The Canaries of Inequality

I thought this odd looking erection was part of the annual Sculpture Key West efforts but that annual shrunken extravaganza has evaporated once again and this thing, looking for all the world like a fried calamari ring past its due date, remains. It turns out it makes a passable reclining bench upon which one waits for one's dog to lose interest in it.

Winter is a time of tourists at Higgs Beach, the county's park in the. Idle of the city. It's a place that is patrolled by an off duty Sheriff's deputy and order has been maintained for the pleasure of beach goers. One brilliant solution to the problem of co-habitation between beach overs and the residentially challenged was to outlaw adults at the park benches fronting the beach.

The homeless who come to Key West in droves for the winter season decamped across the road to the tables covered by smaller roofs next to the dog park, another area closed off to homeless "campers," by virtue of a fenced in area created by public subscription.

When Cheyenne and I were passing we could hear another fish story changing hands, "it was THIS big" he told his Cuban buddies out with their dogs.

Cheyenne is a hot property, and I know this because she walks past people's homes and their trapped dogs bay to be let out to play with her, a game of frolic invariably denied by fearful owners. In the dog park Cheyenne was free to frolic so she decided that was a mugs game and ignored all advances. Good girl.

She, like me, prefers to watch.

And while she watches I like to observe and photograph.

Higgs Beach and the White Street Pier and neighboring Rest Beach are the closest Key West comes to a Third Spaces where people like to gather outdoors. Third place - Wikipedia, the free encyclopedia Of course some people need to exercise and this is where they can do that too.

It's not surprising considering the beauty of the place and the presence of an actual sand beach, after a fashion. Sand is rare in the rocky Keys.

Some exercise, some rest and some live in public. It's euphemistically called "camping."

These places close at eleven pm and open at seven am or thereabouts and they are patrolled by the night watch to clear these spaces of "campers." Under Florida law the municipality must provide a safe place for people to sleep before they can be moved on, and Key West does that with the Keys Overnight Temporary Shelter- KOTS. Key West Diary: Homeless In Key West

The safe zone, as KOTS is also known, is about to undergo change with a more permanent structure under consideration to provide services as well as sleeping arrangements. However for some, homelessness is a way of life, a choice not just a misfortune or a mental illness. In a town with a perfect climate it's hard to deny that there wil be people here who sleep rough.

In the middle of the continuing debate we have public spaces, bike trails, parks and beaches and if they have facilities they get overrun. State Parks with their entrance fees are exceptions and thus become the refuge of the moderately well to do. City parks are home to the least among us, including pigeons.

I like stopping off in these spaces because I feel it's important to reclaim them for those of us that seek not to live here but to rest and enjoy them for a moment in our lives.

In a town as expensive as Key West there are bound to be working poor and there are always the confused who come to "the tropics" as a refuge from hardship Up North and fail to bring the means or the skills with them to find a place here. It's understandable that residents, some wealthy and some barely hanging on resent in some manner or another those that live "for free" in their midst. The homeless taken as a stereotype also put fear in our hearts, as an Awful Reminder of what awaits those of us that fail to submit and work and who don't keep the implicit promise not to upset the social apple cart.

To me homelessness represents boredom, and I am as capable as any of spending my days in idleness, but only so long as it is at my own behest. Were I so reduced that all I could forward to would be days of pointlessness I think I should go mad. I don't view living "for free" as any kind of freedom, emotional or economic.

The social stigma of not paying one's way is extreme in a country that lives by the myth of self reliance. Poverty in America is a moral failing, as mad as that sounds.

We lack the desire to spend our public monies building and maintaining public works, and we pay the price. Bridges collapse and more bridges threaten collapse and the public outrage is nowhere to be found. Eisenhower's America is dead buried and forgotten. We are told that the public debt is so large we are facing imminent collapse as a nation, yet we keep soldiers all around the world and we build vast spacious embassies overseas and we pay mercenaries ten times what we pay our own honest soldiers to represent us in battles that hold no interest for us or purpose for our modest lives.

We are told that half our national debt was generated by the war in the Middle East, the war that secured Iraqi oil for American corporations that pay us no taxes in return. There is no public outcry because failure to pay taxes is seen as smart and clever and in defiance of a government that keeps us under surveillance. It's an extraordinary narrative so well told that even as its effects prove it to be a lie, it's victims continue to believe it.

Yet the homeless and hopeless are the objects of moral outrage. These people who live on pennies are blamed for our national ills. The narrative put about by the one percent say it must be so, so it must be so. I find it absolutely extraordinary.

I read comments by Canadians who whine about the high cost of living Up North and I wonder at their lack of awareness. Mind you Americans down here are less aware of their neighbor to the North than anyone so it's a two way street. Yet the essential civility of the nation to the north of us, devoted to the public good must be paid for, in gas taxes GST, PST and sales taxes and value added taxes. Sales taxes in Canada - Wikipedia, the free encyclopedia The benefits are obscured to many as they look south and see us frolicking tax free. Yet we face economic bankruptcy at every turn in a life filled with stress and anxiety, high fructose corn syrup and mutual disgust. We all of us, liberals and conservatives and libertarians, can lose everything to a bad accident or major disease, yet we cannot agree on a way out of our dependence on insurance companies that deny us medical coverage at every turn.

It is said that a society can be judged by how it treats the least of its citizens, or better yet how it treats it's animals. The pervasive narrative in the US tells us that if we provide the services other industrialized countries provide "they" will live off the fat of the land and not contribute. They are the stereotypes of your choosing, minorities of all stripes of course. Animals we herd in "feed lots," really manure pits and squeeze chickens cows and pigs into torture chambers and feed them drugs to make them fat, and us in turn.

And through it all we blame the government, not the corporations that buy the government at our expense. The narrative is brilliant, and as brilliant as it is flawed. My wife, desperately grateful for her health insurance that keeps her rheumatoid arthritis at bay was brought to her knees by the sight of a man sitting out with a leg in a cast and stuffed paper money into his startled hands. A band aid, even as she seeks her own path off the dependence on chemicals, the very things that enable her to function while enabling Merck to overcharge her insurance.

My only hope is that throughout history when this country has taken a wrong turn after sufficient agony has been felt we have found our way back, usually somewhat peacefully and usually before too much damage has been done. There's something wrong when poverty is a moral failing yet to hoard wealth beyond imagining is viewed as a social good. Throughout history such inequalities have led to violent social change.

How we treat this conundrum of homelessness, poverty, lack of education, wealth inequality and a failure of public discourse is all predicated by the canaries in the social coal mine, the indicators of a society headed in the wrong direction, the modest, despised homeless in our midst.

 

Posted with Blogsy

Corporate Medicine

She is a refugee from corporate America and as such her blog, naked capitalism is always worth a read. However I was disappointed to see  Yves Smith's very negative take on the potential shortcomings of the Affordable Health Care plan. She sees it as a tool to allow corporate America to take even greater advantage of us, and clearly because I have always supported single payer I have not viewed the changes as optimal. But I have been holding out hope that things might get better. Instead Smith thinks things will likely get much worse. Great!

