Friday, March 19, 2010

The Time Has Come The Survivor Said

 This will be the most historically and monumental weekend that will answer the question of whether health care is a right or a personal responsibility since Congress passed similar safety net legislation on Social Security, Medicare, MediCaid and prescription drug subsidies for seniors.

I'll defer the prestidigitation of the politics to First Read whose contributors know a helluva lot more than me.

Likewise, I'll delegate the major cost features also for explanation to First Read.

And, finally, I will refer you to this provocative question and answer session for further details between a family and the Los Angeles Times editorial board.

Now, my take which can best be described as ambivalent.

This is lousy legislation. But it is a start. I must be wearing the same shoes as Dennis Kucinich whose basic complaint for voting no on the first House health reform bill was that it didn't go far enough. He turned after some hardball arm-twisting by President Obama. I turned after considering the alternatives of doing nothing.

It is having a baby only to discover it needs some surgical repairs. That and some tweaking as the years go by could transform it into a productive human being. Whether that means a robust public option or single-payer system as in Medicare for all, I don't know.

I don't believe for a New York second what the Congressional Budget Office calculates as a billion dollar savings in the first decade and a trillion or so by the end of the second decade. As for most economic projections, I won't believe it until I see it.

I don't subscribe to the concept of opening up 32 million new customers for private carriers to insure without more assurances they won't continue increasing premiums, copays and axing benefits. The new commission under Health and Human Services controlling rate increases is toothless and a joke.

The way the new law would be structured allows those mandated to buy insurance or employers offering it makes me inclined to believe the penalties would be cheaper to go without. If those agnostics of the system is larger than expected, the fines and penalties won't come close to covering the anticipated costs of those being subsidized to enroll in the programs.

Another worry I have is whether the economics of the newly structured system will force more doctors, both primary and specialists, and  pharmacies to bail out of the Medicare and MediCaid programs. We have seen that happen in Washington state where Walgreens has pulled the plug on those on MediCaid.

The pharmacy I use in Southern California is a mom and pop operation. The wife told me the state's MediCal system pays only pennies on the dollar and is as much as six moths to a year late even making those reimbursements. She said the business, which serves primarily seniors and the poor on MediCare and MediCal patients, is teetering on bankruptcy.

The question continually arises that the United States is the world's only industrialized nation that does not have universal health care. The closest comparison of what Congress is now addressing is South Korea which enacted a system predominately serviced by private carriers in the late 1980s. As stated in the Times Q&A, by 2000 "the 139 regional insurers were combined into a single national one, with the government regulating the rates it paid to providers."

 For a year now as the debate in Congress and the media raged passionately, the only solid argument I have heard against the health reform package is that it is too expensive and too large of an undertaking to overhaul because of unemployment and the financial climate. Yes, the legislation includes some responsible amendments offered by the Republicans in both houses of Congress.

Little wonder the public is only on board by at best a 48% margin in most polls, depending on how the question is framed. Forgive them for they are bombarded with mixed messages especially if they receive the brunt of their learning exercises from either Fox or MSNBC and TV ad wars.

The taking "personal responsibility" doctrine is a legitimate argument we hear from conservatives. It's easy to say when you are a Congressman earning $170,000 a year, excluding perks. It does not address the element of fate for the millions who are losing their homes because of unexpected medical bills the insurance carriers say exceed their costs of coverage.

It is those people who as Obama is wont to say play by the rules and still crushed by the fickle fate dilemma.

I, for one, speak as a survivor who enlisted the social netting help of the landmark Oregon Health Plan, Medicare and MediCal. Without it, I would have been one of those 43,000 people who die annually for lack of health insurance coverage in one form or another.

Without it you could have read my obituary 15 years ago. As Mark Twain said, news of my death was premature.

That is why I support the legislation now before Congress. It's sausage now but could transform itself into my favorite food -- rib eye steak -- which I no longer chew for good, common sense health reasons.

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