PHOTO CREDIT: Vivien Francis

“My taxes will go up!” One recent uninformed opponent of Obamacare protested.

I have had the great pleasure of being confronted by every stripe of opposition to Obamacare in the five months I have thrown myself into the public discourse by standing with signs and portraits in front of the US Supreme Court and Capitol.

No sarcasm here. I wanted the anti-Obamacarians to throw everything they had at me.  I wanted to know if my conclusions from my own study of the law had merit. Was I missing something?

I have put my finger on the pulse of America’s opposition to Obamacare.  And America should be ashamed of itself.

After 5 months of being confronted by anti-Obamacarians,  it is very clear that the majority know NOTHING of the law. I have been able to have maybe one or two REAL conversations about what is actually in the law. And those were from very intelligent anti-Obamacarians who were surprised when I debunked some myths like “rationed care. “ (I explained what the Independent Payment Advisory Board really is which I will not do now.) They were very curious.

What I have found with the anti-Obamacarians, however, is that they are very well versed in talking points from talk-radio hate speech. And they expect to be engaged in real conversation about the law by repeating these vacuous  declarations whose purpose is to keep the conversation at the level of a 5^th grade schoolyard shouting match.

“The law is 2700 pages. How can it be good?”  “The government is giving away free insurance?”  How so?  Are you talking about the financial aid an uninsured home care giver might get because she makes $22,000/year? SHE PAYS HER FAIR SHARE and then she gets financial aid because uninsured people drag down the economy for everybody.  (A subject for another blog) Anti-Obamacarians don’t want to know.

There can never be any real discussion about the law because anti-Obamacarians don’t know the law. More importantly, their intention, unwittingly or not, is to take down Obama  because that is the mission of the hate speech talk radio hosts and the GOP in general.  Anti-Obamacarians will say any stupid thing about Obamacare because they just want Obama toppled.  That’s the mission – certainly not insuring 50 million uninsured or addressing medical bankruptcies, the leading cause of bankruptcy in this country.

My experience talking to anti-Obamacarians for the last 5 months is that a mob mentality is lassoing people into a feeding frenzy of  “rightness.” And they don’t even know what they are “right” about because they can’t talk about the law. They just spew what hate speech talk radio hosts tell them.

This is a conversation I had on Wednesday in front of the US Capitol.  A pediatrician, anti-Obamacarian, confronted me. We circled around a lot of things but he finished with something I hear a lot. “No more taxes.”

I asked. “Do you file your taxes with your wife?” Yes, he did.

“Do you make over $250,000?” Yes.  We used the number $260,000 for his salary although he never confirmed this was his actual salary. He seemed comfortable with the number.

“Is all that money from wages or is some of it from capital gains (like stock earnings)?”  He made his money from wages.

OK. I explained that the “Medicare tax is increased by .9% (LESS than 1%) on wages OVER $250,000 if you are filing your taxes with your wife.”  Under $250,000 NO changes at all.

“So if you are making $10,000 over $250,000 that would be an additional $90 in taxes.  And you are not OK with that?”

He said “No. I don’t want to pay another dime.”

I asked him how he sleeps at night.  Just fine.   I told him I was going to repeat our conversation. He said he was fine with that.  I asked if I could take his picture.  He said no.

That attitude right there is what is wrong with America. Good Lord, what kind of country have we devolved into?  This Obamacarian making over $250,000/year would admit his unwillingness to pay $90 for a law that will give access to insurance to 30 million people. But would he admit it publicly?

Anti-Obamacarians, stand up and be counted. If you are like this man, be proud to have your picture next to your statements and come out of the cocoon of the talk radio hate speech mob.

Anti-Obamacarians, I have been listening to you for a long time.  If you want to trash the law, you have to KNOW the law. Or are you just getting high from talk radio hate speech? You disappoint.

n.b. Want to know how Obamacare is financed? Here is a link from Reuters.

Ex. of Health Savings Accts. on the Individual Health Insurance Market from healthcare series of portraits

From time to time I will post a picture of a portrait and share what I have learned. I must often research what my subjects tell me because I don’t understand their predicaments. I painted this portrait in March 2010.  Two years later, I have learned a lot about health savings accounts. I share my thoughts in this blog via this portrait.

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I”LL START WITH THE END FIRST: In my research, I think that HSAs are products that should be sold by financial advisors to people who wish to leverage their health for financial gain. These people are willing to take risks. They “play” with money. And they also have money to fund the health savings accounts (HSA) for tax advantages.

