Fairness

I was walking around my neighborhood at six AM today, and sort of mulling life, as my iPod died on my walk. I had a thought, rather a series of thoughts, and wanted to share them with you on this, Yom Kippur.

I guess this train of thought was triggered by watching LinkTV's presentation of an address by author and journalist T R Reid regarding his world tour surveying healthcare abroad.

(SIDE NOTE: If you can give, this is a good time to donate to LinkTV, a network dedicated to bringing you perspective and analysis of the news that you won't get from mainstream media)

Reid consistently pointed out that, logically, it is impossible to frame the current healthcare crisis as anything other than a moral question: Is the healthcare system fair? What is the ultimate responsibility of a government to its people if not to ensure they have long and productive lives?

He has a point: for all the flaws inherent in other country's healthcare systems, most notably the long waits for elective procedures in Canada's Medicare system, they are at their lowest common denominator, fair. The length of time a rich person waits under Canada's Medicare system (which was LBJ's model for his eldercare system) is the same as for a poor person.

It is, at heart, an ultimately fair system. Yes, if a rich person can afford to, he or she can opt to fly to the States and pay for knee surgery or to see an orthopedist, rather than wait a couple of weeks in Canada. But Canada also doesn't extend this triage function to life-threatening conditions: if your heart is on the fritz, you get seen immediately, rich or poor.

Fairness. It never has to be justified. But unfairness does.

And somewhere in the dark of the night of my sleep, this thought nagged at me, and I began to have an insight into human beings.

When we behave badly, we have to rationalize ourselves. We have to justify that behavior. We have to make excuses.

Fairness is inherent. Fairness is obvious. Fairness needs no excusing.

Just like getting up off the couch and taking a four mile walk needs no rationalization. It needs nothing other than "I wanted to stretch my legs."

Sitting on that couch for another hour, that requires rationalizing. That requires excusing: "It's raining. I'm tired. It's cold."

Or to put it another way, when was the last time you had to explain to a cop why you were going under the speed limit?

Good behavior is what it is: Bonnum commune communitatis. Bad behavior needs to be explained, excused and forgiven.

Back to healthcare then: what rationalizations would the corporatists give for the current state of healthcare in America? That it makes a profit for the shareholders of insurance companies?

Is that fair? Is it fair that the CEO of Oxford or CIGNA or Blue Cross earns a fat little bonus at the end of the year while people without insurance, some 700,000 each year, are forced into bankruptcy and 200,000 people die of treatable and preventable illnesses, all because insurance companies have to protect that precious little dividend and that precious little stock price at the expense of a healthier citizenry?

This is not about socializing medicine, either. For example, America generally operates under the German healthcare system, developed by Otto Von Bismarck over a century ago. Private doctors, private insurance, private hospitals, except costs are controlled. For example, Japan, which has 3,000 health insurance providers, cap administrative costs at 1.5% of premiums, meaning insurance companies have to spend 98.5% on insuring patients. Canada caps costs at 6%, and that's with a government health insurance.

American insurance companies bank 20% of premiums as "administrative costs". That's an awful lot of forms to fill out! And the Japanese spend about $3,500 per annum on healthcare and insurance. Americans spend $7,500.

And no one in Japan files bankruptcy because of medical bills.

Fairness. It never has to be explained, it never has to be justified.

It only has to be experienced.

Health Care, Not Insurance

This is precisely why we need a national health service, and not the mishmosh of tangled threads of bureaucracies and naysayers that the Republicans and other fascists want to use to keep us down:

No one disputes that the $2.3 trillion we devote to the health care industry is often spent unwisely, but the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained, as a study released last month says, by our being fatter. Even the most efficient health care system that the administration could hope to devise would still confront a rising tide of chronic disease linked to diet.

[...]According to the Centers for Disease Control and Prevention, three-quarters of health care spending now goes to treat “preventable chronic diseases.” Not all of these diseases are linked to diet — there’s smoking, for instance — but many, if not most, of them are.

We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care.

