Joe Biden's victory in South Carolina shows that the forces of reason are reasserting themselves in the topsy-turvy Democratic Party. The moonbats of progressivism are being brought to heel by the adults in the room.
Realpolitik rules. It's what makes government work, and what makes it a constant disappointment. As I observed in the previous post, what makes a politician on the nominal left electable is the assurance that he or she will continue the inexorable pull to the right.
In the quest for electability, candidates like Joe Biden, Michael Bloomberg, and Pete Buttigeig all in varying degrees make sure that the broader electorate knows that they will not support things like an actual system of universal health care based on patient outcomes rather than corporate income. They don't use the word "free" to refer to education. Nothing is socialistic.
Socialism is a scare word with good reason. It has much less power now than it did when our global nemesis was the Union of Soviet Socialist Republics, but the USSR did plenty to tarnish the brand, which -- in its purest form -- is a recipe for just another kind of heavy-handed government. The negative stereotype has wide, deep roots and a dense, hard grain that you won't cut just by insisting that this socialism is democratic, and doesn't really mean what one definition of the word has always meant: government ownership of the means of production. It's been politically risky from the outset to try to turn socialism into a proud badge of American identity. It was one of those things that you would try to ignore, while focusing on the actual good things offered by the movement. But too many people can't overcome their ingrained visceral repulsion at the term. And then there are the wealthy, who stand to lose, bigly, with the institution of any form of widespread democratization in the workplace and the economy at large.
Small business owners may be even more afraid of humanitarian movements, because small businesses are much more vulnerable to all sorts of destructive forces. Technological developments or social trends may kill demand for your product or service with no quick route to regain your revenue stream. Rising wages not coupled with other social improvements like universal health care and affordable access to education and retraining may make employees too expensive, even though your business volume calls for more personnel. But because universal health care has been widely reviled for decades, you know as a business person that it's too risky even to try. Because everything in this country since 1980 has been based on the pursuit of profit and the glorification of wealth, it's un-American to suggest that education should be subsidized and expanded.
Tax policy could be designed to extract much more from the big earners, especially the corporate behemoths that profit inversely to their social responsibility, but that would require an overhaul of investment culture at its most basic level. Good luck with that.
This is why we can't have nice things: because the people with lots of nice things don't want to give any of them up, and the people who have managed to scrape together a few nice things know from sad experience that they are the ones who will get squeezed if any pie-in-the-sky programs get adopted. The wealthy who control the government will make sure that they get their preferential tax policy no matter what crazy bills manage to crawl all the way through an accidentally and temporarily progressive majority in Congress and get signed into law by the odd and occasional Democratic chief executive.
Even Democratic and unaffiliated voters who might want those nice social policies are afraid to ask for them because they know they will get hammered by the opposition from the GOP, corporate Democrats, and right-leaning unaffiliated voters.
The unifying factor among the majority of voters is that they want to make plenty of money, pay as little as possible in taxes, and take no real risks. Even the lefties who say they don't mind if their taxes are high only accept the taxation as long as the money goes to the kinds of social programs they believe are ultimately good.
Policy fails because its proponents can't convince enough people that it is ultimately good. Because any policy usually takes a long time to show results, the waiting period often spans an election cycle, giving disappointed voters a chance to flip the party dominance in retribution. This generally derails beneficial social policies more than destructive ones, because nurturing and growth are slow processes that require patience. Destruction often shows quick profits, even if they're only a benefit to the rich getting richer. Economic pundits can still point to positive numbers as evidence that this is the way we should have been headed all along. That goes back to the fundamental toxicity underlying investment for profit. And the conservatives gravitate more readily to a warlike model of political interaction, which bolsters gerrymandering and dark money contributions to advance the glorious cause of unlimited wealth on a finite Earth.
Showing posts with label Health care. Show all posts
Showing posts with label Health care. Show all posts
Sunday, March 01, 2020
Tuesday, September 25, 2018
The Rat Maze of American Health Care
In January 2017, I passed a kidney stone. I self-diagnosed, and got through the long night of pain with only profanity, lots of water, and a little bit of beer -- taken medicinally for its diuretic qualities -- to get me ready for work the next day.
After several months, I thought it might be a good idea to inform what passes for my primary care physician that I had suffered this misfortune. I used to go to an actual doctor, but he took advantage of his superior financial decisions to leave the practice and go adventuring. He was a bright guy who laughed at my jokes, but he was also really good at keeping the clinical wall between us. The practice has not provided a consistent replacement practitioner since his departure. The nominal MD at the head of it has never seen me as a patient. The people I have seen have been delightful, but the place seems to be the last stop before imminent retirement for all of them. Or, if it's a young PA or someone like that, it's just a stepping stone on the way to greater things. There's no continuity and little sense of any more than formulaic care for the person rather than the customer.
As an uninsured American -- or even as one with the typical overpriced, under-insuring policy -- I was reluctant to get into the investigation at all, because of the bureaucratic rat maze and unclear pricing of health care services. Because there is no uniform standard for charges and service quality, people travel a long distance to find either providers "in their network" or self-pay prices that they can afford for diagnostic services that their insurance company's accountants have deemed unnecessary to cover.
Does every community disparage its local hospital? Certainly the one around here has garnered its share of scathing reviews from former patients and the surviving family members of patients who didn't make it. Whatever the truth of the matter may be, local gossip describes it as a place to pay too much for too little when you have no other choice.
Because health care is a marketed commodity in this country, health care providers use advertising to communicate, rather than presenting information fully, completely, and readily accessibly. Hospitals are selling themselves. They want you to be happy with the result so that you will patronize them again and tell your friends that it was good, but if you're not happy they'd prefer that you shut up and stay out of sight, same as any other business would. A good business tries to learn from its dissatisfied customers, but dissatisfied customers do not feature as the lead element in any of their advertising.
By a stroke of pure chance, a customer at the bike shop where I work is a nephrologist in the Harvard Medical School system. He had offered many times to help any of us with medical issues. Indeed, as one of the leading researchers studying polycystic kidney disease, he had been very helpful and comforting to my wife and members of her family after they discovered that several of them had that genetic disease. So, when I had a kidney issue, I eventually turned to him. Because he had no commercial motive, and his credentials as a scientist are impeccable, I trusted his judgment.
Unfortunately, his ability to conduct examinations and treatment is limited by his contractual obligations to the hospital in Boston where he works. He can provide his time and knowledge, but no lab work or medical imaging. I have had to scrounge those up for myself, with as much guidance from him as he can provide.
The process of navigating the health care labyrinth is awkward enough without adding any confusion. I already felt unwelcome because of my inconvenient income level and the fact that I don't sport the brand logo of an insurance company. The health care industry in this country is geared toward extracting as much money as possible from reluctant third-party payers. They seem very accommodating to self-payers. But because the majority of participants in the system operate within the framework of the adversarial game between insurance companies and medical facilities, things are very compartmentalized. The seeker of services has to open every door and look in every room with few allies who don't have their own financial stake in the game.
When I go to the local hospital for a service requested by a Boston doctor, what will the local providers think...if anything? Will it occur to them that this is an outgrowth of the intimidating facade of commercialized medicine? Or will they just be resentful that I seem to consider myself "too good" for them? Conversely, will they automatically pigeonhole me as a charity case, uninsured because I am destitute, or a cheapass who simply refuses to fork over the coin for a real insurance policy?
When I was a kid, it was simple. If I got sick, my parents took me to the doctor. If I needed more than what the office could provide, it was arranged. Granted, my parents had the backing of the United States government through CHAMPUS. And I was a kid. Complexities were hidden from me. But health care on the whole seemed a lot more systematic, geared toward healing rather than cash flow.
As I read the history of CHAMPUS, and its transition to the current Tricare system, between the lines I infer that a growing population of people who don't die of their injuries and ailments puts increasing financial strain on any system of medical care. That would be true no matter who is paying, so it does not in the least justify our current American system based on profiting from fear and ill health. But it does explain how accounting departments looking to shift costs would entertain increasingly complex mechanisms to divert expenses onto someone -- anyone -- else. This burst forth in the 1980s and has mostly gotten worse as our country does anything it can to avoid settling down to create one coordinated system based entirely on patient outcomes rather than its own income.
Discouraged by the prospect that any pursuit of health services could metaphorically lead me down an alley where my pockets would be emptied, I have been very slow to follow up on my situation. Having an illness is bad enough. Feeling like an illness turns you into some corporation's cash crop makes it all the worse. I feel like a beggar, and a blind beggar at that. I dropped the ball last autumn after the first round of lab work ordered by my nephrologist friend because I still felt awkward taking him up on his offer, no matter how often he had repeated it. When he confirmed it this summer in person, I felt like I'd let him down by taking so long to go further. But I still have to make the contract for services and pay whatever the bill turns out to be when the dice finish rolling and stare up at me.
In the end, looking for cost-contained, competent medical advice and treatment, I'm not sure if I merely made it much more complicated as I try to manage the interface between my doctor friend and the other service providers in the process. And my situation isn't the stereotypical nightmare of phone tag with higher and higher levels of corporate supervisors that a lot of really sick people have to go through. Imagine having a really serious illness and having to go through a process clearly designed to weed you out.
A genuine system of universal care is decades overdue in this country.
After several months, I thought it might be a good idea to inform what passes for my primary care physician that I had suffered this misfortune. I used to go to an actual doctor, but he took advantage of his superior financial decisions to leave the practice and go adventuring. He was a bright guy who laughed at my jokes, but he was also really good at keeping the clinical wall between us. The practice has not provided a consistent replacement practitioner since his departure. The nominal MD at the head of it has never seen me as a patient. The people I have seen have been delightful, but the place seems to be the last stop before imminent retirement for all of them. Or, if it's a young PA or someone like that, it's just a stepping stone on the way to greater things. There's no continuity and little sense of any more than formulaic care for the person rather than the customer.
As an uninsured American -- or even as one with the typical overpriced, under-insuring policy -- I was reluctant to get into the investigation at all, because of the bureaucratic rat maze and unclear pricing of health care services. Because there is no uniform standard for charges and service quality, people travel a long distance to find either providers "in their network" or self-pay prices that they can afford for diagnostic services that their insurance company's accountants have deemed unnecessary to cover.
Does every community disparage its local hospital? Certainly the one around here has garnered its share of scathing reviews from former patients and the surviving family members of patients who didn't make it. Whatever the truth of the matter may be, local gossip describes it as a place to pay too much for too little when you have no other choice.
Because health care is a marketed commodity in this country, health care providers use advertising to communicate, rather than presenting information fully, completely, and readily accessibly. Hospitals are selling themselves. They want you to be happy with the result so that you will patronize them again and tell your friends that it was good, but if you're not happy they'd prefer that you shut up and stay out of sight, same as any other business would. A good business tries to learn from its dissatisfied customers, but dissatisfied customers do not feature as the lead element in any of their advertising.
By a stroke of pure chance, a customer at the bike shop where I work is a nephrologist in the Harvard Medical School system. He had offered many times to help any of us with medical issues. Indeed, as one of the leading researchers studying polycystic kidney disease, he had been very helpful and comforting to my wife and members of her family after they discovered that several of them had that genetic disease. So, when I had a kidney issue, I eventually turned to him. Because he had no commercial motive, and his credentials as a scientist are impeccable, I trusted his judgment.
