Sunday, December 20, 2009


I am the master of my fate:
I am the captain of my soul.
-- "Invictus"

The kindest interpretation of these lines is that they invoke, like Rudyard Kipling's "If," the virtues of the British "stiff upper lip" attitude towards adversity. Unfortunately, as inspiring as these lines appear, they are pure balderdash.

We are not the masters of our fate. Fate masters us. We live, we die. We are not the captains of our souls. Check and I will bet you have a navel – an irrefutable physical sign that you are joined to the human race with all its foibles.

Do not misunderstand. I am not opposed to a certain kind of individualism. It is commendable for each to do the best he can with what he is and what he has been given to benefit himself and others.

Still there is that navel.

We are born into a family, in a country, at a certain place and certain time. Countless permutations of benefits and deficits are imposed on an individual before he has uttered his first word. More are to follow as he makes his decisions among choices that he has not chosen. In the end, one looks back and realizes there are right decisions that reap ill rewards and wrong decisions with consequences that cannot be escaped.

No, the writer of "Invictus" for all his bravery had it wrong. Ecclesiastes is closer to the mark.

I returned, and saw under the sun,
That the race is not to the swift,
Nor the battle to the strong,
Neither yet bread to the wise,
Nor yet riches to men of understanding,
Nor yet favour to men of skill;
But time and chance happenth to them all.

"Invictus" encourages selfish individualistic fantasies. The Preacher, Ecclesiastes looks at life as it is and invites gratitude and charity in the midst of the unanticipated challenges of life.

Sunday, November 15, 2009

An Unplanned Trip to the Emergency Room

To say that it was a headache would be an understatement. It was a headache from hell. It was a headache that made self-decapitation seem a reasonable alternative.

It was Wednesday, Veterans Day. It was a day off from work for me. The headache came shortly after my wife left for work. It came on suddenly, with full force, closing my left eye. I could not lie down. I could not do anything but pace around the flat howling.

It was difficult, but eventually I called my wife for help. She called neighbors.

One of our neighbors is a retired nurse. She did not take a very long look before she decided that I had to go to the emergency room.

It was fortunate for me that neither she nor her husband is concerned about how litigious this country is rumored to have become. They took me to emergency in their car when they discovered I had no health insurance to cover an ambulance ride. Such generosity is rare and foolish and wonderful. I thank God for my neighbors.

At the emergency room I was asked numerous questions as I writhed in pain. The hospital staff and I each attempted to do our separate parts with aplomb. I cannot complain about my treatment because I was out of my mind.

Blood was taken for tests. A CT scan was run. Nothing came from these or the doctor's examination. The pain was subsiding somewhat, but I was still sick. The doctor prescribed a spinal tap. He was frank about the pain. He was uncomfortably explicit about what the procedure entailed. It sounded terrifyingly medieval.

My head was in pain. I was asked to make a decision. It took time. I have no health insurance. I am spending money and I have no idea how much I am spending. I suspect it is money I do not have. I am sure it is money that was not in the budget. Who budgets for the emergency room?

There was a good chance the spinal tap would show nothing. If the spinal tap revealed anything, it would be something deadly.

I decided for the spinal tap.

The procedure was every bit as uncomfortable as promised. I will take three colonoscopies over one spinal tap any day.

The results: nothing. From the blood tests, the CT scan, the examination, and the spinal tap, nothing to indicate the cause of my sudden extreme headache.

I was sent home with prescriptions for three pain medicines to deal with the headache that might come as a side effect of the spinal tap. I doubt you have to read that last sentence twice to catch the irony. The headache I came to the emergency room with still lingered, less severe, for the next four days. I lost two days of work at a job for which there is no "paid time off."

Now there is nothing very special about my experience. There are people who suffer migraines and cluster headaches frequently. I have never been diagnosed as having either. This little episode, however, does illustrate several facts that undercut the Republican and conservative critique of universal health care.

Health care does not fit in the marketplace.

In my pain I was not offered different emergency rooms with different features. There was no choice of different CT scans with greater or lesser resolutions, or a spinal tap at the base of the spine or the base of the neck. Frankly, those sorts of choices were completely irrelevant. I wanted the pain to stop.