Coming Corporate Control of Medicine Will Throw Patients Under the Bus

One of the most effective scare techniques employed to preserve our grotesquely inefficient, overpriced health care system has been to invoke the red peril of “socialized medicine”. Never mind that foreigners in advanced economies fail to recognize the caricatures scaremongers supply, or that Americans who need emergency care while overseas are almost without exception impressed with the caliber of care and astonished by the low (sometimes no) cost to them. After all, Americans live in the best of all possible worlds,and consumer and business freedom are always better.



In fact, business freedom here increasingly means the God-given right to exploit the vulnerability of the public. The example slouching into view is more corporate control over the practice of medicine. And based on the previews, it will make the horrors falsely attributed to socialized medicine look pale.



Two accounts last week bring the issue home. The first came in the Health Care Renewal blog (hat tip Lysa). It’s a reminder of how the current institutional efforts to regiment doctors undermine the caliber of medical care. It has become distressingly common for HMOs and other medical enterprises to have business-school trained managers putting factory-style production parameters on doctor visits. Outside of foreclosure mills, it’s hard to find similar approaches in other professions.



The post describes how a pediatrician, Pauline, who has developed a reputation for treating chronic conditions is at loggerheads with her for-profit practice. The suits don’t like her patient mix. She gets too many tough cases, when they’d rather have basically healthy kids who are there for a cold or ear infection. Mind you, this is only partly a money issue. These visits can be “up coded” so as to get larger insurance/patient payments, but she get a higher level of patients in less-generous state insurance programs. But some of the pushback is that her practice is perceived as disruptive, since she uses what is perceived as too much of her and staff time, separate and apart from the economics. She’s constantly breaking management’s precious guidelines. One of her turf struggles:



She had set up a visit to see a new medically complex patient and had blocked off 40 minutes, the amount of time she felt she needed to do a good job. The child had a complex genetic disorder, cerebral palsy, and heart, lung, and kidney problems. Both the cardiologist and the nephrologist had called asking her to take this patient. She agreed. After she had scheduled the visit, a manager called her and told her that she was being allowed only 15 minutes to see that patient. After some fruitless discussion with him, Pauline finally said, “Okay, I guess that means that you’ll be seeing the patient instead of me, right?” The shocked voice at the other end of the phone line replied, “What do you mean? I don’t know how to take care of patients.” “That’s exactly my point,” Pauline put in.



Pauline explained that this manager assigned to her office is not even a college graduate. Physicians cannot access the schedule electronically and have no control over scheduling. These functions are controlled by the office manager and (amazingly) by some of the medical assistants who have received some “leadership” training. These medical assistants are even allowed to evaluate the clinical competency and skills of the physicians.



And to add insult to injury, how long did this discussion take? All those minutes the doctor spent fighting with a petty bureaucrat come at the expense of patient care.



As an aside, it’s hard to stress enough that this sort of demoralizing micromanagement an unwillingness to listen to and learn from workers, is a widespread shortcoming of management American-style. And it has weirdly been airbrushed out of the media. When I was a kid in business school, US manufacturers were having their clocks cleaned by Germans and the Japanese. There was a good deal of critical self examination back then. One source of foreign ascendancy was that they had newer factories, so you couldn’t really blame American management for that one. But the second was that it was widely acknowledged that US managers were generally poor at dealing with labor. And this wasn’t “labor” in the union sense, but at having productive relationships with factory workers (note that there has been massive revisionist history since then. When I was in Bschool, none of my classmates, nearly half of whom had worked in major manufacturing companies, had bad things to say about unions. Now you’ll often see the decline of American manufacturing attributed to unions in an “everybody knows that” tone.



Now before you come running to the defense of management against the doctor, think twice:



So let me add a further nugget about Pauline’s background. In one of her previous jobs, she was made the manager of a pediatric outpatient center within a county hospital caring for a largely indigent population. This center had been running in the red for a good while. Pauline took over and within 28 months she’d streamlined the place and had them running well in the black, while still administering a quality of care that Pauline and her colleagues could be proud of. In short, Pauline could probably tell the managers of her current practice a thing or two about how to optimize patient scheduling without compromising care or cost —if they’d listen.



As bad as that is, most patients are unware of how much their care has been fitted to a Procrustean bed. The deliberate degradation in the name of profits is going to become more obvious, at least if the health care industry has its way.



I strongly encourage you to read this post from Whole Health Chicago (hat tip Lambert) in full. http://www.wholehealthchicago.com/5673/you-the-patient-fired/  It shows how the future of American medicine is to fire the ones who are unhealthy. No, I am not making that up. The writer, Dr. David Edelberg, describes a recent presentation by a large insurance company. They’ve apparently been hosting similar sessions with physicians in the Chicago area in large medical practices. Here are the key bits (emphasis original):



The speaker at these evenings is always a physician employed by the insurance company. His/her title is medical director (I begin to think there must be dozens and dozens on their payroll) and he always begins by reassuring the audience that he was in clinical practice himself so he understands something of what physicians–especially primary care physicians–are facing. I view this physician more as a “Judas steer,” the animal that leads an innocent but doomed herd of cattle through the slaughterhouse corridors to the killing floor.



• The health industry hopes that individual medical practices and small medical groups will ultimately disappear from the landscape by being financially absorbed into larger groups owned by hospital systems.



And why do the powers that be regard this as desirable? Although the article does not stress this point, doctors have an established revenue stream. So the acquirers buy them out and impose discipline on those artistic, freewheeling doctors. The “practice style,” which used to mean the independence that doctors once enjoyed, is now an Orwellianism and includes hewing to corporate guidelines as to how to operate.



And here’s what to expect:



Physicians are expected to spend a limited amount of time with each patient, and are encouraged to see as many patients as possible during a workday. The insurance companies, sometimes with the token cooperation of a few physician-employees, create vast books of patient-care guidelines to which they believe their physicians must be “accountable” (remember this word, it will crop up again). These guidelines might mean documented Pap smear and mammogram frequency, weight management and exercise, colonoscopies for patients over 50, and getting that evil LDL (bad cholesterol) below 99 by any means possible…



If the chart audit system discovers that a physician, for whatever reason, is an “outlier”–that she’s either not following the guidelines exactly or not getting the results anticipated for her patient population—she’ll be financially penalized. A quick example of what might occur: if your LDL is 115, you may be on the receiving end of a statin sales pitch from your doctor, not because bringing it down to 99 will improve your longevity, but because your refusal to do so will impact her financial bottom line.



Now of course, you might say, “Well, in fairness, medicine is too much of a cottage industry. Look at how many doctors give unnecessary annual EKGs to patients in low risk groups. How else are we going to get to evidence-based medicine?” The problem is that what we as patients will get isn’t driven by best outcomes, it’s driven by profits. Edelberg explains:



…the subtext of “standardized” always includes the unspoken “spend less money on the patient.” Thus, a doctor might be financially penalized for recommending nutritional counseling to lower cholesterol (“counseling is expensive”) instead of writing a generic statin drug (cheap). Or recommending psychotherapy (“therapy is very expensive”) instead of generic Prozac (cheaper than M&M’s). Or referring patients for massage, acupuncture, or even chiropractic (“expensive, expensive, expensive!”) instead of pushing an over-the-counter antiinflammatory (free to the insurance company, as it’s OTC).



