The doctor will see you now

The worst thing about undergoing a biopsy is the inevitable wait for the results to come in. And if you plan ahead poorly and have the procedure on a Thursday or Friday, I can just about guarantee your weekend will be ruined, because it’ll be Monday before you get the word.

Of course the really worst thing is to have what doctors ironically refer to as “positive” results when they really mean you are not going to be happy to hear them. Your red flags should go up when the doctor asks you to come see him as soon as possible, to talk about your situation.

Imagine this scenario: After sitting in the waiting room with half a dozen or so other patients, you find yourself confronting your future. Your doctor explains that you have a tumor, in fact of the kind that grows fairly rapidly, making surgery the only real option for treatment.

The doctor, whom you trust absolutely and have known for half your life, doesn’t mince words. If you don’t have the surgery, you will die, and soon.

This is not just one kick-in-the-gut time, but two. When you were laid off, fortunately you had enough savings to tide you over until you could find another job, and now that is going to run out while you recover from what will be major surgery. Not only that, but you lost your health insurance with the job, and no other insurance company was willing to cover you because you have had diabetes, even though it has been controlled with dietary changes.

You are looking at tens of thousands of dollars, all told, that you just don’t have. The choice is pretty simple: Find the money or die.

Family conference time: you have a decent amount of equity in your home and will be able to borrow against that. Then two of your kids, who are each doing pretty well, offer to pitch in. They have lots of equity in their homes and can easily raise the money. “We want to keep you around, Dad.”

This is not where you say, “No, I’d rather die than let my kids go into debt!”
At least, I certainly hope not!

How could I even suggest such a thing? Because if you cast the situation in terms of the current opposition to President Obama’s health care plan, you’d be running up a deficit and placing a financial burden on your children.

I don’t know about you, but if I were in your situation, I’d have no problem with that concept. And neither would my children, or so I’m told.

Opponents of health care reform that is likely to add “trillions” to the public debt constantly worry about “passing it on to our children and grandchildren,” as if that made any sense. At worst, it’s a cynical argument to make us feel guilty, at best it’s a pitiful lack of understanding of how the world works.

I’m someone’s child, and grandchild for that matter, and I’m probably still paying for World War II, the GI bill, the interstate highway system, and the NASA program, all things that have kept our country safe and prosperous over the years.

If debt is bad, then get rid of the house, the truck and your kids’ college educations, not to mention that 52” flat-screen TV in the rec room. And forget about the trip to Disney World that your credit card would have made possible.

The point of health care reform is to bring the system under control so that costs will be lower and everyone can afford some form of insurance which cannot be denied for pre-existing conditions. Like diabetes. Like you.

Once everyone is covered, emergency rooms will be freed up to deal with emergencies. Preventive care will kick in and that will lower costs all through the system. A 21st century method of keeping medical records will streamline doctors’ ability to provide informed care and will reduce the enormous amount of paperwork presently required of both doctors and patients, allowing doctors to focus on their patients.

This cannot happen in a month or two, or even in a year. But when we pay enormous amounts for our children to attend college we expect they’ll go through at least four years of study, perhaps more with graduate study. And we don’t expect they’ll be hired into a $100,000 a year job even before they graduate, do we?

In fact, you won’t see a return on your investment for years, but you don’t mind because you’ll know it was worth it as the kids begin to prosper. Same with health care reform; it’ll take a while, but it’ll be worth it.

You’ll get your investment back as costs go down and the system works better — and now your kids won’t have to help pay for your surgery.

A couple of bones to pick

Most folks have heard, at least in passing, about the the Employee Free Choice Act, or “card check,” working its way through Congress this week. And most of what we seem to hear is basically negative. Lies, even.

If you tell the truth you may not get what you want, I guess.

So here we have this great hullabaloo of worry about secret ballots, something the worriers know the American public cherishes above practically everything else. But it’s all a fraud.

What are the worriers worried about? They say they are worried about the process by which employees of a business decide whether they want to bargain as a group for things like hours, wages and benefits.

