Thursday, May 15, 2008

Our Top Priority

I’m going to go out on a limb here and say that I believe that in January of 2009, Barack Obama will be inaugurated as President of the United States of America.

Come January, we will have a remarkable opportunity to not only reverse the damage from the past eight years, but to enact a more sweeping liberal agenda the likes of which the country hasn’t seen since the 1960s. Democrats will most likely retain the House and Senate, liberal groups are stronger than ever, and increasingly the American people support liberal policy. And the first ninety days, the so-called “honeymoon period” where the media typically refrains from much criticism of the administration are vitally important.

So what should be the number one priority for the first ninety days? To me the answer is obvious. In fact it's so obvious and so vital that I believe that every liberal organization from Planned Parenthood to Greenpeace to should let go of their internal agenda for ninety days and focus on one thing:

Universal health care.

You thought I was going to say global warming? Gotcha!

Now why would a woman who spends her days prattling on about the environment turn around and say that for 3 months we should focus solely on health care? Simply because health care is a basic need.

To try and deal with an issue like global warming when millions of Americans have insecure access to health care is not dissimilar to trying to deal with the issue of literacy in India when millions of Indians have insecure access to water. It doesn't work. When Green Bean and I unveiled the "APLS," acronym, I admit, I was surprised by how many people balked at the word affluent. But the truth is, many of us are One Major Health Care Crisis That Insurance Won't Cover away from poverty. How do you like them apples?

If you are an American, you know what insecure health care means. People stay in horrible jobs, forgo early retirement, and give up on owning their own business because of health care. For the uninsured, things are worse. I've had friends ignore countless health-related red flags because they just can't afford to deal with the medical bills. I had an insurance-less friend who had a cyst removed, not in a hospital, but on the floor of a hotel room. And yet another who was denied insurance, because she occasionally took medication for cold sores.

This is not right. 

We can talk about living simply, we can talk about how our uber-consumptive economy doesn't work, but until we fix health care, all that is moot. Voluntary simplicity advocates talk about how if you buy less stuff, you can work less. Sorry, no. Not in America. Because in America part-time work generally does not confer benefits.

Yes, but there are other important issues! We can't drop everything for NINETY days! Global warming, peak oil, ZOMG TIPPING POINT!!

I know, I know, I know. But here's the problem. The health insurance companies have lots of money and lots of power. They have so much power that Obama, who used to support single-payer health care, now advocates a watered down form of voluntary health care. But, I believe universal health coverage is achievable if we all band together. Besides the fact that health care is so basic that it affects everything else.

How so?

Here's an example. About 10 months ago, I was at work when I felt like I was having an asthma attack. I didn't have an inhaler with me, so I started to panic, which made my asthma worse. I quickly decided to go to the drug store and get an inhaler right there and then.

At the drugstore, the pharmacist handed me an inhaler right away. After a few pumps, I felt better and calmer. I handed my credit card over for my co-pay which I was then informed was ... 40 dollars. 

"FORTY Dollars?" I asked horrified. I had never, ever paid forty dollars for an inhaler before. Ever.

The pharmacist assured me that was correct. 

"How much was it without insurance?" I asked. Apparently, $44. My insurance had covered four dollars.

Now, I'd like to say right here, that I have awesome insurance. You know when you hear an "average American" talk about how they love their insurance? That's me. I *adore* my insurance. I want to marry my insurance and have little insurance babies. So the fact that they had covered so little was ... really, really weird.

As I walked back to the office, I fully intended to figure out what the deal was with that ultra-expensive inhaler. But the truth is, I forgot. Forty dollars is a lot, but frankly, I need an inhaler about once a year. I could afford  it. And so it remained one of those strange unsolved mysteries, until yesterday when I saw this article in the New York Times.

Apparently, the reason that inhaler was so expensive was because unlike the original inhalers,  this inhaler was made CFC-free to comply with federal regulations set to go into effect in January 2009. Those old inhalers? Cost $13.50.

I finished the article feeling really bothered, somehow. How, I wondered, had I never known any of this? Isn't it odd, that though I have read countless articles by environmentalists about the effects of pollution on poor kids with asthma, I have never, ever, not once, read an article by an environmentalist about this new, expensive, albeit CFC-free, inhaler and its effect on poor kids with asthma?

