Thursday, August 20, 2009

Health Care Reform and Debate As I See It

Obama and his supporters say the opposition's objections to the Health Care Reform for America Act (HR3200) are not in the bill. And that is mostly true, they aren't. There is no provision for "death panels", end of life and living wills consultations are indeed voluntary, the elderly and disabled are not denied care, citizens can keep the doctor and health care insurance plan they have now.

So why am I still skeptical of not just the bill and plan, but of the underlying intent? Our Constitution was written as negative rights. That is, the Constitution details what the government cannot do, not what private citizens can do. Essentially, citizens can do whatever they want within the strictures of common decency and community standards which are constantly changing. The government is restricted to monitoring interstate commerce and crime, law enforcement ensuring domestic tranquility, and protecting against military threats foreign and domestic. In the current bill (HR 3200), for every benefit extended to the patient, there soon follows a "however" that severely limits the benefit under conditions determined by the Secretary of Health and Human Services for any reason deemed necessary, primarily economic. The Constitution does not say the people have the right to a fair and speedy trial before a jury of their peers, "however... "; the government has the obligation to provide for the common defense, "however...". But this bill is filled with howevers that need to be tracked down because they are listed in entirely different sections and sometimes even different US codes.

The health care reforms are diametrically opposed to the negative rights tradition. The government is positively empowered by HR3200 to determine the services delivered and who shall give and receive those services. The bill clearly states more than a few times the Secretary of Health and Human Services shall define the terms and conditions of service and the terminology used by service providers. That gives HHS wide latitude to define common words and understandings in an uncommon manner to corrupt the public's understanding of everyday life. Speaking to a joint session of Congress Aug 12, 1974, President Gerald Ford said, "A government big enough to supply you with everything you need, is a government big enough to take away everything that you have...."

Much of what is in the bill, one has to question why it's there in the first place. There's a section that mandates the "Medicare and You" booklet be updated both on-line and on paper. Why? There is a section detailing per diem payments to the advisers who are to write the rules. Why? The section about end of life consultations and living wills education is an estate and contract matter for lawyers, as it current is handled. I attended such a meeting last week conducted by a local lawyer at the Credit Union I use. Why is it in the health care reform bill? Wouldn't it be more suited to a medical tort reform bill? Or better, just leave it alone as the information and process is already available.

There is too much that is left for positive action by future governments headed by either party. We may decide to understand that explicit "death panels" are not in the bill today, but the bill does not disallow such use later for cost reduction which is the overriding purpose of the current exercise at health care reform. Too much is left implicit. The vast majority of the plan's provisions are left to non-legislative bodies and non-governmental agencies that have worked with the government, non-profits, and the community in the past. Though not specifically stated, these non-government community providers can be organs like churches and benevolence associations like Lions, Kiwanis, Elks, or Shriners. Or community organizing organs like ACORN, Black Panthers, Hell's Angels, Crips, and Bloods. Taking care of the community is how the Mafia gained popular appeal, John Dillenger was hailed as a Robin Hood who stole from the rich and gave to the poor. The great malevolent governments of the 20th Century gained strength through popular actions like providing food and jobs. "Bread and circus" has been a successful shortcut to tyranny since the Roman Republic perfected the method and then fell under the weight of it's own corruption, perfidy, and indolence.

Obama seems quite oblivious to the 200+ year tradition of American suspicion of government and the power it can wield without limit. Just as certain images appear in our minds when Juliet on her balcony, or Tom Sawyer on his raft are mentioned, common cultural images and memories are elicited at the mention of Orwell, 1984, Fahrenheit 451, Animal Farm, and government agents appearing at our front doors or hospital beds saying, "Don't be alarmed. I'm from the government. I'm here to help."

It just doesn't sit right. Whether the plan is good or bad, it feels bad, it feels wrong in the collective American gut. I've been struggling with this for several weeks. I don't see much benefit in arguing the bill point by point, though it's valuable to know what's there. Arguing point by point gives legitimacy to the whole idea and provides reformers the right to ask for suggestions to improve any proposal. Opponents often feel obliged to offer up suggestions knowing full well the best course of action is to do nothing, or very little, because for the vast majority of Americans the health care system works just fine.

Obamacare supporters are now saying that the opposition doesn't even have a health care plan, therefore, the opposition doesn't really care about the sick, injured, elderly, children, and crippled. That's just plain wrong. The case for doing nothing, or to keep the current system rather than change it wholesale, because there is no problem has not been made or made well enough even though NPR on Aug 13 aired a feature story of health care tourism into Florida by foreigners. If ours is so bad and theirs is so good, why would Baptist Hospital of Miami open branch offices on foreign shores to sign up patients to be treated in Florida? Baptist Hospital and every other hospital in South Florida are competing with each other for the 400,000 foreigners who came to the US for medical care not available in their countries in 2008 spending nearly $5 billion. And that market is expected to double in the next three years. US health care may or not be the best in the world. I figure if the health care anywhere saves life and limb, it's pretty good. I don't need music or television in the waiting room. Newer magazines would be nice, but that's not a deal breaker.

We do need tort reform that could free up doctors, staffs, and dollars to care for patients and procure the equipment needed to give greater care to greater numbers of people at lower cost. Currently, many physicians are paying upwards of 75% of their incomes on malpractice insurance to fend off frivolous lawsuits. We need to reform laws forbidding doctors and nurses from practicing in all 50 States and not requiring them to get 50 separate licenses in order to practice in all the States. Tennessee has had a law to accept all medical licenses from the other 49 states since 1994. The rest should follow suit post-haste and the Feds should do likewise. Health insurance companies should be allowed to sell their product across states lines as most other companies can sell their products. We should also move away from employer provided insurance which every employee loses when terminated from that job adding them not just to the unemployment roles but uninsured also. Easily accessed product and service has always brought prices down, just look at the price of HDTVs today as compared to last December.

We Americans need to do some soul searching and re-prioritize in our own lives. In 2008, we spent $2.4 trillion on traditional Western style medicine paid mostly though employer insurance plans. At the same time, we shelled out from our own pockets $34 billion for alternative care like chiropractic, holistic, acupuncture, and herbal treatments. I see a chiropractor at least four times a year. Many people I know have obtained relief from acupuncture when traditional medicine provided little or no relief. The money came mostly from our own after tax funds. And even more, we spent in 2007 a whopping $41 billion on health care for our pets. In the first six months of 2009 we've doled out from private bank accounts $45.4 billion for our pets. And increasing portions of our incomes go to cellphone, cable and satellite entertainment services which are not needed by most people, but are viewed as necessities of life. No, they're not. Food, water, heat, and clothing are necessities. Health care insurance is an option, but an option that should take precedence over entertainment, cellphone service, and annual vacations.

Of the 47 million uninsured people Obama and Co claim to be in America now, only 2.5% are uninsured for three or more consecutive years and are more than likely in need of serious permanent psychological help. I am more than willing to provide aide to those who truly cannot afford health service. That's what charities are for or they were before government horned in to equalize the expense away from the wealthy. We should support the charities rather than legislating hospitals out of existence as we've done in Southern California with foolish rules mandating unquestioned care for 10 million persons who are not technically citizens of whom 5.6 million are here illegally. Fine, treat them when necessary, but then send the bill to their home country's socialist health care system most probably financed with American foreign aide money. At least, we wouldn't be paying twice for the same aide as we do now. We need health care and insurance reform, so let's start there with those using the service and are not supposed to be here. Then we can move on to "incentivizing" American citizens to take care of their families first and only then go to the movies.







The life of Indigo Red is full of adventure. Tune in next time for the Further Adventures of Indigo Red.

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