I Can’t Believe I’m Doing This

I grew up about 20 miles outside of Washington DC.  I had classmates throughout my years of school that were the children of senators and congressmen, I’ve met multiple lobbyists, political analysts, and commentators.  I have no patience for politics.  I don’t trust the system, I have no faith in politicians and I don’t really believe that anyone in any elected position has any interest in making my life any better.

That being said, I’m going to talk about healthcare.

I’m not going to specifically address the new(ish) healthcare bill for two reasons.  One being that I have no interest in political debate and the other being that I have even less interest in political debate on topics on which I have very little knowledge base and despite the abundance of people complaining about and/or praising the new bill all over the internet, I can find very little that’s actually informative as to what specifically the bill says.

I am going to give you my opinion of government’s involvement in anything (bad) and in something as personal as healthcare (worse).  But first let me lay out for you a few basic facts.

Fact one: Previous to this bill and, I believe, continuing after it, healthcare has been available to everyone.  EVERY- ONE!  No really, it has.  It may not be cheap. It may in fact be prohibitively expensive, but it has been available.  Not-for-profit hospitals (and they’re everywhere) are legally required to give care to any and all comers.  They’ll ask for your insurance info so they know who to bill in the hopes that they’ll get a little cash for the care that they provide, but if you don’t have any they’ll go ahead and treat anyway, they have to, they can not turn anyone away.  Case in point: I work at a childrens’ hospital.  We treat children.  However, when, one new years day, a woman in labor showed up in my OR we sent her down to the ER (because we don’t really have a labor and delivery unit) but we did not send her 100 yards across the sky-bridge to the University hospital (where they do have a labor and delivery unit). Because she had shown up in my hospital, and despite the fact that we were not best equipped to care for her, we were legally obligated to do our best.  So we did, and as far as I know she delivered in the ER and probably lives happily with her child to this day.  What we charged her for that care I have no idea, whether she paid I have no way of knowing, but she did receive care.

Which leads me to fact two: Healthcare is prohibitively expensive.  There’s no two ways about it. I’m not going to try to excuse the cost of healthcare, nor am I going to try to argue that it is an expense that can reasonably be borne by the average family.  It’s expensive, far too expensive.  Healthcare is available to everyone (see fact one) but that doesn’t mean that you won’t be charged a lot more than you can pay and it doesn’t mean that not paying isn’t going to screw up your credit and make it so that you can’t buy a house and have lots of other bad consequences it will, or at least can, do all those things.  I am NOT however going to argue that the natural solution is to get the government involved.  In fact I am going to argue that one of the reasons that healthcare is currently as expensive as it is is government involvement and that if they would just lay off a bit, there’s a chance that the whole thing would figure itself out.

Fact three: There is cost associated with ALL goods and services.  This is the first major fact that our current government system seems to have lost touch with but it is a fact nonetheless.  It may be true that the markup on medical devices is astronomical, it may be true that the cost of 10 minutes in an Operating Room is equal to the price of your first car and that it doesn’t really “cost” that much.  Those things may be true, in fact, I believe that they are, but the fact remains that they do cost something; perhaps not what you were charged but something.

Despite that, in the last 3 years medicare has changed it’s policies.  One of the policies that it changed effected the manner in which it pays for post-op infections.  The new policy doesn’t.  End of story.  Under the new rules medicare does not pay for any care required by the presence of post-operative infections.  That doesn’t mean that we don’t have to treat those infections of course, it just means that the hospital doesn’t get paid for the care that they provide.  The reasoning in the minds of the geniuses at medicare is that if I know that we won’t get paid for post-op infections, I’m going to be more vigilant and careful to make sure that this particular patient does not develop an infection (because usually I don’t care if I give someone an infection).  First of all, I find the whole concept insulting.  I don’t do a good job because of what I’m being paid.  I do a good job because I have been entrusted with the care of another person.  But second, the concept is incorrect.  If a patient develops an infection (which we do our best to prevent but despite our best efforts it happens on occasion) the hospital doesn’t get paid for the follow up care for the infection, the doctors who are billing for the care don’t get paid, but I still get a check.  I’m not paid by medicare, I’m paid by the hospital.  I’m not paid by the case, I’m paid by the hour.  So the hospital may not be paid for the hour that I spend cleaning out that wound but I still do.

Let’s take a moment to review fact three, there is cost associated with the infection.  It’s not nice, it’s not pretty, it may not even be fair but it’s still a fact.  There is a price for having me clean the wound, there is a price for the instruments I use when cleaning out the wound, there is a price for the cleaning and sterilization of those instruments, the gauze, the sterile water, the antibiotic solutions and ointments… All that stuff costs money.  Money that the hospital is not getting back from medicare.  But I still need to be paid and the supplies still need to be bought and the money for that has to come from somewhere.

