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When I lived in Salt Lake City, as preparation for the Olympics, Salt Lake City decided to put in a light rail system. It would go from downtown Salt Lake, and extend all the way out to (if memory serves me correctly) South Jordan. The idea was pretty simple - a train system that could run up and down the city, and the town buses would simply slave to that. Get on a bus, ride to the light rail to where you need to go, get off and either be within walking distance or get onto another bus. Salt Lake City already had a pretty decent bus system - but the light rail would make it excellent.
Only problem was - this was Salt Lake City. And people protested the building of a light rail. Protested spending "my taxpayer dollars on something I don't want or need!" Protested - with signs, in city meetings - about how they wouldn't touch it, how it was a big waste, how any government spending was just evil. Evvvviiiillll!
Even though it would reduce driving, decrease gas spending, improve air quality with less cars running (and in a city like Salt Lake that can be hit with some horrible smog because of the air trapped by the mountains, any little bit helps).
In the end, the light rail was built anyway.
And it was a hit. Huge hit. So huge, that it was packed the first several weeks and they had to add in extra cars. So useful, that the Mormon church buys up the entire light rail every six months for their biannual conferences and the entire city rides for free. Why? Because instead of having everybody try and park downtown, people can get a cheaper hotel room on the outskirts of town, get onto the light rail, and be downtown in 20 minutes bypassing all of the traffic.
So successful, that last I heard from residents, they were planning on extending the light rail all the way up and down the state so more people could save gas and money. I wonder how many people are still protesting this "evil government" service that provides so much worth to the city, to the residents, to the businesses?
When I sat in the Health Care Town Hall meeting, it felt like being back in Salt Lake during those light rail meetings. Granted, not quite as many rude shouters - but there were still angry people outraged that their government would provide a service that *they* didn't personally approve (even though the democratically elected leaders did, and in a representational democracy that's how it works).
People are screeching that *they* personally didn't approve health care reform (even if a majority of the voters do). Government has no place in providing health care based on the Constitution. Then again, the Constitution doesn't mention roads, light rails, or other things, but it does say:
"...promote the general welfare..."
And the Necessary and Proper clause:
"The Congress shall have Power - To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof." - aka, Congress has the power to make whatever laws it needs in order to fulfill its charter (as long as it doesn't violate citizen's rights as defined in the various Amendments or steps on the Executive or Judicial branches' powers.) So if Congress decides to make a law to institute health care, or food safety, or the like to "promote the general welfare", it can do so (again, provided it doesn't trample on someone's personal rights).
My bets is at the end of the day, we're going to have a health care bill. I'm hoping it has the Three Big Things I think it will need to be real reform: constraining health insurance companies to prevent them from denying care, requirement that all citizens are signed up for insurnace, and the Public Option to provide competition against private insurance companies as a check on their power.
If it does, I'm going to bet that US Health Care Reform is going to wind up like Salt Lake Light rail - a lot of noise and protest, followed by a long period of "Woah. This is *awesome.*"
Monday, August 10, 2009
Saturday, August 08, 2009
How to Make Health Care Town Halls a Success
How to Solve the Mob Tactics at Health Care (or other) Town Hall Meetings
Thursday night, I had hoped to attend a town hall style meeting with US Congress Member Kathy Castor and State Representative Betty Reed. The plan is that I would hear these two ladies and duly elected representatives talk about how the health care bill was shaping up, their views, and take questions. I expected that there would be some people who agreed with the idea that there needs to be insurance reform, and some that wouldn’t. Each sides would put forward their questions, and everybody would learn something even if we didn’t all agree.
Yeah. What was I thinking. In the tradition of the Constitutional debates, where Benjamen Franklin stood up shouting “SHUT UP! SHUT UP! SHUT UP!” at Hamilton, who screeched back “I’M NOT HERE TO LISTEN TO WHAT YOU HAVE TO SAY!”, a group of what I assume to be Teabaggers showed up to do nothing but, for almost 90 straight minutes, scream, shout, let it all out and generally make sure that nobody could hear anything at all. Because after all, having a civilized debate like adults is too much to ask for.
OK, the last was sarcasm. It was an ugly experience that every single one of the Shouters should be embarrassed about. It’s behavior that I would not expect out of my youngest child who is five years old and know that you at least take turns.
The problem is, the Shouters are dominating the Health Care Town Halls, sponsored by corporate interests who have created “Astroturf” grass roots organizations that have been filling the Shouters with outright lies. Such as “The Obama Health Plan will euthanize old people.” Or “The Obama Health Plan will raid your checking and savings accounts to pay for it.” Even as recently as a few days ago, quitter Sarah Palin came out saying that the Obama Health Plan would set up a Death Panel that would have killed her Down Syndrome child.
With these kinds of lies filling them, the Shouters are told to show up, disrupt meetings, and prevent anything from being said. As I saw with Congressperson Castor, every time she tried to explain what was in the bill or even what her ideas were, the Shouters screamed like someone was pulling on their Teabags too hard.
It was the most unpleasant 90 minutes of my life. And since that night, I kept thinking about how to prevent such things in the future. How to allow for the free flow of ideas, without letting them get hijacked by people who have no interest in hearing any other view but their own being screeched at their duly elected representatives?
Do insurance reform supporters just get louder? Not useful, since that simply perpetuates the problem of noise silencing proper discussion. Bringing more signs? Holding up protest artifacts? All of this just generates noise.
The goal should be Meeting, Not Mobs.
Here are my thoughts on how to have the kind of town hall meetings we want to spread information, while still allowing those of a dissenting view a chance to air their questions. These ideas will take some work. But, based on what I saw Thursday night, I believe they stand the best chance of working.
The Steps:
5 Police Officers from the local community (if possible, others in plainsclothes for the ground floor).
1 volunteer per every 20 seats.
At least 5 police officers from the local community – two at the doors leading inside, three inside. This can be reduced depending on the size of the town hall to be had, but seeing as 200 seat meeting drew some 1600 people according to some reports, this is probably a good number.
The volunteers are to lead people to their seats. From the beginning, there should be this sense of control via the health care town hall organizers. This is not in a mean or overly authoritarian way. Volunteers should be polite and helpful, but their task is to direct the flow of people coming into the meeting area, and take them to their seat. People will not be allowed to simply sit where they want.
Wait, you say. How do we know people will follow the rules? Hold on. That’s coming.
1 Printed Contract Form for each person we believe will show up
As each person enters, they must put show ID and sign a Town Hall Contract. Each Contract Form says something akin to this:
Naturally, if someone has better language, I am certainly open to it. While this document may or may not be considered a legal contract, the point is that it binds them at their word at least. This basically tells them “If you’re here to cause trouble, you will be kicked out.” And, since the words “…discretion of the Town Hall staff and volunteers” basically means they aren’t allowed to say “What? What gives you the right to do so?”
This is not a "loyalty oath" or other such nonsense. It does not dictate a view they must subscribe to. It simply lets them know what the rules are, and if they can not follow those rules, they may leave.
This step also has another point. It slows things down. It sets a tone – politeness. Civility. It also lets us process each person one at a time, not as a mob, but as individuals.
If they do not want to sign this contract, they will be asked to leave. Period. There are no second chances. The first time they say “I don’t want to sign this,” or refuse to comply with instructions, they must *immediately* be escorted from the premises, preferably by one of the law enforcement officers.
This will be hard for some people, because we want to be nice. We are – we are giving them every opportunity to follow the rules in order to allow everyone a chance to participate. If they wish a Mob instead of a Meeting, they were perfectly welcome under their 1st Amendment Rights to hold that elsewhere, such as inside their house with their friends. Then they can Mob to their hearts content.
