I’ve listened and listened to the ever ratcheting rhetoric about the increasingly vilified Public Option in the Health Care reform bill. And what strikes me is that the vast majority of the people fear mongering about it fall into two distinct camps: 1) those who believe “all government is bad, nothing the government runs can be good or efficient” (my response to this later) and 2) people who are actually currently enjoying the benefits of government run health care coverage but don’t want to share it with others. That latter camp would include the Seniors who are inexplicably waving “Keep Your Government Hands Off My Medicare” signs at Town Hall scream fests. So whose hands do you think are giving Medicare to you? Yup, it’s that bad old government and the simple gist of the Public Option is: Medicare style coverage for all SHOULD THEY CHOOSE TO TAKE THAT OPTION. So you like your Medicare coverage? Let’s extend it to your non-senior neighbors. If they don’t want it, they can choose Blue Cross or a private insurance program. Period. End of story.
Then there are the Congresspeople who have the same low cost, full coverage plan that is available to our military, but don’t want to make that sort of comprehensive coverage — which doesn’t recognize restrictions like pre-existing conditions — available to their constituents. Why is nobody standing up and demanding that any Congressperson who is bent on denying a government coverage option to his constituents must immediately and voluntarily relinquish his or her government coverage and place him or herself at the tender mercies of commercial insurance companies and big pharma?
You don’t hear of anyone taking that step. Because let me tell you, that coverage your Congressperson enjoys? Well, I grew up and thrived under that same coverage thanks to my career Army officer father. It was a coverage plan that continued to provide for my father until his death and still covers my mother. It is excellent and comprehensive coverage that is unmatched in the private sector.
Don’t believe me? Well, under Obama’s plan, you will be free to chose something else. And if you really think it will be that bad, well what’s the fear? If it’s crap, no one will chose it and it will die. Why do you think Big Pharma and the insurance industry are fighting this tooth and nail? Because they know it’s going to be better, more comprehensive and a real challenge to them. They’re scared shitless.
But back to my point, here’s what that government backed coverage did for my family:
1) It deducted a reasonable premium from my father’s pay (which was adjusted fairly over the years in response to his increasing salary).
2) It covered the entire family, including medicine, completely and with no co-pays and with nothing excluded.
3) It allowed us to go to whatever doctor or hospital we wanted — including some of the best in the Nation such as Mass General, Stanford and UCSF — and it covered even experimental and cutting-edge cancer and heart treatments.
Here is what it didn’t do:
1) It didn’t make me, as a teenager, run out and get an abortion (even though that would have been covered.)
2) It didn’t ration our health care. In fact, it covered second opinion visits at a variety of different institutions as well as treatments such as cutting edge pediatric heart procedures for me as a child and aggressive and comprehensive cancer treatments for my father toward the end of his life.
3) It didn’t make me put my parents in front of a Death Panel, even though it offered comprehensive End of Life Counseling.
Want to know what End of Life Counseling is? Well, let me tell you because I’ve been through it. When my father’s cancer had spread to Stage Five and it was found that his liver was slowly shutting down, we were able to have a consultation with medical professionals and receive comprehensive and valuable information about our options. Should we keep on a round of invasive procedures and hospitalizations which would, at best, prolong my father’s life for maybe a few months? Or was there an alternative? Turns out there were a lot of options for home health care that would allow my father to end his life with dignity in his own home, surrounded by family and without being hooked up to tubes. He participated in the discussions of these options and he chose the latter. We could only have made that choice comfortably with the help of health professionals — whose services were fully covered by our government-backed insurance program.
Once my father had chosen Hospice Care, we were provided with home health care nurses to help with his care as well as counseling to help the family through the process. When he died, my father left a family in grief, but not in debt.
It was a coverage that, by its nature, seemed to have some built in efficiencies. Because it was so comprehensive, my parents never missed a check up from well-baby through our teen years. We went to the doctor for every cough, sore throat or health concern. As a result, we naturally fell into a pattern of preventative medicine, getting things checked before they became larger, more expensive and less curable issues. My mother, who has major lung issues (which were a pre-existing condition from her teenage years) has received such good care that, while most other people with her condition are walking around tethered to an oxygen tank, she’s riding horses on trail rides into her late Seventies. Could more be done to promote preventative medicine? Sure. But when you don’t have to weigh the cost of a check up against the cost of dinner, you are naturally more likely to go every six months.
