Warring Holiday Billboards

War On Christmas Spreads To Lincoln Tunnel - Heard this story on NPR today. I thought it was a fun piece, well done. Both sides got to express opinions. And I'm pleased to note that so far (at least, based on what I've seen), the whole argument between the "Merry Christmas" and "Happy Holidays" factions seems to be lower-key and less rabid than it was a year ago. Maybe both sides are painfully aware that we have bigger things to beat each other up about...

Anyway, here are my thoughts on the competing billboards.

Gambling With Insurance

Let us ponder the concept of insurance.

The way I figure it, humans long ago figured out life isn’t fair. A guy spends a whole season cultivating his crop, and then it gets washed away by a flood just before harvest time. Lightning strikes a thatched roof and a family’s home burns to cinders — but the house across the lane, made of exactly the same stuff, is untouched.

After a few millennia of this kind of thing, somebody came up with an idea for easing the random cruelties of fate. Maybe this person addressed a council of tribal elders, or maybe he went door to door explaining his plan. “We don’t know where lightning will strike next,” he may have said, “but if everybody puts one guilder in this strongbox, we’ll have enough money to build a new house for the one who gets hit. Just think, it could be you! Wanta buy in?”

I Miss Mexico

It’s been there all my life, just across the Rio Grande. A good day’s drive from any town I’ve lived in, but a heck of a lot closer than New York or Washington, D.C.

Come to think of it, I’ve never been to D.C., and all I’ve seen of New York is the inside of an airport. But I’ve been to Mexico lots of times.

I’ve shopped and dined in border towns, built sand castles on a Yucatan beach, explored pyramids at Chichen Itza, ridden a train into the Copper Canyon, visited a Tarahumari village, taken my car on the hand-pulled ferry at Los Ebanos, and hung out in a cantina in Boquillas del Carmen, next door to Big Bend National Park. Have you heard Robert Earl Keen’s song, “Gringo Honeymoon”?  That’s exactly how it was.

Texas Politics Makes NY Times

I'm still not ready to ruminate on the meaning and possible effects of last week's election. But Health Beat has had a few things to say. Today's post is about Texas! ... as described in the New York Times ... which reprinted a story from our own Texas Tribune. Ah, the Internet!

Here's a link to the original article.

Coming Into Los Angeles

Here in America, the election is over. In general, it seems that the loudest and shrillest voices won. I haven't begun to make sense of it all. So just for today, I'm sharing a piece that's not at all controversial, and is, I hope, just fun to read. Enjoy.

My spouse thinks he’s in an Arlo Guthrie song. He has never been to southern California, and I let him sit by the window so he can see the huge expanse of the city and its unending suburbs as we come down from the sky. I’m not a fan of big cities. I’m pretty sure I wouldn’t want to live here. But still, it’s something to see. I remember the first time I flew into this town, some twenty-five years ago. It was twilight. Strings of light crisscrossed the landscape like gold necklaces. Then we dropped a little lower, and I saw that each of those gold chains was a twelve-lane freeway.

There’s no such view for my husband’s first visit. Los Angeles is socked in, and we see nothing but clouds. Reasonably clean clouds, from the look of them. Maybe this is honest weather, and not just smog.

Health Reform for Small Business: Burden or Blessing?

Can’t find it right now, but I recently got a piece of campaign mail that claims the health care reform act puts “onerous requirements on small business.” And the U.S. Chamber of Commerce is running an ad that slams a Colorado Congresswoman who voted for the act, “crushing small businesses with billions in penalties.”

Politifact pretty well debunks that claim by pointing out:

-       Businesses with fewer than 25 employees will not be required to offer health insurance or penalized for not doing so.

-       But if they do, many will be eligible for tax credits to offset the costs. Those credits are available now. Here’s more information from the IRS. 

Okay, there’s some paperwork involved. (Isn’t there always?) But on the whole, it seems to me that this bill should be a boon to small business.

