In our three month crash course on health care reform we learned while we’ve been spinning in circles of factual inaccuracies in our public debate, the reality of health care reform is terribly complicated.
If we were pressed on naming a general consensus, we’d have to say it’s the growing sense that we’ve got to get most people insured, make insurance portable (not tied to job status), make it illegal to deny coverage based on preexisting conditions and to rescind coverage once there is an illness (a practice called “recision”).
We essentially already pay for catastrophic insurance for the uninsured today, at no cost to them, because if any of them walks into an emergency room bleeding, we treat them. Unless we’re going to stop treating all bleeding people, it is sensible to require people to step up to share some level of responsibility for the benefit they get.
Ah, but the devil is in the details and universal coverage comes with a direct price tag that’s hard to compare even-up to the indirect price tag society pays for the uninsured today.
From yesterday’s New York Times:
This is not the question of whether the proposed health care legislation is affordable for taxpayers and the federal government â€” an issue that seemed to be answered when the Congressional Budget Office said the Senate Finance Committeeâ€™s bill would eventually help reduce federal budget deficits.
The affordability question vexing Democrats is whether those with moderate income will be able to afford health insurance, even with the subsidies the legislation would provide and all sorts of new rules aimed at controlling costs.
The current Senate Finance Committee plan requires middle-income families to pay up to 12% of their income to health insurance before subsidies kick in. There are amendments pitched at decreasing this percentage, but they start to rub against the cost ceiling for the health care reform package set by Obama.
So even the no-brainer part of health reform isn’t no-brainer at all…
â€œOne man may hit the mark, another blunder; but heed not these distinctions. Only from the alliance of the one, working with and through the other, are great things born.â€
â€”Antoine de Saint-Exupery
(1900-1944), aviator, writer
“Sometimes it’s worth just not saying something that you want to blurt out… We need civility in the political world, we need it in the media world. We need it badly. There is a hunger for it. It may be a longer road to success but it’s worth taking that road.”
–Mika Brzezinski, today’s Morning Joe
Sam Tanenhaus, a student of the history of conservatism and author of The End of Conservatism***, told a story last weekend on Bill Moyers Journal:
There’s a very important incident described in this book that occurred in 1965, when the John Birch Society, an organization these new Americanist groups resemble — the ones who are marching in Washington and holding tea parties. Essentially, very extremist revanchist groups that view politics in a conspiratorial way.
And the John Birch Society during the peak of the Cold War struggle was convinced, and you’re well aware of this, that Dwight Eisenhower was a communist agent, who reported to his brother Milton, and 80 percent of the government was dominated by Communists. Communists were in charge of American education, American health care. They were fluoridating the water to weaken our brains. All of this happened. And at first, [William] Buckley and his fellow intellectuals at NATIONAL REVIEW indulged this. They said, “You know what? Their arguments are absurd, but they believe in the right things. They’re anti-communists. And they’re helping our movement.”
Cause many of them helped Barry Goldwater get nominated in 1964. And then in 1965, Buckley said, “Enough.” Buckley himself had matured politically. He’d run for Mayor of New York. He’d seen how politics really worked. And he said, “We can’t allow ourselves to be discredited by our own fringe.” So, he turned over his own magazine to a denunciation of the John Birch Society. More important, the columns he wrote denouncing what he called its “drivel” were circulated in advance to three of the great conservative Republicans of the day, Ronald Reagan, Barry Goldwater, Senator John Tower, from your home state of Texas, and Tower read them on the floor of Congress into the Congressional record. In other words, the intellectual and political leaders of the right drew a line. And that’s what we may not see if we don’t have that kind of leadership on the right now.
As if on cue, yesterday Joe Scarborough called out Glenn Beck:
“We’re going to have a conservatives’ honor roll on this show,” Scarborough continued, referring to his show, Morning Joe. “And trust me, you want to be on this honor roll. I’m talking to you Mitt Romney, and I’m talking to anybody who wants to be president in 2012 — you need to call out this type of hatred. Because it always blows up in your face.
“When you preach this kind of hatred and say that an African American president hates all white people you are playing with fire and bad things can happen and if they do happen, not only is Glenn Beck responsible, but conservatives who don’t call him out are responsible.”
