THE BAT AND THE BILLS

by Helen Redmond LCSW

As a medical social worker, I followed the story of Natasha McShane with horror and hope.

The luck of the Irish was not with 23 year-old Natasha McShane on the night of April 23rd. The exchange student from Belfast, Northern Ireland, was beaten with a bat and suffered a traumatic brain injury (TBI). She was rushed to Illinois Masonic Medical Center in critical condition and doctors weren’t sure she would live. Natasha did live and so began her odyssey through the for-profit American health care system.

Natasha was a student at the University of Illinois at Chicago when she was attacked. Students at UIC are required to have health insurance and many have CampusCare  a bare bones HMO. The coverage is expensive; $471 a semester. If Natasha had CampusCare, she was out of luck the second the bat crashed into her cranium. That’s because there’s a lifetime maximum benefit of $500,000 and a $2500 maximum drug benefit per year. The injuries Natasha sustained were catastrophic (she was in a medically induced coma for the first month) and required a vast array of medical resources: surgeries, anesthesia, x-rays, IV medications and round-the-clock monitoring by a coterie of highly trained specialists. In less than four weeks in the intensive care unit she would have reached the cap on the lifetime benefit and the drug benefit, in one hour.

Natasha was transferred to Northwestern Memorial Hospital and finally to the Rehabilitation Institute of Chicago. At RIC, Natasha began rehab with a team of physical and occupational therapists, speech language pathologists, social workers, nurses, neurologists and physiatrists.

The health care professionals that treated Natasha saw one thing only: a patient in need of treatment. The three hospital billing departments on the other hand saw the need to send bills which reached astronomical levels. If Natasha was a resident of the United States she probably would have declared bankruptcy. Instead, her parents Liam and Sheila McShane did what thousands of uninsured and under-insured Americans do when they can’t pay medical bills; start fundraising. All over the country medically indigent Americans plan pancake breakfasts, backyard barbecues, bake sales, bar nights, raffles and walk-a-thons. They set up websites that reveal diagnosis and cost of treatment in order to solicit donations. In the richest country in the world, people have to beg, borrow and plead for charity to pay for health care. It is humiliating.

With the help of the Irish community, the McShane’s organized a fundraiser at Cans Bar and Canteen with 15 percent of the bar’s sales given to Natasha. There was a silent auction and a “Natasha McShane Day.” A website titled, Natasha McShane Fund (http://mcshanefund.com) was launched. An astonishing $400,000 was raised and is an example of the enormous amount of sympathy and solidarity ordinary people have for someone in need.

The McShane’s had to wonder why the American health care system doesn’t confer health care as a right for all because they are from Ireland which does. Ireland has a government run, national health care system funded by taxes that covers everyone. Fundraisers at pubs to save people from medical bankruptcy are unheard of. Not even a bad Irish joke.

The luck of the Irish returned to Natasha the second week of July. She was medavaced back home to Ireland. The staff at the Royal Victoria Hospital in Belfast was waiting to admit her. The family must have sighed with collective relief when the plane touched down at Belfast International Airport. The McShane’s wouldn’t get one single bill for the medical care their daughter would now receive. They could focus exclusively on Natasha’s rehabilitation and planning for her future.

I humbly apologize to Natasha McShane for the double assault she endured in my country  the assault with the bat that changed her life forever and the assault of the bills her parents are still trying to pay.

HOW TO GET THINGS WRONG

I thought I understood Atul Gawande. I’ve read his books. They give me hope the medical culture of doctors and particularly of surgeons in the United States had changed. Dr. Gawande writes with clinical clarity, beauty, empathy and frustration about work inside the dysfunctional American health care system. Nothing escapes his surgically trained eyes  inside the operating room or out: nosocomial infections, medication errors, aging in America, military casualties. Gawande is obsessed with how to get things right so patients aren’t harmed or killed. He’s the kind of man who has the honesty, the humility and the cajones to apologize to a patient for almost killing him. And then calls the guy a few months later to see how he’s doing.

Gawande’s new book, The Checklist Manifesto: How to Get Things Right, makes the case for cooperation not competition, more democracy in medicine, the centrality of teamwork and the importance of respect and dignity for all health care providers and patients. As a medical social worker on the frontlines of the health care crisis for 15 years, I share Dr. Gawande’s values.

So I don’t understand why in his article in the New Yorker on April 5th titled “WHAT NOW?” Gawande not only supports the Democrat’s health care bill, he defends the most coercive and punitive aspect of the bill: the individual mandate. He isn’t concerned the legislation doesn’t “get things right,” that it doesn’t reform the health care system based on the cooperative, democratic ideas and values he so passionately espouses.

