History of Health Insurance in the US: Part III

The battle continues.

• The New Dealers attempts for national health insurance was dealt a final death blow in 1939 with the defeat of the Wagner Health bill by the U.S. Congress.
• The outbreak of World War II buried the issue of national health insurance for the time period.
• The National War Labor Board (NWLB) freezes wages to head off labor disputes so employers offer health insurance coverage as a means to attract workers.
• Between 1945 and 1952, President Truman attempts to pass legislation for federally funded medical care but can only block legislation that would have required a poverty test for those seeking insurance aid and legislation that would have expanded the influence of the Blue Cross Blue Shield system.
• During the Eisenhower administration hospital and medical costs rose at a rate that created public pressure for federally funded relief. The AMA agreed to work with the Eisenhower administration to relieve the situation. As a result, in 1960 the Kerr-Mills bill passed which provided funding to the states to assist with the health costs for the elderly.
• In 1961, the AMA helped to defeat the King-Anderson bill which would have paid for hospitalization for the elderly through the Social Security system.
• John Kennedy included federally funded health insurance in his New Frontier programs but he was defeated in Congress.
• In 1964, President Johnson too was defeated in his attempt to pass his hospitalization program.
• A change in the makeup of Congress in 1965 created a climate that allowed for passage of Medicaid and Medicare.

To learn more about the history of health insurance in the United States, click here and here.

Our history of health insurance is not a pretty one. For the most part, the patchwork of programs and plans that we have today is the result of organizations with different agendas having control at different times. These organizations for the most part represent two camps. One that desires profit and another that desires comprehensive universal coverage.

Rather than “do the right thing” our leaders in business and politics have done their thing. It’s time to agree on the definition of the “right thing” and make it happen.

The History of Health Insurance in the US: Part II

Part II takes us through the passage of the Social Security bill in 1935. Social Security was intended to be “social security” including unemployment insurance, a national health plan, national health insurance, accident and disability insurance, old age pensions, and industrial accidents insurance. It never materialized to be true social security because of opposition from so many groups such as the AMA. Roosevelt only presented to Congress what he knew would be accepted. Unfortunately Congress didn’t have the same strength-of-character that Roosevelt had.

• By 1917 most medical professionals and agencies supported the need for health insurance legislation at the federal level. There was also opposition from sectarian groups because they were excluded and pharmacists who thought it would cost them business while they would have to contribute to their employee’s health insurance.
• In 1917, the president of the American Federation of Labor (AFL), Samuel Gompers, stated before the U.S. House of Representatives that when it came to federally funded health insurance, workers would rather rely on themselves than the government. He actually said that federally funded health care would promote workers to leave jobs because they would be guaranteed insurance wherever they worked.
• At the same time, many of the private health insurance companies formed the Insurance Economics Society of America which blocked passage of any health insurance legislation.
• The gains of the AALL were halted in 1917 by our participation in World War I.
• Opponents of mandatory federal health insurance used the rising tide of anti German sentiments to stop all legislation by claiming that federal health insurance was a German concept and should be avoided at all costs.
• The outpouring of anti German sentiment, fear of anything sounding like socialism, and higher physician incomes prevented any growth in federally funded health care through the 1920’s.
• The depression in 1929 started a steep decline in hospital receipts and physician incomes and a renewed interest in health insurance within the medical community.
• In 1929, the first modern group health insurance plan was established. Justin Ford Kimball, vice president of Baylor University in Waco, Texas, headed the Baylor College of Medicine, School of Nursing, College of Dentistry, and the university hospital. He developed a health plan that guaranteed teachers 21 days of hospital care for 50 cents a month. This became the prototype for the Blue Cross plans.
• In 1934, the cross symbol was first used in an advertisement for the Hospital Service Association, today known as Blue Cross and Blue Shield of Minnesota.
• In 1939, the Chicago-based American Hospital Association began using the Blue Cross symbol to signify that health plans across the country met certain standards.
• The Blue Shield concept grew out in the lumber and mining camps of the Pacific Northwest about the same time Justin Ford Kimball, vice president of Baylor University, created his plan. The plan would provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians.
• The Blue Shield symbol was created in Buffalo, New York by Carl Metzger in 1939, and the first official Blue Shield plan was founded in California that same year.
• In 1935, the Social Security Act is passed but national health insurance is omitted.

The History of Health Insurance In the US: Part 1

This will take more than one post because it's a long history and believe it or not it's actually quite interesting. The concerns and problems relating to health insurance haven't changed in the past 100 years. Here we go.

• National health care systems started in Europe with insurance laws put into effect in Germany in 1883.
• By 1912, most European nations had passed national health care legislation.
• By the end of the 19th century, medical care in the US shifted from the home to the doctor’s office and the hospital raising the cost of health care thus increasing the need for a system to pay for medical care.
• In the 19th and early 20th centuries, there were six forms of health insurance available. They were fraternal societies, contract physicians, private physician plans, county medical bureau plans, hospital service plans, and group insurance plans offered by private insurance companies. At that time, a very small percentage of the population purchased any health insurance.
• In 1913, the American Medical Association (AMA) stated that only about 10% of America’s doctors were making a comfortable living.
• In the early 20th century, the general opinion of the American people and the AMA was that some form of mandatory health insurance was necessary but for different reasons. The American people needed a way to pay for medical care because the majority of the population couldn’t afford treatment. The AMA wanted to raise physician’s income.
• During this time the general belief was that the federal government was responsible for providing for the betterment of the masses.
• The drive for mandatory health insurance didn’t come from the government. It came from the American Association of Labor Legislation (AALL). The AALL was formed to address the dangerous working conditions in many industries. After successes in their legislative attempts, the AALL turned their attention to mandatory health insurance. The AALL suggested a health insurance plan that was supported by the employer (40%), employee (40%), and the government (20%).
• In 1916, the AMA formed the Committee on Social Insurance that supported health insurance legislation.
• In 1916, the AALL chose to attempt to pass health insurance legislation at the state level. They selected Massachusetts, New York, and New Jersey as trial states. The bill proposed in New York was opposed by the medical community because it opposed the fee-for-service principle, patients couldn’t choose their own physician, and the plan put the state rather than the physician in control. The problems were resolved and an insurance bill was passed by the state legislator.

Doesn't some of this sound familiar?

Health Insurance in the US

I had decided to write a post describing how we became a country where most of us have employer paid health insurance. In fact, the entire development of the health insurance industry and the start of employer paid insurance is quite interesting so I will post the history here soon. But before I do, I thought you would enjoy this three minute video that's a great metaphor for the entire history and how well it operates today. To see the video, please click here.

Please watch to the end. Only at the end will you appreciate how well we're served today.

I just couldn't pass up this opportunity. Thank you for watching.

No More Bullies in the Playground?

My purpose for starting this blog site has changed from telling my friends and family about the trials and tribulations of getting my book published to promoting a fair and just society where we all respect our fellow man. I started with health care reform. It might not sound like a big deal but it is to me. Do you all remember the bully in the playground? I do.

I remember him well because even though I often wasn’t the target I lived my life in constant fear. I had polio as a child and walked with braces on my legs and crutches under my arms. Often bullies didn’t pick on me because they weren’t sure whether I could hurt them with my crutches. The times a bully found out they weren’t very effective I got to experience the pain a bully can inflict. Well now we’re all grown up and there aren’t any bullies anymore, right?

Guess again. The bullies have grown and become more sophisticated. Now they aren’t just a person they can be a company or an entire industry. Any time a person or organization takes their interest over your interest or the common interest, they’re displaying all the characteristics of a bully and if it quacks like a duck and waddles like a duck, it’s a duck. Recently Warren Buffett the billionaire founder of the investment firm Berkshire Hathaway Inc. asked Congress not to cut his taxes. Specifically he urged the Senate Finance Committee not to repeal the estate tax which is scheduled to come up for a vote by the Senate.