Unfortunately, his ability to conduct examinations and treatment is limited by his contractual obligations to the hospital in Boston where he works. He can provide his time and knowledge, but no lab work or medical imaging. I have had to scrounge those up for myself, with as much guidance from him as he can provide.
The process of navigating the health care labyrinth is awkward enough without adding any confusion. I already felt unwelcome because of my inconvenient income level and the fact that I don't sport the brand logo of an insurance company. The health care industry in this country is geared toward extracting as much money as possible from reluctant third-party payers. They seem very accommodating to self-payers. But because the majority of participants in the system operate within the framework of the adversarial game between insurance companies and medical facilities, things are very compartmentalized. The seeker of services has to open every door and look in every room with few allies who don't have their own financial stake in the game.
When I go to the local hospital for a service requested by a Boston doctor, what will the local providers think...if anything? Will it occur to them that this is an outgrowth of the intimidating facade of commercialized medicine? Or will they just be resentful that I seem to consider myself "too good" for them? Conversely, will they automatically pigeonhole me as a charity case, uninsured because I am destitute, or a cheapass who simply refuses to fork over the coin for a real insurance policy?
When I was a kid, it was simple. If I got sick, my parents took me to the doctor. If I needed more than what the office could provide, it was arranged. Granted, my parents had the backing of the United States government through CHAMPUS. And I was a kid. Complexities were hidden from me. But health care on the whole seemed a lot more systematic, geared toward healing rather than cash flow.
As I read the history of CHAMPUS, and its transition to the current Tricare system, between the lines I infer that a growing population of people who don't die of their injuries and ailments puts increasing financial strain on any system of medical care. That would be true no matter who is paying, so it does not in the least justify our current American system based on profiting from fear and ill health. But it does explain how accounting departments looking to shift costs would entertain increasingly complex mechanisms to divert expenses onto someone -- anyone -- else. This burst forth in the 1980s and has mostly gotten worse as our country does anything it can to avoid settling down to create one coordinated system based entirely on patient outcomes rather than its own income.
Discouraged by the prospect that any pursuit of health services could metaphorically lead me down an alley where my pockets would be emptied, I have been very slow to follow up on my situation. Having an illness is bad enough. Feeling like an illness turns you into some corporation's cash crop makes it all the worse. I feel like a beggar, and a blind beggar at that. I dropped the ball last autumn after the first round of lab work ordered by my nephrologist friend because I still felt awkward taking him up on his offer, no matter how often he had repeated it. When he confirmed it this summer in person, I felt like I'd let him down by taking so long to go further. But I still have to make the contract for services and pay whatever the bill turns out to be when the dice finish rolling and stare up at me.
In the end, looking for cost-contained, competent medical advice and treatment, I'm not sure if I merely made it much more complicated as I try to manage the interface between my doctor friend and the other service providers in the process. And my situation isn't the stereotypical nightmare of phone tag with higher and higher levels of corporate supervisors that a lot of really sick people have to go through. Imagine having a really serious illness and having to go through a process clearly designed to weed you out.
A genuine system of universal care is decades overdue in this country.
Monday, December 11, 2017
Health insurance makes me sick
Whenever enrollment opens for the so-called Affordable Care Act's health "care" marketplace, I get numerous emails urging me to sign up for the great coverage secured at horrendous political cost back when Congress sold us all into bondage to the health insurance companies. Every year since the trap finally snapped shut on all of us, I have run the numbers and figured out that the penalty is noticeably cheaper than the premium for a policy with a huge copay and deductible. But it's not about the money.
The ACA penalty definitely impacts my life. But there's a larger issue here. A health insurance premium goes directly to an insurance company in an industry that profits most by denying care, not by facilitating it. It's like being forced to buy bullets for the firing squad that is going to kill you. The perky little article on Obamacare Facts -- that explains the mechanics of the penalty and how it is spent -- never addresses the predatory nature of profit-driven health insurance and health care, but at least indicates that the money is used to help people in need. It's still filtered through the profit-sucking filter of insurance companies, for the most part, but at least it is not directly from my hand to their insatiable gullet.
I won't deny that I am frightened, living outside the illusion of protection. But illusion it is. The longer we keep feeding the beast, the longer the beast will live, regardless of how it shortens individual life spans in its customer base. Customer survival is not important. When you die, some other poor frightened bastard will already be there to keep paying into the system and getting little in return.
My advice to anyone, young or old, is to find something you really enjoy doing, that is likely to kill you. It can be anything: picking fights in bars, heroin, cocaine, unroped rock and ice climbing, driving a motorcycle really fast, BASE jumping, open water swimming, taunting sharks, being a mercenary, joining a doomsday cult, jaywalking without looking, Russian roulette, find it, find whatever it is, and go at it hard. Your fellow citizens want you dead. The publicity machine that tears down the idea of socialized medicine is based on the simple principle that the moneyed interests have very little use for you and are sick of supporting your worthless ass. When insurance companies can't make bank off of frightened sick people anymore, they'll take their fat investment portfolios somewhere else. It's just money to them. You are just money. And you're only good money as long as you pay in more than you take out.
Health service providers feel the same way. They're not going to come right out and say they don't care whether you live or die, because they're in a somewhat competitive marketing situation. But no one can survive in that business if they start caring too much about individual patients. Even with the best of intentions and the best of care, some of the patients are going to die, and all of the patients die eventually. So that wall of detachment goes up. Away from the clinic floor, up where accounting decisions are made, that wall never comes down. It's bricks thick and yards tall. And you're on the other side of it. You are just money. When the money stops, you'd better be gone already. By the way, your bills are still due, even if you don't make it.
Why do 88 percent of uninsured patients fail to pay their bills? Could it be that the inflated prices have been out of control for so many decades that we're in a death spiral, nearing impact? Any observer of the health care situation as it evolved could have told you that a system based on profit-driven insurance and profit-driven care providers would continue to drive inflated prices and force ordinary working people over the brink. Even with insurance, Americans have trouble paying medical bills. Meanwhile, health insurers and clinics, even cancer treatment centers, are finding the money to donate to public broadcasting. Don't get me wrong, I love public broadcasting. But if I'm giving you money to treat and cure cancer, I want all of that money to go toward treating and finding cures for cancer.
So another year goes by and I appear to slap away that helping hand. "Look, we're giving you hundreds of dollars a month." Yes, but the insurance company has set the premium well over a grand, so the remainder is still going to wipe out every penny I can scrape together. And that's before my out of pocket costs for anything I do need.
I repeat: America is the land where you must pursue happiness with all your energy, and find the good death at the end of a short, glorious run. Get out there and grab it. The 20th Century fantasy of a middle class with a reasonable work load, a pleasurable personal life, and a comfortable retirement was never going to work. Those countries where it seems to work are a beautiful beacon, as unreachable as heaven. Like a favorite TV show where the characters are all friendly and lovable but the actual actors turn out to hate each other, it's probably just a facade. In reality, we are all here to find our deadly pleasure and run to it.
I'll advocate and vote for something more sociable and compassionate. But I expect fierce resistance from many of my fellow Americans who are fighting their own battles and can't see how all of our battles relate to each other. The accounting department stands against us all. And money always wins. Prove me wrong, people. Prove me wrong.
The ACA penalty definitely impacts my life. But there's a larger issue here. A health insurance premium goes directly to an insurance company in an industry that profits most by denying care, not by facilitating it. It's like being forced to buy bullets for the firing squad that is going to kill you. The perky little article on Obamacare Facts -- that explains the mechanics of the penalty and how it is spent -- never addresses the predatory nature of profit-driven health insurance and health care, but at least indicates that the money is used to help people in need. It's still filtered through the profit-sucking filter of insurance companies, for the most part, but at least it is not directly from my hand to their insatiable gullet.
I won't deny that I am frightened, living outside the illusion of protection. But illusion it is. The longer we keep feeding the beast, the longer the beast will live, regardless of how it shortens individual life spans in its customer base. Customer survival is not important. When you die, some other poor frightened bastard will already be there to keep paying into the system and getting little in return.
My advice to anyone, young or old, is to find something you really enjoy doing, that is likely to kill you. It can be anything: picking fights in bars, heroin, cocaine, unroped rock and ice climbing, driving a motorcycle really fast, BASE jumping, open water swimming, taunting sharks, being a mercenary, joining a doomsday cult, jaywalking without looking, Russian roulette, find it, find whatever it is, and go at it hard. Your fellow citizens want you dead. The publicity machine that tears down the idea of socialized medicine is based on the simple principle that the moneyed interests have very little use for you and are sick of supporting your worthless ass. When insurance companies can't make bank off of frightened sick people anymore, they'll take their fat investment portfolios somewhere else. It's just money to them. You are just money. And you're only good money as long as you pay in more than you take out.
Health service providers feel the same way. They're not going to come right out and say they don't care whether you live or die, because they're in a somewhat competitive marketing situation. But no one can survive in that business if they start caring too much about individual patients. Even with the best of intentions and the best of care, some of the patients are going to die, and all of the patients die eventually. So that wall of detachment goes up. Away from the clinic floor, up where accounting decisions are made, that wall never comes down. It's bricks thick and yards tall. And you're on the other side of it. You are just money. When the money stops, you'd better be gone already. By the way, your bills are still due, even if you don't make it.
Why do 88 percent of uninsured patients fail to pay their bills? Could it be that the inflated prices have been out of control for so many decades that we're in a death spiral, nearing impact? Any observer of the health care situation as it evolved could have told you that a system based on profit-driven insurance and profit-driven care providers would continue to drive inflated prices and force ordinary working people over the brink. Even with insurance, Americans have trouble paying medical bills. Meanwhile, health insurers and clinics, even cancer treatment centers, are finding the money to donate to public broadcasting. Don't get me wrong, I love public broadcasting. But if I'm giving you money to treat and cure cancer, I want all of that money to go toward treating and finding cures for cancer.
So another year goes by and I appear to slap away that helping hand. "Look, we're giving you hundreds of dollars a month." Yes, but the insurance company has set the premium well over a grand, so the remainder is still going to wipe out every penny I can scrape together. And that's before my out of pocket costs for anything I do need.
I repeat: America is the land where you must pursue happiness with all your energy, and find the good death at the end of a short, glorious run. Get out there and grab it. The 20th Century fantasy of a middle class with a reasonable work load, a pleasurable personal life, and a comfortable retirement was never going to work. Those countries where it seems to work are a beautiful beacon, as unreachable as heaven. Like a favorite TV show where the characters are all friendly and lovable but the actual actors turn out to hate each other, it's probably just a facade. In reality, we are all here to find our deadly pleasure and run to it.
I'll advocate and vote for something more sociable and compassionate. But I expect fierce resistance from many of my fellow Americans who are fighting their own battles and can't see how all of our battles relate to each other. The accounting department stands against us all. And money always wins. Prove me wrong, people. Prove me wrong.
Saturday, August 19, 2017
Roll the dice: Health care American style
My wife is about to get out of the emergency room after several hours. She had some chest pains this morning, after I had left for work. She took herself to a local walk-in urgent care center. They recommended that she head on down to the hospital to get a bit more in-depth examination.
Right after the stab of death fear, those of us on the lower economic rungs immediately ask ourselves whether our symptoms are really bad enough to incur the long slog through the medical billing process that will drain our coffers for months. When you're part of the huge deductible or self pay category, you are placing a sizable bet. You hope that it's expensive nothing, because the alternative will be lingering and could be death.