Why? Is asthma in poor kids just a means to an end, or do environmental groups really care about asthma? Because, frankly, if environmental groups are just using asthma as a way to talk about diesel buses, then I don't want to be part of that group.

For the record, I have no issue paying $40 myself for a CFC-free inhaler. But $40 is too much money for a medication that many people have to take once a month. Just because we have achieved our goal in mandating a CFC-free inhaler does not mean our job is done. If we really care about poor kids with asthma, then we must make sure that those CFC-free inhalers are easily affordable. Caring about the environment does not mean caring about global warming and ozone depletion while ignoring the very people we claim to want to protect. 

And that's why health care needs to be everyone's priority. Because, really, we're not environmentalists because we want to "save the world." We all know that the world itself will continue to turn. We're environmentalists because we care about the people and other species that inhabit this world. So it's time for us to put our money where our mouth is. If we care about Americans, we must support universal health care. It's time.


EcoBurban said...

I agree so wholeheartedly that it hurts... I have 4 boys, all, for the most part, healthy, thank god. My husband stays in a crappy job, with crappy pay just for the insurance. And, it's not even that great. My son's inhaler cost me $60 last week. He only needs it once a year and yes, we can afford it once a year, but my husband and I had the same discussion about low income families. What would they do? Would their son have to forego the inhaler and suffer because of cost? What about us, would a major car accident or even worse a case of cancer put us into bankrupty? Probably...

We live only about 45 minutes away from the Canadian border and between the war (My oldest boys are almost 13 and god forbid a draft would ever happen...) and the insurance coverage there are days when I think the commute across the border might not be so bad! :o)

Hopefully Obama in '08 will bring us the breath of fresh air our country so deperately needs. I am holding my breath and waiting for November!

Sam said...

I completely agree that health care has to be a priority. I've gone without health insurance for years after I moved to the U.S. and it really infuriates me that doctors create so much trouble for those that want to pay cash for their care. I read stories online about so many people who have had to file for bankruptcy because of exorbitant health care costs and it angers me so much. What the hell can I do? I want to do something. I have phenomenal insurance right now, but it seems a bit unfair that I can have such good insurance and Evan's parents have to face so much financial problems because they don't meet the cut off for whatever income level someone decided was the definition of poverty or below middle class.

I think alot of money has to be spent on preventive care education however...not sure what sort of priority the DHS puts into that. That level of education appears to be only on a local or statewide level. I think if people just took some measure of care on certain things like diet, more money can be diverted to those with HH or cancer or whatever that costs much more money. I am just rambling here...sorry.

I had a question for you...when you travel to places outside of L.A. does your asthma symptoms decrease? I ask only because my asthma symptoms went away after I moved to PA and I suspect the air quality played a part in that. So I'm worried whether its one thing I'm going to have to deal with if I move to L.A. and its supposed bad air quality.

Green Bean said...

Hmm, I definitely would have said we need to focus on solely environmental issues but, having read Common Wealth and being knee deep in Break Through, I have a better understanding of how standard of living impacts ability to preserve the environment. For instance, the discussion of how people in Brazil cannot make conservation their priority because they are still trying to feed themselves.

That said, I'm still on the fence as to whether universal health care should be our top priority. There are so so so many issues . . .

Jennifer said...

You know, it's good to see someone presenting the greys... too many on both sides of ANY issues never enter the greys. SO important.

My husband needs an inhaler about once a year... I don't know that we could afford $40 for a new one for him right now... and we are not poor. Very interesting.

Joyce said...

I like what Jennifer says about the"greys". We seem to rush into so many things, sometimes out of fear, and then have to deal with the consequences.

equa yona(Big Bear) said...

Great post! Preserving the environment and justice should never be seperate issues in my opinion. Excellent point about saving the world-yep it'll keep on turning. We are working to save our sorry butts.

Mouse said...


Arduous, who do you like for Veepers Creepers?

I'd love Sebelius, but she doesn't do anything to boost Obama's weakneses.

I'd love Biden (because he DOES boost Obama's weakneses) but he's a loudmouthed ass.

I like Richardson an awful lot.

