Well, It's Better than Nothing

This is the first in a series of responses to a quote from a likely caucus goer in Iowa. I heard the quote while listening to an NPR piece last week. The quote follows:

“I see a real philosophical difference between me and many of those who’ve spoken here. I want to be in charge of my healthcare. I was paralyzed. I had polio. My parents paid for that. They chose to find doctors who performed three surgeries on me. I can walk. I don’t want that dictated by the federal government, and I think what I hear is all this emotion - this tugging at the heartstrings. It’s bigger than that. What’s the federal government responsible for? It isn’t for making laws that tell me that I can’t eat trans fat. That’s my choice. That’s my choice. And, you know, I am single. I am self-employed. I make a great deal of money through my own hard work. I don’t want to pay for someone else’s child to eat breakfast at school anymore. You know, that it not the role of the federal government.”

Many questions came to mind when I heard this speaker. Among them was...

Should the government play a role in healthcare?

In August of 2006, the Census Bureau released data showing that in 2005, 46.6 million Americans were uninsured. This translated to 15.9 percent of Americans. The 2005 number represented an increase of 1.3 million uninsured over 2004. The number of children who are uninsured rose from 7.9 million in 2004 to 8.3 million in 2005. Source

In the most recent data I could find, an additional 16 million people are underinsured. Among those who are underinsured, 54% percent report going without needed care and 46% report being contacted by collection agencies seeking payment against health care bills. Source

Now, I can (and do) understand that a number of people have the Horatio Alger/Ronald Reagan belief that if you work hard and make good choices, then you’ll prosper. Those same people also feel that if, in spite of your earnestness and zeal, you do encounter difficulties, then you should not turn to the federal government for help. That’s a role for family and churches and charities.

There are at least six flaws to this argument:

1. Not everyone is blessed with the same talents and resources. Even if all of us had the same work ethic and the same desire for independence, we cannot all be CEO’s or self-employed superstars. All economic models count on it, but especially our pseudo-capitalism. Some occupy lower wage positions, so that goods and services we purchase at market are affordable for all of us. For example, someone has to cook fast food (and someone has to do it during school hours when teenagers are unavailable), and those who cook fast food cannot be paid six figure incomes – Big Macs would cost a fortune.

2. Earnest, hard-working, zealous people sometime encounter situations where, through no fault of their own, they lose insurance and still require care. The NPR piece from which the quote above was taken, started with a woman discussing her experience with breast cancer. She said that she lost her job and her insurance while undergoing treatment. Friends held a fund-raiser to help her with her medical expenses. Those who argue that the government has no role in health care or health insurance must imagine a world where there are a lot of garage and bake sales. In the end, no one seems to argue that there’s no void to fill, the argument is about how best to fill it.

3. People who do not have insurance or are underinsured tend to wait for care. While they wait, their treatment becomes more complex and more expensive. At a certain point, even the coldest and meanest hospital will not turn them away; they are given the care they need. That care, once provided, is added to the cost of care for those who are insured. In most cases, doctors get paid whether the patient pays or not. [This also works in for plastic surgery. Surgeons charge a premium for breast augmentations so that from time to time they can do reconstructive surgery on a pro bono basis.] What this means is that either way, you pay. It’s just that in the status quo, you pay more because a health issue that could have been addressed at a lower cost when it was minor is now a major problem, and an expensive one to boot.

4. People like me, who support a single payer health insurance model, do so because we see cost efficiency in creating a very large group of insured. In this model, the healthy who consume few health care services subsidize the care provided to the sick (the way all insurance works – those who make it through the year without car crashes help pay for those who do not). Only there is a very large pool of healthy people to minimize the overall costs.

5. Those who argue for the status quo have no solution for three fundamental problems we experience today – (a) the tendency of rising healthcare costs to outpace inflation by a significant margin, (b) the resulting increase in insurance costs, and (c) the reality that an HMO may deny your prescribed treatment (or refuse to pay for it). These two phenomena illustrate fundamental flaws in the current model.

6. Last, if you strip it all away, you’re left with two things: philosophy (“that’s not the role of the government”) and mistrust (“I don’t want the federal government interfering in…” or, “the federal government will make a mess of it…”). But you can’t treat catastrophic ailments with philosophy. And even under the single payer model, no one envisions an end to an individual’s right to obtain their own insurance and their own care on their own terms. [I’m also tickled that those who have problems with the federal government devoting dollars and resources to insuring everyone, seem to have less of a problem with the $475 billion dollars (and counting) we’re spending in Iraq.]

Heartstrings or no, we end up paying anyway. Let’s treat minor ailments before they become major illnesses. Let’s see that everyone, especially children, is insured. Let’s leverage our ample resources and our government infrastructure to insure the uninsured and adequately insure the underinsured.

