Health vs health care: a false choice
T.A. Barnhart
We argue over policy, over strategy, over debt, over statistics. We divide along party lines, we cling to ideology, we act our ages, we demand our truth prevail. We do everything in this effort to reform America’s health care but shut up and remember that this is not about government, not about philosophy, not about politics, not about money.
It is about people and the quality of their lives.
How easy it is to slip away from that fact, the only true Truth in all of this, and distract ourselves with lesser things. Yes, it’s important to do reform well, to develop programs that provide effective care and don’t waste money; but the legislative process, and the politics surrounding it, are distractions from the fact of people’s health and the quality of their lives. It is, within the context of getting the policy right, necessary to focus on statistics and long-term economic impacts; it is also much easier than thinking about the tens of millions of Americans whose life quality is degraded because of the nature of health care provision in our country today.
Who wants to think about old people going without medication, children not seeing a dentist regularly, families with homes and families and yet a job-loss away from medical-based bankruptcy? Yet those are the issues that matter; that’s all that matters. What we have to do as a nation is provide the care people need, politics be damned.
Which, of course, means we need to chart a new course in the provision of care. What we have been doing is a failure in almost every way. I believe single-payer is our best policy option, but single-payer, or the public option, or co-ops or subsidies for private insurance — these do not provide health care. They provide treatment for sickness. None of these are what we need; the key to reforming health care and bringing down costs does not lie in how we pay to treat the sick, the ill, the dying.
It lies in how we make America healthier.
Provision of doctors, clinics, medicines, etc — the stuff that costs so much — is only a part of the whole health care package. It’s the reactive part, what gets done when someone falls ill. The more important part is what we do very little of, what is far more necessary and, in fact, costs far less than the reactive portion.
We need people to be healthy. To not get sick. Americans need to eat better, live with less stress, exercise more, avoid destructive behaviors; they need to live in a way that reduces significantly how much reactive care they require. Visit a typical supermarket, and you’re looking at wasted lives and money: sick people getting sicker and soon to need expensive care just to allow them the chance to start the cycle again.
This is what’s wrong with American health care, not that it’s run by insurance companies. They make billions off of a portion of the system — and we can destroy the profit incentive within that system by pulling millions of Americans out of the sick-care system and moving them into a real health care system.
In yesterday’s New York Times ("The Way We Die Now"), Timothy Egan wrote about John Kitzhaber’s parents and how they made the choice to put the quality of their lives ahead of simply extending those lives. Our current system forces most people to make the false decision to concentrate on how they will pay for insurance, with its expensive medical treatments and endless medications, rather than making the correct choice to be healthy and rendering insurance the least important part of their health care package. When I got my job, I did not have to sign a form asking me if I chose to exercise, eat well, avoid unhealthy life choices, and so on. I was asked to sign if I wanted to spend a massive portion of my paycheck on the gamble that if I did get sick, I might get treatment that got me unsick enough to get back to work, even if I was still unhealthy.
What a stupid system. What a stupid way to look at health.
We have let ourselves become duped by the system. There is far more money, and political power, in sickness and death than in health; of course we are being told that what we need is this particular policy or to avoid the other policy (and yes, single-payer advocates, I’m including a lot of us in this). We are presenting Americans with a false choice, one created by the insurance and medical industries and underwritten by politicians and institutions, all of whom profit from illness, fear and death.
Egan’s article points out the choice we should be addressing, the truth we need to make the focus of this entire effort surrounding health care: Americans don’t need a new way to insure their illnesses. They need to live healthy lives so that however we pay for illness, we do so far less frequently. We do not need, as Dr Kitzhaber will tell anyone who will listen, better health care.
We need better health.
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8:21 a.m.
Sep 25, '09
We do need better health care, and we do need to get health insurance to everyone. Neither effort is inconsistent with the focus on "health" that you articulate.
Sep 25, '09
We need more intelligent approach to health care in this country. More primary care doctors. Help to prevent chronic conditions (like our local hospital which has cooking classes to teach people healthy, low cost home cooking).
