Tomorrow's Health Care Reform Ruling

Those who would live by the crystal ball must always remember that they should be happy to be fed a diet of broken glass.

The Supreme Court, tomorrow, will rule on healthcare reform. They will in all likelihood strike down the Individual Mandate. What we don't know is what else they'll hit.

But the broader question still stands. Who are we, as a society? Do we cheer, like the citizens of Panem, over someone dying in the hospital or dead, because they have no coverage? Are we, as the only first world nation - who pays nearly three to six times more per person, and ranking 40th in the world, in terms of healthcare - someone who wants to defeat reform ? A country that is the only first world country who has no such reforms?

Get sick in France. You get paid vacation. Get sick in Germany. You get affordable healthcare. Get sick in England, and the doctor is paid to get you well. The better you are in health, the bigger his bonus.

Get sick in America...if you do get care at all you will have to deal with a Healthcare provider that drags his heels to cover your procedures. You have to deal with outrageous hospital bills that come unannounced. You're likely going to end up being prescribed a medicine you might not need, because the doctor is being courted by a big pharmaceutical company. You'll probably end up being operated on by a team of people, because there's so many specializations - nobody will really know how you are doing. You will end up getting fragmented care and ultimately, worse on average than anywhere else. This is not to say you can't get top end medical procedures done - there are elite doctors and hospitals, and they are the exception that proves the rule. And if you're not a member of the one percent, you're not getting treated. It's just that simple.

The healthcare industry is broken. Many doctors are placed in the business of prescribing medicine and not really practicing it. They have to deal with endlessly difficult healthcare providers who drag their heels on paying bills, and debate with them about cost of procedures. Patients don't do this, because they're never told what anything costs. And the healthcare providers and big pharmaceutical companies, in a government designed for the one percent - come up with endless ways to influence our political system. Case in point: in a recent medicare reform, the federal government was banned from receiving wholesale discount on drugs purchased in bulk quantity. This is like a law that was passed, which ensured - if anyone bought doughnuts, and wanted to get a dozen - it is illegal to get them at a cheaper price by the dozen. They could only buy 12, at the price each would retail.

In an exception, there is a Doctor, practicing out West - has decided to charge his patients a low monthly rate for his care. The billing is direct to the patient, and it works well for him. And the patients are happy. Any issue they have, he will tend. Instead of paying the insurance companies, they just pay the doctor. But these exceptions are rare. Doctors commonly hire people just to deal with billing issues and they are often forced by insurance companies to either disregard tests or preventative care or both. There is a case of an insurance company that attempted to pay for only one hearing aid for a young deaf girl. They reasoned that they would cut their costs by 50% , and she could hear out of one ear. Medical training grates against this kind of thing and it's easy to see why some are attempting alternative billing.

But this is rare. Practice and law such as the "not so cheap by the dozen" permeate our country and the accounting practices are even worse. Many Hospitals have institutionalized provider markup and markdown in their accounting systems, so that each healthcare provider or insurance company is charged a different amount based on their fluctuating markup/markdown to the hospital's procedure cost. But this obscures the possibility of a cost or price based market for any procedure. Free market works, if you can find out the price of something. Otherwise, it's not a free market.

When you're sick - the last thing you need, is to have someone hassle you. This is why bankruptcy and foreclosure catch fire on the dry tinder of economic instability - so many people in the middle class are so finely balanced in their finances, that an unexpected medical bill can severely disrupt them. In the old days, when Mom wasn't working and Dad pulled a 9 to 5, there was always the chance that the family could rebound. Now, with both parents working - there is no safety net. Unexpected medical expenses are responsible for 60% of the bankruptcies in the United States.

Healthcare Reform promised a new level of stability to millions of Americans, and
it paid for itself. 2.5 Million young adults now have insurance as a result of it,
and it would have gone into effect in 2014 , with major ramifications. Its exchanges would have allowed better prices for policies, and more competition. People would no longer wait until something becomes critical - they would see their doctor earlier, and practice preventative medicine. Doctors would be in the business of helping people to become more healthy. As it stands, we have large hospitals dealing with emergency after emergency and very little preventative healthcare. Reform offered a way out. Sure, it would have been expensive for the Corrupt. They would no longer be able to bill people 50,000.00 for two nights stay in a hospital, or sink their teeth into the endless stream of emergency expenditure that happens as a result of people trying to save their lives.

