Tuesday, September 13, 2011


I watched the Tea Party/CNN sponsored debate of the GOP presidential hopefuls last night and something profound may have happened.  Political theory and Tea Party character came face to face with real life.  Wolfe Blitzer posed a question to Ron Paul, the libertarian, in the context of the “obamacare” mandate requiring all to carry health insurance. “What should be the policy if a 30 year old male, who thought he was healthy and would not need insurance, and was allowed to opt out of insurance, had a serious health problem and was in a coma for 6 months in a hospital”? Paul, true to the libertarian view, said that individuals should take responsibility for their own health care and have insurance. The follow up question: what then should we do, let him die?
The most telling response from many more than a few in the audience was a shouted chorus of “let him die”.
Even Paul, a physician, was taken back and he responded,” no, when he practiced medicine back in the 60’s at a faith based hospital, the church took care of the expenses.” 
Aside from Paul’s living in the wrong century, where hospital stays cost far more than it did in the 1960’s and most charitable care hospitals have been bought out  by for profit large administration systems because they could not afford to provide charity care or raise enough money to do so, everyone there missed the most important point:
30 million people are left out of the system now and area unable to take responsibility for their own care if they wanted to because  they cannot afford the cost of insurance on their own that is as more as $12,000 per year for a family of 4.
There is indeed charity care.  That young man is not left to die today. However, his cost of care is passed on to consumers who already get health insurance and take responsibility and the expense  is then reflected in health insurance costs which are estimated to cost that family $1000 per year.  This is ER medicine and charity care which now provides everything from treatment of the flu to the long term hospitalization of the lingering coma patients for those who either do not have insurance or now have the ability to opt out of the responsibility of carrying it. We do not feel the cost if we have insurance, because of the matching from our employers or the deductions from pay checks or we have Medicare.  We just pay the deductible and assume that is the cost.  The result is a very inefficient system that costs two and a half times per person more than anyone else in the industrialized world and gives us outcome that ranks us near the bottom when the average is taken between those fortunately to have insurance and those who do not. The cost is buried where we do not feel the cost and we are fooling ourselves.
The universal litany, parroted by all of the GOP candidates is” kill Obamacare”.  Only they do not provide any other solution than, let the private sector be free to deal with it.  What? Isn’t that is the system we have had for the past one hundred years?  Let the private sector compete?  There is no competition in the private sector. Two or three for profit insurance companies control costs across all states and they are exempted by law from antitrust action, free to set prices and divvy up markets.  That is the reality.
Or the old and oft repeated myth that tort reform, which means keeping patients from making a frivolous lawsuits for mal practice (one person’s frivolity may be someone else’s dire situation) has been scored by the Congressional Budget Office as having a minor effect on the entire cost of health care and almost 2/3 of the states have already enacted caps on pain and suffering so bringing along the other one third would not do much.
What was astounding about the “let the patient die” folks in the audience, is that this is coming from the same group of Tea Party seniors who waived their signs in 2009 chanting,” do not let Obama take my Medicare away from me (before they realized it was a government program)” and railed in fear that death panels would decide their care. It is a description of their values that as long as they get their Medicare, others can die if they do not have insurance.  I am speaking as a person on Medicare and I find that view morally abhorrent.
The other oft parroted GOP slogan is that Obama care has stolen billions from Medicare to fund “obamacare”.  That is mostly Michele Bachmann’s shtick.  However, the $500 billion was taken from the useless subsidy of private insurers to administer a program called Advantage that provided an advantage to no one in improving their health outcome.  Instead, the measures taken by “obamacare” extend the life of Medicare by another 8 years, according to CBO.  Perhaps if Bachmann keeps repeating that mantra of hers enough, it will take on a truth that soars above the reality, or perhaps that has already happened.
Two other exchanges reached the level of repeating something when it is false until some take it as truth: Gov. Perry’s assertion that the original 2009 stimulus created no jobs.  CNN’s post reporting “fact check” again cited the CBO which it stated a range of over a million to nearly three million jobs were saved or created by the stimulus, which by the way, contained the GOP preferred many, many tax breaks. 
The other mantra, if repeated enough, could take on the aura of truth, even though reality is quite something else. It was couched is terms that only Tea Party members would catch and the general public would not.  The reform of Wall Street, to help us avoid another bubble crash based upon fraud and banks too big to fail, and obscure and false representation of investments passed on to other institutions, was called by all on the stage:  the Dodd Frank legislation. That piece of legislation is Wall Street Reform passed by Congress.   Just unleash Wall Street to do their thing was the agreement on stage.  What? To do again what brought on the first crash?

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