On the eve of yet another attempt

It is still 24 Feb 2010 (23:25 PST), and tomorrow, the President of the United States will sit down with the ranking members of both Chambers of the Congress (on recent track record, I hesitate to call them "The Congressional Leadership" so please excuse the circumlocution) and make what may be the last attempt to get some level of reform into a health system that kills more people each month than died on 9/11. 

Over the past three years, I have learned more about this system than I have ever wanted to know. I thought I had a pretty good handle on the subject before this. My father was condemned to death when the HMO system that masquerades as health care in California informed him he had used up his quota of Intensive Care hours, and could only extend his Cardiac Care hours by transferring 25 miles to a less costly facility. That bought him more hours; 30 of them. Not enough to for me to get there, nor my siblings. My mother sat with him when they  removed the heart catheter we could not pay for. Had he been able to stay in the better hospital, and complete the treatments, he might have had a chance.

My grandparents both died of cancer. They had good treatment through their respective ordeals, but it cost them their home. They had run through their insurance.

My wife of 26 years had to wait 6 months for a diagnosis of her breathing problems. We lived in an area where there weren't that many doctors that accepted TRICARE, and the system was still in "start-up mode" as we were told. So it was too late when we discovered her supposed pneumonia was a cancerous mass behind her heart roughly the size of a softball. The cancer didn't start in her lungs, but that was where the greatest threat was by the time we got her into the hospital. She had had a number of tests, but they were at another hospital, so we wasted time in having them done again. Hospital policy required it, since TRICARE would pay for it. Would it have helped had the hospital been able to start treatment a few weeks sooner? I'm not sure. From the number of doctors that apologized for the delay, I have my opinions. A little over a year after her death, I got a bill from the hospital on the lose order of $45,000. It seems they had marked several treatments/tests "approved" when they were not. TRICARE did not approve them at the end of the day, so, after much discussion, I got the tab down to $35,000. I am fortunate that my son is academically gifted, and that he was able to put together a package of scholarships, work programs, and student loans. You see, 30 of that 35K was the college fund his mother and I had put together of many years. Three years later, TRICARE moved from being an outsourced service to being a contractor supervised by the DoD. So that kind of thing doesn't happen now.

 I am in California taking care of my mother, who has Stage IV cancer. Last year, since I am spending more time here than at home in Oregon, TRICARE moved my Primary Care Provider to a clinic about 5 miles from here. At home, that's not a big deal. This is the Los Angeles area, and it's a half hour drive for most of the daylight hours. Secondary care is at Los Angeles Air Fore Base. four times the distance, but only 50% more time. Don't ask. I can't explain it. It has something to do with the freeway system and the traffic load at LAX.

Anyway, my point is that I have spent a lot of time in waiting rooms in a clinic that provides primary care for people who are on Medicare, Medic-Cal, private insurance, partial insurance, and no insurance. It's been quite educational. So was the opportunity to talk with the staff where my mother was getting her radiation therapy (until the cancer got ahead of it, and we called Hospice in). There were three techs working the various machines. They worked four hours at that clinic, and four hours at another clinic. They did not have medical benefits at either location. Neither of the clinics could afford to have full-time techs, mostly because of the cost of providing medical benefits. One of the doctors told me "We need four techs. With benefits, I can only afford two." They also had four administrative specialists. One of them kept the records unit going. The other three took care of liaison with the various insurance companies. The doctors were hoping for some kind of public option in the Health Care Reform. The assumption was that they could cut their paperwork in half. It would also drive a reduction in their professional insurance: fewer chances for paperwork glitches. Doesn't look as if that's going to happen.

