HEALTH CARE COMPROMISE OR HYPOCRISY

BY
DAVID ARTHUR WALTERS

To Hell with this kind of CHANGE

Miami’s only major daily published an informative

article about the health care reform proposals this
Sunday. The Miami Herald certainly has improved
since McClatchy bought it from the power elite’s
mouthpiece, the Knight Ridder newspaper chain.
Lone Miami intellectuals used to say that the only
reason to subscribe to the daily rag was that it would
pile up on your doorstep and alert neighbors to your
death, which, incidentally, is what happened to late
newspaper columnist A.C. Weinstein, right hand man
to the last two mayors of Miami Beach, may he rest
in peace. Instead of posing advertising favorable to
the vested interests as good news, Herald
muckrakers are finally at work exposing business-as-
usual as it really is at heart in one of the most
corrupt cities in the United States.

Now we learn from the Sunday edition that the

percent of uninsured people under the age of 65 is
nearly 31 percent in Miami-Dade County, but that
everyone is virtually insured because the uninsured
can go to the emergency room and get medical care,
thanks a lot to the tax payers who pay higher taxes
and higher insurance premiums as a consequence.
Of course people would be healthier and therefore
their care would supposedly be far less costly if
uninsured people did not wait until they were sicker
than stray dogs before they showed up at emergency
rooms.

The reporter leaves it to others to unequivocally

restate that this virtually universal coverage is the
most inequitable and expensive system of health
care delivery in the advanced world, and that
caretakers at health care fairs, such as the recent
one at the Convention Center on chic South Beach,
are saying that the situation in the United States is
as bad as they have seen in undeveloped countries.
He does not report here on the fact that insurance
companies stand to profit handsomely on the reform
plans as they now stand, which they have kindly
helped our political gigolos draft – we also note that
insurance companies are conveniently providing
most of the statistics. Nor does he write that any
plan endorsed by the American Medical Association
is bound to cost patients an arm and a leg. He does
reveal what experts say for sure, that any affordable
reform will have to reduce overall costs, but he does
not say that reducing costs will require rationing
health care differently than the American Way, the
way that the rich get richer and the poor poorer as
per the capitalistic rationing of scarce resources.

Most importantly, our journalist does not observe

that, since the most of us are paying for virtually
universal coverage in one way or another, the most
obvious and logical solution to the debate over
payment and distribution of benefits is to recognize
health care as a public utility and to pay for
fundamental health care out of tax revenues on a
non-profit basis.

But that is anathema because it would gut the

insurance companies rather than let the insurance
companies continue to gut the gullible American
public, which is up in arms now that the wolves are
at the door and some fat might have to be lost. We
cannot help but notice that the people who are most
hysterical at the town hall meetings are those who
can afford to take time off from work to complain,
who have insurance and are generally overweight –
the poor working folk in our country are generally
unrepresented everywhere; if only they would give
up fast food and starve like rats they might,
according to a recent study, live longer.

Positive perception of the British National Health

Service plan is buried on page 21A, and we are told
that we should compare our system with that of the
Netherlands, because it is a public/private mix of
coverage, rather than that of Canada, where the
system is a government entity. The Herald’s
“Worldview” in a nutshell, comparing the United
States with Netherlands, Canada and Germany,
mixes up statistics from three different sources. Life
expectancy in all countries is about the same, but
the United States pays about double per patient for
medical care, and the total cost in the United States
is about 50 percent more of national spending than
the other countries.
Let us take a look at the 2006 comparisons provided
by the World Health Organization: Total expenditure
on health as a percentage of gross domestic product
rose from 13.2 to 15.3 percent in the United States,
from 8.0 to 9.4 percent in the Netherlands, from 8.8
to 10.0 percent in Canada, from 10.3 to 10.6 percent
in Germany, and from 7.1 to 8.2 percent in the
United Kingdom. General government expenditure on
health care as a percentage of total expenditure on
health rose from 43.7 to 45.8 percent in the United
States, from 63.1 to 80.0 percent in the Netherlands,
stayed at 70.4 percent in Canada, fell from 79.7 to
76.9 in Germany, and rose from 80.9 to 87.3 percent
in the United Kingdom.

Now the Netherlands does not look as hot as it did in

the Sunday Herald, but there are more statistics to
be considered to see how it stacks up, including
statistics on patient satisfaction. And the results in
countries with broad government plans have been
adversely affected by conservative efforts to plunder
the public under the pretext of qualitative
improvement through privatization of the plans. We
notice that, while the conservative media in Great
Britain likes to trash the NHS, the general public
when privately polled would not sacrifice it, and
would certainly not trade it for the backwards system
we have in the United States. Mind you, as for the
long waits in Great Britain for elective surgery,
private insurance is available for those who want to
avoid the waiting, but Brits are not fools and many
prefer to wait for the public operation – when their
turn does come up., quite a few people decide
against the elective surgery.
The point here is that much more is involved than a
few figures in the newspaper: and one must dig a lot
deeper than the statistics, which can, like the Bible in
the hands of a persuasive preacher, be used to prove
almost anything. By the way, while looking at the
WHO figures, it may behoove the health insurance
buff to consider moving to Malta, Luxembourg, and
Monaco.