Gawande believes the bill “could prove as momentous as Medicare.” It will not. The core ideology of Medicare is the belief health care is an entitlement, a guaranteed right. It was a government takeover of health care for the elderly supported by the majority of Americans. Single-payer for sixty-five and older.

Gawande’s article outlines the opposition to Medicare by the American Medical Association (AMA) and the entrenched racism in the south during the year it took to enact the program. He explains President Johnson’s role in implementing Medicare but far more important and instructive is the role of grassroots activists, hundreds of thousands of seniors and union members, who fought to win Medicare. In Jill Quadagno’s book, “One Nation Uninsured – Why the U.S. Has No National Health Insurance,” she uncovers this hidden, ordinary people’s history as opposed to “Great Presidents/White Men make history.” The AFL-CIO created the National Council of Senior Citizens (NCSC.) Blue Cartenson, a lead organizer, explained, “We had to make it a cause and we made it a cause… We charged the atmosphere like a campaign… We were a little bitty outfit that was tackling the whole AMA in a little apartment on Capitol Hill….” The movement understood it had to confront the doctor’s lies and attacked their positions relentlessly. They published a pamphlet entitled, “Operation Negative” that sought to “discredit the AMA on the basis of their record.” Busloads of seniors crisscrossed the country advocating for the passage of Medicare at meetings and rallies. Imagine angry and activist seniors rallying for a government takeover of their health care. Once Medicare was established, the formerly and vociferously opposed physicians set about gouging the government. One doctor confessed, “No health care program has ever strained the ethics of the medical profession as Medicare is doing… I’ll admit that I try to take as much Medicare money from Uncle Sam as I possibly can…” Physician avarice led to fraud, abuse and later to implementation of a series of cost control measures doctors complain about to this day.

The civil rights movement set the stage for the integration of hospitals and clinics. Public protests to integrate hospitals and all-white medical societies began after the passage of Brown v. Board of Education in 1954. Activists organized pickets and protests at the headquarters of white medical societies and hospitals. In 1960, four students sat down at a Woolworth’s lunch counter in Greensborough North Carolina and unleashed the struggle to smash Jim Crow and desegregate every institution in society. There were “kneel-ins” in churches, “sleep-ins” in motel lobbies and “watch-ins” in movie theaters.

To be sure, the intervention of the federal government was important, but the highly charged political atmosphere created by the civil rights movement that demanded equality in southern states was crucial to the enactment of Medicare.

In the New Yorker article Gawande posits,“The medical world will wage no civil resistance.” He’s right. The most powerful resistance is being waged by the health insurance industry both privately and publicly. Did it not give Gawande pause when just days after the health care bill passed in March the insurance industry disputed President Obama’s claim that within six months children with pre-existing conditions would be covered? Insurers insisted they had until 2014. Children, sick, disabled and dying children…. And what did Dr. Gawande think in April when insurance companies in the state he practices medicine in, Massachusetts, tried to raise rates up to 34 percent? Insurance regulators said “no” to the insurers for the first time in 33 years! That didn’t stop the greedy bastards though; they filed a lawsuit against the state agency to reverse the decision.

In an interview on Democracy Now!, Dr. Gawande said Massachusetts had near- universal coverage and, “It’s like many European countries now.” Massachusetts has the most expensive premiums in the country, 300,000 are uninsured and there are four levels of coverage: gold, silver, bronze and young adult. Not like Europe at all, actually. I lived, studied and worked in Spain for almost two years – no one is uninsured, everyone receives the same coverage, including the undocumented. The word “uninsured” isn’t in the Spanish medical lexicon.

It’s in insurance company DNA  D for denial, N for NASDAQ and A for avoidance of the sick  to eliminate or blunt regulation that threatens profit margins. There is an escape hatch for insurers and a trapdoor for patients just below each proffered reform. Facts: no regulation of premiums; age-rating  insurers can charge up to three times more for the “near elderly” (a designation I despise); companies can charge as much as 50 percent more for people who engage in “unhealthy behaviors” (the two new words for pre-existing condition); gender-rated premiums in businesses employing over 100 employees.

Starting in 2011, companies will be required to spend 80 to 85 cents out of every premium dollar on health care. Insurers loathe this new regulation and so the gaming has begun to ensure a medical loss ratio favorable to Wall Street investors. Why pay out more for health care if you don’t have to? The trick is to reclassify administrative expenses as medical expenses. WellPoint has already “reclassified” more than half a billion dollars of administrative expenses as medical expenses.

