updated 9:26 p.m. ET, Wed., Oct . 7, 2009
Since August 23rd of this year I have interacted daily with our American Health Care system and often done so to the exclusion of virtually all other business. It is not undercover reporting, and it is not an expert study of the field, but since that day, when my father slid, seemingly benignly, out of his bed and onto the floor of his home, I have experienced with growing amazement and with multiplying anger, the true state of our hospitals, our doctor’s offices, our insurance businesses, our pharmacies.
My father’s story as a patient and mine as a secondary participant and a primary witness has been eye-opening and jaw-dropping. And we are among the utterly lucky ones, a fact that, by itself, is terrifying and infuriating.
And thus tonight, for all those who we have met along the way, those with whom we have shared the last two months inside the belly of the beast, and for everyone in this country who will be here and right soon tonight, Countdown will be devoted entirely to a Special Comment on the subject of health care reform in this country.
I do not want to yell. I feel like screaming but everybody is screaming, everybody is screaming that this is about rights or freedom or socialism or the president or the future or the past or a political failure or a political success. We have all been screaming, I have been screaming.
And we have all been screaming because we do not want to face, we cannot face, what is at the heart of all of this, what is the unspoken essence of every moment of this debate; what, about which, we are truly driven to such intense ineffable inchoate emotions. Because ultimately, in screaming about health care reform, pro or con, we are screaming about death.
This, ultimately, is about death.
About preventing it. About fighting it. About resisting it. About grabbing hold of anything and everything to forestall it and postpone it, even though we know that the force will overcome us all – always will, always has. Health care is, at its core, about improving the odds of life in its struggle against death. Of extending that game which we will all lose, each and every one of us unto eternity, extending it another year or month or second.
This is the primary directive of life, the essence of our will as human beings, all perhaps that is measurable of our souls, the will to live. And when we go to a doctor’s office or a hospital or a storefront clinic in a ghetto we are expressing this fundamental cry of humanity: I want to live! I want my child to live! I want my wife to live! I want my father to live! I want my neighbor to live! I want this stranger I do not know and never will know to live! This is elemental stuff — our atoms in action, our survival mode in charge. Tamper with this and you are tampering with us.
And so we yell and scream and try to put it all in a political context or expand it to some great issue of societal freedom or dress it up in something that would be otherwise farcical, like a death panel. But this issue needs no expansion and no dressing up. The Democrats need draw no line in the sand, and the Republicans need calculate no seats to be gained, and the Blue
Dogs need anticipate no campaign contributions lost. This issue is big enough as it is. This is already life and death. Of all the politicians of the previous century, none fought harder to prevent an administration that promised to involve itself in health care, from ever gaining power, than did England’s Winston Churchill.
He equated his opponents, the party that sought to introduce “The National Health,” to the Gestapo of the Germans that he and we had just beaten just as those opposing reform now have invoked Nazis as frequently and falsely as if they were invoking Zombies. Churchill cost himself the election because he didn’t realize he was overplaying an issue that people were already damned serious about. Irony — this.
Because, a decade earlier, Churchill had made the greatest argument ever for government intervention in health care only he did not realize it. He was debating in Parliament the notion that the British government could not increase expenditures on military defense unless the voters specifically authorized it, just as today’s opponents of reform are now claiming they speak for the voters of today, even though those voters spoke for themselves eleven months ago.
Churchill’s argument was this”I have heard it said that the government had no mandate such a doctrine is wholly inadmissible. The responsibility for the public safety is absolute and requires no mandate!”
And there is the essence of what this is. What, on the eternal list of priorities, precedes health? What more obvious role could government have than the defense of the life, of each citizen? We cannot stop every germ that seeks to harm us any more than we can stop every person who seeks to harm us. But we can try dammit and government’s essential role in that effort facilitate it, reduce its cost, broaden its availability, improve my health and yours, seems, ultimately, self-explanatory.
We want to live. What is government for if not to help us do so? Indeed Mr. Churchill, the responsibility for the public safety is absolute and requires no mandate! And yet today, at this hour, somebody somewhere in this country is arguing against, or protesting against, or yelling against health care reform, because the subject is really life and death, and they’re scared, and they have been scared, and they have been mis-led by the overly-simple words of one side, and misinformed by the overly-complex words of the other side.
