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Healthcare Reform: This simple Southern woman's perspective
by Sharman Burson Ramsey

Marian is a beautician who has worked hard all of her life standing on her feet. Her husband got sick and his care was extremely expensive. When he died he left hospital bills beyond her ability to pay. The hospital, started and partially funded with tax dollars, passed the bill on to the collections agency. Marian worked out a deal to pay the bills over time.

Then Marian got sick with breast cancer. Her bills mounted. Still she works and tries to pay her bills and those of her husband.

Because Marian and her husband could not afford insurance, they did not have the benefit of the "agreements" between a large third party insurer and the provider to accept a reduced fee because of the quantity of clients. Insurance providers like Blue Cross can negotiate better terms with the providers simply due to their size. So, because Marian is an individual and not part of a "group," even though her taxes have helped support that hospital for years, Marian was charged the full amount of the service.

Weren’t they irresponsible people for not having insurance? Marian’s husband was a mechanic at a reputable automobile dealership that offered insurance. However, he made $300 a week and the cost of healthcare was $70 a week. With the cost of their children's  needs, car payments, mortgage and food, that was more than they could afford. When they sought insurance outside of the business, they could not buy it because insurance was offered at the automobile dealership where Marian’s husband worked.

Marian now has a gentleman friend at church. This widower is a professional man who has always invested in a 401-K and was diversified in his other investments. He recently discovered a heart condition which now constitutes a "pre-existing" condition. Although he had planned and saved for retirement the recent free fall in the economy makes that impossible since should he leave his current occupation he would also lose his insurance and now with a pre-existing condition it would be difficult to find an insurance company that would cover him.

My father practiced medicine for over fifty years in Alabama. During that time he made his own X-rays, delivered babies in the mothers’ homes, drew blood and analyzed it with his own microscope, and treated chronic illnesses. His work was frequently not paid for and sometimes paid for in produce. No one was turned away and there was never a sign in the office to arrange for payment before seeing the doctor. 

Medical care changed with Medicare. An office full of staff became necessary to fill out all of the paperwork that came with new government plan. The cost of health care rose and costs rose. Health insurance became more prevalent.

The third party payer system became engrained in the American psyche. Whereas before the cost of medical care turned on what the patient could pay, the cost became what those deep pockets would approve. The patient became a client and medicine became a business. Costs went higher because when third party payers negotiated the provider had to have wiggle room for increased costs with insurance and more clerical office help as well as CYA tests that add up.  Community supported hospitals were expected to make a profit and successful administrators had to show that on the balance sheets or they could not justify their salaries and bonuses. Somehow medicine had become a part of free market enterprise and no longer the profession it once was.

When I listen to those who oppose the President’s Health Care Initiative I notice that many have insurance through government entities whether they are retired military with TriCare or Seniors already on Medicare. They all seem to fear "government intrusion into their health care" never appearing to be realize how hypocritical their criticism is.

I look around me at the number of new homeless on the streets, young and old still well-groomed who apparently are newly down on their luck. So many of these are now in hardship because of government policies like "de-regulation" which freed greedy bankers and Wall Street brokers from the eyes of watchdogs and set up conditions for our current economic debacle. They have lost their jobs as the result of "outsourcing" and "downsizing" which provided justification on a balance sheet for the robber baron salaries and bonuses to those wunderkinds of business who manipulated numbers to prove their business acumen. As long as the average American saw their own bottom line and their investments appreciate, they accepted that attrition as the result of the free market at work and that those who were jobless simply needed retraining.  In what?  Our politicians "gave away" those jobs that kept Americans employed and buying from each other.  They arrogantly decided that those "high-paying" "high tech" jobs would keep America on top and employed.  Unfortunately the high tech bubble kind of looks like the Dutch dependence on tulips at the moment and those economists, gurus of the "smart money" resemble false prophets and our politicians their dupes.  

Legislated government policies like NAFTA, GATT and the WTO pulled down the tariffs that protected American industries and workers giving them jobs with wages that enabled them to buy from their neighbors and gave our country a living standard that has been the envy of the world.  How can those currently blessed with a job and insurance look at those without and call them shiftless, while we buy "cheap" goods from China shifting industries there that once provided jobs those homeless might have appreciated?  How can anyone be so sure their job is safe and their family secure after seeing the economic free fall we are only now digging ourselves out of...through government intervention?  I can only hope our government will pass legislation and set up safeguards to protect us against shysters like Madoff and stock options/bonus/salaries of kingly proportions ($10,000,000? and more) to CEOs of publicly traded industries.  As a stockholder, I would have thought that money would have been reinvested in the corporations for research and development (say of more energy efficient vehicles to make them more competitive with their overseas competitors who have been eating their lunch in the market?)  Yet my heart pounds with the injustice of how they now they get bonuses (something that used to be given for a job well done) while their companies teeter on bankruptcy looking to the government to save them before they fail and take the rest of the economy with them. 