Neither did the services suggested come with a price up front. It was simply take the blood test, the CT scan, and the spinal tap, or leave it. The bill comes later. The doctor gave no indication that he even knew what a spinal tap costs.

Marketplace ideology does not work beneficial health care. A visit to the emergency room is not a trip to the grocery store and conservative critics of universal health care are, at best, fools for not recognizing this.

I was not going to write about this until I read conservative Milwaukee Journal Sentinel columnist Patrick McIlheran today.

Among the many falsehoods the Mr. McIlheran packed into his column was that "of course, the government now ensures the poor and the old get care. It even pays for the not-really-poor via programs like BadgerCare."

This is one of the many assertions conservatives make without support of facts – that the needy are being taken care of, even the not so needy. No need to fix what is not broken.

Well, the call came on Friday the 13th. The hospital wanted to confirm that I have no insurance and screen me concerning my financial situation to see if I qualify for assistance. I do not qualify for any assistance. I will be getting a bill in four figures from the hospital. And a bill from the radiologist and another from the doctor. I am not poor, and Mr. McIlheran is purposely vague about what he terms "the not-really-poor," but there is no Badger Care for me.

This brings to mind another myth about our current system of health care that conservatives like to assert. It is said that hospitals must provide emergency care, even to the uninsured. In addition, it is said that when the uninsured do not pay, that loss of income is simply averaged over the bills of insured paying patients. The uninsured get a free ride.

I am sure that hospitals lose income treating the poor and uninsured. I am sure that they have found some way to recover that loss from the people who do pay.

The poor and uninsured are billed, however. They are expected to pay. After several billing notices, their accounts are handed over to collection agencies. The collection agencies use all available means to recover the cost. There is no free ride for the poor and uninsured in our current system.

I have never been to an emergency room as a patient before and I hope never to make another visit. If this country had the universal health care that is popular in so many other developed countries, preventative care might have discovered and addressed whatever brought on this headache so that there would have been no emergency room visit.

As it is, I have a debt in four figures and an inconclusive diagnosis.

Wednesday, October 07, 2009

Cherry-Picking in Health Care

Last month I wrote that there are two important facts that are ignored in our current health care debate.

Everyone gets sick.

Everyone dies.

These facts are not always ignored. For-profit health insurance companies do not ignore these facts. These facts affect their bottom line. Their response to these facts is to cherry-pick among their applicants. They pick those who are the healthiest and youngest.

The cherry-picking begins with the application for insurance.

I have before me an application. It has three and a half pages of intimidating, broadly worded health questions that must be answered before insurance is granted.

The intimidation works this way. The prospective client must answer all the questions with full honesty, or eligibility will be denied. On the other hand, the prospective client, out of reasonable self-interest, will not want to overstate any health issue or problem, or eligibility will be denied.

In addition, if the prospective client neglects to reveal any condition because it is deemed trivial, or for some reason irrelevant, or the prospective client simply forgets, then the company reserves the right to rescind coverage even after granting the policy.

In three and a half pages, the prospective client must reveal the intimate details of his visits to the doctor with the knowledge that everything stated and unstated will be used against him in the event the for-profit insurance company decides that a claim for coverage should be denied. It is nothing less than three and a half pages of self-incrimination on the applicant's permanent record.

Forget what you have heard about "Washington" getting between you and your doctor. The intrusion of the for-profit insurance company is now much worse. The for-profit insurance company now intrudes, accepts premiums, and then reserves the right to use its intrusive, intimidating health history questionnaire to deny coverage.

The first use of the questionnaire, however, is to cherry-pick. Only the young and healthy will qualify.

In my previous post, I recounted the efforts of a worker to purchase a lower premium high-deductible health savings account policy. The worker is healthy, has a healthy life-style that includes a good diet and regular exercise. The worker has made full use of the preventative exams offered by the worker's current health care plan to stay healthy.

The exams, which should be part of any responsible person's health care, revealed two non-life-threatening conditions.

One condition was revealed by advanced medical technology. A few decades ago, I doubt that it would have been a matter of concern at all. The worker is grateful that the condition is being monitored, but has been told by medical professionals that there is no reason for concern. Simple prudence requires a modest amount of monitoring. (Readers will note that I am protecting the privacy of my source by not going into further details.)

