Friday, January 21, 2011

Will People Really Die Without Health Care?

The derision has begun in earnest.

Those who favor the recently-passed legislation to terminate the "job-killing" Patient Protection and Affordable Care Act (their language, not mine) are laughing --ROFL? -- over assertions that people will actually die if the law is overturned.

Of course, it seems pretty ironic to me that the supposed reason for terminating the law is about jobs and NOT about the kind of health care that Americans deserve. (See previous post for what is a "right" vs. what is "right.") I agree that the PPACA is NOT the ultimate legislation that we need...it has all sorts of holes in it and can and should be vastly improved.

But does that mean that the first step should be to completely terminate it in order to save jobs? (Which is still a debatable conclusion, in my estimation.)

I came across an article in the American Journal of Public Health  -- written in 2009 and based on studies by the Harvard Medical School, the Cambridge Health Alliance, and the Centers for Disease Control dating back to 1984-- that puts the whole idea of people losing their lives over an act of Congress into some perspective. (Read it here)

The study "assessed death rates after taking into account education, income, and many other factors, including smoking, drinking, and obesity...As expected, death rates were... higher for males, current or former smokers, people who said that their health was fair or poor, and those who examining physicians said were in fair or poor health."

Additionally, "uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts..... Another factor contributing to the widening gap in the risk of death between those who have insurance and those who do not is the improved quality of care for those who can get it.... It estimated that lack of health insurance causes 44,789 excess deaths annually."


“The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance,” remarked David Himmelstein, study co-author, associate professor of medicine at Harvard Medical School, and a primary care physician at Cambridge Health Alliance. “Even this grim figure is an underestimate — now one dies every 12 minutes.”


I suppose what I really want to ask the congresspersons in charge of this latest effort at saving jobs is this: "How many jobs does it take to justify the loss of 1 American every 12 minutes?" 

Couldn't we at least slow down the job/cost rhetoric for a while, continue to extend coverage to those who need it and can't get it, and THEN find a way to deal with the more egregious elements of PPACA?

How much is health care costing us...really?

Thursday, January 20, 2011

What's "Right" About Health Care?

A friend's comment made me stop and think this week; usually, that's a good thing to do.

"I don't believe that anyone has the right to healthcare," my friend asserted. I must admit that that took me aback. I literally began to shake my head. In my brain, I thought, "Surely there's something significant about that statement, but I just can't quite figure out what it is."

I do know that it bothered me, mostly because it raised an unexamined assumption in my own thinking. And, as a wise mentor of mine once told me, "You know what it makes out of you and me when we assume too much!" [Just cross off the u and the me in that word assume if you didn't get it...:)]

So I started pondering...what is a "right" anyway? And to what extent am I -- or we, in a just society -- bound by any moral/ethical responsibility in this whole healthcare discussion? (I am seriously not interested in the "politics" of the debate at this point...we have all heard the talking points on both sides ad infinitum, ad nauseum!)

After wrestling with it for a semi-sleepless night, I believe that my friend's statement is TRUE. It does not follow from either the legal or moral basis of our society that any individual deserves (or is guaranteed) to be treated for illness, injury, accident or natural pestilence.

I suppose if that were the end of the thought process and the debate, we could ask Congress to save us many, many billions of dollars and simply cancel ALL federal government support of healthcare, including Medicare and Medicaid.

After all, if it's not a right imparted by the Constitution, then, as the bona fide "we the people" US government, we really shouldn't be in the health care business (with the possible exception of the VA...since one could argue that veterans are, by their service to our nation, guaranteed the right to basic healthcare.)

And, quite honestly, for those who share in the Christian conviction that is part and parcel of the founding of our country, there is not really a biblical mandate to guarantee anything to anyone else -- except to love one another. (Romans 13:8 is the reference for those who might like to check it out.)

Even Jesus said, "Well, it all really boils down to just two main things -- love God with all your heart...and love your neighbor as yourself. That's it...that's all she wrote!" (Of course, I am translating freely here, but you get my drift! Read it in Matthew 22:37-40.)

So, like I said...as far as technically speaking...we're off the hook! Nowhere, anywhere, is there an authoritative document that says we have to give healthcare to people who more than likely can't afford it...or who, by the whim of fate, are afflicted with an "uninsurable" condition.

But that doesn't really seem to settle it for me.

I cannot get those nagging phrases out of my head, one from the Constitution (well, the preamble to the Constitution, so technically speaking I don't know if it counts) and the other from the scripture quoted above:

We the People of the United States, in Order to form a more perfect Union,... promote the general Welfare,...do ordain and establish this Constitution for the United States of America. (read it here.)

Love your neighbor as yourself.

