What's in your wallet, Mr. Gingrich?

Various news outlets reported recently that Mexico has decriminalized possession of small amounts of various drugs, including marijuana, cocaine, heroin, LSD, and methamphetamine. This is a good thing, though not as good a thing as a much broader legalization both there and here would be, but that's not really my topic today. Two of my pet political peeves are health care reform (which I commented on here), and drug policy. Apart from the obvious connection between the two issues (drugs are medicine), something else joins the two topics that I find interesting: Many politicians' views on these subjects are bizarrely disconnected from their own life experiences.

Most of the elite political and business leaders of our society (the people who control the debate and outcome for almost everything important) came of age in the sixties and seventies, which means that most of them a) got high when they were young, and b) are now over the hill and starting to fall apart. One would think that people in this cohort would be able connect those two facts of their existence to the policy questions they face, yet somehow many of them don't, and as a consequence fight for rules that they wouldn't live by if push came to shove.

Here's why I say this:

On the question of drugs, there is virtually no politician anywhere on the mainstream spectrum of left to right even willing to entertain the notion of legalizing drugs. Case in point: Barack Obama. By his own admission, the president regularly smoked pot and snorted cocaine. In his memoir, he placed front and center his realization that he was on the road to self destruction and needed to sober up and grow up, which he did (except for the cigarette thing). Yet when faced with the question of whether marijuana should be legalized (via an electronic town hall in which three million people voted for him to be asked this question), he firmly said that he was against it, and made a joke about the preferences of his questioners. In other words, for him learning how to control himself is OK. Other people should go to jail.

It's become a bit of a ritual that politicians of a certain age get asked about past drug use. Most of them have given up on denying the undeniable. Instead, the politician gets a serious look on his face, talks about how much he regrets having done so, offers the excuse that he was young and stupid, and says that it is wrong to do such things. But the young and stupid thing the politician did was a crime. Can you imagine a seeker of of high public office getting away with the same dance about, say, having sex with a girl he met at a party who was too drunk to give consent? Of course not. The politician gets away with it because neither he nor his interlocutor really believes the conduct to have been wrong, but neither wants to admit it. Whenever the "did you inhale" question gets asked, this is done with the intention of giving the pol an easy out and staying away from the real implications of the admission.

So this is what I'd like to see asked: Given your stance on enforcement of drug laws, is it OK that you got away with using illegal drugs in your youth? Should you have been arrested for this? If there were no statute of limitations on marijuana possession, would you turn yourself in? I would love to see, say, Norm Coleman wriggle his way around that.

So what does this have to do with health care? Well, the thing is, all these aging boomers are, well, aging. They're either already medicare eligible, or damn close. I would love to know how those who oppose universal access to affordable health care square their positions with their actual or impending membership in a publicly-funded, universal (for those of a certain age), affordable health insurance program.

Take, for instance, Tom Coburn, senator from Oklahoma and licensed physician who opposes health care reform of any stripe and wants to throw us all into the free market. He was also born in 1948, which means he's four years away from being medicare eligible (or may already be under certain circumstances). Or Newt Gingrich. He's over 65 already, regularly disses medicare and other government health programs and lobbies for "choice".

Coburn is a special case because he was a practicing physician before he became a politician. I'd like to see him asked: "You are a staunch opponent of government run or funded health programs, and you are on the record opposing both Obama's 'public option' and the idea of 'medicare for all.' Why did you accept both medicare and medicaid patients in your medical practice? Why did you accept fees from government programs you condemn?"

But Gingrich (and any other pundit over or in the vicinity of 65) should be asked one simple question: "Are you enrolled in medicare (or do you intend to enroll when you become eligible)?"

I'd be willing to bet that all of them would have to say 'yes,' because medicare is such a valuable and useful benefit that only an idiot (or that mythical creature known as the consistent ideologue) would turn it down. For reasons that I cannot grasp, media types never ask this. They do ask congress people why they wouldn't want everyone to have access to the same type of employer-provided health benefits they get, but that's really too much of a softball. It's too easy to for them to say that they do in fact want to bring that about, but it's a matter of how and how much it'll cost (which they all say). The question doesn't really expose the, I don't know, cognitive dissonance? hypocrisy? involved.

Looking at it in these terms brushes up against argumentum ad hominem, the fallacy for which I have the most scorn. So I'm reluctant to say that one should disagree with Gingrich, or Baucus, or Boehner, or Ensign or Coburn because they don't even agree with themselves. Still, I can't help but think that in the domain of political discourse on matters of inherently personal import, that the personal is in fact political. So, with that thought in mind, I can't help but wonder whether Newt et al are card carrying FICA members. What's in your wallet Mr. Gingrich? Indeed ...

