Monday, September 1, 2008

Democracy (& Health Care) in America

For reasons far too long & complicated to go into here, my health insurance has dropped me like a load of hot rocks. My one perscription medication that I take daily, name not important (let's just say it's not a 'male enhancement') is now covered by SucksToBeYou Insurance (out of pocket. My pocket). So, I call the drug store where I had been getting this med. This drugstore is part of a nation-wide chain, with the only real distinction being its open 24 hours. With my malady, being able to pick up medication between two & three AM is a real help, which is why I had been going there.

Now, the actual dollar cost of this one med at the 24 hour drug store was $544. per month--roughly the cost of my health insurance premium. So, I called another pharmacy (this one part of a formerly locally owned grocery store chain). THEY charged $300. for the monthly dose--same med, same manufacturer, not a generic, all things really ARE equal. In talking to both pharmacists, I specificed that I was paying C-A-S-H cash--not insurance, and both assured me that didn't make no doughnuts: everyone pays the same price at their shop. However, the grocery store pharmacist said 'You might try CrapCo [not it's real name]. They could be cheaper.'

So, I call CrapCo, and and THEY sell the exact same drug, same everything, with a monthly cost of about $240--or $300. a month CHEAPER than the place I had been going to....Not only that, the CrapCo pharmacist tells me that there is a new generic that's not time release (mine's a time release), and that if my doctor thinks it works for monthly cost might drop to about fifty clams--but I'm not to quote him on that. I laugh, and promise him that I won't try to get him fired....Neither of the other pharmists mentioned that. In fact, the 24 drugstore person told me there was no generic.

Of course, this same medication sells for nickels outside of the US. Granted, there's no FDA in many third world countries (not that the FDA is ringing any bells here, what with a certain president handcuffing any federal organization that helps consumers--but we digress). Still, looking at somewhere between a less than a buck (outside the US) and $550. a month.....What's wrong with this picture?

The American health care system is a POS (legal term of art. Also useful for ducking profanity censors), but for people who HAVE good employer provided insurance, the system works great for them--or good enough....Which is why I think we as a people lack the 'political will' to really do something about health care.

When the first primaries started rolling, I went & looked at the raw numbers of who voted, and what were the percentages of registered voters who actually voted. The numbers (to save you all a long rant) were tiny. What is the consituency who votes? I'm suggesting that the heavy bulk of those voters not only have decent health insurance, but are pretty much happy with the status quo. That number is a small fraction of the population, but consitute a tremendously disproportionate electoral clout--and they know which side their bread is buttered on.

What is the purpose of insurance? To pool risk. How do you minimize the cost of a pooled risk? Throw out everyone who's a bad risk. With single payor universal health care, everyone--especially the bad risks--are covered. For those who have private insurance through United WASP Mutual, being part of a plan that includes all the uninsured & underinsured is going to cost more money. That's bad. Know what's worse? Having some form of a public health insurance that consists of everyone that no private insurance company wants. The total benefits paid out of the public health care program will be much higher (on average) than the private insurer, the pool of insured will (on average) have less resources, so those covered by the public health care will never be able to pay any where near what the actual 'premiums' would have to be for the program to be solvent....So those voters who belong to United WASP are going to get stuck subsidizing the cost of any public health insurance--which is what they should be doing anyway, because what they pay in premiums is artifically low (because the private insurance pool throws out all the sickees who would be a drain).

But that's political poison: paying higher taxes for slackers to get health care, WASPs (and WASP fellow travelers) won't stand for that (why they stand for paying $15 billion USD a month for the war in Iraq, on the other hand, that I can't figure out).

So--if a significant percentage of the population doesn't have access to health care for no good reason (other than perhaps to reduce the average risk of the insurance pool--I'm assuming 'no good reason' here, because the economic argument why there is 'no good reason' would take too long), why did 'Hillary Health Care' in 1992 go down with such a thud? Why isn't health care making the impact at the polls that it should? Only weirdos like Dennis Kucinich talk about single payor health care, and look how he did.

I'm a leftist (I'm not even one of the 1970s 'new left' people, if you can believe it), so I bristle at anything that smacks of 'blaming the victim.' Still--while it's become a cliche, the numbers of people who 'vote' on American Idol and Dancing with the Has Beens continue to outpoll any kind of political election. There are lots of good (and bad) reasons why that is, but at a certain point it's time to start pointing fingers.

There's an old adage that people pretty much wind up with the government that they deserve. Is that the problem with American democracy? The old 'lead a horse to water' phenomena? How long must a group of people engage in behavior that can be considered 'dumb ass,' before you can say 'Wow. Those people really are dumb asses.' I am saying (in a gross oversimplification) that Americans who are either underserved or uninsured who did not vote for Dennis Kuncinich or Ralph Nader are dumb asses.

On the other side of the coin, my parents have United WASP health insurance, and are violently opposed to national health care (I'm not completely clear how they reconcile that belief with their extreme conservative form of christianity, but we pointedly do not discusss it. Come on--we're WASPs). The closest I get to discussing it is when I mention the alarming growth of strains of drug resistant TB, and how MAYBE that's something their own insurance wouldn't be able to help them with....but that goes no where: they refuse to see a connection between their economic interests and seeing lazy ass deadbeat dope heads getting the right medication for TB. So, should I expect the average American Idol voter (discounting all the 'under 18 year olds' who vote for Idol) to pay attention enough to be able to vote their socioeconomic interests?

I guess I do. At some point, that percentage of the population who will pay money to vote for American Idol (but not vote in elections, which with the abolition of poll taxes are 'free') needs to pull their head out of their rear end.

And don't hand me that crap about how 'there's not any difference between candidates.' First, virtually everyone who says that doesn't know squat about the candidates anyway--but if that's your problem, then vote for Bob Barr or Ralph Nader. Don't tell me there's no one out there who reflects your values.

I need to make one more rant on elections, again as an 'old left' ie 'idiot.' For a long time, the US left either avoided electoral politics altogether (because that's 'social fascism'--and I am not making that up), or engaged in campaigns that were sick jokes (like Gus Hall). But back in February 1917, when the Tsar's government collapsed, Lenin was in Switzerland. There's lots of reasons why Lenin was organizing there (e.g. a Marxist view of the evolution of economic systems, where socialism follows capitalism--1917 Russia being largely agarian, the 'socialist revoltion' can't happen there....), but the point is, Lenin was trying to build his revolution in a nation and a forum that he thought was the most productive.

What would be the most 'productive' strategy to organize real political change, not just in the US, but in the world? I would suggest getting a truly representative number of Americans to actually vote their pockbooks.

Just how to do that, though, I have no idea. But I am open to suggestions.

No comments: