Thursday, July 23, 2009

Cal: We the People

Hi Christa and all.

I’m so glad to hear you chime in. Yours is the most compelling argument for reform. In your case (and in probably most cases of the “working poor”, sorry for that) part time employers are usually exempt by state law from extending coverage. That’s the way it is in Maryland. There should be an accommodation developed to prevent this. Right now it would be on a state by state basis because it is each state’s insurance board that determines what is covered and what is not as well as the rules of coverage. Medicare and Medicaid are different because they are Federally mandated programs administered by the states.(Like Highway dollars and Emissions Testing). This is all in the realm of state regulated private health insurance. If we stay with that then the states will have to make the changes. I’d welcome those changes and possibly a contribution from each part time employer to cover you and those in your predicament.

I don’t believe anyone in this discussion wants anyone to be without. I know I don’t. I would like one outcome of this discussion to be the rejection of a rushed- through national single payer health plan. I don’t trust the Federal government. I want to demand of all of our congressional leaders (a pox on both their houses!) that they cut the crap and do their jobs. Making changes to create conformity to the state plans is not that hard. But the elected ne’er do wells insist on injecting political gain (read votes) into the process. It is a disgrace. Let them talk about tort reform so premiums don’t keep rising; negotiate with pharmaceutical companies to shorten the patent period for their drugs so generics can be brought in sooner (determined by the Feds—and here we must recognize that this could impact research on drugs for the “orphan diseases” and “third world” diseases); mitigate end of life invasive treatments ( but no euthanasia, thank you-that’s for you Bob); and more. But I have no gripe with corporations making profits, no matter how huge, as long as they are regulated for efficacy and do the job.

A great physician should make as much money as he or she does (if that is indeed the goal; though one would hope not). Nor Bill Gates, nor Rupert Murdock, nor Stephan Spielberg, nor Michael Jackson, nor Bill Clinton, nor Horatio Alger. It’s a great country!

Now to do away with some anecdotes:

-I have a primary care doctor. It usually takes a week or so to see him for a non-emergency, a month for a check-up, but same day if I am sick or need something urgently. He will refer me to specialist of my choice in my plan. Specialists do take longer. So be it. A specialist is not an emergency room doctor except in the emergency room.
-I have had specialists bend the rules (put words in my mouth) to get me tests or procedures that probably wouldn’t have been approved as necessary. They know how to play this game. They were necessary. A gastroenterologist who be permitted to do a sigmoidoscopy and not a colonoscopy when he knows it is called for because there is family history, knows what will trigger approval. To me this a great doctor.
-I approved minor skin cancer removal for my mother Lucy when she was 96. She died 6 months later. Why that wasn’t rejected by Medicare I don’t know. I regret approving it, though. It was an emotional consideration.
-A number of our family doctors have left their practices over the years. Our obstetrician because of his opposition to REQUIRED CAESARIAN TO LIMIT LAWSUITS!!; our pediatrician because of the red tape when he was forced to join an HMO because of insurance costs; my orthapaedic surgeon because too many of his patients were denied surgeries he recommended. Just some of the Pre-existing conditions of privatized insurance which must be corrected. These doctors were all at the top of their careers, Who’s Who doctors,who simply walked away. I fear much more of this under national healthcare.

As Governor Zell Miller(R) said a the 2004 democratic convention about John Kerry’s voting record, “I could go on…” and then he did. But I won’t. Except…

I think the fact that there is this explosion of very rational and apparently pent up response illustrates that there has been very little discourse on this subject. That, I think, is the fault of the President. Most of us have this feeling of having this thing shoved down our throats, no matter our political persuasion. I, for one, can say honestly that no one has asked me for my opinion or what I want or need. Nor my permission. Nor even acknowledged that it is required. Am I alone here? Government has developed an arrogance that ignores the fact that it is WE THE PEOPLE who grant rights to the government, not the other way around. Hence, the Tea Parties. I wonder if today’s college age kids know that.


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