The vote in favor of passing HR3962, America’s Affordable Health Choices Act of 2009, was 220 in favor to 215 opposed in the House of Representatives last night.

While not a perfect solution to all of the flaws of the American health care “system,” this bill goes further to provide all Americans with health insurance coverage than ever before. And while I am personally in favor of putting all insurance companies out of business and adopting a government-run, single-payor system, I recognized the promise of this bill as one of a series of steps toward the ideal.

In short, this bill isn’t liberal enough to satisfy my ultimate preferences, but it is so much better than the status quo that I just don’t understand how anyone who was elected as a Democrat could vote against it.

And yet, 39 members of the Democratic caucus in the House did just that.

The New York Times has a very helpful chart of those individuals, including the percentage of “nonelderly uninsured” individuals in their districts as well as voting breakdowns from the 2008 election.

Let’s look at some of those figures, along with statements from the Representatives themselves, shall we?

First up, with the highest percentage of “nonelderly uninsured” at 29% is Congressman Dan Boren from Oklahoma’s second district — the eastern quarter of the state. The district has a population of around 690,000 people, according to the 2000 census, which means that approximately 200,000 of those people are the “nonelderly uninsured” documented by the NYT chart.

Dan Boren won his last election by 41%, even though his district voted for McCain by a margin of 32%. And why did he vote against insuring ~200,000 of his constituents?

Two reasons: abortion, and taxes. He’s a so-called “Blue Dog” Democrat, a fiscal conservative, and doesn’t want to spend a trillion dollars on health care by raising any taxes, especially if any of that money goes toward funding abortions.

Except that the anti-abortion amendment, the Stupak amendment, passed by a vote of 240-119. Proposed and championed by a Democrat from Michigan, the amendment forbids any insurance policy purchased through the federally-funded exchange created by the bill to offer any coverage for abortions.

So for Boren, it really came down to money in the end. Money, vs. ~200,000 people without health coverage.

Second is Congressman Harry Teague, from New Mexico’s second District, the southern half of my state, with 25% “nonelderly uninsured.” The district has just over 600,000 people over a vast geographical area, so that percentage works out to about 151,000 individuals without health coverage.

Harry Teague is a freshman Congressman, and won the election by 12 points in a district that went for McCain by ONE percent. And why did he vote against health care reform, insuring ~151,000 New Mexicans?

After waffling about “concern” over the public option, Teague’s official reasoning is that the bill doesn’t go far enough to rein in the insurance companies, or lower costs for businesses. While I am inclined to agree with this statement, I don’t see it as a valid excuse for voting against a bill that does so many good things — particularly abolishing exclusions for pre-existing conditions. And when you represent a district with ~151,000 individuals with no health care at all, I find this vote unconscionable.

For the record, Congressman Dennis Kucinich of Ohio’s tenth district voted no for much the same reason — he is of the opinion that a single-payor system is the only way to go, regardless of the approximately 82,000 individuals in his district who currently have no health care.

There are 36 more Democratic Representatives who voted no, for all kinds of reasons.

And then there is Republican Congressman Joseph Cao from Louisiana, the ONLY Republican to vote for the bill.

I have to say that I personally respect Congressman Cao more than any of the Democrats who voted no because the bill “doesn’t go far enough,” because he actually took his constituents into account rather than pure politics. Louisiana’s second district, encompassing most of New Orleans, needs the health care coverage that this bill provides (PDF), regardless of what the Republican party leadership says, and Cao stood up for them.

I wish more Democrats had that kind of conscience.

I suspect that Congressman Cao will also be easily reelected, particularly if health care reform gets through the Senate and is actually signed into law. Likewise, I suspect the Democrats who voted “no” to face some tough primary challenges, and Republican victories in the general.

As webmaster for the Mountain Desert District, I’ll be blogging events from our District Assembly in Fort Collins, CO, for the next several days. Things started last night with an absolutely stunning concert by keynote speaker Holly Near, performing with with emma’s revolution — my soul is very full already.