Reimbursement rates need to change--a public option which put everyone on current Medicare reimbursement schedules would disadvantage those in states like Oregon over those in states like NY.
The "pre-existing condition" and "lifetime cap" situations need to end in the next year or so, not 2 election cycles from now.
There needs to be reimbursement so that a person of low income can afford, say, a room air conditioner for their apt. so they don't end up in the ER (taken by expensive ambulance) because a medical condition plus heat wave caused heat stroke.
If someone slips and falls in a store, we need a system where the insurance company person doesn't say "we were hoping you could go in and have your ankle examined, send us all your medical records, and then have your insurance company pay for it and we are pretty sure we would reimburse for it". Not something that can change immediately. But like I saw AG Kroger say in a speech to a law school which I saw on CCTV, it is possible now to start at 0 in 2009 and talk about long term planning over the next ten years. But that requires a vision, not just the behavior TA describes in the first paragraph.
And then there is the question of reimbursement for expensive medical tests, but not simple things.
http://blog.oregonlive.com/mapesonpolitics/2009/09/kitzhaber_discusses_his_mother.html
The issue is a lot more complicated than any single slogan.
Can we start talking about that vision and the transition it would require--both the end goal and steps to get there?
Or will there be another year of bashing everyone who does not purely adhere to a slogan?
I want public figures to engage in serious debate, not just attempting to appeal to specific people or groups.
9:35 a.m.
Sep 25, '09
Once upon a time, living a healthy lifestyle was considered your responsibility. Where you needed help was when you had an accident, caught a serious disease or developed a serious health condition, because the cost of dealing with these things put a serious crimp in your budget--if you could afford it at all.
So people bought something called insurance, where we all pooled our money and those relatively few people who developed one of those serious health-related problems at anyone time drew on that insurance pool to pay for it.
Over the years, the number of things covered by this insurance pool grew and who paid into it changed from each of us individually or as a family to having our employer pay in for us. So beyond the traditional insurance role, this pool of money became a way to finance all our health care needs.
Like it or not, that has been the evolution that has changed the debate from how to pay for relatively expensive health care treatment to how we should provide for all of our health care needs, to now the debate over how to make us healthy (presumably whether we want to be or not--but that's another issue).
Some of us are still concerned with making sure everyone has health insurance, as they do in all the other major industrial countries. Those of you who would rather talk about how to make everyone healthier are welcome to have that debate, but it is a different one from the one we are having right now.
And distracting us from the current debate increases the chance we won't get anything done on universal health insurance yet again, which plays into the hands of those to whom you say you're opposed.
9:57 a.m.
Sep 25, '09
I tend to agree with Jack here. And, frankly, I thought the timing of the Egan piece was just plain bizarre. Just when you thought it was safe to go back in the "death panel" infested waters, we get a truly heartwarming story...about pulling the plug on (grand)ma?? Jeez (Harry and )Louise!
Sep 25, '09
Naomi Klein and Michael Moore discuss Capitalism - A Love Story with interesting references to health care.
Sep 25, '09
Deciding to die at home is "pulling the plug"?
Or should everyone die in a hospital hooked up to expensive machines because it doesn't matter how much end of life care costs, by golly every technology should be used to keep them alive as long as possible and how dare anyone want to have control over their own death?
Didn't we have that debate in Oregon about a decade ago and vote on it twice?
Sep 25, '09
Does this mean we (and President Obama) are held hostage to some degree by Big Pharma?
"Democrats agonized over how to soothe worried seniors but decided one idea was too risky because it could antagonize the powerful drug industry whose support is critically needed for President Barack Obama's broader overhaul."
The complete article is here
Sep 25, '09
With respect to all, including John Kitzhaber and myself, who have lost parents in recent years, this article muddles together two separate issues: 1) how to get Americans healthy; and 2) how to provide end-of-life care for the terminally ill.