The second condition is even more benign. Through the medical history questionnaire, the health care insurance company learned that the worker has a "History of Joint Pains."

Yes, the worker is closing in on sixty years of life. There have been "Joint Pains." There have been no tests, only the most cursory of examinations, and no prescription medicines. There may be a need for more serious care ten or twenty years from now – or not. Now the worker has some discomfort because the worker is closer to sixty than fifty – the pains are just part of getting older.

"History of Joint Pains" is how this company cherry-picks the young and healthy and excludes the rest. The "History of Joint Pains" preceded the worker's current health care plan, and did not resulted in one dime of claims under that plan. The "History of Joint Pains," however, does preclude the worker from getting a cheaper plan.

This worker is healthy. This worker is being denied cheaper health care under the current free market health care system. The practice of cherry-picking is denying healthy workers affordable health care insurance because our so-called free market system grants freedom only to the for-profit health care insurance companies for the benefit of their stockholders.

It is high time to admit it. The United States of America does not have a "health care system." The United States of America has a market where for-profit companies feed upon the facts that everyone gets sick, everyone dies.

Our worker is fortunate. Our worker for now has high-deductible coverage. The premiums have repeatedly gone up, but for now, the worker will manage to cover them.

This will not last. Moreover, there are others less fortunate than our worker.

Forget the public option. Anything less than single payer universal coverage is less than what is needed. Anything less is a shame in the greatest country this world has known.

Sunday, October 04, 2009

The Failure of the Free Market Health Care System

Our national health care debate has included numerous anecdotal accounts of the failures of government-run health care policies. From the blogosphere to the mainstream media – and unfortunately today that includes the Fox network – people have come forward to recount how their relative in Canada, Great Britain, Germany and even Norway suffered illness and eventually died.

The fault is, of course, "socialized health care." Never mind that all of the countries named above have widely different systems of providing health insurance to their citizens. Disregard that not all of these countries practice "socialized health care."

Most of all ignore the fact that under any system, sick people will die and bereaved relatives will be offended and will find fault. Sometimes the faultfinding is justified. Many times grief clouds judgment.

What follows is an account where no one is sick, no one dies. It is anecdotal. Nevertheless, it is a true representation of what happens under the free market capitalist system of health care in the United States of America

A worker for a small concern purchases a high-deductible plan that is combined with a health saving account (HSA). It is the dream plan of the Republican Party. Contributions to the HSA are tax-deductible. Funds from the HSA can be used for the high deductible and health care costs not covered by the health care plan.

It is nice that health care savings are tax-deductible. The worker, however, works for a small firm and has an income that is congruent with working for a small firm. Contributions to the HSA necessarily come after paying for daily living expenses. Then there are the health care costs that drain the HSA even while the worker is trying to build this account with tax-deductible contributions.

This system requires constant vigilance.

Happily, the worker is healthy. The worker has healthy habits. The worker exercises regularly. The worker has a healthy diet. The worker is no athlete, and is not young. The worker is responsible and takes full advantage of the yearly physical examinations and screening tests covered by the high-deductible plan.

The worker pays the premiums of the high-deductible plan for two years, during which time the premiums increase no less than three times.

This is where the tale gets interesting.

After the first examination, a condition is revealed which in and of itself is not life-threatening, but could be serious. There are no symptoms of illness. There is only the possibility of illness.

The premiums for the high-deductible health plan go up again. The worker applies for a lower premium plan from another company. The worker's income has never gone up to meet the increase of the premiums.

The healthy worker is denied coverage by the alternate company because of the non-life-threatening condition revealed in the earlier examination. The worker is stuck with paying a higher premium.

The Republican Party has advocated that the free market system offers workers the freedom to make choices congruent with their income. Citizens can choose their health care providers. They can choose their doctors. They can control costs.

The Republican Party needs to return to planet earth.

The only freedom the present system provides is the freedom of heath care insurers to deny coverage and increase profits.

Anyone who is otherwise healthy will have a "pre-existing" condition simply because they have some existence.