A Real Philosophical Difference

Earlier this week, NPR interviewed likely Iowa caucus goers. You will find it here. Republicans and Democrats attended. Before asking them about the candidates they will support, Steve Inskeep asked them about the issues that are important to them. One Democrat attendee started the conversation by discussing healthcare and her experiences as a breast cancer survivor. She made an excellent point:

“It became crystal clear to me when I got my diagnosis, and when I had to take the Family Medical Leave Act, that unless my dear friends in Batavia, Illinois, had had an enormous fundraiser for myself and another single mom, we would not have been able to survive. And we had insurance. The whole health insurance thing is absolutely scary. You only have health insurance as long as you are healthy enough to go to your job and work.”

Moments later, a Republican woman offered the following response:

“I see a real philosophical difference between me and many of those who’ve spoken here. I want to be in charge of my healthcare. I was paralyzed. I had polio. My parents paid for that. They chose to find doctors who performed three surgeries on me. I can walk. I don’t want that dictated by the federal government. And I think what I hear is all this emotion - this tugging at the heartstrings. It’s bigger than that. What’s the federal government responsible for? It isn’t for making laws that tell me that I can’t eat trans fat. That’s my choice. That’s my choice. And, you know, I am single. I am self-employed. I make a great deal of money through my own hard work. I don’t want to pay for someone else’s child to eat breakfast at school anymore. You know, that it not the role of the federal government.”

I was so blown away by the Republican woman’s comments that I’d like to respond to them over a few shorter posts rather than one long one. I’ll end with the question she asked – what is the role of the federal government, but I’ll start (tomorrow) with a different question.

Should the federal government play a role in health care?

In the Immortal Words of Cher: "If I Could Turn Back Time..."

Today at noon, Minnesota Public Radio aired an address that Al Gore gave this summer at the Aspen Institute. You can find it here.

As I listened, I found myself nearly overwhelmed by sadness and regret. He was so articulate and so passionate about something productive and positive. On hearing him, one cannot help but draw comparisons to the inarticulate ideologue, the miserable failure currently dwelling at 1600 Pennsylvania Avenue (in body if not in spirit).

Gore was candid and funny, but more than anything, I had this really weird sense that his words were his own. That he could (shock, gasp, awe) speak (wait for it) extemporaneously.

As I thought about it more, I realized that a lot of my complete apathy toward the Presidential nomination process is really owing to how devastated I was/am by the Supreme Court election in 2000 and (perhaps even more so) by the also tainted outcome in 2004. I still see both as unqualified indictments of the American electorate.

Don’t get me wrong. I’ve paid attention, and I have my favorite Democratic candidates But, I have not donated, volunteered, or even really thought about donating or volunteering.

Still, I’m slowly starting to revert to form. I find myself listening more, reading more, caring more, thinking about it all more, and talking about it more. I'm quite sure I'll be burned again, but I cannot help but touch the hot stove that is Presidential politics.

Anywho, my plan is to weigh on in the selection process over the days leading up to the Iowa caucus.

For now, give me one more day of “what could have been” malaise.

No Country for Old Men, Reviewed (with the ILIM Spoiler Free Guarantee)

I will be very surprised if I see a movie this year or next that I like more than I liked "No Country for Old Men." In my view, it is flawless.

I must confess that I'm a fan of the Coen brothers. I have seen all of their major motion pictures, and I love them all. I even like "The Hudsucker Proxy, Intolerable Cruelty and The Ladykillers." Of them all, I like "Barton Fink" the least - and I like it quite a lot. "The Big Lebowski" is an obsession.

What distinguishes "No Country for Old Men" is the phenomenal script, based on what must be a superb novel (it's on my wish list), and the Coen brothers' unrivaled ability to establish setting. They do this with hyperbole, there's no question about it. Arizona and Minnesota are not as typed as they appeared in "Raising Arizona" and "Fargo," but in both instances, we come to understand something about both places by virtue of the care they take to display what distinguishes them from every other place in the world.

And the Texas of NCfOM is a hard place. It’s as hard as Calechee. You know this from the first minute of the film. Their Texas is inhabited by people of uncommon wit, characters all, soulful men and women who give the tragedy its heft.

Every single actor turns in a very strong performance. Tommy Lee Jones, Josh Brolin and Kelly Macdonald are amazing, but Woody Harrelson, Javier Bardem and Tess Harper are not to be ignored. Last, two supporting roles appeal for a new way to describes actors who are not in the lead Garrett Dillahunt is wonderful (and funny), and Barry Corbin is asked to carry a scene of tremendous importance, the titular scene in fact, and he does it with the natural ease or a practiced professional.

I recommend NCfOM without hesitation, and would only caution those who have trouble with violence to brace themselves for a few unpleasant scenes.

When you go, make sure to laugh. The first third of the movie is full of the Coen brothers' patented humorous touches - enjoy them. And make sure to pay close attention throughout. On the surface, the movie is a slow-paced action film, but at its heart, it’s literature - full of the higher truths that we gain from all the great works.