And it fails to address how to provide affordable access to health care for folks who are living quite active, healthy lives, but occasionally need access to doctors and lab tests and expensive medical procedures. That, as Jack Roberts points out, is the debate we’re having now.
The first half of the article concludes, "We need people to be healthy. To not get sick." But there's no discussion of the role of preventive care provided by a health care system with universal access. The problem right now is 1/6 to 1/5 of America doesn't even have access to preventive care (which makes Kitzhaber's "sideshow" comment about the public option very troubling).
After the first half of the article, with its focus on getting people healthy, it shifts to a discussion of end of life care for the terminally ill. What does the experience of John Kitzhaber with his mother have to do with getting people healthy? The case in question is an already unhealthy, terminally ill patient with Medicare coverage. That's a separate issue from the first half of the article.
Getting children to eat a healthy diet and exercise is great policy and should be pursued. But that won't prevent 88 year olds from dying with weak hearts and cancer.
Yes, there's an issue with reforming Medicare, and potential cost savings depending on how decisions are made for end of life care. But that gets thorny -- there are several testimonials in the comments on the NY Times article from folks who got all the expensive tests and procedures and then lived much longer...who tells them their decisions were wrong?
And the story of Kitzhaber's mother still involves someone with access to the health care system. It does not address millions of folks and their children who are eating well and living active healthy lives, but sometimes via accident or disease require serious and expensive medical care, and who at present simply don't have access to the health care system at all because they can't afford the premiums.
This is a difficult debate. I'm wary of personal, emotional narratives employed by candidates for office like Kitzhaber that misdirect the debate and don't address how we actually provide access to quality health care for all Americans.
Sep 25, '09
"Once upon a time, living a healthy lifestyle was considered your responsibility. "
Once upon a time, workers could be locked into their places of employment and forced to work 12 hour days. Nutrition was for those with enough income to provide solid meals.
Then the Triangle Shirtwaist Factory fire required that all businesses have unlocked exits. Good nutrition for everyone became a cause for people other than just home economists.
"Over the years, the number of things covered by this insurance pool grew and who paid into it changed from each of us individually or as a family to having our employer pay in for us. So beyond the traditional insurance role, this pool of money became a way to finance all our health care needs."
Jack, I'd suggest you have that conversation with someone working in fast food or some other low income job. Or for that matter any part time job without benefits. Or anyone who is self employed.
Don't overgeneralize to the point you think all people fit the same mold.
My favorite history prof was a Hatfield Republican. He said anyone using phrases like "the American people" really meant "people like us".
Your comment makes it sound like you believe every Oregonian has employer paid health insurance. Even when the unemployment rate was lower, that was not true. Ignoring a segment of society when talking about "a way to finance all our health care needs".
How many people you know have insurance to cover vision and/or dental? If a low income person needs such services, what are they supposed to do to pay for them--eat less expensive food? Choose between those services and paying other bills?
Your idealized world does not exist for many Oregonians, esp. those who only find part time work although they were looking for full time work.
Sep 25, '09
We would do well to recognize that a healthy citizenry is in a nation's interest. Two of Europe's most conservative leaders, Otto von Bismarck and Winston Churchill, recognized this and promoted national health care plans. They didn't do this out of a conversion to liberal ideas but for nationalist interests. To be strong militarily AND economically their nations needed healthy people.
Ironically, a sizable portion of the American people don't recognize that good health is both a matter of self-interest and national interest. Among the major culprits are food vendors encouraging people, especially children, to consume fat- and sugar-laden foods that are detrimental to the health of deceived consumers but good for corporate profits.
12:04 p.m.
Sep 25, '09
iris, Kitz' mantra is "health, not health care" - not that he disregards the need for health care reform but that reform needs to focus on health, not fixing sick people. his statements in the article reiterate that. we need to fix how we provide care for those who get sick or injured, not to mention making preventative care (including dental) affordable, but far more: we need to fix the fact that most Americans do not keep themselves healthy in the first place. Jack is right: being healthy is a personal responsiblity. but we need to retrain Americans to understand this, to make it a widely accepted value and not something "health freaks" do.