***It’s worth noting that Tanenhaus distinctly does not want conservatism to end. He thinks it’s the heart of so much of what makes America unique.
Please help us welcome Chris Timmons, who will be making occasional contributions to The Village Square blog to share his insights and conservative sensibilities.
“What I don’t get,” says one of the regulars in Donald Westlake’s hilarious John Dortmunder novels, “is all these clouds.” It continues: “A second regular put down his foaming beer glass to say, “Clouds? Which clouds are these?
“That they’re sitting on…You look at all these pictures, Jesus sitting on a cloud, that other God sitting on a cloud, Mary sitting on a cloud —” Well, yeah, but the point is, can’t heaven come up with furniture?”
Westlake’s skewering of the ordinary man and his whims is one of the many delights of reading his novels. Do me justice: I’m an egalitarian man. I have no choice. I’m poor. Always been.
It interests me as cultural anthropology only —a man fascinated by his own kind.
So many of the notions we ordinary mortals get are out of place, disorganized by carelessness of fact, out of context, incomprehension of an idea —or just a plain unwillingness to be surprised by the randomness of the cosmos.
Do we have to be so knowing?
This health-care debate has been one of those great moments to really look at the virtues and limits of the regular working stiff.
My first attempt at this was watching some of the various town-halls on TV, beginning with Chuck Grassley’s. Then I carried myself to City Hall for our own town-hall with Allen Boyd and two medical doctors.
What I found was a bizarre and often mind-numbing recitation of statistics without factual irony, Bible-thumping and offers of prayer and prophesies of Armageddon, vile and boorish outbursts, rambling questions, and historical illiteracy.
These were to be expected.
Some people have reasons for these phenoms: The proliferation of niche media, the high-watt nature of its mandarins like Glenn Beck and Keith Olbermann, political ignorance, the politics of personal destruction, political inertia, power grabs, a fiscal free-fall, racism, cynicism.
With all opinions or constructs, a point could be made for all of these things being true.
I think there’s among regular folks too much confidence in their political judgments, a knowing-ness that prevents them from taking in all views. How else can niche media be so successful?
Political ignorance is at an all-time high. Most people don’t know a fig about our political heritage, haven’t done any steady reflection on the ideas that have shaped this country since the founding.
Yet they feel entitled to have any kind of opinion on current events. Not only have an opinion, but have politicians and pollster quaver about their superior judgments on public matters.
This is all crazy, of course. Just like heaven having furniture.
I happened to tune in yesterday to a few minutes of Sean Hannity to hear him rant about those controlling government folks again and their infernal state-run media, the Associated Press (which would probably come as a big surprise to the White House). This time it was in relationship to the flu vaccine and the government’s bent toward wanting to kill off all the old people. (Maybe everyone who works for the government was spawned – and probably by you-know-who – and doesn’t have parents themselves who might be among the killed-off?)
Hannity demonstrated his aptitude for flipping reality on its head while never needing to even pause to keep up with all the distortions. I’ve got to admit a grudging admiration for whatever talent that demonstrates. He implied (but didn’t quite say, which is probably his loophole) that the government was going to withhold life-saving flu vaccines from the most frequent victims of flu, our elderly parents. He quoted a couple of octogenarians saying it was OK with them, they’d had a good life and all and were willing to take one for the team. It all sounded so preposterous that I decided to look it up myself.
Here’s one of the AP articles:
The new swine flu seems no more deadly than regular winter flu, which every year kills 36,000 Americans and hospitalizes 200,000. But there’s an important difference: This H1N1 strain sickens younger people more frequently than the over-65 population who are seasonal flu’s main victims. So children are among the priority groups who are supposed to be first in line once swine flu vaccine starts arriving next month, and many schools around the country are expected to offer mass vaccinations.
Turns out that here is what is true:
- The role of the CDC and public health is – and has always been – identifying the most at-risk populations and addressing those needs first, then less priority needs after. How’d you like to manage a public health issue without the them? (Think the AIDS crisis, during which I’d argue we saw true heroism from those government bureaucrats Mr. Hannity likes to rail against.)
- Most years during the normal season flu outbreak, the most at-risk people are seniors both in contracting the illness and severity once contracted. Younger adults take their turn in line every year during flu season after the high risk elderly get vaccinated.
