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Jim Coyle exercises some anger at U.S. Rep. John Yarmuth's recent town hall meeting at Central High School

September 16, 2009

I reserve the right to be angry

How the health care debate went off the rails

Here’s the thing. I just spent my 49th birthday at a town hall meeting on health care. I say that for no particular reason; it’s not like I deserve any special credit for it, and it’s a pleasant enough way to mark the occasion, if you can stomach a room full of people who, given the opportunity, would yell “Get In The Hole” or “You Da Man” whenever someone tees off at a pro golf tournament. Mindless narcissism paired with generalized fear and loathing is annoying, sure; but like the sick and the poor and the 24/7 news cycle, this is with us here on earth.

The health care “debate” made for an awfully uncomfortable August after Congress took a break and filtered back into the hinterlands to hear what was on everyone’s minds. White House insiders who expressed shock at the ensuing ugliness either had to be joking or ignorant of recent political history.

Over the past several weeks, before the president tried to push the train back on the tracks last Wednesday night, the scrum was all-encompassing. I had vowed to stick to the high road, and to certainly not devolve into debating faceless friends of friends on Facebook. I admit, however, only somewhat regretfully, that I broke my own pledge and stumbled into any number of firestorms. Maybe you did too.

The news reports, such as they were, were accurate in describing the various town hall meetings as passionate events. If you thought the culture wars were settled, or that Bill Bishop’s Big Sort theory, about how we’ve self-divided ourselves into like-minded groups, was an exaggeration, the meetings in toto seemed like a pretty strong anecdotal argument to the contrary. Amped up on Glenn Beck, Keith Olbermann and an endless procession of similarly inclined talking heads, we have settled into a too-easy trance state in which we question everyone’s bullshit but our own. Everyone, I think, should have the chance to attend something like a health care town hall and then observe how TV news cherry-picks sound bites to greatly exaggerate what happened.

It left me wondering how to tell a story about what it all means. And it occurred, as I pondered that passion pouring out of random people from all walks of life, that one way of getting at the issue is to simply relate real stories from people I actually know, along with a few I ran across on the reporting trail.

 

My old Little League friend Marvin Bostock got some limelight at Baron Hill’s town hall meeting at IUS. Marv is large — I still laugh about how his coach played him and Big Bill Lawson, both in the 275-lb. range, in the backfield during their senior year. Marv’s a retired police officer now and works at the airport for a firm that ships and insures valuables. (Trivia: He still shows up on a TV commercial for a local chiropractor. And he’s still got a BB in his forehead, courtesy of one of our buddies who got a little carried away when we were 12.)

At IUS, the news cameras zoomed in like buzzards on a dying possum as Marvin, standing in the back of the room, pointed to the po-po just a few feet away. “If I write a check I can’t cover, these Indiana State Troopers will arrest me for fraud,” he intoned, and brought half the crowd to its feet when he asked, “How does our government keep spending money that we don’t have?”

Hill brought up the pay-go rules that were in place during the 1990s, when the federal budget ran a surplus. The rules stipulate that government programs must be paid for up front by raising revenue or cutting spending. Hill said he favors a return to those rules, and the hooting crowd essentially said: “We Don’t Believe You.”

I caught up with Marv on the phone while he was in Gatlinburg, Tenn., for his son’s wedding. He told me he’s a lifelong Democrat but has filed paperwork to become a registered independent. He isn’t quibbling about the need for health care reform but said the country needs tort reform and should let insurance companies compete across state lines.

“I’m not against reform. I think the health insurance industry is out of control and makes too much money,” he said. “But there has to be a way to regulate without government getting involved. Illegal immigration must cease. Finish that fence and get illegals out of the country. Stop paying for illegals to go to the ER.”

After Obama’s speech before Congress, he told me he’s unconvinced. He simply doesn’t believe the president.

 

Kelly Kraft Banks was my next-door neighbor growing up. I spent more time at her family’s house than my own, with all the food privileges a growing adolescent boy could want.

