health care

Sort of a ranty post here, hence the angry gun-toting photo.

My man — and soon to be home-owner (!!!) — Franko had an interesting comment on his blog in response to Sicko:

I’ve had no illusions about how fucked up HMO’s are and always just assume that I’ll never get any coverage for anything. I have never, ever been totally honest with any doctor I have ever had for fear of having my honesty come back to haunt me. No doctor of mine has or will ever know that I used to smoke cigarettes, how much I drink, past drug use etc. I feel that I am always trying to game a system that would like nothing more than to game me.

This is something I’d never actually considered. Frank’s the son of a Doctor so he’s been on the inside his whole life. I suppose I’ve been more of a naive trusting optimist, and having never had any other regular doctor than Dr. Halpern, who was my pediatrician and saw me once or twice as an adult, I’ve always been totally honest with health care people. It’s never occurred to me to do otherwise, because they’re supposed to be evaluating my health, and I assume they need all the data. I also assume at some level that what I share with them is private.

This, of course, is not really how it works. The fact that we have a system which employs the profit-motive to drive denial-of-care of course does mean that people lie to their docs. This is just another example of how deeply-grooved the wrong in our system of Health Care is. It’s paradigmatically perverted. Spiritually fucked.

Critiquing The Critique
A lot of the pushback against Moore’s film has taken one of two tracks. First defenders of the status-quo say the film is just a collection of anecdotes, that every big system will have failures, and that you could (and indeed people have) collect horror stories of the Canadian or any other Health Care system. This is true to some extent. The film is a documentary that follows a limited number of human threads, but the notion that these stories are just that, stories, is wrong.

Sicko isn’t a statistical report — although those have been done and they show our system is out of whack too — but I believe it succeeds in the pursuit of truth precisely because the stories it illustrates are not in any way extraordinary. They are anecdotes which correctly and piercingly illustrate the experience of Americans (people with insurance, I might add) who interact with the US system of Health Care. Everyone I know has a story to tell of their own, of their friends’, their family’s, that would fit right in.

The second thread of criticism — exemplified by MTV’s Kurt Loder here — is essentially, “What Michael Moore’s talking about is Communism, and we’ve tried Communism and Communism hasn’t worked.” Indeed, all the evils of socialism are on parade:

• Waiting lists! As if no American has ever had to wait to get treatment. The way our shit works, you might have to wait months just to get a doctor who’s willing to give you a referral because nobody wants to get involved with you and your problems.
• Cost overruns! As if we don’t spend nearly twice as much per-citizen as Canada. And that’s without covering nearly 50 million people, by the way.
• Quality of care! We have some real high-end stuff here, it’s true, but the proof is in the pudding, and more American babies die before reaching the age of one than in motherfucking Cuba. That’s what “infant mortality“ means, Kurt, you sold-out cocksucker.

What is to be Done?
Health Care is one of those issues, like energy policy, where the disconnect between the People (both in terms of popular opinion and the Public Interest) and our representatives in the leadership class is huge. It makes it hard to talk about without sounding like a pinko, because it’s very difficult to assess the situation and not draw the conclusion that entrenched Corporate power and a corrupted elite are the reasons why we are where we are.

Which is, again, spending twice what any other post-industrial nation does to cram the “covered” people into a Kafka-esque bureaucratic hell with no certainty of coverage, while creating an underclass out of the 17% or so who are left over. Oh and also preventing trust and honesty between doctors and patients, and short-circuiting the basic impulse to provide aid and care to those in need. That’s what we get in return for these great investment portfolio pieces.

In a very real way — and this is a point one of Moore’s interview subjects (Tony Benn) makes — this is part of a complex of oppression, along with endemic debt and an increasingly servitude-based array of “career options.” It keeps us down on the first levels of Maslow’s pyramid of human needs, scrabbling for basic security. The limitations this system imposes on our civilization go beyond basic economic metrics like spending and life expectancy. There is a real moral and spiritual restraint created by the way we care for our sick and injured, and I think this is the essential truth that Sicko attempts to illustrate.