And I shudder to think what becomes of patients who don’t hew to standard templates: the person who had a high body mass but not due to dangerous abdominal fat (which is what creates the health risk) who is pushed to take the latest, greatest diet drug. What about people who don’t buy into the religion of getting your LDL down to below 100 (one reader argued that while it may lower your risk of heart disease, it increases your all-factor death risk by reducing your ability to fight MRSA)? Will they face penalties if they fail to comply?



No, you just will find it nearly impossible to get a doctor to take you:



• Let me close with a best-as-I-recall quote from an insurance company medical director. “We can no longer afford to pay for health care under the PPO model. Our plan is to phase out all fee-for-service care during the next few years. We’ll pay you doctors a finite amount of money to take care of a defined population. We tell doctors, ‘Don’t spend much money and you can keep the difference. Period. Don’t follow guidelines, and you’ll be leaving behind some serious money on the table and we’ll just take it back.’”



In case you think I overstated the implications, Edelberg recapped the discussion that ensued:



One physician piped up…. “But what about the non-compliant patients who won’t take the meds, don’t eat well, don’t have mammograms, continue to smoke? And what about super-health-conscious patients who want their vitamin levels measured and want referrals to acupuncturists?”



Another physician answered wearily for the medical director (who didn’t disagree): “You’ve got to fire patients like that. Get the non-compliant and the super-demanding out of your system. They’ll drag your numbers down. Hit your personal bottom line.”



Hey you, patient. Yes, I mean YOU. Pink slip time! Canned! Take your medical records and don’t let the frosted glass door hit you in the…on the way out.



In other words, if you are high maintenance because you don’t do what your doctor says (and remember, “non-compliant” includes people who don’t follow orders because they think the cookie-cutter approach isn’t right for them) or want higher service or per the example of the pediatrician Patricia’s 40 minute case, have a complicated set of ailments, you’ll be shunted. The brave new world of corporate medicine will eject you.



The rich are unlikely even to know that this change is occurring. There will be a tier of doctors on the high end to cater to patients who want more personalized, cutting edge treatment and might need some prodding. And they can always go abroad if they can’t find what they need here. But for ordinary schlubs, expect to find the doctor’s office become more hostile as the brave new world of corporatized medicine becomes entrenched.





Read more at http://www.nakedcapitalism.com/

Better Living Through Chemistry

Last night my wife woke up in screaming pain. Which meant we needed to visit Marathon quam celerrime and happily Doctor Collins had a space available before lunch.


There are so many women with auto immune diseases you'd think somebody somewhere would be wondering why, but treating the symptoms becomes the way forward in modern medicine. And we all know that treatments bring side effects but when the agony is unsupportable one bites the chemical bullet.


Rheumatoid arthritis is a disease that immobilizes thousands of women, so my wife uses a regimen of strict and copious exercise and a large helping of good luck to keep the insidious disease at bay. Some women are completely immobilized by rheumatoid arthritis, but so far she isn't. When exercise and chemistry and luck sometimes fail her we end up chatting with Dr Collins' skeletal assistant.


It was the ankle that flared horribly this time but it was better by the time we left the house, such that slow supported hobbling was in order.


I guess it was a joint in them there bones that was giving trouble but the more I checked the plastic ankle and compared it to the x ray chart and the less convinced I became that science was the answer. I used to work for the Cristian Scientists years ago on their radio service and they never offered health insurance because when they get sick they pray. I remember my editor was laid up in bed with a broken bone when I filed a story and he edited me through gritted teeth. He was cheerful and prayerful though and never minded I thought his was an act of lunacy. Could he have been right to pray to mend a broken bone? Bollocks I say, thank God for modern medicine is my prayer.


We had to wait a bit but the good doctor provides more entertainment than a mere x ray for his waiting patients. There was a table full of bones which we waggled happily for ten minutes as we waited and speculated about her condition.


"What do you suppose this is for?" she asked as I studied the skeleton for answers. The good doctor came by soon enough, diagnosed no broken bones and prescribed better living through chemistry and no exercise for four days.


We were out $20 later and on our way to lunch. I guess we could have stayed home and done the Christian Science thing for free but science science got my vote today. Oh, and health insurance. Tough for those that have none. Don't you hate those Canadian socialists who don't have to worry out such trifles?

- Posted using BlogPress from my iPad

Health Insurance Wrestling

On August 3rd this year my wife took me to Fisherman's Hospital in Marathon to have some wax in my ear removed. The offending item, lovingly recorded here, got wedged after I spent some time underwater snorkeling at Looe Key, near my home. After a few hours hanging around my ear was flushed by a kind nurse, I paid my hundred dollar copay and went on my way.I work for the city of Key West, a government union job that I took in 2004 fully expecting hard times ahead, times that have become considerably harder than I ever expected, and as a result despite the right wing attacks on this last bastion of living wage employment I am most grateful to have a job with health insurance. Then the paperwork wars started.
I paid a hundred, the insurance paid 154 dollars after a 28 dollar discount and then the mofo's at Fisherman's sent another bill for 495.73. This is the curse of unregulated private health insurance. there is no accounting there is no estimate there is no accountability. Send the money or we go to collections. These days my wife and I couldn't care less about our credit rating. like millions of Americans our only revolt is to tell the bastards to take their credit rating cage and wrap someone else around it, we've been obedient and trapped in it for too long.
I am boring and annoying when it comes to the issue of health insurance. My wife has rheumatoid arthritis and is uninsurable if she loses her job (Republicans please note: the system does need to be changed) but thanks to her government job teaching she can pay the co-pays on thousands of dollars of drugs monthly that have side effects but keep her mobile and employed. Embril, Methotrexate, Prednisone etc etc ends up costing thousands each month. Over all this is the constant demands for paperwork to "confirm" she still has arthritis. Threats to cut off her expensive medicine land on our doorstep from time to time. Complexity is sown in our path just to test our mettle. Believe me, if she could throw off the arthritis she would. So when we got a demand for $500 more I sent the above letter to the insurers and the hospital administration which I believe was engaged in illegal double billing. The Republican candidate for Governor in Florida headed a corporation fined 1.7 billion dollars for just such illegal practices so if he gets elected we can imagine what's to come for we the people of Florida...
No one I know believes me when I say single payer health care would be beneficial to us as a nation, would be better for us as patients and would eliminate the gross profiteering by companies that exploit our current non system. Fair enough I say, then lets reform the current system. Republicans made every effort to block reform while not to putting forward better proposals of their own, and I lost faith in the Obama Administration when they yielded to the corporate interests in this fiasco.The sad thing is I wrote the above angry letter and have received word the bill is paid and I owe 11 dollars which I will mail out tomorrow. How many uninformed semi-literate, fearful Americans would have stood up to these health care "providers" and faced off this bill? Not many, and I know this because there are numerous instances in my life where I have done this and my doctors and dentists have told me I am the only patient they have that will do this. They express the wish more people would. So go on, tell me the system doesn't need to be changed. Would you take your car to the shop and pay whatever the mechanic demanded, even months after service was rendered, with no accounting, no estimate. no recourse? I know single payer won't happen in my lifetime but I know this system such as it is has to change. With Republicans determined to wreck what little reform we have in place, I see no bright future for a country with no safety net, no private sector employment to speak off and burgeoning national debt. Oh and a massive, embarrassing and continuing wars in countries we can't even locate on a map. All those shredded bodies get single payer, government funded health care for life when they come from a war that has no meaning, no purpose and no end. We could fund everyone with the treasure we waste in war. But we won't by God. And then they wonder why I'm bitter. My wife's calling, her arthritis is bad today and she can't open a jar, so I'll go and do it for her, then I'll help her inject herself with her weekly dose of thousand dollar Embril.