1 camera that can be hooked into a computer (such as a web camera)
1 laptop computer to take the pictures
1 printer to print out names and pictures later.
Label paper for name tags for as many people as you think will show up
One thing I observed about the Shouters is they did not want to put their name down onto any pieces of paper if possible. This step is again part of that control and tempo. Once they have signed the contract, their picture will be taken onto the computer and a nametag printed for them. Their picture will be taken, and they will have a name tag made for them.The picture is so when the speaker calls on them, they will have a printed list of names and pictures so they can call them by name so there is no confusion.
It also has the added advantage of freaking the snot out of anyone who wanted to use the anonymity of a Mob to hide themselves. I know – OMG taking pictures so scary! It’s necessary. If people intend on acting reasonably, then they have nothing to fear. If they can not follow the rules and have their picture taken, again, they will be escorted out immediately. No questions, no second chances. Have a nice day.
Any Disruptions Will Not Be Tolerated
This is the most important step. No disruptions. We should at the beginning have a statement read by the facilitator that lets people know people will want to clap, or applaud, or any other expression within reason. However, disruptions, screams, and shouts will not. The first time someone has a problem with this, both a volunteer and a law enforcement officer will be called to escort that person from the room.
This is crucial. By now, with the controls in place, most people should get the message. The first sign of trouble, however, must be met swiftly, but politely. The rude Mob person must be sent outside. They can scream and shout out there (without breaking any “disturb the peace” laws, of course) – but this is a Meeting, not a Mob.
I recognize that these efforts will take some prior planning. These are not draconian, do not require anything other than decency and respect. It does not require anger meet with anger or noise with noise. But they establish proper controls, and allow everyone to participate in the Meeting and, whether they agree or not, be able to gain something from the discussions.
Thursday night, I had hoped to attend a town hall style meeting with US Congress Member Kathy Castor and State Representative Betty Reed. The plan is that I would hear these two ladies and duly elected representatives talk about how the health care bill was shaping up, their views, and take questions. I expected that there would be some people who agreed with the idea that there needs to be insurance reform, and some that wouldn’t. Each sides would put forward their questions, and everybody would learn something even if we didn’t all agree.
Yeah. What was I thinking. In the tradition of the Constitutional debates, where Benjamen Franklin stood up shouting “SHUT UP! SHUT UP! SHUT UP!” at Hamilton, who screeched back “I’M NOT HERE TO LISTEN TO WHAT YOU HAVE TO SAY!”, a group of what I assume to be Teabaggers showed up to do nothing but, for almost 90 straight minutes, scream, shout, let it all out and generally make sure that nobody could hear anything at all. Because after all, having a civilized debate like adults is too much to ask for.
OK, the last was sarcasm. It was an ugly experience that every single one of the Shouters should be embarrassed about. It’s behavior that I would not expect out of my youngest child who is five years old and know that you at least take turns.
The problem is, the Shouters are dominating the Health Care Town Halls, sponsored by corporate interests who have created “Astroturf” grass roots organizations that have been filling the Shouters with outright lies. Such as “The Obama Health Plan will euthanize old people.” Or “The Obama Health Plan will raid your checking and savings accounts to pay for it.” Even as recently as a few days ago, quitter Sarah Palin came out saying that the Obama Health Plan would set up a Death Panel that would have killed her Down Syndrome child.
With these kinds of lies filling them, the Shouters are told to show up, disrupt meetings, and prevent anything from being said. As I saw with Congressperson Castor, every time she tried to explain what was in the bill or even what her ideas were, the Shouters screamed like someone was pulling on their Teabags too hard.
It was the most unpleasant 90 minutes of my life. And since that night, I kept thinking about how to prevent such things in the future. How to allow for the free flow of ideas, without letting them get hijacked by people who have no interest in hearing any other view but their own being screeched at their duly elected representatives?
Do insurance reform supporters just get louder? Not useful, since that simply perpetuates the problem of noise silencing proper discussion. Bringing more signs? Holding up protest artifacts? All of this just generates noise.
The goal should be Meeting, Not Mobs.
Here are my thoughts on how to have the kind of town hall meetings we want to spread information, while still allowing those of a dissenting view a chance to air their questions. These ideas will take some work. But, based on what I saw Thursday night, I believe they stand the best chance of working.
The Steps:
- Control the Flow
- Sign the Contract
- Register and Document
- Any Disruptions Will Not Be Tolerated
Control the Flow
Ingredients
5 Police Officers from the local community (if possible, others in plainsclothes for the ground floor).
1 volunteer per every 20 seats.
At least 5 police officers from the local community – two at the doors leading inside, three inside. This can be reduced depending on the size of the town hall to be had, but seeing as 200 seat meeting drew some 1600 people according to some reports, this is probably a good number.
The volunteers are to lead people to their seats. From the beginning, there should be this sense of control via the health care town hall organizers. This is not in a mean or overly authoritarian way. Volunteers should be polite and helpful, but their task is to direct the flow of people coming into the meeting area, and take them to their seat. People will not be allowed to simply sit where they want.
Wait, you say. How do we know people will follow the rules? Hold on. That’s coming.
Sign the Contract
Ingredients
1 Printed Contract Form for each person we believe will show up
As each person enters, they must put show ID and sign a Town Hall Contract. Each Contract Form says something akin to this:
I, _______________________________ , do agree to follow the rules for this town hall meeting. I seek to learn what my democratically elected representative and their staff have to say. I will not be disruptive during the meeting. If I have questions, I will hold them until the end of the meeting, and then I will wait until I have been called upon to ask them in a respectful manner.
If I violate these rules, I understand at the discretion of the Town Hall staff and volunteers I will be asked to leave.
Signed: _______________________
Date: _________________________
Naturally, if someone has better language, I am certainly open to it. While this document may or may not be considered a legal contract, the point is that it binds them at their word at least. This basically tells them “If you’re here to cause trouble, you will be kicked out.” And, since the words “…discretion of the Town Hall staff and volunteers” basically means they aren’t allowed to say “What? What gives you the right to do so?”
This is not a "loyalty oath" or other such nonsense. It does not dictate a view they must subscribe to. It simply lets them know what the rules are, and if they can not follow those rules, they may leave.
This step also has another point. It slows things down. It sets a tone – politeness. Civility. It also lets us process each person one at a time, not as a mob, but as individuals.
If they do not want to sign this contract, they will be asked to leave. Period. There are no second chances. The first time they say “I don’t want to sign this,” or refuse to comply with instructions, they must *immediately* be escorted from the premises, preferably by one of the law enforcement officers.
This will be hard for some people, because we want to be nice. We are – we are giving them every opportunity to follow the rules in order to allow everyone a chance to participate. If they wish a Mob instead of a Meeting, they were perfectly welcome under their 1st Amendment Rights to hold that elsewhere, such as inside their house with their friends. Then they can Mob to their hearts content.
Register and Document
Ingredients
1 camera that can be hooked into a computer (such as a web camera)
1 laptop computer to take the pictures
1 printer to print out names and pictures later.
Label paper for name tags for as many people as you think will show up
One thing I observed about the Shouters is they did not want to put their name down onto any pieces of paper if possible. This step is again part of that control and tempo. Once they have signed the contract, their picture will be taken onto the computer and a nametag printed for them. Their picture will be taken, and they will have a name tag made for them.The picture is so when the speaker calls on them, they will have a printed list of names and pictures so they can call them by name so there is no confusion.