My conclusion: HSAs are a way to shift more of the cost of insurance onto the consumers.

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The above portrait is of a woman who bought a health savings account on the “individual market.” The individual market is when a person knocks on the door of an insurance company, so to speak, and asks them to sell an insurance policy to one person. This is unlike employers who get policies for their whole “group” of employees.

Health savings accounts are high deductible insurance plans.  Consumers pay more of their upfront, out-of-pocket medical expenses, up to several thousands of dollars, before insurance coverage starts.

When individuals buy HSAs directly from the insurance companies, those consumers must pay the premiums for the HSAs AND fully fund their health savings accounts, separate savings accounts for medical costs. (In group plans, some employers may opt to make a contribution to an employee’s HSA.)

The idea is that a consumer is socking away money in a HSA for when he gets sick and needs to spend the money on medical care. The supposed attraction is that the insurance premiums are less expensive, and the savings accounts can be funded with pre-tax dollars. But the money can only be used for medical expenses.

HSAs are considered “catastrophic” plans because it is believed that consumers will not meet the high deductible until an expensive medical catastrophe happens.

The high deductible plans cover preventive care. The point of a check-up is to catch problems early. If a problem is discovered during a check-up, the patient is faced with the dilemma of moving forward with treatment knowing he will be paying out-of-pocket until the high deductible is met.

Some consumers will put off seeing a doctor if ill because they do not want to pay the out-of-pocket-expense.  Instead, they think of their high deductible insurance plan as a fallback option if a medical catastrophe happens. And they’ll just figure something out if they have to come up with the $5,000 out-of-pocket if a catastrophe happens. They might remortgage a home, for example.

Many consumers know they really don’t have the money to fund the HSAs before they purchase these high deductible insurance plans.  When people don’t fund the savings accounts, the HSAs are not a benefit but  an burdensome idea, a psychological weight that reminds consumers that they don’t have money for the deductibles. (SEE PORTRAIT STORY BELOW)

Critics of HSAs say these policies are for a very narrow slice — a very very healthy slice — of the population that does not use health insurance. People with chronic diseases like multiple sclerosis, for example, could end up paying the very high deductible in a month or two just on prescriptions. Their high, recurring medical expenses prevent them from ever being able to save  for future medical bills. Their expenses are ongoing.

Opponents of the Affordable Care Act, ObamaCare, tout HSAs as a way for individuals to take more responsibility for their healthcare choices. The thinking goes that if you are saving your own money in a HSA, you will shop around and be smarter about how you spend your healthcare dollars. Smarter buying of healthcare services is supposed to bring down the cost of insurance.

The logic strikes me a bit disingenuous. There are 50 million uninsured in the US. Are the prevalence of HSAs really going to bring down the cost of insurance to the point of insuring  50 million more people?  Granted, HSAs are just one component of a plan put forth by anti-Affordable Care Act forces who believe that, along with tort reform and allowing insurance companies to sell across state lines, HSAs will help the free market bring down costs for health insurance.  Its a bit of a stretch when one considers that 60% of bankruptcies in the US are due to medical bills.

HSAs are supposed to make us “smarter” consumers. One of the subjects of this project had a stroke at 27. I don’t know how much shopping around she was in a position to do. This woman did not have an HSA but her experience is noteworthy when evaluating HSAs. This insured young woman said that navigating the black hole of getting health insurance claims paid was a lot harder than recovering from the stroke. She got to the point where she was discussing how the billing departments were coding her procedures on the claims forms.  Should patients recovering from strokes or anything else have to do that? Seems that pricing practices might want to be scrutinized rather than putting the onus on patients to shop around when they clearly can’t in medical emergencies.

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The portrait at the top of this blog post is from my Art As Social Inquiry series of portraits that looks at the way we access healthcare. Using art I look at this social issue through the lives of real people. Here is her portrait story.

Draper, Self-Employed, Age 63, Insured on Individual Market: The day subject turned 60 years old, her health insurance premiums increased by 45%. She could not pay $802/mo. to keep her insurance policy with a $500 deductible.

The insurance company offered subject a Health Savings Account (HSA) for a premium of $584/month. This policy has a $5,000 deductible.  This means that she must pay the first $5,000 of medical expenses out of her own pocket then insurance coverage starts.