Sep 25, '09
"...all of whom profit from illness, fear and death"
I think a more accurate statement would have been "....all of whom profit from illness and fear OF death".
We need both...better health so people have to use insurance rarely AND better health care and coverage for all so that when people choose to see a doctor, they need not worry about the quality of care they receive or have to consider how they will pay for treatments that they choose to pursue.
Currently, the "big" discussion is on the insurance piece and it's necessary. But that doesn't mean the other conversation shouldn't be happening as well--how to help Americans become healthier people overall. I would add a third discussion to this pot---we must start discussing end-of-life care and death in this country in a forthright and compassionate manner, on a national level. It is not a comfortable discussion for many, yet death is one of the few things we all experience and too many leave their rights and their voice at home and allow doctors, insurance companies and hospitals to choose how the last days of their lives are spent. It's disgraceful and needs to stop.
Sep 25, '09
t.a. --
How exactly does Kitzhaber's story about his mother, albeit emotional and likely to gain empathy and maybe votes for a candidate for office, "fix the fact that most Americans do not keep themselves healthy in the first place"? It's a story about a terminally ill 88 year old patient. The connection is tenuous.
If there's a connection between the story of his mother and making preventive care more affordable -- and there may be -- it hasn't been made here.
Further, the story of his mother does not exactly lead to univeral health care.
I'm troubled by Kitzhaber's continued talk of reforming how we deliver health care to the sick and injured, when there's no pragmatic and real talk from him on how to get millions who now have no access to health care at all into the health care system. Dismissing the public option as a "sideshow" and talking about changing how we deliver health care to folks who have no health insurance quickly gets tiring.
1:40 p.m.
Sep 25, '09
iris, i based my comment on reading a lot more of Kitz than a few quotes in this article. go the WeCanDoBetter.org and read what the Archimedes Movement, under his leadership, is doing. time and again, he speaks of the need to promote health, whatever form of insurance we have.
i said we get distracted by focusing on policy; that was not him. my point is that if we put health as the primary outcome, then we will approach reform differently than if we put the availabity of affordable insurance as our primary outcome. which, i am confident, is Kitzhaber's (and Obama's) primary focus.
2:08 p.m.
Sep 25, '09
Jack is right: being healthy is a personal responsiblity. but we need to retrain Americans to understand this, to make it a widely accepted value and not something "health freaks" do.
I don't necessarily disagree with you, t.a., although I get a little nervous about the "we need to retrain Americans" mentality. But my main point is that right now we have a chance to do something about health insurance and we should not let this opportunity pass by stepping back and trying t solve the whole "health and wellness" thing first.
Sep 25, '09
"i said we get distracted by focusing on policy; that was not him."
True. But Kitzhaber said the debate over the public option is a "sideshow." That was him, not you. Kitzhaber's goal of improving health is laudable. But is there anyone opposed to that? What we want is a pragmatic and realistic way to get there.
Though I voted for Kitzhaber twice, I'm agreeing with Jack Roberts here. We have a window to do something about health insurance. Stories about his terminally ill mother's experience under Medicare don't get us there. Getting everyone covered, with access to preventive care, would help. Having an affordable public option to compete with for-profit entities would also help. It's not a sideshow.
America's the wealthiest empire in recorded history. Millions of its citizens have no health insurance. Getting them covered is the primary outcome needed right now.
Get
Sep 25, '09
Healthy choices tend to be tied to a middle class lifestyle although there are plenty of middle and upper middle class people who don't take care of their minds and bodies. Nevertheless, obesity and Type II diabetes are a major problem for poor Americans and particularly for people of color living in poverty. Abundant fresh fruits and vegies, safe neighborhood walking paths and free time to pursue physical exercise are not equally available to all. Generalizations about health and healthy people vs. others make me nervous, particularly in the context of discussing universal health care.