The money to pay me and to pay for the supplies comes from the other patients.  There’s no other alternative.  For every patient we treat for free (see fact one, we have to treat regardless of ability to pay) we have to charge the other patients a little bit more.  And more.  And more. Until more patients can’t pay, so we have to charge those who can more, so more of them can’t pay, so we have to charge those who can more, so… You do see where this is going don’t you?  It’s great to say that your care wasn’t all that you expected or desired so you’re not going to pay except, well, even the, to your mind, substandard care cost someone something and they’re going to need to get paid one way or another.  Which leads to fact two.

Some say that the solution then is to put the government in charge of healthcare and then everyone gets paid and all procedures get paid for and no one gets charged anything.  It’s a beautiful idea.  The problem is that it just… doesn’t work.  I’ve heard that we’re supposed to look at the VA system to see how great this could be. Well, I’ve worked at a VA hospital and friends, it’s not pretty.  It’s not that the care isn’t good, it is (although, I my opinion it’s not the best).  It’s not that the employees don’t care, they do (as much or more than they do in any hospital).  It’s just that there’s no incentive.  The hospital is going to make what the hospital makes, the doctors are going to make what the doctors make regardless for how much care they give so there’s no reason to hurry and get the case that could take an hour done in an hour, the pay for the day is the same even if it takes two or three.  So guess how long it usually takes.   And if we spend three hours doing a one hour case then we can only do two in an 6 hours, but when we do them in an hour then we can do 6 in 6 hours.  When having one specific patient in the hospital doesn’t cost the hospital money then there’s no pressure on the doctors to get them home, so when a patient needs one more x-ray before they can be discharged, but it’s 5:00 on a Friday, at the VA that patient stays, not for the night but for the whole weekend.  At a hospital that has a bottom line to look at, they pay the x-ray tech for another 15 minutes so that they can open up the bed.  And when you open the bed someone else can fill it.

In talking about healthcare in countries where it’s “free” (one of the most grossly inaccurate uses of the word in history) the issue of wait times always ALWAYS comes up and no wonder.  When you remove the incentive to get people better faster, to get things done faster, then they get done slower and if they get done slower than some of them just don’t get done.

What this means in the current climate, I don’t know.  I see where we are and I see where we ought to be, but getting there, that’s the trick.  And it’s now even more of a trick because we’re moving in the exact opposite direction.  But that doesn’t mean it can’t be done.

It’s possible, probable even that I’m cold and heartless, that I’m discussing healthcare as if it’s all about money and well, I am.  However,  if we’re honest we’ll admit that it was money that sparked the whole “healthcare crisis” in the first place and I believe in calling a spade a spade.  Letting the market equalize and therefore making things in the medical industry cost what they actually cost is not going to magically enable the family that can only just afford food able to afford a heart transplant but it may make it so that the family who has enough to occasionally go on vacation could if they needed to.  It may make it so that that first family, the one who’s just scraping by, can afford to have their kid’s broken arm set and casted on their own, without governmental or any other involvement and to have it done the day that he broke his arm rather than a week later.  And wouldn’t that be better for him? And for all of us?

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What Drives My Road Rage

I’m a pretty calm driver, not much given to road rage or maddened careening and cutting off of my fellow drivers.  (My episodes of road rage mostly culminate in a shouted “you are a MORON!” and the occasional hand signal (unless you’re my mother in which case I never resort to hand signals, I don’t even know what that means).

Actually, in the interest of full disclosure (and so that this post makes some sense) I should point out that I’m not particularly prone to road rage directed at other drivers.  The radio on the other hand, well that’s another matter entirely.

I’ve mentioned my annoyance at certain radio commercials before but there’s a new one that drives me up the wall.  It’s a debt consolidation  commercial as the majority of the really offensive commercials are (followed closely by diet commercials and then those for used car dealerships) and the thing that gets me is the reasoning, laid out step by step as if it’s the most logical thing in the world and it’s a wonder that I didn’t come up with it on my own.  It goes something like this: 1. the credit card companies have been “sticking it to you” (that’s a quote) for long enough.  2. Now the government is bailing them out 3. so you shouldn’t have to pay them.

In his book On Writing Stephen King said something to the effect of, no writer should ever say “I just can’t express it in words” because we’re writers and that’s what we do, express things in words (so if you find that you can express it in dance, I guess it’s time to switch careers).  I think Steve’s a pretty smart guy, and he certainly knows his craft so I’m not going to disagree with him.  But I am going to continue to call myself a writer (of sorts) while professing that I don’t think I can express how much the above line of reasoning irritates me.

Let’s take it apart shall we?