If you want to see a man who thinks like me, a man who believes in a fair and just society and is willing to do something about it click on this link http://abcnews.go.com/GMA/Story?id=3869458&page=1 .

If this video doesn’t make you angry, then get out of the playground because we don’t want your kind here.

An Example of Waste of Oil Resources

If you didn’t read yesterday’s post, read it before you read this one. A wonderful example of waste of oil resources is the SUV. The original SUV’s were trucks with fancier bodies on the frame. Trucks were cheap because they were built on old technology that cost less to manufacture. Then Detroit put a healthy price on the SUV’s. They’re cheap to make and Detroit can charge a lot. The SUV was what Detroit needed. A vehicle with a high profit margin that the public wanted.

To make sure we wanted one, they marketed the SUV as the vehicle powerful, successful people drove. The minivan was mom’s car. I have a daughter that was exposed to that marketing and she still won’t buy a minivan even though she will admit they offer more space and convenience and they’re cheaper to own and operate. Do you feel manipulated? You know; bend me, shape me, any way you want me. If you didn’t recognize that verse, click here.

Is the Sky Falling ?

Why are we still so dependent on foreign oil?

Does anyone remember waiting in line for gas in 1973? The lines were long and we were all sure that the end had come for cheap and plentiful gasoline. It was caused by the Arab Oil Embargo. It scared us all and we were ready to do anything to avoid it again. We had gotten used to big, fast cars that consumed fuel like a forest fire in California blown by the Santa Anna winds. The scary part was that we weren’t ready for addressing the Arab Oil Embargo in 1973 or any oil embargo that might happen in the immediate future. Detroit especially wasn’t ready. We had less than spectacular small cars like the Chevrolet Vega, the Dodge Colt, and the Ford Pinto.

The American answer to small cars was definitely more efficient than the behemoths we had been driving but Japan had better cars. Detroit never took small cars seriously because the profit margin on small cars is…well…small. Detroit had a lot riding on its cars. One of the biggest burdens riding on small cars was all the benefits that the union workers were getting and that burden wasn’t going away. In fact, it would be getting worse as the population aged and a glut of workers would retire with all those benefits. It was a promise that Detroit made. It was a wonderful promise but Japanese car manufactures didn’t have that burden. They could make a greater profit on a small car. In fact, they made a better car that cost more and we bought them by the ship load.

We never did have another serious oil embargo so our government wasn’t about to do much about promoting the search for alternate fuels or finding ways to use significantly less oil. Now we’re facing a crisis that we didn’t see coming. The government, the Arab oil producers, and the oil companies have figured out that we don’t complain too much as long as prices don’t go up too fast and we’re not standing in line for gas but now we’re facing a serious problem with supply and demand for oil. The rate of increase in oil consumption by China and India will dwarf our needs. It’s already pushed the price of a barrel of oil to nearly a hundred dollars. We probably won’t see the price of a barrel of oil go down. Wait until we start buying home heating oil. We’ve just started to feel the pain and are we ready? No we’re not. Why aren’t we?

This can’t be said enough – greed and self interest. Business and government leaders should have accepted the responsibility of preparing for the day when oil becomes too expensive to use as our main source of energy. Our government leaders stood by unwilling to irritate the oil companies because the oil companies provided them with the money they needed to be reelected. Detroit needed to make money, a lot of money, to cover the debt they created. Could we have significantly reduced our dependence? Yes, we could have. Brazil did it with cane sugar. It’s not a perfect solution but its better than what we have. Will things get better soon? Watch the advertisements on television and you’ll see the oil companies advertising about the solutions they’re working on. If that’s not the fox designing the hen house, what is?

Have we been duped? You wouldn't think so. Everybody knows the sky’s not falling. Just ask those that could have taken steps to make us less dependent.

Hey, what was that? Some pieces of blue stuff just fell into my yard. Think I’ll get inside.

The Healthcare Fix or One Solution

There’s a new book out titled The Healthcare Fix: Universal Insurance for All Americans by Laurence Kotlikoff. Laurence is a professor of economics at Boston University and a leading scholar on the generational accounting of social security. Laurence has written extensively about the probability of a bleak economic future for the United States without tax reform, health care reform, and Social Security reform.

None of this comes as a surprise to most of us. What do we do to change our future? We go to Starbucks, order a coffee, and sit down with our friends and lament about the future. We do that because we feel confident that our leaders will take care of the problems. Meanwhile lobbyists are feeding the self interest giant in Washington at a rate that will crush us all. Our leaders don’t know we’re paying attention because, for the most part, there are no repercussions for their actions.

That’s why we have the right to vote. If our political leaders thought someone was actually holding their feet to the fire, they might respond appropriately but we don’t understand the problems and we don’t know who’s telling the truth. Therefore, we don’t know which solution makes sense. Many of us vote but for the most part we’re not informed voters.

We can also reach business leaders if we stop buying their products. Unfortunately there are some products important to us that you and I don’t personally buy but we pay for. Health insurance is an example. For those of us who work for a company that provides health insurance as a benefit and most of us do, the company purchases our insurance. Those of you who think you don’t pay for that benefit, please raise your hand. If your hand is in the air, you need a reality check soon.

If you think health insurance is too expensive, you’re right. Employers are looking for ways to cut back on insurance costs but their hands are tied. We don’t respond well to fewer benefits or no benefits any better than we respond to our employer reducing our pay or not giving us an annual raise. The best way to reduce the cost of something is to switch to another product. For an employer with many employees, that’s a daunting effort. For us as individuals, it’s much easier. If we were buying our own health insurance, the GEICO gecko would be selling health insurance and many of us would be switching.

Part of the GEICO philosophy is “We keep costs as low as possible so we can pass the savings along to our customers. We're always looking for better, faster, more efficient ways to conduct our business.” Imagine having a health insurance company that operated with that philosophy. I know the health insurance companies don’t keep their costs low because the administration costs in the health insurance industry are higher than the administration costs in Canada and we know how efficient bureaucracies are.

Okay, back to the book, The Healthcare Fix: Universal Insurance for All Americans. Kotlikoff recommends that we kill Medicaid and Medicare and use the money to provide us all with vouchers to buy our own insurance. I haven’t read the book yet so I’m not sure if he’s talking about just the people on Medicare and Medicaid or if he’s talking about dismantling the entire employer based system. I’ll let you know.

I do know Kotlikoff advocates drastic measures. He says we like incremental changes but we don’t have time to make incremental changes. The only way we will get drastic changes is if our leaders in business and government get the courage to do it; the courage to do what’s right for this country. I’m not advocating any particular fix but I can’t wait to read his book. You might want to do the same. After all, you wouldn’t want to be uninformed.

Controlling the Rising Costs of Health Care

The report I referenced on November 2nd and yesterday, The Challenge of Rising Health Care Costs — A View from the Congressional Budget Office, is from the November 1st issue of the New England Journal of Medicine (NEJM). Yesterday I listed the three reasons given in the report for the rising costs of health care. The November 8th issue has a continuation of the report. The November 8th report addresses how we could control the rising costs. The report mentions several methods but they all come back to one approach and that’s the first one mentioned. I’ve excerpted the following from the report.

“One approach that could reduce total health care spending (rather than simply reallocating it among different sectors of the economy) involves generating more information about the relative effectiveness of medical treatments and enhancing the incentives for providers to supply, and consumers to demand, effective care.”

The reality is that we have documented evidence about the effectiveness of less than half of the medical treatments in use today and little documented evidence whether the additional costs for expensive treatments justify their additional costs. Let’s look at how “generating more information about the relative effectiveness of medical treatments” would affect the three reasons given for the rising costs.

