Responsibility and the Structure of Government
Continuing Catharsis Week, my colleague Steve Pizer and I wrote a Kaiser Health News opinion column that appears today. In it we note the rare demonstration of responsibility of congressional Democrats and the Administration that brought us so close to health reform. Then we explain the forces that contribute to the scarcity of responsible government and to the near collapse of the health reform effort. Just a taste:
Our system of government is designed to produce an abundance of great speeches about sweeping reforms and a pittance of actual reform delivered. So, except for frustratingly brief moments, we really have no government, just a collection of perpetual campaigners, focused on the next election and accepting no responsibility for the country’s long-term problems. In 2009 it was comforting to believe that the leaders of the majority party would use their power to govern responsibly. They tried and failed. The campaigners have taken over, again.
Please read the whole thing.
Though I agree with what we wrote, I’m still disappointed in Democrats for not (yet?) finishing the job they started. The design of our government certainly makes it far harder for leaders to govern responsibly. I get that. But I’m not willing to give the Democrats (or Republicans) a free pass. Perhaps it is because some of them certainly appeared to want to do the right thing. That gave me hope. Then it was crushed, maybe to be revived once more (I still can’t tell).
The last time I was so disappointed in a political party and a president was when George W. Bush took us to war in Iraq. Like the abandonment of compressive health reform, that too was an unnecessary and costly decision that resulted in loss of life. It is hard to forgive, and harder yet to forget, leaders who trade blood and treasure for political gain. I understand why they do it. I just don’t like that they do so. I never could. And that’s why I do what I do and not what they do.
But few of us are 100% free of responsibility and power, small though it may be. Most of us can vote. We can also write or talk to our representatives and/or their staff members. We can demonstrate, volunteer, and contribute money. In small ways we can do something toward making our dysfunctional government and the actions of our leaders ever so slightly better.
Last week I called my Democratic congressional representatives and urged them to continue to fight for health reform. (You can too. Here’s where to find contact info.) If I perceive for a moment that they are not seizing opportunities to make progress on coverage and costs they will lose my full support, and possibly all of it. The same goes for our president.
I don’t expect to have my way on every issue. I understand political realities and the limitations of our government. But I do expect my representatives to do their job within the constraints of our system. When, despite the incentives for irresponsibility, there is a chance to do the right thing, to begin to address a pressing national problem, and when the (super) majority exists to carry it out, then it should be done. On health care it wasn’t, or hasn’t been yet. Democrats defeated themselves once last week. But it is within their power to change course. If they throw in the towel for good that will be a loss for which we will all pay.
Rant Week Special: Autism Edition
There are good political and policy reasons for Congressional Democrats to pass the Senate Health Care Bill, hopefully with a reconciliation “sidecar,” but without one if need be. But I have a personal reason for my desperate wish to see the Senate Bill enacted. My daughter has autism.
In most states, including my home state of Washington, it is legal for insurers to discriminate against autistic insureds by excluding or severely restricting necessary therapy for their condition. For example, we are eligible for reimbursement of only sixty therapy visits a year under our current insurance, a fraction of the over two-hundred that our daughter needs.
Providing adequate therapy and meeting the other medical needs of her condition costs us around $20,000 per year out of pocket. This is on top of the more than $1300 monthly premium that we have been paying through COBRA for our otherwise pretty good, non-profit public-employee health plan since my wife left full-time employment with the state to work part time from home as a contractor in order to spend more time caring for our daughter.
When COBRA runs out, however, we will be in a far worse predicament. Our current plan at least covers diagnostic medical services for the team of doctors, nurses, and psychologists who help to design our daughter’s treatment and manage her medication, as well as for costly genetic screening and other testing to examine potential causes. But the group policy that my law firm provides to its employees has even more restrictive limits on therapy visits and diagnostic coverage.
