Simple Rules for Health Care Reform

1. Prohibit Health Insurance Providers from engaging in anti-competitive practices.

2.. Prohibit Health Insurance Providers from denying health care insurance to individuals with pre-existing conditions.

3. Prohibit Health Insurance Providers from placing caps on annual and lifetime benefits.

4. Establish a mandatory Medical Loss Ratio of no less than 85%.

5. Establish a National Health Insurance Regulatory Commission with the responsibility of ensuring providers adhere by above tenants. This commission shall also field consumer complaints/tips about violations of these provisions. This commission shall also investigate waste, fraud, and abuse in public health plans (Medicare, Medicaid, CHIP, VA, etc).

6. Establish a National Health Insurance Clearinghouse with the following responsibilities:

-Identifying various levels of health insurance benefit packages, and establishing maximum premiums/deductibles/co-pays  for each level, while taking regional factors into consideration. This commission shall certify plans that meet these standards. While insurers do not have to adhere by these standards, individuals may not use governmental subsidies to purchase non-certified policies.

-Collecting and providing electronically to the public, information about all health insurance plans that have been certified.

7. Allow Medicare to freely negotiate with all domestic insurance providers, pharmaceutical businesses, and medical equipment/supply businesses. Increase Medicaid and Medicare reimbursement rates to no less than 60% of average private insurance payments for identical billable procedures.

8.  Incentivize individuals studying to be, and serving as Primary Care Physicians or other non-specialty medical providers through a loan forgiveness option tied to service in clinics/hospitals in undeserved areas.

9. Cap medical malpractice lawsuits to $X million in the most egregious life-threatening instances. This shall represent the uppermost class of suits, a schedule  of other classes of suits shall be established with corresponding maximum liability levels. (Levels/ Amounts TBD by the National Health Insurance Regulatory Commission).

10. Mandate that all children under the age of 18 have health insurance coverage. Increase eligibility for the Children’s Health Insurance Program (CHIP) to 350% of the Federal Poverty Level (FPL). The penalty for non-compliance shall be 100% of the cost of the least expensive eligible health care plan in the individual’s market area. Such taxes shall be directed to a National Health Trust Fund.

11. Incentivize the purchase of health insurance plans by establishing a refundable health care tax credit of $1,000 per individual, $2,000 for couples. Individuals must have maintained eligible coverage for at least 9 months out of the year to be eligible for the credit.

12. Prohibit employers from dropping, without reasonable cause, health insurance benefits for their employees. The penalty for such unjustified actions shall be 100% of the cost savings achieved by the business by dropping the insurance. Such taxes shall be directed to a National Health Trust Fund.

13. Incentivize employer health care insurance benefit plans, by establishing a business health care tax credit of up to $1,000 per employee.

14. Tax employers with at least 50 employers who do not provide health care insurance to their employees 10% of payroll. Such taxes shall be directed to a National Health Trust Fund.

15. Tax individuals making more than $250,000 5% of gross income, and households making over $500,000, 5% of gross income.  All other individuals above 350% of the FPL will pay a 1% tax on gross income. Such taxes shall be directed to a National Health Trust Fund.

16. All tax collections in the National Health trust Fund shall be used to provide a) Subsidies to households making between 350 & 500% of the FPL to purchase certified health care plans & b) payments to providers for uncompensated care provided to uninsured individuals.

-kd-

Other types of reform are necessary as well, including some sort of regulation on Pharmaceutical companies. This list is just a basic beginning for reform, accepting that single-payer health-care’s time has not yet arrived. In addition, % and #’s I provided above where just numbers I threw out there, of course it would require a more thoughtful and deliberative process to hash out such details.

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Naked Neighbors

What if I told you I was going to punch you in the face sometime in the future?

What would you give up to spare this unfortunate collision of knuckles and nose? A dollar? A twenty? Would you invest in a face mask, helmet and Kevlar vest? Would you stay at home and never come out? Would you give a stranger naked pictures of yourself  in exchange for a vague promise of protection? Actually I’m guessing you probably would just tell me to f-off, and/or punch me in the face depending on how hard core you were.

But, what if my name was Osama-Omari-Middle Eastern-Dark-Skinned-Man-with-a-Turban?

And what if Fox, CSPAN and Obama said that I was going to kill you, your family, and any cute floppy-eared puppies in the vicinity of your house? What would you give up then to spare this unfortunate collision of jet-liner with jenny & rover? It’s likely you would go all out, screw a $20, you’d give $2,000. Hell, you’d probably give naked pictures of yourself to all sorts of strangers in return for a vague promise of protection.

Actually, it seems that  you already are! Full body scanners, all the rage of the day, are taking off like co-workers on a Friday. Basically, if a low-income home owner or Mexican hasn’t already caused you to lose your job and you have some money to play with, you should invest in Rapiscan- one of two federally approved manufactures of full body scanners in the USA .