1. The bulk of the spending for health care is from the development and diffusion of new medical technologies and therapies.
   
   The effectiveness of new medical technologies and therapies are typically documented by the companies that developed the technologies and therapies. Their studies may be accurate but at this time we don’t know for sure because no independent research is done. Independent studies could certainly assist the doctors in making informed decisions.
   
   
2. The fee-for-service (rather than managed care) reimbursements to health care providers creates an incentive to provide additional or more expensive services.
   
   Obviously fee-for-service has built-in incentives for the health care providers. It’s very difficult to control costs when five tests can be performed or an expensive procedure done when three of the tests may have been all that was necessary or a less expensive procedure performed but there’s little data to support the use of specific tests or procedures. I’ve had experience with this. I heard about a test for diabetics that I was interested in. I mentioned it to my doctor and he told me the benefits of the test versus another test I was having. I was suggesting both because my insurance pays for both. He convinced me that the second test wasn’t beneficial. Another doctor may have said yes without any thought to the cost versus benefit. In this case, the test has been available long enough for the doctor to have some experience with its effectivenes.
   
   
3. The declining out-of-pocket costs paid by recipients for services. Consumers ask for more when they pay less.
   
   The example above applies here as well. When patients ask, typically doctors deliver. If the doctor has data to support their lack of recommendation for a test, drug, or procedure, they’re more likely to speak up.

I think we would all be more comfortable if some organization was “generating more information about the relative effectiveness of medical treatments.” There is another approach which I advocate and additional study information would help here as well. The other approach is for health care providers to do the right thing. Greed and self interest is almost encouraged by the public. So many people treat those with wealth as hero’s or royalty. It’s a power that can intoxicate anyone. Having the strength of character to do the right thing is rare. Providers would be more likely to find the strength of character if they know that the payer is going to question a treatment based on an unbiased study. The payers could provide a strength of character quotient for providers. A 10 means avoid because they cost us too much money and a 1 is very effective at controlling costs.

Three Reasons for the Rising Costs of Health Care

On November 2nd I said I would summarize a report titled The Challenge of Rising Health Care Costs — A View from the Congressional Budget Office written by Peter R. Orszag, Ph.D., and Philip Ellis, Ph.D. Dr. Orszag is the director of the Congressional Budget Office (CBO). Dr. Ellis is a senior analyst at the CBO. The CBO is a nonpartisan agency that provides budgetary and economic analyses to Congress.

The report describes three reasons for the rising costs of health care.

1. The bulk of the spending for health care is from the development and diffusion of new medical technologies and therapies.

2. The fee-for-service (rather than managed care) reimbursements to health care providers creates an incentive to provide additional or more expensive services.

3. The declining out-of-pocket costs paid by recipients for services. Consumers ask for more when they pay less.

A fair question here is what does rising health care costs have to do with the desire for universal health care? The answer is simple. If we want to have equal health care for all, we need to be sure we don’t break the bank. Next let’s talk about how to control costs.

Let's Meet the Health Care Challenge

"Why is it that we spend more than $6,000 per person per year for health care in this country and still have close to 47 million people with no coverage, while Canadians spend about half of what we spend, yet have longer life expectancies, lower infant mortality rates, and all their people have equal care available to them?”

This is one of the questions submitted to AARP for AARP’s two presidential forums. The question was sent in by Dan Kanoza a retired industrial engineer. The question is the same one many of us in this country are asking. Unfortunately there’s still a lot of us who are satisfied with our health insurance and our health care to ask the question. It won’t stay that way forever. The rising cost of health care ergo the rising cost of insurance is changing the state of insurance coverage every day and it’s not for the better. We’re getting less and it’s costing us more.

At the rate employers are dropping insurance coverage, raising the cost of coverage, and reducing options, in a decade we will have one third of our population without insurance, one third underinsured, and the last third asking why the other two thirds are complaining. We’re all afraid of the Canadian health care system because of the horror stories we’ve heard but Dan Kanoza is right. Canadians do spend about half of what we spend, have longer life expectancies, lower infant mortality rates, and all their people have equal care.

The horror stories of long waits for treatment are the result of a shortage of medical staff and under funding. The shortage of medical professionals is the result of a study performed in Canada in the early 90’s demonstrating a reduction in the need for medical services in the next decade in Canada. Rather than allow the system to find its own level the Canadian government reduced the number of slots available in their medical schools. This has affected all the medical professions in Canada. The Canadian government has also been unwilling to tax their population enough to meet their needs. Even small increases aren’t possible because politicians are afraid to be honest.

Granted there are problems in Canada but the problems aren’t as bad as we’ve heard. The truth is there are too many in this country that have a self interest to maintain the status quo. There is so much misinformation being distributed about other health care systems and what would happen if we made significant changes to our system that the average person is afraid to even suggest there’s a problem. We have the talent to make changes. We have the ability to make our system better but we have to be willing to do it.

We spend too much. Tomorrow I’ll talk about the rising costs of medical care. We have shorter life expectancies and higher infant mortality rates. How could that be? Simple, almost 20% of our population has no health insurance and another 20% are underinsured so they don’t go to the doctor or hospital when they should. I have had a less than optimal insurance plan and I have heart disease. I’ve had two heart attacks and bypass surgery.

A year after the bypass surgery I started having indigestion after exercising. For three days I questioned whether to go to the hospital. I wasn’t feeling the severe pains I felt from a heart attack but I was concerned. Finally I decided to go to the hospital. I waited because I knew it would cost a lot of money to meet my deductible. Just walking into the emergency room was going to cost me a $100. The doctor found two of the bypasses blocked. The bypassed arteries were less blocked than when I had the surgery thanks to my diet. What I didn’t know was that veins behave differently and can block within days after bypass surgery. I needed a stent in one of the bypassed arteries.

How many people wait too long?

I think we’ve waited long enough!

Universal Health Coverage Provided by United States War Funding

As you saw on the map yesterday, Iraq and Afghanistan have universal health coverage provided by United States war funding. In Iraq alone we spent $950 million to establish a universal health care system. The first year after the fall of Saddam Hussein's government Iraq exported $6 billion in crude oil. They couldn’t afford their own universal health care system. Might we be able to afford our own system some day?

Universal Health Insurance Where? OR What's Wrong With This Picture!

Today I've been writing what amounts to four posts. I couldn't decide which one to finish and then in the process of finishing the fourth one I came across this map.

http://upload.wikimedia.org/wikipedia/en/c/c5/WORLDHEALTH2.png

I found it on the Wikipedia free encyclopedia web site when I did a search on universal health insurance in Google. Note the two red countries (you should be able to enlarge the map by clicking on it or holding your cursor over the map and waiting for the size selection icon to appear on the lower right corner of the map). Any comments?

The Health Care Industry and the Pharmaceutical Industry

Wednesday I directed you to an article in the Health section of Consumer Reports’ (CR) web site. The article I found on the CR Internet site Health page is titled 10 medical 'gotchas'. The article the link took you to is titled Overview. As I pointed out, there are a number of other articles you could read. One is titled New drugs, big dollars. This article is about the Pharmaceutical industry. The writer calls them Drugmakers. The Pharmaceutical industry has produced drugs that significantly improve our lives and in fact I would die in a few days if I stopped taking one of the drugs produced by a Drugmaker. I believe they are a blessing but I also believe there are abuses in the industry. Excising those abuses is one of the many challenges we need to address to lower the cost of health care.