And because I am a partner in my firm (and thus a self-employed part owner of the business), I would have to pay the entire $1800 monthly premium, which has been rising annually by double-digit percentages even as benefits have deteriorated. Plans in the individual market cost less, but they offer little in the way of autism benefits when they offer any at all.
The Senate Bill would outlaw autism insurance discrimination nationwide by requiring that autism coverage be included in the basic benefits package. Without it, I truly do not know what we will do when our current coverage runs out.
You Bet I’m Angry
I’ve been holding back a bit lately. I haven’t clearly expressed how I feel about the importance of reform and the relevance of its demise. That ends now. This is Catharsis Week at The Incidental Economist and I’m letting my feelings show.
Actually it started yesterday, vicariously though a guest post by Jack Rodolico, my brother-in-law. In his post Jack tells the story of his wife’s battle with a chronic illness and a health care system that isn’t helping her deal with it. This is a true story and one I’ve witnessed first hand. It illustrates a key purpose of health reform, to relieve the suffering and struggle of many like Christina who cannot obtain insurance and the access to care it facilitates.
I will be deeply disappointed and angry if the possibility for relief for Christina and millions like her is cast aside by Democrats who won’t take one vote. I share Jack’s pain, anguish, and frustration:
I am frustrated by the Democrats, who supposedly had 90% of the bill figured out months ago. They squandered their time in disagreement, completely unable to compromise in a timely manner.
I am disgusted by the Republicans, who made a tactical decision to oppose health care reform as a means of grubbing for power.
I am disappointed with the President, who should still be out there selling and campaigning for health care. In fact, he never should have stopped after he made his address to Congress back in September.
As Aaron Carroll wrote last week, this is not a game! For Jack and Christina and countless others this is not about politics. This is real life.
This isn’t a game; it never was. Like it or not, the problems in the United States health care system are real. I have cared for children who have – literally – died because of bad insurance or no insurance. I have personally known people who have lost everything because of a medical tragedy. And I swear to you, these illnesses involve children who were not lazy or shiftless or deserving of these problems in any way….
Next week we’ll have a pretty good sense of whether or not this bill will pass. And whether it does or not, I will keep on [fighting for reform]. If it fails, nothing will have changed. If it succeeds, there will still be much to do.
I won’t celebrate a “win”. This isn’t a game. And if the bill fails, so be it.
I just wish so many of you weren’t so happy about it.
To those of you who may be hoping for or (prematurely?) celebrating defeat of health care reform as a “win,” what is your solution? What do you say to Jack, Christina, the children Aaron Carroll sees? What if those individuals were your family members? What if you are the next one to lose a job, your insurance, to be hit with a chronic illness? What is so horrible about the Democrats’ proposed reforms that justifies denying so many so much? Where do we go from here on coverage and costs?
Or are these not important questions for you? Is it all about the win? About denying Obama a successful first year? About the midterms? After seeing what lack of ability to obtain insurance can do to an individual I cannot fail to be disgusted with that perspective.
In the coming weeks and months I’ll channel my anger into more constructive analysis and thoughts. I’ll cool off. I’ll get back to trying to suggest improvements to the politically possible. Right now I’m angry. The politically possible seems to be shrinking dramatically and quickly and for reasons I cannot yet accept. And neither can people like Jack and Christina. Nor should they.
A Political Amputation
This is a guest post authored by Jack Rodolico, a graduate student with College of the Atlantic in Bar Harbor, ME, focusing in environmental journalism. Though most of his stories for the Mount Desert Islander newspaper involve local marine issues, he also writes short stories and non-fiction essays. This is non-fiction.
My wife has a chronic health condition for which she needs constant, expensive care. The disease squirmed out of some dark hole and bit her and now she will sting for the rest of her life. She needs it all – pills, X-rays, doctors, specialists (insert “expensive doctors”), therapies, acupuncture, special foods, and maybe surgery someday. Big time surgery. Removing a major organ surgery. She is frequently in pain. On a scale of 1 to 10, I once saw it hit a 12. And then there’s the blood.
