Comments on: Monday Manifesto

By: Daisy

Daisy — Wed, 06 Feb 2008 15:30:00 +0000

J–
Well, I doubt this will shock you, but I don’t see why private insurers are involved at all. I think if we can afford to pay–how many trillions is it now–for a war that does much harm and brings no good, we can afford to pay for everyone’s health care, as much as they need, whether it’s your son’s extensive care or my once a year check-up. Impossibly idealistic, I suppose, but fairly simple, and less expensive to everyone the long run…(My own personal interests are as follows: Maisie is covered under S-CHIP, for which I pay the at-cost fee every month ($168), since I made just a touch too much money last year to qualify for the low-income rates; and I don’t have health insurance at all. But, yes, Maze gets good health coverage because so many people in Pennsylvania are covered through CHIP…). I think my analogy to poetry is only a half analogy: we fight in politics to get rid of the other side; we fight in poetry to keep poetry alive…
D.

By: Michael Gushue

Michael Gushue — Wed, 06 Feb 2008 15:22:47 +0000

wow, great post. “In poetry, people who hate your work, or who think you’re doing everything wrong; people whose ideas about poetry you think are meaningless, or whose work doesn’t interest you—are not the enemy” is going in my permanent daybook under Sanity. Thank you.
I recommend James Marshall (Piggy in the Puddle) over Dr. Seuss. Seuss was kind of a jerk.
Oh, yeah, and best cheesesteak? Pudge’s on DeKalb Pike in Bluebell. Cash only.

By: J.E. Stone

J.E. Stone — Tue, 05 Feb 2008 14:35:59 +0000

Hi Daisy, as you know, my family has had a lot of experience with health insurance over the last decade. It worries me less that health insurers would have a seat at the table in negotiations than that providing universal coverage would end up, via the least common denominator system common in our political process, as a type of coverage that provided basic care and treatments for diseases that have proven & successful treatment protocols, while abdicating responsibility on all other fronts. My family knows, personally, what the cost of that would be: patients need choices in health care treatments, durable medical equipment & other forms of technological assistance need to be affordable for those who need them, and research and development needs to be encouraged not just for large cohorts of illnesses, but also small ones.
So your point of abandoning the idea of political unity as it can be injurious is a good one. We could all agree on the idea that everyone should have ‘basic’ health insurance, but what does that mean? It means that kids get vaccinations and well-child check-ups, and that adults get annual exams, and that people with readily treatable illnesses such as diabetes, high blood pressure, etc., get basic medications and treatments so that their conditions do not worsen. That’s all good, but what happens when someone really does get sick?
My experience is that ‘basic’ health insurance plans in this country do not cover what we would all expect they cover: choice of doctors and care, review of multiple treatment options, physical therapy, wheelchairs, etc. Even most employer-based plans that are mid-range do not have riders for physical therapy, and those that do often limit the number of PT appointments covered to 15 per year–not enough. And ‘medical necessity’ does not mean you get more–you’re entitled to 15 contractually, period. A high-end plan offers 60 total visits combined of PT, OT, and speech therapy annually. You have to do the budgeting. High-end plans are starting to exclude motorized wheelchairs for the disabled as a matter of course (they start at $20K), and do not cover bath and shower chairs (which start at $500-700), or adapted toilets ($700-900). So lowest common denominator–the ‘feel good, everybody’s got some coverage’ plan–will mean that anybody who develops serious medical problems is still screwed.
The relative generosity of insurance companies is all contractual: and that depends on what your employer is willing to put on the plan as a rider. PT and durable medical equipment are each optional riders that employers do not have to elect to include. As is a prosthetics and orthopedics rider. Insurance companies are more generous when that are about 10,000 people in a group. Then the seriously ill and disabled are actuarial blips in the system. If it’s in the contract, you get it, no questions asked–if it’s a big contract, the more likely you’ll get the riders and the lower the cost of the premium.
A large group also means that individuals can select various tiers of plans with benefits and exclusions clearly laid out for them, and decide how much risk they will assume. A small group means everyone pretty much gets the same thing, no matter their needs or relative willingness to assume risk. Of the 5 or 6 insurers we’ve had since my son became seriously ill a decade ago, our problems have come when we’ve been part of a small group. As part of a large group, the insurance company never really seems to bat an eye. And my son chews up an estimated $50,000/year, on average, in medical care.
Another thing is, that in terms of dealing with billing mistakes and other problem areas, doctor’s offices and hospitals are responsible for about 85% of screw-ups. Insurance companies rarely screw up. Trust me. People on the hook unjustifiably for medical billing issues are most likely being screwed over by mistakes by the hospital/doctor. You can easily get suckered by a hospital into paying money you do not owe (per your insurance plan’s coverage)–believe me.
So, these are the basics:
1. larger groups
2. severing of health benefits from employers (you should be able to pick your own coverage level and have it be portable to your next job)
3. no exclusion of pre-existing conditions
4. insurance coverage education for all–what does the plan mean? What are its terms? What’s the jargon mean?
5. continued federal investment in R&D at the university and independent lab level (that’s where the big break-throughs come for smaller disease cohorts–drug companies do the larger cohorts)
6. federal supplements for catastrophic coverage that enables access to treatment choice and the latest technological improvements.
I think, as you discuss with the poets in your analogy, health insurers should still have a seat at the table b/c how else will we know what we’re fighting for? And they might surprise us–public shame has been remarkably effective in getting Kaiser to clean up its act–and believe me, having recently had a Kaiser plan, they’re starting to really care about treatment choice and treated Robert like a human being. They now want people to feel they’re getting good care. Their problem is too many layers of bureaucracy to get what you need–but it’s procedural, not tactical blocking.
As we all think we know the best poem, we all think we know the best health care plan–so preserving options and various pathways is important, rather than letting the process settle on a single politician’s vision. What we need to do with healthcare (not poetry) is figure out the structural blockages to universal coverage in a variety of forms, as well as medical research venues that enable us to apply the vast intelligence reserves of this country to solving as many health problems as possible–not just those with the most sick people or the ones with the best lobbyists.

