Robert Switzer

Health Care

During the late 1990’s and the early part of this decade, my parents were finally beaten down by long-term chronic conditions. They died. I was their intermediary with the health-care system. They had Medicare, a paid Medicare supplement they could barely afford, and at the end, Medicaid. It wasn’t enough, and their care was compromised as a result.

In 2006, my wife was diagnosed with a potentially life-threatening condition. She’s all better now, but the experience was instructive and expensive. And we were well-insured, or so we thought. It was the quest for more-better health insurance that drove me back to work after the bracing autonomy of retirement.

I’m now a pubic employee, a member of that great big union the conservatives love to hate, and because of the collective bargaining agreement negotiated by this union, I have premium health insurance, a guaranteed payout pension, and a measure of job security virtually unheard outside of the C-officer suites and boardrooms of today’s corporations. Yet even though my coworkers enjoy all of these same benefits, including the premium health insurance, many if not most of them are in alarmingly poor health.

Citizens of the United States aren’t at the top of the list of the world’s healthiest people anymore, and an inadequate and over-priced health care system is part of that problem, but not all of it.

If you find yourself without health insurance, do whatever you need to do to get some. Sell the pickup, tap the 401-k, get a second mortgage and a third job, whatever. Providing of course, that a policy is available for you at *any* price. Not having insurance can be fatal. Being poor can kill you.

When I was growing up, like most working-class families, we went to the doctor when we were sick. We went to the dentist when we had a toothache. If we couldn’t see the blackboard at school, we got glasses. My parents, in order to make these visits possible for my brother and me, did without themselves.

I was seriously ill a couple of times as a child, and I remember that the entire process was stage-managed by a general practitioner, who coordinated and explained everything.

When my parents started to get seriously sick, I had to run interference for them with the health care and social services bureaucracies, and the first thing I learned is that nobody coordinates anything. You are totally on your own. And if you’re not proactive, or God forbid, if you’re an elderly person without an advocate, your care is going to suffer and ultimately, so will you.

At the Medicare end of the spectrum, a lot of sick people are competing for relatively scarce healthcare resources. Not all doctors see Medicare or Medicaid patients, and the ones who do usually aren’t the best resources available.

My parents relied on the health care infrastructure of the decaying mill-town ten miles down the road. The mills closed up and moved out in the 1970’s, leaving their aging former employees with a legacy of chronic health problems. My parents didn’t work in these mills, but my paternal grandfather and many of my aunts and uncles did. And almost all of them died from the kinds of chronic lung conditions endemic to the textile industry.

The children of these mill workers, or the luckier ones not imprisoned in the service and retail ghettos, now work primarily in health care, the only growth industry that pays, left in the wake of industrial decay and abandonment. Except none of them are doctors. They fill the more menial roles, while the doctors are largely graduates of medical schools in Mexico, Central America, India, and The Philippines. Are these doctors competent? Who knows. They are the only game in town.

I remember taking my mother to one of these Medicare Mills for the first time, and walking into a dirty, crowded waiting room full of people with chronic respiratory problems. A security guard in a blue blazer and name tag stood in the hall. After 40 minutes, we saw the doctor, a south-asian, and the exam was cursory, at best. The whole office appeared harried and over-worked.

And this office was the rule, rather than the exception. The process of dealing with the various providers was fraught with error and miscommunication. Follow-up was necessary for each and every item. Conflicting appointments and appointments at impossible hours, missed tests, misplaced test results, a reluctance to do hospital admittance and attempts to discharge from hospital sick, elderly people too weak to care for themselves were common.

Threats and even yelling were sometimes necessary to eke out a bit more care, or a higher quality care for my parents. But the sad thing is I know that every advantage I was able to secure for my parents probably came at the expense of other poor elderly without advocates.

If I could have pulled my parents up out of that mess and possibly prolonged their lives, I would have. But by the time I became involved in their care, it was already too late. They’d been misdiagnosed, over-medicated and under-treated for too long. And there *was* nothing else. It was Medicare Mills filled with indifferent and marginally competent foreign-trained doctors. Or nothing.

My Father died from complications related to lung cancer in a Medicaid nursing home bed November 8, 2001. Patients with his diagnosis and better care often live five to ten years. He lived three. My Mother died from complications related to COPD and emergency room error March 25, 2002.

