Two Thoughts on the Progress of Health Care Reform

As action cranks up again in Washington, I have been thinking in the last few days about the progress of health care reform and all that I have read and heard about the issue. All aspects - from philosophy, to goals, mechanics, and international comparisons - has been hashed, rehashed, twisted, and distorted so many times that, if you are like me, it makes your head spin, stomach turn, and brain hurt. Pushing all that aside, there are two primary aspects of this debate that I try to keep in the forefront of my mind.

1. The most important goal of reform should be lower costs for those paying for health care coverage. Easier said that done, right? Right. There a whole host of avenues for potentially accomplishing cost reduction. I have discussed some of these in the past (here and here). The reemergence of a public option in the Senate proposals is encouraging. While health insurance providers are not by any means solely to blame for the recent and continued increase in the cost of health care, they are certainly one culprit. A public insurance option might be the best way to keep insurance companies honest. And let's clear the air - a public option is not, and should not be called, a government takeover of health care. This would be particularly true if Sen. Reid's proposal finds its way into law; his bill includes a opt-out clause for states who do not want to participate (or, ahem, do not want their citizens to be able to participate) in the public option. (As the linked article explores, that opt-out of a federal program could have much more far-reaching consequences for other areas where federal law applies universally.) Opponents of the public option cry that it might run private health insurers out of business. My answer to that is . . . PRECISELY! In its best form, the public option would be a low-cost player in the market that forces other players to examine business practices and make adjustments to remain competitive. Is that not what our economic system is built on?

But back to my first point. For me, the mechanism is less important than achievement of the overall goal of lowering costs. In another post, I highlighted a statistic from Newsweek claiming that in the next few years, twenty percent (20%) of the U.S. GDP will be spent on health care related services. Twenty. Percent. Health. Care. The administration's economic recovery strategy has targeted automobile purchases, home loans, and debt relief. While those are no doubt problematic aspects of many consumer's economic portfolios, the government would be remiss, if not negligent, if it blows this opportunity to impact what is doubtless a huge expense for many consumers.

2. At the core, health care is a moral issue. Despite attempts to relegate health care reform to the pens of political issues or economic matters, the provision of basic, affordable health care should be a addressed as a moral issue. Our nation is founded on the principle that every person should have the right to pursue life, liberty, and happiness. I have never seen any qualifiers applied to that right. To clarify, I certainly do not believe that anyone has the right to have life, liberty, or happiness handed to them. But in the United States, we guarantee people that right to pursue them. To me, that means removing roadblocks, particularly those to obstruct only certain members or classes of our society.

Let me describe a scenario that I play over and over in my mind. While I will concede that it is an extreme, worst-case scenario, it is nonetheless one that is unnervingly close to reality for an increasing sector of the population:

Bill has a job. Its a good job, not great, but it pays the bills, and his employer provides group health coverage. Bill works hard and has managed to put away some money over the years, but he'd be far from comfortable if he lost his job. Due to the economic climate, Bill's employer is forced to make some hard decisions and has to lay off Bill and several other employees. Bill doesn't qualify for Medicaid and cannot find an private insurance plan that he can afford, so opts to play the odds and go without health coverage until he can find a new job.

Bill gets a job interview. It goes well, and he leaves the interview hopeful. The interview was downtown. Bill is cheerful as he walks from the office building toward his car, parked two blocks away. Bill stops at a crosswalk and proceeds after the traffic signals indicates he may do so. About halfway through the intersection, Bill hears car horns and looks up to see Fred's car speeding through a red light into the intersection. Fred plows into Bill, severely injuring him. Fred was wasted and hardly had any idea what was going on when the police pulled him out of his car. He vomited when he saw Bill, bleeding and motionless, lifted onto a gurney and hoisted into an ambulance.