One of my Son-In-Laws works for a Pharmaceutical company so I feel very sensitive about this subject but it can’t be ignored. I’m not suggesting that we should restrict Pharmaceutical companies from marketing to their customers or making a profit but I believe that the relationship between the health care industry and the Pharmaceutical industry needs to be scrutinized. There’s another article on the New England Journal of Medicine (NEJM) web site titled Doctors and Drug Companies — Scrutinizing Influential Relationships by Eric G. Campbell, Ph.D. Click on the title to read the article. The article talks about the efforts to require manufacturers of pharmaceuticals and medical devices to disclose how much money they give to doctors. The money can be in the form of dinners, trips, or consulting fees.

Soon I’ll be posting an overview of another article on the NEJM web site. It’s a great article titled The Challenge of Rising Health Care Costs — A View from the Congressional Budget Office written by Peter R. Orszag, Ph.D., and Philip Ellis, Ph.D. Dr. Orszag is the director of the Congressional Budget Office (CBO). Dr. Ellis is a senior analyst at the CBO. The CBO is a nonpartisan agency that provides budgetary and economic analyses to Congress. You have to subscribe to the NEJM magazine to read the article so I can't link you to the article.

Health Insurance - Why So Expensive?

Yesterday’s post was a long one so you deserve something a little more entertaining. The link below is to an article on the Consumer Reports web site. On the left side of the page there’s a number of articles you can read that you’ll find interesting. The articles will give you a clue to why health insurance is so expensive. Enjoy the articles.

http://www.consumerreports.org/cro/health-fitness/health-care/medical-ripoffs-11-07/overview/medical-ripoffs-ov_1.htm

Hillary Clinton: The American Health Choices Plan

The title of Hillary’s plan and the graphic above copied from the graphic on Hillary’s website points out her emphasis on expanding health insurance choices. The choices are to keep your existing coverage through your employer or your own individual coverage, choose from the same private health care options that members of congress have as part of the Federal Employee Health Benefit Program, or choose a quality public plan option similar to Medicare. The plan calls for the federal government to become a provider of health insurance. The idea is that the competition will encourage the private insurers to offer better plans at a lower cost. Personally I believe that the government needs to stay out of the business of health insurance. It’s another bureaucracy. Competition is healthy but I think it needs to be between the private insurers. Possibly the insurance companies aren’t willing to compete. If that’s true, it sounds like price fixing is occurring which is against the law.

The second part of the plan calls for lower premiums and increased security. Lower premiums will be realized by removing hidden taxes, better lifestyle choices, and focusing on efficiency and modernization in our present health care system. Increased security will be legislated by ensuring that job loss or family illnesses wouldn’t lead to a loss of coverage or high costs and an end to unfair health insurance discrimination “by creating a level-playing field of insurance rules across states and markets, the plan ensures that no American is denied coverage, refused renewal, unfairly priced out of the market, or forced to pay excessive insurance company premiums.” This part of the plan is common across all the plans. There’s little or nothing that could be argued about here. What interests me the most is unfair discrimination. As far as I’m concerned, unfair discrimination is redundant. Discrimination is unfair and it’s against the law everyplace but in insurance. We’ve tolerated it from our insurance companies long enough.

The third part of the plan, promote shared responsibility, is the main emphasis of Edward’s plan. The participants in Hillary’s plan are insurance and drug companies, individuals, providers, employers, and the federal government. Insurance companies will be required to end discrimination based on pre-existing conditions, drug companies will offer medications at fair prices, individuals will be required to purchase health insurance, providers will work with patients and businesses to deliver high quality, affordable care (no more $20.00 aspirins), and employers will help finance the system. Large employers will provide health insurance or contribute to the cost of coverage. Small businesses will receive a tax credit to continue or begin to offer coverage. The federal government will ensure that health insurance is affordable and never a burden on any family. I agree that shared responsibility should be a cornerstone but I’m not sure that employers should continue to be the first line of defense. Think of the cost savings to companies who don’t have to pay for administrating an insurance plan. What if they paid their employees the amount the employer paid into the plan and allow the employee to purchase their own insurance. Employers don’t assist with house or car insurance so why do they need to offer health insurance. I think it’s been a bad practice that we need to end.

The last two parts of the plan are to ensure affordable health coverage for all and institute a fiscally responsible plan that honors our priorities. Affordable health coverage will be realized by providing tax relief to ensure affordability, limit premium payments to a percentage of income, create a new small business tax credit, strengthen Medicaid and CHIP, and launch a new tax credit for qualifying private and public retiree health plans to offset a significant portion of catastrophic expenditures. A fiscally responsible plan that honors our priorities comes from modernizing the heath systems and reducing wasteful health spending, a new tax credit to make premiums affordable, and making the employer tax exclusion for health care fairer.

The plan has a lot of positive points but again the plan calls for too much bureaucracy. There isn’t any reason the government can’t be a watch dog ensuring that everyone plays fair and providing tax credits where necessary.

Caught in the Health Insurance Web

Today I was preparing to post an overview of Hillary Clinton’s health care plan when I came across this letter.

http://ihcrp.georgetown.edu/ahpfiles/victimjanicestatementfinal.pdf.

It’s about a woman’s experience with a health insurance company that turned out to be doing business illegally in Florida. That’s not the reason I’m suggesting you read the letter. The story is about what happens when you have or get a serious medical condition. There are multiple preexisting health conditions that can cause an insurance company to refuse you insurance or not cover any expenses related to your preexisting condition. I know that most people don’t have preexisting conditions so you may think this doesn’t apply to you. That’s wonderful but it’s not realistic. There's a good chance that cancer or diabetes will affect you or someone in your immediate family. That's what this story is about.

Let’s be Scrooge for a moment. You can remove yourself from the concern related to immediate family members. You can divorce a sick spouse or wait long enough and a child who gets sick will grow up. If you’re the one who gets sick, well, too bad. Scrooge may sound heartless but how is our treatment of people with preexisting conditions any different. There is a solution and that is to have group insurance available for everyone and the groups are large enough to spread the impact.

If a group has 10 insured costumers with no medical concerns and one with a preexisting condition, the costs are affordable for everyone. Of course those without any concerns will pay a little more but what kind of world do we want to live in. After reading the letter I hope you can appreciate the hopelessness so many feel. For some it’s a preexisting condition and for others it’s just good old poverty. Not all of us work for an employer who can afford our health insurance. Those days are becoming more unlikely every day. Tomorrow we’ll get to Hillary.

Business and the Left?

It's not just politicians promoting universal health care. Business leaders are taking up the cause as well. Take a look at this article. It’s worth the read.

http://www.nytimes.com/2007/04/01/magazine/01Healthcare.t.html?pagewanted=1&ei=5090&en=636bdc6bb678c4f2&ex=1333080000&partner=rssuserland&emc=rss

The Edward's Plan

John Edwards titles his universal health care plan Universal Health Care Through Shared Responsibility. The responsibility for providing health care will be shared by business, the government, and the individual. John calls our health care system a broken health care system. He points to four major problems with the system: 45 million uninsured Americans, spiraling health care costs, a fragmented system of insurance, and inconsistent quality. John’s plan points out the following.

The 45 million uninsured doesn’t take into account the tens of millions who are at risk every day of losing their health insurance. It’s estimated that one in three Americans is without insurance at some point over a two year period. Many Americans will find their insurance canceled when they have a major illness. Half of the bankruptcies in this country are the result of medical expenses and two thirds of those people had health insurance.

For the past 50 years, health care costs have grown faster than wages and over the past six years health insurance premiums have grown by nearly 90 percent. In the past year, one in four Americans has a family member who has had difficulty paying medical expenses and more than 25 percent of the low and middle income families with credit card debt have charged medical expenses.