Keep up with me at mdduua.org/blog.

I would love if the whole health “care” debate were actually about health care, but instead, it’s about health insurance. The story I’m about to tell/rant is not one of denied treatment for chemotherapy or organ transplant, nothing like that. It’s about the daily experience of seeking treatment for a medical condition, and then dealing with the bureaucracy that ensues.

My family has health insurance. Lucky us. A premium is deducted from my husband’s pay check every month, his employer pays their much higher share, and we carry little blue identification cards that mark us as “insured.”

We go to the doctor and pay a $20 co-pay for a standard visit. Then we get an indecipherable “Explanation of Benefits” statement from the insurance company stating charges, allowances, what they (didn’t) pay, and what our doctor might bill us, and then we usually get a bill from the doctor for an amount that may or may not relate to the “EOB” statement that we received from the insurance company. And then I, as the money person in the household, spend a bunch of time on the insurance company’s website and the phone trying to make sense of it all before, usually, writing a check for some esoteric amount and mailing it off.

Recently, I had to get a blood test. Six months ago, I had the same exact blood test, and I was sent to a lab in the town’s mini-mall for it. That lab didn’t give the results to my doctor in time for my follow-up appointment, so this time, I was told by the very nice nurses to go to the lab in the hospital attached to my doctor’s office, which they said offered the same services but delivered their results more reliably.

“Great,” I thought, “One stop shopping.”

A week or so later, I got the usual statement from the hospital lab detailing what they would bill the insurance company. My insurance company thinks that this particular blood test should be filed under “diagnostic” rather than “routine” (even though it’s really monitoring for a chronic condition that has already been diagnosed, to make sure that I’m taking the right amount of medication), so the cost is applied to my yearly deductible and I pay for it out of pocket, which means that I of course will pay attention to the amount billed on the hospital lab statement. This seems slightly lower than what the mini-mall lab billed for, interesting.

Then I get the “EOB” and, sure enough, the health insurance company doesn’t pay anything on it, and it’s applied to the deductible, and I’m responsible for the charges. Then I look at the discount column, or “allowable charges,” and see that they are significantly higher for the hospital lab than they were for the mini-mall lab. More than THREE TIMES higher.

At the mini-mall lab, I was expected to pay $23.47 out of pocket after the insurance allowable charge was applied. At the hospital lab, I am expected to pay $80.

“Not so great,” I thought when I got the bill from the hospital lab confirming this amount.

So I call the insurance company and ask why, for the very same test, I am expected to pay so much more to one provider than the other. This seems like a reasonable question, right? After all, my family and my husband’s employer pay premiums to the insurance company every single month so that they will negotiate prices and, theoretically, pay for our health care, right?

The answer that I get from the very nice insurance lady is convoluted at best. “Well,” she says, “It’s not the service but the contract that determines how much a patient will be responsible for if they have a deductible like you do. Each provider negotiates their own contract with the local insurance plan, and we don’t have any control of that because we’re just responsible for applying your benefits to the claims. We’re based in Pennsylvania, but it’s the New Mexico plan that determines the charges.”

I point out that I as the patient has nothing to do with these negotiations and that I just went to where the nice nurses told me to go for a blood test. I also point out that the nice nurses in both my doctor’s office AND either of the two labs in question probably don’t know what either lab has negotiated with my particular insurance company, either, so there’s really no reasonable way I could have made an informed choice about how much I would end up paying out of pocket for this test, a test that really should be covered under routine care in the first place, but I won’t get into that.

“You could have called us ahead of time so that we could advise you in these matters,” she says.

I’m all for doing research before making a purchase, but that seems unreasonable to me. I should have to call the insurance company to ask where I should get my blood test done according to what contracts they have negotiated with individual providers? That seems excessive. Why doesn’t the insurance company negotiate the same amount for the same test, with every provider on their list? Wouldn’t that make more sense, both as customer service AND for their own bottom line?

But no, I’m not getting anywhere with the insurance company, because the portion of the company that manages my family’s benefits is not responsible for the portion of the insurance company that sets contract prices with providers in my state.