Who’s doing the worrying? The employers. That should tell you something.

But the employers aren’t worried about the outcome, not at all. They say they are just trying to be sure that their poor dumb employees aren’t denied the right to a secret ballot.

That argument is what’s dumb. The legislation in Congress right now, the Employee Free Choice Act, or “card-check,” provides for each and every employee to receive a card with the following choices:

The employee can sign up in favor of joining a union, or not. Or he can choose to have a secret ballot on the matter. The employees get to choose.

Secret ballot. There it is, right there. If the majority of the cards come back with the secret ballot choice checked, there you are, it’ll be a secret ballot.

But if 50%-plus-one come back checked in favor of having a union, the employees get to have a union. That’s a majority, but it would appear the employers who are fighting this are afraid a majority of their workers might actually want to have a union. The dirty little secret is that employers don’t want it to be simple.

Gotta wonder why.

* * *

Good ol’ Newt Gingrich is back, maybe getting a good start on 2012, and has been on various TV shows holding forth on just about everything under the sun, or at least everything Barack Obama is doing. Which he opposes.

In the context of the leadership struggles within the Republican party, Newt comes across as the sane elder statesman, according to some.

So, last week he suggested that Obama should have taken out the North Korean rocket test with some kind of laser weapon, an idea perhaps intended to show how high-tech he thinks; “high” might be the operative word here because we don’t seem to have such in our arsenal.

On at least one Sunday show he shared his opinion on health care reform, or at least what he perceives as Obama’s plan taking us down the road to “putting everyone on Medicaid.”

Now, I can’t be sure he meant to say “Medicaid,” though he said it several times, because I know the comparison that’s been drawn to one of the options being proposed for a national health care solution is “Medicare,” a very different breed of cat.

Medicaid, a form of health care coverage for the working poor, might as well be unavailable so far as Ellis County residents are concerned. Most doctors can’t afford to offer it because it pays so poorly.

Medicare, on the other hand, which most senior citizens have, is agreed by all but the unfeeling to be good coverage, cost-effective and efficient. A government plan that lets you choose your own doctor and make your own decisions, by the way.

And no, Obama’s plan is not “socialized” medicine, nor is Medicare for that matter; however, that’s the favorite term of argument for those who prefer that private insurance companies continue to make your decisions, choose your doctor, deny coverage when you most need it, and make lots of money in the process.


Originally published in the Waxahachie Daily Light April 13, 2009.

Just one more question, Congressman

Last week I joined a roomful of citizens gathered to hear Congressman Joe Barton (R-Arlington) report on recent doings in the U.S. House of Representatives. Health insurance for poor children didn’t seem to be a key concern for the folks there, but it was included on an official handout that covered immigration reform (1 page), Iraq (2 pages), and energy (3 pages). SCHIP got 2 pages.

Listening and reading, I learned that the Congressman still likes lignite coal and believes in keeping your tires inflated properly to save gas. He told us the Trans Texas Corridor would not be all that different from I-35, and assured us that “it’s not going to be 12 lanes wide, after all!”

Well, I guess that’s true in a way. But since the TTC is planned to be 1200 feet wide, you have to wonder.

That’s a whole different column, though, from the one I want to write today, because some pretty outrageous things are being said and believed about the SCHIP legislation, beginning with Barton’s handout. I don’t think there’s room here to talk about them all, so I’ll just hit the high points.

Item: Well, of course the Congressman’s first concern is the cost. He worries that federal funding will increase by more than $88 billion over ten years; to put that in perspective, the Pentagon is presently spending $6 billion a DAY in Iraq alone.

Shoot, just two weeks out of Iraq and we've got SCHIP paid for!

Item: Barton claims that the legislation would “remove seniors out of private healthcare plans in Medicare Advantage … and greatly increase the number of people eligible for Washington-controlled, bureaucrat-run healthcare.”