The job based system of health insurance works for most of the insured in America but of the 45 million without insurance many are small business entrepreneurs, part time workers, and independent contractors. Many of those insured are in danger of losing insurance if they change jobs. Those buying private health insurance are denied insurance or pay much higher premiums based on age, medical history, specific drugs they are taking, or their job.

We spend twice the amount for health care as the average for other industrialized nations yet we rank near the bottom of the list in areas such as healthy life expectancy and infant mortality rates. In 2005 we had fewer physicians and nurses per capita than the average industrialized nation and despite the fact we have excellent doctors and nurses, patients receive optimal care little more than half of the time. The system is broken.

John’s solution is to maintain the employer based system we have today, institute new Health Care Markets, and expand Medicaid and State Children’s Health Insurance Program (SCHIP). To quote John’s plan concerning the Health Care Markets, “The U.S. government will help states and groups of states create regional Health Care Markets, non-profit purchasing pools that offer a choice of competing insurance plans.”

The responsibility of businesses will be to offer their employees a comprehensive health plan or contribute to the cost for the employee to purchase insurance through a Health Care Market. The responsibility of government will be to offer new health insurance tax credits to those who have to purchase insurance through a Health Care Market, expand Medicaid and SCHIP, require fair terms for health insurance from insurance companies, and secure the present system of public hospitals and community health centers. The individual’s responsibility is to purchase insurance for themselves and their families.

There are a number of other initiatives such as help doctors deliver the best care, invest in preventive care, and improve productivity with information technology. This is a well thought out plan but there are a number of points in the plan that concerns me. At the top of the list is expanding Medicaid and SCHIP. Whatever the problems it’s a least refreshing to see there’s a serious effort to bring our health care system up to the level of the rest of the industrialized world. Franklin Roosevelt wanted to institute a program during the time he was trying to get Social Security passed by congress. He decided it might interfere with his desire for Social Security. Over 60 years later we’re still trying.

I want to point out that I started with Edwards because he was the first candidate to offer a solution. It doesn’t mean I support or endorse John Edwards or any other candidate. The last Democrat I would have voted for was Robert Kennedy. This blog is not a political blog but the issue of universal health care has become a political issue. When we recognized the need for a national highway system it didn’t become a political issue. In that case, we copied the Germans. Maybe we need to do it again.

Universal Health Care - How We Got There and Where We Are

In the September 21, 2007 issue of the New York Times there was an interesting article by op-ed columnist Paul Krugman titled Health Care Hopes. The New York Times and Paul Krugman may be unbiased in their regard to political parties (wouldn’t that be novel) but whether they are or not the article rings true and gives us an idea of how universal health care became such an important issue in this campaign and where each party stands on the issue.

The following (long) excerpt from Paul’s article describes how we got to this point. Click here to read the entire article.

“To see how much things have changed, consider Hillary Clinton’s evolution. Just 15 months ago, The New York Times reported that “her plans to expand coverage are tempered and incremental,” and that “she continues to shy from the ultimate challenge: describing what a comprehensive Democratic health care plan would look like.” Indeed, when she was asked how costs might be controlled, she demurred: “It depends on what kind of system you’re devising. And that’s still not at all clear to me, what the body politic will bear.

But that was then.

John Edwards broke the issue of health care reform open in February, when he proposed a smart and serious plan for universal health insurance — and bravely announced his willingness to pay for the plan by letting some of the Bush tax cuts expire. Suddenly, universal health care went from being a distant progressive dream to something you could actually envision happening in the next administration.”

I’ve said all along that it would take someone who had the strength of character to get universal health care moving in this country and John Edwards appears to have what it takes. I’m not suggesting that he’s my choice for president but he certainly has the attributes I believe our next president must have.

We’ve all heard of the polls that politicians take before they take a stand on any issue. Whether we agree with Bush or not I doubt he spends much time agonizing over the polls. Reagan wasn’t all that interested in polls. I’m not so sure with Hillary. Fifteen years ago she was willing to step up and offer a universal plan but she got burned. Now she’s running for office. I’m concerned when a politician believes in an issue but is afraid to step up when they have the opportunity.

A man I respect very much said that he agreed with a lot of what Hillary is talking about but he’s afraid she’s become too much a part of the system, too unwilling to take a chance. I’m not sure who she is but at least she got on the wagon when John Edwards didn’t get his head handed to him on a plate.

What does Paul Krugman have to say about the Republican’s plans for health care? Read the following.

“There won’t be a serious Republican alternative. The health care plans of the leading Republican candidates, such as they are, are the same old, same old: they principally rely on tax breaks that go mainly to the well-off, but will supposedly conjure up the magic of the market. As Ezra Klein of The American Prospect cruelly but accurately puts it: “The Republican vision is for a world in which the sick and dying get to deduct some of the cost of health insurance that they don’t have — and can’t get — on their taxes.”

But the G.O.P. nominee, whoever he is, won’t be trying to persuade the public of the merits of his own plan. Instead, he’ll try to scare the dwindling fraction of Americans who still have good health insurance by claiming that the Democrats will take it away.

The smear-and-fear campaign has already started. The Democratic plans all bear a strong resemblance to the health care plan that Mitt Romney signed into law as governor of Massachusetts, differing mainly in offering Americans additional choices. But that didn’t stop Mr. Romney from denouncing the Clinton plan as “European-style socialized medicine.” And Fred Thompson claims that the Clinton plan denies choice — which it actually offers in abundance — and relies on “punishment” instead.”

I hate the use of fear but in these days of sound bytes it’s become popular or is it easy. I'd rather a politician who isn't afraid to describe their position at length. There are plenty of forums to use today so there's no excuse not to. By the way, Mitt Romney signed the universal health care plan in Massachusetts but he wasn't the archietect. We'll talk about that soon. Next we’ll be talking about John Edward's plan. I’ll close with the last few sentences from Paul Krugman’s article. As you read it, think about what it takes to do what’s right not easy and note the polite use of the word determination.

“It’s good to know that whoever gets the Democratic nomination will run on a very good health care plan. What remains is the question of whether he or she will have the determination to turn that plan into reality.”

Health Insurance and Diabetes - They Don't Mix

Today I read a post on a blog site I read every day. The title of the post is So this is highly disturbing…. The blogger, Wil, is the coordinator for a community health center in Northern New Mexico. The post is about a patient of Wil’s that’s passed over for a job because he’s a diabetic. They were concerned with the impact his disease might have on the cost of their health insurance.

The company is a small nonprofit so I understand their concern. HIPAA requires group health plans to cover all eligible employees, regardless of health status. I support HIPAA but I understand the consequences. HIPAA solved many problems but it didn’t go far enough. We make patches but we’ve yet to look at the entire problem and fix it. Massachusetts decided to solve the problem and came up with a solution. Other states have done the same. I see the leaders in those states as people willing to do what’s right not what’s easy or popular.

Read Wil’s post and you’ll read about one of the ugly realities of the health insurance industry. This and every other inequity must be resolved.

Concerns About a Universal Health Insurance Plan

I’ve spent a lot of time talking with people about my desire to see a national universal health insurance plan adopted in the US. Almost everyone has voiced the same concerns.

• We don’t need another government program that’s inefficient and expensive.

• We don’t want a program that causes “good” doctors to leave the system and only offer their services to those who can afford to pay.

• We don’t want a program that creates long wait times for treatment.

• We don’t want to affect a system that provides millions of people with the most advanced health care in the world.

I couldn’t agree more that these are legitimate concerns but it shows a lack of understanding of the universal health insurance plans being proposed by the presidential candidates and the plans now in effect in states such as Massachusetts.

Yes, we don’t want another government program like Medicare and we don’t want a national health care system like the one in Canada. Canada’s public health care system does have some positives but I think we can all agree that it would be a disaster in the US. We need to keep our system but we need to make more affordable and equitable.

