America, be brave

If healthcare reform failed to pass Congress, your costs would have become unaffordable and coverage unreliably spotty.

Failure to pass healthcare reform would validate the Republican assertion that it’s too hard to do and the American people prefer unbridled insurance companies designed and operated to make healthy profits off healthy policyholders. This assertion finds it acceptable for a large population of uninsured people who get inadequate healthcare, developing chronic diseases, catastrophic illness and bills that bankrupt them and the public health systems that keep them alive. In addition to escalating premiums and copays, the employed middle class pay the taxes that support those public healthcare systems while they pay premiums that profit private healthcare.

The Republicans and insurers  fought reform tooth and nail. They have good, secure coverage and they want you to think you do too. All those stories about recision and dropped coverage are just other people’s bad luck. They want you to be afraid that healthcare reform is socialism and you’ll face oppression and long waits for the doctor. They want you to quake at the notion that someone will make economic decisions about your medical care besides profit-driven insurers.

Do not drop your guard. The Republicans will continue to excoriate this bill, they will rail against the horrors and contest the progress that will come from the bill. They will use this bill as a rallying cry for their attempt to take a majority in both houses. They are strongly motivated by stubborn conviction and unrestrained corporate contributions to block other necessary reforms – banking, environmental regulation, consumer protection and economic justice.

Sadly, they cannot seem to argue these issues on their merits. They tell big lies, ask ridiculous questions as if they were based on fact (the “birthers” are an example). They need to make the middle class wonder, and worry, and quake. It is a campaign of terror. We cannot abide the fear-mongering. We must stand together, find solutions that bring together a Democratic majority, and use majority rule to enact the change that is so badly needed to restore our democracy.

We have to stand tall against the ridicule, we have to shout back when the fear-mongers distort, lie and threaten. If we are to have peace and clean air to breathe, we must stand together. If we are to preserve our democracy, establish truth and justice and live in a land of liberty, we must unite and demand change.

We have to be home of the brave to save the land of the free.

Healthcare: Stop arguing and fix it

Congress will return after Labor Day and reconsider healthcare reform. Good, because they haven’t done so well quite yet. Lawyers make everything so… complicated.

The problem with healthcare is that 47 million people are not formally covered. That doesn’t mean that they cannot get healthcare when they are on the verge of death or catastrophically ill. It just means that when that happens and the current public health system (yes, Virginia, there is a current public health system) takes care of them, they are left with medical bills they cannot pay. Our tax dollars cover the expenses of the public health system and the recovered person has a debt that scars their credit forever. If they are poor, they can’t afford credit anyway. If they weren’t poor before they got sick, they are poor when they get well.

In the current healthcare system, most people are covered by private health insurance that is subsidized by their employers. Working Americans expect healthcare to be part of their employment. I am not sure whether the employer’s contribution is tax-deductible, but it should be. The employee’s premium, conveniently deducted from their paycheck, is more or less up for grabs, tax-wise, but I would counsel caution before raiding that pantry.

People with private health insurance get a higher standard of healthcare. Compare the menu at local private hospitals to the “food” distributed at local public hospitals, and you’ll see why universal public healthcare terrifies the majority of Americans with private coverage. If food were the only difference (we all wait hours past our appointment times to see the doctor), universal care may be tolerable. It’s not.

I advocate healthcare reform, but I do not want to see the private system endangered. I agree with the president that we are wasting enormous sums in the lavish corporate offices of private insurance companies, but those lavish corporate offices give most Americans a comfortable hospital bed to fall in when they most need it. When compared with healthcare in Spain, England, Japan and Canada, our private hospitals look awfully nice. The average working American – me – wants access to those institutions, and they want our population.

Congress can reform healthcare without eliminating the current system. Simply extend Medicaid to uninsured Americans who cannot afford health insurance. Americans who are working but have no employer-supported healthcare should have access to a moderately-priced, moderate level of healthcare – including affordable meds and preventive care. The private companies, with tax incentives and other government subsidies, should be able to provide such plans. If not, then they deserve competition from a public option.

A word about our doctors and healthcare professionals: America provides quite possibly the best medical education in the world. It costs a lot of money, many years of hard work, but an M.D. (and, in cascading levels, nurse practitioners and RNs) can make a decent living. In order to extend healthcare – good, high quality healthcare – to everyone that needs it, we will need more doctors, nurses and technicians. Therefore, expansion of the medical education system needs to be part of healthcare reform. Generous scholarships should be offered to professionals willing to undertake the rigorous educational demand. In return for the educational grants, the professionals will be required to give years of service to the public healthcare system. It means that some docs won’t get to private practice until their mid-30s, and that the public healthcare system will get the most inexperienced physicians. I’m glad American medical education is as good as it is, because we will need it.

This post is less than 600 pages long, but it outlines a reasonable reform option for American healthcare:

• sustain the employer-subsidized status quo and keep it tax-deductible
• create affordable private health insurance for small business owners and others who cannot participate in employer-subsidized plans
• extend Medicaid to the uninsured that cannot get any other health insurance, and prepare to build up the public health system because they will need massive growth to cover the load
• expand the medical education system to produce more doctors, nurses and technicians.

Of course some streamlining needs to occur in American medical practice – electronic medical records, tax excesses in the private insurance industry, increase the inventory of medical professionals available to the system. But all of that will occur as the marketplace adjusts itself.

America is the most powerful nation on the planet. There’s no reason we should be delivering an inequitable, inefficient, inadequate level of healthcare. Stop arguing and fix it.

You have one shot at healthcare reform – don’t screw it up

Dear Mr. President:

No one wants a well-functioning, effective healthcare system more than you and I. Fortunately, we live in a time where it could happen – there is enough desire for affordable healthcare to make Congressional inertia impossible. There is enough disgust with corporate malfeasance that we might even avoid an overwhelming amount of corruption. But it’s tricky.

Just because people want public healthcare doesn’t mean they want to use it. The conditions that made employers start providing health insurance have been gone for a long time. Employers do it now simply because it’s expected of them and there are tax advantages. Now it gets tricky, right? You want to reverse that?

You’re looking at the massive amount of money it takes to administrate this system – billions, maybe even half of the money we spend on healthcare. I don’t think it’s that much, but it’s a lot. You’re seeing that people are so willing to pay for private healthcare that they support that huge infrastructure, so they might as well pay taxes as well. Stop.