Wednesday, July 22, 2009

Here I Go Again Asking Unpopular Questions

I don't always look before I leap. I don't always watch my mouth. I often say things I wish I could take back. I often email messages I should have read more carefully. Hence why I will never run for public office. I want to jump into this health care debate, but I am having reservations about do so. And here is why. I have no idea what it would take to provide an answer that would make sense and be fair to enough people.
If you polled (you know we're so fond of polls in this country. Apparently you can figure out any right answer just by taking a poll) the American people in general, you would get similar answers across the board on health care. What I don't understand is why no one with representative power is listening. Why spend the money on the poll if you're just gonna toss out all the responses? Maybe to make the American people stop paying attention long enough to get this bill passed and go home so you can start campaigning for 2010? Perhaps I'm too cynical. Last time I checked though, it's all politics all the time. Which is why a satisfactory answer to health care is not going to come any time soon.
I've come to the conclusion there is no way to run a true issue-based campaign anymore. For one thing you still can't win (on a grand scale) as a third party candidate--it's too expensive. And in order to find "consensus" you have to sell your soul to Satan. Believe me I'm all for our Republic. After all, town hall democracy only works in town halls. For a country this large and this complicated, you have to have a representative republic. It's the best way to diffuse power grabbing and to slow single interests that may not be in our best interests. That's why it takes so damn long to get any laws passed. This is a good thing, truly. However, the downside to our Republic is that we've high-jacked ourselves by special interests and two party politics. Most representative Republics are multi-partied in general... but back to health care. I guess I'll jump in the fray while I'm on a roll.
If we are truly TRULY interested in reforming health care, we have to decide what we are going to reform. Are we going to reform the way we practice medicine? Are we going to reform the way we reimburse expenses? Are we going to reform our insurance system? What exactly are we going to change? And of course, how are we going to pay for it? I think the problem with health care reform (and I've said this before) is that we are talking about health care as if it is a single problem. Health care is so multi-faceted it's no wonder the current bill is 1000 pages. Excessive yes, but not surprising. Here are some questions that might make the next bill a few pages shorter, and maybe a bit meatier:

1. How do we create a system of preventative care available to all citizens? I think this is the fundamental question that is up for debate when we are talking about providing universal health care. Meat and potatoes medicine. Well visits, vaccinations, health screenings, blood work, basic cold and flu. Insurance companies don't make any money of off this kind of medicine, but people without insurance don't have access to this type of medicine in a way that is affordable to them. Health departments and ERs and walk-in clinics pick up the slack and are OVERRUN with people without the money to pay for basic routine care. This is one area I think is imperative that we figure out.

2. How do we create a system pool that spreads the risk of all these health problems that doesn't cost a gazillion dollars? I don't think we can. I think a pay as we go system is ultimately the only way we're going to be able to go in the end. I'm in a minority with this opinion, but it's what I think. Pretty much you pay as you go in other countries who have socialized medicine now. The universal bit is the preventative, basic stuff. If you want treatment above and beyond you go to the States. Insurance is basically a scam on healthy people that disproportionately favors people with health issues, that is until they lose a job, or move, or can't pay the premium anymore. If we're going to commit to a system that helps everybody we're going to have to put limitations on what helping everybody means. And we don't like to do that in America--at least not on camera. The way we work it now is to allow insurance companies to perform criminal acts like hiking insurance premiums to levels that people can't pay, dropping people unnecessarily without warning, and enacting the pre-existing condition clause whenever the mood strikes them. I think these above-mentioned practices are worse than a pay as you go system. It leaves people in a lurch, without hope, and in debt beyond what they will ever be able to pay. If you get kicked off your insurance policy or you can't pay the premium anymore, can you get a refund on all those months you paid that you didn't use the system? Now that would be exciting. But that would be like expecting a social security check when you're 67.5 years old if you were born after 1960.

3. How are we going to pay for research? We love the research. We love the potential cures. We love the fact that so many ugly things have been wiped out or are now manageable with drugs. It's part of what we do in America. I'm all for it. Someday I may need it. But it costs money. LOTS of money. There isn't an R&D budget in the country that could satisfy an immunologist or a pathologist. That's what they do. They search for a better way. It doesn't come cheap. It's not because they demand huge salaries, it's because what they do is very expensive. Did you really think a cure for cancer would be cheap? Do you really think AIDS will go away if we throw enough money at it?