Now the Herald provides us with a handy chart

comparing all four House and Senate versions of
reform as they stand, along side the Obama
proposal. But the Obama proposal secretly shifts
almost daily as the President compromises one
campaign plank and ethical principle after another.

“Compromise,” by the way, appears to be an

euphemism for hypocrisy. The candidate promised us
that uninsured people would not be forced to pay
premiums, but the President is in favor of doing just
that lest people do not take a free ride. If they don’t
pay the premium, stick them with a tax even if they
are making less than the $250,000 margin set by the
candidate. The pay the premium or pay a penalty is
based on the failed Massachusetts model. Many
Massachusetts people are paying the penalty rather
than the premium, but 97 percent of the population
is supposedly covered. Now health care costs are
soaring in Massachusetts, far more than anywhere
else in the country, since the adoption of the plan. A
special panel has been formed to find out why, and
what to do about it.
No doubt Massachusetts will not want to ration
health care so that the rich will get less and the poor
more of it. That would be un-American. Americans’
desire for good health is infinite – that is why
commercial insurance companies did not want to
cover sickness in the first place. Since the desire for
health is unlimited, and since the notion of health is
indefinite, there would be no end to claims made
upon insurance companies. Of course sick people
would sign up and immediately file claims. And
morally hazardous healthy people would sign up and
take more health risks knowing they were insured for
the deleterious consequences. But then the
insurance companies figured out how to get their
hands on an unlimited supply of funds to do so.

Indeed, America has come a long ways from the days

when the greatest cost of illness was not doctor and
hospital bills but was the loss of income from missing
work, so people bought sickness insurance similar to
disability insurance. While nations in Europe were
wisely adopting forms of national health insurance in
the 20s, Americans did not feel they needed health
insurance, so legislation proposed by the labor lobby
in several states failed to pass – doctors and
druggists and commercial insurers were dead set
against it because the intervention would restrict
fees. But as the population shifted to the cities,
where homes were smaller, and as incomes rose, and
medical science and technology advanced, and
quality was improved and supply limited by
education, licensing, and regulation such as hospital
accreditation, the demand for professional medical
care increased, and so did the costs.
Hospital associations and insurance companies
solved the problem of how to pay for it all.
Pioneering Dallas teachers contracted with Baylor
University to provide twenty-one days of
hospitalization for a fixed payment of $6. It was
remarked that women spend a dollar on cosmetics
without thinking much about the expense, so people
might be induced to set a dollar aside each month to
pay a hospital bill every twenty years or so. The
hospital insurance plans grew because the plans
benefited the hospitals, which were suffering falling
incomes in the 30s, as well as the insured. In order to
stifle competition between hospitals, the plans were
combined by the American Hospital Association
under the name Blue Cross. Blue Shield is another
story – doctors worried that hospitals would start
setting up plans for physician services or that a
national government plan might be established, so
they organized to set up their own plans, controlled
by doctors.

Now here we are, with health care costs far more

than cosmetics (which were originally a health care
item whereby a woman put her cosmos in order and
protected her hair, eyes and skin, et cetera), and the
Herald chart on the reform plans claims that the
Public Option is in two of the plans, and that the
Obama Proposal includes a comprehensive plan
similar to the one available to federal employees. But
people who have been watching the Public Option
ball closely saw Mr. Obama drop it nearly a month
ago, and conjectured that he had sold his believers
out yet again – most of them will not mind as he is a
nice sophisticated fellow and not a mean moron. He
has most recently declared that his famous Public
Option is not essential to good reform after all.
Compromise or hypocrisy? Or are the terms
synonymous in politics?

A U.S. senator has declared that the Public Option

would have never passed and will not now pass
muster in the Senate, anyway, so there you have the
reality of the Senate that is the vestige of the King’s
Royal Court, where seats are reckoned to be worth a
minimum $2 million – why waste time on elections
when Senate seats could be auctioned off to the
highest bidder, the proceeds going to health care
charities?

Well, maybe Nancy Pelosi can pull some strings for

the Public Option, perhaps blackmail a few senators
or extort a few votes, but that might not do much
good since the uninsured and underinsured are so
downtrodden they apparently do not have the will to
shout down the insured fat cats. It was not that long
ago when the majority of voters polled were in favor
of the Public Option, but now they are running scared
because of the renewed Red Scare.

While looking at statistics, we should pay attention to

out-of-pocket expenditures or co-pays. If health care
were free there would be no limit to the demand for
it since one simply cannot get enough health on
Earth, even if she believes in her future in Heaven.
Big Daddy may be omnipotent, but for our own good
He is inclined to regulate distribution by denying
benefits or by making people pay for a portion so
they will become little Big Daddies and deny
themselves. Out-of-pocket expenditures for private
insurance plans in the United States are about 25
percent of total private expenditure (29 percent in
the Netherlands and 50 percent in Canada for private
insurance plans).