If they aren’t providing health insurance to their employees now – and many of them aren’t – I don’t think it’s because they don’t want to. It’s because escalating prices have made it impossible.

The Customers Insurance Companies Don't Want

From 2007 through 2009, our four biggest health insurance companies refused to sell policies to one of every seven applicants … on account of pre-existing medical conditions.

These were people who didn’t have access to group plans, who attempted to buy coverage on their own. (An estimated 15.7 million American adults are covered by individual policies.) In the three years mentioned above, these four companies rejected 651,000 potential new customers. One company had a list of 425 diagnoses that could be used as grounds for refusal.

During the same period, the companies denied 212,800 claims from customers who had “exclusions” on their existing policies.

Early Medical Adventures

When I was three years old, I survived cancer: a rare type of kidney tumor found only in children. My chances, in 1959, were not good. But my doctors gave it everything they had. They removed the right kidney, sewed up the hole that went halfway around my torso, and followed up with radiation. It worked. I'm still here. And I still have the scar to remind me.

Several years ago, my mother was cleaning her attic and found the receipt for that hospital bill.

It was $1,000. Today, that kind of money might not even get you in the door. In 1959, it paid for a major operation, nine days in the hospital, 40 radiation treatments, and heaven knows how many doctors and nurses and lab technicians.

And for that, our health insurance company kicked me off the family policy.

Pre-Existing Conditions, Part 2

see Part 1

There was a time, 30+ years ago, when a “pre-existing condition” clause in a health insurance policy did not seem unreasonable to me.

I’m working from memory here, looking back to my twenties, when I was just out of school and starting to make my own way in the world. I had a few jobs that offered group insurance, and I recall shopping for an individual policy when they didn’t. At that time, premiums weren’t altogether out of reach for a healthy person with a paycheck.

I’m sure I read at least one plan that excluded coverage for pre-existing conditions. Fair enough, I thought. For the likes of me, that might mean I broke my leg or caught strep throat the week before the policy was in effect. Of course the insurance company wouldn’t pay to treat an illness that didn’t happen on their watch!

Back then, I viewed illness and injury as temporary things. If they didn’t kill you, they could be cured, and then you could get on with your life. I had no concept of injuries that result in long-term disability; of chronic diseases like diabetes that require lifetime management and care.

Pre-Existing Conditions, Part 1

As of two days ago, most health plans will not be allowed to deny coverage or limit benefits to children on account of pre-existing conditions. More information

This is one provision of the Affordable Care Act that I’m really glad to see. I just wish it would kick in sooner for grownups. We have to wait until 2014 to get the same protection.

And of course there are politicians who think that mandated coverage of pre-existing conditions is a crazy idea, that it will put insurance companies out of business. In a recent speech, Mike Huckabee made a crack about trying to buy auto insurance for a car that was already wrecked. Months ago, when the health care bills were being debated in Congress, I heard Senator Ron Paul argue that nobody would sell homeowner’s insurance for a house that was on fire. I can’t give you a direct quote, but he finished up with something like: That’s not how insurance works. If we’re going to make them do that, maybe we should call it something else.

He may have a point, which I’ll explore in a moment. Before I go any farther, however, I should note that members of Congress and other federal employees have access to a range of health insurance plans, none of which have waiting periods or exclusions for pre-existing conditions.

Religious Tolerance (?) in America

Since the Mayflower landed at Plymouth Rock, the country that we now know as the United States of America has been home to people who felt strongly about religion. The spiritual descendants of those early colonists are here today, along with a number of people who feel very strongly against religion. I suspect it’s all part of the same phenomenon, two sides of the same coin. So perhaps the seeds of our current discords have been there from the beginning.

Maybe Americans have always been incapable of believing anything in moderation. Dare I suggest that in this way, we are more like the people of the Middle East than we are like the people of Europe?

I mention Europe because the early settlers, the founders of those 13 colonies that would become the United States, came from there. I know, of course, that there were people here before the Europeans showed up; and people of all sorts have come from many other places in the intervening centuries. Still,  much of what we used to call the “dominant” culture came from the colonists' European roots.

