Friday, August 14, 2009

A really long post + a story

The story:
I'm told frequently, by folks who don't know me, that I have a really great voice.
So - for about a year-and-a-half, I'm been "working" on taking advantage of this asset: consulting with folks on what it takes to develop a 'voice-over' career, crafting audition scripts, etc.
Yeah - I've been at it for 1.5 years. ("As the ancient Romans said, festina lente." - quote from G&S's Iolanthe.)

Anyway: I've recently (today) crafted an audition script for what I propose as a 10-minute radio harangue for a 15-minute early morning (2:35 a.m.) timeslot on local AM radio station ("Hi! I'm auditioning for a position you didn't know you had!").
The basic idea is to be rancorously, not-at-all genteel response to right-wing talk-radio.

I'll let you know how it turns out.
Anyway, here's my unedited script:
Private Buffoon here.

Tonight we’re gonna talk about health coverage.
Limbaugh, Beck, and the other right-wing talking heads would have you believe that universal health coverage is the first step on the way to totalitarianism – give the Government a say in health coverage and next thing you know we’ll be euthanizing Grandma and killing your kids… well, only the ones who don’t get A’s in the “All Praise Our Glorious Leader” class that will soon be required from 1st thru 12th grades in every public school in America.

Let’s start with a few facts.
I know – facts aren’t a good place to start if you’re on the radio, but let’s give it a try.

Pay attention.

The United States of America is a member of a group called the Organization for Economic Co-operation and Development – OECD for short. This group consists of 30 developed countries…
committed to democracy and the market economy from around the world to:
Support sustainable economic growth
Boost employment
Raise living standards
Maintain financial stability
Assist other countries' economic development
Contribute to growth in world trade
It includes Australia, Austria, Denmark, Belgium, Finland, France, Germany, Japan, Korea, Mexico, the U.K., and New Zealand, just to name a few.

Not exactly a bunch of third-world, developing countries under totalitarian despots.

Among these countries, the U.S. is the ONLY country without some form of universal health coverage. The only one.

Not every country has the same system. England – the U.K. – has truly ‘socialized’ medicine: doctors are government employees. Everyone can go to the doctor for whatever medical problems they have. The Government foots the bill and employs the doctors.

Canada has a ‘single payer’ system. Doctors are independent agents – just like in the U.S…. BUT – the Canadian government is the sole insurer. You go to the doctor of your choice, pay a nominal co-pay, and the doctor – he or she – submits the insurance paper-work to a single insurer: the Canadian government.

Other countries do other things… BUT – they all guarantee affordable, high-quality, timely health care to all their citizens…
… Well – all except the U.S.!!!

A comparison of U.S. healthcare to other OECD countries is enlightening.
I’m not making this stuff up – the numbers are from the Congressional Research Service:
A Report on
U.S. Health Care Spending:
Comparison with Other OECD Countries
Prepared for Congress in September 2007.
How ‘bout we talk healthcare spending?
The United States spends more money on health care than any other country in the Organization for Economic Cooperation and Development (OECD). The OECD consists of 30 democracies, most of which are considered the most economically advanced countries in the world. According to OECD data, the United States spent $6,102 per capita on health care in 2004 — more than double the OECD average and 19.9% more than Luxembourg, the second-highest spending country. In 2004, 15.3% of the U.S. economy was devoted to health care, compared with 8.9% in the average OECD country and 11.6% in second-placed Switzerland.

We spend more than DOUBLE the average of OECD countries on healthcare.

So, we have better health than everybody else, right?

What does the United States get for the money it spends? Said slightly differently, does the United States get corresponding value from the money it spends on health care? … among OECD countries in 2004, the United States had shorter-than-average life expectancy and higher-than-average mortality rates. …

… research comparing the quality of care has not found the United States to be superior overall. Nor does the U.S. population have substantially better access to health care resources, even putting aside the issue of the uninsured. Although the United States does not have long wait times for non-emergency surgeries, unlike some OECD countries, Americans found it more difficult to make same-day doctor’s appointments when sick and had the most difficulty getting care on nights and weekends. They were also most likely to delay or forgo treatment because of cost.
The report quantifies these findings.
Life Expectancy. The average life expectancy for a person in the United States is 77 ½ years — slightly below the OECD average, and 4½ years less than toprated Japan. Life expectancy is nearly 2½ years longer in Canada than in the United States. The United States is ranked 22nd out of 30 countries on life expectancy at birth …
Mortality Rates. The United States has a higher rate of deaths from natural causes than 17 OECD countries.
That’s right – of the 30 OECD countries – all except the U.S. with some form of universal health coverage, and all paying LESS than the U.S. for healthcare – the U.S. ranks 18th in mortality – in the bottom half!
Infant Mortality Rates. The United States has the third-highest infant mortality rate in the OECD, after Turkey and Mexico!
Hey – we beat out TURKEY and MEXICO on infant mortality!!!
30 countries in the OECD.
The U.S. ranks 28th in infant mortality!