And that one person, at least that one person, who is tonight so scared that somehow sickness and pain and death will come sooner to them because of reform they do not understand – that one person, if his or her argument is successful and reform is again quoted, that one person arguing against health care reform will die sooner, because they argued against health care reform.
Just as you and I have largely failed to understand the terror, the fear of death, that underlies this debate in the minds of so many, the leadership of the reform effort has also failed to understand it, and failed to lead not just in practical terms, but in rhetorical ones. If you did not know what something called “The Public Option” was, you might instinctively oppose it.
Option? My health care is now optional? Doesn’t that mean it can go away somehow? Doesn’t that mean that when I need it, it won’t be there? Doesn’t that mean somebody is trying to take it away from me? And this insurance that might go away is public? I’m giving control to the government somehow? No “private?” Just “public?”
And so, in seconds, with mental reflexes as acute and natural as any mechanism of “fight-or-flight”, something that will expand health care and reduce its cost, something that will help fight death and pain becomes misunderstood as exactly the opposite. You can blame the one doing the misunderstanding all you want. But the essence of communication is reducing the chance of misunderstanding. And the term “The Public Option” has been as useless and as full of holes and as self-defeating as has been the term “Global Warming.” It is political-speak. It is legalese. It is designed not for the recipient but for the speaker. It is the ego of the informed, strutting down the street and saying “look at me, I talk smart.”
Just as “global warming” is really “bad climate change,” “The Public Option” is in broad essence “Medicare for everybody.” Frame it that way, sell it that way, and suddenly it doesn’t sound like a threat, turning the seemingly solid insurance which people have now, into something “optional” and turning anything “private” into everything “public.”
Once you said “Medicare for everybody,” there would be just as much to explain. If you were under 65 you’d be paying for it. You wouldn’t have to buy it. You wouldn’t have to change from whatever you have now. There are just as many caveats.
Still, the intent of all this would be clearer. Much of the criticism of health care reform is coming from those who have or are about to get Medicare and, in confusion, in fear, in the kind of indescribable realization that we are far closer to the end than to the beginning, they are suddenly mortally afraid that health care reform will take it away from them. “Medicare for Everybody,” might not be literally true, but instead of terrifying, it would be reassuring. And the explanations and the caveats would be listened to, and not shouted down, as anger and fear — fear, remember, of death – swell up inside.
This rhetorical ship, of course, has sailed, and frankly, those leading the effort to reform health care have been so out-flanked, out-argued, out-terrorized by its opponents, that their reflexes seem shot. They are, to use Mr. Lincoln’s words about General Rosecrans, frozen in place, “like a duck hit on the head.”
And yet even from the most insurrectionary of the infamous Town Halls of August, there came report after report of proponents of Health Care reform, responding to the tea-baggers and the genuinely confused, in voices calm, with genuine empathy and honest inquiry, by asking “what are you afraid of? What do you think we can do to improve health care?”
Setting aside the professional protestors, the shameless mercenaries of the equation, the LaRouchebags and the hired guns, the results were uniform and productive. Dialogue. Conversation. Admission of fear. Admission that we are indeed talking about pain and sickness, and life and death. Admission that we are seeking the same things and that this should not be left to the politicians who almost to a man reek of the corruption of campaign contributions from the very monopolies they are supposedly trying to control.
And something else would come up. Something that you never hear included in the debate over reform, in the debate about insurance and bankruptcy and even in the debate over the remorseless rapaciousness of companies that are forever increasing premiums and deductibles while reducing what they give back to the person who is sick. What you never hear about is the person who is sick.
Have you ever stayed overnight in a hospital? All data suggests that in a given year, only about one in ten of us do so it’s not a universal experience. Could you sleep in a hospital? With constant noise, with sharing a room with strangers, with contemplating mortality and more immediately the fog of germs in the place? With staph infections and MRSA and nursing staffs cut to the minimum, and overworked doctors, and medical record-keeping so primitive it might as well be done on blackboards?
And the bills? What about the person who is sick and the bills? How are they supposed to get better, while they are sitting there inside a giant cash register? How do you heal, how do you kill a cancer, when the meter is running so loudly you can hear it?