Leaving aside for the moment his characterization of Medicare and SCHIP, try as I might I couldn’t find anything to support that. But even if in fact he were right, here’s what they’d be losing, according to the official Medicare website:

In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.
… In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

But wait! According to MedicalNewsToday.com, the new legislation will:

Increase Medicare benefits for preventive care and mental health care, raise the value of assets low-income seniors can have and still qualify for the Medicare prescription drug benefit and cover more out-of-pocket Medicare costs for lower-income elderly beneficiaries.

And, get this: It will “eliminate co-insurance and waive the deductible for current preventive benefits covered by Medicare.”

Sounds like Mr. Barton and the insurance companies anticipate that a lot of folks, offered these extra benefits, may abandon Big Insurance for Medicare.

And as for that bit about “Washington-controlled, bureaucrat-run healthcare” — give me a break! Both Medicare and SCHIP are fee-for-service programs where you choose your provider and the provider of your choice sends the bill to the government.

You want to talk about bureaucrats? Ever dealt with a private health insurance company?

Item: But worried as he is about the evils of government provided health care, Barton is really, really worried about what he calls “cuts” in Medicare. The thing I find even more exasperating than outright dishonesty is the sin of omission, making a thing appear bad by not telling the whole story.

In this case, the so-called cuts are really reductions in reimbursements to the Medicare Advantage program by eliminating EXCESS payments. No doubt the insurance companies are going to miss them, and that’s the truth!

In addition, the legislation would delay cuts to physicians proposed over the next two years and instead INCREASE payments by .5% in each of those years.

Item: The Congressman, referring to a 2005 HHS report, claims that “the Democrat [sic] Majority’s SCHIP proposal” provides health care to illegal aliens.

Well, according to an item in the Houston Chronicle, that’s just not so.

Actually, the SCHIP legislation bars illegal immigrants from joining. [There is] a provision that let states change rules on required documentation. This was deemed necessary because many of the applicants, largely poor whites and African-Americans, couldn't find original birth certificates and don't have passports. In any case, Social Security numbers will still be required.

Item: In a section quaintly entitled “The Ills of Universal Health Care,” the good Congressman worries about our health care becoming too much like “the national care systems found in Canada and the United Kingdom.” He tells us that both systems “are rationed-care oriented which leads to lower quality care and long waits.”

Here’s what I found in the April 2007 American Prospect:

A 2003 study in The New England Journal of Medicine found that the United States spends 345 percent more per capita on health administration than our neighbors up north. This is largely because the Canadian system doesn't have to employ insurance salespeople, or billing specialists in every doctor's office, or underwriters. Physicians don't have to negotiate different prices with dozens of insurance plans or fight with insurers for payment. Instead, they simply bill the government and are reimbursed.

And Barton quotes from an article by a Canadian doctor to suggest that Canada’s wait times are horrible and deadly, though he doesn’t offer any fact whatsoever to show that we are any different.

Again citing the American Prospect:

A 2003 study found that the median wait time for elective surgeries in Canada was a little more than four weeks, while diagnostic tests took about three (with no wait times to speak of for emergency surgeries). By contrast, Organisation for Economic Co-operation and Development data from 2001 found that 32 percent of American patients waited more than a month for elective surgery, and 5 percent waited more than four months. That, of course, doesn't count the millions of Americans who never seek surgery, or even the basic care necessary for a diagnosis, because they lack health coverage. If you can't see a doctor in the first place, you never have to wait for treatment.

Couldn’t say it any better.

I have to end this for now, but while I continue my research for the next round, let me just say I would really like to hear the Congressman’s answer to this:
What exactly would be the “ill” in universal health care?

Joe, You Didn’t Tell Us the Whole Story

The other day Congressman Joe Barton, of Arlington, Texas – whose District covers a good swath of north central Texas and includes Ellis County — had an article in our local paper about health care for low-income children.

It talked about the existing program that helps to fund medical insurance for low-income children and the upcoming vote to re-authorize that program. It appears he doesn’t like the way some States are using federal funds under the existing program, under “circumstances” he doesn’t define, and that he doesn’t care for the way others are using (similarly undefined) “waivers” to cover adults — all of which he naturally lumps under one of his favorite words: “abuses.”