Does your head hurt as much as mine, now?

So I call the hospital lab and explain this story, wondering why they charge so much more in the end for exactly the same service, and wondering if I can get any kind of discount since I’m paying this out of pocket. I’m told no, which I expected, and that “any time you use a service of a hospital, you’ll be paying a little bit more, since we’re open 24 hours a day, 7 days a week.” I ask if that applies to the lab, and she admits, “No, but the lab is part of the hospital.” Okay, fine.

It’s not the hospital lab’s fault, it’s not the fault of the nice nurses in the doctor’s office, or the mini-mall lab’s fault, either. This whole convoluted mess is a direct result of an unregulated, nonsensical insurance industry.

This is just a small story, of one claim, and I as the patient end up on the losing side, out $55 extra, because of negotiations in which I have no part.

I have no illusions that this is a unique story, which is part of the reason I tell it — this kind of experience has become the norm for the American health care system, and it just shouldn’t be.

I should be able to go to my doctor, do what she tells me, and not have to worry about all of this crap.

No one should be nickeled and dimed by an insurance company for what minutiae they have decided they will and will not pay for according to purposely inaccessible criteria.

For another example, we had to pay the pediatrician $2.50 for a peak-flow cardboard tube that my son used in an asthma checkup, because the insurance company applied that charge to the deductible rather than as part of a yearly physical for a kid with asthma. It cost more for them to bill the insurance company, then bill us and for me to mail a check than the $2.50 tube in the first place.

It’s not the amounts of money that get my ire up, it’s the absurdity of all of the pieces of paper sent hither and yon, and the hundreds of phone calls that I have to make to just understand why something is happening the way it is, why I’m receiving x bill for x service, for x amount that doesn’t match any other piece of paper with that date on it, that as far as I knew ahead of time should have been paid for by the insurance policy that we pay premiums for, every month.

Over the life of this insurance policy, about two years for a family of four with all of the checkups and a few random mishaps, there have only been TWO occasions in which I have not had to call to get something corrected or clarified or rebilled or FIXED in some way or another, where everything went smoothly and everyone was relatively happy and the right people were paid the right amounts.

And when all is said and done, our premiums plus the amount that we pay in co-pays and deductibles and prescriptions, NOT even including the huge amount that my husband’s employer contributes, are easily FIVE TIMES MORE than the amount of benefits we have received. And yeah, I understand that’s part of what insurance is about, hedging the amount of premiums you pay over possible disaster like a car accident or cancer diagnosis, but still.

Health care just shouldn’t be this complicated.

I mean, imagine if I were really sick.

Here’s a song from the amazing Chris Smither, to compliment the rather wonderful conversation that is still going on over “The False Debate” of atheism vs. theism, below. Enjoy:

(hat tip to Evolution of the Mystery for posting the lyrics earlier today)

Prepared remarks for this speech are here.

With all of the furor going on about whether the President of the United States should be “allowed” to address the students of our nation as they go back to school, to offer them encouragement in their scholarly endeavors, I’ve heard and read all kinds of variations on a theme:

“What can HE say that I can’t say to my own kids?”

Listening to the speech, I heard a lot of things that I have said myself to my own kids. Things like, “There is no excuse for not trying.” Or, “The truth is, being successful is hard.” Or, “Don’t be afraid to ask questions. Don’t be afraid to ask for help when you need it. Asking for help isn’t a sign of weakness, it’s a sign of strength — because it shows you have the courage to admit when you don’t know something, and that then allows you to learn something new.”

But here’s the thing: I’m just Mom. I know that some day, the things that I have said to my children will resonate with them, but right now, I’m just Mom, who makes them scoop the cat box and make their beds and set the table every night.

I’m not so far removed from my own adolescence that I don’t remember brushing off my own parents, though reflecting now, many of the things they said that I didn’t take seriously at the time resonate greatly.

When you have someone like the President of the United States say directly to kids, “You have to do your part, too,” it rings a little louder, a little clearer, in the here and now.

