Things done wrong, things done right on national health care

I think that the vast majority of Americans want health care for themselves and everybody that they love, and want the price for that to be affordable. I think that the vast majority of people who are satisfied with their existing health care insurance plan have never experienced a truly catastrophic medical emergency, or they’d have to revisit the values of their own status quo medical plan.

I was once covered by a medical program that forced me to pay 25% cost share of my family’s medical bills. This was acceptable if my wife broke a leg skiing, but would have put me into bankruptcy if she had broken her back. When I broke my back, the two hospitals that cared for me put up accounting charges of about half a million dollars in the first few weeks – but nobody came in for an early shift, no extra people were hired, and the majority of my expensive care was simply watching me either heal or fail.

Okay, 25% of 500K is $125K, which, tacked on to my permanent loss of income as a pilot, and with my traditional USian home mortgage, would have wiped me out under the insurance program that once applied, and which is similar to many that prevail today.

An awe inspiring number of Americans are perfectly comfortable with insurance programs that limit out when things go very bad. If they’re lucky and never need critical care, and nobody in the family develops a chronic catastrophic illness, they’ll never realize that they’re paying good money for a service that, if they did fall to a catastrophic illness, would put them in the poor-house, make them unable to pay their insurance bills, and then be taken away from them entirely for non-payment. Can that happen? Does it? Yes, in cases across this nation, in every calendar year.

In 1993, Congress over-rode HillaryCare because she folded on taking the insurance industry out of the driver’s seat on medical costs. Congress was absolutely correct to do so. Insurance companies create an interesting form of medical market place, that in another business would be frowned at as completely unethical, and rightfully so. I spoke to an obstetrician during Teri’s last pregnancy, who mentioned that he paid $220K per year for malpractice insurance as a successful obstetrics specialist with a good record, who hadn’t been sued. His personal malpractice insurance was about twice what my maximum pay has ever been. Health insurance companies generally spend about 30% of their income on shearly internal administration, and the medical community has to put up a good chunk of its income on staffing to meet insurance company demands for documentation. This is not done in the face of a real problem with medical embezzlement, IMO, but in an effort to make insurance companies seem necessary. I might be wrong on that.

Insurance companies have a way of making themselves absolutely mandatory by paying whatever the medical provider demands. This completely eliminates the market forces of supply and demand, and thus, any pretense of realistic free enterprise cost controls. An example would be the night I broke my back. An ambulance picked me up at Maui’s major airport and drove me four miles to Maui Memorial hospital. This ride cost about 17 grand. The whole ambulance event took an hour, and everybody involved was already at work. The people who did the work certainly didn’t make 17K for it. My insurance was handled by some combination of Tricare and the federal government, who did not authorize that much expenditure, and shut down the providers complaints when they tried to come back to haunt me for the difference. The $150K or so that Maui Memorial made during the four days I was resident there didn’t involve anybody coming in to work, or any surgery, or any major exhaustive effort. I received MRIs and CAT scans from equipment on site, by staff who were already at work. You could argue that my instantaneous costs were then spread out over time to pay for staff when there wasn’t an ICU case, but realistically, the hospitals in this country always have enough beds filled to pay for their day to day operations and building maintenance. No traditional insurance provider would have squawked a bit about those fees, for the simple reason that traditional medical insurance companies fully depend on the cost of critical care being beyond the reach of the average American. Limited duration high cost emergencies are where traditional insurance companies look best, and get the lion’s share of their letters of appreciation.

I remember bunches of Republicans in 1993 telling their constituents that getting health care under control was a huge priority for this country. But from the day the Republicans took over congress, until they were thrown out in 2009, they never once fronted a major health care reform bill. Not once. My Congressman, Don Young, and my Republican Senator Lisa Murkowski, wrote me following the passage of Obama’s health care plan to tell me, not that people don’t need or want a national health care program, but that they had voted against the plan as written, because it was a bad plan. I agree with them. It’s a bad plan because it caves in to the National Health Care Insurance corporations, just as HilaryCare did a decade and a half ago. Egads, does that mess need to be fixed.

But Obama’s plan is world’s better than the great plans the Republicans fronted during their stay in office. I guess you could say those plans were the ultimate in paperless office practice, since nobody can find them or read them.

During my years as a voter, I’ve voted Republican more times than Democrat. But I’m voting for the man or woman who commits to national health care being a reality, regardless of party, until this mess is straightened out.