Bill's injuries are terrible, but he recovers well enough after spending two weeks in the hospital, including a couple days in the ICU. A few weeks after discharge, he receives a bill from the hospital. Obviously, Bill can't afford the tens of thousands of dollars he now owes the hospital, ambulance service, and other care providers. He hires a lawyer on a contingent basis and files a civil suit against Fred. The case is a classic "open and shut." In frustration, the judge throws the book at Fred, literally, and the jury finds that Fred was reckless in his actions that day. They order him to pay all of Bill's medical fees and then some.

But Fred has the last laugh. He has no auto insurance. He also has nothing to his name. No assets. No bank account. No job from which to garnish wages. All he had was his beater car, which he totaled when he smashed into Bill. Bill has a judgment in his favor, but that's it. Bill's savings are far from sufficient to cover his debts, and he files for bankruptcy. Bankruptcy - over the medical bills he accrued through no fault of his own. Bill comes through bankruptcy with nothing except a black mark on his personal credit.

Extreme? Yes, I'll give you that. Silly? Maybe. Unlikely? Maybe. Impossible? Hardly. Heck, the story doesn't even have to include an insured pedestrian. It could be about one whose insurance company denies the claim after getting the price tag - also not unheard of. It could be someone with a high deductible plan provided by his employer. A run of hard luck, and he doesn't have the funds to meet the deductible. The point is that we live in a country where you or I could find ourselves bankrupt because of another's poor judgment. The Newsweek articles I cited in another post explain that the U.S. is the only Western nation where that is allowed to happen. We're a wealthy nation. We're a nation that places itself on a moral high ground. I cannot find any reason for that possibility to exist.

OK, deep breath . . . and . . . I'm done. Almost. I tell that story simply to illustrate some of the principles our current health care system implicitly endorses. They certainly are not principles which seem to comport with the pursuit of life, liberty, and happiness. I will say this once again: I do not believe that those "inalienable rights" require the government to give handouts, freebies, or whatever. But I do believe it requires the government at least alleviate obvious obstructions put in place by other parties that hinder some individuals from pursuing those dreams.

As I said in opening, the details and rhetoric of the health care reform debate can be overwhelming and nauseating. But keeping a few guiding principles in mind can hopefully keep us and our lawmakers focused on the ultimate prize.

"Suddenly, America digs farming"

L.A. Times: "Suddenly, America digs farming"

This is quite an enjoyable piece from the LA Times musing about the growing infatuation and romanticizing of farming in America. As the piece points out, this new perspective on farming is completely removed from the large, corporately dictated farms that account for much of the farming the U.S. Not to say that there are not independent farmers who are not wrapped up in questionable practices (and ethics) of corporate farming, but that's far from the primary form of farm. The reasons? Who knows? Certainly the popular emphasis on local produce, responsible farming, and the associated benefits - health, economic, and social - have a great deal of influence. Maybe it has something to do with western and work wear being fashionable?

Regardless, I suppose my hope for this new found affection is this. I hope that instead of fostering an unrealistic notion and ideal of farming that this attention will throw some light on where our food comes from, how it is produced, and the costs and benefits of producing food by those methods. I also hope this trend will illuminate some of the things we as consumers can do to encourage and nurture those folks who are trying to farm in a way that is responsible vis-a-vis their land, resources, and environment; their neighboring landowners and community; and their consumers.

Let a Little Sunshine In . . .

Disclaimer: This post will be primarily of interest to you Denver readers out there.

If you are not already aware, Denver is undertaking a massive rewrite of its zoning code. The rewrite aims to overhaul how the city handles planning, zoning, and land use matters. The new code is also taking particular care to incorporate sustainable practices and the variety of mobility options available in Denver. Despite being basically a from-scratch rewrite of the zoning code, the new version is based significantly on the neighborhood characteristics and building types that already exist in the city.

I suppose one downfall of such an ambitious project is the possibility for little issues to become lost in the shuffle. The link below to a Denver Post commentary illustrates one such issue that seems minor in the abstract but would be quite noticeable in practice.