It also has the added advantage of freaking the snot out of anyone who wanted to use the anonymity of a Mob to hide themselves. I know – OMG taking pictures so scary! It’s necessary. If people intend on acting reasonably, then they have nothing to fear. If they can not follow the rules and have their picture taken, again, they will be escorted out immediately. No questions, no second chances. Have a nice day.
Any Disruptions Will Not Be Tolerated
This is the most important step. No disruptions. We should at the beginning have a statement read by the facilitator that lets people know people will want to clap, or applaud, or any other expression within reason. However, disruptions, screams, and shouts will not. The first time someone has a problem with this, both a volunteer and a law enforcement officer will be called to escort that person from the room.
This is crucial. By now, with the controls in place, most people should get the message. The first sign of trouble, however, must be met swiftly, but politely. The rude Mob person must be sent outside. They can scream and shout out there (without breaking any “disturb the peace” laws, of course) – but this is a Meeting, not a Mob.
I recognize that these efforts will take some prior planning. These are not draconian, do not require anything other than decency and respect. It does not require anger meet with anger or noise with noise. But they establish proper controls, and allow everyone to participate in the Meeting and, whether they agree or not, be able to gain something from the discussions.
Thursday, August 06, 2009
My Night at the Tampa Health Care Town Hall
Tonight I headed up to South Tampa, Florida to sit in on the Health Care town hall with US Congress Member Kathy Castor and State Representative Betty Reed. What I got was a front row ticket to pure rage.
I've seen the news lately, so I had an idea of how noisy these events are around the nation. When I arrived, some two hours before the event started at six, there were already 20 some odd people there. Many of them were going over questions, such as "If Obama can't pick a dog in six months, why is he trying to get us to pick a health care plan in six weeks?" (which I thought ignored the other 60 years we've been discussing health care). One gentleman was trying to tell me that insurance companies should be allowed to cancel people's policy, because people would get sick, then sign up for health care, and as soon as they were treated cancel their policy - yet he didn't want it to be mandated that people would have to sign up for insurance to avoid such a situation. The answer seemed clear: If you don't have insurance, it's your own fault, and if you get sick and insurance cancels you, that's your fault too.
I was lucky in that I knew one of the organizers who let me get in a little early to the front row seats. I think the original plan was to have the front two rows or so filled with people who really wanted to hear about the health care bill, instead of letting those rows be dominated by the protesters we've been seeing on the news at other health care events.
If that was the plan, it was not successful. As people came in, several tried to disregard the "RESERVED" seating signs, including one gentleman who ripped it off the chair next to me and stuck it in the chair in front. "Come on man, that's not cool," I said, pointing out the rest of the entire room was empty.
"I don't see why anyone should have reserved seats here," he told me.
"The disabled?"
He finally moved, and I moved the "reserved" sign back to its seat.
Before the doors were open to allow people to sit, it was nonstop shouting. Shouting from people outside who pounded on the doors to be let in and complained because they weren't being allowed to start taking seats 40 minutes before the event was to begin. Shouting because they were told to let people through who were reporters or were supposed to be on the council.
Shouting as the room was filled to capacity and the others had to wait outside, holding signs like "I can't read, cut taxes" (which made no sense to me at all). When Representatives started coming in, people started shouting "No! No! No! No!" The town hall hadn't even started yet.
One thing I noticed was that many of the Shouters, and I came to call them, came in very organized. Many had 3x5 cards with printed questions. Sheets of paper printed out with highlighted text, usually held in the same kind of binder. I'm not sure if they all shopped at the same office depot, but the similarity was eerie.
Reverend Dixon, a prison minister, started off the room with the Pledge of Allegence. And that's when the shouting started. As people read the pledge, one woman shouted out at the "of the United States of America" part "UNDER GOD!" earlier than anyone else (maybe she thought it was the United States of UNDER GOD) - and when the room got to "under God", there was a sudden angry shout of "UNDER GOD!" as if they didn't think people would hear it the first time from the lady who shouted early. Reverend Dixon gave the opening prayer - and then the rage fest really got started.
As Representative Reed introduced Congressperson Castor - boos erupted. The gentleman next to me stood up to applaud her, and many in the room was on their feet clapping for her. Outside the door, a steady chant started.
"BULLSHIT! BULLSHIT! BULLSHIT! BULLSHIT!" Castor hadn't even started yet, and people were screaming. Yelling. Fights broke out outside. Castor held two taped together microphones to her mouth - but then the mob shifted tactics to "YOU WORK FOR US! YOU WORK FOR US!" Every minute, it was a new rage filled series of shouts to keep her from discussing her points. She asked the crowd how many of them paid for health insurance through their employer - and people started shouting.
"READ THE BILL!" People in the crowd kept screeching at her, including one tall gentleman behind me I'll call Mr. Shouty. Throughout the entire time Castor tried to address the crowd, tried to explain what the bill was about, he and so many others around the room screamed "READ THE BILL! READ THE BILL! READ THE BILL!" Then, because she tried to explain how the health care bill would try to provide health care for those who were uninsured, the screams changed to "TYRANNY! TYRANNY! TYRANNY!" "WE LEFT ENGLAND FOR THIS!"
Some of the people who were there to hear the bill tried to shout back at the protesters "Let her speak!"
The reply? "No I won't!" by Mr. Shouty. Instead, he turned back to Castor shouting "60 MILLION JOBS LOST! WHAT ARE YOU GOING TO DO ABOUT 60 MILLION JOBS?" I didn't get that one. He was protesting insurance reform, but wanted Welfare or extended unemployment benefits?
The shouts continued. Castor couldn't even be heard over the din as Mr. Shouty held up a copy of the pocket constitution. "WHERE IS HEALTH CARE IN HERE! SHOW ME WHERE HEALTH CARE IS IN HERE!" (My friend @MariaLaino on Twitter replied "The Necessary and Proper Clause, bitch.")
Castor kept trying to go on over the din, as Mr. Shouty and his group kept screeching "SHOW US IN THE CONSTITUTION WHERE HEALTH CARE IS!" Castor talks about the Donut Hole in Medicare - and the Shouters start screeching "THAT'S TED KENNEDY'S BILL! IT'S TED KENNEDY'S FAULT!"
And as Castor was winding down, the Shouters started squealing "LISTEN TO US! LISTEN TO US! WHY WON'T YOU ANSWER OUR QUESTIONS!" This after almost 20 to 30 minutes of nonstop screaming and temper tantrums from the moment she started walking towards the podium. They hadn't heard a word she said, and screamed when she left the room under escort.
With every speaker, it was the same. A pushing match next to me erupted between Mr. Shouty Man and a union rep who got in his way. Ms. Lee Stirrat stepped up to explain the healthcare issues and about how even she has problems with insurance and trying to get the medication she needs. The Shouters all groan and start shouting, drowning her out as she's trying to explain the problems with people trying to get care under insurance.
When State Representative Reed came back to the podium, the shouts only continue. "FOLLOW THE CONSTITUTION! WHY AREN'T YOU FOLLOWING THE CONSTITUTION!" Evidently, following the constitution means not taking turns with your views, but screaming the other person so nobody can hear anything at all. The Florida Health Commissioner makes the case that life, liberty, and the pursuit of happiness requires a healthy body - a claim that lead to more jeers from the Shouters. He tried to discuss infant mortality issues, only to be screamed at that "OBAMACARE PAYS FOR ABORTIONS! DON'T TALK ABOUT INFANT MORTALITY WHEN YOU KILL BABIES!" Even when he protested he never performed an abortion, it didn't matter. Other Shouters squealed every time infant mortality was said "ILLEGALS! ILLEGALS! ILLEGALS!" This became a refrain. When 40 million Americans without health care was brought up - that was all illegal aliens. Because I guess "real Americans" can pay for their own healthcare. Like, pregnant teenagers.