In the US doctors are, for the most part, paid handsomely for their services. Of course, they may be better off to pursue a career in professional sports, music, or entertainment but most doctors didn’t choose their career based on the paycheck. I’ve never met a doctor that didn’t feel it was a calling but the reality is that doctors do expect to earn a higher than average income. Changing the source of compensation and the amount that doctors are compensated for their services should never be tolerated.

We’ve all heard that the average Canadian has to wait weeks for treatment. The long wait times are due to a shortage of doctors in Canada. According to an article in the Canadian Readers Digest the shortage of doctors “is partly rooted in a 1991 report commissioned by the provincial deputy ministers of health. In that document, Morris Barer and Greg Stoddart, two health economists, predicted that Canada was facing a physician surplus. In response, provincial governments, scrambling to save money, cut first-year enrollment to Canadian medical schools by about ten percent. Dr. Andrew Cave, an associate professor in the Department of Family Medicine at the University of Alberta in Edmonton, says, “Despite the predictions of the gurus ten years ago, in fact, we need more doctors.” Long waits for treatment isn't an automatic result of universal health insurance.

We do have an advanced health care system. Much of that is the result of expensive research and development. Those responsible for this technology know they will be compensated for their efforts and they work hard to provide us with more advanced technology every day. We have the best medical technology and we also have the most expensive healthcare. No one wants to be without the technology but the expense is creating a crisis.

None of the top presidential contenders is suggesting a national plan funded by taxes and administered by the federal government. None of the state programs are funded by taxes and administered by the state. I will write a number of posts about what the presidential candidates are proposing and what one state, Massachusetts, has done. Keep in mind that a national universal health insurance plan would not change the system we have now. It would change how many people contribute to the pool of cash that funds our system. If that’s a negative, I would like to hear why.

Top End Handcycles

Today Cheryl and I went to look at handcycles. We went to Pinellas Park, Florida the home of Invacare Top End handcycles. I tested two cycles and looked at a third. The first one we looked at was the Top End Excelerator. This cycle is designed very much like an adult tricycle. The cycle has a normal sitting position which is very comfortable. What a feeling of freedom. I haven't been on a cycle since I was about four years old. This cycle has a top speed of 15 miles per hour. After about 10 minutes of practice, it's like you've always been riding a handcycle. Considering the riding position and the height; this is probably the most appropriate cycle for me.

The next cycle I tried out was this yellow low slung model; the Top End Excelerator XLT. The XLT is much lower and your legs are straight out. Steering was a little different because your feet are in stirrups attached to the hub on the front wheel. This bike is faster and it felt great. When I'm ready to race I would consider this cycle.

The last cycle we looked at was the orange model you see to the left. It's called the Top End Force. This is for serious racing. Would I like to own this one? Don't be silly. Of course I would. Both the XLT and the Top End Force are very sexy but the Excelerator is more practical for the Ride to Tallahassee and isn't that more important????????

Book Title

My plan for the book title is Whatever it Takes. This title has a special meaning to me as it comes from the inscription on the key fob one of my daughters gave many years ago. Whatever it Takes would be a great title for an inspirational autobiography but unfortunately there are so many books with that title I’m not sure we need another.

Some samples:

Whatever it Takes: How Professional Learning Communities Respond When Kids Don't Learn

Whatever It Takes: Illegal Immigration, Border Security and the War on Terror

Whatever It Takes – “A compelling novel depicting what happens when Butch and Zig Steel, carrying a 25 year grudge, finally gets their chance to unleash hell upon an unsuspecting prey.”

Whatever It Takes – “A book for anyone who knows where he or she wants to go and are willing to do whatever it takes to get there. This coffee table book contains motivational quotes and stories to inspire and celebrate your commitment to excellence.”

I’m not sure I want to abandon the title Whatever it Takes but I do have another idea. In high school there was a young man that had a special way of getting my attention. He would yell, “Hey half-a-man!” My usual retort was, “What part of me you consider a man is twice the man you are.” It got to be a joke and he finally lost interest. I have a very thick skin so, if anything, the comment was a little inelegant but it wasn’t intended to be malicious. Cheryl and I spoke about it and we came up with a sub title of “What makes a man a Man.”

So, what do you think? Keep the original name or strongly consider Hey Half-a-Man!

An Accomplished Hand-Cyclist

Got to be losing my mind. I thought for sure I mentioned Kelly McCall in one of my posts. Can’t find any mention of her. Kelly pedaled a hand-cycle in the American Lung Association’s Big Ride Across America 2007. You can find her at http://members.cox.net/mclieb/index.mht . My Ride is going to be all of 400 miles. Kelly went a measly 2,500 miles. That's two THOUSAND five hundred miles. I'm beginning to feel a little under whelmed with my goal. Actually, I'm not raising money. It's the message not the distance in my case. Kelly raised over $7,500 dollars for the American Lung Association!

Kelly couldn’t spend a lot of time with the other riders because they were on foot pedaled bikes and the hand pedaled bikes are at a disadvantage. Because she couldn’t keep up, Kelly had to provide her own support vehicle. The Lung Association was reluctant to allow her to participate until she said she would get her own support vehicle. I can understand the reluctance. The Lung Association would be concerned with Kelly’s safety and the Association's budget is small for these fund raising events. Every dollar they spend on the event doesn’t go into research.

Kelly said that the drivers of the cars and trucks sharing the road with her were, for the most part, very polite but there were a few times that she had to “bail” off the road to avoid getting hit. One of the most difficult parts had to be the three flat tires she had on the trip. There was a lot of debris in the bike lanes and road shoulder. I’m impressed with her accomplishment. I don’t have six weeks to travel but, if I find people are paying attention and the Ride is making a difference, I’ll just have to keep going. I’ll head for Washington, DC. We’ll see what happens.

Check out Kelly’s site. She’s quite a lady.

Links

There’s something new on this site. To the right you’ll find two link lists to sites with information regarding health care and diabetes. The health care sites posted give you an overview of the different plans suggested and some reasons why we need universal health care.

The diabetes sites are the sites I read and comment on almost daily. Being a diabetic is a full time job and learning how other people are handling their disease and what new products or treatments are available is extremely important. I’m posting these links here because the act of posting the links shows support for those sites. I hope they support universal health care and someday post a link to this site.

I’m keeping this one short so that you might take a few minutes to visit some of the sites I posted. Got a lot to tell you about so see you tomorrow.

An Answer

Rose, who has been commenting here, wrote a comment to my last post as I was writing today’s post. The comment was a question. Today’s post is the answer. Good timing.

Brian Miller from Lee County government called and said I have to observe the rules that apply to the other vehicles on the road; specifically bicycles. There might be some bridges that I won’t be able to cross because they don’t have a lane for bicycles. In this case, the cycle goes in the car and we drive it over.

There are two more tasks that I need to add to the task list. One is writing a position paper describing why I believe we need universal health care (UHC) and what UHC should look like — how it’s administered and funded, etc. The other task is lining up a list of civic organizations to make a presentation to about UHC.

The presentations will give me an opportunity to feel comfortable with speaking about UHC and I’ll discover if I’m addressing the concerns the public has with UHC. The more Cheryl and I discuss this project the more excited we get. I want to have a team that’s as excited as we are. After this project’s over and we’ve succeeded, I’ve got more — gotta wear out that cycle.

On Track

My friend who works for the Lee County Sheriff’s department said I should call the sheriff’s department to ask about obtaining a permit for the Ride. I’m calling it a Ride for now because I’m not very creative — it’s the best I can do. I called the sheriff’s department this morning and spoke with the desk sergeant. He wasn’t aware of any permit requirements and suggested I call the Florida Highway Patrol. I spoke with a woman at the Florida Highway Patrol who said I wouldn’t need a permit but I couldn’t have an automobile follow closely behind me at a rate of speed slower than the prevailing traffic. It would be considered a hazard.