Anonymous said...

Dude, I had heard about the inhaler thing too. As a fellow asthmatic I have mixed feelings and as a med student I feel like for better or worse medicine is an area for me where waste rules do not and should not apply within reason. There are plenty of other areas to cut consumption before we make meds more expensive and give up fluorine in toothpaste.

Having said that I briefly lived in the UK and was a patient under their socialized system, the NHS. It was great having security and this may sound crazy but I think that having securities like health care guaranteed, contributes to the overall mellowness of people like the British. When you know you can get treatment even if you're unemployed it helps you sleep at night. But can you really get treatment under such a system?

If you have major medical problems socialized health care is a NIGHTMARE of waiting lists for operations, etc. There were always stories in the paper in England telling about tragedies of people waiting years to get treatment.

I used to be the biggest fan of universal health care but seeing things through the doctor side of things now I am STRONGLY opposed to universal health care. STRONGLY STRONGLY.

Look at how dysfunctional systems like Medicare and Medicaid & the VA are. Do doctors want to take those patients in their practices? No. Can many of them? NO. Why? They can't afford to. Overhead in the medical business is HUGE and when Congress cuts physician reimbursements docs have trouble making ends meet after paying their 3 insurance specialists, 2 nurses, rent, a lawyer, malpractice, and a receptionist.

People have a distorted view that docs become rich practicing medicine. While that may be true they 1. work themselves into an early grave to do it and 2. Don't do it seeing government medical care patients.

So what happens? Take me, I will have $150,000 plus in debt after graduation at 6.8% interest. That's a mortgage without a house. I will still need to have a house. My starting salary as a resident will be around $40,000 if I'm lucky. I will be heavily financially burdened. Try paying for 2 mortgages and take care of a family for $40,000 while you work 80 hours a week (hello, childcare?) and then have people tell you that they want to cut your wages and force you to see more patients.

Moreover, if we put medical care in the hands of the government some clinical autonomy will be taken away from docs. I'm not sure if you guys know but LOTS of drugs are use "off label," which means there are trials showing it works but it's not FDA approved for that condition because some company couldn't make a profit by getting it FDA approved which costs millions. Put the gov in charge and you get stringent evidence based medicine where vital off-label and experimental treatments decrease in use, which means less clinical options for patients.

It turns doctors who are trained to problem solve and deliver compassionate care into heath hostesses that practice cookbook medicine. As it is family docs can only spend about 10-15 minutes per patient to be cost effective. Decrease reimbursement and you get less time with your doctor.

The final issue? Who would want to be a doctor in such a work environment? The best and brightest folks? Thing again. Bright folks no matter how altruistic want to be able to at least make a house payment. Physician quality and job satisfaction will drop as fewer young people will want to enter medicine or stay in medicine.

I know a lot of that sounds selfish but I think this issue is always from a patient perspective, and for me as a patient: Yeah this system is a friggin mess and we ALL ALL ALL need and deserve health care. NO QUESTION. Health care should be a right not a privilege but the government getting involved is not a good solution for everyone.

What's going to happen if we go to universal health care driven by the feds? Docs will privatize and practice concierge medicine for the rich who will pay out of pocket. That didn't help the people who couldn't afford health care in the first place.

Sorry about the rant but I guess my conclusion is I don't know what a good solution is. I wish to god I did because my future is staked on what's decided but government based health care isn't a good outlook for me.

Have to get back to class now. Great post!

Theresa said...

As a Canadian, I have to say that public health care works pretty well. It's not perfect, but it's darn good. It needs to focus more on prevention and less on drug-prescribing, but it continues to work pretty well for most people. No one is turned away. We used to have to pay about 55$ per month per person as health care premiums (about 100 for a family) but our provincial government has recently discontinued this fee as well. I really hope Obama gets elected too, and wish all of you in the US the very best in making that happen.

ruchi said...

EBM, yes, SO many people stay in crappy jobs just for the insurance. It sucks, and it sucks to feel like you don't have any option but to keep your crap job.

Beany, my asthma actually got much better when I got to LA because I responded well to the dry climate. But I think how people deal with asthma is a very person to person thing, so it's hard to say how you will respond. Certainly I know a number of people who's asthma got worse in LA because of the air quality.