These are the facts. Not MY facts, but FACTS reported by the Congressional Research Service, for members of Congress.
We spend more on healthcare than any other country in the world, no matter how you measure it.
We spend more per capita on healthcare than any other country in the world.
We spend more as a percent of GDP than any other country in the world.

BUT: We are in the bottom half when it comes to basic health outcomes: life-expectancy, mortality rates, infant mortality… and we’re better than only TURKEY and MEXICO when it comes to infant mortality!!!

Sarah Palin worries about Government-sponsored healthcare killing her kids?
She should worry about private insurance killing her kids!!!

Congressional Republicans and conservative talking heads would have you believe that so-called ‘socialized’ medicine would result in healthcare rationing, Grandma being euthanized, and the rest of us subject to arbitrary decisions of government bureaucrats.

Guess what?
We all are ALREADY subject to the not-so-arbitrary decisions of healthcare bureaucrats! They’re called INSURANCE COMPANIES.
Private insurance companies devote tons of money every year to DENYING claims! – I don’t know how much insurance companies spend DENYING claims – if I had the numbers I’d tell you – but my bet is around 20 cents of every premium dollar goes to pay for BUREAUCRATS whose only job is to DENY YOUR CLAIM!

A recent government report, “Coverage Denied: How the Current Health Insurance System Leaves Millions Behind”, explains how this works: - this is a lengthy quotation from the report -
A pre-existing condition is a medical condition that existed before someone applies for or enrolls in a new health insurance policy. It can be something as prevalent as heart disease – which affects one in three adults – or something as life-changing as cancer, which affects 11 million Americans.
But a pre-existing condition does not have to be a serious disease like cancer or heart disease. Even relatively minor conditions like hay fever, asthma, or previous sports injuries can trigger high premiums or denials of coverage.

In 45 states across the country, insurance companies can discriminate against people based on their pre-existing conditions when they try to purchase health insurance directly from insurance companies in the individual insurance market. Insurers can deny them coverage, charge higher premiums, and/or refuse to cover that particular medical condition.

A recent national survey estimated that 12.6 million non-elderly adult – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years
In another survey, one in 10 people with cancer said they could not obtain health coverage, and six percent said they lost their coverage, because of being diagnosed with the disease.
It is still legal in nine states for insurers to reject applicants who are survivors of domestic violence, citing the history of domestic violence as a pre-existing condition.
Even when offering coverage, insurers can exclude whole categories of illnesses related to a pre-existing condition. For example, someone with a pre-existing condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage.
Okay – I’m done reading from the report.

This isn’t my opinion. This is a Government Report!

Even if the pre-existing condition has NOTHING to do with your current ailment – say, you had hay-fever and now have prostate cancer – and EVEN IF you DID NOT KNOW about the pre-existing condition, your insurance company can STILL deny coverage!

You wanna talk about ‘rationed care’???
Sure – let’s talk about ‘rationed care’… UNDER THE CURRENT PRIVATE SYSTEM!!!

Now – I can understand why private health insurance companies want to maintain the status quo: they’re making a mint off of you! – you pay premiums, they get to decide if they’ll pay up when you file a claim.
Maybe they will.
Maybe they won’t.

If they don’t, you’re screwed!

You don’t have a pre-existing condition?
Sorry – you’re still screwed!
A recent Harvard University study found that 62% of personal bankruptcies resulted in part from medical costs and some 78% of those people who filed for bankruptcy had health insurance, in most cases private coverage.
The fine print in insurance contracts frequently precludes the very coverage you THINK you’re paying for!

As I stated earlier – I can understand why private health insurance companies want to maintain the status quo. They’re making a mint off you & me!!!

BUT: why are YOU - presumably sane, ordinary citizens - opposed to reforming this predatory, expensive, non-productive system?

Well… as best I can tell, there is no REASON! – there’s just a lot of corporate-sponsored, ideological fear-mongering going on… and these poor slobs – you, my listeners – are drinking the Kool-Aid!