Dr. Collins, a nutritionist, for a brief time held the room as she explained helping people who have come out of heart surgery - only to be shouted at when she tried to explain people who didn't know how to get good nutrition. Evidently, this was an impossible concept for the Shouters that people don't know how to eat healthy.
Finally, after almost an hour, police offers started pulling people out of the room who were just disruptive. Mr. Shouty was the first, to the applaud of many in the room - but there were still many Shouters to go. As one Ms. Coe stood to explain that as people have lost their jobs - people have lost their health care. The response by the Shouters? "Be more responsible!" One woman shouted out "Responsibility, Oprah!" Yes, the speaker was a black woman.
I think the lowest point was when Reverend Dixon came up to speak, and started to discuss the progress that had made during the 60's and 70's. The woman behind me started shouting "Yeah - we know what you did during the 60's! We know the 'progress' you made!" The look on Reverend Dixon's face was heartbreaking. He knew what she meant - civil rights. The progress made by civil rights groups for equality was some sort of slur now thrown back in Dixon's face.
She knew what he did during the 60's and 70's. Marched for equal rights maybe, or protested.
The questions that came next followed were mostly by Shouters who remained. Why are we paying more for health care when we have so many deficits? When Mr. Newton explained that health care currently costs us a lot of money because people have to use the emergency room - which they are required by law to treat, passing on the costs to us, and so health care reform would be cheaper - yup. The rage was back to shout at him. Conspiracy theory questions were asked, like "The bill says the federal government will gain access to all of our checking accounts." Some guy next to me let me know that when the government took over health care, nobody would go to the doctor because the government would be allowed to read your health care records. Why they would I don't know, or why HIPAA laws wouldn't still apply- but that was this man's fear.
In the end, that was everything for this meeting. Fear and rage. Rage that Castor wouldn't ask questions about 30 minutes of constant screaming at her. Rage that the public option even existed because it would drive regular insurance companies out of business -and when Mr. Newton brought up the example of the US Postal Service versus USPS, the Shouters, well, shouted that "YEAH! AND UPS IS BETTER!" Which, I guess proved his point, but the Shouters acted like they had won some important point. Rage at the uninsured that were all illegal aliens, or were having all of the babies who needed government funding to be born - because "no true American" would be without health care or would be a single mother having a baby. Rage that the public option would somehow destroy health care, or destroy medicare, or something. Rage that people said that insurance companies shouldn't be allowed to drop people from care, or that there were people losing their jobs (evidently all Obama's fault), or that the national deficit was so high (again, also evidently all Obama's fault for waging the War in Iraq then spending money to save the financial system and stimulate the economy). Rage that Rep Reed wasn't "following the Constitution" because it didn't mention health care (then again, it didn't mention interstate roads either).
By the end, the rage was effecting even the health care supporters who tried to shout down the Shouters towards the end. It became like a weird recursive shouting event, as the Shouters shouted and the other people shouted at the shouters to shout them silent.
When it finally ended, almost 30 minutes early I think, I walked out - and the Shouters were still out there, now shouting about Acorn for some reason (maybe they believe insurance policies will be issued by Acorn supporters or something).
A group of 5 police officers stood talking next to the parking lot. I stopped next to them. "Gentlemen, that was more excitement than one man deserves to have. Good job." I tipped my hat as they laughed and drove away.
I've seen the news lately, so I had an idea of how noisy these events are around the nation. When I arrived, some two hours before the event started at six, there were already 20 some odd people there. Many of them were going over questions, such as "If Obama can't pick a dog in six months, why is he trying to get us to pick a health care plan in six weeks?" (which I thought ignored the other 60 years we've been discussing health care). One gentleman was trying to tell me that insurance companies should be allowed to cancel people's policy, because people would get sick, then sign up for health care, and as soon as they were treated cancel their policy - yet he didn't want it to be mandated that people would have to sign up for insurance to avoid such a situation. The answer seemed clear: If you don't have insurance, it's your own fault, and if you get sick and insurance cancels you, that's your fault too.
I was lucky in that I knew one of the organizers who let me get in a little early to the front row seats. I think the original plan was to have the front two rows or so filled with people who really wanted to hear about the health care bill, instead of letting those rows be dominated by the protesters we've been seeing on the news at other health care events.
If that was the plan, it was not successful. As people came in, several tried to disregard the "RESERVED" seating signs, including one gentleman who ripped it off the chair next to me and stuck it in the chair in front. "Come on man, that's not cool," I said, pointing out the rest of the entire room was empty.
"I don't see why anyone should have reserved seats here," he told me.
"The disabled?"
He finally moved, and I moved the "reserved" sign back to its seat.
Before the doors were open to allow people to sit, it was nonstop shouting. Shouting from people outside who pounded on the doors to be let in and complained because they weren't being allowed to start taking seats 40 minutes before the event was to begin. Shouting because they were told to let people through who were reporters or were supposed to be on the council.
Shouting as the room was filled to capacity and the others had to wait outside, holding signs like "I can't read, cut taxes" (which made no sense to me at all). When Representatives started coming in, people started shouting "No! No! No! No!" The town hall hadn't even started yet.
One thing I noticed was that many of the Shouters, and I came to call them, came in very organized. Many had 3x5 cards with printed questions. Sheets of paper printed out with highlighted text, usually held in the same kind of binder. I'm not sure if they all shopped at the same office depot, but the similarity was eerie.
Reverend Dixon, a prison minister, started off the room with the Pledge of Allegence. And that's when the shouting started. As people read the pledge, one woman shouted out at the "of the United States of America" part "UNDER GOD!" earlier than anyone else (maybe she thought it was the United States of UNDER GOD) - and when the room got to "under God", there was a sudden angry shout of "UNDER GOD!" as if they didn't think people would hear it the first time from the lady who shouted early. Reverend Dixon gave the opening prayer - and then the rage fest really got started.
As Representative Reed introduced Congressperson Castor - boos erupted. The gentleman next to me stood up to applaud her, and many in the room was on their feet clapping for her. Outside the door, a steady chant started.
"BULLSHIT! BULLSHIT! BULLSHIT! BULLSHIT!" Castor hadn't even started yet, and people were screaming. Yelling. Fights broke out outside. Castor held two taped together microphones to her mouth - but then the mob shifted tactics to "YOU WORK FOR US! YOU WORK FOR US!" Every minute, it was a new rage filled series of shouts to keep her from discussing her points. She asked the crowd how many of them paid for health insurance through their employer - and people started shouting.
"READ THE BILL!" People in the crowd kept screeching at her, including one tall gentleman behind me I'll call Mr. Shouty. Throughout the entire time Castor tried to address the crowd, tried to explain what the bill was about, he and so many others around the room screamed "READ THE BILL! READ THE BILL! READ THE BILL!" Then, because she tried to explain how the health care bill would try to provide health care for those who were uninsured, the screams changed to "TYRANNY! TYRANNY! TYRANNY!" "WE LEFT ENGLAND FOR THIS!"
Some of the people who were there to hear the bill tried to shout back at the protesters "Let her speak!"
The reply? "No I won't!" by Mr. Shouty. Instead, he turned back to Castor shouting "60 MILLION JOBS LOST! WHAT ARE YOU GOING TO DO ABOUT 60 MILLION JOBS?" I didn't get that one. He was protesting insurance reform, but wanted Welfare or extended unemployment benefits?