GB, the reason I don't think we can focus solely on environmental issues is because you can't separate the world we live in from ourselves. In a sense, they're all environmental issues. I agree that there are so many important issues that it's tough to say, well health care is the most important, but I can't think of another issue that addresses such a basic human need as health care. That's why I think we have to address health care first.

Jennifer & Joyce, yeah, I pretty much live in the gray. That's why I'm difficult. :)

Equa Yona, I agree, but true environmental justice, like I said, means caring about asthmatic kids even when it sometimes isn't in sync with ones goals (like with the CFC-free inhalers.) It's important that we recognize that.

Mouse, I think Sebelius is spectacularly boring. Did you see her give the Democratic response to the SOTU? It sucked so, so hard. My preferences are Edwards (who won't take it), Webb (who we can't afford to lose from the Senate so he's out) and Richardson. Biden, I'm afraid would spend too much time talking about how clean and articulate Obama is.

SDG, phew! I will respond further to you, I swear, because I think you make a lot of important points, but I'm going to have to take a breather and come back to you. I will make one point though. Universal health care does not necessitate single payer. It has, in most countries, yes, but both the Edwards plan and the Clinton plan were, IMO, fairly good and neither of them were single payer systems. Also, see the MA plan.

ruchi said...

Theresa, thanks for commenting. It's always good to get a Canadian/UK perspective. I have to say that I have heard a lot about the long lines for medicine in Canada, but what everyone seems to forget is how long the lines are right here in the US. The last time I scheduled a routine physical/pap I had to wait 4 months for an appointment. And like I said, I have excellent, private insurance (PPO.)

Anonymous said...

Urgh. Checking back, but not seeing my long and eloquent comment - joking, it was long and rambling. There is a more brief but just as rambling version:

As a proponent as both social and environmental justice, I believe both issues need to be addressed urgently. However being the "elitist" I am, I think environmental issues impact more people and more areas, including health, jobs, energy security, etc., etc.

Aside from health care and environment, there is the white elephant in the room - Iraq. Everyday we spend in Iraq is millions of dollars taken away from health care and environmental solutions.

So I guess my point is that we can't afford afford focusing on health care alone. We need to move forward with a few critical issues that are tightly connected.

Donna said...

I don't know that universal health care should be the only issue, but I agree that we've GOT to do something! Most of my friends here in Oregon have had gone without insurance at one time or other because of cost. For us, my husband's job only covers employees and to put myself and our son on his plan would cost over $800/month. So we have individual policies and mine covers virtually nothing because of a ridiculously high deductible, and our insurance premiums INCREASE over $1000 every year. I know universal care has its own problems, but it's got to be better than this.

Natalie said...

I couldn't agree with you more. I totally think that the overwhelming cost of employee benefits (primarily composed of medical insurance) is undermining our society.

In lieu of using advancing technology to reduce the work per employee, the general trend has been to reduce the number of employees doing the work. And as the cost of employing each worker increases (thanks in large part to healthcare costs) there is ever more pressure to hire fewer people - resulting in the need for each employee to work harder.

I can't cite any hard numbers here, but I know I've read numerous times that the annual number of hours worked by the average American is increasing by the decade, if not by the year. So for most of us that means we spend less and less time outside. Less and less time on family and recreation. Less and less time sleeping. Less and less time on community and friends. Less and less time on the things that keep us healthy and sane.

We've become entrenched in "looking out for #1" - out of necessity rather than just greed. We are very busy with all of the busy-ness of our lives. In a subtle and insidious way, we've been divided. We've been conquered. We've metaphorically BECOME the single-serving hermetically-sealed disposble object that we throw away. Bill McKibbon calls us hyper-individuals.

Of course employer sponsored health insurance and healthcare costs are not the root of all evil. But I agree that they are symptomatic of the greater problems we face, as well as presenting a huge obstacle to finding sound solutions.

PS I don't think you're arduous at all. I know you wear that name as a badge of honor, but you are not difficult at all. You are thoughtful, intelligent and caring. You have well-developed, well-reasoned, in-depth opinions. Those opinions don't always seem consistent from topic to topic on the surface. But they are connected by the fact that you have a brain and you use it.

ruchi said...