( I would give you their stock symbol, but Google finance says that’s private.  ERRrr? )

So let’s cut the chase and get to the point here. Basically some guy from Nigeria, whose parents forewarned the U.S. Government about his diabolic intentions, got on a plane and tried to blow up his underwear. The United State’s response? Obama made up a list of 14 “naughty countries” including the major island-nation of Cuba, USA-run Iraq, and reigning nuclear heavy weight Algeria; from now on, anyone flying to the USA from these terroristic nations will have to go through additional screening mechanisms.

In addition, with absolutely, positively no pressure from the United States government or corporate interests, several European nations are stepping up their use of full body scanners on passengers planning to fly to the United States from terror hotspots like Italy, Britain, and the notorious Netherlands.

(Some countries though are dragging their feet however, with Germany stating that before they use such scanners they want the ridiculous assurances that: “they increase security, that they are not a health hazard, and that the scans do to not harm the individuals’s rights)

So what’s the problem with these scanners? Well honestly it’s not that big of a deal, but let’s look at a few:

1)  Some guy takes a picture of you. Naked.

While it’s true that if you are uncomfortable with this technology you can request TSA personnel to personally grope you instead, there’s no guarantee this user-friendly alternative will always be an option.

You might say big deal, sucks to fly to the United States from somewhere else, but the fact is, these scanners have been tested in the US since 2003 and are already operational in 40 major US airports including:  Dallas, Baltimore, Denver, Tampa, Salt Lake City, Las Vegas, Miami, Phoenix San Francisco and Richmond.

2) There is no way to guarantee a passenger’s privacy. Officials say that personnel reviewing the Passengers Gone Wild! images sit in a remote room, will not see a distinguishable face and cannot save or print the images. Sounds great. Then why do I know what Susan Hallowell looks like naked? And how come this guy’s baby maker is on full display?

I highly doubt that Beyonce or President Obama (or me) are going to go through these scanners and the image won’t turn up somewhere.

3) How about this one: are we going to take naked scans of kids? 10 year old Johnny? 6 year old Susie?  Don’t think so? Wait till we get child bombers. Or what about the Muslim women who don’t even reveal their face in public? Are we going to tell them if they want to come to the US we have to check out their goods first? That’s going to make us a lot of Middle-Eastern friends.

4) Or how about health? Don’t the X-ray and MRI technicians always slap a lead vest on you and hide in the next room when they take scans?  These airport scanners are full body and last at least 15 seconds.  Free cancer with every 1,000 frequent flier miles!

5) Here’s another problem- follow the money. The former head of Homeland Security who has been pushing the government to purchase more of these scanners has just admitted that he has a consulting relationship with a full body scanner manufacturer. I’m willing to bet he’s not the only politician, past or present, that stands to gain from this lucrative business- each of these machines are retailing at over $170k, and the TSA just ordered 150 of them with plans to buy another 300.

Okay, so if you’ve stuck with me this long, now I get to the real issues, the aforementioned issues are really just sensationalistic fluff for those of you who saw the word “naked” on facebook and clicked on over.  The real problems are the deeper currents of growing government intrusion in our lives in the name of “security”.

Throughout history, the rights of people in this nation have been compromised for the “safety of the nation”. It seems to me that this line of reasoning got lots of nice Japanese folks kidnapped and locked up on the west coast during WWII.

It Seems to me that this got us a 1,000 page Patriot Act passed in the middle of the night after 9/11. And it seems now that its setting us on the proverbial and terribly cliché “slippery slope” of absolute governmental control over our selves. Nothing is more fundamental than our bodies. Without a right to the autonomy of our own body all other struggles are futile.

Today a guy sticks a bomb in his underwear and we wind up with naked imagery as a solution. This will be about as effectual as building a picket fence with Mexico to keep out immigrants. Know why? Because tomorrow some misguided soul is going to stick a bomb up their rectum- out of the reach of a body scanner. Then what? Full cavity searches for all passengers, spread your leg’s please mam?  Or some jackoff is going to swallow a chemical compound and then we are all going to have to purge in a personal bucket we can reclaim at the security clearance window, two heaves please sir?

Sure it is easy to sit in my cozy terror-free apartment enjoying a slice of sweet potato pie and criticize those who would sacrifice our liberties in the name of our safety

After all I wasn’t on Flights 11, 175, 77, or 93 in 2001, and I wasn’t on Flight 253 this past Christmas—but it is easier still to change the channel,  to turn off the radio, to close the webpage when I come upon a thorny issue that’s not easily reduced to black and white.  So perched up here on my soapbox, do I have some grand plan for national security? No, (actually I do)  but what I do know is that when we accept rapid national adoption of reactionary policies that infringe upon our liberty in order to negate  undefinable threats, we do ourselves a disservice as human beings and as thoughtful engaged citizens.