The shouts continued. Castor couldn't even be heard over the din as Mr. Shouty held up a copy of the pocket constitution. "WHERE IS HEALTH CARE IN HERE! SHOW ME WHERE HEALTH CARE IS IN HERE!" (My friend @MariaLaino on Twitter replied "The Necessary and Proper Clause, bitch.")
Castor kept trying to go on over the din, as Mr. Shouty and his group kept screeching "SHOW US IN THE CONSTITUTION WHERE HEALTH CARE IS!" Castor talks about the Donut Hole in Medicare - and the Shouters start screeching "THAT'S TED KENNEDY'S BILL! IT'S TED KENNEDY'S FAULT!"
And as Castor was winding down, the Shouters started squealing "LISTEN TO US! LISTEN TO US! WHY WON'T YOU ANSWER OUR QUESTIONS!" This after almost 20 to 30 minutes of nonstop screaming and temper tantrums from the moment she started walking towards the podium. They hadn't heard a word she said, and screamed when she left the room under escort.
With every speaker, it was the same. A pushing match next to me erupted between Mr. Shouty Man and a union rep who got in his way. Ms. Lee Stirrat stepped up to explain the healthcare issues and about how even she has problems with insurance and trying to get the medication she needs. The Shouters all groan and start shouting, drowning her out as she's trying to explain the problems with people trying to get care under insurance.
When State Representative Reed came back to the podium, the shouts only continue. "FOLLOW THE CONSTITUTION! WHY AREN'T YOU FOLLOWING THE CONSTITUTION!" Evidently, following the constitution means not taking turns with your views, but screaming the other person so nobody can hear anything at all. The Florida Health Commissioner makes the case that life, liberty, and the pursuit of happiness requires a healthy body - a claim that lead to more jeers from the Shouters. He tried to discuss infant mortality issues, only to be screamed at that "OBAMACARE PAYS FOR ABORTIONS! DON'T TALK ABOUT INFANT MORTALITY WHEN YOU KILL BABIES!" Even when he protested he never performed an abortion, it didn't matter. Other Shouters squealed every time infant mortality was said "ILLEGALS! ILLEGALS! ILLEGALS!" This became a refrain. When 40 million Americans without health care was brought up - that was all illegal aliens. Because I guess "real Americans" can pay for their own healthcare. Like, pregnant teenagers.
Dr. Collins, a nutritionist, for a brief time held the room as she explained helping people who have come out of heart surgery - only to be shouted at when she tried to explain people who didn't know how to get good nutrition. Evidently, this was an impossible concept for the Shouters that people don't know how to eat healthy.
Finally, after almost an hour, police offers started pulling people out of the room who were just disruptive. Mr. Shouty was the first, to the applaud of many in the room - but there were still many Shouters to go. As one Ms. Coe stood to explain that as people have lost their jobs - people have lost their health care. The response by the Shouters? "Be more responsible!" One woman shouted out "Responsibility, Oprah!" Yes, the speaker was a black woman.
I think the lowest point was when Reverend Dixon came up to speak, and started to discuss the progress that had made during the 60's and 70's. The woman behind me started shouting "Yeah - we know what you did during the 60's! We know the 'progress' you made!" The look on Reverend Dixon's face was heartbreaking. He knew what she meant - civil rights. The progress made by civil rights groups for equality was some sort of slur now thrown back in Dixon's face.
She knew what he did during the 60's and 70's. Marched for equal rights maybe, or protested.
The questions that came next followed were mostly by Shouters who remained. Why are we paying more for health care when we have so many deficits? When Mr. Newton explained that health care currently costs us a lot of money because people have to use the emergency room - which they are required by law to treat, passing on the costs to us, and so health care reform would be cheaper - yup. The rage was back to shout at him. Conspiracy theory questions were asked, like "The bill says the federal government will gain access to all of our checking accounts." Some guy next to me let me know that when the government took over health care, nobody would go to the doctor because the government would be allowed to read your health care records. Why they would I don't know, or why HIPAA laws wouldn't still apply- but that was this man's fear.
In the end, that was everything for this meeting. Fear and rage. Rage that Castor wouldn't ask questions about 30 minutes of constant screaming at her. Rage that the public option even existed because it would drive regular insurance companies out of business -and when Mr. Newton brought up the example of the US Postal Service versus USPS, the Shouters, well, shouted that "YEAH! AND UPS IS BETTER!" Which, I guess proved his point, but the Shouters acted like they had won some important point. Rage at the uninsured that were all illegal aliens, or were having all of the babies who needed government funding to be born - because "no true American" would be without health care or would be a single mother having a baby. Rage that the public option would somehow destroy health care, or destroy medicare, or something. Rage that people said that insurance companies shouldn't be allowed to drop people from care, or that there were people losing their jobs (evidently all Obama's fault), or that the national deficit was so high (again, also evidently all Obama's fault for waging the War in Iraq then spending money to save the financial system and stimulate the economy). Rage that Rep Reed wasn't "following the Constitution" because it didn't mention health care (then again, it didn't mention interstate roads either).
By the end, the rage was effecting even the health care supporters who tried to shout down the Shouters towards the end. It became like a weird recursive shouting event, as the Shouters shouted and the other people shouted at the shouters to shout them silent.
When it finally ended, almost 30 minutes early I think, I walked out - and the Shouters were still out there, now shouting about Acorn for some reason (maybe they believe insurance policies will be issued by Acorn supporters or something).
A group of 5 police officers stood talking next to the parking lot. I stopped next to them. "Gentlemen, that was more excitement than one man deserves to have. Good job." I tipped my hat as they laughed and drove away.
Tuesday, July 28, 2009
Health Reform Success Criteria: Part 2
OK, so the other day we talked about some basic things that would make for good health care reform: denying the "preexisting condition" clause that health care companies pull, and requiring that everyone sign up for health care insurance if they could afford it, and government assistance for those who can't.
With all of that money rolling in from an additional 50,000,000 new clients, this gives insurance companies plenty of money to provide care for people. But we still have a basic problem of how do we know we're getting *good* health care coverage? What's to stop the health insurance companies from just running off with the money? What if you sign up with a health insurance company because it's the cheapest - then find out you're going to die because the only thing they cover are cotton swabs and you signed up for a crappy insurance service. Congratulations, it's the market at work, and now you're going to die!
Yeah. Doesn't sound that great to me. So there are few more reforms so we can make sure we get a good health care system.
One of the things I got our of reading Tom Daschle's book is the idea of the Government Health Agency - kind of like the FDA or the FED. Now, hold up. People are now going to start running screaming through the streets. OMG THE GOV'MENT IS GOING TO TELL MY DOCTOR WHAT TO DO! WE'RE ALL GOING TO DIIIIIEEEEE!
As opposed to know, where INSURANCE COMPANIES TELL YOUR DOCTOR WHAT THEY'LL PAY FOR, YOU GIT. That's right. When you go to the doctor, and they say "Guess what - you need to have your filangee removed - but your insurance company doesn't cover that," you've just had a private industry bureaucrat decide your health care procedures.
That's not to say the doctor *won't* remove your filangee anyway - but now you have to pay for it out of your own pocket. That's what already happens, folks - if the insurance company doesn't pay for it, you have to.
What the Government Health Agency (GHA) would look like - if you follow the Daschle plan - is a committee formed of various doctor representatives, nurse representatives, some insurance representatives, patient advocacy representatives, and some others. How these will be selected is probably the same way the Fed is - the President appoints someone, Congress approves, and off we go.