====================================================================

And here's a funny coincidence: in today's Solares Hill weekly in Key West we read of a long time resident and all round good guy who has a treatable form of cancer of the jaw (I think) and he lost his job which had benefits, his COBRA has run out and he can't get treated because the charming Sylvester center in Miami demands insurance or cash. They give a 30% discount for cash but the bill is going to be $250,000. So they are holding a bake sale for him. Good luck with that.

Interestingly he applied for private insurance after his COBRA benefits ran out and they quoted him (before he got the cancer) a rate of $32,000 a year. It would have been a bargain had he known he was going to get cancer. Though of course as we all know insurance companies deny service anyway because they make up crap and claim non disclosure on your application.

Ain't the private sector great? Not slimy at all.

A Comment on Health Care

Every Monday morning J H Kunstler publishes an essay in his blog called Clusterfuck Nation. I recommend it as, whether or not he hits the mark, his writing is always provocative and entertaining. This week he took on health care reform, surprisingly from a very anti-Republican angle. He isn't usually so decisive, even though one would never accuse Kunstler of being Pro-Democrat! Kunstler's world view could be summed up as expecting a decisive economic slide into poverty and limited technological resources for the US and anyone riding on the Empire's coattails. From this week's blog I read this rather cogent comment from someone called Jeff, who offered a personal insight into the US's health insurance mess that resonated with me. This is not a comment by the author of the blog (a link to that is at the end of the page):

I found the summit very useful, not just for exposing transparently obstructionist Republican tactics of the "let's just start over" (repeated ad nauseam) sort but also for laying out some honest-to-goodness policy differences. The mainstream media seemed to willfully ignore those, in favor flogging some personality driven sniping, of which there was actually comparatively little, the better to convey the meeting as some kind of demeaning, reality TV show.

Of the substantive differences, perhaps one of the most telling: Republicans object to the Obama plan in part on grounds of defending Medicare. When you hear a Republican defending Medicare, your bullshit antenna should go up, you should cover your nuts and grab your wallet (not necessarily in that order.) It became apparent that what they really meant is they want to protect Medicare C (aka "Medicare Advantage" plans.) I learned what these things are the hard way recently, by doing bureaucratic battle to get my geriatric father's Medicare advantage coverage accepted by a prominent national cancer center. In a nutshell, these things are private insurance market policies which "replace" the insured's Medicare, plus (in theory) provide a little additional coverage like preventative services, gym memberships, etc., of the sort which are extremely cheap and very infrequently used by senior citizens. For this, the private insurers can charge policy holders additional premium over and above what Medicare would charge, they also get paid an incentive from the government of about 15%, and are permitted to allow doctors and hospitals to whack insured's for an additional chunk of the total bill.

The kicker? Doctors and hospitals are free to accept or reject the coverage on a visit by visit basis. Meaning the policy holder cannot know in advance (as they can with other types of policies which have networks of hospitals and doctors)where they'll be eligible to be treated.

This is what Republicans mean by "market based solutions." The whole experiment has been an unmitigated disaster - - except for the agents and insurers who've reaped huge profits from a previously untapped market. And for Republicans who found a back door way to undercut Medicare, and provide themselves with another example of how "big government" programs don't work. Think Grover Norquist's wet dream of shrinking government down to the size where it can be drowned in the bathtub.

http://www.kunstler.com/blog/

Tort Reform

Earlier this week I got an anonymous comment asking why Democrats don't support tort reform in the current debate about health insurance reform. In the best of times I wouldn't be able to answer such a question "for democrats" and these days, pissed as I am at the Democrat leadership I certainly don't feel qualified, even though President Obama has recently endorsed this idea for inclusion in the new plan. When George Bush was Governor of Texas he pushed for medical tort reform and it was passed into law around 2003. The result has been a massive change in the structure of law firms and a huge reduction in lawsuits. Amusingly enough with the complex requirements to attain proof of damages, the pursuit of tort lawsuits has now become the realm of the wealthy victims only. A mother on welfare has a dismal economic future anyway therefore seeking a settlement will yield very small results. You might argue this was an unintended consequence of tort reform. I'd argue it's another way the Republican myth making machine has convinced working people to argue against their own benefit. Tort reform makes it impossible for working people to get justice against...corproations! Brilliant! And furthermore I dug up this commentary from an attorney opposed (obviously) to tort reform in which Mike Ferrara points out another consequence of Texas tort reform:

Texas Tort Reform is NOT a Model for Nationwide Health Care Reform
Mike Ferrara Attorney
September 07, 2009 8:24 PM

Tort reformers like to talk a lot about how the threat of malpractice suits raises health care costs by forcing doctors to practice “defensive medicine”—the ordering of unnecessary tests, procedures, and prescriptions in an attempt to protect themselves against a possible negligence lawsuit.


In a 2008 AMA survey, they remind us, a majority of the doctors who responded admitted to practicing defensive medicine—a number that translates, the AMA calculated, to $1.4 billion more spent annually on health care. If our doctors weren’t threatened into doing this, we’d all save loads of money and our national health crisis would be over.


Are the tort reformers right? Well, let’s look at Texas. Several years ago, the state passed a stringent medical malpractice law that capped awards for pain and suffering at $250,000, and brought the number of malpractice lawsuits down dramatically.


So the cost of health care in Texas must also be down, you suppose, since doctors don’t face the same malpractice threats as the rest of the country. Eh, No. In fact, Texas is home to three of the top ten most expensive cities in the country to receive health care: McAllen, Harlingen and Corpus Christi. In each of these cities, every Medicare patient is costing the country more than $10,000 a year (a couple thousand more than the national average).


So if defensive medicine against the threat of malpractice suits isn’t driving up costs, what is?


Harvard Medical School surgeon Atul Gawande got a candid answer to this question from a general surgeon in McAllen, Texas:


“Come on,” the general surgeon finally said. “We all know these arguments are [BS]. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.


The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ” –Atul Gawande, The NewYorker



While tort reform like Texas' won't improve the cost of our health care, changing our charge-per-service structure just might.

So, is the high cost of health care the doctors' fault or the lawyers? I'd argue neither: it's the insurance companies. Take your pick.

Vitality Versus Security

I read David Brooks column by that title in the Key West Citizen recently and it's premise won't go away. Grrr! I have to lance the boil...