It is the sort of coverage that should be available to all Americans. It’s the sort of coverage that is available to all citizens of France — who according to the World Health Organization have the world’s best health care. In fact, the WHO rates 36 countries ahead of the US in health care effectiveness. How do they rate that? On statistics such as longevity, infant mortality, major disease rates, etc. Okay, you can get all patriotic and split hairs, wave the flag and say our hospitals and doctors are better than any damned Frogs’. Maybe they are. The problem is, not all of us have access to that highest level of care. Too many of us put off doctors visits until it’s so bad we can’t avoid it. At which point, it usually costs much more to address and the problem may be not so easily cured. And that’s when many are forced to make that tough choice between dinner and health care. Or home, college funds, investments, savings and health care.
You want to talk about rationing of health care? Baby, we have that now. It’s rationing by price and by the whim of the insurance companies. On the military plan and the plan your Congressperson enjoys? No rationing. Well, there must be some point where the plan says “we just can’t cover this.” I’m not sure where that point would be. We had my father go through multiple aggressive courses of chemotherapy, radiation, surgery and other treatments for his cancer. At a certain point, we were told that the cancer had spread so aggressively that his liver was failing, which is pretty much the beginning of the end for a 78 year old man. Would they have denied us a liver transplant if we’d demanded it? Possibly. But my father didn’t ask for it. He weighed his options and his expected lifespan. No matter what was done, the outside estimate at that stage was 6 weeks (which he exceeded by sheer determination). He made the choice, backed by the honest information provided by End of Life Counseling, to live the last days of his life without recovering from yet another procedure that wasn’t promising many more weeks.
My final parting shot? That whole argument that government is bad and government can’t possibly do anything efficient. My friend, government is not some big entity in a parallel universe. Because we live in a democracy, our government is us. Go ahead and rail against it. That’s your right under the freedom of speech we enjoy here. But be honest and accept part of the responsiblity for anything you don’t like about government. Because its failings are your failings. They are a direct result of our failure to research the issues thoroughly and make the informed choices that would put representatives in office that will carry out our will. It is our failure, once those representatives are in office, to demand accountability from them — on a constant basis. It’s our tendency, when our party isn’t in power, to vilify the opposition. No matter who gets elected, they are sworn in to represent ALL their constituents. Barack Obama is everyone’s President, whether you pulled the lever or punched the chad for him or not. Let him know what you want — in a civil and proper manner. Let your representatives and Congresspeople know what is important to you.
Call me a starry eyed optimist, but I think it works. I did not vote for Ronald Reagan or George Bush Senior, but I had a long-standing correspondence with both of them. When they did something I didn’t like, I wrote to them. When they did something I liked, I wrote to them. They were my Presidents and I wanted them to hear my voice. And you know what? They wrote back. Several times. I still have the letters. Well, I’m sure it was low-level functionaries that wrote back. But in the aggregate, I think such communication is effective. Did I make a difference? Who knows? But I bet if there were hundreds of thousands of us who wrote to them as I did, they would have listened. On a more direct level, I helped elect the local, regional and state officials that I thought would more directly represent my interests and keep these Presidents accountable.
I have to accept that a small part of Bush Jr.’s failures must be laid at my door. I allowed myself to give in to the whole “I didn’t vote for this guy, I hate him” trap. I dropped out of active citizenry for awhile. Maybe if I, and thousands of Democrats like me, had stayed respectfully participatory, things would have been different. I won’t make that mistake again, no matter who is elected next.
What didn’t I do during the Reagan and Bush Senior years? I didn’t storm into town meetings and shout people down. I researched the issues and I wrote respectful but firm letters outlining what I wanted and expected from my Presidents. If the return letters I received back weren’t written by Ronnie or George themselves, they were answered by someone who actually read them. Because they always answered the exact points I’d raised with specific thought-out answers. It’s a start. And, as a participatory democratic effort, it beats painting a Hitler mustache on a Presidential portrait.
But I’m a long way from my main point. Which is that the government can indeed run an efficient, fair and medically sound coverage option. My entire family — and every military family I grew up with — is proof of that. Ask me any questions you want about my experiences. I’d be glad to share. If you’ve been covered by a similar government-backed coverage option and haven’t had my positive experience, I want to hear about it.
I think we’re all closer to a solution that we think. And I think it can be done without shouting and violence.
I’ll leave you with this food for thought.
Need a common-sense, plain-spoken explanation of the Public Option? Robert Reich lays it all out in two minutes:
Here’s conservative pundit Bill Kristol admitting that the government runs a first-class health care coverage program for the military, but the average American doesn’t deserve it.
Ready for a laugh (through your tears)? Here’s Paul Hipp with a rousing response to the US status as the Number 37th in health care (as rated by the World Health Organization).
What a wonderful thought out post. The scare tactics being used around health care reform are just making me sick!
This was a great post!