The present system of health care provides no freedom for those who have employer-based insurance. It tethers them to their employer. The present system of health care provides no freedom to those who do not have employer-based insurance. They are at the mercy of companies who can deny coverage for the least reason. The present system provides no freedom for the 45 million who are uninsured. They ignore their symptoms until they need the emergency room. Or they die.

The citizens of the United States are at the mercy of so-called health care insurance providers whose motive is profit and not health care.

Read this essay again. It is not the tale of a sick person needing health care. It is the tale of a healthy person trying to pay for health care in this so-called free market and finding no freedom at all.

This is not my story. I have no health care insurance. I have too many pre-existing conditions. I will probably die before there is a civilized health care system in this greatest country the world has known.

Monday, September 14, 2009

Be Afraid, Be Very Afraid

Is health care reform advocated by the Democratic majority of Congress and the President of the United States a threat to the nature of democracy in America?

Leave aside that there is no one health care proposal from congressional Democrats. These are the cats that President Obama is trying to herd. It is not going well. Between the Blue Dogs and the progressives, it is hard to understand how anyone would reasonably think that President Obama and the congressional majority are initiating any one plan, much less a nefarious plan to undermine our constitutional freedoms.

Nevertheless, there are those pictures of President Obama with Hitler's mustache.

And there is an editorial by associate professor of history at Concordia University Wisconsin, Jim Burkee.

For Dr. Burkee the important and ignored question is, "…what happens to democratic society when non-producers can vote themselves benefits at the expense of the producing class?" (Milwaukee Journal Sentinel, August 9, 2009)

Is it possible, a class struggle in our republic? Yes, according to Dr. Burkee, but the struggle is not between the working class and capitalists. It is between the producers and the non-producers. It is between those who are dependent on government and those who are independent.

Keep this distinction in mind as we give Dr. Burkee the floor to make his case with history.

Our nation's founding generation was profoundly aware of the relationship between economic independence and democratic participation. In classical Athens, Aristotle had argued that political participation required property ownership, since those who did not own property "have no share in the state." Likewise, our founders largely restricted voting rights to those who owned property, believing that a voter's independence of judgment and desire for liberal self-government was found only in those not economically dependent on others.

This is an odd reading of American history for a professor of history.

The founding generation did not have any consensus on the question of property ownership as a qualification for suffrage. This qualification was indeed popular with some of the founding fathers. It certainly was not supported among the Revolutionary War veterans who did not own property. They felt that their participation in the war to establish this nation earned them the right to participate in its governance.

The Constitution never had property ownership as a qualification for suffrage because there was a diversity of opinion on this question.

Indeed our republic has thrived, not on the restriction of suffrage, but on the broadening of the right to vote, first to freed slaves, then to women, and eventually to eighteen-year-olds.

History professor Burkee should review the history of the amendments to the constitution.

The founding fathers bequeathed to us an amazing founding document in the Constitution that we should be grateful for as long as this country endures. It is a work of genius. However, it is not a divine proclamation.

The founding fathers were mortals with all the flaws of mortals.

Among the landowning founding fathers were men who were dependent on the work of slaves. They were hardly the liberal, independent, enlightened property owners depicted by Dr. Burkee. They were not the high-minded producers that he exalts. Their slaves produced, they profited.

This country has profited from what the founding fathers did right. It also suffered a bloody civil war from what they did wrong.

This brings us to the simplistic distinction Dr. Burkee makes between producers and non-producers.

Dr. Burkee is not too clear on whom he considers the producers to be. He has a list of non-producers. The non-producers, remember, as the non-landowners who "have no share in the state," will undermine democracy in America.

The non-producers are recipients of Social Security checks, recipients of payroll checks from the Federal government, recipients of payroll checks from the State government, recipients of payroll checks from local governments. These, by Dr. Burkee's reckoning, are dependent voters. He has figures for each category for which he cites no source.

It is startling to see how many citizens of our country are dependent non-producers, until one queries just whom Dr. Burkee is fingering as the agents of the downfall of democracy in America.

Begin with Social Security recipients. These are workers, people who have labored throughout their lives to give us the goods and services we enjoy and now are retired. Can these people be justly termed "non-producers"?

Many like to take shots at Federal government employees, as Dr. Burkee does. This broad category includes, naming just one group, the men and women of the armed forces who defend us and the free world. Moreover, among the local government employees are the law enforcement personnel who serve and protect our property and persons.