There is no going back to the day when my father practiced medicine. Those with Medicare will never give it up. Large insurance companies will continue to be the 800 pound gorilla that providers will kowtow to. Free market medicine today is an outlandish claim when third party entities have such power to negotiate fees for service. Government policies have legislated many people out of jobs in which they would have had insurance.

We must now deal with the world we have. Hate mongering, hyperbole, misrepresentation and downright lies will not address the issues nor redress the harm already done. So, let us be done with vituperation, demonization and vitriol, recognize that men and women of good will might see the need for public option for healthcare where everyone might benefit from the negotiating power now in the hands of only a few, and let us work together to address all of our concerns and come up with an answer to our dilemma.

Your ideas are welcome:  email me  and I will post the best of your ideas and suggestions.

Here's a couple of mine...I know many of my dear, dear friends will disagree with me.  Fine.  I love you anyway.  But, the older I get the more each young man looks at me with the eyes of my own son.  Each young woman has my daughter's eyes.  Every old woman communicates with my Mother's eyes.  And everyone else's Father reminds me of my own.  And a woman or man of my age reminds me of my dear friends.  There but for the grace of God could walk any one of us.  Shouldn't we find a way to "Do unto others as we would have them do unto" us?

I am sure there are a lot of folks much smarter than I am who could figure out how to make this work.  I am sure these ideas are naive and idealistic.  But, can't we start somewhere?

1.  Expand our health departments by employing Nurse Practitioners to offer Free Primary Care to any citizen who enters the door.  This would free the emergency rooms of the expense for these non-life threatening illnesses. Most cities already own land where they have their ball parks that are used only in the evenings.  That land with that parking availability and convenience would be the perfect location for setting up satellite health departments.  Patients who need specialized care would be referred to the specialty doctors who would be required to accept the lowest negotiated fee from any provider for their fee for service, thereby giving EVERY INDIVIDUAL citizen the benefit of their negotiations.  Stamp a voucher from any form of public transportation for those who go to the health department.

I have heard that Scotland actually sends buses (we've got lots of unused school buses during the day) to different areas of town to pick up citizens for the yearly exams which are scheduled a year in advance.  The ladies dress up for a social occasion with their friends.  Lunch is served on linen table cloths with the table set with style.  Neighbor meets neighbor and perhaps they do not suffer from the alienation many Americans suffer from.

2.  Health departments  could be the portal for electronic filing using volunteer senior citizens to take health histories of patients.  A major cost of healthcare is duplication of services.  With electronic files all information becomes available to every provider and would eliminate expensive duplication.  With files on computer there could be reminders to doctors/nurse practitioners to READ x-rays or LAB reports with a RED FLAG for those that come back with a problem.  If every individual is assured of health care regardless of pre-existing conditions, these electronic files should not be such a bugaboo to those concerned about their misuse and prejudice.  The Mayo Clinic has every doctor enter by computer each patient's health history which is shared by each doctor in the system.  Handwriting errors are thereby eliminated and files are shared to avoid duplication. Health privacy seems ludicrous when hackers access computers every day and transcribers are ordinary citizens doing the best they can to actually read a physicians writing or understand what he mutters into a tape.

3,  The local publicly owned hospital would be the hub of the local web with information available to Emergency Medical Technicians at all times. 

4.  Just like with public schools, participation in this Public Option would be voluntary.  Anyone who chooses could take a "voucher" for medical care and opt out for their private care.  Of course additional policies (like AARP offers) could also be purchased for services beyond what our basic public option might private hospital care.

5.  Some countries, like France, have specialty hospitals.  This actually makes sense with the large number of staph infections that are springing up in hospitals.  A special hospital for infectious disease would quarantine those illnesses from the general public.  It is commonly appreciated that hospitals that do the largest number of a procedure is usually the hospital you want to use because they have the most experience and the best equipment for dealing with those illnesses.  I suggest that one reason for the high cost of health care is the duplication of services and equipment with every hospital trying to be all things to all people and thereby actually lowering the quality of care by shooting for quantity.





Copyright 1996  These are my own working genealogy files that I share with you.  The errors are my own.  But, perhaps they will give you a starting point.  All original writing is copyrighted.  Webmaster

Copyright 1996  These are my own working genealogy files that I share with you.  The errors are my own.  But, perhaps they will give you a starting point.  All original writing is copyrighted.  Webmaster

Copyright 1996  These are my own working genealogy files that I share with you.  The errors are my own.  But, perhaps they will give you a starting point.  All original writing is copyrighted.  Webmaster