In case you were wondering where the cost savings that would pay for this healthcare reform is coming from, those numbers speak loudly. Right there, just in obesity and diabetes, you have a $260 billion a year. A year.

Considering Obama's paltry proposal will only cost $1 trillion this decade, that savings alone, even if only half realized, means American healthcare would show a profit....IF WE ENACT ACTUAL HEALTHCARE!

Now, there are many who would say this is tantamount to dictating what Americans can and cannot eat.

Bullshit. How many Americans really listen to their doctors? Because if Americans were that easily persuaded off their bad habits, we wouldn't need healthcare reform. We wouldn't need to rein in rising healthcare costs.

You'd think the private insurance companies would have glommed onto this fact: if Americans eat healthier, that's more profit in their pockets.

But then you'd have to take into account America's "farm" lobby (really, it's better called "agribusiness" or for a more descriptive face "Big Food"), which is among the biggest contributors to heartland legislators, bigger in many cases than banks or credit card companies.

As an anecdotal example, just try talking to an Iowa caucus about cutting farm subsidies. There's a quick way to lose a primary cycle.

We don't need insurance reform. We need healthCARE reform, a system that encourages Americans, perhaps even thru tax incentives, to eat healthier, to lose weight, to stop smoking.

Indeed, many private insurers do this now, offering cash incentives: $400 per annum to visit a health club, discounts for being a non-smoker, discounts for attending weight-loss classes, and I'm sure there are a few that will actually rebate some of your premiums if in fact you do lose weight.

Imagine on your 1040 being offered the chance to take a few hundred bucks off your bill to the IRS by affirming, honestly, that you've quit smoking? Or can offer evidence that you went dutifully to the gym twice a week? Or you completed a marathon or a hundred mile bike ride?

We already use the tax code to reward good behavior, to construct social good, like the charitable or home mortgage interest deductions. What's wrong with using this device to cut a tax bill that everyone agrees is going to become more bloated as the tax code ratchets up from the ridiculously undertaxed position it has been for the past eight years?

Vacation, Have To Get Away

It astounds me the hoopla raised over a simple week away from the White House:

Senior White House officials have not ruled out the possibility of a town hall -- which, in Obama world, might qualify as a fun vacation activity.

That's probably not First Lady Michelle Obama's notion of the ideal vacation. For months, aides have been planning as normal a summer getaway as possible, whittling down the possible sites until they found a secluded spot on a tony island, where stars and presidents have long been able to expect privacy.

It is, in my opinion, not coincidental that the networks scheduled all these Republicans (including Joe LiebeRman) to speak this weekend, just as the video of Obama stepping off a plane in the Vineyard hit the wires.

After all, we all recall what happened the first summer that Bush took six weeks off to vacation:
But I digress...

The concern trolling on the part of the Republicans (including Joe LiebeRman) has been touching but unnecessary. After all, when Bush was running up half trillion dollar deficits during our last recession...you recall? The one that lasted nearly his entire first term?...no one seemed to mind. Indeed, Veep Cheney pointed out that deficits don't matter.

So long as you're running a war of aggression on a people half a world away that did nothing to harm you.

Once you actually try to help people, well, Katie bar the door!

Even a Nobel Prize-winning economist seems to think the Republicans (including Joe LiebeRman) are talking out their asses.

Others have pointed out that, just because the US government runs a postal service, private businesses are still highly competitive and highly profitable, and that is a good analogy. After all, the US government is mandated by Congress to provide affordable mail delivery to each and every address in the United States. Neither UPS nor Fedex could possibly achieve that and make a profit. They can make a profit on niches that the USPS can't really focus its resources on.

It's called limiting a bureaucracy.

But I put a different case: unions.

Some would make the claim that the government getting into the health insurance business would put private insurance out of work.

Bullshit.

There are union workplaces, and non-union, and if anything, the non-union places seem to be more competitive once the trouble of swallowing the fall-out from union-based benefits is worked through.

After all, if a union shop gets a vacation concession, other companies will start to lose workers to those union shops that have greater goodies, until they too offer more competitive employment benefits.