Some senators, terribly affrighted by the trillion-

dollar price tag for reform, think that consumers
should contribute 35% to help fund the reform. It is
with that in mind that I have a couple of anecdotes
for my more patient readers:

My South Beach dentist’s assistant was quoting me

the fee for a root canal the other day when a little old
lady in the waiting room called me aside to let me
know the name and address of a dentist two miles
away who charged 40 percent less for the same
procedure. I thought it would be great if dentists’ fee
schedules were published so people could shop
around, which might make dentists more
competitive. I did find several offers to sell general
statistics on fee levels, and I noticed that one
workshop for dentists advised them to charge in the
upper range for best results. My dentist is really a
good one, but I could get the all the dental work I
need now done elsewhere and the amount he quoted
would include a Vegas vacation all expenses paid
including $100 in chips.

One day in the early 70s I was feeling extremely

hungry so I walked into a burger joint in Waikiki
owned by a dog food company at the time. The line
was long. I fainted and hit the back of my head on
the floor. The police came, propped me in a booth
and slapped me a couple of times, thinking I was
drunk. I got up and staggered out, and made it to my
apartment two blocks away, where I fell onto the
floor and lost consciousness. A friend of mine found
me there the next day. I was taken to the hospital.
When I regained consciousness, the doctor hovered
over me and said I was not to worry, that I had
sustained a concussion, my brain had swelled up, but
that I was out of the woods. I was discharged the
next day and referred to a specialist, who told me an
interesting story about how he had treated an
astronaut who had fallen down and hit his head in
the bathroom. I informed him that someone had
suggested that I had something called hypoglycemia,
which he said was a myth. He gave me some tests
and determined that nothing was wrong with me.

Two weeks later, I got a statement from Hawaii

Medical Service Association, the local Blue Cross Blue
Shield franchise, and found out that I was to pay a
portion of the charges, which amounted to over a
month of my pay, which at that time would have
taken me over a year to save.

The only reason I had insurance at that time was

because of the Hawaii Prepaid Health Care Act, which
mandated that employers provide health insurance
to employees who work over 20 hours per week. The
employer had to pay at least half of the premium and
usually more, because the employee’s share can
never exceed 1.5 percent of his or her wages. If your
wage is, say, $2,500 per month, and the single
premium is $300 per month, your share would be
$37.50, so you would pay $37.50 and your employer
would pay $262.50. Hawaii had an uninsured
population of around 30 percent before the Act was
enacted, and that rate soon dropped to 5 percent,
but has lately hit 10 percent, one reason being that
employers tended to make sure employees worked
less than the required 20 hours for coverage. When I
returned to Hawaii in the late 90s, I went to a
Chamber of Commerce meeting where an
employment agency’s presentation was roundly
applauded – the gist was that having employees was
a damn nuisance that the employment agency would
be glad to take off your hands. Steve Forbes visited
Hawaii and called it a socialist state. Soon thereafter
the Republicans seized power from the Democrats
who had controlled the state for fifty years – the
Democratic Party was sympathetic to the fact that
Japanese-Americans had been persecuted during the
war. I went to a Republican meeting, where
employers were advised to turn their employees into
independent contractors to reduce insurance and
other employer expenses.

Since I was dismayed by the amount of my co-pay, I

scrutinized my HMSA brochures and my employer’s
master contract, where I discovered that only a
provider’s usual, customary and reasonable fees
(UCR) were covered. Convinced that I was being
overcharged or under-covered, I contacted HMSA and
demanded to see their database. I was turned over
to the entity’s legal liaison, who informed me that
the information was proprietary. I responded that, as
a member of the organization, I was in fact one of its
proprietors, and was entitled to see the records.
HMSA then revealed what my doctor usually charged
for the services he charged me for, what the
customary fees were for all doctors who provided
those services, but he said the “reasonable” part of
UCR was a confidential formula kept in a safe in their
computer room. And the organization would not
allow its members to examine its database so they
could shop for the best deal on fees. When I looked
into the organization’s structure, I discovered it was
largely controlled by doctors and not by the
members. So I concluded Blue Cross Blue Shield was
designed to create a pool of funds to be drawn on by
the medical profession.

Furthermore, it appeared to me that the entity’s

literature was deceptive and fraudulent. I adopted
HAWAII CORRESPONDENCE as my letterhead and
proceeded there under to lodge complaints with
state and federal officials, and I copied various large
employers and unions. Senators Sparky Matsunaga
and Daniel Inouye were helpful. Those were the days
when ordinary individuals could still personally reach
their representatives – even so, I was continually
asked, “Who are you working for?” The late Senator
Matsunaga received me in his office and took me to
lunch. Today Senator Inouye does not even have time
to give me the time of day, maybe because I moved
to Florida.

The end result was that HMSA changed the wording

of its sales brochures and contracts, and I got a letter
from the state ombudsman saying I had helped
hundreds of thousands of people. I did not think
much of the letter, and I lost it, figuring that I would
really had helped people if a law had been passed
giving people access to databases that would allow
them to do some comparison shopping.

Now it is difficult for me to bring this article to an end

without an extended rant, for there seems to be no
end to the hypocrisy when it comes to the physical
and mental health of our people. Suffice it to say
that, as the Public Option slides off the table, I am
about to take down my Vote Obama Today poster,
and to say, “To hell with his kind of CHANGE.”