In the summer of 1995, a week after Kelly buried her mother Pat, she and husband Chuck learned their three-year-old son, Sean, had neuroblastoma — basically, a cancer of the central nervous system arising from the kidneys and adrenal glands. Sean had a 10 percent chance of surviving and no timeframe. A series of procedures culminated in a bone marrow transplant that did not work. A doctor recommended a second transplant. An insurance company bureaucrat told them, in so many words, that the company wouldn’t pay for a procedure for someone who was probably going to die anyway.

Kelly is a registered nurse who knows more about the system than most. She appealed. She fought. An independent doctor enlisted by the insurance company ruled that the procedure should go ahead. And then Sean went into spontaneous remission without the surgery. Today, he’s a 17-year-old high school junior who’s made the most of his reprieve. He is an honors student,
No. 1 in his class and an accomplished drummer and lyricist in a rock band called Two Til Midnight. The cancer slowed his growth — he’s five-feet tall and weighs 95 pounds. And he is cancer-free.

Chuck is bitterer about the experience than Kelly, but they’re both grateful for the miracle. And as one who works in the medical field, she has a certain informed point of view.

“We see a lot of patients without health insurance,” she said. “They get seen — and we pay for it anyway because costs are shifted to us. I know some doctors and nurses don’t see that regularly. I work downtown by JADAC and the homeless shelters, and I see people walk in the door with conditions that are advanced. They don’t come until they are really scared they’re going to lose an arm or die. If they came sooner, we could give antibiotics and send them home. But they get admitted and take up beds.

“People want to make it a Republican-Democrat issue. It’s not. It’s about humans and taking care of people.”

Kristy Myers was my girlfriend for one sweet summer. I had no idea where she was until we reconnected through Facebook. She jumped into one of the little firestorms on my page, then e-mailed me separately to explain why she so adamantly favors a health insurance overhaul:

“Before I went in the hospital for a tumor and hysterectomy they did an insurance estimate. My part of the bill was as much as the insurance was paying — more than $9,000 — when it was a routine procedure and I was supposed to be there overnight. The size of the tumor was seriously miscalculated and getting it out was rougher than anticipated. A five-night stay and a major blood transfusion skyrocketed my situation and my bill.

“I didn’t get better. Four weeks later they went in to take off what they assumed were cysts from the surgery and found my bowel was perforated. An overnight stay became four nights and major surgery; had it been untreated another 24 hours (I was hesitant to go in again because of the bills), I would have died of sepsis.

“I have about $25,000 in medical bills. I ignore them and concentrate on continuing to build a new kind of real estate business that caters more to the current housing crisis rather than the second-home buyers I was used to working with here on Lake Lanier in North Georgia.

“I don’t think the North Georgia real estate crash and my hospital bills will put me into bankruptcy, but it might. I did everything I was supposed to do. Besides my house, if I wanted it, I paid for it. My 2007 (Chevy) Tahoe, paid; my 2005 18-foot Maxxum, paid; my place down on the Ogeechee River in Midville, paid. Money in savings, regular deposits in my IRA, health insurance, auto-debited every month. From my first year as Rookie of the Year in real estate, after my divorce, I worked hard. I have been a longtime mentor in the school system. In 2008 I was chairman of the Dawson County Chamber of Commerce. I serve as an advocate for the battered women’s shelter, something I know far too much about.

“I say this not so you will throw me a parade, but I do not, nor have I ever had an entitlement or victim mentality. In fact, when I was sick, I discouraged my friends and co-workers from making a big deal about it for fear it would be another nail in what was becoming an economic coffin — if I was seen as too sick to represent my clients or take on new ones. When I cried, I did it alone.”

 

Julie O’Bryan runs a law firm that focuses on personal bankruptcy. She is also my girlfriend’s boss.

Through various attorneys, I’d identified three potential subjects to speak about how a medical crisis sent them into personal bankruptcy. Each ultimately opted out of the story; bankruptcy carries a huge social stigma, and it’s just no fun to talk about losing the house you worked 20 years to buy, or how your retirement has been pushed back indefinitely while you go back to work to pay off creditors.

