We need a public option with a French accent

I’ve been thinking a lot lately about the inefficiencies in the US health insurance system, as compared with what seems to be the amazingly efficient French system. Most talk is centered on inequity here, which is the bottom line, of course. Still, we like to believe that the economy (and all progress in this country) is driven by efficiency, innovation, and productivity, so the contrast in this case seems rather alarming.

Listen here to author T.R. Reid on his experiences in doctor’s offices around the globe, seeking help for a “bum shoulder”. Listen, particularly, to his account of the French system of files and payment processing.

[In France and other ‘Bismarck model” European countries] These are private docs, private hospitals, and mainly private insurance plans…

This business in America where we have the in-network deal or we have to get pre-authorization; any doctor, any clinic, anybody in the entire country, you chose ‘em, you go, and insurance has to pay the bill within two weeks or so…

[French doctor’s offices] are Spartan... What’s missing [...] is the files and files of patient records, and there’s no billing office… the patient comes in, out of her pocket she pulls […] the Card Vitale, he puts it in a reader on his desk and her entire medical record shows up on the screen. He chats with her about her problem, he’s typing down what she’s got wrong, and he says “I’m going to prescribe a course of antibiotic” […] and he’s typing all that up. He’s finished with her, […] he hits one key on his computer and the entire bill has gone to her insurance company, he’s going to be paid in three days, and she’s gonna get her copay back from the insurance company within two weeks. Done. No paperwork.

Compare that to the situation now facing my sister, trying to get her daughter needed treatment for a deforming case of scoliosis. The condition is not, of itself, life threatening, but further deformation could begin to impact internal organs, including her lungs. The girl has, since birth, been very susceptible to lung ailments.

The treatment is thoracic spinal fusion, a 7-8 hour surgery that, while not uncommon, is far from routine. My sister’s search up and down California for a doctor competent to perform the surgery who would also accept Medicaid led to UCLA, where the surgery is performed, apparently, hundreds of times per year.

My sister lives in Northern California, so the team at UCLA worked with her doctor up north to coordinate some of the pre-op work and insurance submittals. There were two necessary pre-op trips to LA. The surgery was scheduled for today, September 15. The family flew down this weekend, mom, dad, the patient, and her twin sister. Dad and sis planned to go home Friday, while the patient would not be clear to travel for three weeks, so she and mom would stay down here.

What do you say to a kid about to go under the knife? I told her it would all be over in two days, and she wouldn’t have to think about it anymore.

So I was sickened yesterday when I heard that the surgery had been postponed for at least three weeks, because her Medicaid paperwork had been lost in some shuffle or another and UCLA won’t do the surgery until it is pre-authorized. In the meanwhile, her parents must find money to change tickets and buy new ones, putting more financial stress on an already stressed family.

“Medicaid is a government program!” I can already hear the screeches. But this situation isn’t unique to public insurance. It’s due to an approval system in use by public and private insurers, and it’s stupid, and it’s wrong, and it wastes time and money.

There is (or there was a couple of weeks ago) language in the current house bill that would enable electronic funds transfers between doctors and Medicare/Medicaid, and presumably other public insurers. That’s a good step.

Now how about language that removes pre-approval from the transaction? The doctor treats, the doctor gets paid. If there is reasonable suspicion of fraud after the fact, it becomes a criminal investigation. If the fraud were committed against a public plan, the charges would be federal, and the penalties would be stiff, and would include prison time.

I’d like it if we followed the Swiss model, and made for-profit basic health insurance illegal. If we can’t do that yet, we should build a strong new public option, while strengthening Medicare and Medicaid. These programs should have zero pre-authorization requirements, and be dedicated to innovating payment and record keeping systems.

If the private sector won’t do it, the government must. And if the private sector wants to remain competitive, it’ll have to go along.

(Here's the NYT story on Reid's book.)

Thanks a lot, asshole

At the gas station this morning, and this story came over my local NPR station.

One person injured during altercation at healthcare rally in T.O.

TPM's already got a link up, so the story isn't staying local. There are, as well, conflicting eye-witness accounts of the incident, who did what, the usual. The basic facts are not disputed, though: an anti-reformer and a pro-reformer mixed it up, and the anti-reformer got his finger bitten off at the first knuckle.

Depressing that a pro-reform demonstrator committed assault? Oh, absolutely. Here we've been asserting all summer that we just want a discussion based on fact, that we're trying to be rational and democratic (please note the small d), while the opposition is intent on pushing crazy paranoid junk and intimidation. And someone here in my little town just lost it and irresponsibly engaged in confrontation, and committed assault.

Dude, whoever you are: that's MY corner you just shit on, and I don't really care who started it.