The GHA would look at the various diseases and treatments out there, then say "OK - if you're a health insurance company, by law you have to provide these minimum things. Like, check ups every six months with tests A, B, C. If someone gets leukemia, you have to pay for X percent of bone marrow transplants. You must provide contraceptives for women as part of the package. So on and so forth."
Now, if a health insurance company wanted to offer *more* than the minimum government mandates amount, great! It's like how some states require car insurance if you drive - they have to offer at least a minimum coverage amount, but then insurance companies compete over who can offer more coverage and what kinds at the cheapest price.
This makes sure that everyone, even the people who get the cheapest health insurance, at least gets certain minimum of care. Highest on my list would be preventative measures, like checkups every six months with tests like mammograms for women, prostate checks for men - simple things that can detect diseases far before they get into trouble.
Now, with that, there will have to be minimum standards for the patients as well. If you don't get your checkups every six months or so, or don't show up for your tests - you can't complain if you get sick. Now, if you do the things you're asked to do - within reason, of course - and you get sick anyway, then the insurance company has to cover what they contracted to.
This does two things:
1. Makes sure people are getting preventative care which reduces costs for health insurance companies and the patients.
2. Makes sure insurance companies don't go broke when people people get sick, because they'll be catching diseases at the earliest, most preventable state. And, if they're really smart, they'll encourage patients to do things like lose excess weight, watch their diet, so on and so forth.
There is one other element that I believe will make health care reform a success. And that is - the Public Option.
OMG, run for the hills! It's government provided health care! Run for the wind!
Or, that's what some people want you to believe. Think about the FDIC a moment. Every bank is *required* to use some form of insurance on accounts in the event that they go under, their client's checking and savings accounts are protected.
The FDIC isn't the only game in town, though. There are other alternatives, but every bank is under a requirement to own account insurance, whether through the FDIC or some other institution that offers similar protection.
The Public Option Health Insurance plan would be like the FDIC - it's kind of the option of last resort for people. If you don't have any good health care insurers in your area, or they're too expensive, or maybe you can't afford insurance on your own - there's the Public Option to cover you. It will likely only cover the minimum level (I believe the current proposals have a 3 tier system, with minimum care being the lowest and cheapest).
Why even have the Public Option instead of just letting the private industry cover it? Well, for the reasons above. Some private insurance companies don't cover small towns or rural areas.
The Public Option would simply be a not-for-profit health insurance company, like the FDIC, started up with taxpayer seed money, and after that would rise or fall on its own. If it can succeed better than private insurance companies by not worrying about paying out stockholders or owners - then I guess private insurance companies will have to work harder to keep up. Which means people will get better care, and everyone wins.
I think that's everything I can think of for what I'd consider to be Success in health care reform. Will we get any or all of these? I hope so. I'd expect it.
I guess we'll have to see of Congress will deliver it - or give the insurance companies what *they* want - which is to keep the status as it to keep things the same so they make the most money while we spend more on less health care.
With all of that money rolling in from an additional 50,000,000 new clients, this gives insurance companies plenty of money to provide care for people. But we still have a basic problem of how do we know we're getting *good* health care coverage? What's to stop the health insurance companies from just running off with the money? What if you sign up with a health insurance company because it's the cheapest - then find out you're going to die because the only thing they cover are cotton swabs and you signed up for a crappy insurance service. Congratulations, it's the market at work, and now you're going to die!
Yeah. Doesn't sound that great to me. So there are few more reforms so we can make sure we get a good health care system.
Minimum Health Care Standards
One of the things I got our of reading Tom Daschle's book is the idea of the Government Health Agency - kind of like the FDA or the FED. Now, hold up. People are now going to start running screaming through the streets. OMG THE GOV'MENT IS GOING TO TELL MY DOCTOR WHAT TO DO! WE'RE ALL GOING TO DIIIIIEEEEE!
As opposed to know, where INSURANCE COMPANIES TELL YOUR DOCTOR WHAT THEY'LL PAY FOR, YOU GIT. That's right. When you go to the doctor, and they say "Guess what - you need to have your filangee removed - but your insurance company doesn't cover that," you've just had a private industry bureaucrat decide your health care procedures.
That's not to say the doctor *won't* remove your filangee anyway - but now you have to pay for it out of your own pocket. That's what already happens, folks - if the insurance company doesn't pay for it, you have to.
What the Government Health Agency (GHA) would look like - if you follow the Daschle plan - is a committee formed of various doctor representatives, nurse representatives, some insurance representatives, patient advocacy representatives, and some others. How these will be selected is probably the same way the Fed is - the President appoints someone, Congress approves, and off we go.
The GHA would look at the various diseases and treatments out there, then say "OK - if you're a health insurance company, by law you have to provide these minimum things. Like, check ups every six months with tests A, B, C. If someone gets leukemia, you have to pay for X percent of bone marrow transplants. You must provide contraceptives for women as part of the package. So on and so forth."
Now, if a health insurance company wanted to offer *more* than the minimum government mandates amount, great! It's like how some states require car insurance if you drive - they have to offer at least a minimum coverage amount, but then insurance companies compete over who can offer more coverage and what kinds at the cheapest price.
This makes sure that everyone, even the people who get the cheapest health insurance, at least gets certain minimum of care. Highest on my list would be preventative measures, like checkups every six months with tests like mammograms for women, prostate checks for men - simple things that can detect diseases far before they get into trouble.
Now, with that, there will have to be minimum standards for the patients as well. If you don't get your checkups every six months or so, or don't show up for your tests - you can't complain if you get sick. Now, if you do the things you're asked to do - within reason, of course - and you get sick anyway, then the insurance company has to cover what they contracted to.
This does two things:
1. Makes sure people are getting preventative care which reduces costs for health insurance companies and the patients.
2. Makes sure insurance companies don't go broke when people people get sick, because they'll be catching diseases at the earliest, most preventable state. And, if they're really smart, they'll encourage patients to do things like lose excess weight, watch their diet, so on and so forth.
There is one other element that I believe will make health care reform a success. And that is - the Public Option.
The Public Option
OMG, run for the hills! It's government provided health care! Run for the wind!
Or, that's what some people want you to believe. Think about the FDIC a moment. Every bank is *required* to use some form of insurance on accounts in the event that they go under, their client's checking and savings accounts are protected.
The FDIC isn't the only game in town, though. There are other alternatives, but every bank is under a requirement to own account insurance, whether through the FDIC or some other institution that offers similar protection.
The Public Option Health Insurance plan would be like the FDIC - it's kind of the option of last resort for people. If you don't have any good health care insurers in your area, or they're too expensive, or maybe you can't afford insurance on your own - there's the Public Option to cover you. It will likely only cover the minimum level (I believe the current proposals have a 3 tier system, with minimum care being the lowest and cheapest).
Why even have the Public Option instead of just letting the private industry cover it? Well, for the reasons above. Some private insurance companies don't cover small towns or rural areas.
The Public Option would simply be a not-for-profit health insurance company, like the FDIC, started up with taxpayer seed money, and after that would rise or fall on its own. If it can succeed better than private insurance companies by not worrying about paying out stockholders or owners - then I guess private insurance companies will have to work harder to keep up. Which means people will get better care, and everyone wins.
I think that's everything I can think of for what I'd consider to be Success in health care reform. Will we get any or all of these? I hope so. I'd expect it.
I guess we'll have to see of Congress will deliver it - or give the insurance companies what *they* want - which is to keep the status as it to keep things the same so they make the most money while we spend more on less health care.
Sunday, July 26, 2009
What can be considered health care reform a success
Last week, President Obama gave another prime time press conference, this time to talk about Health Care.
