Archive for August, 2009


Continental view of New World Healthcare

A week ago I saw and old friend from the Netherlands.  He was born there and has lived there his entire life.  I’ve known him for almost 12 years and he visits me once or twice a year.  He told me that as soon as he landed in New York that he bought a couple newspapers and read up on the latest goings-on.  He knew a little about the healthcare debates, but not much more.

After reading the papers, he said that he couldn’t understand one thing about the debate.  He said he couldn’t understand why EVERYONE is does not support healthcare for everyone.  He said he could understand the debate over how to pay for it, but for him it seemed like a given that universal care should be supported by all.  He could not understand opposition.  He didn’t say it as a political point of view.  He said it as a puzzled outsider.  Why wouldn’t everyone have healthcare in America?  In his words, “Why doesn’t everyone have health coverage in the US, the richest nation in the world?”  Arguing over how to pay for it is one thing, but shouldn’t everyone agree in principle that all should be covered?

I tried to explain to him the whole ‘pull yourself up by your bootstraps’ thing of the American psyche.  I don’t think he really understood completely the extent of America’s individualist bent; the each man for himself mentality.  He was just puzzled.  Why not cover everyone, always?  I really could not give a good reason to him other than that’s the way we’ve always done it – when we’ve done anything at all.


Healthcare quick fact

My friend just came back from Germany.  He works there for several months at a time.  He told me he gets so angry watching the healthcare debate from afar.  It seems so ridiculous when you realize how insane our system can be.  Take the example he gave me:

His prescription for 30 pills cost him $142 in the US.

His prescription for 100 pills in Germany – same company, same medicine, same dosage, same box – cost 10 euros, or $14.20.


Ted and Hope

I have been so sad since hearing of Senator Kennedy’s passing. He speaks so to the American experience, so full of pathos and promise, self-destruction and self-determination. Regardless of what one thought about his politics, you have to admire the way he overcame so much tragedy and so many self-inflicted wounds.

Simply, I miss him. We will all miss him.

The fact that we are so close to a vote on healthcare makes his passing all the more tragic. It would have been so wonderful to see him be able to vote his signature issue. My hope is that it can be accomplished in his honor.

And, I do have hope. People are focused on this. People are talking. The crazy people get a lot of airplay because they are good TV, shouting and yelling. Yet, the coverage they get seems more and more to put them in the context of the fringe. People are interested. The debate is pervasive. The Zeitgeist feels like we are heading toward healthcare – maybe not what we want, but something. This morning I saw this on HuffPost. Look at the counts. More people commented on the piece about using reconciliation to push through healthcare than about Miss Universe. That makes me hopeful.

Hope for healthcare


Where free market works

The free market and the healthcare system don’t seem to always produce the best results. Healthcare is just different. I may decide not to fix my ’92 Saturn because it is not worth it, but my 92-year-old grandfather is worth it at any cost. The inability to just walk away or “not buy” is not really an option in healthcare and thus doesn’t fit the traditional model. On top of that there are other issues to consider. There is an information gap. I may be able to tell if the mechanic is trying to pull one over on me when he tries to sell me an “engine shampoo” and I can call Click and Clack and get a second opinion if need be. With medicine, most of us simply do not know enough to really question. You have the drug ads convincing you that you need a pill for every little thing and doctors who also get benefits if you take pills for every little thing. You take them, because the doctor is the one that knows, right? It is hard for the buyer to beware if the buyer doesn’t have the info and not everyone is going to go the med school. Then, on top of that you have another party between you and your doctor doing their best to pay as little as possible in order to make a profit.

The free market does work, though. The story that was on Marketplace last night on my drive home gave me back some faith in our system. Wouldn’t it be really wonderful if the advertisers started only buying ads on news shows that actually gave the news? Just think of it! We might actually have sensible discussions and people might have facts instead of Fox. So, maybe we should all help the free market out a little… anyone have a list of who advertises on Faux News?

If you want to read the story: Marketplace August 24

If you want to hear the story:


Speaking Truth in an Emotional Way

More interesting commentary from Newsweek on Healthcare:

While I was reading this on the stepper this morning, I couldn’t help but think they were all saying the same thing. Sure, they all say we need to do something about healthcare, but more than that. They are all saying that nothing is going to happen unless the proponents of reform learn how to talk about it a little better. Not only are the Democrats disorganized as usual, dealing with different factions in their own party, but they are dealing with what I like to think of as Kerry-fication. (I really like John Kerry, bless his heart.) They give careful and correct responses that can go on a little long and are very difficult to summarize. They are so careful not to misspeak that they often do. What they say is right, but not always politically “sellable”. If only the Democrats had their own Frank “Death Tax” Luntz who could give them the language without causing them to be so maliciously dishonest as the Luntz-ification of the Republicans proved to be. How do you treat the populace as responsible, thoughtful citizens and still get your point across while they run by the TV on the way to work or to pick up the kids at practice? More so, how do you get them to have a passionate response, to care enough to raise their voice and still not try to illicit irrational fear and more irrational rage?

The idea that we only ever deal with something until it is a crisis is a good place to start. Healthcare is a crisis. Tied up in our “fatal flaw” that Zakaria talks about is the fact that we can only see a short distance into the future, say 4 to 8 years. Healthcare is a crisis! It is just a longer term crisis. 2025? 2050? Those years are meaningless, unless you can bring them into the present day and show the crisis in the present. While Alter is right, that healthcare is a civil right, not everyone agrees with that. More so, if a person has health insurance, they are going to be worried about losing what they have over making sure that someone else gets something. You have to make this civil right make economic sense. All of us are paying for those millions without healthcare. Make that a crisis. It is a crisis.