Then things straighten up and fly right and non-union shops can still gouge their workers in other areas.

What unions provide is a single large entity that can negotiate with large corporations, thus balancing an equation that is woefully tilted against an individual worker.

Government ideally should be the firewall between individuals and corporations, but sadly that has been co-opted by the SCOTUS, which has ruled that corporations have the same rights as individuals, plus a few more. Among those rights is the right to free speech, and by extension, to donate to political campaigns.

The concentration of cash in a corporation's coffers makes this a slam-dunk: they will buy candidates that individuals could not possibly afford.

Except thru unions, of course.

The analogy coalesces when one realizes that any health care reform must include a governmental component whereby doctors, hospitals, and yes, insurance companies must deal with some entity with the resources that a government can bring to bear in an industry.

Just like a union can legitimately be the only organ an individual can use to address the inequities of the working world.

This is the sole legitimate function of government: to protect its citizenry.

Amen.

To Your Health

The broad outlines of the Obama healthcare package are coming to light. I'm not sure I like them much:

It's hard to believe that only three months ago, health care advocates worried that President Barack Obama would drop the health reform issue from his first-year agenda. Now, with an August deadline to pass a bill, a compromise that once seemed unimaginable is considered quite possible, both sides say.

Congress this week begins a two-month sprint to pass legislation overhauling the health care system — an aspiration that has eluded generations of American politicians. The task is exceedingly complex and faces the legislative equivalent of an Ironman triathlon, tested at every stage by monied interests, political alliances and an estimated 13-figure price tag.

My beef with it?

It's too complex and in politics, complex means it's too easy to hide the loopholes in.

Think about the laws we pass in this nation for a moment. Take speeding laws: if you exceed the speed limit, in the judgement of the officer who is issuing the ticket, you've broken the law. A traffic court may overturn this, but it's unlikely that anyone is going to get away scott free with every ticket issued.

The rule is simple: There's a defined limit. You exceed it. You pay a price.

Now, take a look at the tax code, one of the most complex systems known to mankind.

Does everyone pay their fair share? No, not even nominally, much less in practice.

Here, we're talking about people's lives. Here, we're talking about creating a bureacratic nightmare the likes of which we can't even begin to fathom.

Government does some things better than the private sector. Take mail delivery. If FedEx or UPS had the same mandate as the USPS (deliver mail to whomever in the United States mail is addressed to) we'd all be paying enormous sums of money to fund the rural delivery system. Government can make it cost effective enough that it costs 44 cents...and that's AFTER FedEx and UPS have skimmed off the most profitable portions of the delivery system: overnight mail and commercial parcel deliveries!

Government is the only organization sufficiently scaled to handle insuring 300 million people. Period.

This entire bill should be scrapped. We should have a single-payer health insurance where everyone knows what they will pay when they visit a doctor (nothing), doctors can still afford million dollar homes (they do in England) and you don't have to argue with an insurance bureaucrat with regards to being treated. If the doctor finds a test medically necessary, there won't be some beancounter sitting over his shoulder, timing the procedure.

Maybe this is a first step in that direction. And maybe it's unnecessary.

Healthcare: A God Given Right

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

The Framers of the Constitution relied heavily on their own prior declarative thoughts when devising the laws of our land, yet were curiously silent with regard to the "life" portion of our rights.

We ought to fix that.

We have guarantees that, no matter how destitute you are, your liberties will be protected. We have an army and police forces that will protect, serve, and defend your property, no matter how meager. We guarantee you access to an attorney should you run afoul of the law or your neighbor.

We don't provide the same protection for your life, however. We don't guarantee you a doctor. If we guarantee you any care, it's emergency room care and the hospital will still sue you for money until they've bled you dry.

Why?

I could get into the whole "well, you know, back in those days the doctor was the local chap who applied leeches and leeches were free" argument, and accept that the Founders were men without vision.

Not impossible. Just unlikely.

I don't think the Founders, as they could not with the Second Amendment, could foresee a day when we'd have advanced diagnostic tools, nuclear medicine, the ability to delay death for decades.