They're all a buncha HIPAAcrites

As the right-wing rhetoric on healthcare reform heats up, I really have to wonder whether some of these propagandists have ever actually encountered our so-called system. I could spend time swatting away the falsehoods, like the one about how Obama is going to require old people to kill themselves. I could also copy and paste the same statistics that every other commentator cites about how the "greatest medical system in the world" leaves us 39th in health outcomes, but that's all a bit too impersonal.

For me, it comes down to this. You've got some symptoms, so you go to the doctor. The receptionist asks you for your insurance information and makes you sign a form that says you promise to pay any charges not covered by insurance, no matter how large. You fill out a bunch of other forms authorizing your doctor to share your sensitive medical information with insurance people, who offer you no guarantees of privacy. You wait, sometimes for a couple of hours. You see the doctor. The doctor takes tests (sends samples to a lab not covered by your insurance; you get a bill). The doctor spends five minutes with you because he can't afford to dawdle, unless he can work a procedure into it, which he gets paid for separately from the office visit.

Days or weeks later, you get the results back. It's something serious. He refers you to a specialist. You go to the specialist. Same insurance drill. You see the specialist. He's a putz. He doesn't know his ass from a hole in the ground. He picks his nose and chews his boogers. All he tells you is that some people die from this, some people get better. We'll cut the top of your head off and take it from there. You want a second opinion.

You go to another specialist. What insurance do you have? Sorry, we don't take that. Do you have out of network coverage? I think so. What's your maximum out of pocket? What's the deductible? What are the co-pays. If you need surgery, you have to work out a deal with the anesthesiologist yourself because they don't take insurance. Now you get to see the new guy. He's great. He knows exactly what's wrong with you. He's treated 5000 people with the same thing, and they all live to be 95. He's gonna save your life, make you feel like you're 25 all over again. Thank god. How much is this gonna cost me? We don't know, could be a few hundred, could be a few thousand. Could be more.

All through this, you get "explanations of benefits" that explain absolutely nothing, and bills from people you never even heard of for stuff that was never done to you, but you're getting sicker, and something has to be done. So now you have a choice: Let the angel in the white coat save your life and wipe out your savings, or let the putz sew boogers into your cranium for free.

OK, so maybe this is a bit of a caricature, but not that much of one. No matter how good any of these doctors is, the first thing you talk about is insurance and money. While you're getting diagnosed, you talk about insurance and money. All of your choices are influenced by insurance and financial concerns. You spend more time on the financial implications of your illness than you do on the medical concerns. Once you're cured, you spend months, maybe years, filing and re-filing the same claims that have been inexplicably rejected, and all this is with "good" insurance. The administrative and financial burden, under the best of circumstances, infuriates you and distracts you from the task of getting better, or taking care of a sick loved one. Moreover, none of this actually about making good health care decisions. Rather, it is about clawing the right quantity of the right kind of care out of the P&L statement of an insurance company that for completely arbitrary and impenetrable reasons has contracts with some doctors but not with others.

Even in a market dominated, capitalist society, it does not have to be this way. Despite the right-wing rhetoric, France, Germany, and Holland are not communist countries. Switzerland is not a communist country. England is not a communist country. All of these countries have simpler systems that provide high levels of care and better outcomes overall at lower costs, without forcing people to do the insurance dance and worry about bankruptcy. Some are single payer; some have a mix of private and public insurance. However, they all have strong, central government bureaucracies that impose universal coverage and consistency without requiring patients to go nuts with paperwork. They all have compromises, but not the ones we're stuck with.

It's also not this way in the United States, if you're over 65 (or at one time, 62). My father had a massive stroke when he was 56 that left him permanently, severely disabled and forced him to retire, at greatly reduced pension. To get to that level, he had to spend four months in hospitals and inpatient rehab, and a year in outpatient physical and occupational therapy, while seeing multiple medical specialists. Managing the insurance and bills became such a huge task that my mother had to cut back on her teaching courseload and hire someone to help her.

Magically, when my father turned 62 (and became eligible for Medicare), all this went away. No more secretary at home. Doctors who wouldn't see my father welcomed him with open arms. Hospital admissions took minutes instead of hours or days. Out of pocket medical expenses were virtually nil. All at a lower overall cost (according to those pesky EOB's) than with private insurance.

No one who has ever been sick and had to deal with the nightmare of our insurance system could spout the nonsense that passes for debate in Congress. Not that I would wish any ill will on, say, Mitch McConnell or Jim Boehner, but maybe these guys might learn something from, say, a heart attack or a brain tumor. Then again, maybe they've already been sick and went to see Dr. Putz, who sewed so much snot into their craniums that the drivel they've been spouting is the best they can do.