When a system of health care has been so refined, so perfected, as to find a way to charge for almost everything, and to reimburse for almost nothing, how does the person who is sick, not worry, always, always, about where he is going to get the money?
And how is somebody worrying always about where he is going to get the money, supposed to also get better? Yet our neighbor, in that hospital bed, hoping half for health and half for the money to pay for it, is still in better shape than at least 122 Americans who might be watching this right now, and who will not be with us tomorrow, because they will die, because they do not have insurance. I will pick it up there and then move on to the question of whether, if health care is not reformed, we should force the issue, by bailing out of this stylized blackmail that is insurance.
Some time around one o’clock in the morning on Saturday the 22nd of August of this year, my father, struggling with knee problems, some generalized weakness, lack of appetite, and lethargy, tried to use the portable urinal he kept by his bed to limit those middle-of-the-night trips to the toilet. Sounds a little gross, but certainly not when the alternative is a 20-minute ordeal of struggling to the bathroom and wondering what in the hell you’re going to do if you don’t make it there in time.
But that night there was an additional problem. He was having trouble going. He tried to adjust his position sitting on the edge of the bed. Suddenly the mattress shifted underneath him and deposited him gently on the floor. He might have been in nothing more threatening than a seated position there, but with his knees as bad as they are, there was almost no chance he was going to get out of it without help. For reasons that would later become apparent, my father would pretend to himself that that wasn’t true. He decided to believe that soon he’d feel better and be able to get up, on his own.
He thinks he dozed much of the night. As it got light, he realized his cell phone was within grasp and he called me, not to say he was in trouble, but only about the move we were planning for him, to his own place closer to me. He never mentioned the precariousness of his position. He had now been stuck on the floor around seven hours.
Some time in the afternoon, between the dehydration and the exhaustion, the hallucinations started. He heard my sister and her family in the hallway outside his bedroom. He could feel the vibration of the footsteps of his grand-kids running up and down. In a startling tribute to the imagination’s ability to make a hallucination like this one completely self-contained and impervious, he heard his daughter say “don’t bother Grandpa, he’s resting.” He thinks he smelled cooking. My sister and her kids were, in fact, in Rochester, New York at the time.
My Dad found himself increasingly angry and finally, sometime after midnight on the morning of Sunday August 23rd, he phoned her and demanded to know why she had been in the house without so much as giving him the courtesy of peeking her head in to see if he was all right. Only after her repeated insistences that she was 330 miles away and had been, all day, did reality regain control. My father apologized. My sister called his neighbor. The neighbor called the cops.
There was never an official diagnosis of just the one incident that night, but I have gone into such excruciating detail because of what I was told that night by the doctors at the ER at which I joined my father, and what I’ve been told by other health professionals since. The hallucinations almost certainly were provoked by dehydration and if not renal failure per se, then certainly a kind of temporary shutdown. By the time he got there, it had been more than 24 hours since he had triggered this cascade of problems by trying to adjust the position of his body so he could urinate. And he still had not done so.
My father’s kidneys were in trouble. Considering kidney disease was what killed his father, this was very bad news. We heard just yesterday about kidneys and insurance. The Waddington brothers, Travis of New York; Michael of Santa Fe. As the New York Times reported, their Dad, David, needed a kidney transplant because of a congenital renal disease.
Each of his sons was ready to donate. But they were warned not even to get tested to see if they matched. For if they did transplant or no they would conceivably be denied insurance for the rest of their lives, because they might test positive for that same congenital renal disease that threatened their father. And thus would they have a pre-existing condition.
And still the Waddington’s and their Dad and my Dad were all luckier than at least 45,000 Americans. Because as discovered in a new study conducted by Harvard University and the Cambridge Health Alliance, that’s how many of us, are dying, each year, because we don’t have insurance.
The number is horrible. But when it is contrasted to what faced my father that night, it is unforgivable. Because as Cambridge’s summary of the findings put it: “Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease.” My father had less to fear that night from bad kidneys than he would have if he hadn’t had insurance!
And yet we let this continue. You and I. This society. Our country. Democrats and Republicans.
