Monday, August 17, 2009

Why I Support Something That Doesn't Yet Exist, or, Me And Obamacare

I have been surprised by the crude language and lies being put forth to attack "Obamacare," the as-yet unnamed and undefined amalgam of no less than five separate bills in the House and Senate that may or may not ultimately provide universal health coverage to most Americans, depending on what it looks like when it comes out of committee and gets voted on, with or without various amendments that may further water it down, if it gets voted on before next year's mid-term elections.

Whatever is currently happening in American politics, America itself is not poised on the precipice of great reform. Health care in America is not going to substantially change any time soon. But you wouldn't know that from watching television:

or reading various newspaper accounts of Obama's "dishonest," "judgment"-ridden program menacing America with roving "death panels" managing euthanistic, abortion-happy "death lists."

Excepting the New York Times' excellent work uncovering the outrageous and opportunistic roots of said "death panels," I've felt frustrated with the national reaction to the wild spectrum of anti-Obama rhetoric informing this "debate."

First, President Obama has not written any bill. His office supports no individual plan. Instead, Obama has set out a series of broad principles that he'd like to see Congress enact, however it best sees fit.

As has been widely reported, Obama learned a lesson from watching President Clinton fail to pass universal health care, and has instead requested that Congress create, debate, revise, and vote on its own variety of bills. Various bills still exist in various stages throughout Congress; there has been no formal vote on one bill in both houses of Congress. When the various current proposals eventually reach the intra-Congress committee, there will be further debate, revision, creation, and voting, after which one (or more) bill(s) will reach both floors of Congress, where there will be further debate and, finally, a vote.

In other words, Congress is doing its job as the legislative branch of our government. It is writing bills.

And Obama is sitting back, offering advice, working behind the scenes. He will eventually either sign or veto whatever bill does reach him, if one does at all.

Presidents and their staffs no doubt work the backroom scene, cajoling and glad-handing with the intention of influencing the various legislative acts. So do lobbyists. There are currently 6 health-care-specific lobbyists for every 1 member of Congress in Washington, D.C.

Think about that for a second: 6 to 1. For each state, that's one basketball team per Senate pair. For New York, that's an entire NBA conference of lobbyists working House members.

Americans should be concerned that so much corporate lobbying influence will dilute the final bills that come out of the Congress.

Instead, it seems, somehow, the outrage is directed at the Congressional members who, it is often implied, hate freedom and conspire in secret to somehow take away government health care coverage from some by extending it to all Americans:

or who conspire to empower Nazis:

or who look to hurt the elderly while giving young girls free abortions:

or who look to deny health care to Americans who need it:

or who want to kill any and all of the above:

To whom is this misinformation and fearmongering helpful? How does it add constructively to the important national debate that we should be having?

I should practice what I preach, right? Okay, here goes:

I'm 32 years old. I was born with bicuspid aortic stenosis. That means that my aortic valve doesn't work properly. Instead of three healthy valve flaps, it has two imperfect ones. Over time, that valve continues to narrow and work less well. As it does so, the aorta compensates by swelling in size. As the valve narrows and the aorta swells, my heart will work less well. Eventually, I'll have to have open heart surgery, at least once in my life (depending on the longevity of the artificial valve they put in to replace the original, and the little sleeve of fabric they use to reinforce my aorta).

Since birth, I have seen a cardiologist at least annually, often semi-annually. Last week, I visited my cardiologist, Dr. Hunt, a rock star Stanford Cardiology doctor who's one of the best in her field. I feel incredibly lucky to have Dr. Hunt currently overseeing my care. I get to see Dr. Hunt because I work at Stanford and I have HMO health insurance through Stanford, for which I pay about $300/month. I bring my records since childhood. She orders some tests, interprets them, and we talk about my long-term prognosis (so far, so good). My condition requires biannual check-ups with expensive tests that include echocardiograms and stress test echos. In the past, with health care that required me to pay 10% of my visits, the bill ran $800-$1,400 as my portion per visit. Expensive stuff.

I cannot get individual health care in America. Likewise, I can't get individual life insurance. I don't quality for either, because I have a pre-existing condition. That I was born with. I didn't develop it and I can't control its progression. All the same, call Blue Cross, Anthem, Kaiser, et al, ask for a health insurance policy and then say, "oh by the way, I have congenital aortic stenosis." No dice.

I'm well-educated and I'm good at finding jobs with group health coverage. When I needed to take some personal time two years ago, I was able to pay for COBRA coverage to extend the time until I got back on my feet.

The things that bugs me, personally, is that I can't imagine what someone in my situation, who doesn't work at Stanford, and/or who doesn't have health care coverage, and/or who has poor coverage, would do. Probably get really sick and then either die or cost a city hospital millions in lost expenses to do dangerous, end-of-life surgery from which s/he may not recover. That someone can be born in America with a condition that requires so much attention, and not be able to get it because s/he can't afford it, strikes me as unfair and short-sighted.

Regular check-ups are expensive, time-intensive, and require meticulous follow-up. Open-heart surgery is very complicated and expensive. It requires a lot of recovery time and follow-up, as well as medications and regular check-ups to make sure everything is working okay, and continues to work okay. And, ideally, you want someone really good at heart surgery to, you know, cut open your chest and tinker with your heart.

I believe in the potential of my country to solve problems, from work programs to social security to veterans' benefits to institutional care for the long-term unwell. Health care costs are a short-term problem, and in the long-term so is the staggering absence of a health care safety net for those who need it most. Having many uninsured Americans who do not treat small problems leads to many uninsured Americans who must treat big problems. It's like the story of the guy who busts his arm, doesn't get it fixed, eats lots of Advil, damages his liver, and ends up in the hospital looking for a donor, a surgeon, a nutritionist, and a welfare officer. All on the government dime. Small problems, left untreated, get big.

Let's have a real debate about real issues. I'm a big Obama fan, and I trust my president to make good decisions as the chief executive. At the same time, I appreciate and understand that others may not. So, let's hash out the issues, rather than score cheap political points:

And let's not get mired down in the muck of hypothetically intellectualizing the real issues we face today, so much so that we grind to a halt and get nothing done. In the words of a great American president, FDR, "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little."

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