- This time, seniors aren’t the most vulnerable, young people are. (I ran into my doc last week and he said that so far he’s calling the swine flu the “piglet flu” – not so severe and contracted mostly by younger people.) Older people seem to have immunity to H1N1, so they drop in priority.
- The government (yes, government) along with drugs companies (yes, “big pharma”) get us our flu vaccines every year. Have no idea how they do it, but they do. Without them, the flu might just mow us all down.
Feel free to do your own sleuthing and give a yell if we’re missing something. I never could find any of Hannity’s quotes from government love-slave seniors willing to cash in their chips to save us $6.50. Please share if you can source them. Hannity’s implication is that millions and millions of Americans who don’t see things his way politically would actual be OK with denying their very own parents health care. Sheesh.
At some point, telling everyone that black is white becomes damaging. I’d say we’re there.
Don’t get your health news from Sean Hannity.
During yesterday’s President Obama talk show Round Robin:
Andâ€” unfortunately, we’ve got, as I’ve said before, a 24-hour news cycle where what gets you on the news is controversy. What gets you on the news is the extreme statement. The easiest way to get 15 minutes on the news, or your 15 minutes of fame, is to be rude.
And that’sâ€” that’sâ€” something that I think has to change. And it starts with me. And I’ve tried to make sure that I’ve sent a clear signal. And I’ve tried to maintain an approach that says, look, we can have some serious disagreements but, at the end of the day, I’m assuming that you want the best for America just like I do.
He also called ugly controversy “catnip” to the media. Ya think?
From a report from The Business Roundtable titled â€œPerils of Inaction: What are the Costs of Doing Nothing:”
â€œWithout significant marketplace reforms, if current trends continue, annual healthcare costs for employers will rise 166 percent over the next decade, from $10,743 per employee today to over $28,000 by 2019.”
In the book, Abraham by Bruce Feiler, he tells the story of an American who after winning fourteen thousand dollars on Wheel of Fortune, decided to come to Israel for a year. Fifteen years later he hadnâ€™t left. He tells a story to answer why:
Two brothers live on either side of a hill. One is wealthy and has no family; the other has a large family but limited wealth. The rich brother decides one night that he is blessed with goods and, taking a sack of grain from his silo, carries it to the silo of his brother. The other brother decides that he is blessed with many children, and since his brother should at least have wealth, he takes a sack of grain from his silo and carries it to that of his brother. Each night they go through this process, and every morning each brother is astounded that he has the same amount of grain as the day before. Finally one night they meet at the top of the hill and realize whatâ€™s been happening. They embrace and kiss each other.
And at that moment a heavenly voice declares, â€œThis is the place where I can build my house on earth.â€
â€œThat story is shared by all three religions,â€ David said. â€œAnd our tradition says that this is that hill, long before the Temple, long before Abraham. And the point of the story is that this degree of brotherly love is necessary before God can be manifest in the world.â€
â€¦This is not only the Spot where it is possible to connect with God, itâ€™s the spot where you can connect with God only if you understand what it means to connect with one another.
â€œThe relationship between a person and another human being is what creates and allows for a relationship with God. If youâ€™re not capable of living with each other and getting along with each other, than youâ€™re not capable of having a re1ationhip with God.â€ He gestured up at the Wall, the Dome, the churches.
Then he turned back to me. â€œSo the question is not whether God can bring peace into the world. The question is: Can we?â€
Here’s the rest of our draft ideas about health care reform. See the first part of the list HERE.
- We â€œrationâ€ now; the main question is whether we want to ration by what really works or by running out of money.
- Americans bear some personal responsibility for the rising costs; weâ€™ve gotten heavier & heavierâ€¦70% of all health care costs are lifestyle dependent.
- The current system encourages more treatment over better care; we need to flip incentives to de-incentivize quantity and incentivize quality.
- Reform requires increased power & choice by consumer; has to be patient-centered both in an economic and a clinical sense.
- Consider the concept of incremental improvements. Good results start with imperfect beginning.
- Lose the search for a villain; itâ€™s not helping us address the dysfunctions.
There is no magic bullet; one solution wonâ€™t do it and real change wonâ€™t come easy.