A 2005 Harvard study said about half of such bankruptcies have a medical crisis at their core, though critics quibble with that figure and point out it is difficult to sort out all of the factors that lead someone into bankruptcy. O’Bryan doesn’t track causation but said a significant number of clients fit that profile — she put the number at 30 percent and noted it could be higher because some clients may have charged medical bills on credit cards. She sees numerous people who’ve lost their insurance because they’ve lost their jobs. “Some people live beyond their means and charge things they can’t pay for,” she said. “But I’d say half the people who file do it because of a medical emergency or a lost job.”

(Note: Washington Post reporter T.R. Reid has studied health care in a handful of capitalist democracies that provide universal care. In those systems, no one goes bankrupt because of an illness. For more, Google “Sick Around the World.”)

Laura LeLaurin has worked as a registered nurse for 35 years. She recently cut back her hours to care for her mother who has Alzheimer’s disease. That disqualified her from her company’s group health insurance plan, leaving her to take COBRA for more than $500 a month or seek a plan on the open market.

She applied for a HumanaOne plan and was initially told she should be approved for about $240 a month. But she was ultimately denied because of a health problem that has since been fixed. Four years ago, during tests before a gall bladder removal, doctors discovered an arteriovenous malformation (AVM); basically, an artery and vein were joined. That once required major surgery but is now handled on an outpatient basis; a coil inserted through the groin seals off the malformed area. Problem eliminated.

But Humana turned her down, citing underwriting policy. She appealed. Her surgeon, Dr. James Sunderland, wrote a letter saying she’d received “definitive” treatment. Her pulmonary specialist, Dr. Harold Haller, also vouched for her. LeLaurin said the adjudicating underwriter, who apparently lacks medical credentials, won’t speak to her on the phone. Humana policy.

LeLaurin, 55, doesn’t smoke, stays in shape, takes no medications and has a stellar medical history. “I want a physician to tell me why I’m turned down — a medically based opinion,” she said. “These are the most rigid, unreasonable people. There is no individual consideration — I am just another number. It’s outrageous.”

Patricia Reilling, 63, once ran an art gallery and provided health insurance for her employees. After it closed in 1994, she told me, she stayed on a group plan through the Kentucky Retail Federation. A year ago she was diagnosed with breast cancer and had a bilateral mastectomy. She contracted a serious case of MRSA in the hospital, which led to two surgeries and seven more days in the hospital. The MRSA ate the tissue that was used in her reconstructive surgery, effectively undoing it.

Her insurance company then dropped her, ostensibly because it was no longer covering one-person groups, though no one ever put that in writing. Later she was told she was dropped because she didn’t respond to insurance company letters that had never been sent to her; they went to her agent, who’d always been spot-on. When she got copies of the letters, they said nothing about one-person groups.

“That was as close to finding out why I was dropped as I could get,” she said. “In reality, it’s pretty transparent. For 19 years I filed no substantive claims. Then I got cancer. That’s why they dropped me, but they won’t say that.”

I have known John Click since 1964. He is my best friend and a fine, meticulous dentist with an overarching view of the profession as a window into one’s general health. His father was a barber and his mother worked in a school cafeteria; he paid his own way through college and dental school (both in the Indiana University system). For 22 years he’s practiced in Crawford County, Ind., a desperately poor rural area — the sort of place health care professionals tend to avoid because they’re not lucrative. John has done well, even while writing off thousands of dollars in charity care each year. He feels a responsibility to work in the state whose educational system helped him get where he is today.

John is religious — his voicemail greeting ends with “God bless” — and conservative politically. He views the health care issue in both moral and practical terms. He also accessed the insurance system a couple years ago when a gall bladder removal went horribly awry — to the point where he wouldn’t be able to get coverage if he changed carriers. His premiums have increased 20 percent since then.

“We try to do too much for too many people,” he said. “If we did more to give basic exams and promote healthy lifestyles, we could take care of a lot of problems before they start.

“Health care has been made into a business by the insurance industry, and they make money hand over fist. I think premiums should be cut if you have a healthy lifestyle and can prove it. Another factor is, we need to determine what an emergency room really is. If you’re dying or have a catastrophic event, go there. Otherwise, the immediate care centers should be the ER for the average person.