Are you going to exclude the overweight and obese from this new world order of health care?
Sep 25, '09
Iris, there are "pragmatic and realistic" questions which need to be answered: What about pre-existing conditions, lifetime caps, and the need for stricter regulation of health insurance companies? Reimbursement rates (Medicare currently reimburses those in states like NY better than those in states like Oregon) and what is reimbursed (medical tests which may be more expensive than useful, or common sense low cost items?) effective date of legislation---if the effective date of prohibiting insurance companies from denial of coverage due to pre-existing conditions does not take place for years, how does that help people denied next year? who would be covered by a public option? Anyone of any income if they already have employer paid health care? Income limits?
I have heard John Kitzhaber addressing these questions and saying there needs to be a path from where we are now to what we want to see, incl. the steps along the way.
I happen to believe that the excesses of the public option debate, such as "If Wyden won't stand up and say we need a public option then we should run someone against him in the primary" as a substitute for making sure that something with the label "public option" answers questions like those above IS a sideshow. If every Oregonian or every American called one member of Congress and said "we must have a public option", how many people denied insurance for pre-existing conditions would be able to buy insurance in the next 6-12 months?
No matter what anyone outside Congress says, a health reform bill must still pass committee, pass House and Senate, and be signed by the president. To say anything else IS a sideshow.
Sep 25, '09
"We have a window to do something about health insurance."
But the problem is that the "health" insurance corporations and their surrogates in Congress are doing all they can to control what passes through. And it looks like that window has a strong shutter against single-payer.
5:35 p.m.
Sep 25, '09
Well said, Greg & Iris.
Sep 25, '09
Now what should this woman have done to not get swine flu and this woman have done to not have a bleeding breast? What should we have done as a nation to make sure the first young woman didn't die needlessly and spare the second woman from the added injury of a punishing bill?
The question isn't health or health care. We need both people to take care of their health as much as they can and health care to take care of them when they can't.
6:13 p.m.
Sep 25, '09
T.A., your title is bizarre. It is you who is arguing that this is a choice. Kitz does talk about "health care vs. "sick care."
In the Oregon MPH program there is a required core course for all tracks called Health Systems Organization. A full health system involves a spectrum:
health promotion & maintenance; prevention; early detection, diagnosis management (sometimes including reduction or cure) of illness or injury; and acute care / treatment.
The issue of insurance matters in terms of how it supports each element of that spectrum. Health promotion is sustained socially -- if you have friends who live active lives and like healthy food that may come from that fact, but regular contact with health care providers who spend time with people talking about choices and encouraging healthy ones helps too, especially if you don't have the first kind of social life. Payment systems that give incentives for providers to see patients frequently and spend time with them aid health promotion -- e.g. I once had a doctor whose practice included a staffer who was a sort of diet & exercise coach who patients were encouraged to see on a regular basis. I had to leave that doctor when my employer changed insurers and that doc wasn't in their network. Clinics headed by nurse practitioners can play similar roles, as can "alternative" or "complementary" practices at least of some sorts.
Prevention particularly of infectious diseases involves treatments, especially vaccinations. All of the above plus treatment of minor conditions, monitoring of health data and less or more formal screening (often age-linked) taken together constitute primary care.
7:00 p.m.
Sep 25, '09
Part of where I think you go most wrong is in making a sharp, polarized distinction between sickness and health. This cuts out one of the most crucial aspects of a proper health system which makes a huge difference in quality of life, which is management of conditions, particularly "chronic" i.e. long lasting or permanent ones, at early stages. This is one of the most crucial areas where the U.S.' fragmented and unsystematic health system fails.
One jargon for talking about this is degrees of "morbidity." You can die of renal failure from type II (non-genetic) diabetes: mortality. You can have severely morbid type II diabetes that causes limb amputation which in turn might pose serious obstacles to active living so that there is comorbidity between the diabetes and other conditions affected by the diet and exercise mix, with lots of pain and discomfort and limitation impinging badly on quality of life. You can have type II diabetes that is caught at a relatively early stage such that it can be managed at lower levels of morbidity that avoid such serious consequences, and expenses related to them, along with much less pain, discomfort and activity restriction. You can have care where risk factors or precursor conditions are identified soon enough to permit changes in activity and diet to forestall development of full-blown diabetes and the costs even of earlier stage treat.