People are quick to jump on the bandwagon decrying how our government failed to protect us and let a terrorist slip through their fingers. I disagree. It is no more reasonable for us to believe the government can ensure 100% exclusion of foreigners who would do as harm, than it was for China to believe the Great Wall was going to keep all the Mongols out.

I will however, jump on the bandwagon of people who fault our government for not doing more to proactively reach out to the world in a positive way.  Here’s one idea- establish a Department of Peace– the legislation  has been raised in Congress over 100 times since 1935- including the last 8 consecutive years (yeah Kucinich!) .  

This singular act would do more for our security than 1,000 naked pictures ever could

You know what f- -k, it, I’m being too idealistic. For our children’s future, let’s all just get anal probes and start a war with Yemen.

-kd-

Further resources:

Petition against body scanners

Rapiscan

Warm & cuddly video on body scanners

Healthcare Reform for Idiots

I really shouldn’t have to do this, but here we go. Healthcare Reform for Idiots:

(Disclaimer: single payer health care is  the best option. Remove the profit motive from health care. No more million dollar CEO’s getting rich by dropping folks who get cancer or other illnesses. But this guide to health care reform for idiots is necessary since single payer was destroyed by wealthy industry opponents)

#1. Congressional Republicans are NOT STUPID (well not literally, but that’s another discussion). Republicans are not intellectually incapable of understanding the problems around healthcare and what the democratic solutions are. What republicans are is MANIPULATIVE.

#2. Since the republicans are not stupid, but rather conniving weasels, the President and Democrats need to be smart. Don’t get caught up arguing that republican objections have no wings, just CUT THE DAMN WINGS! Example: DROP THE PROVISION that republicans are twisting as “DEATH PANELS”. The provision itself would simply allow physicians to counsel patients on end-of-life care, but its just red meat for the republicans.  Its just not that important, and can be done in separate future legislation.  Drop the provision, and just pull the rug out from under the R’s.

#3. Speed is essential. While the R’s are trying to find some new baloney to fiercely oppose, MOVE ON HEALTH CARE. GET A BILL OUT AND TO THE PRESIDENT.

#4. Speaking of speed, Democrats: GET YOUR FLIPPING ACT TOGETHER. Just in case that is ambiguous, let me repeat: DEMOCRATS, GET YOUR FLIPPING ACT TOGETHER. Republicans are able to toe the party line no problem–This is the first time in who knows how long when the Democrats have the presidency, the house, and the senate. DO THE DAMN THING.

North Korea has been obnoxious and obstinate in nuclear discussions. Conservatives  argue a policy of non-engagement. SO GIVE THESE CONSERVATIVES A TASTE OF THEIR OWN MEDICINE. We do not need to engage in their b.s. and beg for their votes.

#5. DON’T PASS A HALF-BAKED PUBLIC OPTION. For a public option to be meaningful, it can’t be watered down to accommodate scheming republicans.

#6. Be Clear about how you are going to pay for everything. Don’t Simply say the reform will cost $700 billion. EXPLAIN THAT WE ARE ALREADY SPENDING MUCH OF THIS MONEY ON HEALTH CARE. Its not like we are just going to tack on new spending. We are restructuring largely how we pay for healthcare.

#7. CHOOSE YOUR BAD GUY. Right now “big government” is the bad guy. Its easy for the right blame the government and rail against it. How about redirecting some of that ire where it belongs? THE HEALTH INSURANCE INDUSTRY. If you haven’t had a personal experience where you, a family member, a friend, or a co-worker was screwed over by their insurance company, you either live under a rock or  in a  FANTASY BUBBLE OF CAREFREE FOLK. Direct some of this justified anger at the industry.

#8. SUBMIT YOUR RESIGNATION if you still can’t figure out how to pass health care reform with a democratic president, house, senate, and massive public discontent with the status quo.

If you really can’t do it, I’m happy to take your job.

-kd-

My Letter to Obama

This is my letter I am mailing to the President, my Senators, and Representative. Please add your voice of support by contacting your legislators.

~~

Dear President Obama,

Since your Office of Communications receives thousands of letters every day, let me get my main point out early: DO NOT DROP A PUBLIC OPTION IN HEALTH CARE REFORM MEASURES.

As a social worker, uninsured masters-level degree holding employee, an individual with a pre-existing condition, and brother to my younger sister who passed 2 years ago for want of  medical care, I am writing you today to let you know that it is absolutely imperative that we have REAL, MEANINGFUL HEALTH CARE REFORM.

I was a strong supporter of yours in the campaign, and am grateful you were elected to office. Further, as a former health care community organizer, I am thrilled that you have elevated the discussion of healthcare reform to an actionable state. While I am disappointed that single payer is not being seriously considered outside of HR 676, I am also pragmatic and understand that our nation is years away from being able to intelligently consider its merit.

