It Helps to Have Perspective

I'm trying to wrap my mind around the angst felt by the tea partiers and conspiracy theorists and give-me-back-my-country types. I'm trying to understand the pain and bitterness they must feel. On average they're pretty well off economically, but they pine for days gone by and cheer along as cable "news" and talk radio give voice to their anger. I'm trying to understand what they're so mad about, what they are afraid of.

My research into this phenomenon has led me to a brand-new, best-selling book that sheds light. I will quote or paraphrase some of its most salient descriptions here:

• Opposition forces are coming together, "showing their teeth and shrieking to high heaven."
• Republicans denounce the President while the conservative media harp on state socialism and demand a return to the good old days.
• Instead of civil discourse there are "private fulminations and public carping" against the President's agenda.
• Some say the administration's objective is "to redistribute wealth"; they want to take it from those who have worked hard and been thrifty and pass it to those who have not.
• They say this is totalitarianism or socialism.
• They say they are waging a "holy war for freedom and the survival of democracy in America."

On the other hand, as the book points out, many people feel these kinds of charges are almost comically overheated. The vitriol flows "from deep reservoirs of fear, resentment, and fury; it [cannot] be answered by an earnest appeal to the facts." It all stems from a kind of psychosis that follows the horrible economic strain the country has just experienced.

The book is Supreme Power by Jeff Shesol. The economic strain was the Great Depression. The President was FDR.

"Plus ça change, plus c’est la même chose."

Stamping out Socialism

I've been reading the new health reform laws. I've downloaded them both -- a total of 1,000 pages; half a million words of mind-numbing legislative prolixity. I've read about a fourth of it carefully and all of it at least cursorily.

My ostensible reason for doing this is that I have a free-lance gig to write a series of articles for the Healthcare Financial Management Association and I need to research the original source material. But my real reason is that I want to stop socialism. I want to take our country back for real Americans. And I want to prevent the federal government from touching Medicare.

But ... I have a problem. The more of the actual legal language I read, the more things I find that sound down-right reasonable. For example, the larger of the two bills (Pub. L. No. 111-148) does the following in just the first section after the table of contents:

- prohibits lifetime and unreasonable annual limits on coverage
- prohibits cancellation of policies except for fraud or intentional misrepresentation
- requires insurance to cover preventive health services
- extends dependent coverage of unmarried children to age 26
- requires uniform explanation of coverage documents
- prohibits discrimination in coverage based on salary (big wigs can't get better care)   
- requires effective appeals processes for denial of coverage
- requires insurance companies to report the percentage of premium dollars they actually spend on paying claims (instead of on administrative costs and profit).

Here are some other things that caught my eye:

• Sec. 1201 prohibits discrimination based on preexisting conditions and guarantees that coverage will be available to everyone.

• Sec. 1251 preserves my right to keep my current health plan if I want to.

• Secs. 1301-1343 provide money to the states to form their own state-run or nonprofit insurance "exchanges" to offer basic insurance that wouldn't otherwise be available.

• Other parts of the law improve coverage of Medicaid for poor people, link Medicare payments to quality outcomes, and set up various studies and demonstration projects (such as on quality issues, training of healthcare workers, and prevention of chronic disease).

• There are 120 pages on "transparency and program integrity," which essentially means prevention of fraud and abuse.

• Sec. 6703 is an entire new law called the Elder Justice Act to protect against abuse, neglect and exploitation of the elderly.

• And there's a voluntary insurance program in Secs. 8001-8002 for "community living assistance services" (essentially, home care for people who need help with the normal activities of dailing living; i.e., the elderly and disabled). This includes advice on decision making at the end of life.

Aha! Finally! When I read this last item I thought I'd struck gold: "Death panels! They're going to kill granny!" But then I read the fine print. It just says someone will be available, when requested, to advise about options such as living wills, health care proxies and advance directives. Drat! That's nothing new; people get that information already in Patients' Rights brochures and elsewhere.

So I'm bummed out. I can't find a communist conspiracy anywhere. There is, to be sure, a lot of technical, financial stuff about taxes and reductions of payment rates to doctors and hospitals. The Congressional Budget Office says that to cover an additional 32 million people will cost a bit more than $900 billion over ten years and that there are cuts and taxes and fees that will cover that amount. They also say the law will reduce the deficit by $124 billion over ten years compared to what it would have been. All of these estimates assume the laws will remain unchanged over the next decade, which of course they won't. I'm not qualified to assess the CBO's work. I know that Republicans take issue with it and Democrats agree with it. It really doesn't matter -- reform is a done deal. It'll get tweaked, but like Social Security and Medicare, it's now part of the fabric of our country.

But in the meantime, I will keep digging. Marx or Lenin or Castro or Mao must be behind this plot somewhere, and I'm going to find out where.

And don't forget: KEEP YOUR DAMN GOVERNMENT HANDS OFF MEDICARE!