I have of late been reading, speaking to other folks of all political persuasions and thinking about the push being made by the Democrats in Congress, and by President Obama, to enact meaningful health care reform.  In the midst of all of this, a couple of over-arching realities just jumped up and “slapped me in the face.”  First, the Democratic Party, in its quest for the solution it believes is the best, the most logical, or the most efficient, beneficial and moral solution to the Health care issue, is on the same “field of play” as are the efforts of the “naysayers”–those persons driven by self-interest of leaving things as they are, and protectionism. That means that both sides of the debate are all subject to the same rules regarding who shall be declared the “victor.”  Secondly, I recognized there is a quantifiable danger that even if the Democratic Party should prevail, while tearing apart the current medical system–which is currently the most atrocious, inefficient and expensive health care delivery system amongst all of the modern industrialized Nations–it might inadvertently construct an even more flawed system which might deliver less efficient, lower quality and even more expensive care to our citizens.  Worse yet, it might construct a system which will simply collapse under the weight of the new strictures and modifications placed upon it.  These are, stated simply, two ways the well-intentioned Democrats may lose this “game.”

 

          As to the rules of competition, there is only one, i.e., at the end of the day he who has the most votes wins.  In our democratic society, no matter how unfair, ludicrous, contemptible or despicable the manner one side or the other might play the game until the “final gun,” it is still a “game” of the most important sort–and it turns entirely upon the art of persuasion.  The “field of play”, of course, is within the halls of Congress (literally “occupied” by angry Republicans, Blue Dogs, and neo-cons, many with large highly-worn nose-rings, this very day!), and the outcome decided in the end by the “contestant” who does the better job of persuading the most senators, representatives and private citizens as to which way to vote.  Note that I do not state that the goal is to persuade the People which is the better result for the system of health care delivery; that is because there is a significant segment of the Public that really does not care what is best or better–and that is the Republican Party itself, which has stated over and over again that its agenda (clearly adopted by the Southern Blue Dog Democrats) is simply to defeat and destroy anything proposed by the mainline Democrats and the hated Barack Hussein Obama.  This is in order that the President be made to appear dull, inept, ineffective and “dithering.”  That victory, even if it should be “on the back” of the welfare of the Nation’s weakest citizens, is what the Republican Party and its agents wish–all in the name of the despicable phenomenon of partisanship.

 

          “Truth” is not relevant in a contest such as the Republicans have made this one.  Nothing is off limits.  Many ploys are based upon racial innuendo,  and nothing the opponents assert need either be true or rational; it merely needs to be loud and disseminated to as many potential citizens as possible so that, in turn, they might then let their voices and concerns be known to their representatives and senators in Congress.  The danger here is that outrageous lies (as in Hitler’s and Goebbels’s “Big Lies”) are often spread more rapidly and believed more readily by much of the Public, especially that portion that holds an underlying animus to the President, or is naturally averse to change…since change itself is often uncomfortable to many of us. 

 

          Thus we have the insanity of the arguments by Limbaugh, Palin and even the entire Republican Caucus on the Floor of the House (!!!) that an early version of the “Affordable Health care for America Act” (H.R. 3962), expected to be passed by the House within a few days, provided that the proposed laws would create “death panels.“  The supposed point was that these “panels” would decide which of our elderly would be entitled to live and which ones would, at a given time and, based upon that life’s lower “value,” simply be euthanized.  I personally know a number of persons who initially believed and were enormously frightened by this absurdity–one that was made based solely upon a vacuous provision merely intending to allow doctors and families to meet at least once every year at Medicare expense to discuss the best course of treatment of elderly family members–something that is done every day even now by close and loving families!  They are even making that same argument (since it “sells”) as to the newer and nearly complete H.R. 3962 just put together on October 29, 2009, expected to go to the House floor.