That is why it is ABSOLUTELY CRUCIAL that you DO NOT ABANDON A PUBLIC OPTION. As an educated and thoughtful individual it is not necessary for me to lecture you on the unsustainable proposition of an unchecked private health care industry. It is already bankrupting untold number of Americans, allowing thousands to die prematurely every year, stifling entrepreneurship, and failing to uphold a basic American value: treat others how you wish to be treated.

The private marketplace, while a remarkable mechanism for innovation and economic growth, has historically demonstrated that sans incentivizing, the most vulnerable and financially burdened individuals and families will not receive an equitable share of resources.

Recent remarks from your administration in which the need for a public option is downplayed in favor of health cooperatives deeply troubles me. I understand that political realities of Washington generally necessitate compromise, and at times generate better results.

HOWEVER, THIS IS NOT ONE OF THOSE TIMES. Political expediency, misinformation, and hysteria have colluded to place serious obstacles in your path and the path of those who would fight for real health reform. PLEASE STAND STRONG. DO NOT SACRIFICE THE AMERICAN PEOPLE. Your failure to communicate (at least publicly) very specific directives to congressional leaders what is non-negotiable worries me.

I urge you to TAKE A STRONG, SPECIFIC STAND ON HEALTH CARE REFORM: MAKE A PUBLIC OPTION NON-NEGOTIABLE. I believe that you, Seblius, DeParle, and other legislative leaders know that health co-operatives, while appropriate in theory, will prove woefully inadequate to make a meaningful dent in the private-insurance dominated marketplace.

Assuming that the fate of millions of American’s will be well served by untested cooperatives, when we have a model before us that we have seen work before (Medicare), seems disingenuous. I know that more than healthcare reform is at stake in this debate. I understand your presidency and the viability of the Democratic Party will be in part, determined by the outcome of health care reform this year.

I understand this. I PROMISE YOU HOWEVER THAT WHEN AMERICANS VOTED FOR CHANGE THEY MEANT IT. I promise you that if you remain strong, self-assured, and confident in your plan and the public option that the majority of the public will follow. A mandate for real change swept the nation with your election, and if there ever is a time to spend your capital, it is now. THE NEED FOR A PUBLIC OPTION IS REAL.

I leave you with your very own words, and pray that they inspire you to action:

“This is our chance to answer that call.  This is our moment.  This is our time – to put our people back to work and open doors of opportunity for our kids; to restore prosperity and promote the cause of peace; to reclaim the American Dream and reaffirm that fundamental truth – that out of many, we are one; that while we breathe, we hope, and where we are met with cynicism, and doubt, and those who tell us that we can’t, we will respond with that timeless creed that sums up the spirit of a people:

Yes We Can.  Thank you, God bless you, and may God Bless the United States of America.” – President Barack Obama

~~

Original Story Here: Obama May Soften Healthcare Plan

~~
Please support healthcare reform & fight back against the hysteria- this is too important of an issue to sit on the sidelines.

Email or call your United States Representative: https://writerep.house.gov/writerep/welcome.shtml
(202) 224-3121

Email or call your United States Senator:
http://www.senate.gov/
1.877.210.5351

Contact the White House- Tell them we need real reform now, and a strong public option. http://www.whitehouse.gov/contact/
White House Comment line: 202.456.1111

I’m happy to answer questions or direct you to further resources.

Thank you.

Where to?

Hello-everyone- Just a quick note to apologize for not posting in a while.  Finishing grad school and finding employment is this job market is about as tough as any cliche phrase that comes to mind, so I’ll just say its not fun.

Hopefully when I am gainfully employed and thoroughly indebted to Sallie Mae I will find more time to write.

Until then, check out the “Brain Buffet” I’ll try to keep that updated- because hey- you gotta eat!

-kd-

Here Come the Chickens

Last fall as the American economy appeared to be slipping over the edge of an economic precipice, those in Congress were faced with some tough choices about whether to prevent giant businesses from going under– in order to spare the economy further economic trauma.

In the midst of all of the chaos and tumultuous stock tickers, then Treasury Secretary Hank Paulson made a bold announcement: he wanted congress to hand him a blank check for $700 billion so he could work his voodoo magic on the economy. In his thinly populated 3 page proposal, he also indicated that congress should mind their business about where he was going to put the money.

I was proud of the level of public engagement with elected officials, as the outrage of American’s translated into thousands of calls and emails to their representatives and senators. I was equally dismayed at the eventual decision of Congress- to essentially concede to Paulson.