This is the kind of message that kids need to hear from people OTHER than their parents, too. This is a message that kids need to hear from all over, so that they GET the message: they are important, not only in the context of their own families, but in the context of the future of their country and the world itself. That what they do, their choices, matter, right now.

“What’s your contribution going to be? What problems are you going to solve? What discoveries will you make? What will a President who comes here in 20 or 50 or 100 years say about what all of you did for this country?”

I figure that the people who are really convinced that end of life counseling = death panels are not going to be swayed by any kind of logic and fact, but it can’t hurt to have accurate information posted everywhere possible, if only to prove even further how ridiculous the whole thing has become.

From Sherwin B. Nuland, in The New Republic:

In 1990, responding to several high-profile court cases–notably, those of Karen Ann Quinlan and Nancy Cruzan, two young women in deep and irreversible comas who were kept on life support for unconscionably long periods, even as their families petitioned for cessation month after month–Congress mandated that any health care institution receiving Medicare or Medicaid funding (which means all but a very few acute and chronic care hospitals) must, on admission, provide patients with three statements: one outlining their right to accept or refuse any type of treatment; another laying out their right to issue advance directives to ensure that their wishes about continuing life-sustaining therapy be carried out; and a third explaining any policies that govern the institution’s withholding or withdrawal of life-supportive treatments.

. . .

In order for patients to make knowledgeable decisions under the 1990 law, it is essential that they thoroughly discuss with their physicians the implications of the directives they are choosing, such as “do not resuscitate” orders. H.R. 3200 would, for the first time, legislate that the physician receive a fee for these discussions, making it more likely that they will take place and that they will be of real substance. From these provisions of the bill, the ignorant, the nefarious, and the just plain stupid have extrapolated that the purpose of the periodic consultations is really to determine life or death, with government officials and even physicians–heaven forfend–taking on the role of Dr. Mengele. It is ironic that the very legislation designed to protect patient autonomy is that from which Sarah Palin and her ilk have derived the fantastical notion that her son, Trig, who has Down syndrome, would be euthanized if H.R. 3200 were passed.

[emphasis mine]

Issue has been taken with the possible cost-saving effects that more people having advanced directives in place will have — as if doctors will be encouraged to pressure their patients to choose to forego medical treatment to save money.

It seems to me that if more people are given the opportunity to make knowledgeable decisions about how they will be cared for in the event that they are incapacitated, it is logical to assume that a majority will choose not to undergo heroic measures or artificially life-sustaining treatments, for any number of reasons — and this will end up saving money, because all of those measures cost a whole heck of a lot. But, that doesn’t change the fact that the default will always be to do everything medically possible to keep a person alive, unless they have a binding advanced directive in place with orders otherwise.

And, an advanced directive can also specifically stipulate that everything be done to keep a person living, no matter the quality of that life. Control of what the advanced directive says is completely in the hands of the patient.

This provision of H.R. 3200 is not meant to pressure people to make a choice one way or another about their end of life care, it is meant to give people the opportunity to make their wishes known while they are still of sound mind and body. This provision is meant to stave off some of the heartache that can occur when one’s family is faced with making tough choices without knowing what their loved one really wants, or fighting with each other to make the right decision when disagreements arise.

It’s about having conversations about hard things, to make it easier in the end. More people need to be having these conversations — with their families, and with their physicians, since a physician’s signature is legally required for an advanced directive to be binding.

There is nothing sinister about giving more people the opportunity to create an advanced directive, and fairly compensating those medical professionals who provide this service to their patients.

Really. There isn’t. The end.

I will be the first to admit that the current health care bill under consideration, H.R. 3200, is flawed. Any bill over a thousand pages is.

But let’s argue over what it actually says, not about crap opponents of any health care reform dream up to scare people.