Liberation from this bondage would hardly eliminate all suffering, but we can be fairly certain that there would be substantially less of it, and that should be worth doing on it’s own. Further, the benefits of greater freedom and security for our people are multivariate and untold. It would be the beginning of a new era in a very real way. We could be heroes.

And yet nobody but Dennis Freaking Kucinich wants to tackle this issue head-on. I’ll say it again: sold-out cocksuckers.

I think, the pressure for change will grow as the Boomers retire, but real movement is not going to originate from the Top. Even back in the golden days of ’92, the Clintons’ proposals were pretty modest, and they got clobbered. Official sentiment lags further behind the Public on Health Care than it does even on the War, and until our leadership caste start to really feel the heat — which means mobilizing and organizing ourselves out here in the fields — it’s going to be more crappy status-quo bullshit like the “Medicare Part D” giveaway to Big Pharma.

Now I’m a filthy capitalist, but I’d much rather have social and economic infrastructure (roads, electricity, health care, primary education, the internet, etc) provided on a not-for-profit/utility basis. It’s an objectively more effective way to operate, and it frees us all up to do more and interesting things with our lives.

Anyway, I really hope something credible does emerge around this issue because it’d be up for another stint of “investment activism.”

UPDATE: I stumbled across this similar piece by James Clay Fuller which was more thoroughly researched and gave me the name of the British MP (Tony Benn) and this great quote:

All of the pieces I’ve read about “Sicko,” have what I find to be a glaring omission.

Not one mentions the comments by Tony Benn, a former member of Britain’s Parliament. Yet Benn’s statements probably are the most profound element of the film.

He notes, as other good people often do, that “if we have the money to kill (in war), we’ve got the money to help people.”

But, more importantly, Benn tells Moore, that all of Europe and many other places have good health care systems while the United States lacks such a basic service because in Europe and elsewhere, “the politicians are afraid of the people” when the people get angry and demand some action. In the United States, he observes, “the people are afraid of those in power” because they fear losing their jobs, fear being cut off from health care or other services if they speak up and make demands.

“How do you control people?” Benn asks, and he answers: “Through fear and debt.”

Also found some on YouTube:

So, you know, you can get this off the internet the same way I get most of my video entertainment (savvy?), and I just watched it and it was really good. I don't go for Moore's coy, "gee mister, don't people in Cuba have to pay for healthcare" character, but his films can be quite thoughtful, and this is some of his best work. The assembled stores really speak for themselves.

One thing that stuck out for me was this bit from France, where they make sure that if you're poor and you need to take a cab home you can walk out with some cash. There's a line where the French doctor says, when asked about paying bills, something along the lines of, "the only qualification for walking out is that you're healthy enough and are going someplace safe."

That hit home for me, reminded me of the bike crash that got me wearing a helmet:

Actually, the stitches are not that much of a pain. There were a few woozy moments in the ER, but the real damage is muscular. I righteously pulled out my groin and jammed by elbow, both on the left side. Heading in I could walk and move pretty well. Walking out of the hospital took me a full five minutes gimping along, coming close to out and out crying on the ramp leading to the street. It’s a hell of a thing to be totally incapacitated.

That was a real fucked-up five minute walk down a 40-foot hallway. I was scared that I wouldn't be able to make it, moving literally one foot in front of the other out to the street to get a car to take me back to Brooklyn. The way the hospital staff would look away as they passed by, or give this kind of sheepish "good luck" grin, still sticks with me. I believe the system we have is evil on a kind of spiritual level for creating moments like that.

Another thing that stuck with me was the first thing Dr. Miller (he was good; I remember his name) asked when he saw my head was whether or not to send me up to a plastic surgeon. I did a double-take and told him I didn't have any coverage and he paused a beat and then said "I'll do the absolute best I can."

As like I said, he did good. Those stitches healed up straight and true and unless I've gotten a lot of sun you can barely tell they were there. And anyway, chicks dig scars, right?

