Showing posts with label Political positions of Sarah Palin. Show all posts
Showing posts with label Political positions of Sarah Palin. Show all posts

Sunday, January 16, 2011

Do You Want to Live Forever?

I've long been an avid reader and watcher of science fiction. There are lots of movies and books that deal with immortality: Highlander, Zelazny's This Immortal, Haldeman's Buying Time, Blish's Cities in Flight, much of Varley's and Niven's work, and pretty much any vampire story.

Who wouldn't want to live forever?

To tell the truth, a lot of people. Old, sick, lonely people.

Several years ago my wife's grandmother was in a nursing home. She was 96 years old, unable to walk, going blind, going deaf, and always in pain. Her husband was dead. All her friends too. She had outlived her eldest daughter. Even the small town where she'd lived most of her life had disappeared. She was all alone. So at one point she just gave up and died.

Until then I never understood why characters in immortality novels so often got weary with living forever. It seemed so unrealistic and stupid to welcome death. But I was looking at it from the viewpoint of a young, healthy person. Who wouldn't want to to live forever if you're strong and vigorous?

But that's not how it works. We weaken and decline as we age. Seeing through the eyes of my wife's grandmother, I finally understood. We slowly lose everything: friends, family, strength, mobility, vision, hearing, taste, control of our bowels. Sure, you can struggle on life support for years, live in pain, or have your mind dulled by drugs, or perhaps worse, lose it completely to Alzheimer's. But why?

Last year the big flap over the health care bill was over death panels. The term itself was an outright lie. There were no death panels in that legislation. It was a provision to pay physicians for an end-of-life discussion with patients. Something that every elderly patient is going to have with their physician in any case, and something that was actually allowed for in previous legislation. It basically gave doctors a charge code for the discussion so that it could be properly accounted for, rather than bill it under some other category.

But real death panels do exist. One of them is the Republican-run government of Arizona. Jan Brewer signed a law cutting Medicaid payments for seven types of transplants. Two patients have died since the law went into effect in October, likely because of they were denied transplants.

And that's not the only death panel. Health insurance companies have life-time limits on the number of dollars patients can receive. The committees of the private companies that set these limits are death panels that decide who lives and who dies.

When you apply for insurance the company has a panel that looks at your medical history and decides whether they'll accept you. If you have any untoward risk factors -- say, you have cancer or need a heart transplant -- this panel of health insurance company employees will deny you coverage. In effect, sentencing you to death.

But wait, there's more! Other death panels include the statisticians who look at medical costs and decide what the premiums will be for insuring employees of small businesses. By putting these employees into their own tiny risk pools, they guarantee that the premiums will be high -- usually too high for most small businesses to afford, thus locking them out of health care coverage. If you work for a small company and have a disease, the insurance company will sentence you to death by making the premium too high for your employer to pay. Big employers can often avoid detailed scrutiny and all their employees get accepted automatically

That's the reality of health care today. We have private companies making for-profit decisions on who will live and who will die. The company can either cover thousands of additional families or pay the CEO a billion dollar stock bonus.

And when these private companies ditch you, who picks up the slack? Well, the federal government. When you're sick and destitute enough you'll qualify for Medicaid and you may be able to get some help. Unless you live in Arizona and need a certain type of transplant.

My point here is not really to slam Brewer for making hard choices on who lives and who dies. The cuts in Arizona may well be right thing to in the grand scheme of things. We only have so much money to spend on health care, and we've got to spend it on things that do the most good for the most people. Transplants are expensive and very often not successful, especially when there are other underlying risk factors, as is the case with at least one of the patients who died in Arizona. Transplants require that you live the rest of your life with a depressed immune system to avoid rejection, which is a time-bomb in itself.

I'm slamming the hypocrisy of people who railed against the health care bill and are now vowing to repeal it without offering any replacement. The core of the bill is common-sense provisions that Americans want: no limit on life-time payments, preventing insurance companies from denying coverage for preexisting conditions, preventing companies from dropping your coverage when you start getting expensive, and being able to get insurance if you lose your job.

The problem is paying for this. During the health care debate the Republicans refused to engage in any reasonable discussion of how to finance it. They ignored the nuance and subtleties of the problems that Brewer is facing now in Arizona. They made the public option -- obviously constitutional, since it's just a tax -- politically toxic, making it impossible for many Democrats to go along with it. Their only goal was to hand Obama a big fat defeat.

The Republicans need to stop playing political football with our lives and our health, and get serious about health care reform. Pretty much all Americans think we need the protections mentioned above, no matter what they think about the health care bill itself. You don't like being forced to buy insurance? I don't either, but someone's got to pay for it. Mitt Romney used to understand this, before he started running for president.

Right now we're paying much more for our health care than other countries do, for worse outcomes as a nation. People don't get regular care for problems as they arise. They wait until problems become critical and put them in the emergency room, which is ridiculously expensive. At which point their health is compromised and they'll have ongoing costs that will be much higher than if they had dealt with the problem in the first place. This is especially true with the epidemic of obesity and diabetes going on now.

The system is broken. There's too much overhead, mostly concentrated in the health insurance industry. We don't really need dozens of armies of private-sector beancounting middlemen to "manage" our health care system, especially when their interest isn't in actually cutting medical costs, but rather to get a percentage of an ever-growing pie. (Many of these companies are forming vertical networks, providing insurance and care. Which means they now have no incentive to cut costs).

The biggest problem with the health care bill is employer mandates, not the mandate that everyone get health insurance. It's just an accident of history that companies used health care as a cheap recruiting gimmick in the 50s. Employers don't pay for our food or housing (unless we're CEOs), why should they pay for our doctors? We should all be responsible for our own health care, as we are for other necessities. This would also put everyone should be in the same risk pool, since we'd all be directly insured instead of being segmented up by employer. Relieved of the direct burden of employee health care, companies should pay a tax to keep premiums lower for everyone, and to pay for Americans who can't buy their own insurance. The rate should be based on the amount of harm their industry causes to the health of their employees and Americans at large. McDonalds, Coke and Pepsi would have a real incentive to make healthier products. And Phillip Morris? Well, the handwriting has been on the wall for years.

There is at least one positive aspect to the Republican push for repeal and the individual mandate. It makes it that much more obvious that single-payer is the only logical way to do this. The Obama administration shied away from it because they wanted to the get the insurance companies on board. But in the long run I think everyone realizes single-payer is going to happen. It only makes sense. And it already exists for senior citizens, even though so many of those Tea Party protesters yap about keeping the government's hands off their Medicare.

Do we want to live forever? It's a moot question at this point. Our health care system should be focused on providing the longest, healthiest lives for the greatest number of Americans. We should all be paying for it because we're all using it: kids breaking their ankles skateboarding, young women having babies, annual medical and dental checkups. Everyone catches colds and needs vaccinations.

And at the end of it all death panels of neither government bureaucrats nor money-grubbing corporate execs should be deciding grandma's fate. She should be making her own decision with the advice of her physician.