Here’s a pulls-no-punches fact check on the viral email claiming that this bill represents the end of the world, from FactCheck.com. In particular, the truth about the absolute nonsense going around about advanced directives:

Claim: Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia? Claim: Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time. Claim: Page 425: Government provides approved list of end-of-life resources, guiding you in death Claim: Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends. Claim: Page 429: Advance Care Planning Consult will be used to dictate treatment as patient’s health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT. Claim: Page 430: Government will decide what level of treatments you may have at end-of-life.

All False. These six claims are a twisted interpretation of a provision in the bill that says Medicare will cover voluntary counseling sessions between seniors and their doctors to discuss end-of-life care. Medicare doesn’t pay for such sessions now; it would under the bill. End-of-life care discussions include talking about a living will, hospice care, designating a health care proxy and making decisions on what care you want to receive at the end of your life. Doctors do the consulting, not the “government” or a “bureaucracy.” The e-mail author’s assertion that the bill calls for “an ORDER from the GOVERNMENT” for end-of-life plans rests on language about a patient drawing up such an order stipulating their wishes, and having that order signed by a physician. There’s nothing about “an order from the government.” The bill defines an order for life-sustaining treatment as a document that “is signed and dated by a physician …[and] effectively communicates the individual’s preferences regarding life sustaining treatment.”

To quote Sarah Palin, “Let’s stop making stuff up.”

Repetitive activity is always a kind of meditation for me, whether it’s playing mindless computer games and letting the mind wander, or currently, spackling the top edges of three out of four walls in my daughter’s room where previous owners were to lazy to do it right before applying molding painted fire engine red, against the ceiling painted dark blue. I have two walls to go, and am taking a break. And I can’t feel my elbow, especially after divesting the same walls from the ugliest glow in the dark rocket ship wallpaper border I have ever seen.

But I digress. Repetitive activity=busy brain. So I’ve been thinking a lot about the idea of compromise, particularly in the realm of health care reform, and I’m more and more convinced that consensus, while possibly desirable, just can’t happen here. When you have Glenn Beck screeching on national television about the conspiracy between Obama and ACORN to create an oligarchy (well, “oligarhy,” to quote him directly) and people are still listening and nodding and feeling like victims because they’re sure health care reform = socialism and death panels and the end of the world because maybe insurance companies won’t be allowed to cheat people quite as much as they can now, I don’t know how consensus is even a word in the conversation any more.

It is so frustrating for me, as a thinking human being, when so many people are willingly going off the deep end, regardless of the facts. So no, I don’t think we should compromise with crazy people when it comes to health care reform.

This is not to say that everyone who is opposed to the specific reforms the Democrats are proposing is crazy, because there are all kinds of good ideas and valid viewpoints around the facts. But when it comes to the purely fear-driven obstructionist crap that is being presented as “the other side,” I think it’s time to call bullshit and move on without it.

The New York Times agrees with me this morning:

If the Democrats want to enact health care reform this year, they appear to have little choice but to adopt a high-risk, go-it-alone, majority-rules strategy.

We say this with considerable regret because a bipartisan compromise would be the surest way to achieve comprehensive reforms with broad public support. But the ideological split between the parties is too wide — and the animosities too deep — for that to be possible.

In recent weeks, it has become inescapably clear that Republicans are unlikely to vote for substantial reform this year. Many seem bent on scuttling President Obama’s signature domestic issue no matter the cost. As Senator Jim DeMint, Republican of South Carolina, so infamously put it: “If we’re able to stop Obama on this, it will be his Waterloo. It will break him.”

So while it’s unfortunate, it’s time to put up or shut up. And any sane Republicans who have a chance to break with the crazies who are currently controlling their party’s message need to put up as well. I would think that in the end, those who are on the side of reasonable, much-needed, sensible health care reform will have a better chance of being reelected than those who insist on just getting in the way in order to score cheap political points.

Now I must go back to the spackle.

Mankind Is No Island from B2GYouth.com on Vimeo.

This video was shot completely on a cell phone.

I will fully admit that Bill Maher, so-called comedian, makes me nuts. He’s obnoxious, he’s not funny, and I just can’t stand him.