I've lived largely without insurance since graduating from college, all except for the year I worked for MFA, and for the most part it's been ok. I'm lucky to be strong and healthy in spite of my breakneck lifestyle and questionable diet. One time I got a bad flu and went to the San Francisco Free Clinic, which is a leftover from the 60s, but where I got penicillin for $3. The first time I really wrecked in NYC it was late and there was no traffic cop to see me go down and hustle me into an ambulance, and I didn't need stitches or anything, so I biked home and just gutted it out.

I've done allright. I've been lucky. As I get a little older I get to feeling a bit more risk-averse. Soon we'll have insurance through work, and that'll be nice; but the truth is, as this film makes abundantly clear, an insurance-based, profit-driven health care system will always be extremely problematic, as it's paradigmatically oriented away from providing treatment. Even for those with coverage.

I've said before that I want my first new car to be an alternative fuel or electric vehicle. Similarly, I'd really like it if by the time I have kids we've gotten our shit together to where health care isn't such a humongous clusterfuck. Here's hoping.

I disagree with most of my friends. I think the Health Care plan John Edwards proposed yesterday is a massive dud, and I'm very disappointed.

Here's Candidate Edwards looking and sounding pretty good on the issue:

But here's a summary of his plan, which also remarkably light on specifics and isn't available as HTML (wtf?):

• Require businesses and other employers to either cover their employees or help finance their health insurance.
• Make insurance affordable by creating new tax credits, expanding Medicaid and SCHIP, reforming insurance laws, and taking innovative steps to contain health care costs.
• Create regional Health Markets purchasing pools to ensure that every American has a way to purchase an affordable, high-quality health plan, increase choices among insurance plans, and cut costs for businesses offering insurance.
• Once these steps have been taken, require all American residents to get insurance.

Emphasis all mine, but notice the difference? Candidate Edwards says the word "insurance" exactly once: to attack a sick and parasitic industry which combines the worst aspects of Socialist Bureaucracy and Capitalist Profiteering, and is rightly loathed by virtually all Americans.

His plan, on the other hand, is all about making insurance affordable and creating new markets and choices for insurance. Oh, and also tax credits for insurance too.

This is a huge mistake, for a couple reasons.

First of all, it's beyond off-message. As I said, nobody likes insurance companies. You may or may not be trying to legislate them out of existence, but your sell is about health care, not insurance.

This indicates to me that either the Edwards campaign is terrifically disorganized, lacking internally coherent strategy for talking to the public, or else they're afraid of arousing the ire of the insurance industry. Both options are problematic and neither bode well for a campaign that needs to gain ground to have a chance.

Secondly and more substantively, this is the wrong way to address the actual problems of health care.

Are You Ready For Some WonkBall!?!?
Insurance plans redistribute wealth. They take money away from all the little people who contribute, pool it, and dole it back out when needed. Public entitlements like Social Security -- which will be around as long as we want it and I fully expect to draw -- can redistribute wealth from the top to the bottom by providing somewhat more generous benefits to the less-affluent recipients vs. what they put in. This is financed by stiffing the rich people, and/or diverting money into the pool from other sources (e.g. taxes on corporations, puppy-killers, and the like). That's nice.

Privately-run insurance corporations, on the other hand, make a profit by not paying out all the money they take. They redistribute from the bottom to the top; the wrong way from a fairness standpoint. They take more from the little people than they pay out to doctors and hospitals, and that money goes to administrative costs (including bulging CEO salaries) and profit (e.g. investors).

Mandating that everyone purchase insurance mandates that everyone join this wealth-redistribution scheme. This is also a problem w/auto insurance FYI. In the context of a private insurance marketplace, mandated coverage means propping up "reverse Robin Hood" redistribution, making the rich richer at the expense of everyone else. Which side of the "Two Americas" are you on, John?

"But!" they say, "The plan says that some public option needs to be available! There will be tax credits! There will be expanded acronyms!"

This is true, and the plan probably does represent some incremental improvement over what we have now. However, it's not a very good plan, and there's no good reason for not doing it right. Here's Atrios:

If you want everyone to sign up, don't "mandate" that they "buy in" to the program. Just, you know, sign them up and take it from their paycheck. If they don't have a paycheck, they're still signed up.