1. The credit card companies have been “sticking it to you” for long enough.  Exactly how are the credit card companies “sticking it to you?”  You got a contract, it was your responsibility to read said contract (I know that none of us really does but whose fault is that?) you signed said contract therefore you are obligated to abide by said contract.  I’ve gotten, skimmed and signed my fair share of these contracts and without exception the deal is something like this, well lend you money and you ‘ll have to pay it back with interest.  The amount of interest varies as do some of the penalties but well, that’s the deal.  Now I’m not the champion of the credit card companies, in fact I think that the entire money lending industry is evil and immoral. (Except what you do Chris, you are in the only decent sector of the whole evil thing and even your sector has been run by a lot of immoral folk more interested in making money than helping their customers for the majority of … well forever.)   But the morality (or lack thereof) aside, they are pretty straight forward in what they do and what they expect.

Now, I’ve been on the wrong side of credit card penalties.  A few years ago I missed two credit card payments to two different credit cards.  (I had written them in my checkbook, I had entered them on the spreadsheet I just hadn’t actually sent the payments.)  As soon as I realized my mistake, and make no mistake about it, it was MY mistake, I called both companies to see if they would waive my penalties (they’ll do that sometimes).  Company A.  said, “no problem, we’ll take that late fee right off and have a nice day.”  Company B said “we’ll take off part of the late fee but it’s still going to cost you about $30.  The amount owing to that particular company was only about $12 if I remember correctly (which I probably don’t) so I wasn’t too happy about that but well, I signed the contract, I made the mistake, so I put on my big girl panties and paid the bill (and then promptly closed the account) all the while vilifying company B and praising company A.  Until I got my next bill in which credit card A, the card with, up until that point, the lowest interest rate of any of my cards, and saw that my little bitty interest had suddenly gone from something like 9% to 32.5%.  I wasn’t happy about it.  The rate was too high, the bill was more than I could pay and I ended up refininacing my house because of it, but not once did I suppose that the credit card company was at fault.  They weren’t sticking it to me, they were running a business.  Is there anyone out there that views credit card companies as anything other than sharks?  I doubt it.  So here’s a tip, swim with the sharks and you’ll occasionally get bit(ten).

2. Now the government is bailing them out. Now I’m not really in favor of bailouts of any kind, but well, you’ve got a company that you promised to pay later so that you could have that new pair of jeans now so they paid the store that had the jeans and you took them home but when it came time to actually pay for the jeans you, well not YOU necessarily but a lot of people, refused to pay.  That leaves the company out of that cash and without the jeans.  I think they deserve one or the other and I wonder how most consumers would feel about having their lattes repossessed?

3. So you shouldn’t have to pay them. What? Please someone tell me how this makes sense!  Other people didn’t pay causing the company to nearly go bankrupt, resulting in a government bailout because the government’s not going to let one of its country’s major industries (and make no mistake, Credit is one of the county’s major industries) implode, so now, even though you had been paying up until now, you shouldn’t have to any more.  Gaaaaa!!!!!!

Can we please stop being victims and take a little, just a tiny bit of responsibility for our actions?!

I’m not trying to condemn those who get themselves into credit trouble, as I mentioned before, I’ve been there.  Nor am I saying that it’s somehow wrong to try to work out a deal with your credit card companies to get your rates lowered, maybe come up with a new, lower one time pay-off amount, I’ve done that too, and I took the credit hit for it.  But I never once thought that it was the credit company’s fault.  The fault, well, I suddenly find myself wanting to quote Shakespeare.

Yay! and Grumble Grumble Grumble

I’ve been given this award:

This blog invests and believes, the proximity. [meaning, that blogging makes us ‘close’ -being close through proxy]. They all are charmed with the blogs, where in the majority of its aims are to show the marvels and to do friendship; there are persons who are not interested when we give them a prize, and then they help to cut these bows; do we want that they are cut, or that they propagate? Then let’s try to give more attention to them! So with this prize we must deliver it to 8 bloggers that in turn must make the same thing and put this text.

And the thing that’s even more cool about it is that it was Madhousewife who gave it to me and I didn’t think she even really liked me.  (I’m tempted here to do the Sally Fields but I just don’t have it in me this morning.)  I am delighted by the award but I’m not going to pass it on to the 8 friends that I’m supposed to because I’m hemorrhaging and I don’t feel like it.

And now, lest you are overwhelmed by my gushing, I have something to complain about.  Have you seen this? (There is a little bit of language for any of you who are a little squeamish, mom.)

I find it tiresome.  Aside from the celebrity propagandizing which I hate but I’m not going to go into this morning, I hate what they’re trying to do.  I hate the idea of a bunch of kids who saw Jennifer Aniston tell them to vote, registering and voting.  If you have to have Ellen tell you to vote, tell you that you need to register in order to vote, then obviously you have no idea what you ought to be voting for.