We've convinced ourselves that this is the way to treat ourselves and each other, rather than the easy access and peace of mind that comes with a universal system of health care. Peace of mind is tyranny!
When you turn out to be okay, that means you're in good shape to get back to work and pay off that debt.
Friday, March 03, 2017
Why health care fails in the USA
Most of the opposition to universal health care in America is based on our longstanding traditions of greed and double crossing.
The colonies that became the United States were founded as business ventures. Religious dissenters may have been used to staff some of them, but that was because they provided a substantial number of people willing to relocate far, far away. Along with their conscientious convictions, they had obligations to provide returns to their investors. As far as the investors were concerned, the obligations were all that mattered. This was the leading edge of capitalist expansion.
Business thrives on a certain amount of deceit. Profit is itself the amount that a business is able to overcharge for goods and services, in order to have funds to invest in things like other ventures, and the egotistical indulgences of people in charge. We put up with a little of it. The businesses push for a little more. Various forces push back if they can. But between nations, and against indigenous peoples, the deceit includes frequent signing -- and then violation -- of treaties. As the colonies became the nation and the nation developed, deals were struck in back rooms, palms were greased, and history written to show that the good guys always won.
Time and again the little guys have been reminded that the big guys look out for themselves first, and the rabble a distant second. We're conditioned to expect to be double crossed if we're not paying constant attention to how the cards are being dealt. It's almost a point of pride.
We do have our traditional belief in honesty and integrity, truth and justice, freedom and equality. But little of that was reflected in the period when robber barons amassed legendary fortunes to set the contemptible standard of wealth that still afflicts us.
All this conditions us to expect that any system will be gamed, and that cheaters will abound at the top and the bottom. What do you hear most often from people carping about social programs? They hate paying for freeloaders. And the second most common thing? They fear that the system will be inefficient and corrupt. It does not matter to them that the current system is already inefficient and corrupt. They assume, from historical precedent, that the government and corporate interests will collude to fix prices to the advantage of rich investors, and that the users of the programs will most likely be goldbricking slackers.
There is more support for the first contention than for the second. Most Americans work as hard a they can. Some strivers are fortunate enough to be able to find enough jobs to work way more than the 40-hour week we were once led to believe was a reasonable standard. Others fail to connect as well with virtuous toil, and end up living with their parents for a few decades, or falling onto public assistance. And yes, there are goldbricking slackers, but to assume that the person you see using food stamps or lining up for unemployment is just a loser with low morals looks through a pretty distorted lens. Most people have dreams and hopes. Unrealistic though many of them may be, they're generally innocent enough.
When it comes to health care, I often hear that objectors to a universal system don't want to pay for someone else's health care.
You pay for someone else's health care whenever you do business with a company that provides benefits for its employees. You pay for someone else's health care whenever you pay your own insurance premium. You pay for someone else's health care whenever you pay your taxes. By inserting the overhead costs and profit desires of insurance companies into a haphazard agglomeration of risk pools, we jack our own costs higher and higher. The idea that you are not paying for someone else's problems is a dangerous illusion. We all pay for other people's problems, and we always will. Even in libertarian anarchy we would pay dearly for other people's problems, as they acted them out without restraint for as far as they could extend their influence.
Accepting for the moment that we will believe in the innocence and integrity of most clients of a universal health care system, that still leaves the cheaters on the supply side. Only the unwavering resolve of a citizen government will restrain that. Raising children with better ethics will help keep such a government going. Abandon the unrealistic expectation that anyone can become filthy rich and that it's perfectly fine to try.
The social contract becomes complicated when it depends on the good faith and responsible behavior of large numbers of people, but the only alternatives are authoritarianism or anarchy. Put the unruly mob under an iron heel, or pull off all the controls and let the forces of nature bring tides of slaughter, interrupted by brief respites of exhaustion. Breed without restraint, planning on the deaths of many. Become less attached to specific people, places and things, because all will be in danger. Let most of civilization go. It's too expensive and complicated to maintain.
Reproduction is a controversial issue. The compulsion is basic and powerful. On the one hand, I can imagine a thoughtful society replenished by small families with carefully raised children. On the other hand, who knows where the next great mind might come from? The fruitfully multiplying crowd says to replicate early and often. On yet another hand, each generation uses the ideas that are born near it and within it to interpret and shape the world in which they find themselves. You never know to miss what you never had. So controlling the inflow to population seems much better than speeding up the outflow to maintain sustainable levels. Otherwise, any social system will be overwhelmed.
A democratic government, even on a republican model, requires educated, informed citizens asking good questions and focusing on the balance between the desires and needs of individuals and the best interests of the group. That seems to be falling apart, as the desires of individuals and sub-groups supersede the national interest. And that national interest has to acknowledge that the nation exists on a finite planet with other people on it. Conquest has not been possible, nor should it be. All we are left with is cooperation or annihilation. Didn't someone we revere once say "Join or Die?"
It goes beyond the borders of 13 colonies or 50 states now. We don't have to like each other. But we are stuck with each other. We have to figure out how to make it work.
The colonies that became the United States were founded as business ventures. Religious dissenters may have been used to staff some of them, but that was because they provided a substantial number of people willing to relocate far, far away. Along with their conscientious convictions, they had obligations to provide returns to their investors. As far as the investors were concerned, the obligations were all that mattered. This was the leading edge of capitalist expansion.
Business thrives on a certain amount of deceit. Profit is itself the amount that a business is able to overcharge for goods and services, in order to have funds to invest in things like other ventures, and the egotistical indulgences of people in charge. We put up with a little of it. The businesses push for a little more. Various forces push back if they can. But between nations, and against indigenous peoples, the deceit includes frequent signing -- and then violation -- of treaties. As the colonies became the nation and the nation developed, deals were struck in back rooms, palms were greased, and history written to show that the good guys always won.
Time and again the little guys have been reminded that the big guys look out for themselves first, and the rabble a distant second. We're conditioned to expect to be double crossed if we're not paying constant attention to how the cards are being dealt. It's almost a point of pride.
We do have our traditional belief in honesty and integrity, truth and justice, freedom and equality. But little of that was reflected in the period when robber barons amassed legendary fortunes to set the contemptible standard of wealth that still afflicts us.
All this conditions us to expect that any system will be gamed, and that cheaters will abound at the top and the bottom. What do you hear most often from people carping about social programs? They hate paying for freeloaders. And the second most common thing? They fear that the system will be inefficient and corrupt. It does not matter to them that the current system is already inefficient and corrupt. They assume, from historical precedent, that the government and corporate interests will collude to fix prices to the advantage of rich investors, and that the users of the programs will most likely be goldbricking slackers.
There is more support for the first contention than for the second. Most Americans work as hard a they can. Some strivers are fortunate enough to be able to find enough jobs to work way more than the 40-hour week we were once led to believe was a reasonable standard. Others fail to connect as well with virtuous toil, and end up living with their parents for a few decades, or falling onto public assistance. And yes, there are goldbricking slackers, but to assume that the person you see using food stamps or lining up for unemployment is just a loser with low morals looks through a pretty distorted lens. Most people have dreams and hopes. Unrealistic though many of them may be, they're generally innocent enough.
When it comes to health care, I often hear that objectors to a universal system don't want to pay for someone else's health care.
You pay for someone else's health care whenever you do business with a company that provides benefits for its employees. You pay for someone else's health care whenever you pay your own insurance premium. You pay for someone else's health care whenever you pay your taxes. By inserting the overhead costs and profit desires of insurance companies into a haphazard agglomeration of risk pools, we jack our own costs higher and higher. The idea that you are not paying for someone else's problems is a dangerous illusion. We all pay for other people's problems, and we always will. Even in libertarian anarchy we would pay dearly for other people's problems, as they acted them out without restraint for as far as they could extend their influence.
Accepting for the moment that we will believe in the innocence and integrity of most clients of a universal health care system, that still leaves the cheaters on the supply side. Only the unwavering resolve of a citizen government will restrain that. Raising children with better ethics will help keep such a government going. Abandon the unrealistic expectation that anyone can become filthy rich and that it's perfectly fine to try.
The social contract becomes complicated when it depends on the good faith and responsible behavior of large numbers of people, but the only alternatives are authoritarianism or anarchy. Put the unruly mob under an iron heel, or pull off all the controls and let the forces of nature bring tides of slaughter, interrupted by brief respites of exhaustion. Breed without restraint, planning on the deaths of many. Become less attached to specific people, places and things, because all will be in danger. Let most of civilization go. It's too expensive and complicated to maintain.
Reproduction is a controversial issue. The compulsion is basic and powerful. On the one hand, I can imagine a thoughtful society replenished by small families with carefully raised children. On the other hand, who knows where the next great mind might come from? The fruitfully multiplying crowd says to replicate early and often. On yet another hand, each generation uses the ideas that are born near it and within it to interpret and shape the world in which they find themselves. You never know to miss what you never had. So controlling the inflow to population seems much better than speeding up the outflow to maintain sustainable levels. Otherwise, any social system will be overwhelmed.
A democratic government, even on a republican model, requires educated, informed citizens asking good questions and focusing on the balance between the desires and needs of individuals and the best interests of the group. That seems to be falling apart, as the desires of individuals and sub-groups supersede the national interest. And that national interest has to acknowledge that the nation exists on a finite planet with other people on it. Conquest has not been possible, nor should it be. All we are left with is cooperation or annihilation. Didn't someone we revere once say "Join or Die?"
Tuesday, February 28, 2017
Health insurance is an enemy of freedom
In a comment on Senator Jeanne Shaheen's Facebook page, I reported that I could not afford insurance under the ACA:
Senator Jeanne, due to peculiarities in my circumstances, I am unable to afford coverage under the ACA. Health insurance is not health care. And at this point I have neither one anyway. Last month, I had to pass a kidney stone alone at home and then go to work the next day, business as usual. My retirement plan consists of various scenarios for suicide when I can no longer take care of myself. I guess this makes me the ideal citizen, as far as the conservatives are concerned. Work 'em 'til they drop.
Another commenter suggested this:
Really maybe you need to find a better job. personally I have never had a job that didn't offer insur(ance). (Actual post had a typo in the last word.)
I answered:
Forcing people's career choices in search of insurance is not freedom. It indicates a country run for the benefit of insurance companies.
Isn't that pretty obvious? Along with getting people to use the terms health insurance and health care interchangeably, we've conditioned ourselves to seek "benefits" as a survival need, in a wilderness where we have to grub for every resource. Those who control the wealth determine how it is doled out, even if that means working for the destructive economy or choosing to live at risk for the sake of what you believe in. We are all soldiers facing death for a cause, even if we conscientiously avoid using combat for conflict resolution. I happen to have ended up in a place where the job that suited many of my abilities and needs only briefly provided "benefits," regardless of my usefulness to the business or that business's service to the community. Society at large benefits from the unheralded life and death of numerous benefactors for whom no public buildings are ever named.