This is the sticking point, and it's unambiguous. From Edwards' 7-page PDF:

Once insurance is affordable, everyone will be expected to take responsibility for themselves and their families by obtaining health coverage.

Contrast this with Edwards' nice rhetorical (and, it appears, purely rhetorical) point that "we've got to stop talking about access to health care." Good point, except your plan stabs you in the back, dawg.

He's talking about putting people into a complex and confusing marketplace (lots of choices, and tax credits too) for "coverage plans." That's access to an insurance marketplace -- once it's "affordable," of course -- not Universal Care. I call bullshit.

Universal Health Care means Universal Health Care. It means you're taken care of. You don't need to worry about it. You don't need an accountant to pay for it. It's there. You get hurt or you get sick? You're covered.

This is how civilized societies treat their citizens. It's how decent human beings deal with one another.

This is not a place to kowtow to "market forces" or to genuflect before some mythological notion of "personal responsibility." This is a place to enact a new right: the right of every citizen to be taken care of should they become injured or fall ill. You don't need to legislate the insurance industry out of existence to do that. You just need to cover everyone. Why is that so hard to fucking do?

Atrios again:

True universality in that people are essentially automatically enrolled... You could default people into Medicare and let insurance companies compete with that to lure customers away, or whatever. The details of course matter, but this absurd extra step of "mandating" that people "buy in" is just dumb. There's no reason for it.

Word.

Bringing It All Back Home
Finally, on a personal note, I'm probably harping on this (and I am harping, make no mistake) in part because my Grandmother is going through end of life issues, and my mom is dealing with all the byzantine complexities of our health insurance system. It's hard to communicate how deeply, completely, and inhumanely fucked the whole scene is.

It's fucked. It's totally fucked. The people who profit from this are vampires.

Suffice to say, my second-hand experience alone is enough to give me a serious feeling of "disgusted" that this is considered by young centrist policy wonks to be "a big step forward." Any plan that doesn't address the needless complexity of our current system and which isn't fully universal is not one that will get me excited.

What Edwards offers still leaves us well behind the rest of the industrialized world, and for no reason other than... well, I don't know. Continued subservience to some kind of magical thinking about marketplaces, fear of pissing off the insurance industry (hint: they're going to hit you with everything they've got anyway), or perhaps a reflexive aversion to government programs to support the Public interest. Any road, not what I've been hoping for from Johnny Sunshine.

In the larger context, he can always change up, but this costs him in my eyes. Hillary can be counted on to come in with an even more corporate plan, and Kucinich will do something that will not matter at all. It would be a bold move for Barak "Binding Resolution" Obama to come through with a true Universal Coverage plan here (Vote It Up!), though I'm not holding my breath on that.

67% oppose the war in Iraq and 70% disapprove of Bush's handling, but nobody is talking about taking a hard stance against the Bush/McCain/Lieberman tactic of escalation.

Likewise, everyone knows the health care system doesn't work and understands that the only entity which has a shot at fixing it is the federal government, but we've yet to hear anyone step up and catch that 70% of public opinion in their sails.

Finally, clear majorities want to invest in efficiency and alternative energy sources, and yet our leaders are stuck dicking around with ANWAR and a few underfunded pilot/mostly-for-show projects.

My point is, the Public is actually not that fucking stupid. Our leadership is just timid and out of touch -- if not outrightly corrupt -- and our organs for articulating Public Opinion have fallen so far from the Jefferson/Franklin ideals that they're closer to the state propaganda machines in the USSR than a legitimate Free Press.

People in this country are a little out of shape and kind of materialistic, but "big dumb America" actually has much a better grasp of what the fuck is going on than the elite leadership.

We're going to see some serious realignment over the next decade, with either a major shift in "national prorities" from the power-elite, or the rise of localism as cities, counties, states and regions begin to abandon the ossified and ineffective federal system in favor of their own problem-solving.

Hopefully we get both. ;)