a very simple fact. The United States is the last advanced economy to expand health coverage to all of its citizens. Every major economic competitor has some form of universal health coverage. Indeed, the last two countries to revise their health care delivery systems - Taiwan and Switzerland - did so without much of the political bile that has been spilled this past August. Taiwan took the time to study other health care systems and crafted a program best suited Taiwanese expectations. It even included health care auditors who visit those patients excessively accessing health care. Imagine that coming to an American hospital near you!
As Paul Krugman noted in today's New York Times op-ed, at best it can be argued that Obama and the Congressional democrats are steering the United States towards a Swiss style health care system where coverage is provided by private insurers. Whether there is a public option to get coverage for those individuals whom private insurers least desire to cover - those with pre-existing conditions or those facing catastrophic medical procedures - now hangs in the balance as the result of constant demagoguery. And, in the absence of a public option, what would pressure private insurers to act more reasonably and accept a Swiss style health care system?
With whom should one have a rational health care debate? Newt Gingrich? His op ed in Sunday's Los Angeles Times might have conveyed the impression that he could reasonably debate the various Democratic positions. Senator Chuck Grassley? At his outdoor address to his Wisconsin constituents, he admitted that his presence on one of the Senate committees reporting out health care legislation was essentially a stalling operation. That he confessed this while stating that American citizens were justified in fearing Obamacare ought to remove him from any bi-partisan considerations. Sarah Palin? She is a one-woman wrecking crew would shouldn't be allowed to blog, let alone get her bizarre views broadcast on a national basis.
Indeed, some of the most reasonable voices have been heard at Mr. Obama's town hall fora. It certainly is a legitimate question to ask how a public entity would impact private insurance providers, especially when the playing field might not be level. Would a public entity be allowed to lose money providing coverage for those least able to afford it or those whose medical bills would threaten private insurers? Would a public entity be subject to political tampering every time it went to Congress to make up for deficits that it could conceivably run?
There may be answers to these questions, but you won't hear them from voices within the Republican party. The Republican party - what's left of it - seems hell-bent on marching toward the sea. Lemmings everywhere unite and head toward the cliffs, and let the rest of us reform a health care delivery system on the verge of collapse.
No, for the past several weeks we have witnessed irate constituents berating Democratic representatives in the House and the Senate for betraying the Constitution, taking aim at Grandma and attempting to turn the United States into a 21st century USSR. A few of the participants seemed to be in search of answers. Too often, representatives were treated to boorish individuals rude enough to shout and shove to cut off debate before it began. Many of these were egged on by media bloviators such as Rush Limbaugh. Others, perhaps, read the blogs of former Alaskan governor Sarah Palin or sought inspiration in the musing of Sen. Charles Grassley of Wisconsin who claimed that Americans had every right to be fearful of Obama style health reform. The spectre of "death panels" dooming decrepit granny to a premature death were just the tip of Republican demagogy. At the more extreme wing of the opposition, there was a display of one representative dangling from a noose.
Whew! For the mostly older participants of these angry demonstrations of know-nothingism, it is tempting to give them exactly want they want: no government run health care. Take away Medicare, the primary care vehicle for most retired persons, and let these people insure themselves in the private market. Take that you ignorant old farts!
Where would the many elderly constituents who most prominently savaged Senator Specter of Pennsylvania during not one, but two town halls be without Medicare, the last major contested innovation in the American health delivery system? Destitute. Indeed, even with Medicare, many elderly have had problems coping with infirmity in old age. Prescriptions are expensive and many have fallen through the donut hole created in the Bush era modification of Medicare to include partial government aid for prescription drugs. Medicare, at least, ensures that the elderly will receive health care that would not and could not receive through private insurance.
Lost in all the hyperbole about health care is a very simple fact. The United States is the last advanced economy to expand health coverage to all of its citizens. Every major economic competitor has some form of universal health coverage. Indeed, the last two countries to revise their health care delivery systems - Taiwan and Switzerland - did so without much of the political bile that has been spilled this past August. Taiwan took the time to study other health care systems and crafted a program best suited Taiwanese expectations. It even included health care auditors who visit those patients excessively accessing health care. Imagine that coming to an American hospital near you!
As Paul Krugman noted in today's New York Times op-ed, at best it can be argued that Obama and the Congressional democrats are steering the United States towards a Swiss style health care system where coverage is provided by private insurers. Whether there is a public option to get coverage for those individuals whom private insurers least desire to cover - those with pre-existing conditions or those facing catastrophic medical procedures - now hangs in the balance as the result of constant demagoguery. And, in the absence of a public option, what would pressure private insurers to act more reasonably and accept a Swiss style health care system?
With whom should one have a rational health care debate? Newt Gingrich? His op ed in Sunday's Los Angeles Times might have conveyed the impression that he could reasonably debate the various Democratic positions. Senator Chuck Grassley? At his outdoor address to his Wisconsin constituents, he admitted that his presence on one of the Senate committees reporting out health care legislation was essentially a stalling operation. That he confessed this while stating that American citizens were justified in fearing Obamacare ought to remove him from any bi-partisan considerations. Sarah Palin? She is a one-woman wrecking crew would shouldn't be allowed to blog, let alone get her bizarre views broadcast on a national basis.
Indeed, some of the most reasonable voices have been heard at Mr. Obama's town hall fora. It certainly is a legitimate question to ask how a public entity would impact private insurance providers, especially when the playing field might not be level. Would a public entity be allowed to lose money providing coverage for those least able to afford it or those whose medical bills would threaten private insurers? Would a public entity be subject to political tampering every time it went to Congress to make up for deficits that it could conceivably run?
There may be answers to these questions, but you won't hear them from voices within the Republican party. The Republican party - what's left of it - seems hell-bent on marching toward the sea. Lemmings everywhere unite and head toward the cliffs, and let the rest of us reform a health care delivery system on the verge of collapse.
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