In the 1700s, you were lucky to live until forty if you were a man and fifty if you were a woman. Why worry about maintaining your health if all it would do is give you a few weeks?

They didn't have antiseptics (Joseph Lister wasn't born until the 1820s). They had pain-killers after a fashion...basically, rum... microscopes were a relatively new thing as was the concept of microbiology and bacteria and viruses causing human diseases (remember the whole "leech" thing?). Antibiotics weren't even on the horizon. Sterilization and pasteurization were half a century in the future.

Who needed healthcare coverage?

Well, now we do. And as the Delcaration of Independence requires government "to secure these rights," the only solution to this perplexing problem is the most obvious and simplest one. As well as the most patriotic.

National health care.

A Dream Realized

It's too early to open the champagne or to even assess the package, but we've taken a big step as a nation:

Late last week President Barack Obama and Democratic congressional leaders agreed to use "budget reconciliation" if necessary to jam a massive health-care bill through Congress.

Most Americans probably greeted this news with the glazed eyes and yawns that should rightfully accompany any discussion of "the federal budget process" longer than 30 seconds. But this decision is a deeply troublesome attempt to circumvent the normal and customary workings of American democracy.

It's a radical departure from congressional precedent, in which budget rules have been designed and used to reduce deficits, not expand the size of government. And it promises bitter divisiveness under an administration that has made repeated promises to reach across the partisan divide.

If we can ignore Sununu's posturing and calling for a whaaaaaaaaaaaaaaaambulance, on balance what this means is that some form of national health coverage will be in place within the next few weeks.

Undoubtedly, it will piss everyone off, which means either it is stellar piece of legislation or a complete bonehead bill.

National health care is long overdue in this nation. For too long, health insurance and healthcare has been both overpriced and underservicing the needs of the people of this country, unless you were rich enough (or worked for or with a large enough organization, which is diametrically opposed to American capitalism) to afford premium coverage.

Health insurers knew they have a captive audience and treated us all monopolistically. You went to work for an employer: take it or leave it.

Healthcare decisions effectively became the domain of your employer, who picked and chose coverage not based on what was best for you, but for his or her bottom line. By extension, your health care plan was next determined by the actuaries and bean counters at the insurer, not the doctor you saw. Their decisions guided not only his courses of treatments, but in some cases even forced him to tailor his diagnosis to get you out of his office faster, not necessarily healthier.

Doctors are not innocent in this scam, to be sure, although their guilt is not one of conspirator but of expeditor. The doctor or hospital must look to their own bottom line, knowing that their revenue stream is determined by two factors: limited time (who can work 25 hours a day?) and limited reimbursements.

Therefore, the faster they can churn patients out, the more money they can earn. This is not conducive to good healthcare, much less preventive healthcare. What doctor is going to waste precious revenue-earning time with you, discussing diet alternatives or recommending a good heart monitor? "You're fat, lose weight, next?"

Sununu's problem is two-fold: one, he sees national healthcare as socialized medicine (as if somehow our free enterprise model is helping anybody), and two, he's watching a parliamentarian trick used against his party.

Here's how that works: normally in the Senate, a bill must pull a supermajority. Sounds stupid and it is, but because of the filibuster rule, a simple majority is no longer sufficient to determine the will of the people.

The filibuster is the subject of a very long post in its own right, and I can't do justice to it here. Suffice it to say I feel it is necessary when something as controversial as committing the resources of this nation to a foreign objective is at stake, but quite unnecessary when 51 Senators determine, after 218 Representatives, that something as fundamental to the "life, liberty and pursuit of happiness" of the American people is at stake.

And there's the rub. Rather than letting health insurance stand or fall on its own merits, in the conference to resolve discrepancies in the annual budget Democrats can slip it in as a budget resolution, and it passes with a simple majority.

Tricky, to be sure, but whatever it takes, this is necessary. To delay this vital need of the nation a year longer or more until even the most hard-headed conservative "gets it" is both deadly and economically dangerous.

So John?

Shut up.