Okay SDG, back to you. First of all, you make some excellent points and I appreciate your bringing a doctor's perspective to the discussion.

As far as the quality of Medicare, Medicaid, VA, I'll give you the VA as being crappy. But I actually think Medicare is a fairly strong program. I know we are always being told, government is a beauracracy, you can't trust the federal govt, they're inefficient etc etc. But ... seriously, I barely trust private industry with my cable. And even then they can't give me consistent cable service! I mean I don't know a private industry lately that isn't inefficient, beauracratic, and intensely annoying. At least with the government, they are SUPPOSED to be working for you.

I think you make a very solid point about doctor compensation. And it's an illustration that you pull on one string, and then a billion other strings come loose. You're right. We absolutely can't move straight to single-payer health insurance tomorrow with no other changes being made or doctors will get screwed. But what I liked about the Edwards/Clinton plans is that they kept the system but allowed us to suege to single payer which gives us a few years to address college tuition. Simply put, tuition is out of control. Universities are playing fast and loose with what it means to be a "non-profit" and tuition rates are rising MUCH faster than tuition. The reason doctors aren't broke in the UK is largely because they don't have the ridiculous student loans that we have in the US. If we want single-payer eventually, we are going to have to dramatically decrease the cost of medical school.

Also, just because the govt is paying for health care doesn't mean that I think they should have control over doctors. But the reality is doctors don't have control today. A doctor might believe you need certain tests, but if the insurance disagrees, tough shit. I know personally I've had several instances where a doctor prescribed a specific medicine for a specfic reason, only to have to give me something not as good because insurance wouldn't cover the medicine. That's not autonomy.

It's a complicated issue, no question. And the last thing I want to do is fuck doctors over. But the current system is just not working.

ruchi said...

Cindy W, I don't think you're elitist at all and I actually agree with you that environmental issues affect everything. Which is why I think that as environmentalists, our first priority should be health care.

Let me back track. Why are we environmentalists? Is it because we're obsessed with carbon parts per million in the atmosphere? No, it's because we're concerned about how those carbon emissions are going to affect people.

Health care is a basic issue. My thesis is that until we deal with health care, we can't effectively deal with issues like global warming.

I agree that Iraq is the white elephant in the room. However, I don't think there's much anyone can do about Iraq. Ultimately, staying in or leaving Iraq comes down to the President. I think health care IS something though that we CAN have a lot of influence on, both as individuals and as organizations. That's why I'm saying health care.

Donna, that's the problem. There's been a lot of attention focused on uninsured Americans, but not enough attention focused on "insecurely insured" Americans. That is, people like you who technically have insurance, but whose insurance covers virtually nothing.

Natalie, I couldn't agree with you more. Americans aren't more selfish than anyone else in the world, but like you say, we are driven to look out for number 1 out of necessity. Thank you for the compliments.

Anonymous said...

You're right about Medicare. I was thinking about it later and really Medicare is the standard most private insurance companies base their rates and coverage on to some degree.

You're right about the long lines. I think it's ridiculous about waiting to get simple visits taken care of.

I'm not totally against the idea of single payer. It wouldn't probably reduce the cost of health care. I just don't want that payer to be Uncle Sam.

Honestly I didn't read too far into Edwards/Clinton idea because it rang false to me that she had taken so much money in contributions from insurance companies and then wants to "help" the people by requiring them to buy insurance. Who does that help when you already can't afford it? Again I'm probably missing stuff.

You're right arduous. Doctors are already screwed and it's eating away at a great profession. I watch docs in their 60s talk about a time when doctors were gods and nothing came between them and their treatment of a patient and how now everything is hella messed up. I think the way we medically educate our docs is whack too, and the financial burden we put on them.

Even if it's painful for doctors initially, if it's better in the long run I would like to see change where insurance companies play a smaller role in patient care rather than a larger one.

Going Crunchy said...

Wow, I'm just so chewing on all of these comments. Amazing post and responses.

Quite frankly, just think of what we could have done with 800 Billion spent on Iraq- - green technology and health care.

I am mixed about the government taking over health care- - at least our government and how it is going at this point. I look around and see shoddy schools, roads falling apart, a slack ass FDA, government housing issues, heinous DCFS,....on and on.