Gawande lets the predatory insurance companies off the hook when he argues the success of health care reform is the responsibility of providers and local communities and declares, “We are the ones to determine whether costs are controlled and health care improves…”

The “historic” legislation Gawande hails just forces millions to buy steerage berths on the Titanic. The ship will sink. It is a mathematical certainty.

Perhaps most disquieting is what Dr. Gawande writes toward the end of WHAT NOW?, “The most interesting, under-discussed, and potentially revolutionary aspect of the law is that it doesn’t pretend to have the answers.” Huh? For over a year the Democratic Party carried out an internecine battle full of rancor, high drama and daily, dire declarations of doom and then threw women, labor and the undocumented overboard to pass a bill that doesn’t have an answer to end the health care crisis? Absolutely unacceptable. Unacceptable when 45,000 human beings die every year because they lack access to health care. Unacceptable when nearly 25 million are underinsured and medical debt is the leading cause of bankruptcy. Unacceptable when racial and ethnic disparities in health care persist.

The enormity of all the unnecessary pain, suffering and death begs the question history books in the future will attempt to answer: Why didn’t we end it sooner? Why didn’t we eliminate the Jim Crow insurance industry instead of giving them more power and profits and enact a government-run, single-payer system based on the notion that health care is a human right and on the values of social solidarity, equality and freedom?

And how is it Atul Gawande the researcher and physician who believes in science, well-controlled studies, statistics, possesses a profound respect for human life and desperately wants to get it right in order to save lives  who held a dying patient’s bleeding heart between his fingers and compressed the cardiac muscle until it started beating again  supports a bill that in 2019 still leaves 23 million people uninsured and therefore at higher risk of death?

Gawande has got things wrong.

Kucinich, Air Force One, The Snake and the Sell Out

When I heard Dennis Kucinich would be flying on Air Force One with President Obama to Ohio I knew he was in trouble. Danger, even.

What transpired was part Air Force One with Harrison Ford and Snakes on a Plane with Samuel L. Jackson.

Here is a rough transcript of what happened to get Kucinich to switch his vote from a no to a yes on the Senate health care bill.

President Obama and Rahm Emanuel are in the Air Force One situation room.

Rahm: Where is that fucking vegan UFO believer? I’m gonna kick the shit outta him. When I’m done, he will be an unidentified flying object. I was a soldier in the Israeli Defense Force. Best military training in the world. Learned a lot of cool torture techniques. The press always mentions I did ballet not that I was a soldier. Because I did a few plies I’m a pussy?

Obama: Easy tiger. We’re not getting physical with Dennis. He’s going to cave. He always does. He talks the talk but doesn’t walk the walk. Remember when he delivered the progressive Democrats to John Kerry?

Rahm: I hate the word progressive when it’s in front of Democrat.

Obama: Okay. Which Democrats do we have on board for the bill?

Rahm: John Conyers. Easy. The man hit the mat the minute you won the election. You know he’s down with the first African-American president. He’ll do anything for you and nothing for the Congressional Black Caucus. He’s one old dog we don’t have to teach new tricks. Signed on with HCAN principles right away and shilled for the public option. What a bunch of fucking, fake bullshit that was. It was never going to be in a bill that passed. Conyers is a legislative loser and his staff a bunch of morons. What’s he ever passed that was important?

Obama: The bill that made Martin Luther King an official federal holiday. It took him 15 years.

The two men burst into laughter and do the fist bump.

Rahm: That fucking faggot Eric Massa went down. He was a single-payer supporter.

Obama: Rahm, don’t use that word.

Rahm: I apologize Mr. President. What I meant to say was I’m proud he had the courage to come out of the closet at this juncture. And then resign.

Obama: Who else?

Rahm: Anthony Weiner. I personally crushed his nuts. You see me yelling into my Blackberry, I’m yelling at Anthony. Hey Anthony, shut the fuck up about single-payer! But he’s my people, good Jew Boy, supports Israel, articulate, good looking, too. Supported single-payer, the public option and now the Senate bill. A logical progression. We have to reward his loyalty. Appoint him to an important committee.

Obama: I read Michael Moore is urging people to get behind the Senate bill. He just wrote a piece attacking Stupak for not supporting it.

Rahm (Enraged): I hate him! Big Fat Stupid White Man. Capitalism: A Love Story. What’s that guys’ problem? He’s from shithole Flint fuckin’ Michigan that’s his problem. But he always ends up caving. He supports Nader one year and then begs him not to run the next. Fuckin’ loser. At least he understands lesser evil politics.

Obama: You’re pissed because Moore wants to replace you with himself. I read the open letter he sent. It was funny. I like his films. I’d never say that in public, though.