Since that time the Treasury Department has doled out billions of dollars to many businesses- among them- $170 billion to AIG. What did AIG do after receiving their very own welfare check? They sent their employees to a luxury resort in California- a week long respite to the tune of nearly half-a billion dollars. Congress, in all of their indignance, rattled their sabers and made biting remarks to the media about AIG’s wasteful spending of tax payer dollars. BUT, payments to AIG continued.

Now that it has come out that AIG is distributing $169 million in bonuses to employees as a result of “contractual agreements”, Congress, and the President, are again parading around in anger. Give me a break. First of all- Congress set this all in motion last year when they opened the floodgates of corporate bailouts without significant oversight. Then, when discovering unscrupulous behaviors by AIG and others (see Merrill Lynch), Congress simply complained loudly- but made no significant attempts to right the problems.

Now we once again see the result of private businesses making decisions that would make most of us squeamish, and again the clamor is loud. Senator Grassley even went as far as to suggest AIG exec’s should commit suicide. Now the Senate & House are discussing legislation that would impose virtually a 100% tax on bonuses for companies that have received governmental bailouts.

The general frenzy with which the public, the president, and the congress have been swept up in over $169 million is almost comical. With another $30 billion scheduled to go to AIG, when all is said and done, AIG will have received over $200 billion dollars from American taxpayers- and we are upset over $169 million dollars? Seriously? Get real people. Lets direct at least some of this anger where it belongs- on congress for so poorly  regulating the dissemination of taxpayer money.

Even looking past Congress’s culpability, lets think for a minute about the actual idea behind a 100% tax on a portion of businesses spending done in a legal manner. Did I miss something? First of all- many of those receiving the bonuses from AIG don’t even work for the company any more. Taxing AIG isn’t going to do a thing about getting the money back from those payees. Second of all- Congress needs to stop sending mixed messages. Either we are nationalizing businesses- where the government takes over control, and makes decisions for the business- and maybe this is the right thing in certain instances; or the government is simply providing financial aid to a business with some stipulations attached– and maybe this is the right thing in certain instances.

But trying to retroactively punish businesses for engaging in legal, albiet shady, practices, is not the job of the government, and recouping $169 million is nothing more than a publicity stunt- especially when another $30 billion is scheduled for release to AIG in the near future.

So what are the lessons?

1- Americans need a longer attention span. Lets not forget the actions that set these unregulated bailouts in motion.

2- Americans should not be duped by this publicity stunt. Sure AIG’s actions were reprehensible, but in the grand scheme of things, is $169 million the best thing we can think of to be angry about? Seriously?

3- Bailing out businesses that are “too big too fail” should be an indication, in the sage words of a C SPAN commentator this morning, that they are indeed “failing”. Congress needs to carefully consider what the root problems are in a business or industry before blindly throwing money at it. If they did perhaps they would discover that the problems in part, were created by those whom they would give fat checks to, to fix it.

Last fall Congress hastily got itself into the business of bailouts without proper research, debate, or forethought. The chickens are coming home to roost now, and its becoming pretty amusing to watch all the fingerpointing.

I for one, am pointing my finger right back at Congress.

-kd-

The Superior Scribbler Award!

So it turns out that some of the folks who come by this page appreciate my rambling, theorizing, and sometimes satirical take on all things political. I am honored to announce I have been awarded the The Superior Scribbler Award by fellow bloggers over at the dynamic blog: To The Wire.

The idea behind this award was started by the Scholastic Scribe, where 5 bloggers originally received recognition as “superior scribblers“. In return, these 5 bloggers passed the award on to 5 others and so on…

I’m flattered to have been included in this love fest (^_^)  and include my 5 awardees & the rules here:

• Each Superior Scribbler must in turn pass The Award on to 5 most-deserving Bloggy Friends.
• Each Superior Scribbler must link to the author and the name of the blog from whom he/she has received The Award.
• Each Superior Scribbler must display The Award on his/her blog, and link to this Post, which explains The Award.
• Each Blogger who wins The Superior Scribbler Award must visit this post and add his/her name to the Mr. Linky List. That way, we’ll be able to keep up-to-date on everyone who receives This Prestigious Honor!
• Each Superior Scribbler must post these rules on his/her blog.

********************

And here are my picks:

1. Margaret and Helen These two 80-something year old women offer up daily doses of biting humorous commentary. You won’t regret stopping by.

2.The Unhappy Camper. Joe is a middle aged man living in Miami who is currently homless. He blogs from local libraries when he is not chased out, and offers his reflections, in all their honesty, about life, and how he’s feeling.

3. Pennsylvania for Change is an activist blog that offers up an interesting liberal perspective on national and state events.

4. Advocating for Freedom. This is the blog of a friend of my here at Penn. She doesn’t write on it very often, and will  likely have no idea I gave her this award, but the few posts she has written are very thought provoking, and well worth the read.

5. Quaker Agitator. This is a solid and comprehensive blog that is aptly described by its title.

Enjoy the good reads & Congrats to the new winners!