 

          Another assertion of the Republican strategists–without any facts or studies whatsoever backing it up–is simply stating in massively circulated television advertisements that the new health care system proposed by the Democrats will add Three Billion Dollars to the National debt which  our grandchildren will have to pay off.  In a Nation already traumatized by: i.) the so-called Wall Street “bail-outs” of the giant investment banks–in return for security interests, ii.) the various “stimulus” packages of government investments in given automobile  manufacturers and to other, smaller retail banks (all in exchange for investment securities as opposed to grants), and iii.) the current continuing “George W. Bush Great Recession” and the horrific unemployment problems in the Country as a result thereof,  such assertions, no matter how absurd, quickly gain traction.

 

          And that is a short version of the first of two great truths.  No matter how good the proposals may be, due to the vast, negative, cacophony of hatred, and the cabal of naysayers may possibly be striking just the right “chord” in the collective mind of enough of the public to yet again foul the health care system and the welfare of the People.  President Bill Clinton came down this same path and lost; but he did so with not nearly as much sophistication as President Obama has demonstrated in fighting the same cabal of self-interested insurance and “Big Pharma” opponents.

 

          Then we need to consider, “How does a person or a group of persons greatly interested in the outcome of this game “get its message out?”  Playing to legitimate news organizations is, of course, one way.  The problem there for the Republican position is that legitimate news organizations will most often check the accuracy of the assertions and make counter revelations or observations to vacuous and sometimes rabid charges by one side or the other.  Other methods are: a.) placement of irresponsible advertisements on television, radio, the internet, and the shameless use of some columnists and commentators in spiritual accord with the naysayers.  This includes persons such as Rupert Murdoch’s and Robert Ailes’s Fox News and its cadre of irresponsible and irrepressible former radio disc jockeys pretending to be political commentators, e.g. such as Glenn Beck and Mike Huckabee (also a glib former Southern Baptist preacher, guitar player with his own rock band and a Governor of Arkansas, a state he referred to on Howard Stern’s national radio program as a “Banana Republic”), and, of course, by the grand nattering, negative, nabob of all naysayers, Rush Limbaugh, the Republican Party’s semi-official spokesperson who has used his radio commentary and press appearances to capture the minds of untold millions of people with his brilliant brand of prejudice, racism and nihilism; and b.) secondly, there are the gifts of Hundreds of Millions of dollars to the campaign funds of the actual congressmen and senators who will ultimately decide the winner and the loser of the contest–which said gifts already, in the first six months of 2009 per Jim Acosta’s CNN report of October 15, total over one quarter of One Billion dollars!   

 

          There are so many business interests in the fight over health care fearful that reform will cost them money, that each of them potentially affected is willing to spend enormous sums of money to shape the debate–and to kill any reform.  This attitude–protecting the financial interests of the large health insurers, the gigantic pharmaceutical companies, the hospitals and the medical equipment and device manufacturers–obviously aligns these entities with the Republican Party.  

 

          Several Republicans who I admit are quite intelligent, say to me, quite incorrectly, that the health care delivery system in the United States is not “broken” and that it is foolish to try to “fix it”–especially when the means of doing so as proposed is to cost us, as referenced earlier, over Three Billion Dollars over the next ten years and vastly increase the National Debt.   They also smugly add that what we now have in the U.S., a capitalistic country, is in the “natural order of things…” with the assumption that these final words give the askew status quo some sort of legitimacy.

 

          What these very intelligent people do not know, since they make no pretence of speaking truth and either do not know or purposefully ignore the impact of health care’s unique development in the United States business and its impact upon society–especially the middle class and the poor.  They do not point out that is that this marriage of health care delivery and Capitalism in the United States was not part of the “natural order of things”, but, rather, was merely an accident of history–and that it actually amounts to a marriage made in hell!  