She is 27 years old.
Life is unpredictable and not necessarily fair. We can both accept this, even with a smile. What we cannot accept is a system of governance that has the power to help us, but is impotent because of its disorganization and discord.
I am not one to blame government for all my problems, or to say that government can or should fix all problems. But I am cognizant of the fact that health care cannot be fixed without major government intervention. Consider my wife, Christina.
Christina cannot get health insurance. We are too “rich” for Medicaid, we are too poor for private insurance. We are so deep in the middle we cannot get to either shore. If we get poorer, she could get Medicaid; but who would accept that as an option? If we get richer, we could afford health insurance; but this, too, is unlikely because at the current rate her medical debt is increasing we will most likely continue to break even. Besides, she has a preexisting condition, which means the health insurance companies won’t even let her in the door. Both of us are trying to finish a graduate degree to improve our job prospects, but this puts us deeper into debt (good debt, right?) and further away from health care we can afford. Plus, nowadays she cannot hold onto a job because of her erratic health status. This makes the option of employer provided insurance out of the question until her health stabilizes, if it stabilizes. If it were not for some very good luck and the financial support of family, we would be totally screwed – I imagine there are a lot of Americans who are.
And there we were – all of us – on the verge of a major health care overhaul. Something that would benefit those of us who are being torn in half by the system, who are being hustled like a kid in a pool hall. And what happened? Well, one Senator was elected – 1 out of 100.
At first I was disappointed, but after marinating I am angry. Not with the Senate race, that is. I honestly don’t care much either way; politics is, after all, a pendulum. I am utterly fed up with a system that can so easily cast aside what is necessary for so many people. I am fed up with everyone, from the top to the bottom.
I am frustrated by the Democrats, who supposedly had 90% of the bill figured out months ago. They squandered their time in disagreement, completely unable to compromise in a timely manner.
I am disgusted by the Republicans, who made a tactical decision to oppose health care reform as a means of grubbing for power.
I am disappointed with the President, who should still be out there selling and campaigning for health care. In fact, he never should have stopped after he made his address to Congress back in September.
I am appalled by the media, who by and large try to report simple facts before the competition does, or to report with more bells and whistles. Right now the media should be flooding the airwaves with stories about people who will get left out in the cold by anything other than aggressive reform. Instead they just report on what this Senator said, or what the President hinted at. They keep a scorecard.
I am fed up by a political system that is so dysfunctional that it can neither operate with a super-majority or with a balance of powers. Both political parties – Democrat and Republican – are endlessly posturing and jockeying for the next election. Everything they do seems to be either a desperate grasp for more power, or a pathetic attempt to hold onto it. The notion of compromise in order to come to a common solution is an abstraction to them, a lofty goal they talk about but never seriously work towards. And what is the result? One Senate seat – a single seat! – switches hands, and an entire year’s worth of deliberation, hard work, and the energy of a thousand suns is all extinguished by a tiny splash. I know that one seat represents more than one vote in many ways, and so it is not just one seat that changed hands. But that we allow it as a culture to represent so much is precisely what I am so fed up with.
And finally, I am really fed up with us – the American people. Are we really that short-sighted, that a few extra months of debate led to rampant uncertainty about the viability of a health care overhaul? Are we going to allow health care reform to sparkle and fade, leaving plenty of people far worse off than Christina to sit back and watch the market “fix” the problem? Is there a pill to cure our cultural ADD?
I don’t know – I’m still bewildered by the whole thing. Maybe something good will still come of this, whether in the near or distant future. But what it seems like now is that if Christina and I try to find her health insurance tomorrow or in a year, we will be in the same position we are in now. As I see it, there is very little I can do to change this.
With one exception, that is. Next time around, I am voting for a third party candidate. I hope we all come to our senses and use a scalpel to amputate our diseased political organ before my wife decides to excise her colon.
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