At what stage intervention in a developing chronic disease process like that occurs, or if it does, can be strongly influenced by insurance status. That included lack of insurance, but it also includes costs within insurance that become prohibitive. Dr. Paul Gorman of Portland Physicians for a National Health Program at the Sept 22 "Big Insurance Makes Us Sick" rally last Tuesday told the story of an insured woman who chose not to get treatment for heart condition for fear of losing her house and marriage, since a previous hospitalization and its costs -- implied is that her life probably will be shorter and quality of life in that time lower.
7:03 p.m.
Sep 25, '09
T.A.
You are quite right that our health system is dramatically skewed to late stage acute treatment, with bad consequences for life-cycle health, quality of life, and also costs to individuals and society.
But something you don't recognize is how American ideological obsession with personal responsibility contributes to this pattern. The ideology itself makes that proposition counter-intuitive, but most public health professionals of my acquaintance think it's true.
In your article it manifests itself in absence of mention of genetic predispositions to chronic conditions. Greg D.'s very apt description of the effects of structural class inequalities (often significantly racialized as well) in creating differential opportunities and obstacles that enable or constrain choices could be extended. In addition there are entire other layers of such effects, ranging from job requirements and their stresses, and effects on time for physical activity or healthy eating, to the stresses of being on the wrong end of racial inequality, to the continual bombardment of what the Center for Science in the Public Interest calls "food porn" in our advertising system.
Jack worries about encouraging good health, but apparently not about the private sector social engineering involved in Taco Bell's promotion of "fourth meal" or Carl's Jr.'s various ads that often verge on the salacious with variants on the theme of "big meat" with or without implied comparisons to the body of a woman as in one recent campaign, to cite just two examples of ubiquitous market-based anti-health promotion.
To paraphrase Karl Marx on history: We make our own health, but we do not do so under conditions of our own choosing.
If we really want as a people or a community to have better health, as individuals, as a statistical population, and as socially connected groups of whatever size, we need to recognize a mutual social interest in supporting one another in being healthy, but also in being less rather than more sick and in getting better when we are sick.
And a piece of that, an important piece, is getting national health insurance that will let us restructure the incentives in the system to health promotion, prevention, primary care and early stage management, and remove obstacles to individuals engaging with the system in ways that enable better choices.
7:06 p.m.
Sep 25, '09
One last, short illustration. When you write about biking, you inspire me. You provide social support for imagining making better choices.
In this piece you don't quite lecture about personal responsibility, but the way you talk about it I would say probably does less to encourage it than some of your other writings.
Sep 25, '09
T.A, who claimes native ancestry seems to have forgotten everything he surely must know about the welter of known cofactors to wellness or not we have identified in the diversity of populations across this continent.
Sep 25, '09
However, TA, I'll give you this: you are a passionate man.
Sep 26, '09
More reasons for single-payer: The Best Health ‘Reform’ Money Can Buy
Sep 26, '09
Oregon voice mysteriously missing from the mix: Mitch Greenlick, onetime head of the OHSU School of Public Health. Wonder why he is not standing front and absolutely center with his public voice on healthcare reform? I'm certain we'd have heard it a LOT if he was making it his business to be The Guy on this with all of his contacts in the academic, research and policy infrastructure.... his connection to the Kaiser Center for Health Research is solid gold, and his reach, professionally was nationwide.
Rather than an MD who has been a politician for as long as I've known of his name, why are we not hearing from our Perfessor now? Anyone here have contacts with his office? It would be such a dream come true if all this talent we have in Oregon would band together and do something marvelously Frontline. We used to be such leaders in environmentalism and ecology in this nation. Why can't we step up here and take the jump in this arena? The BlueJean Brainy Coalition needs to do what they do outstandingly.