“Drinking the Kool-Aid” is a metaphor deriving from the Jonestown mass suicide of 1978. Hundreds of perfectly sane, perfectly healthy individuals somehow were convinced by Jim Jones to commit suicide by drinking cyanide-laced Kool-Aid. These folks were no different than you and me – honest, hard-working, conscientious citizens who fell under the mesmerizing spell of a charlatan
You – my fellow citizens – have come under a similar spell, of another charlatan.
Not a charismatic individual, but a charlatan nonetheless – Big Insurance and Big Health.

These are the folks you need to fear, not the government!

Just like the residents of Jonestown, you are being convinced, against your better, rational judgment, to “drink the Kool-Aid” – in this case, to oppose what every other developed country in the world has already adopted! – with less cost and better outcomes than the broken system we have inherited – a government-sponsored program to assure affordable, timely access to high-quality health care!
Just as Jim Jones’s followers committed suicide by “drinking the Kool-Aid”, so are YOU being asked to commit financial suicide by “drinking the Kool-Aid” of Big Insurance and Big Health.


Why have you bought into the irrational propaganda?

Again: Every other developed country in the world has some form of national health insurance, guaranteeing their citizens access to affordable, timely, high-quality health care. Not the U.S.

You folks on Medicare: you’re already GETTING U.S. Government-sponsored access to affordable, timely, high-quality medical care.
Do you hate it??? – No, I didn’t think so!
Has anyone threatened to take it away… well, except for the right-wing, who thinks Medicare is an evil Socialist conspiracy?
There’s NOTHING in the current health-coverage reform bill that threatens Medicare! NOTHING!!! – you’ll still get your United States Government-subsidized health insurance, aka MEDICARE!

There are two (2! – count ‘em!) things on the table:
1. Regulation of private insurance companies so they can’t deny the rest of us coverage based on so-called ‘pre-existing’ conditions.
2. Offer the rest of us – those of us under retirement age – a program similar to Medicare.
You’re happy with Medicare – why can’t we have something similar???

“Rationed care”???
You’re getting it now – with private insurance companies!!!

When Sarah Palin and Senator Grassley talk about “death panels”, they’re lying to you - to put it bluntly.
This should not be too surprising – conservatives lie to you all the time.
(More on this in another installment!)

That’s what the word means – “conservative” – “conserve the status quo.”
Keep things just the way they are.
(Note: I’m okay using the word “conservative” to describe the folks who are lying to you. BUT – I would prefer to use the term “conservative Republicans” – I choose not to use this term because I really do NOT want to alienate any self-identified Republicans among my listening audience.)

A couple of observations.

When the idea of Medicare was first proposed in the late ‘50s, early ‘60s of the last century, who rose up to oppose it?
Conservative Republicans, to be exact.

If Medicare were enacted, all sorts of horrible things would result!!!
You wouldn’t be able to choose your own doctor.
Medical care would be rationed.
The United States would descend into a godless Communist hell.
(For what it’s worth, Saint Reagan – the patron saint of conservative Republicans – was one of the mouthpieces for this propaganda.
Guess what? – he was wrong!)

Under LBJ, Medicare was created!!! – Yes – a “socialized medicine” program was created under an ultra-liberal Democratic President!

Know what else?

Medicare is one of the most popular, most successful Government programs in history!

Sort of takes you back to 1935 when Social Security was made law.
Social Security is close to the most popular, the most successful social insurance programs ever enacted.
Guess who did it?
Liberal Democrats under a liberal Democratic President – FDR!
Guess who hated it? – conservative Republicans.

Even as recently as 2005, President George W. Bush and his Congressional Republican enablers tried to kill Social Security!
These are the folks you think will lead you into the Promised Land???

Again, when Sarah Palin and Senator Charles Grassley talk about “Death Squads”, they’re lying to you.
They just want you to be afraid.
Afraid of everything, all the time.
They don’t care about you – they just want you to be afraid.

I suppose I ought to dispose of the “Nazi” scare tactics at some point.
How ‘bout now?

Let’s start with obvious.
Yes, “Nazi” is a shortened form of National Socialism. – BUT – words aren’t reality.

Somehow, at the mere mention of “Socialism” we’re all now supposed to run to our caves and cow… shuddering at the word!