-kd-

Grey Hair

I had to check in the mirror today to see if I was getting grey hair. In the past couple of months, I’ve had flashes of conservatism, and I’m wondering if the whole “get conservative” as you get older is coming true.

I wouldn’t consider myself “older” by any stretch of imagination, unless I’m comparing myself to last year. Or for that matter, the year before. But in all seriousness, I am starting to question whether my relatively one sided perspective on the “pro’s” of a big, liberal government actually plays out in reality.

I think the first chink in my thinking came during when I was engaged in an conversation about universal health care with a friend who was equally enthusiastic as I am about the idea. At some point we touched upon the issue of employer sponsored health care, or payments to the government in lieu of actually providing coverage for employees. And then a very basic question struck me: What responsibility do employers have to their employees to provide health care? Or more importantly, What right does the government have to impose such a regulation?

Now before all of you who know me think I’ve gone crazy to even ask such a question, hear me out. I as much as anyone, (and probably more than many) (okay, definitely a lot more than most), believe that health care should be a right. The right to live a life of freedom, self actualization, and prosperity crumbles without the prerequisite foundation of safety, health, shelter and sustenance.

But if we have this “right” to health care, and other basic human needs, the question then becomes, from whom do we demand or receive this right?

It has only been in the last hundred years or so in America, where we have turned to employers, and the government to provide for these fringe “rights”. Employers only began offering workman’s comp, health insurance, and other benefits as a means to attract and retain employees- not because they were genuinely concerned with guaranteeing the “rights of the people”. Over time, these benefits in kind have become the accepted domain of the workplace, and indeed for a business to be competitive, they must offer them.

However, simply because they do offer these benefits, does that mean that they have to? If McDonalds begins offering retirement plans, does that mean in 10 years we will demand that all fast food restaurants provide retirement insurance? Of course, employment is one logical marketplace for health care- an exchange of labor for benefits- but that in itself, does not mean employers should have to. There are exceptions of course- in hazardous industries, some provisions for the health and security of the employee should be made.

So back to the question- where do we obtain our “rights from”? If we do not turn to employers, the only other possibilities are the private market, or the government. We have seen that the market has no financial incentive to provide affordable health care  to the sick or indigent (or for that matter, most social services), so that means the only logical place left would be the government. And herein lies the fundamental contradiction I have encountered in my thinking:

On one hand, I would like for the government to provide these basic “rights” or “needs” of the people because they market won’t (health care, child care, education, police, fire, etc) but on the other hand, I decry excessive government interventions in other areas (military, domestic surveillance, national ID, etc). So the problem becomes that I am not for big government as a matter of fact, but rather for big government, when the ends suit me.

If I (a liberal), feel certain ends do not suit me (PATRIOT Act, immigrant deportation, civilian surveillance, business subsidies), then I wish for a smaller government. Accordingly, many conservatives are threatened by big government in certain instances (welfare, taxes, health care), but actually want big government in other areas (military, aid to businesses). It is this irony that allows the right to decry social service spending, but support  military budgets; at the same time that the left can decry military budgets, but support social service spending.

So where does this realization leave me? For starters, conflicted. As a social worker, as a human being, I believe that there are certain things that all people should have access to: food, health, security, shelter, clothes, education, etc. However, how do we draw the line between what falls in the public domain and what falls in the private? The more we put in the public domain, the more rights we sacrifice in exchange for these services, and the more we put in the private domain, the more we sacrifice those who are not served by the market.

I think that grappling with this complex balance of ideas is a necessary part of informed opion formation and decision making. However, the ever present danger remains getting caught up in ideological debates and rhetoric at the expense of arriving at solutions. For an example of this, turn on CSPAN, FOX, or CNN, and notice how ideology colors everything from floor debates to coverage of political issues.

Becoming trapped in an ideological corner is the inevitable result of a two party political system, where if it’s not black its white, its us against them, and one half of the country will be perpetually unsatisfied. The difficult reality for many, including myself, lies in realization that compromise is the only solution to resolving these vexing issues. It means being open to dialogue, new perspectives, and change.

-kd-

“274 events”

So I snore pretty loudly. Sure lots of people do, but how many of their friends would liken their snore to the sounds of a whale? I have at least one. Over the past few years I’ve grown used to being the brunt of jokes about the volume of my snore, and I’m sure the number of nights my girlfriend wakes me up complaining “babe you’re snoring!” is vastly outnumbered by the nights she rolls over and tries to fall asleep. So a few years ago, after she noticed that not only was I keeping the dead from sleeping, but that I would often stop breathing- I decided to get checked out.

At first, I wasn’t even sure I could get it checked out- as a college student, with a college student health plan, I had learned first hand that medical insurance does not always equal medical coverage. But after a few calls, I was surprised to learn that Aetna would pay for me to visit the Windham Hospital Sleep Lab.