In addition, subject has the option to fund her own HSA. She is not completely clear on how health savings accounts work but she opted for this policy because the premium is affordable. She considers it catastrophic coverage.

Her strategy: Try not to get sick, and avoid check-ups and treatments until she’s eligible for Medicare (Interview March 2010) (oil on canvas 40 x 30 in.)

Artist’s Note (2011): As of 2011 subject’s premium for the Health Savings Account policy with $5,000 out-of-pocket rose to $683/month.

Subject also now understands that in addition to her premium, which she pays to the insurance company, she is permitted to put additional money in a tax-free health savings account – money that has not been taxed and can be spent on health expenses. After she spends $5,000 out-of-pocket, her health insurance coverage starts.

She also discovered that since she is buying insurance on the individual market, her tax deduction is 20% of the premium (not 100% as is the case for group policies). She feels uninsured since saving money to fund the health savings account is a challenge in addition to paying the $683/month premium. She is eligible for Medicare on<br /> Dec. 1, 2011.

Artist’s Note (5/2012): Subject enrolled in Medicare last December. She expressed great relief in having affordable medical coverage.

PRO and CON Positions on The Affordable Care Act- in the Wall Street Journal.

Here is my response.

Mr Cannon,

I do believe you are making the case for single-payer. ” ….force insurers to limit services.” (He refers to The Affordable Care Act)

Insurers can limit services and ALREADY do because they answer to shareholders and will find every way to deny claims.

Insurers don’t have to make us happy as customers and they don’t. We all desperately need their product. There is no free market when it comes to buying insurance.

As a capitalist, I do not see how capitalist principles apply when the one half of the capitalist equation, the customers, cannot vote with their feet. Insurance companies do not compete. They collude. They raise prices indiscriminately because, well, who was to stop them before reform?

Insurance companies do not need to vie for our business. They cluck at each other to see who will have the greater share of the spoils, our premiums. And we cannot march with our capitalist feet.

So the bigger question. The system for accessing healthcare has failed so many millions in this country, so what is this really about?

The arguments against REAL reform are sounding rather specious just as I imagine those against abolishing slavery must have in their day.

Confronting Congress Directly

How could I possibly say I am not “political” when I advocate for healthcare reform and support the Affordable Care Act? Is it a political act to spend 55 hours/month standing with a portrait and sign in front of the US Supreme Court and Capitol? I am, after all, there to influence the political process.

Where I live in Pennsylvania two major roads converge, Routes 202 & 263.  These two routes actually share one road for a few miles then split and go their separate ways. And so it is with art and politics for me.

I did not create Art As Social Inquiry to bolster a political ideology. I did not say, “I believe XYZ, and I will devise a way to express my political beliefs.

I saw people suffering and wanted to know why.  I paint portraits of people in order to examine the human condition. I allow myself to be led wherever and however that inquiry takes me. And this artistic inquiry into healthcare has landed me smack on a political highway.

http://www.youtube.com/watch?v=8x-ctz9vrQ0

Traveling in these political fast lanes has taught me a few things.

Firstly, I owe a huge THANK YOU to all the activists I met who have taught me what a life dedicated to advocacy really means.

I’ve witnessed these good people work like barge-pulling mules. They never miss an opportunity to elevate the discussion to address REAL concerns for the middle class.

I suppose we could say that ALL politics is about people. Yes, the best kind of politics is about PEOPLE. And the health and welfare of a nation are a good politician’s business. True activists make it their life’s work to fulfill that political mission.

Just as I wish to understand and alleviate human suffering through art, I have met many good and  very hard-working people who use politics toward the same end. And to those people I say, “God bless.”  I have neither the skill, patience nor appetite for the political stew. And to those who do, THANK YOU. My job is easier than yours.

The difference between me and a political activist is that I will go where my questions and art lead me. Some of those questions will overlap politics if the questions happen to be on the political agenda. Other inquiries will take me deep into the human psyche and diverse cultural landscapes like my next art project where I will be looking at “How We Die.”

I, on my artistic path, and those on a political course are sharing the same road for now. One day I will move on and make art that addresses other topics but I will NEVER stop painting healthcare until we create a system where ALL can access medical care. And so the road I now share with my political activist friends (and you know who you are!) will eventually split   And we will go our separate ways. And I will have been made a better person for the sharing.