My wife is also a public employee, and at the time of her diagnosis, she was carrying the health insurance for the entire family, a policy that is generally perceived as one of the best you can get. As we started making the rounds of the doctors, it was immediately clear that we were at a different tier of the health care system than the one my parents were forced to occupy. The doctors were graduates of US medical schools. The waiting rooms were both less crowded and cleaner. And the doctors were more available to talk at length about prognosis and treatment.

Yet the whole process was still largely self-service. We gleaned the majority of our information about my wife’s condition and treatment options from the Internet, and leveraged this information with the health care providers we were using to improve care quality and options. And we still had to coordinate tests, follow up for results, and double-check for errors and omissions. Once again, if you just passively take the default in all the interactions without questioning and following up, your care will suffer.

And from the very beginning, there were ominous financial rumblings. It was made crystal clear immediately that any amounts not paid by insurance were due and payable immediately, up-front and prior to treatment. At this point, we found out that the first $5000 would be out-of-pocket. Luckily, we had a flexible spending account, and were able to distribute this out-of-pocket expense over an entire year, and pay it with tax-free dollars. And ultimately, it cost a lot more than $5000 to satisfy that requirement, as many of the things we had to pay for out-of-pocket didn’t count toward satisfying this out-of-pocket minimum.

But the major shock came when we realized that there was a chance my wife could be disabled by her condition, and unable to continue working. In which case, she’d have no health insurance, and she’d either have to continue her coverage via COBRA, which is extremely expensive and is only temporary, with an 18 month cap, or we’d have to buy private coverage, which was unlikely to be available at any price, given that my wife would have been disabled. A disability retirement with pension and Social Security Disability with Medicare would be an option in this situation, but this takes years to apply for and get. And of course, the rest of the family would still be without coverage.

Luckily, the doomsday scenario didn’t happen. My wife continued working, with health insurance, through her treatment. But it was a major wake-up call.

If only one member of your family is carrying insurance for all of you, what happens if this person gets sick? What happens if they are disabled? That’s the question that sent me back to work. Now my wife and I both carry full coverage on each other, so in the event one of us becomes too sick to work, or loses a job, there will still be uninterrupted coverage. And health insurances can be set up as primary and secondary, with charges not being paid by the primary policy falling through to the secondary coverage for payment.

Short-term disability coverage, which was a part of my compensation package with a private-sector employer (albeit a very good one)
twenty years ago is no longer available, even in a public-sector unionized environment. If you get seriously ill and need to be off work for three to six months, and you don’t have the sick-time saved up, you’re just shit-out-of-luck. So now I also carry a private short-term disability policy that will pay me 75% of my salary if I’m disabled for 30 days up to two years.

Granted, it’s expensive and redundant; a belt-and-suspenders approach. But the consequences of *not* having medical coverage and income when you need it, unlikely as this may be, are too dire to contemplate.

So, what’s the solution? Two words. Single Payer. Nationalized health insurance for everyone, with an enhanced social safety net to cover short and long-term disability, as well as long-term and systemic unemployment and underemployment. Universal health insurance will benefit the poor and working poor, obviously. But it would also act as an engine fueling innovation, as a major operating expense for small and medium-sized companies would be eliminated.

But great universal health insurance, disability, and catastrophic employment-change insurance is only part of what’s necessary to bring the United States back up to world-leadership in citizen health and well-being.

Let’s go back to my new coworkers in the public sector for a minute. These are folks that already have much of what I think all of us deserve. They have good job security, great health benefits, and a pension to buttress Social Security in their old age. Yet many of them are in startlingly poor health. Most are significantly overweight. Many still smoke in middle age, and eat an extremely poor diet.

The diet, the smoking, the overweight are in large part due to ignorance as a result of inertia and social and media conditioning. Fast food tastes good, and is advertised ad-infinitum. Cigarette advertising is now illegal, but 007 smokes. I also suspect busier schedules, an inability or unwillingness to cook, combined with an over-reliance on pre-packaged food. Trans-fats and high-fructose corn syrup are culprits too, I think. And there is a justified mistrust of the medical profession — if you’re unsophisticated enough to take things at face-value, and you’re too timid to bark back, anything can happen. Diagnostic screenings and early detection efforts often seem arcane, painful, and unnecessary, especially if you’re feeling OK.