Everyone â€“ hospitals, insurers, doctors, patients, attorneys, the government â€“ has skeletons in their closet. The solution needs to have many fronts.
At this week’s Dinner at the Square we gave away door prizes by picking cherries with numbers on them out of a bowl. It was our little way of coming down firmly against cherry-picking facts.
Cherry-picking is epidemic these days. People use it as a launching pad for their fury. You see, if you can ignore the context of the many facts surrounding a problem, a situation, a person, an organization – then you can continue in your self-righteous fury unabated. And self-righteous fury is sooo the new lazy.
Gone are the old-fashioned days when more of us sought to understand each other, tried to grasp the facts, and might have even given putting them in context a go. Anger is sometimes the appropriate response after all that, but these days it’s out-of-the-starting-gate-de-rigueur.
Our institutions are beginning to reflect our hair-trigger fury and bent towards preferring only the facts that support how we want to feel. The market-tested-out-the-wazoo-uber-individualized culture we live in knows exactly what we want and we want fury. And they’re all about giving us what we want. Fury is good for ratings. We have whole evenings of programming devoted to cherry-picking in service of fury. It sells newspapers too. (Or maybe it doesn’t because really furious people aren’t usually mollified by being thrown bones. They’re like fury crack addicts who will just want more.) Maybe we’re getting the television, the newspapers, and the Congress we deserve.
Picked cherries lately?
Here is a draft of wisdom drawn from our work learning about health care. It doesn’t yet incorporate last night’s input from our very wise panel. We know it will be hard, but part 2 is tomorrow.
- The current rising prices of health care are unsustainable; doing nothing is not an option. Rising costs hurt us as consumers, they hurt small businesses, they hurt larger businesses competing in global markets.
- It is important to avoid using anecdotes as a basis for reform rather than examining evidence in a more systematic fashion.
- Free market forces are not functioning properly in health care to find efficiencies.
- Insurer between doctor and patient pays bill; no incentive for conservative care and no supply and demand curve.
- Patient lacks specialized knowledge and adequate information to function fully as informed customer.
- Who bargain shops for their triple bypass?
- We have a concerning shortage of primary care physicians because it is not financially rewarding compared to specialization. There is potential for other physician shortages with a larger pool of insured subsequent to potential reforms.
- Potential point of consensus: Combine individual mandate for insurance with portability and prohibition for both excluding pre-existing conditions and recision of policies.
- If there is a pubic plan, there has to be a level playing field; it cannot pay 80 cents on the dollar as Medicare does. Better model is federal employeeâ€™s health plan.
- Single payer is not the same as socialized medicine. Single payer replaces private insurance as the source of payment; socialized medicine means all physicians are employed by the government, which also operates hospitals.
- This problem requires long-term thinking. Politicians will always think in 2,4, and 6-year cycles. Itâ€™s us, the people, who have to think 50 years out and insist that they do too.
- The health care industry is full of structural distortions; people respond rationally to the economics created by the distortions.
Tonight we’ll be having a real discussion about health care, with the range of opinion and experience at the table. We’re sorry if you couldn’t join us, but I wanted to take a moment to tell you how you (along with everyone else who is interested) can be there next time.
The Village Square is currently a national finalist in the Knight Community Information Challenge. Our proposal is that we will be a model for the town hall of the 21st century. Imagine instead of just one room of people, we can have a streaming broadcast of the program online, complete with being able to answer online viewer questions as well. You can join us in the slippers, no babysitter required. Imagine if you could participate in solving our problems as we build an information base and decision matrix as a resource to citizens confused by the constant partisan back and forth.
The key to seeing this happen is…. drums are rolling… YOU. Knight will ultimately judge us by how well we meet the local portion of the fundraising goal: $50,000. They want to see that YOU like us, that YOU, support us. If we win (and we think we will) then your donation to us will be tripled. (Beats Wall Street any day.) You can donate to us online HERE. Or you can mail a check to: The Village Square, PO Box 10352, Tallahassee, FL 32302. Donations to The Village Square are tax-deductible.
Our next step will be moving our concept to new cities. We think our model is inexpensive to run and highly effective for the minimal investment. We hope you’ll consider investing in us.