THANK YOU for all you have taught me. I love you.

I will talk more about my form of art activism at the PA Progressive Summit on Saturday, Feb.11. Hope you can make it.

(Photo taken during a Guantanamo Bay protest on Jan. 11, 2012. I usually have the sidewalk to myself)

KICKSTARTER PROJECT: Bearing witness on the sidewalk in front of the US Supreme Court.

The US Supreme Court will be deciding the constitutionality of some key aspects of Obamacare, the Affordable Care Act.

If all Americans cannot access healthcare, I would like to know why not.  My question to the Supreme Court is, “All Americans cannot access healthcare because_____??Explain it so I understand.”

I am taking my question and my  portraits to the sidewalk of the US Supreme Court. I stand facing the Court with a portrait and a sign for 3 1/2 hours in the morning; 2 hours in the afternoon on days the Court hears oral arguments (6 days/month). Also, I will be standing in front of the Capitol an additional 4 days a month holding my portraits and sign with the same question.

As a former business owner, I could not move on with my life when I found myself thinking that I could avoid paying healthcare premiums if I hired part-time workers instead of full time.  I knew if I was doing this, hundreds of thousands of employers across this country were doing the same thing. I realized that the employer-based system for delivering insurance would harm us greatly and weaken us in a competitive global marketplace. I got really scared for my country.

I decided to explore the subject of accessing healthcare in the US through my art project called Art As Social Inquiry.

I have been so troubled by the suffering caused by our current for-profit system. Many working people are left uninsured. And it is not uncommon for an insured person to go medically bankrupt. Our for-profit system serves shareholders not our citizens. And the idea that healthy competition spawns innovation and choice has proven to be a specious argument.  There is no competition when the consumer cannot walk away from a product he cannot afford. The insurers do not fear that we, the customers, will not like their products because they know we can’t live without insurance.

We artists don’t ask if we will be able make art.  We only contemplate the “how” of it knowing full well we will do it.  An apt analogy albeit a little crass — artists who don’t make art are “stopped up.” And nothing will ever be right in the world until we express and explore through words, dance, paint, stone, fabric… Oh sure, a life in art could be fertile ground for the ego to run amok. But once we get past that,  the art life is no less a trek into the Unknown than a mystic’s hunt for the Divine.

Kickstarter is a foray into the kooky-crazy ethers of the internets where all is redefined, all is possible.  I am NOT looking for friends to reach into their pockets.

Rather, I am hoping to have the Kickstarter page shared ad infinitum until it lands before the eyes of someone who perhaps wants to splurge for an oil sketch or painting.  It’s my way of saying “I’m open for business for a short time.  If you like my style of art and would like a portrait, contact me.”

Sharing the Kickstarter page and perhaps a link to this blog would be much appreciated.

Thank you so much .

Can you believe I was a panelist at breakout session??? OMG  I had so much fun. Who wouldn’t?  It was like girls sittin’ around being real with 500 of their friends in the audience.  And I got to talk about Art As Social Inquiry. Christmas came early in this studio. Thank you!!!!!!

The theme of the conference was Live Fearlessly!  Here’s the dish on my breakout session.And just for good measure, the organizers asked me to write down 5 things to share with the audience about reinvention. I wouldn’t call it reinvention for me, truth be told. Changing careers at 50 was more like putting on a pair of shoes that actually fit.  I’m not feeling bravery as much as relief.  I’m a little embarrassed to share these deeply personal thoughts, but they really are my mainstays..and this is my blog, right?

(Ahem, I can be the princess of typos, but the above are not mine.  I have plenty of my own to keep me red in the face.)

Anyone who is indifferent to the well-being of other people and the causes of their future happiness can only be laying the ground for their own misfortune. Dalai Lama

In 2008 I started an art project I call Art As Social Inquiry. The idea for this project surfaced after decades of observing the hundreds of thousands of people (and I mean that literally) I encountered in 30 years of working in the restaurant business. You can imagine that, after so many conversations, I had heard many thousands of stories of people helping people. One day it struck me, “Why do so many people who support so many charitable causes withtheir time and money get absolutely livid and resolute in opposing real reform for creating a system in which all people can access healthcare in the United States?”

Surely, if these good people really knew what was happening to the “others,” the ones who had no or not enough health insurance, the ones not like them, they might feel differently. I wanted to create an honest dialog by connecting the issue of access to healthcare to real lives — lives affected by our opinions and the society shaped by those opinions .