Rahm: We’ve got all the liberals backing the bill: The Nation, Moveon.org, Robert Reich. Without the public option. They never ask for anything in return. Pathetic wimps. We just raise the specter of the Republicans back in power and they fall like dominoes. Works every time. It’s beautiful in its simplicity.

Obama: They don’t ask and we don’t tell.

Rahm: The New York Times is with us. We’ve got Krugman.

Obama: I worried Paul wouldn’t cave. He prefers single-payer, it saves money and covers everyone. How about Harvard, my alma mater? Who do we have there?

Rahm: Atul Gawande. Surgeon. Don’t you remember we passed a couple of his New Yorker articles around the Whitehouse?

Obama: I didn’t read them. But David Himmelstein, Steffi Woolhandler and Marcia Angell are at Harvard too and that’s a problem. They’re hardcore PNHP, outspoken, single-payer doctors and haven’t buckled. They’re constantly criticizing and pointing out all the problems with our plan and do solid research on the health care crisis.

Rahm: Which we use to scare Americans into supporting the Senate bill. Mr. President, I don’t mean any disrespect, but your previous association with PNHP and Dr. Quentin Young hurt us. What were you thinking when you spoke at that AFL-CIO conference and endorsed single-payer and said we just have to take back the Whitehouse and Congress? That video gets tons of hits on YouTube.

Obama: I was young, naïve, needed votes and PNHP members are very persuasive. I really believed in a national, single-payer system.

Rahm: You woke up, smelled the Kona coffee and realized you couldn’t get elected to the presidency and support the abolition of the private insurance industry. Any chance we could get Dr. Young to endorse the Senate bill?

Obama: Hell no. That guy has principles. He was Martin Luther King’s physician. He hasn’t compromised on single-payer since the founding of Physicians for a National Health Program twenty years ago. I admire that.

Rahm: The New York Times said Nancy is running a “massive whipping operation.” That triggered a massive fantasy for me. She’s wearing sharp, stiletto heels, tight, black leather pants, bustier, screaming and cracking a bullwhip on those motherfuckers that won’t vote yes. Hot shit! Her district in San Francisco, they’re all into S & M and B & D.

Obama: Really Rahm? Fantasy? Your staff tells me your 7am meeting every morning is like what you just described and you act like Nancy… Let’s get this over with. I’ll talk to Dennis first. We do good cop, bad cop.

Rahm (Embarrassed): Sorry Mr. President. Before I go, say the catch phrase, please?

Obama (In a stentorian voice): Not now. Not this time. Not on my watch.

Rahm: That’s killer! The American people are eating it up.

Obama: Thanks. I’ve been working on the delivery.

Rahm exits. Kucinich enters the situation room. .

Obama (Stands up, smiles, shakes Kucinich’s hand): Dennis, welcome to Air Force One. Did Ms. Smoot give you the tour?

Kucinich: Yes Mr. President she did. But I have to say, I miss Desiree Rogers. That woman was beautiful, talented.

Obama: It’s still the people’s Whitehouse, Dennis.

Kucinich: I know why I’m getting this awesome plane ride Mr. President.

Obama: Dennis I need your vote. This bill isn’t perfect, I know that, but it’s a step in the right direction.

Kucinich: I believe health care is a civil right. This bill doesn’t move the country in that direction.

Obama: I feel your populist rhetoric. I’m using more of it myself in the countdown to the vote. But come on. You’re going to tell me about civil rights? I’m all about civil rights. I’m a product of the civil rights movement.

Kucinich: You used to be a single-payer supporter. What happened?

Obama: I’m a pragmatist and politics is the art of compromise.

Kucinich: I saw the video of you on YouTube talking about taking back the Whitehouse and Congress and then enacting single-payer.

Obama (Irritated): I have to get YouTube to take that video down. I said that 5 years ago. Today I need your vote. My reelection depends on it. You want Palin in two years? You want the Republicans back in the Whitehouse, because if you vote against this bill that’s what you’re voting for.

Kucinich: I’ll be branded a huge sell out, unable to stick to my principles. I voted against the lousy House bill. How can I vote for the Senate bill which is even worse?

Obama: Dennis, the good, hardworking people of Ohio support this bill. They understand something is better than nothing. And it’s not like you haven’t sold out before. Don’t worry my PR people will help spin the switch.

Kucinich (Hesitating): I… I don’t know.

President Obama gets up and walks to the door.

Obama: Take some time and think about your decision. And remember what I said at a rally a few days ago: If not us, who? If not now, when?

Kucinich: Is that your new catch phrase?

Obama: No, it’s this; Not now. Not this time. Not under my watch.

Kucinich (Mesmerized): That is really powerful Mr. President.