By: Daisy

Daisy — Tue, 05 Feb 2008 11:17:04 +0000

Corey–
In practice, bi-partisanship means the Republicans do a tremendous amount of damage and help the wealthy, and then, when the Democrats get into power, they let things stay as they are, damage in place.
Daisy

By: John Blackard

John Blackard — Mon, 04 Feb 2008 17:58:06 +0000

Daisy, I couldn’t agree with you more. Here’s something that could be a meeting of the Senate’s Armed Services Committee, a board meeting at Microsoft, or a university writing program selection committee— you decide:
Committee Work
He imagines outside his building
a tree full of magpies still
roosting in the middle of the day.
Inside no coups or shake-ups
planned, no Mein Kampfs about
to be written. The seated slap on
My Name Is ___ tags, office geishas
serve up today’s numbers.
Old business follow-ups:
motivational posters pulled down;
studies show they have negative
effect on morale.
“Whatever happens in Vegas
stays in Vegas” no longer an acceptable
reason/excuse for maxing out
the company expense account.
Outrageous.
Token IRA contribution set up
to compensate employees for
the 2.4 seconds it takes
the government to spend
their lifetime tax payments.
Promising new business: R&D
brainstorms entire population
of US could fit into ten major league
stadiums in liquid form.
Cutting-edge research to begin on
products and services appealing
to twelve-fingered humans who will
achieve majority status by 2412.
Secure six golden handcuffs,
extend seven golden handshakes.
Notify legal.
Employee #131313, John Blackard,
scheduled for interview without coffee
Christmas Eve. No severance package.
Nothing else for the good
of the order; everything appears
copasetic. Meeting adjourned.
Circling the parking lot in
his head, magpies chase and peck
bad dogs with chicken carcasses
wired around their necks.
John Blackard
http://www.johnablackard.com

By: corey

corey — Mon, 04 Feb 2008 17:24:05 +0000

“Why should we want unity with pro-lifers, war-and-torture-mongers, gay-hating religious nuts, etc.?”
Isn’t the answer “Because we live in a pluralist democracy?” There are all sorts of politically and socially unsavory (and downright repugnant) groups that make up the American polity. Our next president will be the President of the United States, not just the people that agree with him or her. If more people votes for Democrats and send Democrats to Congress, that’s great; it’ll be that much easier for a Democratic president to pass health care reform. If not (and even with a Democratic Congress) its going to take some support from Republicans to get certain legislation passed. So it goes in politics and our democracy. I think you’re mistaking “bipartisanship” –which is a necessary reality for many things in politics–with “non-partisanship” where we would all pretend that differences didn’t matter and through principles and convictions out the window (or the policy proposed was so wildly popular that almost any individual would support it).
“…but I won’t do more than vote begrudgingly for a guy who, discussing his ideas for health care reform, announces that ‘the HMOS and insurance companies will have a seat at the table, but only a seat…’ (quoted from memory). That’s like letting murderers sit on their own jury.”
If the Democrats could snap their fingers and change the players in the game or the system, they would. And while they’re at it, I would also like a pony. But these are the (entrenched) players at the table, and we can either put together a broad and strong political coalition to change things or we can fight different political interests tooth and nail for every inch of political ground. There are many progressive health care experts who see both the Obama and Clinton plans as strong reforms of a broken system. Dare I say they will be gladly voting for Obama.
But who knows, perhaps progressives can have their political revenge on Republicans (who needs conservatives in America?) and I can have my pony.