Also at this time I was phasing myself out of the restaurant business and returning to art-making, something I had studied for a brief time in my twenties. I had the idea that I could paint portraits and tell every kind of healthcare story I could find. If I created an overview by lining up these portrait-stories side-by-side, and then invited people to look at was happening in real lives across the spectrum of healthcare access, would our opinions about how we get healthcare change?

Any doubts I might have had about this new venture were quickly scuttled when I felt a bit of a spiritual push. I recognized that I, in my small way, was responsible for creating this class of “others” who could not get health insurance. As a small business, our health insurance group was comprised of my husband, me and one other full time employee. When our one full time employee decided to leave after 3 years, I said to my co-owner/husband, “If we hire only part time employees, we won’t have to provide health benefits.” I felt nauseous. I had to either lie to myself about how I was planning to control costs in our system of employer-based coverage. Or, I had to admit that I would be contributing to this national epidemic of the uninsured like the hundreds of thousands of other small businesses looking to hire only part-time workers. I thought, “Is this any way to run a country?”

Fast forward to the present. I am 45 portraits into my social inquiry of how we access healthcare in the US. My goal is to paint at least 100 portraits and have an art show travel the country for many people to see the portraits and hear the stories.

The portraits I paint are large, expressionistic canvases, 40 x 30 inches. I have no interest in painting literal images of my subjects. First I listen listen listen then intuitively express in the painted faces what I’ve heard. The subjects of my paintings retell what is often the most harrowing emotional, financial and health nightmares of their lives. To paint their faces, I must feel as they do in the recounting of their stories. When the image I paint on the canvas stares back at me as the real live person did from across the table during the interview, I know I have succeeded.

These portraits stories and the people behind them have taught me a few things. For 2 ½ years I have listened to real people tell me how they accessed or tried to access healthcare. My conclusions reflect the lessons I have taken away from listening to the stories of my subjects, and so many others I have not painted. I encourage you to read the stories online (ArtAsSocialInquiry.org) and draw your own conclusions. And I would add that what I found is so disturbing that I must speak up as loudly and as often as I can.

But the one glaring finding from all my interviews: It is in all our best interests for all to access healthcare in the US.

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Employer-based healthcare is very much a part of the economic/jobs crisis. Our current system incentivizes businesses to control healthcare premiums by eliminating them; that is, businesses hire part time employees wherever possible to avoid paying health benefits for full time workers. Employer-based healthcare is a contributing force, and a very powerful one, that keeps workers from getting full time work. More part-time workers ergo less benefits paid. (n.b. If an employer does not provide health benefits to anyone at all, however, then it doesn’t matter how many hours a person works. The company just doesn’t provide coverage. This is becoming more the case for small business employers. Some employers just don’t provide benefits to anyone. Period. These small business owners not offering insurance even to themselves sometimes get insurance by becoming dependents on their spouses’ group policies through the spouses’ employers. )

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Unbeknownst to the American public, lack of access to healthcare is creating a public health risk. I recently interviewed a clinic director. She told me about a restaurant worker who delayed treatment for scabies, ahighly contagious skin disease, because he was uninsured. He was handling food. Think this is the only story of its kind? I don’t. When faced with spending $40-$50 out-of-pocket to see a doctor, and who knows how much for tests and a prescription, an uninsured low-income person typically puts off treatment for as long as possible.

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The uninsured are most often working people who do not qualify or are not offered insurance through their employment. They are full time workers not working for corporations, people working two or three part time jobs, or people who have lost jobs and cannot afford to pay premiums for COBRA (a plan that allows them to stay on their former employer’s group plan for 18 months.) They are nannies, restaurant workers, pizza delivery guys, photographers, home health workers, bakers, landscapers, widows, students, jewelers, musicians, casino workers, acupuncturists, drapers, handymen, convenience store clerks, hairdressers, masseuses, contract workers and many more. They are those with pre-existing conditions and deemed uninsurable (read “unprofitable”); they are the very sick who become too sick to work, lose their jobs and along with it their health insurance; they are sole proprietors who cannot afford to buy health insurance on the individual market. (Insurance companies sell coverage directly to an individual rather than to an employer who has a “group” of people on a plan.)