Funnily enough I don't disagree with him on this one because I have long since viewed health care reform (insurance reform whatever term suits you) as a step away from the devil-leave-the-hindmost attitude of Reaganomics. What the Right calls the rising tide that lifts all boats, dinghies and gin palaces equally. Early on when it became clear that health care reform was a possibility, and noise started to be made about a true public option, I too saw this as a step toward a more social-democratic state in the US. Social democracy as defined by Western Europeans is, broadly speaking a mixed economy as defined by some people in the US. Essentially social democracy offers the population at large a protective safety net of benefits, economic and medical below which the bulk of the population need not fear falling. It can consist of government paid for child care so mothers can work, extensive sometimes permanent unemployment benefits and of course free health care for all. Free in the sense that taxes are twice as high as they are here. In motorcycling terms I read in a magazine recently that a Harley Sportster that sells in the US for less than $10,000 might cost three times that much in Denmark. That's just another way to pay for government programs. We hear a lot of noise about extended European vacations, but Europeans have to pay back their free education with a lifetime of work to garner a modest government pension at the end. Making a sudden (albeit well earned) fortune in Europe is next to impossible compared to the US where large sums of money (used to!) routinely change hands in corporate buyouts and as rewards for creative thinking and hard work...

Brooks's point, and it's a good one, is that by seeking to provide coverage for all in the US we are starting down the path to government oversight in much more than just our health care. It is, as he says, a civilizing effort. As we try to remove the terror of illness or bankruptcy from the lives of ordinary people we inevitably increase costs and thus increase the need for more...taxes! He's right, I don't see how universal coverage can be obtained without increasing costs not matter what they tell us, but here's why I think it is fundamentally necessary, even though my wife and I have adequate coverage as I write (and low taxes in penurious Florida!)

The problem for me lies not with the notion of universal coverage, but the reason why we don't already have it in our free market system. If our private insurance based system worked I would stand alongside all those who sought no change- "If it ain't broke don't fix it!" But it is broke! There are too many horror stories of insurance companies failing us, too many and too well known to go on listing them here. Our system costs more per capita than universal coverage systems underpinned by other industrialized governments, our lives are constrained by lack of health care, by insurance tied to our jobs, by unaffordable premiums and by insurance companies who set the terms that cannot be debated. If you get an unfair or illegal bill to whom do you appeal? This system tortures Americans of good faith and less financial means. It tortures decent families and people forced not only to suffer illness and catastrophe but financial ruin. Something has to change, Senator Lieberman and the Catholic bishops notwithstanding. I have yet to hear a non-coverage horror story from a member of Congress or their families. We deserve no less than they.

And if, in so doing we take one small tentative step down the path to social democracy and away from free market piracy, so be it. If the insurance companies understood how badly they have mauled us we wouldn't need to fight tooth and nail for a strong public option. If I could shop for an insurance policy across state lines to find the cheapest competition we wouldn't need change...If a life flight helicopter to Miami didn't charge $23,000 for 40 minutes in the air...or a ground ambulance $800 for a five mile ride across Key West...If a heart attack didn't cost $70,000 to treat...If insurance companies had to present timely detailed explanations of charges...If co-pays were capped by law....If the chronically ill got government help...If...if...if. Instead we face medical and financial catastrophe like no other industrialized nation and our leaders won't lead us out of the wilderness. Universal coverage is sensible and compassionate, not socialism. And if it is the first step to socialism let the insurance robber barons shoulder the blame, not the sick.

Names Of The Dead

This video, from the Congressional representative ofFlorida's 8th District (Eustis, of all places) shocked me for a couple of reasons. The first two names mentioned involved the two towns I have lived in and called home in the US. The second reason is that Representative Alan Grayson quotes 44,000 dead each year in the US thanks to the lack of health insurance. That's 120 people a day. I keep thinking of the rather unpleasant remark made by a former reader from Georgia, a man who claims to be a Christian and opposes health care reform on the fatuous grounds of "cost." He wrote to me once and said one should revisit Obama's plan in two years and see how bad things are. Reform very likely won't go the exact way I'd like but if we do wait two years to do anything, a hundred thousand Americans would be dead by then and countless more suffering horribly for lack of people like this self professed "Christian" giving a damn and demanding any kind of reform. I am reminded of Christ's remark to his disciples about giving a glass of water in His name... but I am not a Christian so what do I know?

It will I think be a cold day in Hell before a representative of the America's Health Industry stands before we the people and reads such a list. Damn the gummint for giving a damn!

Health Insurance Blues

From the Huffington Post:



A CIGNA employee gave the finger -- literally -- to a woman whose daughter died after the insurance giant refused to cover her liver transplant.

Hilda and Krikor Sarkisyan went to CIGNA's Philadelphia headquarters, along with supporters from the California Nurses Association, to confront the CEO Edward Hanway over the death of her 17-year-old child.

In 2007, Nataline Sarkisyan was denied a liver transplant by the company, on the grounds that the operation was "too experimental" to be covered. Nine days later it changed its mind, in response to protests outside its office. It was too late: Nataline died hours later.

"CIGNA killed my daughter," Nataline's mother Hilda told security. "I want an apology." Sarkisyan was not able to speak to Hanway; a communications specialist talked to her instead. After their conversation, employees heckled the group from a balcony; one man gave them the finger. CIGNA called the police and had the family and their friends escorted from the building.

A CIGNA executive apologized for the incident in a letter about a month later.

"I was very disappointed to learn of the behavior of one of our employees when you were at our company's headquarters," wrote John M. Murabito, executive vice president for human resources.

"I sincerely regret this individual's offensive and inappropriate action," he continued. "Please know that he did not represent the views of our company or the views of other employees who work here. We deeply empathize with you and wish you peace and comfort in your loss."



"What unbelievable nerve," said Americans United For Change spokesman Jeremy Funk in a statement. "A case that should have prompted CIGNA to seriously reevaluate its policies instead led its employees to taunt and insult a grieving mother who lost her daughter. Absolutely sick. Does Congress need any more reasons to pass meaningful health insurance reform now?"

The Sarkisyan family's wrongful-death suit was thrown out of court because of a 1987 Supreme Court ruling that shields employer-paid health care plans from damages over their coverage decisions.

The Sarkisyans say the law needs to be changed to allow people to sue health insurers for these kinds of decisions.



Read more at: http://www.huffingtonpost.com/2009/10/08/cigna-employee-flips-off_n_314189.html

Frontline Health Reform

I downloaded this program from Netflix to exercise by and I learned a few things from it about health care delivery system in other countries. The reporter visited the UK, Japan,Germany, Taiwan, and Switzerland and found in some respects we resemble each of these countries in parts of our health care system. Each country has problems and some dissatisfaction but none of them comes even close to paying as much as a proportion of Gross Domestic Product as the US. What the hour long program does conclude is what the reporter states at the outset: the US "system" needs to be repaired. He does it with an eye on what might or might be acceptable to the average (insured) American.
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

As we watch our leaders inch forward in an attempt to debate how to make the needed changes. It's impossible to have a debate when the only people open to change are tghe Democrats. The Republicans for some reason continue to refuse to contribute to the debate. As long as they say there is no need to make changes the Democrats have to form their usual circular firing squad, to the detriment of what's left of the debate. That people without health insurance can support the Republican rhetoric is an ongoing source of amazement to me. My wife and I paid a preventative visit to our family doctor yesterday. Her copay is $20, mine is $25 through our work insurance. She pays $320 a month for insurance, I pay nothing. We still get heaps of paperwork and occasional refusals to pay. However over the years we have learned how to refute refusals to pay but it is painstaking and irritating. I still support Medicare for all and would join medicare now if I were allowed to.