But yet, it’s the diagnostic/preventative stuff that keeps you well and really pays off in terms of extended years of quality life. I had a colonoscopy myself last year. On an unpleasantness scale of 1-10, prepping for the colonoscopy is a 10. Yet the procedure is invaluable in heading off colon cancer. In my case, I had a benign polyp in my ascending colon. Maybe nothing would have come of it if it hadn’t been removed. On the other hand, if it had turned malignant, by the time I had sensed any symptoms or discomfort, it would have been way too late.

It takes education and awareness to convince people that the most productive visits to the doctor are the ones you make when you’re *not* sick. Many of my coworkers aren’t getting routine physicals. They’re doing what we did in my working-class childhood. They’re not going to the doctors unless/unitil they’re sick. And by then, it’s usually too late. A chronic condition has already taken hold and is irreversible.

Education about the importance of diet and exercise in long-term health needs to be stressed, and coupled with a new regulatory structure with teeth. Poisonous foods, sham diets, snake-oil health claims, and sales of products that damage people or make them sick need to be stopped.

The social interface to the current health care system sucks, sucks, sucks. Three people I work with are diabetic. Our medical coverage *pays* 100% for diabetic testing devices and consumables, yet all three until recently were either paying $200 out-of-pocket a month for these supplies, or doing without them, simply because no one was able to tell them that the Durable Medical Equipment benefit, which is administered separately from the health coverage proper paid for the meters and the test strips. What they needed was a meta-interface that straddled all the care available and could direct them quickly to the appropriate resource for their needs. I suspect in my organization, health issues go under-treated, and insurance resources go under-utilized simply because people don’t know *how* to intelligently apply the resources they have.

I get really pissed every time I see a billboard, advertisement, or slick PR magazine handout from a health care institution. I say *fire* the marketing vice presidents, drain the ad budget, and spend that money on making sick people well. Spend that money on project managers/caseworkers/coordinators for people who don’t have the resources to do this for themselves, because God only knows, you need it if you’re going to get decent care.

After nearly fifteen years of dealing with the health care and social service bureaucracies, I can say with 100% assurance that the system is definitely, irreparably broken beyond fixing. Greedy insurance companies and for-profit healthcare have got to go if the United States is to regain world leadership in terms of citizen health and well-being.

Where will the money come from? We’re already spending more per person than most of the world. We simply need to redirect more of the money to care that matters. Fire the CEO’s and marketing vice presidents. Let the Doctors run the show. And then there are taxes. I suggest we start with private equity firms, hedge funds, and their traders/managers. These people by and large profit from a zero-sum speculative game that drains public companies and pension funds of resources while creating absolutely nothing of productive value. If these ill-gotten gains can be confiscated, and better yet, if the whole thieving business category can be taxed into oblivion, so much the better.

Civil rights groups filed a suit with German prosecutors on Tuesday seeking war crimes charges against outgoing Defense Secretary Donald Rumsfeld for the alleged abuse of detainees at Abu Ghraib and Guantanamo prisons.

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Bill Maher just outed the head of the entire Republican Party, Ken Mehlman, as gay on CNN’s Larry King Live. See the video.

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My gaydar is definitely broken. I had no idea. Though when I broke the news to my wife, it was clear to me from the look on her face that I was probably one of the last to know …

Mehlman has been conspicuously absent from post-election coverage. I wonder what he’ll do, though there aren’t many options. He can either come out, or deny he’s gay. This is just too much fun. I predict I’ll be spending way too much time in front of the TV soaking up all the post-election coverage …

I’ve taken more than one cheap shot at Ted Haggard, and I’ve enjoyed more than one joke at his expense. And I’m not alone. A lot of people have had a lot of laughs at Pastor Ted’s expense.

According to reporting this morning on CNN, Ted Haggard will soon begin a 3 to 5 year process of ’spiritual renewal’. This process will include counseling, confrontation, and ‘the rebuke of godly men’.

What is going to happen to Ted Haggard now is no joke. Run Ted Haggard, run. Listen to who you are and heed what you know to be true about yourself and put as much distance between yourself and these people, these ‘godly men’, as you can.

Because these ‘godly men’ are going to beat you down until you choke on a bolus of your own self-loathing.