Begley is right, we are losing the war of words. Opponents may have great sound bites, but the proponents have some really compelling stories. The story of the 17-year-old girl that died because Cigna denied coverage because they claimed her liver transplant was “experimental” should be in every town hall meeting. This, and many other stories like it, could be the “Willie Horton” ad of the health care reform battle. It has been shown that people respond better to a tragedy of a single person than they do to a tragedy of millions. Hence, Feed the Children shows you a child that you can help to feed. Given such a widespread problem, people feel overwhelmed and like they can make no difference. We have to put a face or faces on the healthcare issue.

And if we could come up with some catching phrases, that would help too. Freedom to be Healthy Act? Right to Care Act? Proud to be a Healthy American?


Open Letter to my representative on healthcare

I am fortunate. My family and I have healthcare and we are healthy. I have no sad story to offer as an example of the healthcare systems inadequacies. Nevertheless, I see the incompatibility of our “system” with “health”.


Even though my views and your views differ significantly on almost every issue, I beg you to please put aside the election politics for just for a brief moment and look at the issues. Please.

It would be kind to call many of the comments by politicians, journalist and citizens as merely “crazy”. Many things being said are simply hyperbolic lies that I can only assume are meant to stir up fear and drowned out significant conversation. All of that needs to go away. Let’s just look at some simple things that maybe we can all agree upon.

  • Our “best healthcare in the world” costs us more than any other industrialized nation and ranks us as at 37 as far as health. Is that best? Really? It costs the most but the results don’t bear out “you get what you pay for”.
  • It is cheaper to prevent than to treat.
  • It is cheaper to catch things early rather than waiting until it requires an emergency room visit.

Those are easy thing, right? So is the fact that things could be much more efficient. A patient’s medical records and tests should be portable – not redoing the same tests over and over. Finding a software system to digitize medical records would not only make things more efficient but could create jobs.

My wish would be for a single payer system. Not a government run system, but one where there was only one person paying the bills. It just would be more efficient. I know this is off the table, but want to add my voice to those who are calling for its consideration. That said, I do support a government option to compete with the insurance companies. So many of our dollars go to profits for the insurance companies and the inefficiencies in the system, it seems the competition is needed.

Even in these more contentious issues, there should be some common ground. There are inefficiencies in the system that could be corrected. For example, when my husband’s company switched insurers they had a meeting to discuss new procedures. They were told that their claim would be denied when they first sent it in, but just to resubmit it. Huh? How much time and money is wasted in the insurance companies trying not to pay, trying to dupe people into paying instead, and hospitals and doctors doing their best to recover the fees that they are owed? How much of the cost built into those fees is really to compensate for the wasted time and money lost to such a system? That is nothing compared to the stories of dropped coverage just as a person needs it due to “inaccuracies” found in the records. How much time and energy is spent trying to find excuses to drop people versus just taking care of people? This is simply criminal.

There are many things that present very difficult choices that stretch the bounds of what can be agreed upon. Even these can be addressed. The fee for service model incentivizes “care” over “health”. Changing that system would be contentious. However, a point of agreement could be found in coverage for preventative care and health services.

The issue has many flash points and there have been much influence of political considerations and lobby influences. Yet, it seems there are some things that we should be able to come to a consensus on. Here is my wish list:

  • Coverage must be universal and there should be a government plan as an option.
  • Health services such as wellness checks, annual physicals, dental checkups and dietary and lifestyle information should be promoted and covered.
  • Regulate insurers to eliminate the denial of coverage for “pre-existing conditions”, the practice of dropping coverage, and diversionary tactics to avoid payment. There should be incentives to be efficient in paying providers.
  • Incentives for providers must be focused on health outcomes, not merely the number of services.

Thank you for your time and consideration.


Kid consumerism

I went to the movies the other day and one of the many ads that played before the previews was for JC Penny. It showed “tweens” to barely teens in the school cafeteria. They switched off the lights, threw on some spotlights and music and made the lunch tables a fashion runway. Since then, I have seen shorter versions of the commercial on TV. There is also the ad from K-Mart that starts off with a teacher giving out a spelling word – “rock stare”. The kids jump up to explain that it means the look you get when you look like a rock star. They model the K-Mart collection by twirling around to be sure the camera catches the embellishments on the back pockets of the jeans. Can we talk about on how many levels these commercials are wrong?

First, is school not hard enough? Are kids not cruel enough? Does the peer pressure to fit in not start off early enough? Let’s just jack all that up a notch to where my tween boy is even concerned that he wear the right clothes to fit in. Silly me. I thought boys weren’t supposed to care that much about fashion. Wrong. These commercials are by outlets that are budget friendly. That doesn’t matter. The focus on having to dress or look a certain way especially so early is detrimental to kids self-esteem and takes away the focus of the main reason they are supposed to be at school.

Second, they play to the notion that it is all about what you look like. The girls strut down the “runway” and the boys look. Do we really need to promote this so early? Trust me, high school is plenty enough time to develop serious body images issues. You don’t need to add middle school to that curriculum.

Third, modeling by kids, especially young girls, in which they show their butts to the camera is just creepy. We make kids clothes look more and more like small versions of adult clothes and then put them in front of the camera acting like they are little adults?

Forth, the ads seem like an end run around by the ad men. Everyone’s cutting back? Ok, we will get your kids to beg for the right clothes and shoes so they fit in at school. You will deny yourself but not your baby.

Let me just say again, isn’t school hard enough?