If I handed over health care to the same people mismanaging the country as it is then that *may* go down the toilet as much as many others.

And from what I've heard and read the state of Medicare and Social Security as it is are in grave peril and we have no hope of sustaining these program with our current economic standpoint.

But what is happening now ain't working either.

Right now I pay $390 a month to cover my two children, and I'm lucky that mine is covered. We cannot afford to insure my husband - - and if you've read my blog we are one of the people that is one step ahead. In this past year we had one ER visit for him, one shoulder break, one CT brain scan when he was injured. Right now he is suffering through a bout of sciatica - - (he has seen the dr. twice and there is really nothing but bedrest anyway).

When he had his sledding accident and head injury we had to make the choice to bring him home that night rather then an overnight stay. I'm lucky my next door neighbor is a high level nurse and came over several times.

When I had my two children the medical bills just even beyond insurance were insane. All the co-pays, out of pockets, etc. I had further medical issues - - and good golly, the bills.

Anyway - - the point is that even with insurance many of us cannot afford general medical bills.

Granted - -I could quit my "save the world" kinda job and go into another type of consumer business and probably up my salary a tremendous amount. But I have "time affluence" now, and get to work AND be a Mama and that means more to us in so many ways.

I guess my long-ass winded comment didn't solve anything either- - the system is broken and I don't think any one of us have the answer.

ruchi said...

SDG, I know that it can seem intuitively off that universal health care "forces" everyone to pay into healthcare. But unfortunately, thems the breaks. We also "force" every tax-payer to pay for education. And we "force" everyone to pay into social security whether they like it or not. The problem is, if we allow it to be voluntary, it often means that the young, healthy people opt out of the system. You know better than the rest of us how insurance works. Everyone pays in, and the healthy pay for the sick. If the healthy people all opt out, then health premiums end up being more expensive. The reason we need everyone to pay in is to keep health costs down. (Of course if you are at a certain level of poverty, your fees are waived.)

Shannon, I hear you. I really do. The past eight years have shown us the worst in government. But I don't think it HAS to be that way. Many right-wingers see government as bad, and that becomes a self-fulfilling prophecy. But government also has the capacity for great good as well.

Finally, I'd like to thank everyone who read & commented for such a wonderful, thoughtful discussion. Thank you all for sharing your stories, and thoughts, and such a remarkably insightful discussion. I really truly appreciate and value you all. (This is in no way to close the discussion. If people have more to say, keep it coming!)

Anonymous said...

I'm Australian. I have asthma, at times in my life it's been severe and I've had a couple of trips to casualty. I don't have private health insurance, and I'm not working (for money) at the moment.

None of this is stressful to me because: Our Medicare system charges everyone a levy as part of the tax system. You earn a lot? You pay more for healthcare (but still not that much). You earn nothing? You get your healthcare free or very cheap. If you want you can take out private health insurance in addition to the public care, that (at least in theory) means you can choose your doctor, stay in a private room, have your surgery in a place with nicer carpet and possibly nicer food.

I've never been charged more than $15 for an inhaler. With a prescription and my Health Care Card (which proves I have a low income) my inhaler, and any other prescription costs me $5. If I need more than $x worth of drugs in a year? After that it gets cheaper.

It's not a perfect system. There are things that aren't covered, in some areas there can be a wait to see a doctor, public dental care has really long waiting lists, and mental health care is far from fabulous. But getting sick, or having a car accident doesn't bankrupt people here.

And finally: Universal health care costs our community (and British and French and Cuban people) less than it costs Americans to go private. Even after eleven years of appalling Federal government in Australia, our health system is better than yours. It doesn't matter how well you train your doctors if people are too scared to go for fear of subjecting their children to a lifetime of poverty.

Oh and one more thing: our doctors spend a fair bit less on getting trained. It isn't free any more, but it's a lot less than $150,000.

Anonymous said...

All I can say is: amen to that.

ruchi said...

Innercity, thank you for giving us a look at the Australian health care system. I really appreciate your in depth appraisal of your health coverage.

Julia, thanks!

Anonymous said...

Well said! I totally agree. I hope Obama win :).