So I called them up and arranged for an overnight study. Basically, I went to the hospital late in the evening, had dozens of wires and electrodes stuck to my body with an unfriendly goo, and hopped into bed. Trying to fall asleep knowing that the technician in the room over whose voice was omnipresent  via unseen speakers, was watching over my every toss, turn, and scratch was a tricky task. Finally , I managed to fall asleep, and 8 hours later awoke to a new morning, eager to run home and grab a couple more hours of sleep before the day began.

Shortly after, I returned to the hospital to meet with the doctor in charge of my case. Sizing me up with curiosity, he announced that I had severe obstructive type sleep disordered breathing (sleep apnea), despite the fact that I was about 20 years too young and 60 lbs too light. Then came the real shocker: I had severe heavy snoring disease. I had to chuckle inside a little at that one, and promptly noted the condition so that I could explain to my friends I was not being purposefully obnoxious when I slept.

But getting back to this sleep apnea business- what exactly did that mean? In a nutshell, during the 6.1 hours of sleep I was observed, “274 respiratory events were manifested”, i.e. I stopped breathing. That didn’t sound so great. So what did this mean for my body? Basically, every time I stopped breathing, extra stress was put on my heart as my brain kick-started things. I learned that over a period of time, untreated sleep apnea can lead to high blood pressure, heart disease, and a host of other undesirable side effects, including the “moderately severe reduction of REM sleep” I exhibited: read I miss out on the deep rejuvenating stage of sleep every night.

The answer supposedly was a CPAP machine- an awkward looking device (pictured above) that you hook up to your face before you sleep each night. It is supposed to generate a constant flow of air into your lungs to prevent the “respiratory events”. Dr. “X” told me the technicians would simply need to schedule a second night of observation during which the CPAP would be hooked up to me and calibrated specifically for my breathing. Then a order for a machine would be placed with a local supplier, who would then come to my house, set it up, and show me how it worked. Bada-bing! Problem solved.

Only not really. When the Dr. mentioned a second night at the hospital, I told him that probably wasn’t going to happen any time soon. The fact was, my student health insurance had a “per-condition, per-year” policy cap of $1500 or so. That meant spending on any one condition over $1500 came from my pocket. I told him that I would have to see how much the 1st night’s bill came to before scheduling a 2nd night. I called the billing department- and ouch! One night in the lab had not only wiped out my cap for the year- but had exceeded it.

So in the span of just a few weeks I incurred hundreds of dollars of medical debt payable by me, just to learn that I had a dangerous sleep disorder that I couldn’t schedule a follow up study for. So I grinned and beared it. I waited until my next policy year started, and contacted the hospital to set up the 2nd night of my study. It had taken a while, but at least now I could complete the process. It was a lovely idea, but the hospital thought otherwise. Apparently in waiting for my policy limit to reset, the first night of the study had become void- the data was too old to use for a 2nd night’s sleep.

By this point I was pretty ticked off. I explained my dilemma to the Dr. & staff, and they came up with a solution- they would schedule me for a split-night study. Instead of observing on night #1, and intervening on night #2, they would split one night into 2 parts, waking me up half-way through. And so I trudged back to the hospital, submitted to goo and electrodes, and fell asleep easier this time, not nearly as creeped out by the watchful eyes in the dark this time.

So finally  the problem was just about taken care of- the split night study went well,  my order went into the CPAP vendor, and I should be all set in a couple of weeks. Then came the best news of all: Aetna declined to pay for the CPAP machine. I must admit I was surprised. After all, before even embarking on this journey, I had done some homework and learned that CPAP would likely be the answer the sleep lab recommended. So when I asked Aetna if they would pay for the study, I also asked if CPAP would fall under “durable medical equipment”- which had its own cash limit. They informed me it would, and did not count towards the “per-condition” limit. So why did they turn down my medical treatment?

“It was not medically necessary”

I had to laugh. It was all too ridiculous. If Aetna denied me medical treatment now because it was not medically necessary, in 20 years, Aetna, or other insurers could deny me medical coverage for developing what they would then call a pre-existing condition: heart problems. Indeed, even if I tried to switch insurers then, I would run into problems: many insurance companies will not pay for conditions that  a “reasonably prudent” person would have taken care of in the past.

I asked My Dr. appeal Aetna’s decision, which he did,  but it was to no avail. I joined the ranks of the millions of American’s who fall into the no-man’s land of “underinsured”. Much talk is had of those without insurance, and those with insurance who pay too much- but little focus is placed on those ostensibly with insurance, who find their coverage exists only on paper.

After this experience I vowed when I moved on to grad school to drop Aetna and pick up a new carrier.  However, when the time came, after weeks of research and inquiry  I was chagrined to learn that my new grad school also used Aetna- and it was the only coverage I could afford with my now “prexisting condition”.

