Standing Watch

August has been a particularly volatile month in the United States. The health care reform debate, which had been hotly debated by politicians and media pundits for months, went from simmer to full boil-over, as shouting matches erupted in public forums, and heavily armed citizens arrived for presidential events. In fact, death threats against President Barack Obama, according to the US Secret Service, have increased by 400%, presenting a particularly difficult situation for the USSS, given the current political climate. There are even media reports of religious leaders calling for the President of the United States to be murdered. The most notable, or notorious, account of this was on CNN recently, where Pastor Steven Anderson of the Faithful World Baptist Church in Tempe, AZ, called for the children of President Obama to become orphans, and his wife to become a widow.

There is little doubt that the health care debate has gone beyond debate, and has moved into a borderline insurrection that advocates the overthrow of the federal government and assassination of elected and appointed government officials. Most of the vitriol and potential for violence can be laid squarely at the feet of failed politicians, media pundits, and right wing extremist groups seeking to promote an entirely different agenda. Unfortunately, a considerable amount of the hatred we are seeing can also be laid squarely at the feet of the President himself, as well as so-called “Blue Dog Democrats,” who are more beholding to their corporate masters than to The People they swore to represent and protect.

Lost in all the threats of violence and other acts of hate that garner all the media attention is the actual health care debate. Despite claims in the media from pundits and politicians, a full 15% plus of AMERICAN CITIZENS, meaning persons born in the United States or who earned and obtained their citizenship entirely by legal means, are uninsured (2007 US Census Report), and are completely locked out of the health insurance process for various reasons. Another estimated 20% are underinsured, meaning they lack sufficient health coverage to pay for basic preventative care, routine care, and emergency care due to high deductibles, high co-payments, and extensive exclusions within their policies. Another estimated 10% will have their policies canceled arbitrarily by their insurance carriers when they go to actually use their insurance to pay for their care.

The United States is also at a serious competitive trade disadvantage with other industrialized nations, all of whom have either a universal single payer health program, or who have a very strong public option that keeps costs for health care down through direct competition. US businesses are forced to either provide third party health coverage, or have opted to “self-insure,” effectively becoming the insurance company. Businesses who cannot offer health coverage, generally small businesses and start-ups, can’t compete at all, and usually end up going out of business because they cannot effectively compete in the labor market for skilled employees.

Clearly, something needs to change. Having tens of millions of US Citizens without any access to health care services beyond rudimentary emergency care presents a very serious health risk for the entire nation on a number of levels. Add to that millions of immigrants, both legal and illegal, who are also uninsured or underinsured, and you have all the ingredients of a health care disaster. Problem is, the insurance issue isn’t only one crashing the health care system.

For-profit private hospitals routinely refuse care to those without health coverage (except for the very wealthy cash patients), even emergency care. In a procedure known as “turfing,” patients considered unable to pay in a timely manner (as defined by corporate policy) are stabilized, and then shown the door as quickly as possible. Here are a couple of examples of how this works:

• A patient presenting with signs of extreme hypertension will be given drugs that bring the blood pressure down temporarily, and then sent home and told to contact their physician at the next opportunity. That night, the patient has a major stroke, and either dies or is left seriously disabled for life.

• Another patient arrives complaining of neck and back pain after a fall. The pain is treated, and the patient sent home. They end up paralyzed from the neck down due to a spinal cord injury.

• Yet another patient arrives, this time with major trauma to the head. With no insurance, all the hospital does is get all the vital signs stabilized, and then has the patient transferred to a hospital that takes patients who can’t pay, 50 miles away during rush hour traffic. Enroute, the patient dies.

And it’s all perfectly legal. No private hospital is under any obligation in a medical emergency to treat the emergency. All they are required to do is get the patient stabilized, which eliminates the emergency, and then the patient is out the door by whatever means necessary. Human life becomes a commodity to be exploited, and to be disposed of when there’s no profit to be had from it.

Public hospitals, on the other hand, are required to treat anyone who comes through their ER doors, and cannot “turf” patients (though some do). If the above cases arrive, they have to assess the patient, prioritize them based on the severity of illness or injury, and treat them accordingly. Stabilization isn’t enough, they must prevent further harm, and do what they can to make the patient well and whole again. Often times, however, these taxpayer funded facilities are grossly underfunded, the personnel seriously overworked, and the emergency rooms crowded. In addition, most of their patients can’t pay, which compounds the problem. Those that can are only able to pay a token amount monthly, and rarely are able to pay the full cost of their treatment.

And, when someone cannot afford health care, every health issue becomes an emergency room case, since they cannot afford a family doctor. We see this every winter during flu season, as emergency rooms fill up with the sick who have nowhere else to turn. Of course, there is nothing to be done about the flu, which a family doctor would tell them if they had one. But, each patient must be seen, assessed, evaluated, and then sent home with the same advice they could have gotten over the phone or by a $40 office visit, rather than the $400 ER visit.

But, where the problem becomes apparent is with the result. Tuberculosis, which was fairly easy and once inexpensive to treat, is now drug resistant and potentially fatal because patients cannot afford to comply with the year long treatment regimen. Nearly eradicated childhood diseases are on the rise as families are forced to choose between immunizing their children or feeding them. Easy to treat injuries go untreated, resulting in permanent disability that need not happen. We now even have children and adults dying from simple dental issues, which no one is required or obligated to treat, and which are now very expensive. If you require corrective lenses (glasses or contacts) to function in life, well, welcome to having to adapt to blindness in a world that sees corrective lenses as a fashion statement, not a life necessity. An eye exam runs about what a week of groceries runs for a family of four, and the glasses can easily eat up a month’s salary for a blue collar worker with no vision coverage.

