| Number 238 | January 9, 2004 |
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This Week:
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Greetings, Last year at this time I began a semi-regular feature called “Anti-War Resource of the Week.” It appears that this feature could continue indefinitely, but I choose in the new year to move on to one of the most important domestic issues of the 21st Century: Health Care. This week I inaugurate something I’ll call the “Health Care Outrage of the Week.” In fact, I could have chosen any of a number of issues to feature in this way, since our political process seems to be eroding or reversing our advances in many areas, from education to the environment to our economic life to media and information to who-knows-what else. In my introduction I explain why I chose this particular issue to highlight in the upcoming series. The last couple of weeks I published little collections of things, which was a good idea but left me with a backlog of items that are begging for comment. I thought about doing another “double issue,” but I have done a number of them lately, and I know you all have other things to read. So, this week I’ll limit myself to health care, and just hope we get to war, mad cow disease, suicide bombings, elections, and all the rest before we’re too far into 2004. Welcome to the new readers that came on board over the holidays! I look forward to your comments on the things you see in these pages! And thanks, as well, to those of you who sent in pledges of financial support in the past month. The rest of you may follow their example and donate now: there is no need to wait for April and the next Nygaard Notes Pledge Drive. Thank you so much! Until next week, Nygaard |
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This is from the New York Times (“All The News That’s Fit To Print”) of January 9th, 2004, taken from an article headlined “Latin American Allies of U.S.: Docile and Reliable No Longer:”
To understand this “quote” properly, consider this definition of the word “extortion,” from the Oxford English Dictionary:
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Health Care 2004: Needs Great, Failure Obvious, Solution Clear |
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I think Nygaard Notes has been weighted, in recent months, a bit too much towards foreign policy and military issues. That shouldn’t surprise anyone, since the news in recent months—really, since September 11, 2001—has been dominated by news about war, international terrorism, and so forth. But, still, as we head into a presidential election year, there is a whole range of domestic issues that need attention. Very high on the list is the issue of health care. Unlike foreign policy—even war!—which can seem sort of abstract and “over there” to many in the United States, issues of health strike pretty close to home. When your father has heart disease, or when your cousin dies of undiagnosed cancer, or when you are told that your life-saving surgery will cost $30,000 and you have no insurance, it’s not the same as seeing pictures on TV of “smart bombs” or some alleged “terrorist” being taken into custody. ‘Way back in Nygaard Notes #39, in July of 1999, I published “We Need Universal National Health Care: What You Can Do,” and I’ve written numerous articles on the subject since. Just in the past year I published “Bush Attacks Medicaid” in Notes #219, “Orphaned by Industry” (about the medical industry’s failure to produce vaccines for “diseases of the poor”) in #220, “The Pharmaceutical ‘Marketing Machine’” and “High Drug Prices Explained” in #221, and “Generic Capitalism, or High Drug Prices Explained (Again)” in #223. But there is much more to be said. The subject actually comes up quite often in the Mainstream Corporate For-Profit Agenda-Setting Bound Media, often in quite revealing ways. Last August I ran a piece called “The Happy World, The Sad World,” in which I juxtaposed media stories from the month of July about health care from the “happy” perspective of the Health Care Industry and from the “sad” perspective of the human beings who are trying to get their health care needs met. Now, in the year 2004, I want to talk some more about the world of health care, adding in some very hopeful information about the research and organizing that is going on that is slowly forcing a new vision for U.S. health care onto the national stage. I suppose I’ll talk a bit about Medicare (and the Bush vision for the program revealed therein). No doubt I’ll say something about legislative efforts to reform our health care system, and I plan to throw in lots of miscellaneous stuff that’s been in the media (good and bad) that you may have missed. An Issue to Organize Around I think health care provides a unique opportunity to organize people into political action, since the needs are so great, the failures of our present system are so obvious, and the solutions so clear. Since the health care system touches everyone so directly, it presents a unique opportunity to build organizing bridges across barriers of race, gender, age, and—with the exception of the wealthiest among us—class. Health care affects everyone. I’ll tell you my bias right off the bat: I think we need a universal and publicly-guaranteed system of health care—either a single-payer system or a fully-socialized system—in this country. Over the coming weeks I’ll tell you why I think this, and give you lots of information so you can decide for yourself what kind of health care system is best for the United States of America in the 21st century. Along the way I’ll probably tell you some things you don’t know, and challenge some things you think you do know. This week I offer a personal story that I think reveals a lot. It’s the first installment, I guess, of what I might call the “Health Care Outrage of the Week.” The series won’t be all about outrages, though. Where I hope to end up is by showing how simple and elegant are the possible solutions to the ongoing crisis in health care that we are facing. But please remember as we go along: “simple” does not mean “easy.” There are a lot of very powerful interests in this country who like things just the way they are. |