With a system of universal care, rather than profiteering schemes of insurance, freedom of movement, choice, and work will make our society more innovative and our citizens more free. By making health insurance a marketed commodity, we actually hurt many other aspects of the free market economy. If you want unfettered freedom, live in anarchy now and take whatever happens to you. If you want a reasonably free society with well-maintained infrastructure and civilized amenities, accept that some things cannot be turned to profit. Some things are autonomic functions of society, that need to run quietly in the background. These include health care and energy production. If either of those intrudes on the peace and progress of the human species, we're doing something wrong. Right now, those intrusions make up most of the news. The rest of it hinges on inanities like what color we want our neighbors to be.
Senator Jeanne, due to peculiarities in my circumstances, I am unable to afford coverage under the ACA. Health insurance is not health care. And at this point I have neither one anyway. Last month, I had to pass a kidney stone alone at home and then go to work the next day, business as usual. My retirement plan consists of various scenarios for suicide when I can no longer take care of myself. I guess this makes me the ideal citizen, as far as the conservatives are concerned. Work 'em 'til they drop.
Another commenter suggested this:
Really maybe you need to find a better job. personally I have never had a job that didn't offer insur(ance). (Actual post had a typo in the last word.)
I answered:
Forcing people's career choices in search of insurance is not freedom. It indicates a country run for the benefit of insurance companies.
Isn't that pretty obvious? Along with getting people to use the terms health insurance and health care interchangeably, we've conditioned ourselves to seek "benefits" as a survival need, in a wilderness where we have to grub for every resource. Those who control the wealth determine how it is doled out, even if that means working for the destructive economy or choosing to live at risk for the sake of what you believe in. We are all soldiers facing death for a cause, even if we conscientiously avoid using combat for conflict resolution. I happen to have ended up in a place where the job that suited many of my abilities and needs only briefly provided "benefits," regardless of my usefulness to the business or that business's service to the community. Society at large benefits from the unheralded life and death of numerous benefactors for whom no public buildings are ever named.
With a system of universal care, rather than profiteering schemes of insurance, freedom of movement, choice, and work will make our society more innovative and our citizens more free. By making health insurance a marketed commodity, we actually hurt many other aspects of the free market economy. If you want unfettered freedom, live in anarchy now and take whatever happens to you. If you want a reasonably free society with well-maintained infrastructure and civilized amenities, accept that some things cannot be turned to profit. Some things are autonomic functions of society, that need to run quietly in the background. These include health care and energy production. If either of those intrudes on the peace and progress of the human species, we're doing something wrong. Right now, those intrusions make up most of the news. The rest of it hinges on inanities like what color we want our neighbors to be.
Sunday, January 29, 2017
Collected thoughts
Just a few snippets from social media posts
If corporations are people, what gender are they? And should that affect their right to merge?
In case anyone still thinks that term limits would fix anything, look at what Trump has done in the first 10 days of his first term in the only elective office for which he has ever run.
Authoritarian conservatism is a system of selectively breeding for obedience. It's remarkable how they bait the trap by saying they're protecting liberty.
I vastly prefer people who remind me to be peaceful over those who try to solicit my aggression.
There are two kinds of people in this world: the ones who realize that we're all in this together and the ones who are wrong.
With all the heartwarming support for climate change awareness and opposition to pipelines and fracking, how much are you doing as a consumer to reduce fossil fuel use? No corporate behemoth will waste money on a product that is not selling. For all that we need to stand up for regulation and oversight, those will never win as long as we keep supporting the social model that made the problems in the first place. By the way, I realize this is hopeless.
Just the fact that health care is referred to as an industry tells you everything you need to know about America's attitude toward human suffering. The health care industry is highly rated as an investment these days. That means lots of return for shareholders.
Getting people to use "health insurance" and "health care" as interchangeable terms has been one of the biggest propaganda victories of the last couple of decades.
When the result is millions of people turned into cannon fodder on both sides, you have to wonder whether titanic clashes of good and evil serve either side very well.
Who knew that the some of the people you can fool all of the time would turn out to be such a significant voting bloc?
I'm sure we can all agree that there is no issue on which we can all agree.
A country that threatens other countries with its nuclear arsenal is a hostage-taking suicide bomber.
Human race informed that they will not get their security deposit back as they depart from Earth to find a new planet.
In 2017, millions of people in the developed world followed through on their resolution to get rid of the clutter and excess possessions in their homes. Suddenly, everyone was living in airy spaciousness and marvelous simplicity! It was also the first year in which you could walk across the Pacific Ocean on the mat of trash and discarded possessions.
If you try to challenge and refute every ignorant assertion with well-reasoned, fact-based arguments, you will spend your time doing only that, until you die of exhaustion. On the other hand, unchallenged ignorant assertions often become accepted as truths because they sound snappy and no one has publicly blown them up.
I got in touch with my emotions. They seemed pissed off that I had found their hideout.
If corporations are people, what gender are they? And should that affect their right to merge?
In case anyone still thinks that term limits would fix anything, look at what Trump has done in the first 10 days of his first term in the only elective office for which he has ever run.
Authoritarian conservatism is a system of selectively breeding for obedience. It's remarkable how they bait the trap by saying they're protecting liberty.
I vastly prefer people who remind me to be peaceful over those who try to solicit my aggression.
There are two kinds of people in this world: the ones who realize that we're all in this together and the ones who are wrong.
With all the heartwarming support for climate change awareness and opposition to pipelines and fracking, how much are you doing as a consumer to reduce fossil fuel use? No corporate behemoth will waste money on a product that is not selling. For all that we need to stand up for regulation and oversight, those will never win as long as we keep supporting the social model that made the problems in the first place. By the way, I realize this is hopeless.
Just the fact that health care is referred to as an industry tells you everything you need to know about America's attitude toward human suffering. The health care industry is highly rated as an investment these days. That means lots of return for shareholders.
Getting people to use "health insurance" and "health care" as interchangeable terms has been one of the biggest propaganda victories of the last couple of decades.
When the result is millions of people turned into cannon fodder on both sides, you have to wonder whether titanic clashes of good and evil serve either side very well.
Who knew that the some of the people you can fool all of the time would turn out to be such a significant voting bloc?
I'm sure we can all agree that there is no issue on which we can all agree.
A country that threatens other countries with its nuclear arsenal is a hostage-taking suicide bomber.
Human race informed that they will not get their security deposit back as they depart from Earth to find a new planet.
In 2017, millions of people in the developed world followed through on their resolution to get rid of the clutter and excess possessions in their homes. Suddenly, everyone was living in airy spaciousness and marvelous simplicity! It was also the first year in which you could walk across the Pacific Ocean on the mat of trash and discarded possessions.
If you try to challenge and refute every ignorant assertion with well-reasoned, fact-based arguments, you will spend your time doing only that, until you die of exhaustion. On the other hand, unchallenged ignorant assertions often become accepted as truths because they sound snappy and no one has publicly blown them up.
I got in touch with my emotions. They seemed pissed off that I had found their hideout.
Thursday, September 11, 2014
"Affordable Care"
After hearing some hopeful things about the Affordable Care Act in New Hampshire from friends who have been using it, I finally had to sign up myself after the insurance from my wife's former employer ran out.
To start with, it's not affordable. Even with my "subsidy" in the form of a tax credit I would be paying more than $300 a month to have a deductible of $5,750. The $40 co-pay for doctor visits isn't bad, but at my income level, $300 a month is a chunk, especially when you consider that I have to pay out of pocket for everything up to $5,750 and, if I did get seriously ill, would still have to go to work to earn the money to keep my premiums up. And of course the deductible resets every year.
I'm not a political pea-brain, so I don't blame Obama. Indeed, the people who make Obama a bad president are the same people who made George Bush a bad president. In the case of Bush they reinforced everything he did. In the case of Obama they throw roadblocks in front of everything. So one president drove us down a rocky slope and when the next one tries to steer us back onto the road the yahoos keep grabbing the steering wheel and stomping on the brakes.
I did not vote for Barack Obama in the 2008 primary in part because his health coverage proposal was basically like Mitt Romney's system in Massachusetts, based on private insurance that everyone has to buy. After he won the general election, Obama began adding better features to his proposal, like the publicly funded option which would, in fact, blessedly have killed the private insurance industry and set us on a path toward a true universal coverage system. But the insurance lobby and the largely Republican political operatives who serve them made sure that went away.
I know that plenty of Democrats have financial obligations to corporate interests. But most issues tend to divide pretty neatly between the D's and the R's.
If someone said they were going to repeal the Affordable Care Act and replace it with a universal, single-payer system and some strong, rational controls on medical service and drug pricing I would support it instantly. And that's simply never going to come from the Republican side of the aisle.
Meanwhile, that leaves me unable to afford Affordable Care. I will return to the ranks of the uninsured, get my self-pay discount from medical service providers, pay the much more affordable tax penalty in lieu of the fat honkin' premium and hold on for Medicare.
To start with, it's not affordable. Even with my "subsidy" in the form of a tax credit I would be paying more than $300 a month to have a deductible of $5,750. The $40 co-pay for doctor visits isn't bad, but at my income level, $300 a month is a chunk, especially when you consider that I have to pay out of pocket for everything up to $5,750 and, if I did get seriously ill, would still have to go to work to earn the money to keep my premiums up. And of course the deductible resets every year.
I'm not a political pea-brain, so I don't blame Obama. Indeed, the people who make Obama a bad president are the same people who made George Bush a bad president. In the case of Bush they reinforced everything he did. In the case of Obama they throw roadblocks in front of everything. So one president drove us down a rocky slope and when the next one tries to steer us back onto the road the yahoos keep grabbing the steering wheel and stomping on the brakes.
I did not vote for Barack Obama in the 2008 primary in part because his health coverage proposal was basically like Mitt Romney's system in Massachusetts, based on private insurance that everyone has to buy. After he won the general election, Obama began adding better features to his proposal, like the publicly funded option which would, in fact, blessedly have killed the private insurance industry and set us on a path toward a true universal coverage system. But the insurance lobby and the largely Republican political operatives who serve them made sure that went away.
I know that plenty of Democrats have financial obligations to corporate interests. But most issues tend to divide pretty neatly between the D's and the R's.
If someone said they were going to repeal the Affordable Care Act and replace it with a universal, single-payer system and some strong, rational controls on medical service and drug pricing I would support it instantly. And that's simply never going to come from the Republican side of the aisle.
Meanwhile, that leaves me unable to afford Affordable Care. I will return to the ranks of the uninsured, get my self-pay discount from medical service providers, pay the much more affordable tax penalty in lieu of the fat honkin' premium and hold on for Medicare.
Friday, February 17, 2012
The Free Market Military
The defense of our nation and its interests is of such crucial importance that we devote upwards of 600 billion dollars to it annually. It is considered an indispensable service although its budget is theoretically almost infinitely variable based on present and projected future needs. Military spending has been part of the total federal budge for a couple of centuries. It's not going away any time soon.
The defense of the health of individual citizens is largely left up to the individual. The fact that "a good job" included "benefits" during the later half of the 20th Century masked the fact that individuals had no guaranteed protection. During a time when jobs with benefits seemed plentiful and easy to find, anyone changing jobs would expect to hear about the new coverage replacing their old coverage as a routine part of the transition. People did fall through the cracks, but the cracks were masked like snow-covered crevasses. The glacial metaphor is apt because, as the system fails, the ice coverage shrinks drastically, leaving more and more people either on thin ice or standing disconsolately on the mud.