It's after Midnight here. On the East Coast the dawn will hit Blair Han hour or so. Mr. Obama has this assumption that if you treat your enemies honorably or long enough, they will eventually respond. It is entirely likely that this is going to fail again. It's an approach called for by all three Abrahamic Religions, as well as by their various divisions. It falls apart when faced by the dishonorable. I have known people who would rather lie than tell the truth, even when the truth would serve them better. Most of them have not fared well in life. I often thought that was a fairly good example of the Universe tending toward balance. But the people who will walk into Blair House in a few hours have been quite successful. Mendacity has been their friend. Supported by people who can't stand the idea of President Obama, as well as by corporate interests unfettered by even minimal regulations, they have conducted the various levels of negotiation in a manner so duplicitous as to make the North Koreans blush.

At the end, even though the President's compromise pretty much consists of everything the Conservatives have demanded, this discussion will probably fail. No joy in that, for it will bring even more pain to the people who look to government to do for them those things they cannot do for themselves. But caring for the less fortunate, or even the less influential, or the less wealthy is a virtue of the Abrahamic Faiths, among others, and if there are any of their number among the Conservative Party, they are not obvious. I have read the various Holy Books, in their many versions and with a shelf-full of commentaries, discussions, apologia, histories, and speculations of each. I cannot find a way one can follow the practices of  the Congressional Conservatives without violating several of the precepts, practices, and principles that make one an observant Muslim, Christian, or Jew.

A slight delay between that paragraph and this. Mom had a coughing spell, and I was doing what I could to help. The people from Hospice have provided a number of medications, and quite a bit of equipment, but nothing seems to help much. She is in no immediate danger of death at this point. There is a possibility she may regain her strength and get have more time left that seems possible. Hospice exists outside of the civilian insurance structure, and functions very well with a combination of volunteers and thoroughly underpaid professionals. We have access to it as an extension of Medicare. Not that way everywhere. NOt even everywhere in California.

This nation needs a national health system. We also need a national education system. We also need a national financial system. We're not likely to get any of those in the near future. The Balkanized patchwork of the current systems do not come even close to serving the needs of the populace, but they do a dandy job of serving the needs of the people who can afford to pay their own medical bills, or who can send their children to private schools that actually are better that those available to the masses, or who have people who take care of their financial affairs for them. The collective term for such people used to be "The Aristocracy". These days, the terms are unclear, but I can't find one of them who isn't mobilizing the Conservative base against all those national programs we need.

It's WHOSE money?

Along with the less savory chants being heard over the CPAC weekend, there were the usual ones that fall into the "just plain silly" tier.

"Drill, Baby, Drill" sounds nice, and it's easy to remember, but this is going to solve the energy problem how? Maybe of we gave a lot of money for drilling in Canada and Mexico, that would help. They are, after all our biggest foreign suppliers. But with Alaska providing some of the highest production costs (once you figure in the money the Federal Government kicks into both ends of the effort), that's not a player, and neither are the fable "secret reserves" under the Rockies. Yet there they were, waving their fists in protest of the horrible plots to keep our energy future in the hands of terrorists. So that would be Saudi Arabia? Kuwait?

And the "No Ba Ma" chant helps underscore the Republic Party premise: "If the President likes it, even if it was one of our ideas, we're against it!"

But by far, the silliest was "It's Our Money!" The theory seems to run like this. Congress mandated this whole series of evil taxes, in clear contradiction of the beliefs of the Founders and the Framers. Therefore, since they have taken our money, and since they are paid from that money, they are our employees. From this, it follows with some elegance that we, the taxpayers, have an absolute right to have approval authority over every penny.

It's attractive, in a simple-minded sort of way. I have paid for government, so, if I don't like the actions of government, I should be able to tell them "Don't spend my money on the office of Faith-Based Outreach! But I want you to spend twice as much on the National Endowment for the Arts!!" One of my neighbors wants more money for farming subsidies, and less money "wasted on welfare." All right, it would take a large army of civil servants, armed with the very latest in information technology just to keep up with the initial input, and they would, in turn, be dwarfed by the people who would have to keep up with those of us who change our minds.