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Here’s a personal anecdote from my own life, drawn from last month. I have poor vision, and have worn eyeglasses since I was ten years old. As I recall, my first pair of glasses cost $20. Total. I think the eye exam, with good ol’ Dr. Gutfleisch, was about $15. These things cost a little more now. Like, maybe, 10 times as much, or more. And therein lies a tale... About MinnesotaCare As readers may know, I am a participant in the publicly-subsidized health insurance program in Minnesota known as MinnesotaCare. As my “health plan” puts it, MinnesotaCare is “a program for people who live in Minnesota and do not have access to affordable health insurance.” People below a certain income level are allowed to sign up for MNCare and pay a certain monthly amount as a premium. The difference between that amount and the actual cost of the monthly insurance premium charged by actual private insurance companies (they now call themselves “health plans”) is paid by the State of Minnesota. My “health plan” is called UCARE Minnesota, one of the smaller “health plans” in the region (I think we used to call such organizations “health maintenance organizations,” but it’s hard to tell these days.) I chose UCARE simply because the primary care doctor I want to see is a member of that plan. About Eye Care There are basically three types of eye care providers in the United States. The lowest level is called an optician. These are the people who fit glasses and sell glasses; they’re not medical people in any sense of the word; they can’t even do eye exams. The next level up is the optometrist. Optometrists are not doctors, but they are skilled in diagnosis and treatment of eye conditions. They can diagnose eye conditions and, increasingly, can treat them. An ophthalmologist can do all the things that an optometrist can, plus more stuff, like surgery and prescribing more medications, etc. An ophthalmologist is a medical doctor. About MinnesotaCare and Eye Care I’ve been in the MinnesotaCare program for years, and they have always paid for my regular eye exams. There’s a lot of sense in this. A typical eye exam includes some basic eye health checks, such as a check for glaucoma. Glaucoma can cause irreversible vision loss, but an eye exam can detect it in its early stages, before any symptoms are evident to the patient and when it can still be effectively treated. Regular eye exams, in other words, are an example of basic preventive health care, something everyone agrees is a good thing. My regular eye exam was due last month. However, I knew that Minnesota had cut back the MinnesotaCare program as part of the budget-balancing mania of 2003, and that the cuts had taken effect on October 1, 2003. So, I thought I had better check with my health plan to see if eye exams are still covered. What I learned was revealing. I was told that my needed eye exam would no longer be paid for if performed by the optometrist that I have been seeing for 18 years. However, if it were performed by an ophthalmologist, it would be paid for. This seemed odd and backwards to me. Why did this seem odd and backwards to me? Well, I guessed that the cost of having an eye exam done by an ophthalmologist instead of an optometrist would be much higher. And, in fact, a few calls to some “approved” ophthalmologists (approved by my “health plan,” that is) confirmed it: My optometrist would charge me $100 for the exam. The “approved” ophthalmologists quoted prices from $200 up to more than $400. I called both the people at MinnesotaCare—very nice, very competent people!—and the people in UCARE “customer service”—very nice, not-very-competent people!—and asked about the reasoning behind this type of reduction in coverage. Neither of them were able to express a reason, nor is it their job to express a reason. Their job is to help me understand and comply with the rules. I spoke with my optometrist about this when I went in for my eye exam. He told me that it was highly likely that ophthalmologists did not even want to do routine eye exams, as they were more interested in attending to their specialties, whether it be surgery or more sophisticated treatments of eye disease. So, my optometrist told me, this particular change in the MinnesotaCare rules will likely be repealed in the near future. (Time will tell if he is right.) Being interested in the process that results in odd and backwards laws being passed only to be repealed, I then called the Minnesota State Senate and spoke with the Senate Counsel, Katie Cavanor, whom I was told had helped to write much of the language in the 2003 bill that imposed this silliness on the MinnesotaCare program. I described my situation, told her I was a journalist writing a piece on the issue, then asked her, “What was the rationale behind this change in the law?” Her response: “I don’t think there was, really, a rationale.” “Oh,” I said. She went on to explain that the original proposal last year from the Governor of Minnesota was to eliminate the MinnesotaCare program entirely, and that the last-minute frenzy of activity to save the program—in any form—resulted in “some silly things” being put into the final bill that nobody really thought about. The fundamental dynamic, Ms. Cavanor told me, was that “They were attempting to cut back the program,” and that some things got thrown in at the end, in a “last-minute attempt to keep some coverage.” The fact that much of this “last-minute attempt” really makes no sense is a regrettable fact. It likely will not prevent me from getting regular eye exams. But it will, no doubt, cause some people to put off, or avoid entirely, their eye exams. And we will thus not only bring about completely preventable human suffering, but may end up costing the state more, as well, as we proceed to provide care and treatment for people who are losing their vision. And all in the service of “No New Taxes.” |