Where this will all become obvious to everyone will be with the next predicted health disaster, the H1N1 flu virus that caused a global panic last spring, and which is expected to go pandemic at the very start of this year’s flu season. It’s already become clear that there will only be enough drugs to vaccinate 15% of the population, and the price is expected to be very high. Tamiflu, which by the way won’t work with this particular bug, has long been sold out, and there are reports that the need is being filled by dangerous black market counterfeits that do not work, and could be fatal.

Okay, these are things we all see, and we all recognize as problems. Where the debate should be is on how to fix these problems. Unfortunately, that is not the direction the debate went.

It started out with Obama breaking his promise, to sign into law by the end of his first term a bill for universal single-payer health care. For those who are unaware of what that is supposed to be, universal single-payer means the government pays, through your taxes, any medical bills for necessary treatments and procedures you and your doctor decide upon. The government’s role is to pay for the medical care, prevent fraud, and negotiate with the health care industry on prices. This is what most industrialized nations have already, and it has worked for them for decades. Even in the US, it’s most commonly known form is Medicare (for retired and disabled persons) and Medicaid (for low income families and certain retired and disabled persons who cannot afford the almost $100 per month premium for Part B).

Unfortunately, Obama started from a very bad bargaining position, giving up before discussion even began on universal single payer health care, and went right to the middle of the road position, the often derided public option. This option is one where the government forms a non-profit health insurance program that provides coverage similar to Medicare to those who cannot obtain coverage elsewhere. Premiums would be sliding scale and based on income, and pretty much anyone could opt in. In using this middle of the road negotiating position as a starting point, rather than working towards it from a much better starting position. In other words, had Obama had an ounce of political sense, and didn’t want to desperately appear bipartisan for the history books, we would probably have a public option before the holiday season started.

But what we got instead was HR 3200, the notorious health care legislation being debated in the US House of Representatives, as out starting point. Universal single-payer health care is out, and as of this writing it appears the public option plan, if it does remain, will be so weak as to be just another paper tiger. With media reports that Obama has cut a deal with United Healthcare (via their proxy, AARP) and PhRMA (the Pharmaceutical Research and Manufacturing Association lobbyist group), which appears to be true now that PhRMA, AARP, and United Healthcare are running the advertising campaign alleged to be agreed upon in the deal (Huffington Post has a copy of the memo obtained from a lobbyist who grew a conscience).

But the battle isn’t quite over yet. Republicans, media pundits, and bloggers, some of which are being directed and funded by Dick Armey’s FreedomWorks, smell blood and fear in the water coming from the Obama Administration, and want to defeat any reforms whatsoever. In order to achieve this goal, a viral email is circulating, and is now widely used in the media and by conservative bloggers, that is mostly misleading, and even contains 26 outright lies. Where this sort of tactic becomes alarming is what the end result was, the aforementioned protests, complete with protesters showing up at Obama events carrying semiautomatic rifles. Even so-called Blue Dog Democrats have joined the efforts to spread the disinformation and lies about HR3200.

The problem is, HR3200 does have serious flaws, none of which are even being addressed. For instance, if a viable public option were offered and found successful, what provisions are being made to establish a safety net and retrain health insurance employees for other careers? How is this plan to actually be paid for? Why isn’t there a plan to also have a public option for malpractice insurance, which would drive down those rates and likely eliminate many of the bogus lawsuits that are filed every day, not to mention remove from practice negligent or incompetent practitioners (the real culprits behind skyrocketing malpractice premiums)? Where are the provisions to encourage experienced health care professionals to educate others, especially nurses and family doctors? Where is the funding to pay for the education of future health care professionals?

These are real questions, ones that everyone needs to ask. What are we being told to question instead? We’re being told any plan would involve health care rationing, which is already going on through private insurance. We’re being told there will be “death panels,” which already exist in corporate board rooms. Neither of these already existing practices in the private insurance industry would occur in the original public option plan (who knows what the final version will be like). We’re being told it will be too expensive, despite the fact that the currently proposed public option will cost participants at least 40% less. In fact, we’re being told a lot of things that aren’t true in the proposed legislation, but are in the current commercialized system.

The current health insurance industry is corrupt to the core, putting quarterly stockholders reports and financial incentives ahead of human life. The delivery system is just plain broken, with multiple critical staffing shortages, lack of educational resources, and underfunding in almost every area. There are no real plans for dealing with changing the system, and the inevitable consequences of those changes.

Shouldn’t we be paying attention to the real issues, and finding common ground on the solutions to them, rather than focusing in on the hysterics of attention seekers, media hype, and those promoting agendas totally unrelated to this discussion? At my age, and with my health issues, I know I won’t live long enough to see a viable cohesive, coordinated solution to our collapsing health care system. Okay, I can handle that, because time isn’t on my side with this one.

What bothers me, however, is I seriously doubt any of you readers will see such a plan in your lifetimes, either. I have to wonder what would have happened had Hillary Clinton, who is not politically naïve and who had a good idea with her plan in the 1990’s, had won the election and was president. Instead, we got a political novice, who’s greatest goal in life is to make everyone happy, no matter what the cost.

I remember hearing, repeatedly, that we in the United States will never get the government we want, but we always get the government we so richly deserve. After watching the hysterics and disinformation campaign the last several weeks, I couldn’t agree more.