That's the corner where we demonstrated every weekend from November 2002 through March 2003 against war with Iraq, the corner we've returned to many times since, to rally or to mourn. That's the corner where we stood silently while people yelled obscenities at us, that's the corner where we stood in pouring rain while Catholic schoolgirls engaged in counter-demonstration across the street.

That's the corner where I stood smiling, eyes full of tears, as teenagers gleefully and proudly joined our ranks in support of marriage equality and against discrimination in all its forms.

That's the corner where we have peacefully gathered and sometimes cried and always been respectful, reminding our neighbors that here in Reagan country, there is a liberal population.

And that's the corner where I have personally engaged in some amazing conversations, like the time a young Army recruit came to ask me to explain if we could support the troops and oppose the war. The Catholic schoolgirls I mentioned above, who were really very brave, out there in the rain, and we talked about Catholic beliefs (Pope John Paul, remember, spoke out against the invasion of Iraq), and how they could support the invasion if they understood that civilians would die.

I wasn't there last night. I haven't been there for a demonstration since shortly after prop 8 passed. I don't respond to the MoveOn organizing emails lately, because there are several people here in the Conejo who are well-connected and can be relied upon to answer the call (in fact, often several people put up the same event). They're very good at this, so I'm not much needed, really.

One thing you can generally count on at larger demonstrations is that there will be a group charged with being peacemakers. Often, their jobs will be to just keep the two sides physically apart. At the 2004 March for Women's Lives in DC, attendees were asked to come to peacekeeper training the night before. During the March, peacekeepers often formed human chains, arms linked, keeping the marchers separated from the anti-abortion protesters who staged a "die-in" at the front of the march (they were removed by law enforcement), and stationed in clumps along the way. At Camp Casey in the summer of 2005, a firm no-man's-land was monitored by both the local police (who were wonderful, and friends of the Camp) and designated campers. In both cases, in addition to the peacekeepers, all attendees were admonished at the start to refrain from engaging the other side in anger.

In TO, the corner has always been so small, 35 to 150 people, and always familiar faces. Organized peacekeeping hasn't been necessary. Individuals reminding each other to behave is really all it's ever taken. There has been no hard fast rule about crossing the street, because people who cross the street do so to shake hands and agree that we all have good intentions. 

(Ok, there was the one time I lost it on a neo-Nazi, but I'm only human and anyway once I realized I was screaming I forced myself to walk away.)

So it would seem that the conversation in this country has become so heated that even here, in little TO, the civility of the population cannot be taken for granted anymore. I'm sickened that our corner was disgraced last night. I'm wondering if I feel a responsibility to be there from now on, or if I'm having grandiose notions of just how much help am.

I have no wise conclusions as of this morning. I'm just sad, and angry too.

Incidentally, it's interesting, in a vaguely nauseating way, that the intensity of emotion over health care reform trumps the public concern over the invasion of Iraq.

Anticipation and Expectations

Wow. Just re-read my 1/20/09 posts for the first time in months.

I still believe that the country voted for transformation. Harder to gauge: whether destructive/dishonest political rhetoric will completely undo the hope, and replace it with ill-informed cynicism.

I still see Obama as the guy I voted for; he's mostly behaved the way I thought he would. I have deep concerns in the areas of civil liberties, accountability, and adherence to the rule of law; but he's been practical, cautious, and wise in most areas thus far.

Mostly, I worry about wasted opportunity, whether wasted by congress or the people or the man himself. But it's only been 7 months, after all, so I cannot say I am disappointed.

Boiling it down for the boy

My kid is a news media consumer, even at his young age. He listens to NPR in the car with me, he watches The Daily Show and Colbert- which have become media criticism programs as much as comedy shows- he asks for background and then he considers and forms opinions. And we discuss.

These discussions give me a chance to cut through the BS and clean up the points in a way that talks with adult friends often do not. There isn't a self-affirming loop, nor a descent into accusation. Instead, there's the responsibility of clarification, because I will not let him grow up parroting the talking points of either side.

So this morning, NPR's reporting something or another on the health insurance reform debate. Conversation goes, basically, like this:

Him: It's like they said on The Daily Show; Jon said "But Bush supported end-of-life counseling," and Wiley said "Yeah, but he was a guy that I voted for!"

Me: Here's the thing, boy. The debate in congress isn't about "death panels". The debate in congress is simply this: Should government dip its hand into the health insurance industry, or not? And if so, how much will it cost and should that money be spent?

The health insurance industry has a powerful voice in congress, and they do not want to tamper with the market. Fiscal conservatives do not want to spend government money, on principal.

The thing is, politically speaking, it's easier to get the people riled up if you pretend you're debating death panels and government control and who's tactics are worse and which side has more crazies.

And that is, really, all there is to it.

