Vic Socotra

19 November 2009

Step Right Up

(W. C. Fields as sideshow barker Gabby Gilfoil in the 1927 film Two Flaming Youths- Corbis-Bettmann Archives.)

“You need perfume?
We got perfume, how 'bout an engagement ring?
Something for the little lady, something for the little lady,
Something for the little lady, hmm
Three for a dollar
We got a year-end clearance, we got a white sale
And a smoke-damaged furniture, you can drive it away today
Act now, act now….”
- Tom Waits

Well, the other shoe dropped last night. I could hear it all the way out at Big Pink. We are going to act now.

Democratic leaders in the Senate unveiled their proposal for overhauling the health care system, outlining legislation that they said “would cover most of the uninsured while reducing the federal budget deficit.”

This is better than the ever-sharp Ginsu knives or the dinner that cooks itself on the way home to the office, no kidding.

I am no tea-bag, knee-jerk reactionary. Or maybe I am, I don’t know, but I am rational enough when I get the daily dosage right. I would like to think that I have a healthy sense of self-interest, tempered by a strong adherence to the social contract.

The problem is that it is difficult to figure out what that might be from day to day, since new implied contractual agreements are cut from whole cloth.

Harry Reid, bless him, unveiled the long-awaited plan to extend health benefits to 31 million people who currently do not have any, including several million who don’t appear to want it, since they were already eligible for a variety of programs, or who are too young to need it.

They have the gall to call it a fancy new name: “The Patient Protection and Affordable Care Act.” I parsed the words carefully, and could only find two inherent contradictions in the first seven words.

Here is what they are saying at first glance: the plan also adds new benefits to Medicare, though I am not sure how that works, given that the popular program is also going to be squeezed for savings.

Here is the good part: Mr. Reid says the Bill will reduce projected budget deficits by $130 billion over a decade because the costs would be more than offset by new taxes and fees and by reductions in the growth of Medicare.

I was born at night, but not last night.

What this means is not an expansion of benefits, but rather the dilution of a finite system to accommodate increased demand while slamming the income of the people who provide the services and continuing to line the pockets of the thieves in the insurance industry.

Surprised that mammograms really aren’t necessary for younger women any more? Just think what else might be next. I seem to recall that the prostate was declared not that much of a problem just a few month ago. Things must be getting a lot better.

Before my chat with Doc Nino this week, I might have been more sanguine about the future, but the system is in fact collapsing now.

A pal wrote to tell me that Nino’s experience is not unique. He visited his primary care doc this week and was told that one of the partners left the practice to join the US Public Health Service as a Commander, since he could make more money there than as a practicing civilian MD.) The remaining doctor confided that he made less than $150 grand a year. My pal gets the statements from the doctor, and the reports of what is paid out by the retired military insurance, and they are always less. The doctor, he says, is expected “to eat the difference.”

So, in simple terms, what is going on right now, before any bill of any kind is passed, is forcing him out of business. He is getting hit by a double-whammy of chiseling private insurers and a parsimonious government that cannot afford the benefits it has already handed out.

When I think back to what I had to go through to find Doc Nino, using an agent inside the government system to get a referral in the first place, it makes me more than a little queasy. And it turns out that getting on the Doc’s appointment calendar is actually costing him money.

So, reactionary or not, I am smart enough to take heed at the fact that the system as it exists now is collapsing, and all our old assumptions are going away.

Since we have not previously had a chance to look at what the Senate is going to debate, this is a brand new world this morning. There are close to two thousand pages of legislation in the House version of the Bill, and that is going to be the baseline for the discussion between whatever it is the Senate eventually passes.

There is a long way to go on that, but a couple fun facts about Conference Committees is useful to understand how our elected representatives duck responsibility for what they do in either chamber.

A provision in the bill is only considered “conferenceable” if it is mentioned in both the House and Senate versions of the legislation. The amount of money associated with the provision can only be increased from the lower of the two amounts.

The provisions can only expand, never contract.

I encourage you to look at the side-by-side comparisons of what has been passed by the House and what the Senate is going to debate. What is going to happen can never be less than what the Senators eventually agree on, only the same, or more.

Doc Nino gave me some good advice at the end of our chat yesterday, maybe the best medical counsel ever. He told me to not get sick.

“You can step right up, step right up
That's right, it filets, it chops, it dices, slices,
Never stops, lasts a lifetime, mows your lawn
And it mows your lawn and it picks up the kids from school
It gets rid of unwanted facial hair, it gets rid of embarrassing age spots,
It delivers a pizza, and it lengthens, and it strengthens…”

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