 

          A large group of school teachers in Dallas, Texas, can be given credit for the creation of what we know as “modern” health insurance in a contract they made with Baylor Hospital in 1929, in which Baylor agreed to pay the entire group of teachers’ their hospital and medical costs in return for something like a quarter a month from each teacher.  A number of health insurance companies (including Blue Cross/Blue Shield) began appearing in the 1930’s and 1940’s writing both individual and group health insurance in the Mid-West.  But it was, perhaps ironically, Kaiser Industries (headed by Henry J. Kaiser of “Liberty Ship” and later Kaiser automobile fame) and the steel workers unions working in U.S. defense industry during World War II that truly developed modern employer-based group insurance as we know it and, at least initially, made it economically viable. 

 

          And from that point forward large employer-based group insurance and the insurers who wrote the business became the biggest “players” in the health care dynamic.  This is simply because they, by reason of their contracts with large employers and a mass of small employers had “most of the money” and had become the “model”, or norm, for assuring the payment of health care costs to the medical community.  Bartering for medical services had disappeared along the way!  The old days when the “doc” had traveled out into the rural countryside with his horse and wagon and gladly took a turkey or a side of beef in return for his services was over.

 

          Society continued to advance in the development of “medicines” from: i.) the original coal tar or liniment for burns and sprains and “elixirs” sold from the rear of trade (”snake oil”) wagons for about any other illness; to ii.) actual medicines as developed, tested, manufactured and patented by corporations which grew, over time, into financial behemoths.  And all sorts of other “tag along” business (e.g., prosthetics, rehabilitation services, imaging, patient transfer) came along as well to take care of the “leavings,” that is, follow-up or tangential medical services–of which some are still independent entities, but most of which were over time acquired by ever-expanding corporate not-for-profit and for profit hospitals. 

 

          Then we had Presidents Kennedy and Johnson who recognized that the elderly in America needed a great deal of help in order to assure their receipt of proper medical care, and their Herculean efforts resulted in the passage of the Medicare and Medicaid Acts in or about 1964–making them a powerful yet vulnerable part of an increasing complex medical landscape. 

 

          Hospitals had long been in place, of course, but until the insurance companies became involved, almost all medical care was simply paid for by the patient or family in the initial manner described above, i.e., cash, credit, and sometimes even barter.  Originally, along with the Baylor model, almost all hospitals were charitable or “not-for-profit” entities, often now referred to as IRC Section 501(c)(3) corporations, since as long as they fulfill their charitable purposes, they are exempt from income taxes under the Federal Income Tax Code (IRC).  As of 2009 there are almost five thousand hospitals in the United States, eighty-five per cent of which are still not-for-profit.  But it is important to note that all hospitals, even the eleemosynary, must pay their expenses and find that “magic” balance which is required of them all to stay in business.  And they, ultimately, dealing with the insurers, pharmaceutical industries and the physicians are, metaphorically, in the precise center of the “medical storm” sweeping across the United States.

 

          Citizens of the United States are generally aware that their health care delivery system is not one of the best in the world.       A study by the Pew Charitable Trust released on July 24, 2009, demonstrated that fifty nine per cent of Americans felt that our system was merely average or below average.  Only fifteen per cent felt that it was the “best in the world.”    While I have cited it earlier in another post, it is important to again note the finding of T.R. Reid in his book  The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health care“, Penguin, NYC, 2009.  His most startling finding is that “…the government of every developed nation in the world has determined that it has a moral obligation to provide health care to its citizens.”  They do it in varied ways; but all other nations against which we are to be properly compared covers one hundred per cent of its citizens.  And when I place my personal sense of honor up against this incredible reality, I find it repugnant that the People of the United States have allowed big business to “boondoggle” them for so long!