The president exits and huddles with Rahm.

Obama (Whispering): Is Jackson ready? Where is he?

Rahm: He’s in your office getting into character. Wacko Jacko is going to whack Kucinich with his snake.

Obama (In awe): He brought the snake? Alright! And don’t hit Dennis. Do not lose your temper. Understand?

Rahm: Yes Mr. President.

Rahm walks into the room. Kucinich jumps back in his seat, a look of fear spreading across his face.

Kucinich: I didn’t know you were on Air Force One.

Rahm: The president and I thought we’d surprise you. I’m not going to waste any time. What the fuck do you think you’re doing Dennis the red fucking menace?

Kucinich: You’re not going to bully me into voting yes, Rahmbo. I have principles and ethics that are non-negotiable.

Rahm (Explodes): Bullshit! Everything is negotiable. You selfish, fuckin’ prick. You’d rather have the president lose the election in two years than vote yes on a bill that gives health insurance to 40 million people.

Kucinich: 30 million over 10 years. Maybe.

Rahm: Millions of people are going to be able to buy private health insurance because we’re going to give them billions of dollars.

Kucinich: Billions of dollars for the insurance industry – the cause of the health care crisis. All those CEOs care about is profits not patients.

Rahm: Don’t give me that bleeding heart, commie crap you fuckin’ retard. This is capitalism. The Democratic Party is a capitalist party. You don’t get that? If you believe that “patients over profits” bullshit what the hell are you doing in the Democratic Party?

Kucinich: I’m inside the party to move it to the left. Make it more progressive.

Rahm:(Bursts into laughter): You gotta be kiddin’ me. You don’t move the party left, you always move to the center or the right. You deliver the progressives to the party every four years. You’re more fucking retarded than I thought. Hey, watch this.

He turns on the TV. It’s live video feed of Michelle Obama and Mrs. Kucinich.

Kucinich (Nervous): Is that my wife? Elizabeth’s on Air Force One?

Rahm: The president didn’t tell you we invited her? Just watch.

Michelle: I’m heading up the initiative to fight obesity in children. It’s one of the leading causes of diabetes. The disease is an expensive drain on our health care system so it’s best to prevent it. I started a garden, too. People have to take personal responsibility and make healthier food choices and gardening is a great way to eat more organic, fresh fruits and vegetables.

Elizabeth: I heard about the garden on the news. You’re growing collard greens and kale, right?

Michelle: (Annoyed, but smiling): No, we’re growing arugula, radicchio, cardoons and asparagus. So tell me, is your husband going to vote for my husband’s bill? If the bill passes it will improve the health of America’s children. The bill will expand Medicaid to millions of poor children with obesity and diabetes. Who could be against a bill that does that?

The TV is shut off.

Rahm: You have a beautiful wife and daughter.

Kucinich (Panicking): My daughter Jackie is on board?

Rahm: Yes.

Kucinich: (Angry, turning red) You bastard, don’t you dare hurt my family!

Rahm: Right now. What’s your vote? Up or down?

Kucinich: I want to see my family immediately.

Rahm: No problem, Dennis.

They walk toward the back of the plane. President Obama and Jackson are waiting. Kucinich’s wife and daughter are standing by the ramp guarded by Secret Service agents.

Jackson: (Reprising the famous scene from the movie, brandishes a gun and shouts): Enough is enough. I’ve have had it with these muthafuckin’ snakes on this muthafuckin’ plane. Everybody strap in. I’m about to open some fuckin’ windows.

President Obama and Rahm smile and clap wildly.

Jackson (Still shouting): Mr. Kucinich, you’re the only muthafuckin’ snake on this plane. You gonna sell out this bill? Y’all are going off this plane if you don’t vote for it.

The ramp door starts to open, red lights flash, alarm bells go off and cold air rushes in.

Jackie (Shouting): Leave my father alone! President Obama you’re the sell out. You sold out to the insurance and pharmaceutical companies, the Wall Street banks and to the warmongers in the Pentagon. Carbon credits and clean coal my ass!

Rahm: Someone shut that girl the fuck up.

Jackson dangles the snake in Kucinich’s face and drags him to the edge of the ramp.

Kucinich (Shaking and sweating profusely): Okay, okay, you’ve got my vote Mr. President.

Obama: I knew I could count on you Dennis.

Jackson: Mr. President, say the catch phrase. It’s got real soul, brutha.

Obama (In his most stentorian voice ever): Not now. Not this time. Not under my watch.

Helen Redmond is a medical social worker in Chicago and a medical writer. She can be reached at: redmondmadrid@yahoo.com She blogs at: http://helenredmond.wordpress.com