The retiree, the soldier, the police officer – these are among the agents of big government that Dr. Burkee views as the non-producer threats to our democratic way of life.

On the other hand, there are the producers, like the entrepreneur who is constantly spamming you with the promised benefits of colon cleansers. He is to be valued above the retiree, the soldier, the police officer. He is a producer in a free market economy.

Dr. Burkee admits to one resource for his opinion, "political philosopher Isabel Paterson."

Isabel Paterson had no credentials in political science or philosophy. She had only a couple of years of formal education and no high school degree. Her biography is not in the Britannica. She is not referenced in Macmillan's Encyclopedia of Philosophy. She was an amazing autodidact, to be sure, making her living as a novelist and critic.

Isabel Paterson is regarded as a "political philosopher" only among radical libertarians. She was an influence and once friend of the atheist Ayn Rand.

This is the point at which we should worry about democracy in America. President Obama with a Hitler mustache is the product of those who look upon our time as a struggle between a producer elite and the non-producing masses.

We have little to fear from the Democrats, President Obama, and the reform to health care. We should be wary, however, from the fear-mongers who paint mustaches on the President and make facile distinctions between so-called producers and non-producers.

Friday, September 11, 2009

Is the Opposition Loyal?

South Carolina Representative Joe Wilson has apologized. President Barack Obama has accepted his apology. Speaker of the House Nancy Pelosi has said that despite the violation of House rules, she is satisfied not to press the matter further since the President has accepted the apology.

It would be nice if the matter ended here. But it has not and it will not.

Mr. Wilson's Democratic challenger received hundreds of thousands of dollars in contributions instantly over the Internet in response to his outburst. The Democratic party is going to make use of this unfortunate incident in its future fundraising.

Mr. Wilson shouted, "You lie," when President Obama stated that the proposed health care reform would not provide coverage to illegal aliens. All authoritative reports have stated that President Obama was right. The proposed reforms explicitly exclude illegal aliens.

Republicans and organizations advocating stronger measures against illegal aliens contend that the proposed heath care reforms, while excluding illegal aliens, contain no measure sufficient for the enforcement of this exclusion. Whatever the merits of their position, it is an issue beyond what President Obama was addressing. He was not lying.

Nevertheless, while Mr. Wilson has become a symbol of Republican intransigence for Democratic fundraisers, he has also become a hero to those who are advocating stronger measures against illegal aliens.

"It is a real shame that the rest of Congress was not on their feet pointing out the president's lie about illegal aliens in his healthcare plans," said William Gheen, president of the Americans for Legal Immigration, a political action committee. (Los Angeles Times)

Without going into all the other permutations of this event, and without detracting from Mr. Wilson's apology or in any way questioning his sincerity, it is important to focus on just what happened and why his action was an offence.

President Obama was acting in his official capacity in addressing a joint session of Congress. There are rules that govern the conduct of the members of Congress in these events. Mr. Wilson and his party have recognized that he violated these rules.

This was not a town hall meeting. This was an official address to the elected members of Congress. It was not a time for debate.

Neither should the customs and rules of this event be confused with the customs and rules of a meeting of Parliament in Great Britain where the Prime Minister is regularly shouted down by the opposition.

We are Americans. We have different rules and customs by which we show respect for the elected head of the executive branch of our republic.

The Republican minority appropriately registered their displeasure with President Obama's speech by remaining seated at the several points when the party of the majority stood and applauded. That is their right. They also have the right to criticize the President after the speech on the floor of their respective bodies and in the press.

What we have here is an instance when the opposition ceased to be the loyal opposition. Mr. Wilson's outburst was not merely an act of opposition, but an act of disrespect for the office of the Presidency. It was such an act, in and of itself, even if – as I suspect – Mr. Wilson did not intend it to be. It was an act of disrespect for the office of the Presidency because it violated the rules and customs for a joint meeting of the Congress.

It is in the observance of these rules and customs that respect for the office of the Presidency is expressed.

William Kristol of the Weekly Standard has advocated that the Republican Party act as the loyal opposition to the agenda of the President and the majority in Congress. This is certainly acceptable and even beneficial for the republic.

