The president speaks, sort of ... and other notes
President Obama took to the broadsheets over the weekend, attempting to inject some sanity into the discussion.
... reform will provide every American with some basic consumer protections that will finally hold insurance companies accountable. A 2007 national survey actually shows that insurance companies discriminated against more than 12 million Americans in the previous three years because they had a pre-existing illness or condition. The companies either refused to cover the person, refused to cover a specific illness or condition or charged a higher premium.
We will put an end to these practices. Our reform will prohibit insurance companies from denying coverage because of your medical history. Nor will they be allowed to drop your coverage if you get sick. They will not be able to water down your coverage when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses. No one in America should go broke because they get sick.
Most important, we will require insurance companies to cover routine checkups, preventive care and screening tests like mammograms and colonoscopies. There’s no reason that we shouldn’t be catching diseases like breast cancer and prostate cancer on the front end. It makes sense, it saves lives and it can also save money.
This is what reform is about. If you don’t have health insurance, you will finally have quality, affordable options once we pass reform. If you have health insurance, we will make sure that no insurance company or government bureaucrat gets between you and the care you need. If you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan. You will not be waiting in any lines. This is not about putting the government in charge of your health insurance. I don’t believe anyone should be in charge of your health care decisions but you and your doctor — not government bureaucrats, not insurance companies.
(Obama)
This is what the president wants; indeed, we could go so far as to say it is what he is promising. This might be news to some people, of course, because the public discourse is so fraught with disingenuous noise.
But let’s make sure that we talk with one another, and not over one another. We are bound to disagree, but let’s disagree over issues that are real, and not wild misrepresentations that bear no resemblance to anything that anyone has actually proposed. This is a complicated and critical issue, and it deserves a serious debate.
(ibid)
This is exactly what Obama's opponents
don't want. They tell us that there should not be a bloated government bureaucracy standing between us and our doctors. They do not wish to address their tacit advocacy of a bloated
private bureaucracy standing between us and our doctors. They tell us the government should not ration—decide who does or doesn't get care—but the loudest voices seem to have no problem with a private corporation making those decisions. They do not believe the government can be held to account for the best interests of the people, but don't wish to discuss the corporations' dedication to greed of their executives and shareholders. In short, they are simply trying to project all of the problems with the current system onto the government.
Eternal vigilance, as the saying goes, is the price of liberty. Yes, we will have to watch our government closely in this. But the naysayers show little concern for guarding against private interests. Our social contract with the government is clearly spelled out in the Preamble to the United States Constitution. Yes, we should hold our public servants accountable under this contract. But the alternative put forth often and prominently disregards the social contract of the corporation, which is simply to make money.
The American Medical Association has thrown in, as has the American Nurses Association. AARP is in. This is a start. President Obama suggests there is "broad agreement in Congress on about 80 percent" of the reform package, but that number means there is a significant amount left to do. It would be helpful if Congressional Republicans would give the issue some genuine effort instead of hanging back and waiting for the midterm election. But that doesn't seem to be part of their plan. Meanwhile, the loud, angry, dishonest push continues:
In the coming weeks, the cynics and the naysayers will continue to exploit fear and concerns for political gain. But for all the scare tactics out there, what’s truly scary — truly risky — is the prospect of doing nothing. If we maintain the status quo, we will continue to see 14,000 Americans lose their health insurance every day. Premiums will continue to skyrocket. Our deficit will continue to grow. And insurance companies will continue to profit by discriminating against sick people.
(ibid)
Our friend
Madanthonywayne suggests that, "We should pass reform in small, bite sized bits. You know, bills small enough that everyone can actually read them." This seems about in line with his political needs: It extends the debate, gives the insurance companies as much time to adapt and figure routes to exploitation, and keeps the noise machine going as long as possible. Yet what are the primary challenges demanding reform?