But I can’t help but agree with him that it is high time for the Obama administration to give up on the experiment of “collaborating” with the Republican party to get health care reform done (video from his Tonight Show appearance last night can be found here, if you’re interested).

The Republican party, as a party, is just not interested. Sure, there are sane individual Republicans, such as Senator Johnny Isakson from Georgia, who proposed that Medicare actually pay for a voluntary counseling session between doctors and patients about end-of-life directives: living wills, or durable power of attorney, do not resuscitate orders, etc, and then got demonized as the creator of DEATH PANELS, BEWARE!! (For the record, here’s a great transcript from Ezra Klein about the whole thing.)

But when you put them all together, and have Rush Limbaugh and Sarah Palin whip them into frenzies about the “evils” of government and especially the “Democrat” party, which you know wants old people to be euthanized at age 65, just ‘cuz, they all turn into morons.

Sure, that’s a generalization, but I don’t really care at this point. Barney Frank has been getting alternatively lynched and sainted for daring to compare “debating” whether or not health care reform is a Nazi policy to having a discussion with a dining room table. I don’t think he’s worthy of sainthood, and he probably could have been just a little more polite, but the woman he was talking to wasn’t actually interested in an answer to her “question,” but merely to ask it in an inflammatory manner and get some attention.

It was high time someone called a spade a spade, but of course the media turned it into a story about “did he go too far?” rather than about the actual issue at hand — that the “debate” over health care, and about any other important matter before our lawmakers for that matter, has become an embarrassing mish-mash of he said/she said bullshit, reporting the fact that people have opinions rather than the validity of those opinions. What happened to civil, logical discussion of how to actually make laws that help people and make their lives better? Why aren’t we talking about what should be in those laws that will help the most people? Or about how to make sense of these tough issues using reason and good sense rather than vitriol and fear?

The President’s most recent YouTube address is great, and level-headed, but the people he’s really trying to convince just won’t have it.

They’re not even all that interested in being right, just in the Democrats being wrong. I’m talking about Betsy McCaughey, Sarah Palin, Glenn Beck, Bill Kristol, and you can name your own personal right-wing nutjob here if you like, especially the ones who aren’t famous but like to parrot what the famous ones are screeching on the TEEvee all damned day.

It’s not about facts any more, it’s not about real concerns over what might be in an actual health care reform bill, of which there isn’t just one at this point, it’s about winning. Barack Obama could sign an oath in the blood of Jesus on the flesh of an angel held by God Himself that you can keep your private health insurance if you want to, and these people are still going to make scary insinuations about socialism and government-sanctioned euthanasia of old people and babies with Downs Syndrome. That’s how they have been trained, and they’re not going to change, not for anything in the world.

So it’s time to call a freaking wingnut a freaking wingnut and get on with the business of fixing health care. There is no way to possibly hear every person out who wants to be heard, especially if they’re not interested in actually contributing to the issue at hand but just to the conspiracy theories and fear mongering and demonization of the Democrats’ motives.

So why am I posting this, if I think the debate is over before it has begun? Well, I’m an eternal optimist, and I’m hoping that there are folks out there with good ideas about what should be in the health care bill. And I think that conversation, free of the false dichotomy of winning vs. losing on the issue, could actually be interesting.

Personally, I believe that health insurance is a giant scam and should be eliminated entirely, but I understand that we have to take some baby steps. So, first off, I want to see a public option, Medicare-for-all kind of thing, something where we’re not requiring people to give money to private insurance companies. And secondly, I want to see much tougher, Federal rather than state-by-state, regulation of insurance companies, particularly over pre-exisiting conditions, actuarial tables, and they way they nickel and dime people over every aspect of care rather than allowing doctors to proscribe treatment — patients shouldn’t have to worry while they’re being treated about what it’s going to cost.

Those are my must-haves, though there are a lot of other great ideas floating around as well. What about you?

(And please note that any hint of hijacking the conversation for the above-ranted-about conspiracy theory bullshit will be immediately deleted. This is not the place. Period.)