The nature of disrupted town hall meetings of August and this incident with Mr. Wilson raise serious questions, however, about the loyalty of the minority's opposition. Unfortunately for Mr. Wilson, his outburst is within a larger context that he may or may not be party to.

To give just one example.

When continued unreasonable questions are raised about the constitutional eligibility of Mr. Obama to be President, and no one in the opposition denounces this absurdity, the question needs to be asked: Does the opposition recognize the decision of the electorate and the legitimacy of this Presidency? Or is this opposition so self-righteously dedicated to its position that it will not let respect for the office or the electorate stand in its way?

It is way past time for the conservative minority to demonstrate the loyalty of its opposition.

Tuesday, September 08, 2009

Two Ignored Health Care Facts

Tomorrow, President Barack Obama will address a joint session of Congress about the need for health care reform.

In my short life, I have never witnessed a president throw himself so vigorously into the work of his administration. It would be unfair to say that Mr. Eisenhower golfed through his presidency, Mr. Reagan slept, and Mr. George W. Bush spent much of his time trying to untie his tongue. Nothing near these caricatures will be made of Mr. Obama.

Mr. Obama is faulted for trying to do too much. He has not come near violating the Constitution –an accusation that has been made against a couple of our previous presidents. He is faulted for calling upon the legislative branch of this government to do the work of the people and address the problem of health care. He has vigorously taken his case to the people. Agree or disagree with him – and on many subjects I do disagree with him – Mr. Obama is earning his salary.

Yet, there are two facts central to the health care issue that I predict he will not address. He cannot state the case for reform as vigorously as he should because the nation is in a state of denial about these two central facts.

Health care costs are unacceptably rising for those who have health insurance. There are approximately 45 million who do not have health insurance. Even among those who do have health insurance approximately 25 million are underinsured. These and other figures can be disputed and argued about endlessly.

The two central facts remain.

Everyone gets sick. Everyone dies.

We are dealing with mortality.

President Obama is not the foremost agent feeding our national state of denial on this issue. The fear-mongers on the right ranting about socialism, euthanasia, and a host of other horrors have done the most to keep us from considering the consequences of our undeniable mortality.

Talk to a Republican about health care and he will offer you a tax break.

Hence we have Health Savings Accounts coupled with high deductible insurance plans. This is a great idea on April 15. Unfortunately it does little to deliver necessary heath care.

Taxes do not kill people. Wave the voodoo magic supply-side economic tax wand and remove all the taxes. People will still get sick. They will still die.

We would all like to have the life of Paul Newman. Mr. Newman led a vigorous and productive life for many decades. He was beautiful and gracious. And then he died. His death was relatively quick.

Unfortunately this is not true for most. Some get sick early in life and need care for many years. For others, illness is something that needs little medical attention. Still others need hardly any medical attention for many years, and then there may be years of debilitating illness.

The only bright spot in dealing with our mortality is that we do not all get sick, we do not all die in the same way. The fact that we do not all get sick and die in the same way is, over the years and in the population as a whole, a benefit. It means that financial resources can be pooled. Services can be distributed to those in need from the resources of those who have less need. The morality of this pooling and distribution is that everyone will have some sort of need eventually. Because everyone gets sick, everyone dies.

Our undeniable mortality is exactly why a free market capitalistic economic system fails in the area of health care. To recognize this fact is not to embark on the slippery slope to socialism. Capitalism was not revealed to us by God, and it is, like every human invention, imperfect. There is a time and place to pool our finite resources to deal with life's uncertainties.

Those who say that the United States has the best health care system in the world are living in denial. They are ignoring the rising premiums, the millions of uninsured, the millions of underinsured and the millions who will be losing their insurance in the years to come as our population gets older. They are also ignoring the many other industrially advanced nations that, regardless of their other weaknesses, are in fact doing a better job than the United States in this area.

Capitalism does a fine job of delivering goods and services for our temporal existence. We have the freedom to choose many goods and services we want, ignore what we do not want, save and work for what we desire. In many areas of life where our desires go beyond our means, we can still live and find some degree of happiness.

Health care deals with where we lose our freedom to choose. Illness comes unbidden.

Shopping for a car or a house is a fine activity in the marketplace. Shopping for a cure is an act of desperation.