General welfare...neighbor as yourself...what do those phrases have in common? Hmmm...there may be some value in thinking about what I can and should do for my neighbor, even if I am not required. There may be some things that I could/should agree to do -- actions that are "right," even if it's not a "right."

Of course, as my friend Dr. M. has repeatedly reminded me, there are really no limits on me, or on any church or charitable organization that I belong to, concerning how much I can and should help other people. That does not mean that it can/should be the domain of government.

General welfare...just such an intriguing phrase, though, that must have been stuck in the minds of the framers of the Constitution. What did they mean by that? How could I construct a meaningful framework for sorting through this hotly-debated issue?

How does any of us...and, most importantly, how do all of us as part of this Union (and not to mention as neighbors,) cooperate for the general welfare, a concept defined as "a contented state of being happy and healthy and prosperous." I guess it's the healthy part that has me thinking.

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This post has gotten overlong already...so I'm going to have to post one more significant piece of the discussion I've been having with myself in the next installment. Thanks for reading...all comments (and I mean ALL) are welcomed and appreciated!

Monday, January 17, 2011

They That Live by the Law...

There's a term I've been trying to understand for some time now... the "strict constructionist" view of our US Constitution, which is advocated by no small number of self-described "conservatives" in our nation -- including a few of my friends.

I think I get that it has something to do with applying the Constitution "only as it is written"-- thereby requiring judges and other enforcers of the law to resist the temptation to "legislate" from the bench.

Seeking to interpret the law in any way is a big-time no-no from this point of view; judges who participate in such helter-skelter behavior have been served their walking papers in recent days as the tide of "original intent" has swept over a number of legal beachheads.

And, of course, many who favor the Tea Party movement, of not inconsiderable note in our country, are of this judicial persuasion -- including freshly-minted Rep. Mike Lee of Utah, who has been at the forefront of the Constitution-waving demonstrations that have peppered the start of the 112th Congress.

As I said in a previous post (see Except the Parts We Don't Like, below) I'm all for waving the Constitution -- though I'd actually prefer that more people READ it. And that goes double for the men and women who serve us as our congresspersons in Washington.

Mr. Lee recently made a great show of his understanding of how far our federal government has over-extended its reach in jurisprudence. He deftly and "expertly" explained how the US Congress erred in the early 1900's by outlawing the practice of child labor. (I'm not making this up...you can catch his campaign video clip here!)

His basic argument? Yes, we all know that child labor is bad; but, the Congress had no right or authority to regulate it. That should have been an issue of states' rights and the Feds should have left it alone. He even cites a Supreme Court decision that illustrates his point: Hammer v. Dagenhart, 1918.

Clearly, Mr. Lee intones, the Supreme Court recognized that the founders would NEVER have weighed in on such an issue -- and, therefore, neither should we today similarly cede power to the central government even in a situation involving clear moral hazard. (emphasis and interpretation mine)

Evidently this speech played well to the base, as they say, since Mr. Lee is now Rep. Lee. But there's just one tiny flaw in his reasoning. The Supreme Court reversed itself in 1941, in a case known as United States v. Darby:

The conclusion is inescapable that Hammer v. Dagenhart was a departure from the principles which have prevailed in the interpretation of the Commerce Clause both before and since the decision and that such vitality, as a precedent, as it then had has long since been exhausted. It should be and now is overruled.  (emphasis mine; quote from Sec. 117 of the decision, which you can read in its entirety here)

Wait a minute...the Supreme Court says that there is a "principle of interpretation" that must be considered when fiddling with the whole rule-of-law-thingy?

And, by the way, Mr. Lee kind of didn't mention that the Court overturned itself on the very case he cites as the pinnacle of his interpretation. Well, how do you like them apples?

Guess we'll just have to wait and see what else the Tea Party has brewing for us in Washington now!

Friday, January 14, 2011

When Guns Are Outlawed...

Rep. Louie Gohmert, the distinguished gentleman from Texas, has his own preferred legislation in response to the tragic events in Arizona this past week.

"If members of Congress wishes [sic] to carry a weapon in the federal District of Columbia, it should be permissible. Accordingly, we are in the process of drafting a bill that will allow members of Congress to do that." (Read the quote here, if you'd like.) Rep. Gohmert perhaps envisions a return to the days of dueling lawmakers and vigilante justice. Hmmm...he might be on to something there!

There is just one slight problem with his legislation. It's NOT illegal to carry a handgun in the District of Columbia, with proper training and permitting, of course. District of Columbia vs. Heller, heard before the Supreme Court in 2008, struck down a 1975 law that had banned firearms in federal enclaves.

But, hey, what's a little Supreme Court decision or two amongst friends? And why should our legislators be bothered with knowing the law? They can just make new ones!