This is the study Congressman Grayson of Florida quoted, about which the Republicans demanded an apology when they should have been standing there shrieking, demanding we fix this. “Uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts.”
People, in short, are dying for the lack… of money. Dying as surely as they did when Charles Dickens wrote about the exact same problem. Of a boy who couldn’t get sufficient medical care for his affliction. Of the underprivileged, suffering not just privation but death, as the comfortable, moved silently and unseeingly through the streets of London.
The book was called “A Christmas Carol” and the boy Dickens imagined was called “Tiny Tim” and it was published on the 19th of December, 1843, and it is 166 years later and the problem is not only still with us, it is getting worse. The mortality rate among Americans under the age of 65, who are uninsured, is 40 percent higher than among those with insurance. In 1993 a similar study found the difference was only 25 percent.
We are moving backwards! We are letting people die because they do not have insurance.
What’s worse is that barring meaningful health care reform, this will only grow. The difference between the surveys from 1993 and now suggest this fatal insurance gap is growing by about one percent, per year. Your chances of dying because you don’t have insurance are now 40 percent higher than those who have it.
By extrapolation, three years from now your chances will be 43 percent higher. Your chances of dying because you used to smoke compared to those who never smoked, only 42 percent higher. You heard that right. At the current rate, in 2012, you will be more fortunate, more secure, more long-lived, if you used to smoke, than if you don’t have insurance. It is mind-boggling, and mind-less. This is the country you want? This is the country you will accept?
Do those other people in this country have meaning to you, or are they just extras in your movie, backgrounds in your painting, choruses in your solo? Without access to insurance for all of us and the only way we get it is with the government supplying the gaps, just like it does in flood insurance for God’s sake that fatal gap will just keep growing.
A 45 percent higher likelihood of death for the uninsured compared to the insured by 2014.
By 2022, the figure will be 53 percent higher. Fifty-three percent! In the 1840s, as Dickens wrote a “Christmas Carol” – in a time at which we now look back with horror, the city of Manchester in England commissioned a crude study of mortality among its residents. Doctor P.N. Holland categorized the sanitary conditions of the houses and streets of Manchester into three classes.
And when he compared the death rate in the First Class Houses in the First Class Streets, to the death rate in the Second Class Houses in the Third Class Streets, he found mortality in those worst locations was 53 percent higher. If we do not reverse this trend, in fourteen years’ time we will not be living in the America of 2022. The shadows of the things that may be, tell us, that we will instead be living in an insurance-driven version, of the Dickensian England of 1843!
God Bless Us, everyone.
I told my father the other night that the insurance I really want to get for him and me is called Corporate-Owned-Life-Insurance. “COLI” — like in E. coli. How fitting. With or without your consent, your employer is permitted by law to take out life insurance on you. It can, in fact, take out life insurance on everybody who works for it. Who gets the money when you die? Your employer does.
Dad pointed out that theoretically this would give them motivation to kill you. That, of course, would be for the same reason, as Michael Moore points out in his new movie “Capitalism: A Love Story,” that you can’t buy fire insurance on the house of the guy who lives next door to you. Golly gee, that’s right, suddenly you’d have a motive to burn down his house and the world is already too much like that symbolically to make it like that in reality.
No, it’s really unlikely that even the most evil corporation would think of killing you to get a payout from the COLI insurance plan. This exists for a much more mundane and passive reason. You’re going to die anyway, and the tax laws of this country are such that if your company has a hundred thousand employees, it can take out small whole-life policies on everybody and just let the actuarial tables do the work for it. Ten thousand dollars here, $20,000 there, maybe $50,000 back here and all of it tax-exempt.
Oh and your employer can borrow the money to pay the premiums on the secret insurance it has on you. And the interest on that loan is tax-deductible. And your employer can, in essence, over-pay the premium it has on you and your fellow drones, and the extra money in the kitty is called “Cash Value,” and it can be stuck into a pension-benefit plan or other product of the mad world of accounting. And “Cash Value” is also tax-deferred. It can be returned to your employer as a tax-free loan. And if your employer goes bankrupt, the Cash Value of those insurance policies is protected by the tax-laws – from creditors!