The failure of free market economics on health care is obvious with for-profit health insurance companies.

The rightful task of any for-profit company is to deliver a profit to its shareholders. For-profit health insurance companies are by definition involved with a conflict of interest. They cannot deliver service to very many ill premium-paying customers without cutting into their shareholders' profits. Yet their premium-paying customers are paying them for exactly that reason –to provide care when illness eventually comes. The several different ways for-profit companies unfairly deny claims will always happen because these companies need to serve their shareholders.

There are many other ways the current health care system fails the citizens of the United States. One does not have to be an economist, a medical authority, a pharmaceutical company executive to see were the problem is.

We need to start with the facts – everyone gets sick, everyone dies.

Tuesday, April 07, 2009

Doctor's Charges

We were expecting a bill from our doctor. What we received on 1 April 2009 was much worse. It was a letter.

Dear Valued Patient, it began. The adjective was the first false note. Just what made me a "valued" patient? What kind of letter uses the salutation to pay a compliment? How much is this going to cost me?

As you know I love practicing medicine and enjoy being your physician, the letter continued.

Actually, I did not know either of these things.

A little over a decade ago, we chose Dr. Arthur King to be our physician because he was within walking distance of our home. This became particularly important in recent years when we gave up having a car.

I have not seen him in over a year. As I am without health insurance, there is little point. The lab work for a decent physical is more than I can afford.

We procured a high-deductible policy for my wife recently. It was for a diagnostic examination for a condition that could prove serious – but thankfully so far has not been – that we expected a bill.

Therefore, we cannot claim the close relationship that our doctor seemed to think we had. His office staff has been cordial and understanding. He has been professional and never prescribed snake oil. Nevertheless, the last sentence of his overly flattering first paragraph sent a chill.

Unfortunately, the current system does not allow me to provide your care in the way I know you deserve.

Then came the pitch. He was going embark on a new method of medical practice "that enables the patient-physician relationship to be a true partnership." The services under this "new" system were described in bulleted short phrases.

Opposite "Higher quality care experience" was "Total care coordination with specialists and other providers," "Test result consultation," "Post-specialist visit explanations," and "Assistance with insurance filings."

The verbiage was pretty, but the first three points simply describe standard operating procedure when a general practitioner makes a referral to a specialist. The last is how a doctor gets his money.

Opposite "Incredible access at your convenience" was the truly incredible claim of "24/7 access to me via cell phone, email, or office phone." Notice that this is not access to "service," but to Dr. King himself. The FAQ sheet, which accompanied this letter, was equally unambiguous on this point, offering "Direct access to your physician any time of the day or night."

Only God is accessible 24/7. Mere mortals do not have this power. Leaving aside the fact that even doctors must eat, sleep, and take days off, there is the conflict of dealing with a patient in the examining room when the cell phone goes off. "More about your colonoscopy later, Fred, I have to take this call."

There was one new item that followed "Incredible access" – "House calls as needed" (italics in original). There was no statement about who would determine the need or how need would be determined, making this an empty though enticing promise.

All the puffery and empty promises of this letter came down to this. Dr. King claims to have 4,000 patients. Under the new ModernMed practice he can have no more than 500. Of those 500 patients, the first 300 to sign up will be offered the introductory monthly rate of $75 a month. The unfortunate remaining 200 patients will be charged the normal rate of $125 a month. Given the terms offered, everyone will be paying $125 or more a month in the years to come just to be a patient of Dr. King.

That is right, friends, this retainer fee does not cover office visits or tests or anything else. It is a simple retainer fee, promoted with pompous and incredible claims. There is nothing offered under this new system that is not either standard operating procedure of a good general practitioner or available elsewhere for less or nothing.

The advantage is all with the doctor. He dumps 3500 patients. He dumps some who have come to him regularly for any number of reasons. He dumps some who come only under the compulsion of dire illness. He keeps only those who can pay for the privilege to call him their doctor. He receives over a half million dollars annually under the introductory rate, three-quarters of a million in the next year, and undoubtedly, a million and more in the years to come, in addition to any fees charged for the actual practice of medicine.