And so I have grudgingly been forced to enroll again with Aetna- a health insurance company that considers each one of my 274 nightly respiratory events of medical insignificance. It is in this way that 18,000 American’s die each year for want of adequate health care. My beautiful sister Holly was one of them 1.5 yrs ago, and it appears that Aetna is perfectly happy to add me to the count after they collect my premium.

With a new Health Czar, a new HHS secretary, increased money for Medicaid, funding for new health centers, and tomorrows health care reform summit, the temptation to mistake action for progress will be great. It is up to everyday Americans to make sure that Washington remembers health care reform is not just about policy options, but about people.

-kd-

Further Resources:

Kaiser Network

Obama’s Health Care Plan

Sustinet: Connecticut’s Current Universal Health Care Proposal

Pennsylvania’s Universal Health Care Efforts

United States Department of Health & Human Services

Families USA

Health Care for America Now

Universal Health Care Action Network

What’s Yours is Mine :)

As an undergraduate student in a social work program, I had become accustomed to sharing ideas and conceptions about our society, its ills, their causes, and their remedies, with many of my liberal peers. Many of those beliefs were reinforced by our professors, including the virtue of wealth redistribution. What’s more American than paying taxes?

One day, our Social Welfare Policy professor decided to challenge us and our vehement convictions. Walking to the front of the class, he began writing a string of numbers: 99, 92, 87, 84, 76, 51, etc…

Turns out they were grades from our last test. When he turned to us and said we were going to have an experiment I knew I didn’t like where it was going. He then tallied up all of the points we had cumulatively scored on the test. Let’s call it 2400. He then posed the question to the class: “How do you want to distribute these points among the class? I will accept whatever decision you make“.

After a moment of tittering among us, he continued. “There are 2400 points here, you could say, divide them evenly and make sure everyone gets a 76– no one does really well, but no one fails either“. Or, we could decide to just take points from the top performers and award them to the lower scorers. Yet another option would be for everyone to contribute some of their points to a pool, and then assign them according to need. Finally, we also had the option of keeping things as is: we could just keep our original scores.

Instantly people began talking, and asking questions of him. “No, no” he said, “You all are a group, you decide what you want to do“.

It was a telling process that followed, as those who performed poorly on the test began talking about being fair, and suggested that those of us who did well should share some points, etc. Those of us who did well (myself included) objected. Why should we do worse on our test than we deserved? It wasn’t my fault others didn’t do well! Then the low scorers began cajoling us “what about your social work values?”, “don’t be greedy!”

As one of the top performers on the test I was conflicted. For a while I had unquestionably believed that those who did better in society (financially) had an obligation to share that wealth to help others who were less fortunate. Now I was that rich person who didn’t want to give up my hard earned salary to support others! It was quite a difficult situation to be in, and really challenged my assumptions about the validity of wealth redistribution.

At the end of the day, I came to the conclusion, that the exercise wasn’t fair- it presupposed that my relative success on the test had in some way caused others to do worse. I strenuously rejected this notion. Perhaps I have been lucky to have generally performed at a higher academic level than some of my peers, but it certainly didn’t mean that I should have to sacrifice my success!  Some time later (since I thought about this for quite a long time), I realized that this example was closer to real life than I had wanted to admit.

In the same way that I did not believe that it was my fault that others did not do as well on the test, many in our society do not believe that it is their fault that others do not do as well economically. Why should they sacrifice their hard earned income just because others don’t do as well? I could point out that our society is full of historical inequity, male privilege, white privilege, heterosexual privilege, nepotism, and structural barriers that do in some way both contribute to the success of some and the failure of others. But, many do not see this connection- do not want to see it- or do see it and simply shrug it off. In the same way, I did not consider how privileges I have had in my  life (male status, excellent primary education, etc) might have inherently positioned me to perform better on the test than others- and so I really didn’t see why I should give up my points.

It is interesting in  retrospect to consider what I would do. Would I advocate for absolute communism in the class? Everyone gets equal points despite  unequal contributions? Would I push for a highly progressive tax system? Virtually no taxes on the “poor” and lots on the “rich”? Would I support a regressive tax system? Tax those at the bottom at relatively higher rates than myself? Would I fight to protect the status quo? Let the points lie where they may and to hell with the failing students?

I’m not sure what the answer is, but the experience does give me slight pause when I talk about wealth redistribution. Given all of the social factors that contribute to wealth inequity, surely some equalizer needs to be introduced- but where do you draw the line? Do you give food stamps to the poor- but only just enough so they don’t die? Do you seize the assets of the rich- and simply give them to the needy?

More than likely, we simply elect others year after year to struggle and fight over the answers so that we don’t have to.

-kd-