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http://www.youtube.com/watch?v=_r17z939-aI

Good people are finding ways to con the system. One woman I painted (anonymously) married her good friend just to get on his health insurance plan so she could get treatment for cancer. When a graduate student was required to carry the school’s insurance because she did not have her own, she devised a way to circumvent the requirement with a sleight-of-hand maneuver in the paperwork. She could not afford the out-of-pocket expense of the school’s policy. “I felt like I was uninsured anyway. So why have the school’s insurance that I was never going to be able to afford to use if I got sick?”

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Our for-profit healthcare system is designed to cherry pick the healthiest among us who pay premiums. Healthy people use the system a lot less than sick people. Healthy people leave more of their premium dollars in the company’s hands. Conversely, selling health insurance to the sick eats up more of a company’s profits, and becomes something to be avoided in our current business model for accessing healthcare. We see this at work when companies set a premium price for more than it would cost for a sick person to pay out-of-pocket to get treatment. For example, a young woman, a college graduate and type I diabetic, found it was cheaper for her to buy her insulin than to buy health insurance.

Insurance companies know the cost of treating a type I diabetic and set rates accordingly i.e. price the insurance higher than the cost of her insulin. Why would a for-profit business take a financial loss by making the insurance premium less than the cost of paying for the needs of this type I diabetic? It would be against a corporation’s mission which is to produce profits and maintain share value for its shareholders.

In a free market we can decide to buy or not buy a product as was clearly seen in the recent Netflix debacle. Over 800,000 subscribers were unhappy with Netflix’s new pricing . The consumers expressed their dissatisfaction by cancelling their subscriptions as one can do in a free market. The market, in turn, saw plummeting sales and backtracked. Netflix reached out to the consumers in an effort to regain market share. Here’s the rub with health insurance in a free market. We can’t drop health insurance. If we could we would have expressed our displeasure long ago and walked away from health insurance premiums just as the Netflix subscribers walked with their dollars.

Every person is a cost/benefit analysis. The most fortunate sick people belong to group plans provided by their employers. The employer contracts with the insurance company for coverage for his employees. Small employers run the risk of having too many employees using the insurance (especially employees who have had medical catastrophes and need long-term care but still work). Small groups are subject to the same cost/benefit analyses as people buying insurance on the individual market. If the insurance company is not making enough profits from a particular group, the corporation will jack up the cost of premiums excessively high in the hopes that the employer will drop the insurance coverage. (I have heard of premium increases of as much as 40% in one year.) The insurance company wins because it has effectively dumped a profit-losing small group/business. This practice penalizes small employers for having unwell (but still productive)employees, and incentivizes them not to provide insurance at all.

Divestiture of the unwell has a face. The uninsured young woman, the type I diabetic, tried to save a few dollars by cutting down on her nighttime dosage of insulin. She thought she had the flu. She was actually falling into a diabetic coma. Courtney Leigh Huber, 23, died for want of a little insulin she was paying for out of her own pocket because the premium per month cost more than buying the actual medicine every month.

A cost/benefit analysis for a 23 year old, female, Type I diabetic would reveal how high a premium would have to be to cover the insulin AND make money. Logic says to price the premium to equal cost of medicine PLUS desired profit. Why would any self-respecting for-profit business sell a product on which it would take a loss? We see tangible consequences of this for-profit business model in our society: untimely deaths like Courtney’s (many thousands of them), citizens encumbered by medical debt (from being under-insured), medical bankruptcies, a stressed-out society afraid of getting sick for fear of what it will cost. The cost to a society far exceeds dollars and cents. The for-profit business model has brought the American people to its knees –uninsured and afraid of getting sick; afraid of losing a job and health insurance with it; afraid of actually using the insurance for fear of what it will cost out-of-pocket. Afraid, afraid, afraid. And we’re going to compete in a global world when fear is eating away at our workforce?

•••

Profits are also maximized when consumers are confused and make mistakes. An insurance company will find every way it can to deny claims because denying claims means more profits.(Sounds harsh, but I must refer the reader back to the portrait-stories.) Denied claims thrust under-insured patients into this labyrinth of twists and turns of procedures being coded incorrectly, hospitals in network but the doctors aren’t, etc. One wrong move in how care is sought by the patient, and he or she could be on the hook for thousands of dollars. The onus is on the patient (and medical professionals) to be the expert in not making mistakes that the insurance company can then dangle in front of them as reasons to deny coverage. Imagine the distress we feel just trying to straighten out one mobile phone bill with a customer rep. If a person with a serious illness has a pile of bills five inches thick — “explanations,” denials frominsurance companies, etc. — just imagine how much fear, tears and stress are caused by countless calls to the insurance companies. And imagine how stressed this person would be if she were fighting for her life AND facing financial ruin because of unpaid medical bills. For those who are sick and under-insured (and there are many millions), this is real. One of my insured subjects who suffered a stroke actually hyper-ventilated on the phone with an insurance company representative as she was fighting to get some of her claims covered.