She also said there might be an ordinance in Lee County that would prevent the use of hand-cycles on bike paths. I thought that was interesting; can’t ride a bike on a bike path. I understand the concern. The hand-cycle is very low and they’re wider than a standard bike. She suggested I call Lee County government and ask about an ordinance then she gave me the number. The woman I spoke with at Lee County government said there’s no such ordinance but I should speak with a particular gentleman in the office to determine if he was aware of any problems I might encounter while cycling through Lee County. I called the gentleman and left him a message. The search continues.

I Need a Team

The walk/pedal to speak out in favor of universal health care will require a lot of preparation. I’ve left a message with a friend who works for the Lee County Sheriff’s department to ask about gaining permission. There may be some obstacles. The activity of walking or hand-cycling to raise awareness on our roads could be considered unsafe. Walking or cycling on most streets is legal but I'll need a car to follow closely behind me to ensure some level of safety. How would that be addressed by the local sheriff’s department? I think I’ll have the answer to that soon.

The other tasks I need to complete before setting out are being sure I’m Mister Know-It-All on universal health care, getting in the proper physical shape, and getting a lot of practice using a hand-cycle. I’ve been spending a lot of time learning all I can about universal health care; that’s ongoing. I haven’t started the getting in shape part yet but I'm on a diet. I’ve lost a few pounds so far. I need to start the process of getting in shape. I think I can kill two birds with one stone here. I can use the hand-cycle to get in shape and I’ll be well practiced by the time I’m ready to go.

While I’ve been waiting for the call from my friend, I’ve been thinking about what to call this walk/pedal. It’s not a protest or a walkathon. It’s not a march or a demonstration. So what is it? My goal is to raise awareness of the need and viability of universal health care. So what I need is a name for what I’m doing and I can’t call it a walk-a-pedal. If you’ve got an idea, write a comment here. Also, I need a team to help me plan and get this underway. I know I haven't come close to listing all the tasks that need to be accomplished before I hit the road. If you would like to be part of the team, let me know. There’s a lot to do so let's go.

Obedience

I’ve spent my life speaking to God but very little time listening. I’ve always felt confident that I was making the correct life choices. I remember so vividly asking God to perform a miracle and cure my legs. When I became diabetic I thought it was a display of God’s humor. I looked up and said, “Okay is this your way of changing my focus or have you just gotten tired of the same request.” God and I never had a conversation. I did all the talking and until recently no listening.

For the third time in 10 years, I’ve found myself out of work. Actually I’ve been out of work a lot in my career but that’s typical when you work for small high tech companies. Many fail or get bought out and move. This time is going to be different. Eight years ago I started writing the book I’m writing now and I never got very far. This time I started and decided to stay with it. That was eight months ago. Six months after I started the book I got the phone call that my services weren’t needed.

My first reaction was to start looking for another job. In fact, I had already started the process months earlier because the company I worked for had been bought out by a French company and I had a suspicion that the company would close the US operations. Once I got serious about looking for work some opportunities came available. One was very promising but the position is in Massachusetts and we’re not ready to leave Florida.

One day Cheryl said to me, “What are you doing; how many times do you have to be hit on the head?” Of course, that got my attention. I decided I better ask some questions. It’s bad enough I have selective loss of hearing but to completely ignore my wife; not a chance. What Cheryl was suggesting was that God might have been trying to get my attention AGAIN and maybe I ought to pay attention. I stopped talking and struggling and listened for a change. What I was hearing was that I needed to stop and start looking for a literary agent.

Now I’m not saying I stopped looking for work. The agency responsible for unemployment compensation might be listening. What I am saying is that I’m staying on course. I will get the book published and I will listen rather than do all the talking. For the first time, in many many years I feel like I’m being obedient. Now I know why my head hurts.

Ouch!

Deception

I love marketing. My first experience with marketing was accidental. It all started in the year 1960 or 61. Our Boy Scout troop was going to summer camp and I wanted to go just like all the other scouts. The problem was that the cost for the two weeks at camp was substantial and would have meant some serious sacrifices for my parents to afford to send me. My parents had already sacrificed a lot and I wasn’t so sure I wanted to bring this home to them. Then the scoutmaster had another announcement that was the answer to my problem. One of us scouts was going to go to camp at no cost.

Every spring there was a Boy Scout Jamboree held at the local coliseum. It was an exciting time with all the troops in the area participating in a demonstration of our many skills. This year we were going to stage a real honest to goodness attack on a wagon train by a group of wild Indians. We were going to use all our skills to build the wagons and horses. The wagons would be miniatures of the real thing and the horses would be plywood cutouts that the riders held onto. The planning and preparation would take months.

The problem was that the jamborees were not well attended. A lot of parents and some relatives but that was about it. The scoutmasters wanted to see a larger audience so that the whole affair would be more spectacular. They had visions of filling the coliseum. For us scouts, it would be a moment to remember. To get more people at the jamboree, a contest was going to be run. Every year the scouts sold tickets to the jamboree. This year the scout who sold the most tickets would go to camp free. I was pumped. This was my opportunity to unload the burden from my parents. I immediately hit the streets knocking on doors. I discovered that everyone would buy at least one ticket from me. What a salesman.

My cousin Fred followed me on one of my sales trips and he said after five or six sales, “Hey you could sell anything.” I said, “Yes I can.” Then he told me why. He said, “Those people don’t have a chance with you being on crutches.” I came to the conclusion that Fred was right so we just kept knocking on doors. When I finally turned in my sales I sold more than three times as many tickets as my nearest competitor. I won. Now I think that was a little deceptive. I wasn’t lying to anyone. The jamboree was a spectacular event that year. The problem was that many of the people who bought a ticket didn’t get any value for their outlay. They weren’t going to the jamboree and I knew it but that didn’t stop me from selling them the ticket.

There's an example of deceptive advertising that really gets me angry. I’ve seen it in print and on television and now I've found it on the Internet. Actually this example isn’t quite as bad as the others because it tells the whole story. The American Diabetes Services has a web site where they provide low cost and free diabetic supplies. There’s an article on the site titled New Advances in Pain-Free Testing for Diabetics. An excerpt from the article says the following.

“For many people living with diabetes, frequent testing of blood glucose levels can be the most valuable tool for maintaining control of symptoms and avoiding long term complications. New advances in pain free testing, including painless glucose monitors from many manufacturers, make pricked fingers and drawing blood a thing of the past.”

Now isn’t that exciting. That’s what I’ve heard on television and I’ve seen in print advertising. I was excited the first time I heard the message on television. Twenty five years of drawing blood four plus times a day was over. If you read on, the article says.

“Alternative site monitors allow the patient to replace finger sticks with blood draws in less sensitive areas of the body such as the forearm and thigh.”

Watch for the television commercials. This last part either isn’t mentioned or it’s so subtle you wouldn’t notice. Less sensitive areas! What a ruse. I’m marketing myself to agents with an honest query letter. Now I wonder if I should make some changes. Let me see. The most successful salesman the world has ever seen writes about his easy to use methods. It's got a chance.

Getting it Write

My sister Donna read the first three chapters of my first book and she enjoyed them but I enjoyed most her comment “you made it sound too easy.” Her comment to my last post was “It's a good story, if you admit you had some problems.” I went back and read the chapters and she’s right. I haven’t said too much about what I was feeling emotionally and physically. Much of what I experienced I don’t care to relive but Donna’s right. My defense was humor and the chapters reflect that.