And he objected to the bill to re-authorize and expand the program because, he said, a family with an income of $200,000 “could” qualify for help — but he doesn’t say how.

Still, the reader comes away with the impression that good ol’ Joe just loves to help poor kids get medical care and there are just a few tiny details to work out.

Well, last week he voted against it in the House.

I’ve been following this story for awhile, my interest in universal health care being one of the reasons — after all, if SCHIP (the acronym for the State Children’s Health Insurance Program) and Medicare both make folks so happy, can relief for folks in the middle become an idea worth looking at?

Another reason for my interest in the story is kind of contrarian: the President says he intends to veto the legislation. Yup, put the kibosh on it, stick a knife in it. And when the President is hot to kill legislation, I just can’t help wondering why.

Both bills would expand coverage to another 3.3 (Senate) to 5.5 (House) million children and some pregnant women. This would be done by allowing in families with twice the poverty level, around $43,000 per year for a family of four (which the Heritage Foundation sweetly calls “wealthier families”).

The proposal is to pay for the expansion by cutting excess payments to insurors and increasing taxes on cigarettes.

Now, anything that will help me quit smoking is fine by me! Anyone got any problem with that?

While the Congressman was all a-twitter worrying about how other States choose to treat their citizens, a whole gaggle of spinners hit the talk shows to inform us that the legislation included — gasp, horrors! — cuts to Medicare! “It will take from our senior citizens and probably send them to the poorhouse, or at least take away their insurance!”

Well, folks, then I received an email — addressed to me personally, since I am one of them — from AARP. You know, the organization that stands like a pitbull on behalf of the senior citizens of America. And y’know what? They LOVE this legislation!

“AARP applauds those Members of Congress who voted for the CHAMP Act. These lawmakers put the needs of older Americans and low–income children ahead of special interests.“

Seems that the Republicans who objected to the bill’s “cuts to Medicare” were in fact objecting to eliminating overpayments in the subsidies paid to insurance companies who cover Medicare recipients; it was discovered they had been paid 12% OVER what was due to them!

Between the tobacco companies and the insurance companies the pressure must have been unbearable.

And still another horror: This legislation will “expand government-run health care” and put us “on the path to socialized medicine”!

Oh, good grief! That old canard. Why would they haul that out? Because, sad to say, it still works with some people.

First of all, what government-run health care are they talking about? It’s help with INSURANCE, you idiots! Oh, sorry. I’m sure they are not idiots. But if they are not, and they are still saying this, what does that make them, exactly?

Likewise, the bit about “socialized” medicine. It’s not “socialized medicine.” What England has can be called “socialized medicine,” perhaps, because its hospitals are owned by the government and its doctors are government employees.

Whether it’s a single-payer system or Medicare, doctors in private practice and privately-owned hospitals send their bills to the government and get paid. Private. Choice. Not “government-run.”

In the case of SCHIP, just consider the name: State Childrens Health INSURANCE Program. We provide funds to help pay for insurance coverage for poor kids and in some cases their parents (a matter that obviously chafes the Congressman).

Why should we care? What if we don’t feel a twinge of pity for the poor, nor particularly care if they get to see a doctor, because we have other things to worry about? Well look at it this way: If your kid goes to school with a child who can’t afford to see a doctor for the preventive care that might have kept him from coming down with the flu, guess what he’ll bring home?

Of course, the “mark-up” meeting to work out differences between the House and Senate versions of the bill is still to come, so it’s not final yet. But since the Senate also passed a bipartisan version, I’m optimistic.

The fact that this legislation was passed with bipartisan support may not matter to the President, although when he counts the votes perhaps he’ll have an attack of reason. Protective reason. Other battles may become more important.

Meantime, if you have any thoughts about this, the Congressman will be in town this week, and I’m sure he’ll love to hear from you.