Sep 26, '09
And: jeez Chris. Run for office. You simply slay me when you take it on and remain eloquent, gracious and controlled.
Sep 26, '09
LT, thanks for addressing that awful "once upon a time" narrative. I was afraid I would rant. I am trying to stem the rising tide of rantiness I'm slipping into again.
Iris, also thanks, such a reasonable, incisive invitation to further discourse. Kitz has much to be respected for, brings a lot to the zeitgeist in politics. However, conflation is rampant in the mosh pit of discussion nationwide. We need calm untanglers such as yourself and others here.
Sep 26, '09
We are in the days of Nietsche's Last Man, an apathetic creature with no great passion or commitment. Unable to dream, tired of life, he takes no risks, seeking only comfort and security, an expression of tolerance with one another: "A little poison now and then: that makes for pleasant dreams. And much poison, at the end, for a pleasant death. They have their little pleasures for the day, and their little pleasures for the night, but they have a regard for health. 'We have discovered happiness'-say the Last Men, and they blink."
Sep 26, '09
notn: funny, I kind of ranted that out a few days ago, asking if anyone was gonna stop mouthing platitudes about everyone deserving what they have... but I'm sure few of us would truly accept any substantial negative impact on anything we have for health care access on the way to pushign the standards and the bar to where I believe they belong, we all seem to say we believe it belongs! Yours is a more-acceptable way to get it said.
3:37 p.m.
Sep 26, '09
rw, i never claimed native ancestry. you have me confused with someone else. there's some Cherokee on my dad's mom's side, but it's pretty diluted in me. the Barnharts have been in this country for 11 generations, but that's not really relevant. not sure what you were talking about up there. not to mention, my only point is that health is the most important thing. how we provide medical care, which is the current focus of the reform debate, is secondary to that. it's the means, not the goal.
Sep 26, '09
Yes, when I had things to say about current genocides and lumped Andrew Jackson in there as an example of genocide strategy (instead everyone else's favorite "HIIIIITLERRRRR"), you were quick to tell me your native bonafides and then say that as a man of his times he was not so bad.
Sigh. Yes, viz monetary policy, patriotically thoughty. My rejoinder was to share the research of a good number of figures who were not fringe elements who actually decried what Jackson was doing.
Us Cherokee (we are a Cherokee family - enrollees, a famous bloody family feud to our fame [they shot up eight marshals and then cleared the Old Courthouse with people diving out the windows to escape the killing of a rain of gunfire....]) are surely the most spread-around, most-claimed, resolutely dilute portion of the tribes of this continent! :)
Sep 26, '09
My point, Barnhart, is that native people are a fine, incredibly well-documented exemplar of generations of impact viz poverty, lack of access, family culture, destitution of "home" culture and lifeways. Then let's look at the actual biological differences in the native person and the continuing impact of generational grief, loss, displacement.
And, given your quickness to call native last year, I assumed you were very in touch with the concept of not blaming folks and shaming them for the baggage they must address day after day after day in the life they live. There is a lot of it. And thru kindness during this boot camp we know as life, you accomplish so much.
Sep 26, '09
For all the people caterwauling for single-payer and about the superiority of Medicare, some food for thought from a recent article in the September 2009 issue of The Atlantic:
'From 2000 to 2007, despite its market power, Medicare’s hospital and physician reimbursements per enrollee rose by 5.4 percent and 8.5 percent, respectively, per year. As currently structured, Medicare is a Ponzi scheme. The Medicare tax rate has been raised seven times since its enactment, and almost certainly will need to be raised again in the next decade. The Medicare tax contributions and premiums that today’s beneficiaries have paid into the system don’t come close to fully funding their care, which today’s workers subsidize. The subsidy is getting larger even as it becomes more difficult to maintain: next year there will be 3.7 working people for each Medicare beneficiary; if you’re in your mid-40s today, there will be only 2.4 workers to subsidize your care when you hit retirement age. The experience of other rich nations should also make us skeptical. Whatever their histories, nearly all developed countries are now struggling with rapidly rising health-care costs, including those with single-payer systems. From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent - all comparable to the 40 percent growth experienced by the U.S. in that period. Cost control by way of bureaucratic price controls has its limits.'