"Retain Solar Access in Code"

For those readers in Denver, I would encourage you to check out the site www.newcodedenver.org. There you can find all sorts of information, summaries, blogs, and profiles of the folks who are actively working on this project. I would also encourage you to take a look at the proposed zoning maps and see how your property or neighborhood might be impacted by the code revision. On the site, you can also find information about public comment, meetings, and hearings if you do have concerns about how the new code will affect you. I am working my way through the second draft of the proposed code, so if you have questions, feel free to get in touch with me and I will see if I can be of any help.

(If you are really really interested (read: nerdy interested) in Denver zoning, you can compare the old zoning code with the new proposed code. The old code can be found here. Scroll down the table of contents on the left to Chapter 59 - Zoning.)

The Elephant in the Room

"Let's Try Cap-and-Trade on Babies"

"The single most concrete, substantive thing a young American could do [to help curb climate change] is not turning off the lights or driving a Prius. It's having fewer kids."

That statement by Andrew Revkin, author of the New York Times Dot Earth blog, highlights the problematic relationship that exists between the environmental concerns facing the global community and the increasing population crammed within its confines. Talk of family planning and population control rarely elicits a benign response. But remove emotion and philosophical ethics from the conversation and a relatively simple concept remains. In ecological terminology, the concept is called carrying capacity, and it refers to the population of a particular species that its habitat can sustain. When graphed, carrying capacity appears as a curve in which the Y value (population size) increases exponentially until it abruptly plateaus at a particular value. Once the population reaches carrying capacity, it may fluctuate just above or just below that line, but the size will not ever indefinitely increase above the carrying capacity.

I highlight this article and present these thoughts not as an advocate for population control, family planning, or whatever other moniker you would like to give the concept of limiting the global human population. What I do find interesting about this scenario is the way social influences dictate the way we address problems and solutions. The number of people on this globe is a fundamental contributor to many of the global crises of the past few decades - food shortages, water shortages, climate change, pollution. Even if population size is not a cause of the problem, so to speak, population size magnifies and exacerbates those issues. On top of an increasing global population, many more people are living an increasingly consumptive lifestyles as developing countries continue to grow economically.

But the solutions for dealing with the size of the global population seem to be taboo when it comes to discussing action to deal with the aforementioned issues. Instead of dealing with foundational problems, solutions attack symptoms that are, in relative terms, uncontroversial. When I was younger, a bit more brash, and much more naive, I would get myself moderately intoxicated and pontificate about the merits of population control measures, reproductive limits, and licenses to breed. Like I said, the point of this piece is not to advocate for those measures. For me to do so would, at the least, a little hypocritical, if not a return to the brashness and naivety of my youth. Rather I want to point out, as I often strive to do, the difficult underlying issues that few people want to talk about. Certainly I believe that we can all do small things in our lives to help alleviate the symptoms of the global issues that touch us in big and small ways each day. But I wonder if, at a certain point, that will be enough . . . .

Then again, maybe I worry too much about things that won't change -

"The universe is expanding . . . . Well, the universe is everything, and if it's expanding, some day it will break apart and that will be the end of everything." - a young Alvy Singer, Annie Hall

Encouraging Walking and Biking Among Kids

I recently read about an organization called Freiker, a contraction of the term "frequent biker." The organization has created incentive programs that encourage kids to walk and bike to school, when (and where) possible. The organization issues ID tags to students at elementary schools and places scanners outside the schools so that participating students can check-in electronically. The electronic scanners allow Freiker staff as well as the students to keep up with accrued points and track progress toward Freiker-sponsored prizes.

Walking and biking to school has declined in recent decades, with a variety of causes. Sunset Magazine indicates that in 1969, 88% of students living within a mile of their grade schools walked or biked to school. Currently, less than 16% do so. Numerous safety concerns are obviously one reason for the drop. But the increased prevalence of cars and driving-dependent lifestyles play a role as well. It should come as no surprise that taking away this source of everyday physical activity has contributed to the increase of weight-related health concerns among young children.