As victims of a market-based system we are told we can shop around. As private insurance is reshaped we will get to select from a much wider menu of flawed solutions worded in confusing ways to mask the corporate profit that motivates insurance companies to dabble in medical care in the first place.
For various reasons, most of them not good, a lot of people are tempted to turn national defense over to private contractors because the private sector is ever so much more efficient than the dumb ol' government. It works as a metaphor but not as a real-world solution. For it to work properly as a free market, we would have to shop around for the best deal. When the country was attacked we would have to send out a request for bids, sift through the applications and choose what appeared to be the best one. It's perfectly analogous to the process of shopping for medical care and coverage when faced with a serious disease that might be advancing rapidly, like a hostile army.
A taxpayer-funded, government-run military service is accountable directly to the citizen government in ways a free-market pool of militaristic contractors is not. We tell our fighting forces to take pride in their training and the traditions of excellence attached to each branch of the service. Why not call on a similar devotion and fighting spirit in our medical forces? Create the image and then live up to it. Fund it as a social necessity like defense. Let medical contractors vie for lucrative government contracts. Make the war on ill health as high a priority as the war on real and imagined adversaries around the globe, for which we develop sophisticated weapons apparently with little regard for the cost. Huge salaries and bloated retirement packages in any part of the private sector can't be used as incentives for much longer. A solid income and a decent retirement as a government doctor or nurse might start to look pretty good to the medically inclined. And ordinary citizens would not have to make the decision to commit slow or rapid suicide rather than get regular medical checkups and take care of things in a timely fashion as they occur.
The defense of the health of individual citizens is largely left up to the individual. The fact that "a good job" included "benefits" during the later half of the 20th Century masked the fact that individuals had no guaranteed protection. During a time when jobs with benefits seemed plentiful and easy to find, anyone changing jobs would expect to hear about the new coverage replacing their old coverage as a routine part of the transition. People did fall through the cracks, but the cracks were masked like snow-covered crevasses. The glacial metaphor is apt because, as the system fails, the ice coverage shrinks drastically, leaving more and more people either on thin ice or standing disconsolately on the mud.
As victims of a market-based system we are told we can shop around. As private insurance is reshaped we will get to select from a much wider menu of flawed solutions worded in confusing ways to mask the corporate profit that motivates insurance companies to dabble in medical care in the first place.
For various reasons, most of them not good, a lot of people are tempted to turn national defense over to private contractors because the private sector is ever so much more efficient than the dumb ol' government. It works as a metaphor but not as a real-world solution. For it to work properly as a free market, we would have to shop around for the best deal. When the country was attacked we would have to send out a request for bids, sift through the applications and choose what appeared to be the best one. It's perfectly analogous to the process of shopping for medical care and coverage when faced with a serious disease that might be advancing rapidly, like a hostile army.
A taxpayer-funded, government-run military service is accountable directly to the citizen government in ways a free-market pool of militaristic contractors is not. We tell our fighting forces to take pride in their training and the traditions of excellence attached to each branch of the service. Why not call on a similar devotion and fighting spirit in our medical forces? Create the image and then live up to it. Fund it as a social necessity like defense. Let medical contractors vie for lucrative government contracts. Make the war on ill health as high a priority as the war on real and imagined adversaries around the globe, for which we develop sophisticated weapons apparently with little regard for the cost. Huge salaries and bloated retirement packages in any part of the private sector can't be used as incentives for much longer. A solid income and a decent retirement as a government doctor or nurse might start to look pretty good to the medically inclined. And ordinary citizens would not have to make the decision to commit slow or rapid suicide rather than get regular medical checkups and take care of things in a timely fashion as they occur.
Wednesday, February 23, 2011
When the world changes right nearby.
The world is always changing. it's just that most times it's far and muffled. But sometimes you're yanked out of bed, swung around by one leg and flung into a new universe.
The phone went off with a harsh jangle at about five past midnight last night. Usually the initial surge of alarm subsides when the caller turns out to be someone in a different time zone who forgot the difference or a caller excited by something great that happened to them.
Once in a while it's as bad as the first surge of fear and then some.
The cellist answered the phone. It's on her side of the bed.
"What? No! How? When? Are you all right?" She sounded instantly breathless and shocked. I could hear a tearful woman's voice on the other end of the line. I began repeating the questions the cellist was asking, to know what had happened, to whom, and how badly.
Her brother had been found dead in his house while his wife and two toddlers were away visiting her parents. He was 47.
Over the years I have had friends of friends die young. Just a couple of weeks ago I finally got a solid Google hit on one of my old fencing teammates I'd been trying to track down for years. It was his obituary.
While I'm no great fan of death, it doesn't freak me out when it happens to someone young. By the time I finished high school I'd lost one schoolmate to cancer when she was in fifth grade. Another graduated from high school with one leg. By the end of the following year she had lost the other leg and her life. I know death has no respect for your age, your plans, how beloved you are or your social position. Some people live a long time. Others don't. Sometimes the death makes a certain amount of sense: the deceased may have a medical condition, dangerous habits or hazardous activities. Our cars kill 40,000 of us a year in the United States alone. But when someone just drops, and he's the only parent in his group of siblings it changes everyone's outlook. The man is dead, that's shocking enough. His survivors still need to live. We all have to figure out how to help them with the plain practical matter of going on.
When we went to bed we thought the bad news was that we had less time than we had thought to find a kidney transplant facility for her and see if we need to set up one of those transplant chains to get live donors lined up with matched recipients. If I match her it's just $150,000 worth of plug-and-play. The odds are against it.
Organ transplantation isn't like any other purchase. You only get one shot. The organ has to be right. The surgical team has to be right. It's a lot to absorb. We have about six years. Will a medical miracle change our situation? One can hope, of course, but again, the odds are against it.
The future looks complicated and expensive. In the meantime we still have to get to work every day and pay our bills. The future is unknowable. Lay the groundwork for what you hope to reach. Remember that most of your plans and absolutely none of your hopes guarantee anything.
The phone went off with a harsh jangle at about five past midnight last night. Usually the initial surge of alarm subsides when the caller turns out to be someone in a different time zone who forgot the difference or a caller excited by something great that happened to them.
Once in a while it's as bad as the first surge of fear and then some.
The cellist answered the phone. It's on her side of the bed.
"What? No! How? When? Are you all right?" She sounded instantly breathless and shocked. I could hear a tearful woman's voice on the other end of the line. I began repeating the questions the cellist was asking, to know what had happened, to whom, and how badly.
Her brother had been found dead in his house while his wife and two toddlers were away visiting her parents. He was 47.
Over the years I have had friends of friends die young. Just a couple of weeks ago I finally got a solid Google hit on one of my old fencing teammates I'd been trying to track down for years. It was his obituary.
While I'm no great fan of death, it doesn't freak me out when it happens to someone young. By the time I finished high school I'd lost one schoolmate to cancer when she was in fifth grade. Another graduated from high school with one leg. By the end of the following year she had lost the other leg and her life. I know death has no respect for your age, your plans, how beloved you are or your social position. Some people live a long time. Others don't. Sometimes the death makes a certain amount of sense: the deceased may have a medical condition, dangerous habits or hazardous activities. Our cars kill 40,000 of us a year in the United States alone. But when someone just drops, and he's the only parent in his group of siblings it changes everyone's outlook. The man is dead, that's shocking enough. His survivors still need to live. We all have to figure out how to help them with the plain practical matter of going on.
When we went to bed we thought the bad news was that we had less time than we had thought to find a kidney transplant facility for her and see if we need to set up one of those transplant chains to get live donors lined up with matched recipients. If I match her it's just $150,000 worth of plug-and-play. The odds are against it.
Organ transplantation isn't like any other purchase. You only get one shot. The organ has to be right. The surgical team has to be right. It's a lot to absorb. We have about six years. Will a medical miracle change our situation? One can hope, of course, but again, the odds are against it.
The future looks complicated and expensive. In the meantime we still have to get to work every day and pay our bills. The future is unknowable. Lay the groundwork for what you hope to reach. Remember that most of your plans and absolutely none of your hopes guarantee anything.
Tuesday, February 01, 2011
It's gonna get deep in New Hampshire
Yeah, we have a big snowstorm headed our way. The total between today's light shot and tomorrow's big dump could be as much as 22 inches. It's gonna get deep around here.
It makes a nice metaphor for the beginning of primary campaigning for the Presidential election in 2012.
My risk of a stroke went up with my blood pressure this morning when I turned on the television looking for an updated weather forecast and instead caught a few minutes of Mitt Romney in an interview on Good Morning America. That's not good for an aging man with no health insurance.
Mitt's health care plan in the 2008 campaign was to make everyone in the country buy health insurance, as he had made everyone in Massachusetts buy it when he was governor. Now he says that President Obama's health care bill, requiring all Americans to buy health insurance, is unconstitutional. He says it's a power reserved to the states. If your state is a slum, tough luck.
According to what I've read, Thomas Jefferson would never have envisioned a state like California or Texas, as big and rich as a small country. His original concept called for small states of more uniform size and a largely agrarian character. As I recall, we weren't supposed to keep a standing military force, either. Instead we would call together the state militias in the event our federation was threatened. The coastal states can furnish naval forces. The ships can be built of the native wood.
Following Mitt's logic on health care, instead of trying to get a plan through one federal bureaucracy, we the taxpayers and working stiffs have to try to get something through 50 state bureaucracies with widely varying tax revenues. If the federal government offers some sort of aid, that bureaucracy will have to grind its gears to dispense these funds to help the poorer states make up their shortages.
Mitt says he's pro-business. He's certainly favorable to the insurance business. While politicians wrangle in Congress and state legislatures all over this mythically great land, the insurance business will go on as usual, making book on people's health and writing rules to suit themselves.
Living in New Hampshire gives us a front-row seat to the political circus early in the process. It can be fun to watch all the candidates until you start to listen to them and care what they say. Then you wish they were doing it somewhere else. It's only funny when they step on a cow flop. And with the state of agriculture in this country, that doesn't happen nearly often enough.
It makes a nice metaphor for the beginning of primary campaigning for the Presidential election in 2012.
My risk of a stroke went up with my blood pressure this morning when I turned on the television looking for an updated weather forecast and instead caught a few minutes of Mitt Romney in an interview on Good Morning America. That's not good for an aging man with no health insurance.
Mitt's health care plan in the 2008 campaign was to make everyone in the country buy health insurance, as he had made everyone in Massachusetts buy it when he was governor. Now he says that President Obama's health care bill, requiring all Americans to buy health insurance, is unconstitutional. He says it's a power reserved to the states. If your state is a slum, tough luck.
According to what I've read, Thomas Jefferson would never have envisioned a state like California or Texas, as big and rich as a small country. His original concept called for small states of more uniform size and a largely agrarian character. As I recall, we weren't supposed to keep a standing military force, either. Instead we would call together the state militias in the event our federation was threatened. The coastal states can furnish naval forces. The ships can be built of the native wood.
Following Mitt's logic on health care, instead of trying to get a plan through one federal bureaucracy, we the taxpayers and working stiffs have to try to get something through 50 state bureaucracies with widely varying tax revenues. If the federal government offers some sort of aid, that bureaucracy will have to grind its gears to dispense these funds to help the poorer states make up their shortages.
Mitt says he's pro-business. He's certainly favorable to the insurance business. While politicians wrangle in Congress and state legislatures all over this mythically great land, the insurance business will go on as usual, making book on people's health and writing rules to suit themselves.