4. How do we pay for an aging population? This is a serious question that is only going to get more serious. We walk a fine line in this country when it comes to saving people and helping people live longer. Think of all the degenerative diseases out there can last half a lifetime for people. Alzheimer's comes to mind right out of the box. Think about how early we save preemies in this country--24 weeks now. Not only do we "save" the very old indefinitely, but we "save" the very young too. I write the word "save" in quotes because sometimes I wonder what kind of life we are saving people for. I would rather take a bullet than spend my remaining years in a hospital bed in a skilled nursing facility. And there is a reason a human baby takes 40 weeks to make. Please don't misunderstand me. I don't mean to be callous, uncaring, or insensitive. I would never do that on purpose. If it was my child or my parent I would want heroic measures taken if I thought there was any chance the measures would work. We've made such huge strides in modern medicine in the last 100, 50, 25, even 10 years that there is every reason in the world to try to save a person. Doctors are successful alot of the time. That's what makes medicine so hard and why I'm not a doctor. How do you make rational decisions about life and death? I tend to emote more than rationalize. I wouldn't be good at medicine. Medical decisions from routine to cutting edge costs lots and lots and lots of money. And we want to pay for everybody. Everybody. Everybody.

5. How are we going to pay for it? Please please please don't say rich people. I'm over that answer. Wealthy Americans already pay a disproportionate amount of the bill already. I'm not sure when America (the place people STILL to this day come to be all they can be and make a better life) decided that rich people are the devil. Not only is it oxymoronic, it's demoralizing and frankly unjust.
While I'm harping on tired old rhetoric, the lines about how criminal it is that the richest country in the world has people who are poor, who don't have this, that, and the other is growing thin and tiresome. Did anyone ever take a moment to think that not everyone wants to be saved? Has anyone ever tried to determine what poor means? Did anyone ever take a moment to think about whether or not it is the fiscal responsibility of the rest of us to take care of everybody?
Conservatives run into problems when they try to answer the question of fiscal responsibility. It isn't that their logic is wrong, they just can't sell the response. 1) No it is not every person's fiscal responsibility to take care of everyone else. But there are many people out there who are in serious need by no fault of their own. 2) It may not be our fiscal responsibility, but there is a pretty powerful argument that we have a moral obligation or personal conviction to take care of those who cannot take care of themselves, or those in a spot of trouble, or who could use a hand up. Some people call that American patriotism. Some people call that Christianity in action. But then again, our President just spent a great part of his first 6 months convincing the world we aren't a Christian nation, so I'm not sure about that argument anymore. Last time I checked we didn't have an official religion or language, but I'm pretty sure we are a tolerant, Christian nation with a healthy dose of religions represented who worship in peace within the borders. I could be wrong.
The problem with the "who deserves help argument" is 1) the government does not discriminate between deserving and undeserving. If it did, no one would ever get a fair shake in the judicial system. Vigilante justice would prevail. Our founding fathers guarded against derailing a fair process by eliminating a deserving/undeserving argument as much as they could. 2) When money stays local, it's easier to discern the best use of funds to reach the most people. Now the government wants all that money and local sources of discernment are drying out. 3) Many of those we help cannot be put to the test because they are either children, victims of circumstance, or disabled. The part I can't figure out is how I am to help the people I am morally obligated to help when all the money I would use to help them goes to a morally reprehensible group of people located inside the beltway about 8 hours north of here under the guise of the IRS and some misguided notion that it is my patriotic duty to pay more because I make more.
So anyway, I hope Congress can figure all this out before the Summer recess. I'd hate for the momentum of insanity to be stopped by any serious questioning of voters. How on earth are we supposed to find serious, even-handed, long-lasting answers when we're rushing to pass a bill that no one has read!?!?!?! I tried to read it. I didn't make it all the way through. My husband thinks I've read more of it than most Congress members. He may be right, but Congress does have staffers to do that sort of thing for them. I urge you to contact your representatives and talk to the latest staffer about your questions on health care legislation. At least leave a message saying how you feel about it.
Meanwhile, I'm going to keep tossing up these random questions even though the firestorm of responses from some of my friends will reign down upon me. Somebody has to ask the unpopular questions right? It's not like I'm running for office. I couldn't ask these questions if I had serious designs on an elected office. What does that say about us as voters? If I were to campaign on the serious, untouchables of politics I couldn't get elected at all. Hmm, definitely a blog for another day.

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