And I wouldn’t worry about going to hell, Pastor Ted. Because if you put yourself into the hands of these people, you’ll already be there.

Anyone remember when the Bushies called Rumsfeld Rumstud?

After 9-11, Donald Rumsfeld’s astringent, decisive, clear, no-nonsense platform manner certainly impressed. Like his pal Dick Cheney, Rumsfeld was someone who definitely looked and sounded as if he knew what he was talking about.

Shortly after that, I remember reading about Rumsfeld’s ambitious plan, called ‘Transformation’, that was designed to totally change the military from a slow, bureaucratic industrial-age behemoth to a light, fast, smart information-age force.

As I read about ‘Transformation’, I kept getting deja vu. I’d read it all before. The smaller-lighter-faster rhetoric read a lot like contemporary management theory, the kind of stuff written by business gurus like Tom Peters.

In a previous post, I talked a bit about how much Rumsfeld, Cheney, and the entire Bush entourage resembled the current state-of-the-art in corporate top management. It was all there — the imperial arrogance, the absolute refusal to acknowledge even obvious error, the magical thinking, the isolation, the yes-men echo chamber. And of course, they also exhibited the will to play as dirty as necessary to advance their pet agendas.

None of this should come as a surprise as Rumsfeld, Cheney and company had spent a significant portion of their lives as top executives of large corporations. And it’s equally unremarkable that the corporations led by these men were part of industries with significant government insulation from the vagaries of the free market these same men seem so rhetorically fond of.

In large, static bureaucracies such as large government contractors, pharmaceutical companies, and think tanks, the core competency is looking right, sounding right, and having the ability to vanquish and marginalize internal rivals.

And ole Rumstud was good at all of the above. Along with pal Cheney, he was able to slap down Colin Powell and contain Condoleezza Rice.

Unfortunately though, ole Rumstud finally found himself in a position where he would have to produce a specific, unambiguous result. And no amount of handwaving could get him off the hook, though it wasn’t from a lack of trying.

He still looks and sounds as if he knows what he’s talking about. Only now, even the dumbest among us recognize that the man is stone cold incompetent. A general who served under Rumsfeld put it this way, “Rumsfeld is incompetent tactically, strategically, and operationally”.

What the country needed during Rumsfeld’s tenure was a Secretary of Defense who could produce a specific, tangible result. And that result was quickly and decisively winning a war with a minimum loss of life — specifically the lives of our brave soldiers, but also the lives of innocent civilians.

In achieving this specific, tangible objective, Rumsfeld failed decisively. And now he’s gone, but I can’t help thinking about all the people who took responsibility for Rumsfeld’s actions in his stead, in the most personal and costly way imaginable — with their lives.

Montana, Missouri and Virginia are still uncalled. But the noxious Rick Santorum is history, at least for now. And the Democrats control the House Of Representatives. I’ll take that. It’s bedtime.

Yet another creepy, repressed, hypocritical, closeted right-wing evangelical Christian homosexual is exposed to the light of day. And this time, the person in question is the pastor of one of the largest evangelical Christian super-churches in the nation, as well as being the head (no pun intended) of an influential group of evangelical Christian pastors.

He’s been fired from his job, and of course all of his contemporaries are rapidly distancing themselves, while appearing to remain sympathetic.

Time Magazine last year called Pastor Ted one of the 25 most influential evangelicals in the country, someone who had the ear of President Bush. Someone who was in regular communication with the President via a weekly conference call.

I find it hard to suppress the contempt I feel for people like Pastor Ted, and by extension, the people who take him seriously, accept what he says, and most importantly, give him money.

Yet this very contempt feeds into and strengthens the virulent and toxic mimetic virus that fuels both the evangelical Christians and the authoritarian right.

Here is a link to a chilling excerpt from the Richard Dawkins BBC Documentary ‘The Root of all Evil’. In this excerpt Pastor Ted and Richard Dawkins square off on the Bible and on evolution.

Pastor Ted demonstrates complete ignorance about the mechanism of natural selection in evolution. Dawkins calls him on it, and Pastor Ted counters with one of the uglier and more virulent memetic weapons in the evangelical arsenal. He accuses Dawkins of being an arrogant intellectual looking to denigrate the beliefs of ordinary folks, People Of Faith.