If the idea is to inspire, than the reader has to experience what I experienced; the struggle and the success. The hardest part of writing is painting a picture with words that draw the reader in. I was a technical writer for a number of years and I’m very successful with that style of writing. Being a lot more touchy feely is an exercise. I find myself rewriting and rewriting. I’ll get there. I’ll have to share some of my rewrites here to get your comments but I’m not quite ready yet.

This reminds me of Good Morning America when they have a story about someone who wrote a book and they have a portion of the book online for us all to read. If you haven’t figured it out yet, all those fun shows in the morning and late night talk shows are a marketing tool. I hope I never get accused of that. My motives are always of the highest order. They are!

A Response or Two

Yesterday I said at the end of my post that I hadn't got any responses yet to my first five query letters. Right after I completed the post the mailman came and there was one of my self addressed stamped envelopes (SASE) in the mail.

I felt like Charlie in Willie Wonka opening the candy bar. You know don’t you, Charlie had to open more than one bar before he got the golden ticket.

I opened the envelope and inside it looked like the agent had sent my letter back????? I took the letter out and flipped up the top of the letter and sure enough it was my letterhead. I didn't see anything other than my letter. Then I opened the rest of the letter and there it was, a circle around a word, and a line coming off the circle to some words.

My heart was in my throat. I was sure that it was a note saying I had misspelled a word. I've been told that's a death sentence for a query letter and I sent out five of that letter. Well, it wasn't a misspelling. The agent circled the word autobiography. She wrote that she wasn't doing any autobiographies at this time.

Today I got another one. This time it was a form letter saying how I must know that publishing is a difficult business and the agent didn't "feel strongly enough about the work." I was happy to see that I'm one more response closer to getting that golden ticket.

Healthcare Elsewhere (and here)

I’ve been busy reading the information on the Internet about healthcare systems and I’ve come to a conclusion. None of the healthcare systems are perfect. What’s great for us is that we have, for the most part, a private, voluntary system in which insurance is provided primarily through employers. That type of system is a great framework from which to build a universal system. Fortunately we weren’t the first to have a universal system. We lag way behind countries such as Canada, Great Britain, Germany, France, The Netherlands, and Japan. The fact that we lag way behind is a plus. We can learn from the mistakes of those who went before us. We even have many states that have instituted a universal system. What a gold mine.

I found a document titled International Healthcare Systems Primer prepared by Jessica A. Hohman at Miami University (Ohio) for the American Medical Student Association. The document put a lot of the information I had been reading in one place. You can read the document at http://www.amsa.org/uhc/IHSprimer.pdf . You can read more about universal healthcare at http://www.amsa.org/uhc/.

Reading the document I discovered that the major problem with universal healthcare plans in countries I mentioned is that the average person who needs to see a doctor finds themselves on a waiting list. The average Canadian has to wait weeks to see a doctor even for serious problems. I needed bypass surgery in 2000. I went to the hospital in the early evening with a heart attack. They stabilized me and did the surgery the next day. I’ve spoke with Canadians who had to wait several days before they had surgery. They were stabilized and waited in line.

I was surprised to find that Germany and France had the best systems. They still have problems. One which they all share is the rising costs because of our aging populations. That baby boomer bubble affects us all. Now there's a problem that will resolve itself. Some good news.

When we hear about these problems we recoil in fear at the suggestion of universal health insurance. Okay, lets all agree that any system designed by man will have problems. The space program has had serious failures but we got to the moon. What I’m saying is that we weren't a nation of people who stuck our heads in the sand with every problem. We solved the problem and moved on. We have a great healthcare system. It’s just that many people can’t afford it or they have to select an insurance plan that leaves them underinsured. It’s kind of like leasing a car that you can only drive 5,000 miles a year. Drive it more and you’re going to pay big time.

There is another reason that many people recoil and it has nothing to do with the inefficiencies of other systems. It’s the belief that we should remain a country in which government involvement in our lives is held at a minimum. Many people vehemently believe that and I agree but I have reservations about services such as healthcare. I wish I was articulate enough to describe what I believe but I’m not. I’ve been thinking about this issue being a moral issue and that we shouldn’t treat health insurance like merchandise and then I find it’s a point already made. The following excerpt from an article titled The Case for Universal Health Care on the American Medical Student Association web site says it all.

“At its root, the lack of health care for all in America is fundamentally a moral issue. The United States is the only industrialized nation that does not have some form of universal health care (defined as a basic guarantee of health care to all of its citizens). While other countries have declared health care to be a basic right, the United States treats health care as a privilege, only available to those who can afford it. In this sense, health care in America is treated as an economic good like a TV or VCR, not as a social or public good.”

Getting back to the document, International Healthcare Systems Primer, the following are some excerpts from the section about the healthcare system in the US.

“The US is plagued by high administrative costs, and studies have estimated as much as 31% of all healthcare costs in the US go to administration (Woolhandler, et al. 2004). Health insurance premiums continued to grow at unsustainable rates; from 2003 to 2004, premiums increased 11.2%, a much faster rate than inflation (2.3%) and wage increases (2.2%).”

“The increasing number of uninsured individuals and skyrocketing health insurance premiums continue to be the most visible problems within the US healthcare system.”

“The central challenge facing the US healthcare system is extending this excellent healthcare to all of its citizens, not just those who can afford it.”

“The US is a leader in groundbreaking biomedical technology and innovative life-extending procedures, and those Americans who are well-insured enjoy arguably some of the best healthcare in the world. Despite this, the US entered the new millennium with a healthcare system characterized by skyrocketing costs, administrative inefficiency, and significant health disparities by race and income. Perhaps most visibly from an international standpoint, the US remains the only industrialized country in the world without guaranteed healthcare for its citizens.”

Addressing this is so much easier than getting to the moon, you know, Whatever it Takes.

Now I think it’s time to put this to bed until I'm ready to hit the road. I need to do more than just write. I need to start planning for that walk/pedal. I’ll talk about the plans here and I’ll get back to some posts about the book; maybe even some excerpts of my own.

An Update

I've been doing a lot of research on healthcare systems and found some great sites. One in particular had a plethora of unbiased information. I'm finishing that post but the picture you see here really caught my attention. This is a hand pedaled cycle. Okay, it’s a high-tech, racing, hand pedaled cycle. Isn’t it beautiful? This one is a little expensive and not what I'll purchase. It cost $3,600. These cycles aren’t mass produced so the cost is high.

Anyhow, as I mentioned in my last post, the plan is to pedal and walk when I venture out speaking about the need for universal health insurance in the USA. It makes sense to pedal because if I walk every day I'll only get about four to six miles per day. It will take me a week just to get out of Fort Myers. These bikes can travel up to 30 miles per hour. That’s only for a very short distance because it’s all arm strength. The average speed will probably be 12 to 15 miles per hour. At that speed, I can cover some distance.

My youngest daughter and son-in-law said they will pay for a portion of the bike as a corporate sponsor. They own a web based business, miamibeach411.com. Check out the site. The more reasonably priced bikes cost around $2,000. Obviously, I’m going to put some miles on the cycle so I want to make sure I get a good one. The next challenge, after getting the bike, is getting in shape.

I believe an update on the book is called for now. I’m selecting the next five agents to send the query letter to tomorrow. It’s been a week since I sent out the first group of five and no word. I didn’t expect any responses by now but wouldn’t it be exciting to get a phone call in the next few days. I won’t even mind getting a form letter thanking me for my letter but no thanks. There’s a possibility I might get some advice from one of the responders. That would be appreciated.

This week I spoke with a man in town who is a published author. He gave me some suggestions on how to get the book published. He told me about a site called PublishAmerica http://www.publishamerica.com/ . That’s not the path I’ll take at this time but it’s an option. Well time to get back to the other post. See you soon.