In short, your employer can get a tax-deductible loan to buy insurance on you that until this past June he didn’t even have to tell you about, and the money is first tax-deferred and then tax-free, and when you die, the payoff it gets is tax-exempt, and when the company dies, the boss still gets to keep the money away from the creditors even if somehow you, the guy on whom your boss has surreptitiously taken an insurance policy – happen to be one of the creditors.
And even though it’s based on insurance on your health and your life, all of that tax-free, tax-exempt, tax-deferred money not only doesn’t go to you, it also doesn’t go to the government. And so if we really are ever going to do anything about federally-supported health care as an alternative to these private insurers, there’s that much less tax money to do it with.
And some of the money that isn’t going to you, and isn’t going to the government, is going to strengthen the already monolithic insurance companies!
And just in case this isn’t a sweet enough deal, the government is almost silent about telling that employer of yours about what kind of health insurance it must give you. And year after year, the companies get smarter and more audacious about either cutting what your health insurance covers, or cutting the number of employees the health insurance covers, or both.
And if that still isn’t enough, there is something called the National Association of Insurance and Financial Advisors. And it has a Political Action Committee, IFAPAC, and last year IFAPAC had one million, $492,000 worth of campaign money with which to buy politicians.
And you’d be amazed how many of them you can buy with even one million, $492,000.
And these are the same people who are not only influencing the health care debate, spending more than a million dollars a day to defeat reform, they are also the same people, who by raising your premiums and cutting your reimbursements, who by manipulating prices at hospitals and doctor’s offices for everything from tongue depressors to enemas, who by influencing health care in this country more effectively and more selfishly than a dictator could ever do these are the people who decide what kind of health care you get, how much you pay for it, and whether or not they’d rather not see you get it.
It is your skin. Literally. And it is in the hands of people, insurance companies, who can still make money by betting against your good health. There is only one comfort here and it is cold indeed. Profit while you can, insurers. Sickness and death wait not just for your customer. They also wait for you. And they are double-parked. The doctor who treats you and the pharmacist who makes you pay through your nose are not your enemies in this. It proves they are as much victims as you and I are. And the time has come to realign the battle here, so that it is not just us versus the entire medical and health care establishment, it is us, and the doctors, and the nurses, and the pharmacists, and maybe even some of the hospitals, against the real enemy: The insurance companies… the Insurance companies who are right now at war against America! That’s where I’ll pick it up when this Special Comment continues.
Dr. Albert Sabin was by his own description, pretty full of himself when he managed to temporarily stop the testing of the Salk Polio Vaccine after a bad batch sickened and killed some children early in the first tests in the 1950s. Sabin recounted this in a television interview in the ’80s. He was weeping. He had believed he was doing right. He had convinced himself that the fact that Salk’s vaccine, the so-called “inactivated polio vaccine,” had been chosen for use instead of Sabin’s own “live polio vaccine,” was irrelevant to his efforts.
He was weeping as he recounted this, too. Ultimately there proved nothing wrong with Salk’s vaccine, the one batch had been improperly handled and manufactured. But Sabin and others delayed all further testing for weeks. Sabin was weeping as he remembered. In 1983, Sabin had contracted a rare disease of his own. Surgeons operated, relieved the intense pain and muscle weakness, and then ten days later it came back, ten times worse, enough for him to be yelling and crying, virtually all the time.
The pain, he said, “made me want to die.” And Dr. Albert Sabin suddenly remembered that the stopping of the Salk vaccine experiments had led to death. Death of children. More immediately, it had led to pain, physical and emotional, for the children, and the parents.
He said it had not occurred to him that the first thing doctors must do, the first thing a health care system must do, is stop pain. He vowed to spend the rest of his life relieving pain.
His own searing agony, and paralysis, gradually, inexplicably, faded. They moved my father this afternoon. I don’t mean they moved him to another hospital. They moved him. In his bed. Into a different position. It was agony for him. Agony enough that he could barely see us.
Agony enough that they had to give him all the pain-killer he could handle. Then he couldn’t talk any more. Another moment when somebody like me wonders about what it would be like if he was going through that, and I was watching it, worrying about whether we could afford the pain-killers.