Lately I've thought maybe there was a fundamental difference in those Europeans who crossed the water to put down roots in the New World. I’ve seen some museum exhibits; I have a vague idea what trans-oceanic travel was like in those days, and it was no picnic. It took serious motivation to get on those ships, to leave behind the known world and venture into the new as a colonist, an explorer, a missionary. Every one of those people must have had an extraordinary need to conquer, some fervent belief, or a high sense of adventure; and perhaps some were so persecuted that they simply couldn’t stay where they were.

One could make the argument that everyone in Europe who had a capacity for living in moderation stayed home. Maybe that's why public discourse on religion is so much livelier in the U.S. than it seems to be on the other side of the Atlantic.

... although France's recent action to ban burqas appears to have ignited some sparks. More on that next time, perhaps.

On the Subject of Burning Books

Book burners give me the creeps.

I’ve been following the story of Terry Jones, the Florida preacher who announced plans to observe 9/11 with a “Burn the Koran Day.” As I write this, he appears to have called it off, but he may reconsider. I don’t know what he will do. But it gives me hope to see the range of people, from all areas of the political and religious spectrum, who have stood up and objected to his planned demonstration. Here’s a sampling:

A preacher on Fox News
John Kelso in the Austin American-Statesman
The Huffington Post
An Evangelical Christian website

Personally, I think book burners are about as low as the human race can go.

Of course, you’d expect to hear that from me. I’m crazy about books. I have three 8-foot bookcases in a fairly small house, a short pile of books on my nightstand, and more books in boxes that I can’t figure out where to put. I’ve loved books since I learned to read. Maybe even before that. I still have a few of my childhood favorites, and I treasure those books. I love them as much as I loved any pet I’ve owned. I know, in my rational mind, that books are inaminate objects. Just ink and paper, not alive and capable of loving back like a cat or a dog. But they’ve kept me warm through many a cold and lonely night. They contain characters who live in my imagination, and speak the wisdom of authors who are long gone, but in a sense immortal, because their words are still here.

I myself am an author. I have some idea what it takes to bring those words out and set them to paper. Writing a book is a lot like giving birth -- except that in my case, the gestation period was considerably longer.

I don’t have much respect for people who ban books. They do it, I suppose, when they don’t want others to find out what the book-banners don’t want them to know; or they don’t want others thinking what the book-banners don’t want them to think. Book banners are an affront to the American ideals of free speech and free expression.

Book burners have the same desire to squelch knowledge and expression, but they’re more into drama and violence. They don’t simply want to ban a book; they want to obliterate it. To take those words that someone composed with so much thought and turn them into smoke. To make sure that nobody will discover that book, years from now, in an attic or a library stack or a quirky used bookstore. They want to silence the voice, kill the ideas, and sear the flames into the public mind, in the hopes of sending a message to anyone who might dare to pose an unorthodox idea in the future.

Let me be clear here. I'm not talking about legal rights. If this preacher in Florida decides to go ahead with his Koran-burning, he has the right to stage that demonstration. Provided, of course, that any books destroyed were owned by the people that brought them to the fire. That means bought and paid for, or otherwise legally acquired. If they are snitched from libraries or bookstores, or taken by force from Muslims on the street, those who profess to be Christians need to review the Eighth Commandment.

When There's No Insurance...

I know a married couple who are getting along without health insurance and say they prefer it that way. They don’t get sick often. When they need a doctor or medical treatment, they pay cash. They don’t carry any kind of insurance, except on their vehicles (being working musicians, they do spend a lot of time on the road.) These folks have made no secret of their views in recent months. They believe insurance is a dirty game, and choose not to play it.

I can respect that. My own feelings about the insurance industry aren’t exactly warm and fuzzy. If I had to sum it up, I’d sigh and say, “Can’t live with ’em; can’t live without ’em.”

