Gridlock

My friend stopped by yesterday.  He succeeded in getting his disability.  Take this with a grain of salt, since I'm no doctor, but he's certainly no more disabled than my wife who suffers (at times quite literally suffers) from neck and back pain, the causes of which are visible even to a lay person looking at an x-ray, and the scars of three very expensive surgeries to prove it.  He was disappointed that he wasn't awarded all the "back" disability pay, but nevertheless seemed quite pleased with himself, like someone who had won a battle of wits.   He also gets his medical care from the VA, and takes some very heavy duty prescribed pain meds, which no doubt helped along his disability claim.

He is, of course, a republican, in part because he is a self-professed "evangelical," and evangelicals are, well, republican in this day and age.  He would vehemently deny that he is a "practicing" socialist -- that is to say, he tacitly approves of "democratic socialist programs" because he is taking benefits from at least two such government run, tax-supported programs -- and, indeed, has said that "Clinton is a socialist" in much the same way that he would say "Clinton is shit," with the same expectoration of the sibilants, with the same expectation of self-evident evil.  I don't want to make too much of my friend.  He is not as smart as he thinks he is, and he completely lacks a sense of irony when it comes to self-knowledge, but he is typical.

The resentment I feel toward him stems, not from his receipt of a government benefit, but from the fact that he gets it, through persistence and subterfuge, and my wife doesn't.  She has more severe disability, and spent longer in the military, and I do -- just can't help it -- resent the fact that she "qualifies" for neither disability nor VA benefits.  Part of the issue results from the very notion of "needs" or "means" testing.  On the former, of course, having some form of "needs" testing is inherent to "disability."  I resent the fact that he was able, through a government sponsored program, to have his "need" tested and presumably affirmed, but we cannot afford to have the procedures necessary to demonstrate my wife's "need."   The PET scan would cost about $5,000, and that assumes we can "shop around" and get the best price. The other day, she suggested a "divorce," not because she wants to end the reality of our 30 year marriage, but because, as a single woman, she would be "destitute" and qualify for medicaid.

As I said, the resentment I feel toward him stems, not from his receipt of a government benefit, and I am not qualified to judge whether he actually "deserves" the benefit or not, but the invidious comparison.   I do believe -- and I say this without irony or shame -- that health care should be a "universal right" or entitlement.  I am more than willing to pay my share of taxes to support it.  As I've said, contrary to the republican claims that America is one of the highest taxed nations on earth, we are one of the lowest.  I can only speak for myself when I say that I would be willing to pay more if I received comparable benefit in return.   Unless, of course, there's some form of complete social collapse, comparable to the great depression and the second world war, we'll never get there from here.   No matter how much I support Bernie Sanders, Katie was right when she asked him how he would get past a grid-locked republican congress to get anything like a "universal" system in place.

Beyond that, my resentment stems from our "gridlock" with the health care systems.  We applied for health insurance, per state law, through Your Health Idaho, our mandated state exchange.  We received confirmation of our application for insurance through Select Health, our private provider.  The long and short of it is this:  Your Health Idaho claims to have sent the necessary information to Select Health.  Conversely, Select Health claims they did not received the "correct" information.  Your Health Idaho, the state agency, will not contact Select Health to determine the correct information, saying "we have done everything we can."  Conversely, Select Health cannot contact Your Health Idaho to "inform" them of the missing or incorrect documentation, ostensibly because the state agency will not speak with them, and so claims "we have done everything we can."  In the meantime, of course, we are without insurance.  We cannot even pay the full freight on the insurance. Select Health simply would not do so for reasons that were incomprehensible to me.   In the meantime, we are without insurance.

I wrote to my congressman, Mike Simpson (R).  Although I received a call almost immediately from his staffer, requesting that I fill out a privacy release, this is ultimately what I received from him:

March 28, 2016

Dear Dr. Picard:

Thank you for entrusting me to assist with your case.  I am glad to have the opportunity to provide assistance to you.