We must reform a system that lets my father get better care than yours does, or better care than Mike’s daughter does, because by the accident of life, I make more money than he does, or my checkbook can hold out longer than his does, or yours does, as the bills come endlessly like some evil version of the enchanted water buckets in Fantasia.
The resources exist for your father and mine to get the same treatment to have the same chance and to both not have to lie there worried about whether or not they can afford to live!
Afford to live? Are we at that point? Are we so heartless that we let the rich live and the poor die and everybody in between become wracked with fear — fear not of disease but of Deductibles? Right now, right now, somebody’s father is dying because they don’t have that dollar to spend. And the means by which the playing field is leveled, and the costs that are just as inflated to me as they are to you are reduced, and the money that I don’t have to spend any more on saving my father can go instead to saving your father that’s called health care reform!
Death is the issue! How can we not be unified against death? I want my government helping my father to fight death! I want my government to spend taxpayer money to help my father fight to live and I want my government to spend taxpayer money to help your father fight to live! I want it to spend my money first on fighting death. Not on war! Not on banks! Not on high speed rail!
Spend our money, spend my money, first: on the chance to live!
And we must be unanimous in this, not to achieve some political triumph for one side against the other, but to save the man or the woman or the child who will be dead by morning, in this country, in this century, on our watch, because we are not spending that money tonight. I will not settle for a compromise bill and I will extend my hand to those who are scared of the inevitability of death but have been told they are scared of reform, those who have been exploited by the others, paid, or forced, to defend the status quo.
And we must recognize the enemy here: an enemy capable of perverting reform meant for you and me, into its own ATM that mandates only that more of us become the slaves to the insurance companies. The monies interests that have bled their customers white, and used their customers’ money to buy the system, to buy the politicians, to buy the press, cannot now even be checked by the government.
Ordinarily the solution would be obvious: we would have to do it for the government. We would have to bring the insurance companies to their knees to organize, to pick a date, to say enough to, at a given hour, on a given day, to stop paying the premiums. An insurance strike.
But the insurance companies’ stranglehold on us is so complete that lives would be risked, lives would be lost by the very act of protest. What parent could risk the cancellation of their child’s insurance? What adult could risk giving his insurer the chance to claim that everything wrong with him on the day of an Insurance Strike was suddenly a pre-existing condition?
Even as the pay-outs move inexorably downwards, to being less than what you have paid in over the years, we are such serfs to the insurance companies that just to invoke the true spirit of the founding of this nation, are to give them more power, not less.
So I propose tonight one act with two purposes. I propose we, all of us, embrace the selfless individuals at the National Association of Free Clinics. You know them; they conducted the mass health care free clinic in Houston that served 1,500 people. I want a mass health care free clinic every week in the principle cities of the states of the six senators’ key to defeating a filibuster against health care reform in the Senate.
I want Sens. Lincoln and Pryor to see what health care poverty is really like in Little Rock. I want Sen. Baucus to see it in Butte. I want Sen. Ben Nelson to see it in Lincoln. I want Sen. Landor to see it in Baton Rouge. I want Sen. Reid to see it in Las Vegas.
I’ll donate. How much will you donate? We enable thousands of our neighbors to have just a portion of the bounty of good health, and we make a statement to the politicians, forgive me, William Jennings Bryan, “you shall not press down upon the brow of America this crown of insurance; you shall not crucify mankind upon a cross of blue.”
We think these events will be firmed up presently. You will be able to link from our website.
Trust me, I’ll remind you. Because in one party, in one demographic, in one protest movement, we are all brothers and sisters. We are united in membership in the party that insists that every chance at life be afforded to every American seeking that chance.
We are united in membership in the party that insists on the right of everyone to the startling, transcendent blessings of the technological advance of medical science. We are united in membership in the party that is for life, that is against death, that is for lower premiums, that is against higher deductibles, that is for the peace of mind that can be provided only by the elimination of the fear that cost will decide whether we live or we die!
Because that’s the point, isn’t it? It is hard enough to recover, to fight past pain and to stave off death, if just for a season or a week or a day. It is so hard, that eventually for you, for me, for this president, for these blue dogs, for these protestors it is so hard to recover, that for all of us there will come a time when we will not recover. So, why are we making it harder?