Are there true believers in congress who would hold their positions with or without industry lobbying? I think so, but I don't think their beliefs are grounded in anything common to our society in general.

Are there members of congress who really, on principle, think that the economic health of the country depends on freer markets and less social spending? Of course, but I'd argue that they've held sway for 20 years and the outcomes make a damn good argument for reform.

And there are those who, no matter the outcome, see this as an opportunity for political gain. That isn't part of the congressional job description, and it's a deplorable perversion of power, but again: keep screaming about death panels and maybe no one will notice.

And sure, a few may actually believe in the threat of death panels and the destruction of the constitution. But they're just really stupid.

Today

Just got home from gathering with friends, a re-watching and champagne, and food. And we all sang, and joked, and the most cynical of friends celebrated hope.

I'm watching Barack and Michelle enter parties and say words and look wonderful. (While I love writing and saying President Obama, I still feel a closeness and an inclination to call him Barack)

When I picked the boy up from school today, he told me about watching the inauguration. And the reason that the schools watched it is clear: this country elected and inaugurated our first black person to our highest office. This represents a closure of wounds, an opening of opportunities, a flowering of inspiration.

Is there anyone who was not moved to tears watching black residents of DC crying and celebrating today? Say to yourself "I don't discriminate". Say to yourself "I am not to blame for slavery or Jim Crow". Whatever you say does not matter. The fact is that in our nation's capital, an entire population has been disenfranchised and mostly invisible- right up to today.

That matters.

But there is more. Today is even bigger thank that.

Today is also the end of the Bush presidency, and everyone should be able to agree, an historic one. This has been a radical presidency, an administration that has not flinched from formulating new arguments, enabling the power of the White House to take steps that were momentous departures from much of what we have seen in our history, and in our system of law.

In his speech today, Barack drew a clear line, he ended it. It was not merely a rebuke- it was in eery sense of the word a place to end and start anew.

That's not even all of it, though. The election of Barack Obama is the result of what I believe is a tectonic shift in American politics. The "villagers" in Washington didn't understand it, maybe they still don't . Barack is the candidate who understood it, who grasped it, who chose to lead a changed people.

He said today that the time has come to set aside childish things, that tired dogmas of the past were done. That the questions posed by the men at our pulpits- is government too big? or too small?- meant nothing anymore, that the question is, what works?

I've been listening all month to pundits wondering if he's a liberal or a moderate, a hawk or a dove, if the "liberal base" would be angered by his pragmatism. And the thing is, they have no idea what all this means, what I really think we have voted for.

We have voted for human dignity and common purpose. We have voted for optimism, not idealism. We have voted for strength, and we have voted for an open table.

We have voted to be competent and practical, but more, we have voted to be one, in this country and with the world.

There are no labels that fit exactly what we have voted for, but our founding documents can speak to it.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed,

That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.

So today we started anew, and we have a chance to make significant change in the world. We gotta do it together, and I believe we have a president who wants to lead us.

We shall see, we shall see. Today feels really good, though.

01.20.09

High clouds scattered across blue sky in lovely Thousand Oaks. The air feels clear, not dry as it has been. Watching the former presidents enter the inaugural seating, and really want to remember this. All of it.

My hope: that we are witnessing the return of competency. That the new administration will continue to welcome all voices to the table, while guiding according to solid principle. That the American people hold on to this upswelling of hope and commitment and the desire to work hard and move forward together. That this election is evidence of a paradigm shift in American politics- a shift that was evident throughout the campaign, but Washington insiders did not understand.

Moving vans in front of the WH on the teevee at the moment. President Clinton and his wife, the Secretary of State, have entered. Waiting for President Bush, followed by our President Elect.

What a day.

Update: 8:29
Love to see the mall so full. Love to see residents of DC out and celebrating. Can't imagine what it must feel like.

Update: 8:32
It would really suck to be George W Bush today. He has to go to a party where they're celebrating his departure.

8:39
First glimpse of the man. He looks appropriately somber and perhaps a bit whelmed.
He's just entered, and the tears are starting.
8:46
Di Fi welcoming the croud. "our work is not yet finished, but future generations will mark this morning... the dream that was echoed from the steps of the Lincoln memorial finally (something) the walls of the White House"

Here comes Warren.
While I appreciate the points he is trying to hit, this is actually a fairly uninspiring prayer. I have high standards for prophetic speech.

8:53
'RETHA!

8:59
Vice President Biden

9:03

Tis a gift to be simple
'Tis a gift to be free
'Tis a gift to come down
Where we ought to be
And when we find ourselves
In that place just right
We will be in the valley
Of Love and delight.
When the true simplicity
Is gained
To bow and to bend
We shall not be ashamed
To turn and to turn it will
Be our delight
'Till by turning and turning we
Come 'round right.

9:05
Mister President
Amen.