Sigh. Looks like health care “reform”, as defined by getting a magic bill through Congress, is heading for another train wreck. It might behoove Democratic members of Congress, and the administration, to reflect on the nature of the New Deal’s success in getting legislation passed.
Neither FDR nor Congress had a grand plan in March, 1933 for rejuvenating the economy and building a social safety net. Rather, they produced, over time, a series of bills which, collectively, worked. Trying to cram EVERY single needed change into a system which encompasses over 15% of our GDP and maybe 18% of our workforce is bound to rattle a few cages.
Rather, our representatives should work on a series of one-off changes, and vote on each of them, building a majority coalition for all which may shift from bill to bill. That way, specific things which some legislators object to, or favor, can be enacted, without everyone having to swallow the whole package.
My little list of “things we can do right now” includes:
- Authorize Medicare and Medicaid to begin negotiating with drug companies for discounts on drugs payment under Medicare Part D and Medicaid.
- Open up the Federal employees’ health benefit plans (these are health insurance plans, using a standard benefit package, provided through private insurance carriers, in local areas) to all Americans.
- Embark on a ten-year process to reduce Medicare funding to the lowest 20% of the 300+ Medicare service areas, adjusted for local cost-of-living differences. This would eliminate the atrocity of Medicare paying over $10,000 per year for Medicare enrollees in Miami, Boston, and Los Angeles, while paying only $5,000 in Minneapolis, Seattle, and Portland. To say nothing of similar differences in more rural areas such as McAllen, TX (high) and Grand Junction, CO (low).
- New taxes on incomes over $250,000, on payments for health insurance by individuals and business above the 50th %-ile, and use this money to pay for income adjusted subsides for the cost of health insurance purchased by individuals below about 300% of the federally defined poverty level.
Expand coverage. Insure more people. Find money to pay for it. Reduce the costs the government has control over. This are the core of what needs to happen NOW. All the other things which bloat the 1000 + page bills are just “pet projects”, like earmarks, for Democratic/progressive interest groups. Don’t let them high jack the changes the whole country needs NOW.
*****************
For example:
Yesterday’s group ride started calmly enough. We only had about 7 or 8 people going out, as many were doing races, especially the Lake Stevens Half Ironman (70.3). This summer, the rides sometimes swell to a couple dozen. Since much of the route is through the Ft Lewis Army base, where the only traffic to compete with are Strykers, Hummers, and the occasional artillery blast, even with a group that large there is little to no inter-vehicle conflict. I mean, if you see a half-track in the road ahead, there’s no question about your cyclist’s attitude – you get out of the way!
For me, the ride was meant to be a long steady pull. I did 25 miles from home down to the group ride start locale, then would latch on for 50 miles of good hard time trialing, and another 25 home. All at 20-22 mph, HR in the one-teens and twenties, 150-210 watts.
Our strongest rider that day was Allen, who is going down to Australia for the ITU World’s Championship (I made the team also, but chose Kona over the Gold Coast). He can hold 26-7 mph for 5-10 minute tempo intervals, making him just perfect for me to follow in those intervals. Otherwise, I was either leading a small group at my pace, or just cruising solo. The day was cool, no sun, 60s, minimal breeze.
After the climb up from the Nisqually River (which I “won”, as usual, despite being dead last, as usual, in the first steep section), we turned away from the hilly section onto the flats through Rainier. Allen led the paceline for the first five miles at 22, then I snuck around the group at the turn, and pulled for a few miles until Allen diesled by again. THis put me about 5th wheel, but going easier than I wanted, so I snuck over to the far right of the shoulder, into the wind, but about a foot back.
The road was pretty clean, and Allen seem to be in a zone. He wasn’t pointing out hazards, because there weren’t any. I could easily see the rock, so I assume everyone else did, too. But just after the fist sized (a Shaq fist) chunk of granite appeared right in the middle of our track, I saw the second wheel bike launch straight up into the, a blue blur, with a yellow jersey flung awkwardly down into the rain ditch to out right.
“Shit, shit, shit ..” I kept repeating, as the guy in front of me and I both did our best to avoid the melee. I was far right, hovering over the drop off to the ditch, “Luckily” (for a lot of reasons), Mark and his bike had flown off the road and did not engage any of the rest of us. We safely, miraculously all steered straight, avoiding wheels in front and behind, and slowed to a a stop. We had to holler after Allen, who was oblivious to the carnage behind him.
I lay my bike down in the ditch, mumbling “That didn’t look good”, while someone else, younger, spryer than I, raced back to the scene of the fall, shouting, “He’s going into shock for sure!”
When we got there, Mark was curled up in a fetal roll, blood coming from the usual spots on his right forearm, right calf and knee, and right hip. He was holding his right shoulder. Elena, a pathologist, was probing along the right clavicle, and Mark did not wince, so I figured his collar bone, the most likely fracture, was intact. He then stood up, sat back down, and was obviously conscious and ambulatory, So no immediate worries about head injury or hip fracture. All of these possible disasters went through my mind, and I ruled them each out. but said nothing. My job, I thought, was to make sure nothing went wrong – let others take action, I would only stop or intervene if I thought something was not going right.
With Mark talking, and moving, and denying any pain except superficial skin lacerations, I took stock of his bike – lost an end cap, scrapped his right shifter, and knocked his front brake out of true. But the wheel were straight, the frame was intact. Someone noted his chain was off the gears – wow, if that’s all that happened, both he and the bike were VERY lucky.
A Good Samaritan in a red pickup, who had been passing us just as Mark launched, circled back, and offered to help. We put Mark and another guy in back, with their bikes, and they headed for the local fire station. We rode on with our slowest guy leading, all a bit shaken and cowed to the tune of and 18 mph cruise into the Texaco, where we re-grouped.
“Well, that’ll take the wind from our sail,” I said to Allen as we dawdled along at the rear of the line, behind even Elena.
We pulled into the Texaco, just as Mark headed back in, hauled from the vacant fire station by a red-shirted volunteer. This started a whole new round of activity. As Elena poured hydrogen peroxide on his forearm, I got my first close look at the lacerations. In addition to general abrasions, he had two linear, narrow gouges, full surface through the dermis, dripping blood.
“Oh yeah, you really should get stitches for that.”
“I don’t have any health insurance. I’m not paying one dime, can’t afford an ambulance ride to the clinic, nothing.”
But it turns out his sister is a family physician, up in Bellevue.
“Well, CALL HER UP. Tell her to meet you with suture and lidocaine. You need to get those closed. And see if she can stitch up that hole in your shorts, as well.” His $220 Assos cycling shorts were shredded over the road rash spreading purple around his right hip.
Here’s a man who can afford a $3,000 bike, shorts twice the price of mine, and has a great job. But he’s afraid to get his skin stitched up, because setting foot in the hospital will cost him more than those two items together. Just to keep his skin from scarring up. We can do better, I think, especially for those who don’t have a good job, or spare cash for toys, or who aren’t healthy enough to ride at 22 mph on a pleasant Saturday morning through Thurston County.