I for example, get quite upset with my local Public TV stations when they air yet another "Celtic" music extravaganza. I like traditional Irish and Scottish music, and I've even picked up a buck or two here and there playing it, but that ain't it. I'm also unhappy with the guy who recycled Positive Thinking from the 1920's and acts like he thought of it himself. So when Fund Raising Week (or fortnight, depending) comes around, just give my share of the NEA money to the Harbors and Waterways Commission.

The obvious point is simple. Once you transfer funds from your care, custody, and control to another party, the funds are no longer yours. We can deal with this in other venues. When you send the mortgage cheque to the bank, you don't attach a little note insisting they use it to make loans to ambidextrous Laotian cat jugglers. Nor do you inform them that you are very upset at finding out your money went to ambidextrous Hungarian ferret jugglers. To quote Falstaff: "Twas mine, 'tis his, and has been slave to thousands." 


If you've not made the connection yet, try this. You are visiting our house. It comes up that we are a bit pressed for funds, and my beloved wife makes a comment to the effect that we need to find $300 by next week or we may not have electricity for long. Out of the kindness of your heart, you quietly write out a cheque for that amount, and hand it to her. She rushes out of the house. You assume she is going to the electric company. An hour later, she comes back with a new set of one-of-a-kind designer sandals and brags about she got them for half price: $250. You may not be coming back for a while, but it's highly unlikely you're going to make a scene. You gave her the money. She spent the money. Unless there was some sort of understanding (not likely) prior to you handing her the cheque, she has every right to do as she saw fit.


When you pay your taxes, either as an annual lump sum, or through the withholding system, or through a mechanism of a sales tax, it ceases to be your money when the funds transfer. The government (federal, state, or local) now has care, custody, and control with the expressed purpose of funding those expenditures required to run the nation, state, or locality. 


I can remember when people were trying to protest military involvement in Southeast Asia by paying that percentage of their taxes that did not go to the military. It didn't work. Now, people have a whole raft ot things for which they do not wish to pay. Same game, different goal, same answer. When the money moves, ou do not retain any form of control. You want the laws changed, elect somebody who agrees with you, and support him or her. When you sign in at the Congress, you get a key to your office, a parking space, a special ID card and a little lapel pin that gets you past the checkpoints, and some neat photo ops with the party leadership. No magic wand, no legal obligation to check with the folks back home before you take any action, on any issue. So you do what you think is best. If people don't like what you do with the monet, there is this wonderful removal tool. We call it an election.

To everything there is a season...........

And the CPAC weekend is certainly a season. It used to be called "Silly Season" but we are not supposed to use anything that might incite the well-honed sensibilities of the PaeleoCon community. 

They don't mind questioning the legitimacy (in several senses of the word) of the President of the United States. They don't mind claiming that the members of the United States military are willing to break their Oaths of Enlistment or Commission at will. They certainly don't mind calling for the overthrow of the American government by force and violence.

On the other hand, when a cartoon show writes a spot for a female character who is assertive, who is confident, who is quite capable of dealing with the world at large, and, oh yeah, has Down Syndrome, the CPAC attendees and speakers (paid and otherwise) rise as one to claim the whole thing is an Anti-Christian plot. As closely as can be determined, when the character tells her date that her father is an accountant and her mother is the former Governor of Alaska, the writers were mocking Sarah Palin, her youngest child, her daughters, any future children, any and all people with Down Syndrome, everyone who has made the choice to carry a Down Syndrome fetus to term, and (because this was secretly written to mock Sarah's objections to an off-the-record comment by Rahm Emmanuel) a sneaky way to continue the Jewish oppression of Christians so prevalent in the United States.

So even though she is not present at CPAC, Sarah Palin manages to  remain part of the story. Isn't that nice? Of course, the cartoon episode was written months before she decided to chastise the Chief of Staff for using a word common in Right-Wing Talk Radio, so that doesn't work. Similarly, the actress (who has Down Syndrome) who did the voice for the character didn't have a problem (in fact, she did a swinging open letter pointing out the need for Ms. Palin to grow a sense of humor whilst she chastised the way that she (Palin) used the child as a prop). And the off-beat goes on.