Betsy, since you work for the government, you’ve had even more recent experience with a “public option”. Is it still working for you?
This is an excellent post. It’s thoughtful, honest and real. You bring it home to those who are letting their emotions get the best of them. Your point about government–that it belongs to the people–is what people should stop shouting long enough to think about. The distortions, lies and rabble-rousing going on around health care won’t make the system better. And making it better is in the best interest of every citizen.
It amazes me that there was less debate about going to war twice, or passing the patriot act than there is about this ‘debate’. Can you really have a debate if neither side listens?
Great post, real life is better than fictional corporate town hall BS. I just wished the people who need your wisdom would read your post. Oh, well back to banging BHO.
Bin, for someone who voted for Barack, you give him the hardest time. But I enjoyed your post today demanding that our President channel his inner Patton. Folks, see it here:
There is passion on both sides of the arguement and sometimes that passion squirts out past better judgement.
I know you won’t be surprised, but I’m not with you on this one. Now, back to the garden.
Not with me that the government administered insurance plan for the military is top notch? Or not with me that our government’s performance is largely our responsibility?
As a beneficiary of the military’s health care plan for some years now, I’m not with you.
Oh, it definitely has its benefits and the medicine is one of them. It’s just that it doesn’t cover a few of the prescriptions I need.
It’s not true that I can see any doctor I choose. I am assigned to one. I can request a transfer. I have twice and been refused.
Getting an appointment with the highly touted “same day appointing” is, frankly, impossible. When all the appointments are filled for the day, you’re told to call back and try again the next day. I’ve participated in a “group” call effort – four us with cell phones and redial, all of us getting busy signals for over an hour. When one of us finally got through, there were no appointments available.
How good TriCare is depends on where you live. I have a feeling I’d love it if I lived near Fort Jackson instead of near Barksdale Air Force Base.
This is not my experience alone — the appointment we were all trying to get was for my daughter, the wife of active duty Army.
When my youngest daughter was in college 1200 miles from home, she was in a different TriCare region than her sponsor and it was very difficult getting TriCare to cover her.
BTW, you inspired a new blog post:
Interesting Donna. I grew up under CHAMPUS. I think they switched to Tri-Care well after my parents retired and I moved out, so that’s not my experience. I’ve heard grumblings from old timers about how Tri-Care, which is a managed health care system, wasn’t a patch on the old CHAMPUS coverage. (Why does “managed health care” always seem to “manage” to make health care less accessible.) I also understand Tri-Care now includes three levels of coverage including PPO and HMO tracks — which I’m assuming differ in what they cover and accessibility just as they do in civilian life. Are you on Tri-Care Prime which I understand requires care primarily through military facilities? I’ve heard that varies according to the size of the base you are near. The old CHAMPUS program used to rely on supplementing the care network with liberal use of civilian sources. Which probably accounts for the fact that in my day, there were so many more choices.
But then, under Bush Jr. there were such disasterous cuts in Veterans benefits and services (including a shocking drop in funding for Veterans health care and military hospitals) no military care is like it used to be. (But that’s a rant for another day.)
The old Champus program, I’m told, used to be pretty liberal in letting you choose your doctor. My mother’s condition required a lot of specialists, so I think they were also pretty open to letting her go to whoever she wanted, as just your average GP wasn’t enough for her.
Thanks for weighing in. I’d like to talk to you more about this off-line.
Thank you for this well written post. I agree with you. The Republicans have always been very sore losers. I would think that they would put forth their own ideas instead of wasting their time spewing anger and hatred. Oh wait. That’s right. They have no ideas to put forth. Any party that only has a soccer mom and a radio talk show host as their purported partly leaders is a sad state of affairs. The fact that they can get any sort of a following makes me despair of this country.
Well, I’m also owning my own “sore loser hood”. While I stayed active and participatory during Reagan and Bush Sr., I sort of dropped out during the Bush Jr. years, as I fear so many of us did.
If only a great many more of us had stayed active in politics — with polite, respectful, but firm participation — things might have been different. We needed to mobilize, elect officials who would hold the Bush administration accountable and stay active and engaged with those elected officials to make sure they kept the heat on.
I fear one of the reason the Bush Administration ran roughshod is that so many of us — in elected positions and in the citizenry — rolled over and just spent our time grousing.
Actually, one of the changes for the better in TriCare happened under Bush II – the total out of pocket expenditure before 100% payment kicks in was drastically reduced.
Yes, I am in TriCare Prime. We are retired and on a fixed income (we’re not poor, there’s just a limit every month) and I wanted to be able to budget a maximum yearly expense.
So, in that way — it’s wonderful.