Public Option Please

I got a notice from the home insurance company that covers a rental home my wife and I own. They said that they were canceling the policy because we now had a swimming pool on the property. I called and told them no renter had asked me to pay to put a pool at the house and what were they talking about? They hummed and hawed and sort of, kind of admitted perhaps their agent had checked the wrong home. They will check again they said. I couldn't even blame the government for this stupidity, this is a private insurance company hard at work showing us how well the private sector operates. Here's another, more grievous example from the Huffington Post. Remember: I don't for one minute believe that that Big Pharma is spending a million and a half dollars a day lobbying Congress against the public option because it is in the best interests of We The People. Nor should you. Of course one has to wonder what tort reform will do in cases like these. Texas has reformed tort laws to no visible effect on the cost of medical insurance.

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The South Carolina Supreme Court has ordered an insurance company to pay $10 million for wrongly revoking the insurance policy of a 17-year-old college student after he tested positive for HIV. The court called the 2002 decision by the insurance company "reprehensible."

That appears to be the most an insurance company has ever been ordered to pay in a case involving the practice known as rescission, in which insurance companies retroactively cancel coverage for policyholders based on alleged misstatements - sometimes right after diagnoses of life-threatening diseases.

The ruling emerges from a conservative Southern state with one of the most pro-business climates in the country. And it comes as progressive Democrats on Capitol Hill are pressing for health care reforms, such as a public insurance option, that reflect wariness about the private insurance industry's motives.

The Supreme Court on Monday upheld a lower court's verdict against Fortis Insurance, now known as Assurant. The trial jury had awarded the former college student, Jerome Mitchell, $15 million in punitive damages; the Supreme Court reduced that amount by $5 million.

Mitchell learned that he had HIV when, while heading to college, he donated blood. Fortis then rescinded his coverage, citing what turned out to be an erroneous note from a nurse in his medical records that indicated that he might have been diagnosed prior to his obtaining his insurance policy.

Before the cancellation of the policy, an underwriter working for Fortis wrote to a committee considering whether or not to rescind his policy: "Technically, we do not have the results of the HIV tests. This is the only entry in the medical records regarding HIV status. Is it sufficient?" The underwriter's concerns were ignored and the rescission went forward.




Read more at: http://www.huffingtonpost.com/2009/09/17/insurance-company-must-pa_n_289841.html

Baucus Sells Out

The Chair of the Senate Finance Committee Max Baucus, a supposed Democrat representing Montana has offered up his version of health care reform. he is viewed as the stumbling block to a public option and he came through for the insurance industry. Bear in mind insurance companies have funded his reelection campaign to the tune of three million dollars, though of course he would tell you no way is he influenced by more money than I will earn in the rest of my working life. Also interesting to note, none of the Republicans on Baucus's critical committee have joined with him in supporting his plan and he has gutted the public health care option to bring Republicans into his supposed "compromise." I tell you this: if the insurance companies don't want a public option it has to be good for we the people. Period. Let me also point this out: no member of the US Congress has ever been denied health insurance through their collective Congressional health insurance scheme for pre-existing health conditions or for rescissions (which are claims by private insurers that people lied on their applications and thus void their policies when they need them the most). How I wish we had FDR at the helm in the White House right now, a man who was reviled far more than President Obama ever has been and who stood up and did what was right. The only trouble is, in a country that doesn't know it's own history no one knows what I mean when I mention FDR, the New Deal or the Great Society.

I found this Associated Press report on Baucus's explanation of his sell out plans on the Huffington Post:

WASHINGTON — Sen. Max Baucus on Wednesday brought out the much-awaited Finance Committee version of an American health-system remake – a landmark $856 billion, 10-year measure that starts a rough ride through Congress without visible Republican backing.

The bill by Baucus, chairman of the Finance Committee, would make major changes to the nation's $2.5 trillion health care system, including requiring all individuals to purchase health care or pay a fine, and language prohibiting insurance company practices like charging more to people with more serious health problems.

"This is a unique moment in history where we can finally reach an objective so many of us have sought for so long," said Baucus, D-Mont. "The Finance Committee has carefully worked through the details of health care reform to ensure this package works for patients, for health care providers and for our economy."

Consumers would be able to shop for and compare insurance plans in a new purchasing exchange. Medicaid would be expanded, and caps would be placed on patients' yearly health care costs. The plan would be paid for with $507 billion in cuts to government health programs and $349 billion in new taxes and fees, including a tax on high-end insurance plans and fees on insurance companies and medical device manufacturers.

But the bill fails to fulfill President Barack Obama's aim of creating a new government-run insurance plan – or option – to compete with the private market. It proposes instead a system of nonprofit member-owned cooperatives, somewhat akin to electric co-ops that exist in many places around the country. That was one of many concessions meant to win over Republicans.

In other ways though, including its overall cost and payment mechanisms, the bill tracks closely with the priorities Obama laid out in his speech to Congress last week.

Baucus is still holding out hope for GOP support when his committee actually votes on the bill, probably as early as next week.

US vs Costa Rica

I found this video on Huffington Post, it's by Paul Hipp who has integrated some rather recent images into his song. Who knew Italy was #2 on the list? Or the Republic of San Marino was number three? Anyway here's Hipp's take on the WHO rankings:

Here is a song celebrating our proud ranking in the World Health Organization's list of world health systems for all the obstructionist hecklers to sing as they continue down the road to total irrelevance. Enjoy!!

The President's Plan

This is the plan the Republicans have been fighting while saying we don't need reform in this country. If you look at the points it addresses you will understand this is a modest enough goal for the world's leading industrialized nation. especially as we spend 13 trillion to save big banks and trillions more to kill people in Afghanistan and Iraq to no visible purpose. I would prefer the cheaper more sensible single payer system, but for the next 14 years until I qualify for Government-run "socialized medicine" in the form of Medicare this will have to do. Is this so damned revolutionary? Really? I despair of my fellow Americans sometimes.

From Getty Images Republican Joe Wilson (South Carolina) calling the President a liar:
THE OBAMA PLAN
More Stability and Security for ALL Americans

If You Have Health Insurance

More Stability and Security
• Ends discrimination against people with pre-existing conditions.
• Prevents insurance companies from dropping coverage when people are
sick and need it most.
• Caps out-of pocket expenses so people don’t go broke when they get sick.
• Eliminates extra charges for preventive care like mammograms, flu shots
and diabetes tests to improve health and save money.
• Protects Medicare for seniors and eliminates the “donut-hole” gap in
coverage for prescription drugs.

If You Don ’t Have Insurance

Quality, Affordable Choices for All Americans

• Creates a new insurance marketplace – the Exchange – that allows
people without insurance and small businesses to compare plans and buy
insurance at competitive prices.
• Provides new tax credits to help people buy insurance and to help small
businesses cover their employees.
• Offers a public health insurance option to provide the uninsured who
can’t find affordable coverage with a real choice.
• Offers new, low-cost coverage through a national “high risk” pool to
protect people with preexisting conditions from financial ruin until the
new Exchange is created.

For All Americans Reins In the Cost of Health Care for Our Families,
Our Businesses, and Our Government.

• Won’t add a dime to the deficit and is paid for upfront.
• Creates an independent commission of doctors and medical experts to
identify waste, fraud and abuse in the health care system.
• Orders immediate medical malpractice reform projects that could help doctors
focus on putting their patients first, not on practicing defensive medicine.
• Requires large employers to cover their employees and individuals who can
afford it to buy insurance so everyone shares in the responsibility of reform.