At $125 a month, his patients will pay an annual $1500 in addition to their health insurance premiums, deductibles, and office visit co-pays. They will receive for this sum nothing beyond what is expected of the general practice of medicine.

What is being promoted here is "a new revolutionary model of medical practice." What we have is medical extortion.

Tuesday, January 06, 2009

Rule of Law

California Sen. Dianne Feinstein goes against Senate Majority Leader Harry Reid in saying Illinois Gov. Rod Blagojevich has made a legitimate appointment to the US Senate. – Fox News, Web Headline.

It is a new year with a new president and a new Congress. With the new comes the strange. Strange for me is agreeing with a radically liberal senator from – of all places – California.

You know the story. Indicted Illinois governor Rod Blagojevich has made his selection for the senatorial seat vacated by president-elect Barack Obama. Governor Blagojevich's chances of beating the rap of trying to sell this Senate seat are nil. In addition, he has a potty mouth which has made him the butt of late night humor.

Nevertheless, the fact is that as Mr. Blagojevich is the governor, indicted, but innocent until proven guilty, state law empowers him to make this appointment to the Senate. In addition, there have been no allegations against his appointee.

So where is the rule of law in denying Roland Burris a seat in the Senate?

The appointment was tainted? By what? A foul-mouthed governor? Sad to say, but many of our elected officials suffer from a lack of vocabulary in their private speech. This does not rise to a point of law, in my humble opinion.

Unless there is some evidence that Mr. Burris himself was involved in the federal accusations against Governor Blagojevich, the Senate of the United States of America, the greatest deliberative body in the world, is guilty of an unconstitutional hissy fit.

As a white guy living in Wisconsin, I have no dog in this fight. There is this concern. After eight years of the administration under Mr. Bush playing fast and loose with the Constitution, this first act under a new regime does not bode well.

Senator Feinstein is right – I still cannot believe I am writing this – Mr. Burris should be seated.

Saturday, January 03, 2009

Post-modern Luther

On this day in 1521, Pope Leo X issued the papal bull Decet Romanum Pontificem, excommunicating Martin Luther. On May 26 of that same year, the Edict of Worms declared Luther an outlaw, putting his very life in danger. Neither the excommunication, nor the edict, however, would prevent Luther from writing, preaching, teaching, marrying, and fathering children, until he died in ripe old age on 18 February 1546.

It would not be an exaggeration to say that the Modern Age began with this man on this date with this papal act of excommunication. This is not to say that Martin Luther was a great man. He was, but the beginning of a new epoch takes more than a great man. It also requires a confluence of economic, political, and cultural circumstances. The story of the Sixteenth-Century Reformation includes everything from improvements in mass communications to shady banking practices.

At the center of it all is Martin Luther, a brilliant, irascible, complex man, who, because of circumstances, did not suffer burning at the stake as his Czech predecessor Jan Hus did in 1415.

It is a sign of the poverty of our post-modern era that the popular understanding of Luther – where there is any recognition at all – goes no further than the 2003 movie Luther staring Joseph Fiennes. This movie attempts to capture the drama of Luther's life without being encumbered with the facts of history. Scenes depict not only events that never happened – which might be defended on the grounds of "dramatic license"—but events that are out of character for Luther.

In one of the most impressive scenes, Luther himself buries a suicide on consecrated grounds. This never happened. It bears little relevance for what Luther taught and wrote. It does give Fiennes a fine opportunity to overact, something he does throughout this movie.

In another scene, Luther preaches to a congregation, not from the pulpit, but walking in the midst of the congregation like a modern American Evangelical, dressed in a fine chasuble. For centuries before this movie, Luther was always depicted preaching in the traditional way, from a pulpit, and in modest dress.

This movie is fiction, not fact, promoting an idea of Luther, and bears no resemblance to what he was. Fiennes, coming off a film where he fictionalized Shakespeare (Shakespeare in Love), hardly even musses his hair to take on Luther. He rants, he raves, he throws himself around the room, but for all the energy he expends he does not have the gravitas of a Luther.

This is the popular presentation of Luther in our day. Because it was a mainstream picture, with legitimate actors, even some of the most conservative
Lutheran churches embraced Luther. It was obvious that the stars got in their eyes.

On this day in 1521, the Modern Age began. It would be nice if we understood something of it.