“If it were up to me and they really wanted to look at health care in this country, they’d look at oil and put a 2-cent tax on every gallon of oil. We’re over a barrel in this country — literally. Oil companies should be willing to pay that back, and then it wouldn’t be government-run health care.

“It’s a Christian, ethical issue. Jesus said, ‘Bring me your sick and infirm.’ It’s not a right, but it’s a responsibility of a compassionate society to aid those in need. And we need to teach good health practices.”

Susan and Sam Cilone own a small business called FASTSIGNS. I recently began playing in a band with Sam, whom I met through mutual friends. They started the company in 1994 and have 14 full-time employees, each of whom participates in the company’s group insurance plan. The Cilones pay $100 per policy and the employees pick up the rest of their own premiums, which now range from $136 (single male, 20s) to $775 (parents, 20s, two kids). Susan says it’s a good plan, with no deductibles and 100 percent major medical coverage. They also offer a dental plan, and pick up the whole $25 premium.

Susan, the CEO who also handles HR functions, said insurance typically increased about 10 percent a year, but last week their rep called to set up a meeting, two months ahead of schedule. Their plan will go up 28 percent this year, which means employees will likely be pushed to plans with deductibles for the first time.

“It is getting very hard for my employees to afford their premiums,” she told me before she learned of the increase. “They are conscientious about having coverage, and I want them to be able to afford their premiums.”

I asked what concerns her about the proposed reform plans: “I am most concerned by the inaccurate information which is being disseminated by those who oppose health care reform. I am very supportive. I believe everyone should have access to affordable health care.”

 

Al and Jessica Knable live in New Albany. He is a dermatologist who focuses on medical issues (skin cancer and diseases as opposed to cosmetic issues). Every time I wash my hands and sing “Happy Birthday” — the requisite period to make sure the soap works — I think of Al. Medicaid patients, who many physicians won’t see, comprise about 10 percent of his practice. Jessica is a stay-at-home mother of four who told me she’s never worried about politics until she didn’t care for an answer about end-of-life care that Obama gave at an early town hall. Her father gave me the journalism bug two decades ago. For years, I knew her only through the precious photograph in his office, a young girl standing near a balcony railing with her head tilted backward.

As an Air Force officer, where everyone was on one medical plan, Al said he saw stupid bureaucracy, and he worries what would happen if the whole nation had a single payer. At one point he cleared a huge backlog of patients, and then another, before a superior officer told him to slow down because he was making people “look bad.” In a plan that removes incentives and pays doctors a set salary, he thinks some would behave in that way.

Al’s medical group operates in Kentucky and Indiana and offers health insurance to all 60 employees. The plan doesn’t work well for his family, he said, so he has opted for a health savings account with a $10,000 deductible, a plan he likes a lot.

He favors tort reform — Indiana has an innovative system to head off frivolous malpractice suits, but Kentucky does not — and agrees that doctors order extra tests to cover their asses against malpractice suits. He said insurance reimbursements have gone down 2 percent to 3 percent a year; he makes it up with volume but knows there are limits to how many patients he can see.

Al is politically conservative but said he is “not totally free-market on this commodity.” He would like to see insurance companies regulated like a utility. If a company dropped someone for filing a claim or denied coverage because of a pre-existing condition, that could be settled by an impartial panel, which could also examine inordinate insurance company profits.

He said young people who don’t have insurance have “a moral duty to contribute something. If you have high-deductible catastrophic coverage for those people, they have not only contributed but they’re protected by an umbrella they helped create.”

He implemented electronic medical records three years ago and doesn’t think it’s saved any money or improved efficiency. He advocates preventive care but says, “You have to have a willing populace.” As for pending legislation, he said it probably won’t be quite right until all of the interested parties are upset about something in it.