(1) Cost: Long have we blamed medical costs on lawyers, and there is some share of blame that falls with malpractice suits. However, the counterpoint there is that doctors and nurses are accidentally killing as many as a hundred thousand people a year, and injuring countless more. The solution to our health care problems does not rest in cutting compensation to those affected by malpractice. We might consider some degree of tort reform, but the bigger challenge is to reduce the number of malpractice incidents. Additionally, the cost of services and equipment is constantly rising. Manufacturers and providers have obvious need for some degree of profit, but at some point we have to recognize that this isn't the same as charging forty bucks for a dildo, or twenty dollars for a compact disc. This is, as the president noted, "about people's lives and livelihoods." The insurance companies as well are far too devoted to profit. If the neighborhood lemonade stand doesn't put enough sugar in the mix, you're out a quarter, or maybe a dollar. If the insurance company decides to cancel you because you need to file a claim, you might well be out your life. We might add R&D to that, because some of it is very strange. After all, research is vital to health care, but why is the most prominent recent product of expensive pharmaceutical research an erection drug? Aren't there more important challenges to focus on? And, yes, the profits from such drugs can be poured back into research, but what will the next big product be? Maybe a drug for excessively shy people that has the side effect of making them lose bowel control? Oh, wait, we already saw that several years ago.
(2) Service Provision: Nurses' strikes are always controversial. When talking to a friend of mine who is an RN, we discussed how overworked she and her colleagues are. And this isn't just a matter of whether nurses are trying to be lazy. Understaffed, overworked nursing corps make more mistakes. Which, of course, leads back to the malpractice issue. There is an issue of wait times, but therein lies a question of staffing, personnel availability, and profit margins.
(3) Recission: This is the big, emotional one. And for good reason. What is the purpose of having insurance if they just drop you when you file a claim? In Congress recently, health insurance executives testified about the practice of recission, by which one company saved an estimated $300 million by dropping 20,000 policyholders after the fact. These policies were cancelled for alleged fraud, but if you want to talk about redundancy and bureaucracy, what they were looking for in reviewing those policies was any failure to cross every t and dot every i. This is one part of America where you are presumed guilty, and opponents of health care reform haven't done much to address this point. Furthermore, when asked directly if they would stop canceling coverage except in cases of demonstrable and intentional fraud, the three executives called to Congress flatly said no, they would not.
What else? Add to the list. And then let's take it in small chunks, then. Recission? How dare the government meddle in business! It's anti-American to tell a business they can't make money! Service provision? Well, let's do some union busting. We can't let better staffing interfere with excess profits, after all. Cost? Let's take it out on the malpractice patients, because don't you know a business needs grotesque profits to survive?
No matter what, it all comes back to money and liberty so long as we treat health care as just another market commodity like lemonade, dildos, or snow globes. But that's the American way, right? Free enterprise? The American dream?
Where were the teabaggers when it was a bogus war? Where were the teabaggers when it was petrol companies gouging people for gasoline? It wasn't the black man with a strange name in the Oval Office, so they were just fine with how things were going. The noise and bluster holding back the public discourse has little to do with health care itself. It's time to get over this, and move on with the real issue. But grim, complex discussions about family finances over the kitchen table late at night just don't make sexy headlines. So we can fault the media for its role in pushing the story and thereby granting the ludicrous disruptions the kind of legitimacy reporters and pundits were unwilling to extend to arguments against the war in Iraq.
The problem is that there are more than two sides to every argument, and the argument against health reform receiving the most attention right now is the least legitimate. If the Republicans want to take up the banner of reasonable and productive opposition, I think even liberals would welcome that at this point. In the first weeks of the Obama administration, many were giddy about the apparent collapse of the GOP. But nature abhors a vacuum, and what has risen to fill that void is something altogether uglier.
The challenges are known. The end goal is known. But in between is a tangled nest of misdirection and hives of angry, buzzing wasps aiming to chase people away from the issue altogether.
If they succeed, we won't ever get there. I would ask my neighbors to consider that simple prospect, and what it means to them. Maybe you have health care today, and like your policy. But try to promise yourself that it won't disappear as soon as you truly need it. Some people are so paranoid about government that it's the idea of government, not the violations, they focus on. This results in the appearance that they're just fine with the private sector committing those very violations.
And if that's truly the case, there is not much good to be said for them.
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Notes:
Obama, Barack. "Why We Need Health Care Reform". The New York Times. August 15, 2009. NYTimes.com. August 17, 2009. http://www.nytimes.com/2009/08/16/opinion/16obama.html