Living in New Hampshire gives us a front-row seat to the political circus early in the process. It can be fun to watch all the candidates until you start to listen to them and care what they say. Then you wish they were doing it somewhere else. It's only funny when they step on a cow flop. And with the state of agriculture in this country, that doesn't happen nearly often enough.
Tuesday, December 14, 2010
Why private health insurance can't help but fail
An advertisement for United Health Care on television last night stated that they can provide high quality service because of their size. In other words, their group is large enough to buffer inevitable losses, should they be forced into actually paying a claim. They take in enough in premiums to pay their executives and managers, and the legions of telephone operators health insurance companies place between the customer and customer satisfaction, i.e. medical services actually reimbursed by the company.
If you believe the advertisement, all is well with the health insurance titan. As a corporation competing in the marketplace, it has gathered many customers. One can safely assume these customers have been gathered from United Health Care's competitors. Those competitors are therefore smaller, less able to withstand the stresses of being in business, and less able to offer tempting premiums (relatively speaking) in the health insurance field.
By the principles of business competition, these weaker players must fail or consolidate. Unless some artificial external force, like regulation, steps in to prevent United Health Care and the other players from duking it out everywhere in the country, market forces will prevail.
By the principles we've been told guide the level of premiums, the biggest company should be able to provide the best coverage. Let's ignore for a moment the temporary and misleading "introductory offers" a smaller company might use to gather customers who will later pay for their folly with a sharp spike in their costs. Just judging a company's value on the basis of size, the best health insurance company would have a nationwide monopoly and a group that includes every living soul. In short, it would be universal. But just when you think the socialists have maneuvered the free marketers into checkmate, remember two things: monopolies get broken up (at least according to legal technicality, if you're thinking of the oil and drug cartels), and private businesses will push for the most profit they can squeeze from the industry in which they operate. If that industry has no real competition, everybody has to fork out whatever the company demands. Introduce a competitor and you make smaller groups, pushing premiums up on the basis of the increased risk.
One giant group, insured by a non-profit entity, is the only approach that will control costs and cover everyone fairly. That's never going to happen in this country. I just wanted to remind y'all what you will be missing and why.
If you believe the advertisement, all is well with the health insurance titan. As a corporation competing in the marketplace, it has gathered many customers. One can safely assume these customers have been gathered from United Health Care's competitors. Those competitors are therefore smaller, less able to withstand the stresses of being in business, and less able to offer tempting premiums (relatively speaking) in the health insurance field.
By the principles of business competition, these weaker players must fail or consolidate. Unless some artificial external force, like regulation, steps in to prevent United Health Care and the other players from duking it out everywhere in the country, market forces will prevail.
By the principles we've been told guide the level of premiums, the biggest company should be able to provide the best coverage. Let's ignore for a moment the temporary and misleading "introductory offers" a smaller company might use to gather customers who will later pay for their folly with a sharp spike in their costs. Just judging a company's value on the basis of size, the best health insurance company would have a nationwide monopoly and a group that includes every living soul. In short, it would be universal. But just when you think the socialists have maneuvered the free marketers into checkmate, remember two things: monopolies get broken up (at least according to legal technicality, if you're thinking of the oil and drug cartels), and private businesses will push for the most profit they can squeeze from the industry in which they operate. If that industry has no real competition, everybody has to fork out whatever the company demands. Introduce a competitor and you make smaller groups, pushing premiums up on the basis of the increased risk.
One giant group, insured by a non-profit entity, is the only approach that will control costs and cover everyone fairly. That's never going to happen in this country. I just wanted to remind y'all what you will be missing and why.
Sunday, September 06, 2009
Why Universal Coverage is NOT Socialized Medicine
The Federal Government already acts as the purchasing agent for its citizens in a number of important transactions. The best example is the US military.
Currently, the Pentagon consumes at least $534 billion of your tax dollars. It's always been the big eater in the federal budget. Has anyone called it "socialized defense?" Hell, no. Even though the military services are in fact socialist societies, no one makes much of a time about that. And that's not the critical factor here. What matters is the way government expenditure interacts with the private sector.
No one can claim that government funding and involvement has stifled innovation or decreased profitability in the area of inventing exciting ways to devastate enemy nations. Quite the contrary. Competing for competitive bids, the military-industrial complex has supplied an endless stream of guns, bombs, missiles, tanks, aircraft that don't show up on radar, shrapnel that doesn't show up on X-rays, stuff with computers, lasers, gas, germs and trained dolphins. Why should the response of the medical industries be any more restrained?
By making the government our negotiator and purchaser of medical supplies and services, we put the full power of the treasury to work for us. Hey, we put that money there! Let's get something back.
Private insurance is a mortally wounded business. They're shot, they just haven't fallen down yet. Here's why: a service provider can only be profitable if they can reasonably estimate their costs. Sickness does not succumb to the same statistical modeling as death, for instance. The stakes are higher. A policy holder could become expensively ill. The cost effective thing to do with someone who has started costing more than they're bringing in is to lay them off. Private insurers hire legions of phone operators to try to hold back all but the most determined petitioners who have been denied. It's frustrating and expensive for all concerned. Putting them out of this dead-end business would only be merciful. Euthanize the private health insurance companies! They'll find someplace else to invest their money! Corporations have diversified and evolved forever. If they're so crappy at business that they can't weather a complete market shift like that, we don't want them managing something as important as health care anyway.
There is no need to fear a non-profit, public funding source that will act the way insurance began: as a shared risk pool in which everyone pays a share and gets only such recompense from it as they actually need. We're not furnishing someone's corporate suite, paying for their private jet or funding their weekend in Vegas. With a public, non-profit health insurance system, we're paying for health care, period. As a government entity, it HAS to operate under full disclosure (nothing classified in health care, UNLIKE the military). We get to look at the books whenever we want. When was the last time (or even the first) that a private insurance company invited you to do that?
The government can be frustrating to deal with. Just remember that it is your government. Take some interest beyond simply voting in the Candy Man and then throwing him out when he isn't perfect. We have laws that give us tremendous access to what goes on in domestic affairs. It isn't perfect, but nothing is. And it isn't socialism. It's our shared business venture as shareholders in the United States. Let's build it right and make it work. We owe it to our investors.
Currently, the Pentagon consumes at least $534 billion of your tax dollars. It's always been the big eater in the federal budget. Has anyone called it "socialized defense?" Hell, no. Even though the military services are in fact socialist societies, no one makes much of a time about that. And that's not the critical factor here. What matters is the way government expenditure interacts with the private sector.
No one can claim that government funding and involvement has stifled innovation or decreased profitability in the area of inventing exciting ways to devastate enemy nations. Quite the contrary. Competing for competitive bids, the military-industrial complex has supplied an endless stream of guns, bombs, missiles, tanks, aircraft that don't show up on radar, shrapnel that doesn't show up on X-rays, stuff with computers, lasers, gas, germs and trained dolphins. Why should the response of the medical industries be any more restrained?
By making the government our negotiator and purchaser of medical supplies and services, we put the full power of the treasury to work for us. Hey, we put that money there! Let's get something back.
Private insurance is a mortally wounded business. They're shot, they just haven't fallen down yet. Here's why: a service provider can only be profitable if they can reasonably estimate their costs. Sickness does not succumb to the same statistical modeling as death, for instance. The stakes are higher. A policy holder could become expensively ill. The cost effective thing to do with someone who has started costing more than they're bringing in is to lay them off. Private insurers hire legions of phone operators to try to hold back all but the most determined petitioners who have been denied. It's frustrating and expensive for all concerned. Putting them out of this dead-end business would only be merciful. Euthanize the private health insurance companies! They'll find someplace else to invest their money! Corporations have diversified and evolved forever. If they're so crappy at business that they can't weather a complete market shift like that, we don't want them managing something as important as health care anyway.
There is no need to fear a non-profit, public funding source that will act the way insurance began: as a shared risk pool in which everyone pays a share and gets only such recompense from it as they actually need. We're not furnishing someone's corporate suite, paying for their private jet or funding their weekend in Vegas. With a public, non-profit health insurance system, we're paying for health care, period. As a government entity, it HAS to operate under full disclosure (nothing classified in health care, UNLIKE the military). We get to look at the books whenever we want. When was the last time (or even the first) that a private insurance company invited you to do that?
The government can be frustrating to deal with. Just remember that it is your government. Take some interest beyond simply voting in the Candy Man and then throwing him out when he isn't perfect. We have laws that give us tremendous access to what goes on in domestic affairs. It isn't perfect, but nothing is. And it isn't socialism. It's our shared business venture as shareholders in the United States. Let's build it right and make it work. We owe it to our investors.
Friday, September 04, 2009
A Bunch of People Shouting in the Dark
In the debate over health care reform on the Internet, you have to judge a person by what they write and link to, unless they post video.
Yesterday I let my temper get the better of me when I saw a comment under a post on a friend's Facebook page summing up anyone without health coverage as a lazy person who wanted a free ride. Such an assertion had to come from either a rapacious neocon of the sort that has been laying waste to the financial services industry for nigh on 30 years, or an aging conservative who has been hating "hippies" for nigh on 40.
For some reason I envisioned the poster as a neocon female. Its name was Dana. Its chirpy tone reminded me of Republican housewives I know, who spout a good line about getting a job and pulling your own weight, but who are buffered from many of the realities of the quest to obtain and retain gainful employment. As the conversation evolved, however, I began to sense that this was an older gentleman. The femmy vibe probably has to do with the fact that the body produces fewer masculine hormones as a man ages. At least he sounds like a young bitch rather than an old one.
It was joined by what seemed like a more verifiable young Reaganite. The young Reaganites are not so young anymore, but they drew their greatest strength after the tenure of St. Ronnie from the ranks of people younger than I am, who became the most dedicated of the antihippies. Many of them were the children of liberals who chose the neocon path as their rebellion against the parental non-yoke.
As the argument goes on it seems like a bunch of people shouting in the dark. No one has more than a second. Nuance is the first casualty. Everyone just yells something pithy, hoping to pith off the other thide. Thus will the entire laudable campaign fall apart, as both sides come to view it as a political liability. It's another no-win situation. "I voted against health care reform, but only after I voted for it."
Substantial reform is highly unlikely, however sorely needed.
This country is like a car speeding toward a jumble of fallen boulders. Half the passengers are screaming to turn right. The other half are screaming to turn left. Only one direction is correct. They will probably compromise by agreeing to plow into the boulders. We may well end up with something too damaged to drive. Let the younger generations build what they can from the wreckage.
Yesterday I let my temper get the better of me when I saw a comment under a post on a friend's Facebook page summing up anyone without health coverage as a lazy person who wanted a free ride. Such an assertion had to come from either a rapacious neocon of the sort that has been laying waste to the financial services industry for nigh on 30 years, or an aging conservative who has been hating "hippies" for nigh on 40.
For some reason I envisioned the poster as a neocon female. Its name was Dana. Its chirpy tone reminded me of Republican housewives I know, who spout a good line about getting a job and pulling your own weight, but who are buffered from many of the realities of the quest to obtain and retain gainful employment. As the conversation evolved, however, I began to sense that this was an older gentleman. The femmy vibe probably has to do with the fact that the body produces fewer masculine hormones as a man ages. At least he sounds like a young bitch rather than an old one.
