We All Need Health Advocates and Advisors

healthNew Orleans   The more I get my arms around the current American health system, the more I’m convinced we all need real help and representation and need it badly.  

            Two hugely disturbing cases of predatory abuse in the current health care system underscore my concerns.   One was a story as old as usurious interest rates about how some professions including dentists are offering patients special credit cards at shamefully high interest to pay for procedures they need but can’t afford.  Another was robbery not at the point of a drill but hidden behind the mountains of bills from hospitals involving so-called network versus non-network billing practices for doctors, anesthesiologists, and the swarms of others that a patient and family can’t possibly sort out in the throes of a health care crisis.

            This network non-network thing is too wild.   When you go to a doc or a hospital within your insurance network, you’re solid, but once they pull the curtain and put you in a standard issue hospital gown, you may assume everyone you are dealing with is Blue Cross or whatever kosher, but that’s definitely not the way the game is played.   Other docs might be called in for consults or anesthesia or whatever by your doc, but they may be out of your insurance network, and you won’t know until you get the mountains of multi-paged bills later and find literally thousands of dollars of charges your insurance company will refuse to pay but that are building a small and desperate mountain on your dining room table.   A heart rending story in the Times by Tara Siegel Bernard brought this home for a young couple with a baby who had to have heart surgery.   Luckily, the grandmother was a bear and quit her job to become the hospital bill wrangler for the young parents and after herculean effort managed to jawbone most of the bloodsuckers down to the “network” rate so that they were only stuck with an extra $10000 in bills.   Did I just say, “only?”  My point exactly!

            This is not a comment about the complexities of the Affordable Care Act, but ACA is in the mix because although Obamacare caps consumers’ out-of-pocket costs within network, this out-of-network mess is all Wild West still.   I actually think there’s a recognition embedded in the ACA that we all need help or at the least that we will be fortunate if can find a grandmother, a wrangler, or an advocate.    At the end of the ACA application there is a space to designate a healthcare “representative” in filing for Obamacare.   They are onto something here.

            The point hit home with me the other night when I was at a meeting at Fair Grinds Coffeehouse where people were coming into the Common Space to ask questions about health insurance and how ACA worked.   The last two people I visited with at nearly nine o’clock were two healthcare professionals, one who worked in physical plant issues at LSU and the other who was a doctor working at both LSU and Tulane hospitals.   Interestingly, the doctor didn’t have insurance.   Both were deeply skeptical of health insurance and in some ways their own institutions, and each had a million different questions about what might be best for them and their dependents under ACA and, frankly, in general.   One really wanted to know where it was possible to get real advice even if it meant an accountant or CPA?  The other was basing a lot of what he thought he knew on a random conversation with a friend in New York State where the marketplace is completely different from Louisiana.   I don’t think these conversations are unusual.

When even healthcare professionals are lost in the dark forest of health care and insurance complexity, grasping any twig they can find and crying in the wilderness, it is hard to avoid the conclusion that we all need real help in finding open, solid ground to make good decisions.  Given the dollars involved and the predatory, game-the-system strategies at play by big institutions, reliable advice, reasonably priced, might save us all thousands today and in the future.  


Obama Right to Refuse to Negotiate with Himself

2obama1-popupNew Orleans   For five years whenever I’ve been asked for advice from various national campaigns whether immigration reform or healthcare or living wages or whatever, when it’s come to how to move President Obama, I’ve always argued, don’t lobby, don’t email, don’t tweet, point all the heat you can generate directly at him.  His record has always been that he will make some concessions.   None of my advice is meant to  be disrespectful nor to imply that pressure will guarantee the precise results sought, but nonetheless any analysis of his record of response and reaction to hard heat, is that he always gives up something, and often way more than he should have.   Unfortunately, watching the Tea Party, the shutdown mess, and the rearguard attack on the Affordable Care Act, no matter how quixotic and improbable, it’s fairly clear that the Republican Taliban also had about the same analysis and more will than progressives to make the fight.

            Now it’s with real pleasure that I can say that finally I’m wrong, and President Obama is holding the line by finally wisely reckoning that since he is unable to negotiate without giving concessions to opponents committed to bargaining in bad faith, the best strategy is to refuse to negotiate at all.   Yes, this is a dangerous strategy, but, damn, that’s why he gets paid the big bucks for his work in the trenches and not for his speech for the Nobel Prize.  

            It could blow up in Obama’s face, and there are still signs of sniveling everywhere for example in the reports of  little toehold compromise discussions on special interest pieces of the Affordable Care Act to curry favor from medical device manufacturers, fans of Cadillac policies including some unions, and various delays.   Hopefully Obama will hold the line there as well, since the real changes that are needed are on closing the big loopholes like the fact that rip-off, high deductible policies are being approved for big companies, and family members are being trapped outside of the exchanges by these same pretend-policies.

            This Administration has a couple of years left.  There’s no question we are in for a horror show for another year through the mid-term elections, but the only chance Obama has or any of us have who support progressive policies, is if the President holds the line for a change, and manages to rewrite the narrative so that what is won is finally done, and we can move forward, not keep failing to have a “meeting of the minds.”