I have contacted Your Health Idaho on your behalf.  Although, I cannot guarantee a particular outcome, I have asked the agency to address your concerns in a fair and timely manner and to send a written response to my office.  In order for the agency to give your case the proper attention it deserves; please allow at least thirty (30) working days to receive a response.  If a response is not received in that timeframe, my staff will contact the agency for a status update on your case and will keep you informed on the matter.

In the meantime, if you have questions or additional information, please feel free to contact Linda Culver at (208) 734-7219 or send written correspondence to my Twin Falls office at 1341 Fillmore #202, Twin Falls, Idaho 83301.

Once, again thank you for bringing your concerns to my attention.  I look forward to working with you to resolve this matter.

Sincerely,

Mike Simpson
Member of Congress

To be honest, I didn't expect much more, but "30 days" with no "guarantee [of a] particular outcome?"  Let's be honest, he is a republican.  He opposes "obamacare."  His answer to health care reform goes something like this:

I strongly oppose Obamacare and have voted over 50 times in Congress to repeal it. I also strongly oppose Congress receiving a special exemption from Obamacare. That’s why I cosponsored the bill to repeal Nancy Pelosi’s special deal for Congress. I will continue to the fight to repeal Obamacare. We need real reform of our healthcare system, and Obamacare doesn’t do it. As Congress continues to look for ways to delay, defund, alter, and repeal provisions of this devastating law, we must not stop exploring ways to improve both the quality and cost-effectiveness of our health care system. Medical malpractice (tort) reform is an idea that most Americans support that would bring down health care costs for taxpayers and improve access to care. Our current system increases costs both directly, in the form of higher malpractice insurance premiums, and indirectly, in the form of defensive medicine—when medical services are prescribed primarily to avoid liability rather than for the benefit of the patient. Placing reasonable limits on health care litigation would help reign in these costs and protect quality of care.

I'm not sure how limiting the way in which common people, like thee and me, can sue for medical malpractice will make all the changes needed to our health care system.  I'm can see that it might reduce the cost of medical malpractice insurance to providers, but unless the "tort reform" also carries provisions mandating that those "savings" be passed along to the consumer, I don't see how it benefits thee or me.    I DO see how it might improve the profit margin for corporate providers.  

Insofar as "defensive medicine" goes, I would agree that there are some medical procedures that are purely CYA, but let's look at it slightly differently -- as "thoroughness."  Given the fear of litigation, doctors are as "thorough" as possible in their approach to patient complaints, perhaps to the point of over-zealousness in their "thoroughness."  I don't see how "thoroughness," even "over-zealousness," itself is a bad thing.   I DO see how tort reform benefits corporate medicine, reducing insurance costs while allowing them to act with greater impunity and cut back on care given less fear of litigation.  I guess I'm not "most Americans" because I don't really support tort reform, and even view it with some suspicion because I don't see how it alone "protects quality of care."   I DO, however, see how it might diminish quality of care.  In the meantime, we are without health insurance.

Again though, its not substance, but tone.   I would absolutely agree that "we need real reform of our healthcare system, and Obamacare doesn't do it."  I believe we need a universal, single payer healthcare system.   In the meantime, we are without insurance, not because Obamacare is a "devastating law."  Indeed, if the state exchange worked the way it is supposed to work, we would indeed have "affordable" health insurance.  I suspect, however, that Your Health Idaho has not been set up to succeed.  In this staunchly republican state, I suspect, rather, that it has been set up to fail, and I suspect this, as one small piece of evidence, because wait times on hold approach an hour every time one calls, and the poor person on the other end of the line is not empowered to do anything except say "I understand how you feel" and "we've done everything we can."  I suspect that Mike Simpson, along with the state legislature, absolutely want us to be "pissed off" at the government enough to agree that we should what?  dismantle it?  Finally, I suspect that Mike Simpson, along with the governor and state legislature of Idaho, would rather see the law fail, not because it provides no benefit to the people of this country -- it could and does elsewhere -- but because ... well, really?  why is it so "devastating?"  I have heard the assertion, but I have not seen the evidence.  I would love to have an answer to that question.