Meanwhile, Pastor Ted also claims that the Bible contains ‘no contradictions’, a position that anyone who has actually read the Bible knows to be patently false.

Everybody’s entitled to an opinion, right? And Pastor Ted’s opinion is just as good as Richard Dawkin’s, right? So by pointing out that Pastor Ted doesn’t know shit about natural selection and evolution, and is in fact misleading his congregation about the nature of each, Richard Dawkins is exhibiting arrogance and disrespect for these just plain folks, these ‘People Of Faith’.

In my last post, I wrote indirectly about the cultural backlash that seems to be fueling both the growth of evangelical Christianity and the authoritarian right.

A large part of this backlash is fueled by what the constituents of this backlash believe to be a tyranny of false expertise that mitigates against all claims to specialized knowledge, valid or not.

So, by extension, all expertise is ‘just an opinion’, and just like assholes, we all have one. And Richard Dawkins, one of the most influential evolutionary biologists in the world, has no more authority with these people to speak on evolution than Pastor Ted.

We just finished watching ‘The Staircase’, a documentary about the high-profile murder trial of novelist Michael Peterson. Directed by academy award-winning filmmaker Jean-Xavier de Lestrade, the film documents both the trial itself and the initial preparations by both the defense and prosecution.

The film is chilling in it’s depiction of a gross and cynically orchestrated miscarriage of justice perpetrated by the corrupt police, vindictive district attorney, and the backward, narrow-minded and ignorant citizens of Durham, North Carolina. I’ll cheerfully add this city, and perhaps the entire state of North Carolina to the growing list of places I’ll never visit.

We watched a porcine district attorney and his assistant, a screeching fishwife with an outlandishly bad makeup and fashion sense, drone portentiously about homaseckshuls and pure-dee filth. But more than that, we saw yet another righteous attack by the god-fearing silent majority against what they perceive as the tax-hiking, government expanding, latte-drinking, Volvo-driving, New York Times reading, body-piercing, Hollywood loving, God-mocking left-wing freak show.

Michael Peterson, a wealthy, urbane, sophisticated and cultivated man, had the double misfortune of losing his beautiful and loving wife to a tragic accident at home and then being mis-cast as a murderer and falsely convicted on limited evidence by a prosecution willing to stoop to the very lowest depths to play to the very worst instincts and prejudices of what might as well have been a rural, small-town jury.

Peterson, a successful writer, was forced to spend over $800,000 to defend himself against malicious and trumped-up charges entered against him by a vindictive and deeply bigoted prosecution. He was then convicted of first-degree murder in the absence of a murder weapon, witnesses, motive, or any compelling forensic evidence. In North Carolina, the penalty for first degree murder is life in prison without possibility of parole. Today, Michael Peterson is in prison, where he has already been hospitalized as the result of an assault by other inmates, and where he will remain for the rest of his life.

Michael Peterson wasn’t convicted of something that he’d done. He was convicted of something he might have done, could have done, or possibly wanted to do, based on who the prosecution and jury considered him to be. He was convicted because of who he was, and the atypical life that he led.

Michael Peterson, born in 1943, was the son of a career military officer and moved around quite a bit while growing up. In the early 1960s, Peterson studied political science and was editor of the student newspaper at Duke University in Durham NC, graduating in 1965 with a degree in political science.

Peterson dropped out of law school and took a job in 1966 researching arguments in favor of increased U.S. military involvement in Vietnam. The research led to Peterson’s four-year enlistment in the Marine Corps, He later saw combat in South Vietnam.

After the war, Peterson worked as a government consultant and lived overseas for 11 years.

In 1989, the Peterson family moved to North Carolina. Between 1983 and 1998 Peterson published three novels informed by his experiences in Vietnam: “The Immortal Dragon,” “A Time of War” and “Charlie Two Shoes and the Marines of Love Company.”

Peterson’s books received little critical acclaim, but they enabled him to buy a large house at the corner of Cedar and Sycamore Streets in a wooded, upper-middle class Durham neighborhood. Peterson continued researching and writing fiction while writing a column for the local daily newspaper, the Herald-Sun.

In the mid-1990s, Peterson met Nortel executive Kathleen Atwater, and her teenaged daughter Caitlin. Peterson’s children say they accepted Atwater because they saw a love connection between their father and Kathleen that their parents never had.