Some, have been at the expense of college education funds. Many go without necessities to simply make ends meet. The middle class has recently and vividly undergone a sharp, sudden decline. If not the major role, then healthcare plays a major role in said decline.

Tomorrow's healthcare reform ruling will be a work of careful jurisprudence.
And likely, we will learn something from it about who we really are.

In the book "The Hunger Games" a dark image of America was painted in its capitol Panem. It is a city of evil people, dedicated to feeding off the work of others. The author chose the name after a latin phrase "Panem et Circenses" .. which translates to "Bread and Circuses" - that referred to a political strategy employed by Ancient Rome, who kept the endless entertainment going as a means of political control. It was a political philosophy that relied upon the idea of a Republic, and the continued control of the 99% by the 1%. In their time, they used the Gladiatorial Arena, as a way of talking to the masses. The capitol was kept in bread, and luxury. The one percent. Over time, they gradually acquired a taste for more excitement, and the gladiatorial arena became more and more violent. Inhuman. We have, of course, found a different way to bring it up to date. We have become post humanist. This continues unabated through our society and has accelerated through 2012. It is not a passing trend. It is a dark portent.

The Hunger Games should have drawn uncomfortable parallels. It ultimately did not. We viewed it , and read the Trilogy - for the fun of it. But we miss its message. Like Ancient Rome, we are likely unable to see when we've gone too far.

Perhaps if I was alive, when the Emperor Caligula - saw that his gladiators were dying off too fast and chose to cull innocent citizens into the arena - I might have been bothered by it. I am sure that most did not. Rome has always been painted, in its decline, with shades of decadence and hedonism. But mostly,apathy. Rome burned, but for it to fall - it took years and years and nobody really noticed until it was too late. Citizens of Ancient Rome took it in stride. A privatized fire department, that only put out the fires of those who had insurance coverage.. wasn't a good idea. If your home caught on fire tomorrow, would you want "free market" fire engines to come to your home, then haggle about your deductible while your home office and kitchen went up in smoke? Certainly you would not want your leader to play the violin as your city burns. This is in part why we do not have privatized Fire Departments, or Libraries, or Roads. Nevertheless, on the subject of healthcare - there are today political leaders who use the destruction of reform, for its entertainment value and their personal gain - and citizens suffer.

Ancient Rome's inhumanity to its fellow man was the seed of its destruction. The actions of the Republicans telegraphed far and wide that Rome was a country in decline. This is a very dangerous message to send. China is country that could care less about how many different ticker crawls can be put on the bottom of a news media entertainment screen. They have hunting instincts, and are carefully watching for signs that we are country in decline. And they're building aircraft carriers.

But the work of those who would reform and revitalize are country will work against them. Stardom, criticism, and scandal - have long been a part of American politics. Mostly for worse, if not some for better. A post watergate era epitath to a once congenial and effecient system. Particularly in the late 90's - when we telegraphed to then-weakened Al Qaeda that we were preoccupied with dog and pony shows. I remember vividly an Al Qaeda training video taking place with the Monica Lewinsky scandal as the backdrop.

Fixing a broken system - takes time. Sometimes, it's really worth it. In the era of throwaway technology there is great value in the slow process of change and repair. Think for a minute, about the internet. There is no such thing as replacing it. You simply improve the segment you find yourself upon. And try to keep it as open and as connected as it can be.

The positive measures represented by the Affordable Healthcare Act were and are a great start to rebuilding, in our country a framework by which healthcare is common, affordable, and above world standard. Today, as a country, we stand dead last in the world. This is according to Reuters in a decidedly a non biased news report. To quote:

Americans spend twice as much as residents of other developed countries on healthcare, but get lower quality, less efficiency and have the least equitable system

It is imperative that any attempt to reform this system must be re-started,
barring whatever setback to occur tomorrow. And I say it may occur, because I am confident that the so called individual mandate - which was a stand-in for a viable single payer system, will be struck down. That is the one thing that needs to be restarted most desperately. It is a funding mechanism.

Tomorrow's ruling will have far reaching consequences.
Justice is indeed blind. Let us hope that Supreme Court Justices, are not.