It was joined by what seemed like a more verifiable young Reaganite. The young Reaganites are not so young anymore, but they drew their greatest strength after the tenure of St. Ronnie from the ranks of people younger than I am, who became the most dedicated of the antihippies. Many of them were the children of liberals who chose the neocon path as their rebellion against the parental non-yoke.
As the argument goes on it seems like a bunch of people shouting in the dark. No one has more than a second. Nuance is the first casualty. Everyone just yells something pithy, hoping to pith off the other thide. Thus will the entire laudable campaign fall apart, as both sides come to view it as a political liability. It's another no-win situation. "I voted against health care reform, but only after I voted for it."
Substantial reform is highly unlikely, however sorely needed.
This country is like a car speeding toward a jumble of fallen boulders. Half the passengers are screaming to turn right. The other half are screaming to turn left. Only one direction is correct. They will probably compromise by agreeing to plow into the boulders. We may well end up with something too damaged to drive. Let the younger generations build what they can from the wreckage.
Wednesday, August 19, 2009
Panic and Anger Breed Panic and Anger
How many of the people joining the rage fest against health care reform are doing it just because they see other people getting upset? Whoever started the panic knows that these things take on a life of their own. Something spooks the herd. Once they're running, it takes a lot less to keep them running. Rumors flash among them. Bystanders start to run, too. They're driven by whip cracks and shouts, by imagined attackers in the dust cloud kicked up by their own feet.
Democracy in action. Voting with their feet against their wallets.
Everything is going to be all right. Individuals will suffer. You will be one of them sooner or later. In general, however, life will go on for somebody.
Democracy in action. Voting with their feet against their wallets.
Everything is going to be all right. Individuals will suffer. You will be one of them sooner or later. In general, however, life will go on for somebody.
Monday, August 17, 2009
Partisan Pissing Contest Threatens to Drown Health Care Reform
An election is like a mountain climbing expedition. Funding comes from people who will never see the peak. Equipment is carried and messages are relayed by climbers who know they will never go high enough to be spotted with a telescope, let alone photographed in a triumphant pose beside a flag.
Many porters will labor just for a paycheck to ease their poverty, their lives barely improved by the success of the summit team.
On some of these expeditions, the team members don't even like each other that much. They do what they do so that their team will win. They lift their designated winner as high as they can and hope it's close enough for strength and skill to bridge the last gap. And then they all celebrate.
Most of politics takes place in the lowlands. The summits are metaphorical. The swamp is never far away. Whoever is king of the hill becomes a target for mudballs slung from the weeds where the losers dwell.
The opponents of health care reform have already succeeded in turning it into health insurance reform. The insurance companies know they can't provide quality care to a significant majority of citizens, let alone all of them, and still make a profit. Administrative costs alone must account for a large portion of the double-digit annual inflation of premiums. The paltry few percentage points of profit hardly seem worth it. So reforming that is like trying to wash a turd.
The saddest part is that the losing team in the last presidential election doesn't care one way or the other about health care. They only care about making Barack Obama lose at something. It might as well be this, because the issue is complicated enough to provide lots of entry points for scare tactics. If they can turn a constructive search for the best options into a contentious debate over ridiculous assertions they can befuddle and bore the American public into giving up the pursuit entirely. And then they can claim a Great Victory for their party against that young whippersnapper who managed to get elected strictly on the basis of grand-sounding, empty oratory.
Even if the effort to construct usable legislation continues, the partisans who play politics for points will need to gut it so the resulting product satisfies nearly no one. We've seen it before. We're seeing it now.
Before you get all wound up over this sort of thing, remember that opportunity only comes at a price. A lot of people have to lose for one person to win. If you want a chance to be that winner, you have to accept the possibility of losing. You have to extend that acceptance to your own health and life. Get rich or die trying.
In order for the American culture of opportunity to be truly fair, no one should get a hereditary advantage. Inherited assets not only should be taxed, they should be illegal. Everyone should start at square one. But then how would we maintain any great institutions? If we give a corporate entity a measure of immortality, how do we give it continuity of leadership without making it or another institution more powerful than any accomplished citizen? Whether anyone wanted to tackle that question or not, we have chosen instead to let fortunes pass and an elite tier of society wield power. Parents who bear children in the lower tiers must tell them that they have to take their chances. Get rich or die trying.
Because humans seem to have trouble grasping any value except monetary value, everything gets measured by that standard. Even something aesthetically or spiritually beautiful gets linked to money eventually. A starving artist's works may command far more in the years after the artist's death than their creator ever saw in life. Preachers of various spiritual disciplines receive financial contributions. Some of those preachers spawn institutions that outlive them. These institutions have a financial life. Great musicians hope to pull down a ton of money for gigs. Every thing of beauty or power has a price tag that can be manipulated.
Money can't keep you alive forever, but it can certainly help you put up a good fight. The struggle for money can destroy nature, love and whole societies, but we've made it the fundamental aim of our species.
Get rich or die trying. Give lip service to the value of the common folk, but what you're really grateful for is the fact that they're down there and not you. So the political fight for a victory on points doesn't really matter when we had no intention of doing anything benevolent in the first place. It's not a matter of nuance and detail. It's a fundamental acknowledgment that losers have to suffer. If you happen to be sick and you happen to fall short of a fairly high financial hurdle, something is so basically wrong with you that you will not be missed. Any one of you cheap dirt bags can be easily replaced. So suck it up.
I say this as a cheap dirt bag who has so far been fortunate enough to wiggle through any of the perils presented to me. I don't look forward to the one that does get me, but there's nothing I can do about it. Maybe I'll figure out how to get rich. Then I can live in my hilltop castle and empty my chamberpots down on the filthy dregs crawling up to seek my mercy.
E Pluribus Unum: out of all you dirt bags, ME. I got mine. Go get your own. If I feel nice I can give a little something to charity. Either way, you have to kiss my ass.
Isn't it about time we admitted that?
Many porters will labor just for a paycheck to ease their poverty, their lives barely improved by the success of the summit team.
On some of these expeditions, the team members don't even like each other that much. They do what they do so that their team will win. They lift their designated winner as high as they can and hope it's close enough for strength and skill to bridge the last gap. And then they all celebrate.
Most of politics takes place in the lowlands. The summits are metaphorical. The swamp is never far away. Whoever is king of the hill becomes a target for mudballs slung from the weeds where the losers dwell.
The opponents of health care reform have already succeeded in turning it into health insurance reform. The insurance companies know they can't provide quality care to a significant majority of citizens, let alone all of them, and still make a profit. Administrative costs alone must account for a large portion of the double-digit annual inflation of premiums. The paltry few percentage points of profit hardly seem worth it. So reforming that is like trying to wash a turd.
The saddest part is that the losing team in the last presidential election doesn't care one way or the other about health care. They only care about making Barack Obama lose at something. It might as well be this, because the issue is complicated enough to provide lots of entry points for scare tactics. If they can turn a constructive search for the best options into a contentious debate over ridiculous assertions they can befuddle and bore the American public into giving up the pursuit entirely. And then they can claim a Great Victory for their party against that young whippersnapper who managed to get elected strictly on the basis of grand-sounding, empty oratory.
Even if the effort to construct usable legislation continues, the partisans who play politics for points will need to gut it so the resulting product satisfies nearly no one. We've seen it before. We're seeing it now.
Before you get all wound up over this sort of thing, remember that opportunity only comes at a price. A lot of people have to lose for one person to win. If you want a chance to be that winner, you have to accept the possibility of losing. You have to extend that acceptance to your own health and life. Get rich or die trying.
In order for the American culture of opportunity to be truly fair, no one should get a hereditary advantage. Inherited assets not only should be taxed, they should be illegal. Everyone should start at square one. But then how would we maintain any great institutions? If we give a corporate entity a measure of immortality, how do we give it continuity of leadership without making it or another institution more powerful than any accomplished citizen? Whether anyone wanted to tackle that question or not, we have chosen instead to let fortunes pass and an elite tier of society wield power. Parents who bear children in the lower tiers must tell them that they have to take their chances. Get rich or die trying.
Because humans seem to have trouble grasping any value except monetary value, everything gets measured by that standard. Even something aesthetically or spiritually beautiful gets linked to money eventually. A starving artist's works may command far more in the years after the artist's death than their creator ever saw in life. Preachers of various spiritual disciplines receive financial contributions. Some of those preachers spawn institutions that outlive them. These institutions have a financial life. Great musicians hope to pull down a ton of money for gigs. Every thing of beauty or power has a price tag that can be manipulated.
Money can't keep you alive forever, but it can certainly help you put up a good fight. The struggle for money can destroy nature, love and whole societies, but we've made it the fundamental aim of our species.
Get rich or die trying. Give lip service to the value of the common folk, but what you're really grateful for is the fact that they're down there and not you. So the political fight for a victory on points doesn't really matter when we had no intention of doing anything benevolent in the first place. It's not a matter of nuance and detail. It's a fundamental acknowledgment that losers have to suffer. If you happen to be sick and you happen to fall short of a fairly high financial hurdle, something is so basically wrong with you that you will not be missed. Any one of you cheap dirt bags can be easily replaced. So suck it up.
I say this as a cheap dirt bag who has so far been fortunate enough to wiggle through any of the perils presented to me. I don't look forward to the one that does get me, but there's nothing I can do about it. Maybe I'll figure out how to get rich. Then I can live in my hilltop castle and empty my chamberpots down on the filthy dregs crawling up to seek my mercy.
E Pluribus Unum: out of all you dirt bags, ME. I got mine. Go get your own. If I feel nice I can give a little something to charity. Either way, you have to kiss my ass.
Isn't it about time we admitted that?
Monday, July 20, 2009
Practical Matter, Political Process
A strange creature called health care reform takes shape in the hilltop laboratory of the mad scientist known as the United States Congress.
The problem is simple: how can we make health services effective, affordable and available to our citizens? You'd be doing well to get any two of those. With all the bickering and posturing, we won't get one. And it really only counts as a success with all three.
Costs of health care and health insurance are freaking legislators out. Many of them, and the vast majority of citizens, also have not fully separated the concepts of insurance and care. Therefore, many so-called solutions still cling to the fatal flaw of for-profit insurance on top of for-profit care.
Profit is supposed to provide a more effective motive than compassion to insure that high standards are met in all aspects of health maintenance and repair. Forget caring about the patients. Can I make a bundle off my expensive education and long hours? I suppose it's only fair. Health service providers have to deal with nothing but grody stuff. They are reminded constantly of the frailty of life. A little moolah helps keep them interested in case they lack sufficient dedication to the alleviation of human suffering.
If a new system requires every citizen to purchase private insurance, it does create the giant pool including everyone, which is supposed to spread risk and lower costs, but really all the private companies still face the problems they have with small pools and skewed risk percentages. So insurance costs remain high and insurance companies still have ample motive to deny care.
If a new system falls entirely under governmental control, funded by tax increases, profit motive is eliminated, everyone is included and the associated higher taxes replace the scandalous insurance premiums that used to be the norm.
Legislators opposed to meaningful health care reform claim to have the interests of the taxpayers in mind. Yet by saving the taxpayers from the evil of higher taxes to pay for universal coverage they throw those same taxpayers to the wolves of high private insurance costs.