But I know plenty of musicians, artists, and small-business owners who don’t have health insurance. In most cases, I don’t get the idea that they are happily paying cash for their medical expenses. They simply avoid going to doctors. They don’t get checkups. If they get sick, they try folk remedies or just wait for it to go away. And if, God forbid, they suffer a serious injury or an illness that can’t be cured with a few cups of herb tea, they go to the emergency room. Where they often get decent treatment. And then their friends get together and organize a benefit show or a silent auction to help them pay the bills.

In the past twenty years, I’ve attended more of these benefit events than I can count. I’ve served on organizing committees, donated items to auction, and been a performing act at one or two. Musicians in my community spend so much time playing benefit shows for free, I wonder how they make any money at all. But most are glad to do it, when asked. They know that, fate being what it is, it could be their own bills that need paying next time around.

I used to think of all this as an informal support network for people who were “outside” the health care system. But two years ago, as my spouse and I were discussing how much we could afford to donate to a friend who fell off a horse and broke herself in several places, it hit me that I’d been looking at it wrong.

It takes a great deal of time and energy to stage a successful benefit. With few exceptions, all that work is done by unpaid volunteers. And folks, this is PART of the system.

I’m lucky enough to have health insurance, but it doesn’t come cheap. My employer pays most of the premium. I kick in a share for my dependents. And over the years, in order to keep us insured, I’ve made some choices I wish I hadn’t had to make.

There are people who are much worse off than I am, and some of my tax dollars are used to provide health care for them.

And then our crazy, dysfunctional system counts on me and the rest of my crowd to dip into what time and money we have left, to take care of people who fall through the cracks: the hundreds of thousands of Americans who can’t afford health insurance (or can’t buy it at any price) but are too well off to qualify for public assistance.

Ah, well. For your friends, you do what you have to.

But wouldn’t it be better if all the people you care about could afford their own health care, and you could show your friendship by dropping off a casserole or offering to mow the yard while they’re laid up?

Health Insurance at Work

I’m one of the 158 million Americans who get health insurance through our jobs. My plan is a decent one. I like my primary care physician, and she’s good about referring me to a specialist if I need one. Seven years ago, I faced a life-threatening condition that required major surgery. I got excellent care, and my insurance paid what it was supposed to without giving me any grief.

You may say, “Gee, texaslupine, you’re one of the lucky ones. Why would you want to mess with a system that’s working for you?”

Because even from where I sit, I can tell the system is broken.

Two weeks ago, I compared our current health care mess to a slow-motion train wreck. Let’s say I’m riding that train, in a Pullman car close to the back end. Somewhere up ahead, my train has collided head-on with another in the middle of a high trestle. Both locomotives are doing a swan dive into the gorge, with cars careening off behind them. The car I’m riding in is still on the tracks –- for the moment, anyway -- but there’s no reason to think it’ll stay there.

I’m a State of Texas employee. I’ve been with the state nine years. Before that, I spent a few years on staff at The University of Texas. Which means that since 1996, I’ve had health insurance through the Employees Retirement System. I know it’s a valuable benefit, way better than a lot of my friends have. But still, I’ve seen that benefit erode over time.

• When I worked at UT, and when I first signed on with the state, employees had a choice of health plans. Everyone had access to the self-insured plan administered by Blue Cross/Blue Shield, and depending on where a person lived, there might be three or four HMOs available. Nowadays, there may be one HMO in a given area; in many parts of the state, the self-insured plan is the only choice.
  
• In my job at UT, I was amazed to find that health insurance was in effect on my first day. Other places I’d worked had a waiting period of one to six months before new employees could enroll. Well, state employees used to be covered from day one, but not any more. New people coming in have a three-month waiting period. This doesn’t affect me personally, since I’m already in the system. But it’s another example of benefits being gradually chipped away.
  