Jessica quibbles with the figure of 45 million uninsured, saying many are illegal aliens, some could buy insurance but choose not to, and some qualify for Medicaid or Medicare but don’t enroll. She does not see the issue in moral terms. “People like me come off looking bad, as if we want people to die in the streets,” she said. “People deserve affordable health care. I think you have a right to emergency care. But it’s not a moral issue. It’s not a God-given right.”

Nick McIntosh was walking to his car after my birthday town hall. He saw my media credential and asked who I was writing for. “LEO,” I said, and his friend said, “That’s Yarmuth’s paper,” and mimicked hitting a joint before allowing, “Yarmuth’s OK.”

Nick knows that; as a veterans advocate on behalf of the Military Order of the Purple Heart, he’s met with the Louisville congressman and LEO founder — who sold the newsweekly in 2003 — on veterans’ issues and finds him reasonable. McIntosh said that while the VA’s medical services have improved greatly in the past 15 years, he worries about more government involvement in health care. He said tort reform would help curb costs and said the VA’s use of electronic medical records has also contributed.

I asked him about how insurance companies drop coverage when someone files a claim or deny coverage because of pre-existing conditions. “In all the years I’ve dealt with vets, and a lot of private insurance, I don’t recall that happening. I’m sure it does but I assume it’s not as prevalent as the scaremongers want to portray it. We are in a sound bite society, and certain elements drag out their worst-case scenario, which may be a minuscule part of the problem, for sympathy. I don’t know enough about what they do on pre-existing conditions to voice an opinion.”

He is worried about government requiring everyone to have insurance. “I think that is a major sticking point for a lot of people. They don’t like the government mandating behavior. A good example is the food police: Years ago they decided coconut butter is bad, so popcorn cooked in it is bad for me. That destroyed movies for me.”

Nick was a fun interview; his vocabulary rocks, and he told me about some voice-recognition software that he thinks could help simplify things like health care administration. And he said this about the Obama-as-Hitler signs: “I’m embarrassed when someone on my side of the issue does something stupid like that. I’ll stand toe-to-toe and argue with you, but even if I think you’re an idiot I try to keep it on issues.”

I’m left with a number of impressions. I’m not educated in economics and law, and can’t really argue the case on those bases. I do think you can trust your eyes. We’re a generally unhealthy country that’s yielded too easily to the ugly confluence of reduced exercise and increased consumption of heavily marketed “food” that slowly kills. At Yarmuth’s town hall, he noted that Kentucky is one of the least healthy states. “Bullshit,” a guy behind me bellowed, “You don’t know your state.” Really?

I’m trying to look past the unintended ironies — Medicare patients screaming about keeping the government out of their plan; those who complain of rationing but can’t see that insurance companies (through their own “bureaucrats”) ration care; those who can’t see how a system that forces the uninsured to the ER blows back on everyone who can pay; and so on.

I can’t so easily overlook the malevolent, self-interested forces who act like the jackass in middle school who instigated a fight just for kicks. Result: People who have been or will be screwed by an insurance company, fighting tooth and nail in defense of insurance companies.

The economist Paul Krugman recently wrote a piece wondering how economists failed to foresee the economic meltdown. The school of thought that supplanted Keynes held that markets are entirely predictable in spite of inconsistent human behavior. Krugman points out how the meltdown severely tested that theory.

The same assumption of rationality shows up in the health care debate. Will Rogers said, “We don’t know what we want but we are ready to bite somebody to get it.” George Carlin noted that anyone who drives faster than you is a maniac, and anyone who drives slower is an idiot. You say too-may-toe. I say eggplant. And a lot of people today are saying, “I’m frightened by the unknown and I don’t believe anything you tell me and I reserve the right to be angry even if I don’t know why. And I’ll spill your blood if you’d like.”

Now that Congress is back in session, let the politics commence. I asked Yarmuth whether people there are willing to lose their seats if they vote their consciences. He thinks some are and said he most certainly is. He also believes basic reforms will pay off quickly and persuade voters that it’s a good thing.

I keep thinking of the oil filter TV commercial where a mechanic talks about why preventive maintenance saves money. “You can pay me now,” he says, “or pay me later.” That seems about where we are. Health care is not going to heal itself.