How about this: Let anyone who can afford it buy health insurance or pay outright for services. Let health service providers refuse service to anyone who does not show proof of ability to pay. A lot of people would remain miserably sick. Many would die. It would cost the least amount of money in premiums or taxes. It would create jobs and stimulate the economy the way mass die-offs always do. Real estate will change hands. Goods and services will be bought and sold. The population will go down, easing strains on the environment, infrastructure and the food supply. Energy consumption will drop. Oil companies would have to learn to deal with it, but they would just jack prices with sound economic excuses.
An increasing death rate would justify attempts to raise the birth rate. Poke away, folks! Life is cheap and easily replicated! Raise your kids strong, clever and ruthless. They will need those qualities to survive and flourish.
To reduce fraud, everyone would have to carry an implanted device that gives health service outlets an instant financial status report. If you're dragged in unconscious from an accident, the hospital should not be expected to waste time on a deadbeat. First responders would have to carry the financial status scanners so the health service industry wasted the fewest resources on a patient with insufficient funds.
In borderline cases a patient might receive treatment until his or her financial status dropped below a certain threshold. At that point the poor loser would be thrown out. Clear that hospital bed for someone who deserves it!
One might think that children deserved special coverage. Debate that if you will, but admit it: aren't the children of the wealthy just that much better than the wretched spawn of the working class and the poor? Any child who manages to rise out of the clutter will appreciate and deserve the status and security earned against long odds. If they never make it, they probably wouldn't have done any better if they had been sucking tax money out of their betters.
When are the United States Congress and the American people going to admit that they feel this way and embrace a true meritocracy? We can't keep flailing around between half-assed socialism and half-assed hard-core money worship created by politicians more concerned with staying in office than with solving problems.
People who have been thrown to the wolves either outrun the bastards or end up as wolf shit. Either way, problem solved.
The problem is simple: how can we make health services effective, affordable and available to our citizens? You'd be doing well to get any two of those. With all the bickering and posturing, we won't get one. And it really only counts as a success with all three.
Costs of health care and health insurance are freaking legislators out. Many of them, and the vast majority of citizens, also have not fully separated the concepts of insurance and care. Therefore, many so-called solutions still cling to the fatal flaw of for-profit insurance on top of for-profit care.
Profit is supposed to provide a more effective motive than compassion to insure that high standards are met in all aspects of health maintenance and repair. Forget caring about the patients. Can I make a bundle off my expensive education and long hours? I suppose it's only fair. Health service providers have to deal with nothing but grody stuff. They are reminded constantly of the frailty of life. A little moolah helps keep them interested in case they lack sufficient dedication to the alleviation of human suffering.
If a new system requires every citizen to purchase private insurance, it does create the giant pool including everyone, which is supposed to spread risk and lower costs, but really all the private companies still face the problems they have with small pools and skewed risk percentages. So insurance costs remain high and insurance companies still have ample motive to deny care.
If a new system falls entirely under governmental control, funded by tax increases, profit motive is eliminated, everyone is included and the associated higher taxes replace the scandalous insurance premiums that used to be the norm.
Legislators opposed to meaningful health care reform claim to have the interests of the taxpayers in mind. Yet by saving the taxpayers from the evil of higher taxes to pay for universal coverage they throw those same taxpayers to the wolves of high private insurance costs.
How about this: Let anyone who can afford it buy health insurance or pay outright for services. Let health service providers refuse service to anyone who does not show proof of ability to pay. A lot of people would remain miserably sick. Many would die. It would cost the least amount of money in premiums or taxes. It would create jobs and stimulate the economy the way mass die-offs always do. Real estate will change hands. Goods and services will be bought and sold. The population will go down, easing strains on the environment, infrastructure and the food supply. Energy consumption will drop. Oil companies would have to learn to deal with it, but they would just jack prices with sound economic excuses.
An increasing death rate would justify attempts to raise the birth rate. Poke away, folks! Life is cheap and easily replicated! Raise your kids strong, clever and ruthless. They will need those qualities to survive and flourish.
To reduce fraud, everyone would have to carry an implanted device that gives health service outlets an instant financial status report. If you're dragged in unconscious from an accident, the hospital should not be expected to waste time on a deadbeat. First responders would have to carry the financial status scanners so the health service industry wasted the fewest resources on a patient with insufficient funds.
In borderline cases a patient might receive treatment until his or her financial status dropped below a certain threshold. At that point the poor loser would be thrown out. Clear that hospital bed for someone who deserves it!
One might think that children deserved special coverage. Debate that if you will, but admit it: aren't the children of the wealthy just that much better than the wretched spawn of the working class and the poor? Any child who manages to rise out of the clutter will appreciate and deserve the status and security earned against long odds. If they never make it, they probably wouldn't have done any better if they had been sucking tax money out of their betters.
When are the United States Congress and the American people going to admit that they feel this way and embrace a true meritocracy? We can't keep flailing around between half-assed socialism and half-assed hard-core money worship created by politicians more concerned with staying in office than with solving problems.
People who have been thrown to the wolves either outrun the bastards or end up as wolf shit. Either way, problem solved.
Tuesday, July 14, 2009
Oh *&^% YEAH! What'd I *&^%*-in' tell you?
Research indicates that cursing lessens the sensation of pain, according to an article on Web MD.
We cursaholics know well the balm of the F-bomb in situations that deal both actual and emotional pain. Admittedly, some of us resort to these painkillers too frequently, but it's no different from abusing over-the-counter or prescription remedies.
Indeed, medical use of profanity may come in with the legitimization of medical marijuana.
"I want you to smoke one doobie every six hours and say $&^$^%#! *&%*&! @$%#&%! once every four hours. If you need to, you can increase the dosage of $&^$^%#! *&%*&! @$%#&%! without too many side effects. Just beware that while marijuana carries no risk of addiction, you may find $&^$^%#! *&%*&! @$%#&%! to be very habit forming."
We cursaholics know well the balm of the F-bomb in situations that deal both actual and emotional pain. Admittedly, some of us resort to these painkillers too frequently, but it's no different from abusing over-the-counter or prescription remedies.
Indeed, medical use of profanity may come in with the legitimization of medical marijuana.
"I want you to smoke one doobie every six hours and say $&^$^%#! *&%*&! @$%#&%! once every four hours. If you need to, you can increase the dosage of $&^$^%#! *&%*&! @$%#&%! without too many side effects. Just beware that while marijuana carries no risk of addiction, you may find $&^$^%#! *&%*&! @$%#&%! to be very habit forming."
Monday, July 06, 2009
Drink a pot a day, drink a pot a day, YAY!
New study shows that heavy coffee consumption helps combat Alzheimer's Disease. Jeez, how bad would I be without it?
Check out the details of caffeinated lab mice here. Be better at the rat race! Endorsed by actual rats!
Check out the details of caffeinated lab mice here. Be better at the rat race! Endorsed by actual rats!
Monday, September 17, 2007
Hillary Romney, Mitt Clinton
Hillary Clinton has embraced a mandatory insurance plan reminiscent of Republican rival Mitt Romney's, as she tacitly admits that she can't beat the insurance companies or pry their talons off of health care financing in this country.
In that regard, at least, the next two presidential terms will be business as usual. Neither party apparently has the stones or the integrity to try to provide equal access to treatment across the financial spectrum.
Remember: your value is measured in dollars. Get lots of dollars and you will be all right. The market is wise and will reward the best people and products that humanity can produce.
Really? Then why do opium, tobacco, alcohol and gambling do so well? People are willing to pay for them well beyond the point at which they provide any improvement to the quality of life. Drugs are so popular we have to have laws against them and devote kilos of money and time to try to eradicate them. That's the free market in action. The drug dealers don't even get to hire the best ad agencies and flood the airwaves with carefully calculated messages to promote their product. Demand rides high on word of mouth alone.
John Stossel presented an infomercial for laissez-faire economics the other night, lambasting socialized medicine and lauding the market-based approach. The leaps of logic and begged questions went by too fast for me to catalog and consider them all. It masqueraded as an in-depth news analysis, but its slant was clear from the outset. Socialized medicine bad. Free-market health care for profit good.
Okay, okay, I get the picture. Maybe it's time to quit voting and let the country run itself. I feel sorry for my friends' children, and for my nephew and children-in-law. But hey. The only thing you're guaranteed in this life is a death.
About all human beings do is fuck and argue anyway. In the freewheeling past, our sex drive slightly offset the destructive forces of famine, pestilence and our crappy personalities. No one had to think too hard about anything. In fact, it was probably better if you didn't. Unfortunately, a few people thought a little more and a little more clearly, enhancing our survival ability and our capacity to kill each other at the same time. Even so, people got more and more hooked on the idea of long, prosperous, somewhat peaceful lives. That pursuit of peace and prosperity has led to more complex arguments degenerating into larger and bloodier wars as time has gone by.
Money and advanced technology obscure the animal nature of human activity and the philosophies used to try to exalt it to some higher status. There isn't even anyone to tell, because the few who can see it for what it is have no power to change it. I mention it merely to go on record as one who noticed. I will now shut up and let it run its course unchecked. I will probably continue my local activities, futile as they may be, just for something to do while I wait for my exit cue. I have some friends here, and I hate to let them down.
In that regard, at least, the next two presidential terms will be business as usual. Neither party apparently has the stones or the integrity to try to provide equal access to treatment across the financial spectrum.
Remember: your value is measured in dollars. Get lots of dollars and you will be all right. The market is wise and will reward the best people and products that humanity can produce.
Really? Then why do opium, tobacco, alcohol and gambling do so well? People are willing to pay for them well beyond the point at which they provide any improvement to the quality of life. Drugs are so popular we have to have laws against them and devote kilos of money and time to try to eradicate them. That's the free market in action. The drug dealers don't even get to hire the best ad agencies and flood the airwaves with carefully calculated messages to promote their product. Demand rides high on word of mouth alone.
John Stossel presented an infomercial for laissez-faire economics the other night, lambasting socialized medicine and lauding the market-based approach. The leaps of logic and begged questions went by too fast for me to catalog and consider them all. It masqueraded as an in-depth news analysis, but its slant was clear from the outset. Socialized medicine bad. Free-market health care for profit good.
Okay, okay, I get the picture. Maybe it's time to quit voting and let the country run itself. I feel sorry for my friends' children, and for my nephew and children-in-law. But hey. The only thing you're guaranteed in this life is a death.
About all human beings do is fuck and argue anyway. In the freewheeling past, our sex drive slightly offset the destructive forces of famine, pestilence and our crappy personalities. No one had to think too hard about anything. In fact, it was probably better if you didn't. Unfortunately, a few people thought a little more and a little more clearly, enhancing our survival ability and our capacity to kill each other at the same time. Even so, people got more and more hooked on the idea of long, prosperous, somewhat peaceful lives. That pursuit of peace and prosperity has led to more complex arguments degenerating into larger and bloodier wars as time has gone by.
Money and advanced technology obscure the animal nature of human activity and the philosophies used to try to exalt it to some higher status. There isn't even anyone to tell, because the few who can see it for what it is have no power to change it. I mention it merely to go on record as one who noticed. I will now shut up and let it run its course unchecked. I will probably continue my local activities, futile as they may be, just for something to do while I wait for my exit cue. I have some friends here, and I hate to let them down.
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