What mess? The mess that has the U.S. spending 16% of our world’s largest GNP on health care, when poorer first world nations, which is to say, all of the other first world nations, spend 10% of their smaller GNPs on health care, and are in just as good of health as we Americans are. The mess that forced my wife’s mother to remain in Boise, ID, for the last several years of her life, because her health care plan only covered her while she lived in Idaho (it covered benefits while she took trips, but not if she moved away), and she couldn’t, at 90+ years old, find another insurance carrier (Age is a preexisting condition). The mess that forces small businesses to pay $1500.00 or so per month for each of their full time employees to have medical care, which forces many of them to make almost all of their employees work part time so that they won’t have to cover full time benefits (not a new situation, my sister spent twenty years working several concurrent food industry jobs, because none of her bosses could afford to pay her benefits as a full time worker). The mess that forces doctors to pay more than I’ll ever make in a year, every year, in order to be insured against the most litigious community in the world, which jacks up prices, which are paid by insurance companies who hire expensive lawyers at both ends of the deal. The Insurance and litigation societies of America are in some sort of unholy alliance that I’ll talk about during some other rant. I want to talk about it separately, because I don’t think that unholy alliance is really intentional on anybody’s part, it’s just real …

What mess? Medical professionals should be the most respected members of US society. Not just the doctors, but the daily care professionals who do most of the heavy lifting. If you’ve messed with blood and shit to help somebody survive, you’ll understand my stance that it’s the toughest work in the world, with as much heartbreak as joy to look forward to. But the people who make hospitals work aren’t where the money is going. The doctors who are making the huge incomes the Democrats tend to deride, are kicking those huge incomes back into self protection against customers who aren’t evil, and generally aren’t even convinced that the doctor was at fault. What they are is grieving and destitute from paying their cost-share. Medical care professionals should be among the most respected members of American society, but they don’t need to be the richest. Maybe they all ought to be paid as well, and as reliably, as the active duty military ought to be.

Too many messes? No fix? I don’t believe it. I think the Democrats luffed in accepting the insurance industry as a viable overlord for medical costs. I think the Republicans and libertarians are trading away the best good of America on a theory of every man is an island, when poor Republicans who can’t pay for their own emergency care nonetheless vote to support a status quo that isn’t working, and is growing worse by the month, because they fear that fixing it will somehow be worse than pretending it ain’t broke.

Compared to health care costs, I don’t care about gays in the military. I don’t care about abortion. I don’t care about civil rights. I don’t care about the ACLU. I don’t care about most of the hot-button issues that consume the media, because they are qualitative, and don’t affect the vast majority of us. America is rapidly becoming slave to health care costs. Our unemployment situation is made much, much worse by the hidden costs of being an employer, which often enough are as great as the take home pay of full-time employees, and which almost all translate out to health care costs (medical and dental and workplace injury, Oh My!). Oh, I do care about the other things, but they aren’t going to destabilize our economy or our country’s political existence. Health care costs, left to be stabilized by market forces that don’t exist, are more than sufficient to do those things, during our lifetimes.

Skipping Church

I’m skipping church because my daughter isn’t feeling well. I’m not helping her to get better, or taking care of household chores so that Teri can nurse her I’m not really sure what my logic train is, but since Alexa doesn’t feel well enough to go, I kept us all home, and now I’m hiding in the basement blogging.

Okay, it may be that I’m hiding in a more general sense.

We have two lovable puppies terrorizing the house, I owe a semester schedule to my late starting class, who just handed me a truly enjoyable set of first essays (which I gave back last week), and my regular classes gave me their essays last week, which means I owe them graded essays tomorrow. I’m having to take security and file management courses for the job I start in December. Unpaid hours and days of electronic misery, upon which my new job, which won’t quite pay for the creaky Alaska Dream Home/money pit, and our weekly forays to Red-Robin where we live beyond our means, depends.

My space opera lies fallow, badly wounded and perhaps dying on the vine, victim of unkind words by an agent I wanted but who I can’t work with, and by the fact that I must re-rack my thoughts to push writing down to tier two – stuff that I like to do, but shouldn’t obsess about since there’s no sign that I’m ever going to have an income stream from that avocation. I’ve got a bunch of agent queries out, and a whole new list of potential agents to query.

I’m not processing rejections well in two ways. One, I’m not keeping an adequate tracking sheet, so I’m no longer certain that I’ve sent queries or submissions to certain presses. I need to fix that. Two, I’m letting rejections for stupid reasons bother me for weeks, when I should just write them off. A major U.S. publisher can’t even look at Zook Country because I’m without an agent, and it’s being published in German, by a small press. I got a nice note from their slushpile editor and we went back and forth on the issue for a couple passes, but it comes down to she’s not allowed to read the manuscript because somebody in Germany liked it enough to publish a couple hundred copies – even though that version is entirely in German, and my English Language rights are completely unconstrained. Then, an agent who I had really thought would like my work rejects it after a full year for reasons that make it clear he completely missed a sub-text that every beta reader I’ve had picked up on immediately.

I’m whinging. I’m at that stage where I have enough things I ought to do that I’m sitting around talking about how busy I am rather than actually doing the work. And the sad thing is, my whole to-do list would have been minor chores back when I was on active duty.