But, access to care is limited, no matter the cost. I can’t get a referral to an off-base specialist without first getting an appointment with my PCP on base, which as I explained above is sometimes impossible for days.
On a more general note, sometimes I’ve obtained referrals to a specialist and then not been able to get an appointment because there’s a general shortage of that specialty or because too many in that specialty have decided not to except TriCare patients.
There is a medical school here, so I wonder at the seeming shortage of some specialties. There may be a shortage of other specialties too.
And then — no matter where I see a doctor, there’s this fee for service and 10 minute appt. problem. I can see the doctor’s point of view… they are only going to get paid for 10 minutes and treating one problem no matter how long they spend with me or how many problems I’ve got.
Frankly, I worry that Congress does not even understand the problem(s) and that they are, in whole, not smart enough to come up with solution(s). I wish President Obama would be more specific in his instructions to them instead of giving them a general outline of the outcome he’d like to see.
I would also like to see reform done in incremental steps, so that successes/failures can be more readily copied or fixed. If there was a bill that did two things – prevented insurance companies from refusing to cover pre-existing conditions and expanded Medicaid coverage (by raising the pitifully low income restrictions for one) I’d be all for it.
Since the plan, if passed today, would not go into effect until 2013, why would it be a problem to implement it a piece at a time over the next four years?
Email me anytime. I’m always here, or on the phone trying to get a doctor’s appointment 🙂
Thanks Donna, for adding more insight to the discussion. I’m wondering if the difficulty in seeing a specialist or even your favorite doctor is a function of your health care plan. Or just the general problem of supply and demand for specialists. (Hell, I can’t even get an appointment with my hair stylist when I want!) I’m on Blue Cross and its always a challenge to try to book a specialist. Tri-Care just got my mother into Stanford (one of the top cancer facilities in the country — and the world) after being told the specialist was booked until February. We got on a wait list and something opened up.
There are so many successful health care programs around the world. I don’t understand why we are feeling the need to reinvent anything. Plans exist, empirical and historical data tells us how they’ve worked and where their flaws are. Let’s just pull something together from where people have gone before.
“Not with me that the government administered insurance plan for the military is top notch?”
You may have been using this plan years ago and in fairly good health. It’s interesting to get Donna’s thoughts. It’s also interesting to learn about the 912 activities. After all, I’m in Bakersfield.
Back to planning a camellia garden.
I think the reason that many remained silent during George W’s tenure is that to disagree with his policies was to be labeled unpatriotic or worse. That’s no excuse for not opposing the Bush administration. But, it is a reason. President Bush had some people in his administration that had power and were not afraid to use it. And, some would say that power was abused.
yes, I was covered years ago under CHAMPUS. But I’m pretty familiar with how Tri-Care deals with the extreme end of the health care spectrum. Dealt with health care all while my Dad was at the tail end of his cancer treatments. Now my mother is facing surgery to remove a tumor that may be cancerous. It was discovered with a scan a week ago. Tri-Care had her booked with Stanford Medical Center for a pre-op and operation for the end of the month.
That’s pretty good service in my book. But the important point is that, at no point during my father or my mother’s illness, was their fixed income compromised or were they in any fear of losing their house or having benefits cut. That’s the real news.
I wonder if the difficulty getting appointments has to do with rural areas versus big metropolitan areas. Which is going to be a problem no matter who handles health care. Unless we do something creative such as have a school loan forgiveness program for young doctors who agree to practice as GPs in rural or underserved areas.
Hi Lisa, I’m back from some travels to New England for fun so in answer to your question about civilain federal gov. care, things have changed, but the coverage is still better than some– not as good as SOME industry plans, though. The premiums of course have gone up, as has the percentage paid by the individual, vs. paid by the USG. I can choose from dozens of plans every year to suit my needs and budget. I don’t change that often, though, of course. While my son was little and getting all the usual kid stuff, I carried the higher, better options. Now, I’m still healthy, and I’m being cheap… in another year or two, I’ll raise my own coverage. But, yes, the plans do carry into retirement, etc. USG dental and vision are not very good; it is necessary to buy a supplemental plan to get any decent dental coverage and orthodonture is generally not covered. Prescription drugs have fairly low co-pays.
I think most govt plans can be viewed via the OPM website, http://www.opm.gov — the 2010 options will be available for view in October.
I’ve recently been watching the republicans talk about how much this will cost and where the money will come from. Funny they didn’t bring up this issue when they spent trillions on the iraq war we didn’t need or a huge tax break for the rich. Now that we are talking about something that could really benefit the American people as a whole they raise this question. I’m with Lisa, take away their health insurance until they can provide us with a comparable plan!!!!!