As my wife pointed out, if you've been following the discussion, he didn't seem to really add anything to the table. And if you weren't paying attention in the first place, I have the feeling that what he was talking about didn't make sense.
Part of the problem is that the health care debate is just complex. Just what *exactly* is the US Health Care system going to be like? Nobody really knows, because it's a huge problem.
You have 50 million people without health care. Some because they're just too poor to afford it, some because they don't think they need it (unless they get into an accident, fall off a tree, and then you'd bet they need health care). You have others that have it, but then either get denied health care for "preexisting conditions". Others who want it but can't get it because an insurance company isn't going to take on someone who's *already* sick, or someone else who had it up until they lost their job.
It's a huge complex stinking mess that, if you haven't read over the 100 years of history of health care in America to understand *why* it's so complex, it just seems like a bunch of nonsense that shouldn't be this hard.
It is a hard problem, though. It's hard because you have people who want health care, but don't want to pay anything for it. You have insurance companies who want to make money, which means (as per the capitalistic system) you provide the most care for the least amount of money - and that means if someone is already sick of cancer or some other very expensive illness, you're not going to add them on. And it's hard because there's a history of employer based health care for so many Americans, and which means once you change or lose your job (something that's happening a lot in this economy), you find yourself without health insurance even though you spent all that money on premiums for so many years.
I'm not going to go into the history here. It's long, sorted, full of lobbyists and stupidity and inaction. So instead, I'm going to list what I'd consider the basic health care plan needs to have in order to be considered "successful." Some of the things I list here are both what I'd like to see, and how I consider the country to pay for it.
One comment I see a lot is "The market can solve the whole healthcare issue. Just get the government out of the way, and things will become cheaper!"
Amazingly, it hasn't worked for all these years. Unless by "get the government out of the way," you mean "don't allow health care lawsuits when doctors/hospitals screw up, don't enforce basic health care rules and regulations so people don't get defrauded out of real health care, etc, etc, etc."
The problem is that the insurance companies have already rigged themselves so they're above the fair market system. If I went to buy a car for $20,000, and the second I drove it off the lot it broke down, some people *would* say "Well, caveat emptor - let the buyer beware! Now you'll know better than to buy a car from that dealership/manufacturer again! Next time you'll spend your money more wisely!"
It's a nice thought in an Ayn Rand dominated dream world, maybe that would work. Problem is, if I just spent $20,000 on a car that I'm not going to get back, I'm just going to go out and blow it again on another car right away. I can't afford it. Maybe I can't even go to work anymore if I don't have a car. Now I can't even make another $20,000 for another car.
People realized this, and that's why we have Lemon Laws and other things to prevent people from defrauded in this country. Sure, to a certain extent, it's still "let the buyer beware", but if you offer a car and promise it can go 50,000 miles on a warranty, you have to fulfill that promise.
Right now, health insurance companies have this big escape hatch. If you get sick, and if they can prove you had a "preexisting condition", then they can deny you care. Sometimes that "preexisting condition" means things like "had a yeast infection and now that you have cervical cancer we can deny you care." Or other "reasonable" (hah!) excuses.
So that's got to be the first thing to go. If we expect people to have health care, then insurance companies can no longer be allowed to pull the "get out of paying free" card and say "Oh, um, you had a preexisting condition, we don't have to pay any more!" If you get sick, your insurance company has to pay for it.
And on top of that, health insurance companies are no longer to be allowed to refuse people to sign up for their health insurance program either. Doesn't matter who you are or what your health care issue is, if you want health care insurance, they have to give it to you.
Wait. There's a problem here. This can get expensive real quick for insurance companies. And let's face it, it isn't fair that suddenly they get hordes of sick people signing onto their lists. The way insurance is suppose to work is a kind of a bet. You're putting your money in because you're betting that sooner or later, you're going to need some help. Your $200 a month will go to pay for people who have their spot of bad luck. Or to pool resources so my $200 a month can go to pay a doctor's salary that can see a set of people, or pay for equipment so everyone pooling their $200 a month can use. If you start adding on just sick people, then you're going to have overworked doctors and have to buy new equipment all the time.
So we need a way to pay for it. And there's one way to make it fair.
Everyone. Every single person must get health insurance. No exceptions. Many states have laws on the books saying that they to drive, everyone must have car insurance, because when even the safest driver has an accident, someone has to pay for it.
If we're going to demand that insurance companies fulfill their obligation to give everyone the care they need, then we have to make sure that every single person is covered. There are two ways of going this - either the government pays, or individuals pay. What we're really doing is saying "insurance companies, here's another 50,000,000 people who are going to pay you money every month. Of that 50,000,000 people, odds are the majority are perfectly healthy and only need annual checkups. In return, you have to give them coverage."
There are going to be some people who are too poor to be covered, and that's where the taxpayers will have to step in. But for the majority, they can pay for it.
It all comes down to this: either individuals pay a tax to the US government who then pay the insurance companies, or individuals pay the insurance companies. If someone is unable to because of income, then people can step in. Maybe that means we take some money out of the defense budget (oh, noes - no more F-22 fighters that have never flown and don't do any good!), or maybe a 1% tax on people making more than $280,000 a year, which would hit 5% of the population (oh, noes, if I make $290,000 a year, then I have to pay 40% tax on $10,000 - I'll be ruined to go from paying $3,900 to $4,000 in taxes!).
I think you can sense my sarcasm.
You still have employers who offer employees health insurance, but now the US government can offer tax breaks to those who do. Those who already have health insurance keep it.
If we start with these two elements, then you provide care to people, and prevent insurance companies from getting around the market system by playing the "oh, preexisting condition" game.
This is a good starting point. Now, I haven't gone into how we deal with people changing insurance companies or employers, or what we hold as a "basic" level of care. I'll cover that in another post, since this one has gone on long enough. More later.
As my wife pointed out, if you've been following the discussion, he didn't seem to really add anything to the table. And if you weren't paying attention in the first place, I have the feeling that what he was talking about didn't make sense.
Part of the problem is that the health care debate is just complex. Just what *exactly* is the US Health Care system going to be like? Nobody really knows, because it's a huge problem.
You have 50 million people without health care. Some because they're just too poor to afford it, some because they don't think they need it (unless they get into an accident, fall off a tree, and then you'd bet they need health care). You have others that have it, but then either get denied health care for "preexisting conditions". Others who want it but can't get it because an insurance company isn't going to take on someone who's *already* sick, or someone else who had it up until they lost their job.
It's a huge complex stinking mess that, if you haven't read over the 100 years of history of health care in America to understand *why* it's so complex, it just seems like a bunch of nonsense that shouldn't be this hard.
It is a hard problem, though. It's hard because you have people who want health care, but don't want to pay anything for it. You have insurance companies who want to make money, which means (as per the capitalistic system) you provide the most care for the least amount of money - and that means if someone is already sick of cancer or some other very expensive illness, you're not going to add them on. And it's hard because there's a history of employer based health care for so many Americans, and which means once you change or lose your job (something that's happening a lot in this economy), you find yourself without health insurance even though you spent all that money on premiums for so many years.
I'm not going to go into the history here. It's long, sorted, full of lobbyists and stupidity and inaction. So instead, I'm going to list what I'd consider the basic health care plan needs to have in order to be considered "successful." Some of the things I list here are both what I'd like to see, and how I consider the country to pay for it.
No More Preexisting Condition
One comment I see a lot is "The market can solve the whole healthcare issue. Just get the government out of the way, and things will become cheaper!"
Amazingly, it hasn't worked for all these years. Unless by "get the government out of the way," you mean "don't allow health care lawsuits when doctors/hospitals screw up, don't enforce basic health care rules and regulations so people don't get defrauded out of real health care, etc, etc, etc."