Maybe I'm being a little hard on Rep. Gohmert...but, then again, this is the same guy who melted down JUST A WEE BIT in an interview with Anderson Cooper on CNN when Andy challenged his assertion (actually first delivered on Fox News) that pregnant foreign women are having babies in the U.S. “with the nefarious purpose of turning them into little terrorists, who will then come back to the U.S. and do us harm.”
COOPER: The FBI says this is just not happening. You are spreading scare stories, and this is completely about politics.
GOHMERT: It is happening. It is happening.
COOPER: Where? Give me some evidence. Tell me one person, one terror baby that’s been born? Can you tell me?
GOHMERT: The explosions will not happen for 10 or 15 or 20 years and then you will be one of those blips. I’m not comparable to Winston Churchill, but the detractors like you are comparable to his detractors. [...] Anderson, do you really believe that the ones that want to destroy the United States are more stupid than these entrepreneurs in China, than these people in Mexico? [...] And I bet you, on 9/10, he were to come on your show and say there is no credible report of a plan to take down the World Trade Centers, because he didn’t have one.
COOPER: OK. So, you don’t believe the FBI when they currently say there is no credible report?
GOHMERT: — taking shots at me and look at the gaping hole in the security of this country. I’m an easy target, and you and Jon Stewart can have your fun. But please, at some point, look at the gaping hole in our security. (see the clip here)
I'm certainly not saying that security should become lax, nor am I opposing true Second Amendment rights in our great country. But, I guess I am questioning just a LITTLE bit the reactionary, emotional response that is being encouraged by some of our elected leadership. Election, in my understanding, implies a certain level of responsibility not only to and for your constituency -- but to your country -- all of it! 

I suppose that the good people of Rep. Gohmert's district are entitled to return him to Congress for as long as they wish. We've had Ted Kennedy, Strom Thurmond, Ted Stephens, Charles Rangel and others over the years who were returned repeatedly by the electorate despite attitudes and actions considered outside the mainstream of American life. That's just part of who we are, and part of our greatness.

Now that we've questioned the use of such terms as target and crosshairs in political discourse, maybe Mr. Gohmert can help us consider the wisdom of "taking potshots" at those who disagree!

Saturday, January 8, 2011

A Deadly Spin

I often (and purposely) write this blog with good-natured tongue placed firmly in my cheek. At least, I intend for it to come across that way. There's plenty of perfidy and malfeasance afoot in our world, especially in the realm of politics. I figure a laugh or two along the way toward making a point is not a bad thing.

Today, I write with no good-natured or humorous intent whatsoever. The subject is serious to me, and to many others. It is no exaggeration to say that it is deadly serious for many.

Much ado is being made over efforts in Congress to "repeal and replace" what has come to be termed Obamacare, the health care legislation passed in 2010 and known formally as The Patient Protection and Affordable Care Act.

I'm not here to argue the deficiencies or merits of the law...that's a whole other series of posts. What has struck me is the very issue of trying to build a system of health care that is dependent on for-profit insurers for regulation and decision-making when it comes to who gets care -- and how much, what kind, etc. -- and, painfully, who does not.

One of the friends of my youth (thanks, EG) raised a significant point earlier this week as we bantered over healthcare via Facebook: "Obamacare" is NOT health insurance, and is far too dependent on forcing both citizens and insurors to participate in the system. It is a "dog that will not hunt," to borrow his colloquialism -- one that any true child of the South will reverberate with.

To wit, an article by Dr. Pauline Chen in Thursday's New York Times. Dr. Chen tells of her own personal experience with the story of Nataline Sarkisyan, a 17-year-old young woman who died during the struggle with her family's health insurer over the approval of a liver transplant. I'll let you read the details of the story here; let's just say that the giant insurance conglomerate, CIGNA, took a real kick in the ass of their public approval over the whole affair.

CIGNA's former head of corporate communications, Wendell Potter, has detailed the stories of Nataline and many others in his new book, Deadly Spin. He describes his task there this way: “It was my job to enhance those firms’ reputations. But as one of the industry’s top public relations executives and media spokesmen, I also helped create and perpetuate myth that had no other purpose but to sustain those companies’ extraordinarily high profitability.”

Dr. Chen calls it "a fascinating book that details the methods he and his colleagues used to manipulate public opinion...including myth-making...front groups, paid spies and jiggered studies."After working to save CIGNA's reputation over the Sarkisyan case, Mr. Potter remarked: “It became clearer to me than ever that I was part of an industry that would do whatever it took to perpetuate its extraordinarily profitable existence,” he wrote -- “I had sold my soul.”

The point that intrigues me is not to pursue endless criticism of health insurers (though a healthy dose of skepticism wouldn't hurt!) -- but rather to examine what Potter and Chen lift up as the fact that the United States “has entrusted one of the most important societal functions, providing health care, to private health insurance companies.”