Unreality on the Right

A perspective from a British columnist, Johann Hari who published this commentary in The Independent on August 24th. I read it on Alternet and thought it was an articulate reflection of my views in this crazy "debate" we are having in the US these days.

The election of Obama - a black man with an anti-conservative message - as a successor to George W. Bush has scrambled the core American right's view of their country. In their gut, they saw the US as a white-skinned, right-wing nation forever shaped like Sarah Palin.

When this image was repudiated by a majority of Americans in a massive landslide, it simply didn't compute. How could this have happened? How could the cry of "Drill, baby, drill" have been beaten by a supposedly big government black guy? So a streak that has always been there in the American right's world-view - to deny reality, and argue against a demonic phantasm of their own creation - has swollen. Now it is all they can see.

This editorial cartoon from the Dayton Daily News was published in The Citizen August 24th.

Since Obama's rise, the US right has been skipping frantically from one fantasy to another, like a person in the throes of a mental breakdown. It started when they claimed he was a secret Muslim, and - at the same time - that he was a member of a black nationalist church that hated white people. Then, once these arguments were rejected and Obama won, they began to argue that he was born in Kenya and secretly smuggled into the United States as a baby, and the Hawaiian authorities conspired to fake his US birth certificate. So he is ineligible to rule and the office of President should pass to... the Republican runner-up, John McCain.

These aren't fringe phenomena: a Research 200 poll found that a majority of Republicans and Southerners say Obama wasn't born in the US, or aren't sure. A steady steam of Republican congressmen have been jabbering that Obama has "questions to answer". No amount of hard evidence - here's his birth certificate, here's a picture of his mother heavily pregnant in Hawaii, here's the announcement of his birth in the local Hawaiian paper - can pierce this conviction.

This trend has reached its apotheosis this summer with the Republican Party now claiming en masse that Obama wants to set up "death panels" to euthanise the old and disabled. Yes: Sarah Palin really has claimed - with a straight face - that Barack Obama wants to kill her baby.

You have to admire the audacity of the right. Here's what's actually happening. The US is the only major industrialised country that does not provide regular healthcare to all its citizens. Instead, they are required to provide for themselves - and 50 million people can't afford the insurance. As a result, 18,000 US citizens die every year needlessly, because they can't access the care they require. That's equivalent to six 9/11s, every year, year on year. Yet the Republicans have accused the Democrats who are trying to stop all this death by extending healthcare of being "killers" - and they have successfully managed to put them on the defensive.

The Republicans want to defend the existing system, not least because they are given massive sums of money by the private medical firms who benefit from the deadly status quo. But they can't do so honestly: some 70 per cent of Americans say it is "immoral" to retain a medical system that doesn't cover all citizens. So they have to invent lies to make any life-saving extension of healthcare sound depraved.

A few months ago, a recent board member for several private health corporations called Betsy McCaughey reportedly noticed a clause in the proposed healthcare legislation that would pay for old people to see a doctor and write a living will. They could stipulate when (if at all) they would like care to be withdrawn. It's totally voluntary. Many people want it: I know I wouldn't want to be kept alive for a few extra months if I was only going to be in agony and unable to speak. But McCaughey started the rumour that this was a form of euthanasia, where old people would be forced to agree to death. This was then stretched to include the disabled, like Palin's youngest child, who she claimed would have to "justify" his existence. It was flatly untrue - but the right had their talking-point, Palin declared the non-existent proposals "downright evil", and they were off.

It's been amazingly successful. Now, every conversation about healthcare has to begin with a Democrat explaining at great length that, no, they are not in favour of killing the elderly - while Republicans get away with defending a status quo that kills 18,000 people a year. The hypocrisy was startling: when Sarah Palin was Governor of Alaska, she encouraged citizens there to take out living wills. Almost all the Republicans leading the charge against "death panels" have voted for living wills in the past. But the lie has done its work: a confetti of distractions has been thrown up, and support is leaking away from the plan that would save lives.

These increasingly frenzied claims have become so detached from reality that they often seem like black comedy. The right-wing magazine US Investors' Daily claimed that if Stephen Hawking had been British, he would have been allowed to die at birth by its "socialist" healthcare system. Hawking responded with a polite cough that he is British, and "I wouldn't be here without the NHS".

This tendency to simply deny inconvenient facts and invent a fantasy world isn't new; it's only becoming more heightened. It ran through the Bush years like a dash of bourbon in water. When it became clear that Saddam Hussein had no weapons of mass destruction, the US right simply claimed they had been shipped to Syria. When the scientific evidence for man-made global warming became unanswerable, they claimed - as one Republican congressman put it - that it was "the greatest hoax in human history", and that all the world's climatologists were "liars". The American media then presents itself as an umpire between "the rival sides", as if they both had evidence behind them.

It's a shame, because there are some areas in which a conservative philosophy - reminding us of the limits of grand human schemes, and advising caution - could be a useful corrective. But that's not what these so-called "conservatives" are providing: instead, they are pumping up a hysterical fantasy that serves as a thin skin covering some raw economic interests and base prejudices.

For many of the people at the top of the party, this is merely cynical manipulation. One of Bush's former advisers, David Kuo, has said the President and Karl Rove would mock evangelicals as "nuts" as soon as they left the Oval Office. But the ordinary Republican base believe this stuff. They are being tricked into opposing their own interests through false fears and invented demons. Last week, one of the Republicans sent to disrupt a healthcare town hall started a fight and was injured - and then complained he had no health insurance. I didn't laugh; I wanted to weep.

How do they train themselves to be so impervious to reality? It begins, I suspect, with religion. They are taught from a young age that it is good to have "faith" - which is, by definition, a belief without any evidence to back it up. You don't have "faith" that Australia exists, or that fire burns: you have evidence. You only need "faith" to believe the untrue or unprovable. Indeed, they are taught that faith is the highest aspiration and most noble cause. Is it any surprise this then percolates into their political views? Faith-based thinking spreads and contaminates the rational.

Up to now, Obama has not responded well to this onslaught of unreason. He has had a two-pronged strategy: conciliate the elite economic interests, and joke about the fanatical fringe they are stirring up. He has (shamefully) assured the pharmaceutical companies that an expanded healthcare system will not use the power of government as a purchaser to bargain down drug prices, while wryly saying in public that he "doesn't want to kill Grandma". Rather than challenging these hard interests and bizarre fantasies aggressively, he has tried to flatter and soothe them.

This kind of mania can't be co-opted: it can only be overruled. Sometimes in politics you will have enemies, and they must be democratically defeated. The political system cannot be gummed up by a need to reach out to the maddest people or the greediest constituencies. There is no way to expand healthcare without angering Big Pharma and the Republicaloons. So be it. As Arianna Huffington put it, "It is as though, at the height of the civil rights movement, you thought you had to bring together Martin Luther King and George Wallace and make them agree. It's not how change happens."

However strange it seems, the Republican Party really is spinning off into a bizarre cult who believe Barack Obama is a baby-killer plotting to build death panels for the grannies of America. Their new slogan could be - shrill, baby, shrill.