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Clinics, emergency rooms and Medicaid are often proffered as ways to deliver healthcare to the uninsured. Medicaid is for the very poor. Even an uninsured man who took a job making $12,000/year could not qualify for Medicaid. He ended up dying for want of a defibrillator. Emergency rooms are required to “stabilize” which means if they patch you up, they need go no further. The man needing a defibrillator could get the “paddles” to get his heart started, but he could not get a new device that would keep him out of the emergency room for good. And emergency rooms are not free. Poor or struggling middle-income patients get billed which further pushes them underwater financially.

Yes, some hospitals have generous charity care, but if this were the norm, why do so many thousands of uninsured people go untreated and die? Some clinics are propped up by hospitals which keep them solvent, but many are stand-alone operations that do beg-a-thons to stay in business to serve the uninsured.

If politicians point to Medicaid and clinics as solutions giving the uninsured access healthcare (as my representative often does), why don’t these same politicians support generous funding for the clinics hobbling along trying to serve the 50 million uninsured? Why do these same politicians support cuts to Medicaid?

•••

This hodge-podge way of delivering care to the uninsured is inefficient and costly. And, in the end, inefficiency and wasteful spending end up costing the consumers who are paying health insurance premiums. Our current system is not sustainable for those actually paying the premiums. The sick people are uninsurable. They go to emergency rooms for care. They get billed by the hospitals but cannot pay. The hospitals can only eat so much bad debt until they needs to recoup losses. So the hospitals raise their fees. Now the hospitals want more money from the insurance companies, and the insurance companies want more money from people paying the premiums. Those paying for insurance end up paying for the uninsured in the form of higher premiums.

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The ultimate lie is that uninsured and under-insured people are, at best, just short of deserving access to healthcare and not clever enough to figure out how to get care from clinics, charity care or Medicaid. At worst, the uninsured and under-insured are slackers, dregs of society and deserve their fate. We are beating up a class of working people by not creating a system where all can access healthcare when they get sick. And we expect these very same people to be the backbone of this nation and make us the best in the world. Our psyches are hammered with pat slogans about what it means to be patriotic –pull yourself up by your bootstraps. Work harder. You’re not ingenious enough. The message is that an uninsured person in this country has done something wrong. Shame on our representatives for rigging the system with favors bought by corporate money and influence; and then blaming the consumers for not being able to access the healthcare system – a corporate system that has successfully exploited democracy by buying politicians. For those unable to get care when they are ill, it is much like those games where you put in your 50 cents and try to grab the toy with the hook. Somehow the hook never gets the toy. It’s rigged. It’s not profitable to insure sick people. For-profit corporations must tend to their profits first. The American workers are made to believe they aren’t good enough. Nobody is talking about the toll these lies about the American people are taking on our national soul.

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There is so much demagoguery and misinformation about ‘Obamacare.’ The rhetoric has convinced a huge chunk of middle-class America to vote against their own best interests in the name of “patriotism”. Too many distortions to list here. The biggest one, however — Obamacare is socialized medicine. The Affordable Care Act (‘Obamacare’) calls for competitive marketplaces where for-profit health insurance companies sell their products. I repeat, for-profit companies selling their products. The Affordable Care Act imposes consumer protections on those products, things like rate review, medical loss ratio, no pre-existing condition clause, no rescission, basic benefits packages and more. Most of the reforms don’t start until 2014, so this hysteria about reform driving up current rates is unfounded and meant to scare people and influence them politically.

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The definition of patriotism has been co-opted by the corporations and their lobbyists whose campaign contributions give them privileged access to our representatives in Congress.