Glenn Beck looks forward to Nazi eugenics based on “end-of-life” planning.
That’s a good place to start.
Here’s the exact wording of HR 3200, section 1233 – and, yes, I’m going to read it in full:

(a) Medicare-

(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--

(A) in subsection (s)(2)--

(i) by striking `and' at the end of subparagraph (DD);

(ii) by adding `and' at the end of subparagraph (EE); and

(iii) by adding at the end the following new subparagraph:

`(FF) advance care planning consultation (as defined in subsection (hhh)(1));'; and

(B) by adding at the end the following new subsection:
Okay – pay attention! – here’s the definition of “Advance Care Planning”!
`Advance Care Planning Consultation
`(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

`(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—

`(I) the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual changes;

`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

`(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State—

`(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

`(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

`(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that—

`(I) ensures such orders are standardized and uniquely identifiable throughout the State;

`(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional's authority under State law) may sign orders for life sustaining treatment;

`(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

`(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

`(2) A practitioner described in this paragraph is—

`(A) a physician (as defined in subsection (r)(1)); and

`(B) a nurse practitioner or physician's assistant who has the authority under State law to sign orders for life sustaining treatments.

`(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).

`(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

`(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

`(5)(A) For purposes of this section, the term `order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that—

`(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional's authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;

`(ii) effectively communicates the individual's preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

`(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and

`(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.

`(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—

`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

`(ii) the individual's desire regarding transfer to a hospital or remaining at the current care setting;

`(iii) the use of antibiotics; and

`(iv) the use of artificially administered nutrition and hydration.'.

(2) PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(FF),' after `(2)(EE),'.

(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended—

(A) in paragraph (1)—

(i) in subparagraph (N), by striking `and' at the end;

(ii) in subparagraph (O) by striking the semicolon at the end and inserting `, and'; and

(iii) by adding at the end the following new subparagraph:

`(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;'; and

(B) in paragraph (7), by striking `or (K)' and inserting `(K), or (P)'.

(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.

(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-

(1) Physician'S QUALITY REPORTING INITIATIVE- Section 1848(k)
(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:


`(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.

`(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.'.

(c) Inclusion of Information in Medicare & You Handbook-


(A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:

(i) An explanation of advance care planning and advance directives, including--

(I) living wills;

(II) durable power of attorney;

(III) orders of life-sustaining treatment; and

(IV) health care proxies.

(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including—

(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);

(II) website links or addresses for State-specific advance directive forms; and

(III) any additional information, as determined by the Secretary.

(B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.
(note: i tried to indent this bit appropriately but gave up!)

Okay – so what does all this legalistic jargon mean?

It means – if you don’t want to be the next nationally televised Terry Schiavo, you can decide for yourself, now, today, what to do if you’re deemed to be in a “permanently vegetative state” – and not have your husband or wife or parents agonize over what you may or may not have wanted…

… AND: you’ll be reimbursed for the Doctor’s time helping you to make this decision.

Does it mandate “Death Panels”???
Does it REQUIRE that you plan ahead???

BUT: conservative Republicans – and the Health Insurance Industry – would really like it if you could be convinced that this simple promise that you’ll be covered for end-of-life decisions meant that YOU’LL BE PUT TO DEATH!

That’s what THEY want you to believe.
That’s NOT what the legislations says!

As it so happens, I agree with Sarah Palin that a system that required a
“death panel” … to decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.
You know what, Sarah?
Such a system would be downright evil.

You know what else?
NOTHING like that is being proposed!

You’re just saying this stuff to SCARE US!!!

It’s what conservatives do – you’re just like the rest of ‘em:
You want us to be SCARED – all the time, of everything!

So – next time one of your conservative Republican friends wants to SCARE THE BEJEESUS out of you with tales of euthanasia and Nazis –

It’s about time we joined the crowd, adopted some form of universal health coverage, and maybe actually got the “health” we’re paying for!!!

We’re long overdue for reform.

We voted for Democrats because we were sick of Republicans!


Write your Congressman and Senators today!
Tell ‘em that you don’t want to drink the Kool-Aid!!
Tell ‘em that you’re sick and tired of being ruled by Big Corporations!!!

Tell ‘em that you believe in the Preamble to the U.S. Constitution:
“… to promote the general welfare”
Not the welfare of big business and the heartless plutocrats who now rule our country, but the GENERAL welfare – YOUR welfare!!!
Yeah - I'm pissed!

1 comment:

  1. Fantastic post. Why don't you do a podcast of it?