Failure among the Faithful

I'm just not cool with the government insisting that an excessively large and growing share of the output of the motivated and responsible achievers ought to be diverted to the unmotivated and irresponsible. -- A Christian’s posting to Facebook.

It does not matter who wrote the above. The sentiment is common, particularly and sadly among politically conservative Christians.

The argument is that any tax on corporations and persons of wealth to fund programs to help the poor, sick, and elderly is immoral. When the government uses its power of taxation for any other than military appropriations, it is an act of theft. The rich are rich because they are “motivated and responsible achievers.” The poor are poor because they are “unmotivated and irresponsible.”

This argument is straight out of Ayn Rand’s essay “Collectivized Ethics” from the book, The Virtue of Selfishness. “Only individual men have the right to decide when or whether they wish to help others,” Rand pontificates, “society – as an organized political system – has no rights in the matter at all.”

Rand offers no supporting evidence for her assertion. There is not any. The progress of Western civilization itself is the refutation of Rand’s thesis. More on that another time.

I have no reason to believe that the Christian who made the above post to Facebook has read Rand. However, as I posted on 23 October 2010, Randism has poisoned our political discourse (See “The Threat").

Take for example the untenable distinction of the rich as the “motivated and responsible achievers” from the poor who are “unmotivated and irresponsible.” There is no empirical evidence for this. In fact, it runs the other way. Most rich individuals in the United States acquired their wealth the old-fashioned way – they picked rich parents. The poor, conversely, are to be faulted for not choosing parents of ample means.

It is, however, of little concern that our Christian has imbibed a bit of Randism or does not know the social science that refutes his simplistic distinction between rich and poor.

What is disturbing is that the Faith has little or nothing to do with the political thought of too many conservative Christians. Instead of the compassion of Christ, we have the cruelty of Randism. Instead of concern for the weakest in our country, there is a perverse concern for the supposed imperiled rights of the most powerful.

I do not doubt that most conservative Christians believe this is a fallen world, corrupted by the sin of our first parents. Nevertheless, they also seem to think that, miraculously, justice has been preserved in the distribution of wealth in this country. They seem to think our Lord was issuing a command when He said, “The poor will always be with you.”

Big Government

Elizabeth Henderson has a concise prescription for what ails the nation's health care system: Limit the federal government's role. "I want government out of my life. I can make my own decisions," Henderson, of Union Grove, said Saturday, as she and others gathered at a "tea party" to protest the health care legislation pending in Congress and other issues. –Milwaukee Journal Sentinel, Sunday, January 17, 2010

Ms. Henderson probably rode or drove a car, or perhaps even an SUV to her "tea party." She traveled over paved streets from which the snow had been plowed. It was the government that regulated the company that made her vehicle so that it is safe to drive. It was the government that paved and plowed the roads that she drove on.

Yet, she wants the government out of her life.

Perhaps you would object that the subject is not the government, but the huge health care reform legislation that Ms. Henderson is speaking about. Look at Ms. Henderson's statement again. She did not say that she did not want health care reform. She said, "I want the government out of my life."

The boogeyman that the anti-health care reform, anti-tax, tea party crowd continually raises up for excoriation is "big government." At this point, let us dismiss Ms. Henderson. She might be more of a victim of the "tea party" movement than a proponent. Let us focus on the meaning of "big government."

The unquestioned evil of "big government" needs to be questioned.

In this big 21^st-century world, just what is so evil about a "big government?"

Can a small government protect its commerce on the high seas from third-world pirates? Can you expect a small government to detect a solitary Nigerian terrorist plotting to board and bomb an international air flight?

The answer is obvious. We want the largest, most powerful government we can have to protect us from foreign threats.

Health care is not a foreign threat. It is a domestic issue. Perhaps we do not need "big government" interfering in domestic issues.

Even here, however, questions must be raised.

Was it "big government" that caused the 2009 financial meltdown? Did big government cause the savings and loan failures, the malfeasance of Enron, or invent no-down-payment mortgages and credit default swaps? Would Bernie Madoff have been caught in his nefarious schemes by a smaller government? Could a bigger government have prevented him from going as far as he did?

We need a big government because this is the largest, most powerful nation in a world with complex international political and economic relations. We need a big government to protect us from nefarious domestic and foreign powers that would rob us of life, liberty and the pursuit of happiness. We need a big government to uphold the Constitution, which is the greatest man-made guarantor of individual liberty the world has ever known.

This country has progressed far beyond the Jeffersonian agrarian republic envisioned by some of the founding fathers, due, paradoxically, to the wisdom of those same founding fathers. A succeeding generation built upon their legacy in a bloody civil war that enlarged the place of the federal government and brought the promise of liberty to a large portion of the populace that the founding fathers had ignored. That promise of liberty came to be more of a reality though the turmoil of reconstruction and the Civil Rights movement of the 1960s.

Is big government really a threat? A big government, grounded in the rule of law, protects us from plutocracy, the rule of the very rich. A big government, elected by the people, protects us from oligarchy, the rule of a small number of interests groups.

A big government, which observes the rule of law, cannot protect us from demagoguery. We are protected from demagoguery only when free citizens denounce simplistic, manipulative, paranoid assertions – like the idea that big government is always and only evil.

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 13^th. 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.

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.

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.

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.

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.