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Somehow it has become unpatriotic to set regulations in the health insurance industry to protect the health and welfare of the citizenry. We won’t accept lead-tainted toys from China or listeria-ridden cantaloupe. Without regulations, the tobacco industry would be selling cigarettes to minors. But somehow telling an insurance company it needs to spend 80-85 cents of every dollar it takes in on actual claims (as per the Affordable Care Act) and not on executive pay and administrative costs is unpatriotic. If this regulation were in place a year ago, an insured woman who needed a PET scan might be alive today. Her cardiologist needed the scan to determine whether a tumor was pressing on the woman’s heart. The insurance company refused to pay for it. By the time the family was able to raise the $7,000 for the PET scan, the cardiologist said it was too late. The patient was too weak to operate on. Death panels are alive and well and they are housed in insurance companies.

Millions of Americans are rallying under a corporate banner bolstered by bought politicians who say it is unpatriotic to regulate a product. Yet that product affects the health and welfare of an entire country. This PR assault on reform is so effective that many people don’t even know that Obamacare IS the Patient Protection and Affordable Care Act (commonly referred to as The Affordable Care Act). People dismiss the consumer protections of The Affordable Care Act by calling it, derisively, “Obamacare,” as if they were rejecting communism. How clever and successful of the market-teers to link corporate profits to patriotism thereby making foot soldiers of hard-working Americans who think they are saving our country from socialism by rejecting healthcare reforms that would benefit them. The corporations through our representatives in Congress have sold the American public a bill of goods: health care reform is socialism.

This for-profit system has become so complicated that to even just talk about it or try to pick an insurance policy, one has to be an expert. Average Americans are flying blind and only realize how lacking their coverage is when they get sick and need insurance. And the insurance companies want to keep it that way. If we are confused about their dealings, we won’t want to speak up and risk looking stupid, or being shot down by some smooth-talking politician who will infer we’re not patriotic. If an insurance company can’t profit on the free market by selling products that don’t bankrupt or under-insure the person buying that product, then maybe they don’t belong in the marketplace. If insurance companies can’t produce products that do well in the marketplace without currying favor with bought politicians, then they don’t belong in the marketplace.

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Regulations are a counterpoint to the money the lobbyists throw at our representatives. Politicians who are financed by corporations are paying back their financiers by trying to weaken the Affordable Care Act. The Affordable Care Act sets a ceiling and floor in which the for-profit corporations must operate if they are going to sell products that affect the health and well-being of the American public. (After all the interviews and research, I, personally, would opt for a single-payer system. I didn’t start with that idea. I arrived at it after many hours of listening to the horror stories of people trying to access healthcare.)

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Some of the solutions put forth by those who oppose “Obamacare” are specious at best. For example, health savings accounts (HSA) are often touted as a big part of the solution to our healthcare crisis. Health savings accounts sold on the individual market (not a group plan) are a disaster for people who maybe can afford the monthly premium paid to the insurance company, but then might not understand that on top of the monthly premiums they must fund a special savings account from which they are supposed to pay their medical bills up to $5,000/year(or depending on what kind of HSA they choose.) Confused yet? HSAs may be a viable option for an employer group plan IF the employer pays both its portion of the premium AND fully funds the health savings account (or close to it) for the employee to use. Yeah, it’s a lot to sort out. Health savings accounts will solve our healthcare crisis as much as single hammer will build a skyscraper. There are those who say “I want reform just not Obamacare.” For those in the know, the collective eye-rolling could cause a mushroom cloud. Politics– while people go bankrupt, are maimed trying to find care, or die.

I am one person who learned a lot from listening to people. Real life stories and not political ideologies. The jig is up. O sweet country of mine, I have listened and understood. It is in all our best interests for all to access healthcare in the US.

Five years ago I lost a dear high school friend in a car accident. In that same year I was honored to be a part of another young friend’s dying process (cancer). Both were named Maria. I wrote this sonnet for my two friends. Seems spring was a time for dying for Marias in 2006.

ITALIAN SONNET FOR TWO MARIAS

Death pries open the sash we
Try to slam on its grubby affair.
You can’t have her! Stillness…no roar?
The Call, a valley weighted by a lumpy Fog.
The Knell, shadowless imps. They breathe
God’s stillness touching you everywhere,
Every here, every there, a spaceless, timeless future.
You go out with the tide of ubiquity.

What is it I thought I knew slumped
Over the correctness of my life? Assess
Her human-ness by her courage of opinion,
Dear Lord, by her easy laughter and unapplauded
Kindnesses.  As she passes through the proverbial gates
Even YOU will be awed by the one You have taken.

©2006