Sure, healthcare for everyone who needs it regardless of their ability to pay sounds wonderful.  But I work in a hospital and believe you me the hospital and the doctors are going to need to get some money from somewhere.  Lower taxes?  Great absolutely, sign me up.  But what does that mean?  Where is the government going to cut that money out of the budget?  And then there’s the war and the economy and abortion and stem cell research and energy and the environment and…  It takes a lot of work, a lot of study.  First to find out where you stand and then to suss out where exactly the nominees stand (and they’ll make you work for that information).

Call me elitist (no seriously, come over to my house, look at my hood and call me elitist) but I believe in a democracy run by people who actually find out about, and form opinions on, issues.  I’ll be the first to admit that I haven’t done nearly as much of that work as I ought but I at least know that I need to.  Did you watch it?  They’re talking to people who don’t even know that they need to register first!  Do you really want someone who can’t figure that out on their own being a part of the decision making process concerning where this country is going?

I don’t want to rock the vote.  If you just want to vote because Leonardo DiCaprio told you to then please, don’t vote!

In Which I Expose My Ignorance

Green Day has made millions of dollars decrying the ignorance of the American public and I totally agree!  “Don’t want to be an American idiot, One nation controlled by the media.”  I sing along, I wave my arms, love it!  Look at all these people who have no real idea what’s going on.  They watch American Idol and Desperate Housewives and don’t even know the difference between a republican and a democrat.  Naturally, I feel somehow exempt from this indictment.  I’m socially conscious, I think things through, I’m educated, that’s obvious isn’t it?  I do listen to Green Day after all.  *Snort*

I like to believe that I’m smarter than the average bear, and maybe I am but I do absolutely nothing with that.  I am the stereotypical American.  It is possible, probable even, that I read a little more than the average gal (because reading Janet Evonovich novels is obviously a sign of superior intellect and social consciousness) and I can honestly say that I have never voted for an “American Idol” (something I can’t help but throw in there because it makes me feel somehow virtuous) but I don’t have any idea what’s going on with Russia and Georgia.  Heck, I didn’t even know how to spell Georgia, I had to look it up! ( I know it seems obvious but it could have been Jorja or something.  I don’t know!)  I didn’t even know there was a country named Georgia.

I grew up just outside of Washington DC, my father has worked in government on either national or local levels my whole life.  I have no interest in politics.  I like to give those two facts a cause and effect but if I’m really honest maybe I have no interest because I’m not responsible enough to take an interest.  I do know the difference between a democrat and a republican though.  Democrats, like Barack Obama and Kristen Day are pro-abortion and republicans, like John McCain and Rudy Guiliani are Pro-life.   Oh, wait…  (Before you write me a scathing comment follow the links.)

In my defense I did watch a little of the news the other night (I hate the news!) and the guy was reporting from Beijing on- wait for it-  FAST FOOD!!!!!! I kid you not, he went to Beijing and he prepared a report on McDonalds, Pizza Hut and KFC (not too popular with the Chineses apparently).  Is it any wonder that I hate the news?  Granted that was the local news but CNN, which is on all day at the hospital, isn’t really much better.  The news there runs on a roughly 45 minute loop and I can’t tell you how many reports I’ve seen about Britney Spears and Paris Hilton but it’s a big number.  Isn’t there a war going on?

And when they’re not reporting on Lindsey Lohan, it’s teacher who are having sex with their students and other pedophiles.  I work in a childrens’ hospital, I don’t need more things to worry for my kids about.  i know it happens, offer a solution or keep your mouth shut.

Maybe, probably, that’s the real problem.  I find the news depressing, (wars and rumors of wars much?) and politicians are people so their positions are confusing (unlike mine as stated here which are crystal clear) and I already expend a vast amount of mental energy in a day on things like what’s for dinner and where are my shoes, I just don’t have time for “news.”  But It’s becoming more and more difficult to feel superior when I hear things that implicate the ignorant American Masses.

The only solution, for my ignorance,  I can come up with, assuming I want to, is to *gulp* start reading the newspaper.  So that’s my goal.  I’m starting small.  For the next week I will try to read one real article a day about real news. This, unfortunately excludes stories on the fast food in foreign countries and the relative chances of the dancers on “So You Think You Can Dance” (I’ll still read that one, I just won’t count it).  I don’t get the paper and I’m too cheep and lazy to start but I figure if I look I can find some decent stuff online right?  Well, you read it here, so now you can hold me to it.

Or maybe I’ll just go check out Fearless Fourteen and wonder why I occasionally hear stuff about Georgia and Russia.  What are Russians doing in the southeastern United States anyway?