 

          The business interests which have captured the affiliation of so many Americans with lies and distortions consist of Health Insurers, Health Professionals, Hospitals and Clinics and Pharmaceutical and Health Products Industries.  It might surprise many to ascertain that the larger contributions have come from the pharmaceutical companies—for the simple reason that they have “gamed” the system much more efficiently and have so much more to lose by a curing of its ills.  It may be recalled that one of the highly successful ads run by the Republicans, actually paid for by the Pharmaceutical lobby, is the one that claims tens of billions of dollars would be “…taken away from your Medicare…” if the reform is passed.   Naturally, they do not wish it known that the money they are referencing is that taxpayer subsidy that Congress, under President Bush, to make possible the “Cadillac” Health Advantage HMO plans under Medicare–which are essentially what Congresspersons themselves have.  the apparent thinking of the “Big Pharma” lobby, the very rich and Congress is that “…birds of a feather…” , you know the rest.  They clearly feel they are entitled to more than the rest of us…at our expense.

 

          I learned some time ago that while the Veterans Administration is entitled to bargain or negotiate with pharmaceutical companies for the best prices they can get, Medicare is prohibited from bargaining.  It and its elderly members are required to pay every penny that is demanded of them by the pharmaceutical companies.  I can understand why the V.A. would be allowed to bargain for prices–as are all traditional large groups, but there is something “rotten” somewhere when the senior citizens of America are denied treatment equivalent to Veterans and, indeed, to that given to every member of the United Automobile Workers.

 

          Among those supporting the changes set forth in the current House Bill as of this date are the American College of Physicians, the American Medical Association and the American Association of Retired Persons.  It is to be noted that the ACP and the AMA are associations representing the leading medical practitioners in America, those who have sworn to the Hippocratic oath, which, in a portion I now deem pertinent, recites as follows:  “I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”

 

          While no one would be expected to memorize them all, the findings made by the American College of Physicians in its National Health care Briefing Paper of 2008 should be “required reading” for every Senator and Representative in Congress.  Just a few of the more pertinent finding are:

 

1.       In 2008 we spent more of health care per capita than any other industrialized country in the world…and we get much less in return.

 

2.       We are last in Access and in Equity.

 

3.       We spend more in administrative costs to deliver health care than any other nation in the world.           In the United States, where health care decisions are made primarily by insurers, the administration cost is 7.3% of every dollar of care delivered.  In Germany, the next worst in terms of administration, it is 5.6%; and in France it is 1.9%.

 

4.       More money does not means more quality.   In fact, the United States is second to last of the industrialized world in overall quality of healthcare.        

 

          One might think it odd, but I do not at the moment wish to argue specific provisions of the Act, as they are all tentative until the matter is fought out in floor debate.  The larger point is that a real effort is being made to put it all on the floor and have the People’s representatives (hopefully ALL of them) wrestle over what is the best system for us as a Nation.  It is, too, difficult in just a few pages to describe the contents of a 1,900 page bill!  Things would be so much better, of course, if the leaders of the Republican Party actually cared about its constituents–which I do not for one moment believe is the case.

 

          There is a danger alluded to earlier which I remarked is “quantifiable.”  The healthcare system is enormously complex; and there is no one, right, simple answer to many of the issues.  The more answers in the legislation which are wrong and can be worked out within the three year “phase-in” the better, but there may still be some problems that will have to worked out further down the road.  Should there be a “Public Option” or a health exchange as proposed at the moment?  Perhaps…but I do not really think so.  The “Assigned Risk” system of the casualty insurance industry has worked beautifully for many years, and I see no reason why the principle may not be applied to health insurance as well.  It should likely be accompanied by a universal morbidity rate system since the whole population would be covered–and the insurers once promised this if the whole population were covered.  The key point here, however, is that the insurance administration coverage of patients would be more in the hands of at least professionals…even if, as we know, not fully qualified in all instances.  In a brand new government bureaucracy, it is much like a “pig in a poke.”

 

          The greatest point for reform…and if this point and no other were passed it would, nonetheless, mean tremendous strides have been made: and that is to construct a means to return decisions as to the welfare of patients to their physicians and not leave them all to the mercy of the insurance companies.

 

Don Switzer

Rogers, Arkansas

WWW.POLITICSANDWHIMSEY.COM

(c) November 5, 2009