Sep 26, '09
Old news, Trossie. Plus the New Yorker article that made the rounds with total saturation.
10:59 p.m.
Sep 26, '09
rw, ever since "Custer died for your sins" it's pretty embarrassing to mention to mention having a (part) Cherokee grandmother -- but she was. i, however, make no native claims; i'm a euro/brit mutt, nothing more.
the native stuff last year was other people, including Ted Picolo; not me. if i mentioned it in passing, it was nothing more.
as far as related health issues & native people - duh. one of the shames of this nation is the on-going abuse of the people from whom this land was taken. not to mention a whole bunch of other people who did the hard, brutal, often deadly work to build America's greatness. a focus on these people, among other, is part of what i'm talking about. we need to separate means -- single payer, public option, etc -- from ends: health care for all. all
Sep 27, '09
T.A. Barnhart:
We do everything in this effort to reform America’s health care but shut up and remember that this is not about government, not about philosophy, not about politics, not about money.
It is about people and the quality of their lives.
Bob T:
Okay, fine. But in the fifteen or so years since so-called HillaryCare bombed (and even for many years prior to then), why didn't the Dems do things like, say, break up the State-AMA partnership that has for many decades limited the supply of physicians (is there any reason why we can't have as many doctors as there are lawyers?), or allowing individuals to have the same tax breaks for medical insurance as businesses, or allowing people to purchase such policies from companies in any state, or reducing many of the ridiculous coverage mandates that make such policies more expensive than they need to be, or revisiting various licensing restrictions so that many minor procedures can be dealt with by nurses and other assistants, and so on?
Just because the Republicans essentially did nothing regarding reform doesn't mean the Dems couldn't have tackled these items as well, one at a time. Maybe these are good ideas, and that's why neither party was interested.
Bob Tiernan Portland
Sep 27, '09
Barnhart - you are dragging my comment off into whatever perception you have of me. Don't give me the duh stuff. I am saying that your "shame! shame! seek health you terrible american couch potatos" is not very effective. Kaiser Permanente already does that, charmingly, and via refusing timely appointments to the non-pushy!
Don't give me the duh shit. My point, T, is that your message is just not relevant to MANY and the natives are one fecking example of it, if you need a glaring example to get your attention for a moment. I can name more subtle ones, but not sure it would have gotten your attention.
Sep 27, '09
And: you did claim your nativeness. And went on about the goodness of Andrew Jackson. A man for his times. I recall you quite clearly as your name rather stands out. We could ask old Teddy if it was he. Perhaps it was some thread you wrote, more of your "passionate man beats chest with feeling" with substance thrown in.
Sorry, that was a cheap shot, but I had a real point, and you are just being a twerp. The point, which I'm sure you prefer to cloud with some little bit of twerpiness, is that your message, your underlying message, was unbelievably irrelevant to MANY threadlets of society, the natives only being the easiest for you to understand at a glance.
Sep 27, '09
rw: incomplete thought stub - it's possible, vaguely, that picolo posted in a thread that you wrote that inspired the genocide-strategy-for-the-times... but I know also someone else commented on your native ancestry too... sooooooo... and somehow I have quite a memory of you telling me not to judge older age ppl by the standards of now... upon which I presented the looking I had done to test just this bias I suspected in myself... how could I have come up with that out of the air, my dear? I do not assume such of folks who do not vaunt it. I assume quite the opposite - and even when they do vaunt it, if it is cherokee and it's old and it's grandma and "back then they did not talk about it" that is a common meme for "i wish i wish i wish o how i wish".
And we just courteously put up with it. History is clouded.
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