• Earlier this year, state employees were notified that our health care plan was out of money and might be forced to make some changes. I was invited to fill out a survey, which basically presented a range of unhappy options and asked me to pick the ones I hated least. The result? Our monthly premiums will increase next month, and so will our co-pays for doctor visits, hospital stays and prescription drugs. And the ERS website ominously states, “More changes will be necessary in the near future.”

Yes, and with all the recent news about state budget cuts, there’s no guarantee that I’ll even have a job two years from now.

Somewhere out there, I hear the faint sound of a violin playing “My Heart Bleeds…” Okay, I’ll stop whining, and I really wasn’t asking for sympathy. I just wanted to share a story that is, I believe, representative of what’s happening everywhere. I suspect all Americans are paying more for less coverage than they were ten years ago.

… that is, if they can get any coverage at all. We’ll talk about that next time.

Health Care Reform: The Individual Mandate

When health care reform takes full effect in 2014, nearly everyone in the United States will be required to carry some kind of health insurance.

I have mixed feelings about this.

From a philosophical standpoint, I don’t like it. My gut says nobody should be forced to buy something, especially if he has to buy it from a private company. And since the “public option” got dropped along the way, that’s what many of us will have to do.

On the other hand, I can see that reform won’t work unless we all participate. Under the new law, insurance companies will no longer be allowed to deny coverage on account of pre-existing conditions or kick customers off the plan for getting sick. This is a huge improvement. Over the past decade, when I’ve thought about all that needs fixing in our current health care system, that thing about pre-existing conditions tops the list.

There are economic realities in this equation. A recent post on HealthBeatBlog explains it well:

"If the law didn’t insist that everyone have 'minimal coverage' (or pay a financial penalty), many young, healthy Americans might well wait until they were injured, or seriously ill, before signing up for a policy—safe in the knowledge that no insurer could refuse them, or charge an exorbitant premium. If that happened, insurers would find themselves covering a pool made up largely of the elderly, the disabled, and the chronically ill. Premiums would sky-rocket. If we are going to try to provide health insurance for all citizens, the healthy must join the pool…."

So, despite my distaste for the mandate, I support the health care act. And I confess that somewhere in the back of my mind, I’m hoping this will eventually work itself out. If the law works the way I hope it does, if it forces insurance companies to be better corporate citizens, if health insurance becomes more affordable and works better for the people who have it, maybe it will come to be seen as something everybody wants and needs, and a mandate will be unnecessary. Perhaps the changed playing field will give rise to non-profits, co-ops, or new types of health care/health insurance providers we haven’t even thought of yet.

There are some big “ifs” in those scenarios, but I can dream, can’t I?

In Defense of Health Care Reform

My home state, along with a dozen others, is suing the U.S. government over the Patient Protection and Affordable Care Act.

Yes, I’m talking about Texas, Our Texas, the place where I was born and raised. A state where one in four people has no health insurance; a state that’s home to more uninsured people than any other.

I don’t mean to say I just found out about this. The suit was filed last March, the same day President Obama signed health care reform into law. But I just got around to reading the 23-page document last night. Clearly, the chief attorneys for all these states are hoping to get the act thrown out before it fully takes effect.

Come on, people. The system we have isn’t working. Why not give this new law a try?

As I see it, the current state of health care in this country is a slow-motion train wreck. I’ve watched for twenty years at fairly close range: as a consumer of health services…a breadwinner with responsibility for other household members…a friend of working musicians who have played countless benefit concerts for sick and injured colleagues who can’t pay their doctor bills. It’s a tangled mess that ruins lives and warps our whole economy. And it’s steadily getting worse.

I have a lot to say about various aspects of this imbroglio. I’ll share some in future posts, and hope to get some additional comments from readers. For now, I’ll just say this:

If I knew how to fix health care, I’d have typed up my plan and sent it to our last four presidents. So I’m not going to point fingers at the members of Congress who spent a year debating this legislation, tweaking its provisions, making deals, and finally getting it passed.

I don’t agree with every single provision in the act, but I think there’s enough good stuff there to make a start on fixing some very thorny problems. I’m more than willing to give it a chance.