Obviously, this is a situation in which a balance must be struck among all concerns. Fears of crime or traffic accidents should not be taken lightly, particularly among young children who have not had the opportunity to gain knowledge that comes with life experience. However, I also believe that parents should not pass upon the opportunity to teach some basic lessons and instill some foundational values at an early age. A simple activity like walking or biking to school, when and where appropriate, can provide parents a chance to converse with their children about a myriad of issues - exercise and health, traffic safety, safety around strangers, etiquette, the environment, and community. I applaud organizations like Freiker who are helping to make those chances a reality.

Some thoughts from Bob Dylan about living in fear.

While traveling last week, I started reading Bob Dylan's Chronicles: Volume One. In the early chapters, he weaves accounts of his early days in NYC and recollections from his childhood. His words were particularly poignant in one excerpt, where he recalls Cold War era grade school air-raid drills:

"It seemed peculiar. Living under a cloud of fear like this robs a child of his spirit. It's one thing to be afraid when someone's holding a shotgun on you, but it's another thing to be afraid of something that's just not quite real. There were lots of folks around who took this threat seriously, though, and it rubbed off on you. It was easy to become a victim of their strange fantasy. I had the same teachers in school that my mother did. They were young in her time and elderly in mine. In American history class, we were taught that commies couldn't destroy America with guns or bombs alone, that they would have to destroy the Constitution - the document that this country was founded upon. It didn't make any difference, though. When the drill sirens went off, you had to lay under your desk face down, not a muscle quivering and not make any noise."

Newsweek's "The Case for Killing Granny"

Last week's issue of Newsweek magazine had several very interesting and informative articles about health care issues. As I was traveling for the last ten days, and not writing, I had a chance to do some reading. I thought the articles in that issue provided some insight and statistics that seem to have been overlooked in the popular rhetoric.

The front page feature, "The Case for Killing Granny," discussed aspects of end-of-life care. Get past the controversial title - the article itself is not particularly radical. The gist of the piece is that, as a culture, we fear death instead of embracing it as a natural part of the life cycle. That perspective has a dramatic effect on the steps some people choose to take to fight it. Compounding the issue is the fact that death is not something people want to discuss, particularly their own; thus, those close to death are generally ignorant of what the process will be like. As the Newsweek piece points out, this leads to one-third of annual Medicare expenditures going to chronically ill persons.

Go ahead and call me a cold-hearted bastard, but I do believe that with a change in perspective and some real discussion about what we can expect near the end of our days here on earth, we can not only solve some of the financial issues plaguing the U.S. health care system, but we can also bring some comfort and understanding to the issue of dying. As a person who, over the past year, has been face-to-face with mortality, I can tell you that there will never be a cure for death. No matter how far or fast we run, it will catch us all in time. Why not spend those sunset days of our lives enjoying what we can because we have knowledge and we have planned for what is to come?

See other readers' reactions to the article as well.

Newsweek also ran a piece last week comparing health care systems in other western nations - "No Country for Sick Men." I do not have quite the passionate reaction to this article, but I did find it very interesting. I will point out a theme to look for: challenging the idea that the quantity of health care available in the U.S. means that Americans receive the best quality health care. Particularly for the price. Newsweek claims that in a few years, twenty percent of the U.S. GDP will be spent on health care. One-fifth of the money paid for goods and services in the U.S. will be for health care expenses. Think about what that does to discretionary spending, particularly in the middle class. How will we ever make an economic recovery?

Read the articles.

Keep an Eye On...

"Bennett and Romanoff: Two of a Kind"

Whichever party line you vote along, keep an eye on the potential for a Democratic primary for the senate seat vacated by now Interior Sec. Ken Salazar. The primary will not resolve the question of who should have received Gov. Ritter's original appointment to the seat. It could, however, have a significant impact on the ultimate outcome of the 2010 election. Aside from the potential division among Colorado Democrats, a primary could give the GOP challenger plenty of fodder for his/her attack ads during the election season. The primary could also force the candidates to move either left or right of their traditional left-center stances and, as Haley points out, force Sen. Bennett to clarify his positions on controversial legislation like the Employee Free Choice Act, a bill he has yet to take a firm stance on.