The problem is that the insurance companies have already rigged themselves so they're above the fair market system. If I went to buy a car for $20,000, and the second I drove it off the lot it broke down, some people *would* say "Well, caveat emptor - let the buyer beware! Now you'll know better than to buy a car from that dealership/manufacturer again! Next time you'll spend your money more wisely!"
It's a nice thought in an Ayn Rand dominated dream world, maybe that would work. Problem is, if I just spent $20,000 on a car that I'm not going to get back, I'm just going to go out and blow it again on another car right away. I can't afford it. Maybe I can't even go to work anymore if I don't have a car. Now I can't even make another $20,000 for another car.
People realized this, and that's why we have Lemon Laws and other things to prevent people from defrauded in this country. Sure, to a certain extent, it's still "let the buyer beware", but if you offer a car and promise it can go 50,000 miles on a warranty, you have to fulfill that promise.
Right now, health insurance companies have this big escape hatch. If you get sick, and if they can prove you had a "preexisting condition", then they can deny you care. Sometimes that "preexisting condition" means things like "had a yeast infection and now that you have cervical cancer we can deny you care." Or other "reasonable" (hah!) excuses.
So that's got to be the first thing to go. If we expect people to have health care, then insurance companies can no longer be allowed to pull the "get out of paying free" card and say "Oh, um, you had a preexisting condition, we don't have to pay any more!" If you get sick, your insurance company has to pay for it.
And on top of that, health insurance companies are no longer to be allowed to refuse people to sign up for their health insurance program either. Doesn't matter who you are or what your health care issue is, if you want health care insurance, they have to give it to you.
Wait. There's a problem here. This can get expensive real quick for insurance companies. And let's face it, it isn't fair that suddenly they get hordes of sick people signing onto their lists. The way insurance is suppose to work is a kind of a bet. You're putting your money in because you're betting that sooner or later, you're going to need some help. Your $200 a month will go to pay for people who have their spot of bad luck. Or to pool resources so my $200 a month can go to pay a doctor's salary that can see a set of people, or pay for equipment so everyone pooling their $200 a month can use. If you start adding on just sick people, then you're going to have overworked doctors and have to buy new equipment all the time.
So we need a way to pay for it. And there's one way to make it fair.
EveryOne Must Get Health Insurance
Everyone. Every single person must get health insurance. No exceptions. Many states have laws on the books saying that they to drive, everyone must have car insurance, because when even the safest driver has an accident, someone has to pay for it.
If we're going to demand that insurance companies fulfill their obligation to give everyone the care they need, then we have to make sure that every single person is covered. There are two ways of going this - either the government pays, or individuals pay. What we're really doing is saying "insurance companies, here's another 50,000,000 people who are going to pay you money every month. Of that 50,000,000 people, odds are the majority are perfectly healthy and only need annual checkups. In return, you have to give them coverage."
There are going to be some people who are too poor to be covered, and that's where the taxpayers will have to step in. But for the majority, they can pay for it.
It all comes down to this: either individuals pay a tax to the US government who then pay the insurance companies, or individuals pay the insurance companies. If someone is unable to because of income, then people can step in. Maybe that means we take some money out of the defense budget (oh, noes - no more F-22 fighters that have never flown and don't do any good!), or maybe a 1% tax on people making more than $280,000 a year, which would hit 5% of the population (oh, noes, if I make $290,000 a year, then I have to pay 40% tax on $10,000 - I'll be ruined to go from paying $3,900 to $4,000 in taxes!).
I think you can sense my sarcasm.
You still have employers who offer employees health insurance, but now the US government can offer tax breaks to those who do. Those who already have health insurance keep it.
Just the Starting Point
If we start with these two elements, then you provide care to people, and prevent insurance companies from getting around the market system by playing the "oh, preexisting condition" game.
This is a good starting point. Now, I haven't gone into how we deal with people changing insurance companies or employers, or what we hold as a "basic" level of care. I'll cover that in another post, since this one has gone on long enough. More later.
Monday, July 13, 2009
Why the "New Atheists" are Right-Wing on Foreign Policy
I would say "amen" without irony - but I can not agree enough.
Just because Mr. Hitchens has right wing tendencies (though he used to be a Marxist) doesn't mean that all atheists - or even all "new atheists" (which really means nothing - you might use the term "vocal atheists") are right wing. It's like saying that William A. Donohue speaks for all Catholics, and therefore all Catholics must be right wing voters (something I'm sure the majority of Catholics who voted for our current President would not agree with).
It doesn't mean that President Obama is "a right wing new Atheist" simply because he wants Israel to follow its commitment to not build more settlements - something Israel agreed to. Now, why are people building more land there? Oh, yes - religious reasons.
SecularParent gets it exactly right. Atheism isn't a left or right wing phenomenon, and has no leaders or spokesmen other than what others nominate.
About Terrorism
Read the Article at HuffingtonPost
Just because Mr. Hitchens has right wing tendencies (though he used to be a Marxist) doesn't mean that all atheists - or even all "new atheists" (which really means nothing - you might use the term "vocal atheists") are right wing. It's like saying that William A. Donohue speaks for all Catholics, and therefore all Catholics must be right wing voters (something I'm sure the majority of Catholics who voted for our current President would not agree with).
It doesn't mean that President Obama is "a right wing new Atheist" simply because he wants Israel to follow its commitment to not build more settlements - something Israel agreed to. Now, why are people building more land there? Oh, yes - religious reasons.
SecularParent gets it exactly right. Atheism isn't a left or right wing phenomenon, and has no leaders or spokesmen other than what others nominate.
About Terrorism
Read the Article at HuffingtonPost
Coburn can understand pregnant women
Coburn seemed very surprised that justices made up almost entirely of old, white men wouldn't be able to understand what it's like to be a pregnant teenage mother.
I can see why - I found this picture of him taken when he was 16. I guess he does understand what it's like to be a teenage mother....
Friday, July 10, 2009
Anyone else sorely tempted to go to Ireland - and start blaspheming things?
I'm usually rather nice about respecting other people's religion. I may not believe in divine beings, but I don't go wandering into their churches and insulting them (if anything, I try and interview them for a show in a very nice manner so people can see we don't have to be afraid of each other).
But this law passed in Ireland is tempting me. I want to go there now, to walk the green fields and stony paths. And blaspheme the hell out of everything. I want to make jokes about how we know that Jesus never married, or how Brigham Young would have killed for a Viagra, or who would be most insulted by a double bacon burger - a Muslim or a Hindu.
Not because I want to really insult anyone but the people who made this ridiculous blaspheme law. I'd love to see legions of people, wandering Ireland like Gandhi or Doctor King, being arrested in the name of blaspheme to show what a ridiculous law it is.
I'm probably just being an ass, but stuff like this makes me want to do things, even if its just insult the hell out of the people that are creating ridiculous laws that the world doesn't need.
But this law passed in Ireland is tempting me. I want to go there now, to walk the green fields and stony paths. And blaspheme the hell out of everything. I want to make jokes about how we know that Jesus never married, or how Brigham Young would have killed for a Viagra, or who would be most insulted by a double bacon burger - a Muslim or a Hindu.
Not because I want to really insult anyone but the people who made this ridiculous blaspheme law. I'd love to see legions of people, wandering Ireland like Gandhi or Doctor King, being arrested in the name of blaspheme to show what a ridiculous law it is.
I'm probably just being an ass, but stuff like this makes me want to do things, even if its just insult the hell out of the people that are creating ridiculous laws that the world doesn't need.
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