[Note: Guess who holds the single largest number of exemptions to the new Health Care Act for their employees? CIGNA -- with 265,000! There's not a single union or employee organization that even comes close...check the data here.]

This issue goes WAY beyond partisan politics; it's too important for any of us-- and certainly for our elected leadership -- to submit to hearsay and emotional rhetoric in order to find a solution. Please, Messrs. O'Connell, Boehner, and Obama -- try to work together and, for God's sake, get it right!

Before too many of the rest of us have to die.

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Post-Publication Note --

Another good friend of my youth (thanks to the former Ms. Hollis) has pointed out that Mr. Reid and Mrs. Pelosi should be included in the group I have implored to work together. Amen, sista!

Friday, January 7, 2011

Except the Parts We Don't Like!

One of the more interesting...and a bit unusual...news tidbits of the day concerns the reading of the "entire" US Constitution at the opening of the 112th Congress in the US House of Representatives.

The move, scheduled by the "new" leadership who have pledged to bring a breath of fresh air to the halls of Congress, was intended to illustrate the commitment to return to the basic values envisioned by our founders. Some have roundly applauded the move, while others have soundly derided it as a political stunt (costing the taxpayers an estimated $1.1 million, when you consider the salaries paid to the staffers who were required to be there for a "non-business" session.)

I kind of like it...I think we should do much more actual reading of the Constitution, and less waving of it. And besides, what's an extra million or two here and there? Before it's all said and done, Mr. Boehner, et al, are going to trim that $100 billion out of the budget anyway, aren't they?

But regardless of your take on the propriety of reading the entire document to begin the session of Congress, it seems that there was one little mix-up in the whole affair. They didn't actually read ALL of the Constitution. The Republican leadership decided that there were some parts that were just a little too...um, controversial, I guess.

According to Ryan Witt on Examiner.com, Article I, Section 2 of the Constitution was omitted from the reading. True, the words in this paragraph deal with how our founding fathers thought it best to count slaves as 3/5 of a person for the purpose of the US Census and subsequent Federal tax apportionment (you can read it here.) I suppose one could argue that omitting that part of the document didn't really matter, since it doesn't necessarily apply today.

But, isn't that kind of like saying we shouldn't read the parts of the Bible that don't apply to us? Whether we feel that the passage is applicable to us or not, it's still there! It's still part of a foundational document that shapes who we are. Though tempered by the later 14th Amendment, the language was never removed from the Constitution. If you are going to read the WHOLE Constitution, then you need to read every word...don't you?

Or are we allowed to ignore the parts we don't like?

I guess I'm just waiting and watching to see how the "new bunch" are going to follow up on their grandiloquent promises. So far -- with the broken budget reduction promise and the almost-but-not-quite Constitution reading -- I'm not sure we're off to a great start.

That fresh wind may turn out to be just so much more hot air!

Thursday, January 6, 2011

When in Rome

The mid-term elections of 2010 provided a thunderous victory for the Republican party (and/or the "Tea Party" folks who helped to ignite their base.) Changing Washington was one of the main themes, most notably the "tax and spend" liberality of the Democrats who had been running the legislature since 2006.

The sound-bite battle cry was the promise to eliminate $100 billion from the federal budget. Currently, there is a growing threat by the aforementioned "Tea Party" representatives and other hard-line Republicans to block the raising of the Federal debt limit ceiling.

As in 1995 (following the then highly-touted Republican sweep to power in Bill Clinton's first term,) such an action could force the shut-down of Federal operations. Our government could basically become kaput with no money on which to operate.

To borrow a phrase from Dr. Phil : "And how did that work for you last time?"

Anyhow, it seems that the enormity of the effort to actually deliver what they promised is coming home to roost for those who have arrived afresh in our nation's capital. There is widespread dissembling and disambiguation over the $100 billion budget cut pledge. As Howard Fineman, writing for the Huffington Post, reports:

...they are talking about cuts as slim as $30 billion, blaming the change on the fine print that no one read -- or if they read, did not understand.It turns out the $100-billion figure meant $100 billion from a budget that President Barack Obama proposed, which was never passed. And now that the fiscal year is nearly half over, well, there's just no way ... (emphasis mine, you can read the article here.)

Various other representative of this far-to-the-right wing have their own spin on what they meant, but the most honest representation may come from freshman representative Morgan Griffith (R) of Virginia:

"I still think it's realistic, but the trick will be how we get from here to there."

Aye, there's the rub!

Going to be interesting to see how it all plays out in the coming days and weeks. Maybe they actually will accomplish something new and different in Washington for a change. But it all sounds a little like the observation by Ambrose of Milan (Italy, not Tennessee!) in the fourth century:

"si fueris Romae, Romano vivito more" -- "When in Rome, do as the Romans do!"