Leveraging the name recognition he had from his books, his community involvement and newspaper columns challenging the Durham establishment, Peterson made an unsuccessful run for mayor of Durham in 1999. In his columns and during the campaign, Peterson pointedly challenged both the Durham District Attorney’s Office and the Durham Police Force.

The Petersons were relaxing and enjoying a few drinks on a Saturday night in December of 2001. Sometime after Saturday night became Sunday morning, Kathleen decided to go to bed, while Michael stepped outside to check the pool lights. As she started up the narrow back stairway, Kathleen, tipsy on valium and wine and wearing flip-flops, tripped and fell backwards down the steps, hitting her head multiple times on the door jam and steps as she went down, resulting in several bloody scalp wounds. As she attempted to right herself, she slipped on her own blood and fell a couple more times, further injuring herself. Michael Peterson found her an hour or so later on his way to bed, and immediately called 911.

The medical examiner on the scene ruled the death an accident, but by the next day, the Durham police department had characterized the accident as ’suspicious’, obtained warrants, searched the Peterson residence during Kathleen Peterson’s Wake, and removed 66 pieces of evidence, including computers and data.

The Durham Police have a richly deserved reputation for incompetence and corruption. Witness the latest Keystone Kops escapades surrounding the alleged rape of a stripper by members of the Duke University lacrosse team. If a rape actually occurred, the slipshod investigative practices of the Durham police would frustrate bringing any actual perpetrators to justice.

As a journalist working for the Durham Herald-Sun, Michael Peterson was highly critical, often abrasively so, of the Durham District Attorney’s office and the police force.

Michael Peterson was also a known bisexual, apparently preferring male prostitutes for casual sexual contacts, while maintaining a loving and mutually satisfying relationship with his wife and immediate family, who were aware of his extra-marital activities and sexual orientation.

The Durham police, who probably had anecdotal evidence of Peterson’s bisexuality, wasted no time in going public with the details of Peterson’s sex life as it was verified by the data and email on the computers collected during the search of the Peterson home.

But even though it was proven that Peterson infrequently had sex with male prostitutes on a pay-to-play basis, no evidence of any kind was introduced that would indicate a love triangle between Peterson, his wife, and any other person, either male or female, that would serve as a motive for homocide.

The issue of Peterson’s bisexuality was cynically introduced by the prosecution as a manipulative device to shock and prejudice the jury against Peterson and the defense.

Homosexuality, real or perceived, is the new race-baiting. Witness the 2004 election. Gratuitous anti-gay marriage legislation was introduced on ballots in key swing states to mobilize a base of conservative evangelical voters known to be sympathetic to the Republican Presidential ticket.

The Peterson trial represents one of the most egregious, unvarnished and ugly examples of bigoted and ignorant backlash against an innocent person who had the misfortune or audacity to be different than or threatening to a socially conservative status quo.

The big question in my mind is why the ordinary people on the Peterson jury, and to a lesser extent, the ordinary people in the Durham Police Department and District Attorney’s Office felt so threatened by the mere existence of Michael Peterson that they were willing to ignore the rules of evidence and the obligation to impartiality that comes with jury duty, not to mention common decency to railroad a man who had already suffered one of the most damaging losses a person can experience. Michael Peterson will be in prison for the remainder of his life.

Onetime Republican presidential candidate Gary Bauer explained it to The New York Times like this: “Joe Six-Pack doesn’t understand why the world and his culture are changing and why he doesn’t have a say in it.”

Thomas Frank, who is considerably younger, smarter, and better looking than I am has a partial answer to this question in his books ‘The Conquest of Cool’, and ‘What’s The Matter With Kansas’. He’s currently working on another book, due out in 2008, that further explores the question. I’ll be delving some into his take on backlash, as well as my own in future blog entries.

The world is beginning to doubt the moral basis of our fight against terrorism, said Powell, who served under Bush and is a former chairman of the Joint Chiefs of Staff. To redefine Common Article 3 would add to those doubts. Furthermore, it would put our own troops at risk.

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When he announced last week that he would be transferring 14 alleged al-Qaida terrorists from secret prisons and that the “tough” methods employed by the CIA had pried loose valuable intelligence from the suspects,” President Bush also unveiled a bill to set up military tribunals to try the prisoners. This bill is more than meets the eye.

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