Jack Riepe's Perspective

A guest essay submitted by Jack Riepe to stimulate sensible and thorough debate on health care reforms proposed for the United States. Please comment at length and sharpen your pencils to add your thoughts. All points of view are welcome, and will be printed by me unedited and uncensored, as will all comments in reply. My only time limit on this experiment is the day some sort of reform is finally passed, be it ever so inadequate, and signed into law by the President.

I am Conchscooter, aka Michael Beattie, 743 Indies Road, Ramrod Key, Florida 33042. Send essays to me at mikigboat@hotmail.com and post as many comments as you like below the essays. Unless you are the pornographic asian spammer, in which case send your pictures directly to Jack riepe at Twisted Roads (http://jackriepe.blogspot.com/)

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My Perspective: The Healthcare Debate-- Let's Start Over, the Right Way...

I want President Obama to put the brakes on the current healthcare public relations disaster and come up with three substantive, but different programs, that address all public concerns, to serve as the basis of a nation referendum on healthcare.

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Proposed legislation should come from the Democrats, the Republicans, and the insurance industry, (who should be advised that they can take the lead in offering an honest reform program, or be reformed by popular consensus and legislative action).

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The process should also be open to proposed programs set forth by labor unions or other social groups, like the Salvation Army. There has to be more than one answer to this problem. The proposed bills should be limited to 25 pages, plus an executive summary. A matrix for each plan (the size of a tabloid newspaper page) would also be prepared.

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Then I want President Obama to conduct a national referendum, that will be based on a factual analysis and presentation of the pros and cons of each program, conducted by an independent auditor and the US Government Accounting Office (GAO). Prior to the referendum, there will be be three one-hour television specials, with experts explaining how each plan would work. On three consecutive days (or as many days as it would take to present each program to the general public via various media outlets), newspapers across the country would run full-page ads, detailing each program using the executive summary and the appropriate matrix. The same data would be made available online. Proposed changes to these bills would be collected via e-mail and hard copy and tabulated prior to a final draft of each. (These could run into the millions.)

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It is to be hoped that each submitted program would include the input:

• Of respected medical authorities, who would be named in each bill.

• Of an accounting firm who would certify that all data, percentages,and cited costs were correct. (This means that all three proposalswould have to use the same base numbers regarding the nation's uninsured... And that means making an effort to accurately to define"uninsured" and count them.)

• Labor unions, professional associations, social networks, clubs, andlocal political groups would be encouraged to support or endorse one program, but not to criticize the other two. For example, rather than declaring one plan to be the national socialization of America, or the Nazification of the US lifestyle, it would be in the best interests of groups supporting another plan to point out the its benefits (i.e. keeping the US Congress out of the insurance business, while promoting a single payer concept).

• The bill would then be voted on in a special national referendum. Legislation may be necessary to accommodate such a vote. If so, Congress can make that happen.

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Now I realize this rational approach to resolving this problem will take at least six months to a year of dedicated legislation drafting, hearings and public coordination; and take all the fun out of name-calling and screaming, but it has some real benefits.

1) It will get the US public actively involved in solving a national problem -- in a constructive manner. (For presentation on television, I suggest canceling "Dancing With The Bullshit Stars," or "American Idol." unless the idols are school teachers, firemen, or single moms who hold two jobs and still find a way to pay for their kid's music lessons.)

2) No one will able to say a better alternative wasn't discussed or made available.

3) Every qualified social, political or professional entity (in addition to every US citizen) will have an opportunity to contribute to the finished legislation.

4) The final decision will be left to the voting public.

5) Politicians will be forced to work together, and adhere to public outcry, or face the consequences on election day.

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Republicans (and I am a Republican) will be forced to pull their heads out of their asses, and regard the common man and woman, with an income of $45,000 or less as their actual constituency. They are going to have to become known as "progressive Republicans" or "SRRs, Socially Responsible Republicans," committed to the man (and woman) on the street first. It may be easier to train tigers to ignore bloody gazelles.

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Democrats (and I supported a lot of these assholes) are going to have to acknowledge that the Continental United States is more than Boston, New York, Philadelphia, Chicago, Los Angeles and San Francisco. There are millions of people who live in between these places who do not trust government for good reason. Alienating these people further is not good politics. Acting like they don't count is the first step in declaring a single term Presidency.

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If the President were to adopt the policy I have outlined above, it will do the following:

a) Give him more time to get this right.

b) Enable him to act upon new data regarding the acceptance of a program of this nature by the American public. Let's face it, the self-congratulatory Democrats were under the impression there would be no or limited opposition to this "40 acres and a mule" legislation. It blew up in their smarter-than-thou faces. (And their first reaction was to call the opposition organized stupidity bereft of social awareness, and nothing more than a neanderthal diversion tactic -- in an effort to discount resistance to a poorly communicated, over-complex document that is being rushed through Congress.

c) Tell the Democratic party not to mix issues with this program, and to assure (not just tell) the voters, "We're going to fix it." Of course, this means Obama will have to become the real leader of the Democratic Party. Democratic leaders have been waiting for their turn to screw the American public for so long that it may be easier to train tigers to ignore bleeding gazelles.

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So Conch, this would be my approach. I didn't mean to clutter up a great blog with this, but I rather got the impression you thought that I didn't think healthcare was important, or that I wasn't thinking about this, or that I was an idiot. It's just that I have no patience with government bullshit and no confidence in their bullshit promises. Among the things that President Obama promised were two elements of real change... They wouldn't cost any real money... They wouldn't raise taxes... They wouldn't even make a real splash at first, considering the average American is as dumb as dog shit and incapable of reading anything longer than a Twitter message. And yet, Obama couldn't drop these promises fast enough.

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The first was the promise that all legislation would be presented to the general public in plain language, 5 days before a vote would be taken. A nicer touch by a powerful leader eager to promote change would also have been to eliminate the rider system of passing legislation in the dark. But it was stupid of me to get my hopes up even for the initial offering. Can you imagine the value of the above legislative action in the promotion of a well-written bill, the acceptance of which by the American pubic was crucial to a major enhancement of the US lifestyle? You could use the healthcare bill as an example. But Co-President Pelosi and company is not really interested in smartening up the US voter.

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The second promise made by Obama was to eliminate all lobbyists and special interest representatives from his administration; and to require that all dialogues between elected officials and lobbyists be recorded and reported. This took my breath away. Only leaders like Attila, Pope Gregory, Napoleon, Washington, and Ghengis Khan make promises like that. As you can imagine, Co-President Pelosi and banking industry sexual aid Chris Dodd -- in addition to the rest of the occupants in the "Little Whorehouse on the D.C. Prairie" -- got real quiet on that one.

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It was for these two campaign promises, and because the Republican Party performed so poorly over eight years (treating rank and file Republicans, let alone the American public like they were idiots and cannon fodder), that I supported President Obama. He has performed like a true ward-heeler since getting into office.

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I routinely write to my elected officials, and my name is on hundreds of press releases that urge the feds to act responsibly (albeit on transportation issues), and with forethought, as opposed to highlyemotional responses that get headlines, but no results.

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So these are the kind of blog comments I write when I am not thinking about motorcycles, or women, or rum, or nude beaches in Key West.

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Fondest regards, Jack Riepe Twisted Roads

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"I have a good mind to join a club and beat you to death with it."--- Groucho Marx