Kimberly Krautter's Open Salon Blog

10,000 Words from Ted Kennedy: A little girl and the Lion

Wed, 26 Aug 2009 14:08:36 -0400

By Kimberly Krautter

The first time I met The Lion of the Senate, I was not nearly as in awe of him as I was of then House Speaker Tip O'Neill. I was about eleven years old and four-foot nothing, and the Speaker was enormous to me. In truth, he dwarfed most. Being precocious and a political junkie even then, I was of course aware that both were giants, and I was eager to sponge every essence of the meetings. I was impressed for all of the obvious reasons but also because both gentlemen had a twinkle in their eyes, a mirthful laugh and massive paws that enveloped mine into a generous but gentle handshake that pulled me into a hug.

I also remember being so proud of my dad whom I was shadowing as he made visits on The Hill, championing his dream -- and an official project of the State of Georgia -- of helping Americans learn as much about citizenship as they know about baseball. Each listened to my dad, agreed it was important, pledged their support, and I believed them. Neither let him down. The dream and the project live on.

The second time I met Senator Kennedy it was on a political junket with "The Dean's List," a group of high donor fundraisers for Governor Howard Dean's Presidential Primary campaign. We had been invited to participate in the "Unity" events that aimed to get all Democrats and party backers on board for the John Kerry nomination. Our friend Terry Lierman put together an amazing day of small group meetings with Democratic Party luminaries from both congressional chambers, and we were all very impressed and honored. But THE man we were most excited and abuzz to meet was Senator Ted Kennedy.

He did not disappoint.

The broad, welcoming grin, the twinkle in the eye and the mirth I remembered were there, but our group was treated to something entirely different. There was an urgency in his message to us that day. We must be unified. Our young people were dying in a senseless war while our enemies were being emboldened and multiplying as our military endeavors were distracted from the real perpetrators of 9/11. And if we didn't unify on the matter of health care reform, our entire economy would face collapse and the government would go bankrupt. We had to get together.

I remember thinking, wow. This is one man who can use 10,000 words to say something so simple. The thought was one of admiration for how earnest he was and how he spoke, not as a grizzled, jaded and fading political vet. Rather, he spoke with the vim and vigor of a young pup candidate, a true believer.

And so, we believed him. I wonder if we'll let him down?

Did the Inglorious N.O.P. Bust a Cap in Health Care Reform?

Tue, 18 Aug 2009 12:08:45 -0400

By Kimberly Krautter

This is not your grandfather's Grand Old Party. Now revealed as a cabal of quitters, liars and philanderers who propagandize a new brand of Hatriotism, there's nothing grand about it.

In their desperation to replay an election they lost last year, they have left no lie unchampioned. They use the public airwaves for fear mongering, hate speech and race-baiting. Let's get real. The "birther" drive is as old as D.W. Griffith's “Birth of a Nation,” and it has absolutely no relationship to the majesty of Abraham Lincoln. Barry Goldwater and Ronald Reagan are surely spinning in their graves with fury over what is being done and said in their names. It's a sad, sad state of affairs when “Mr. Conservative” Goldwater would be considered a liberal by today's narrow standards.

The Republican Party is now led by a collection of drug addicted gas bags like Rush Limbaugh and Glenn Beck and inarticulate, intellectually lazy quitters like Sarah Palin. It is less big tent and more tent revival where those who do not ascribe to and vote in lock step with their narrow dogma are labeled traitors... and you know what they do to traitors, don't you?

This Just Say N-O Party, its adherents and hate media champions should be ashamed. Just plain ashamed.

Is President Obama, whose campaign for "real change" showed courage and electrified the nation, really going to capitulate on the public option in health care reform based on the biggest bald faced lie of all -- a one liner on Facebook by none other than Caribou Barbie? We thought he had more grit.

If Congressional Democrats (Liberal, Progressive or Blue Dog) fail to pass a public option they will prove Palin right: that her team could have won if she had been cut loose to gin up the hate machine. Indeed it will be Obama’s Waterloo, and it is not worth sacrificing all of the hard work and gains that millions of Americans have made to repair the damage of a decade of Bush/Cheney -- and elect those very same Democrats to office. Grow a spine. Or you are all lame ducks.

Are Democrats and the President really going to let this very small, ignominious group kill the public option and perpetuate a fraud of toothless health care reform? Are they really going to let a minority of Americans composed primarily of one generation so desperate to hang on to the delusions of the Eisenhower era that they have been using the same sophistry and fear tactics to rally against de-segregation, one man one vote, Civil Rights and Medicare? They are the same misogynists who rallied against the Equal Rights Amendment and who to this very day condemn women in the workforce as the thread that unraveled the fabric of their America. These are the same lemmings who goose stepped to war based on lies, not against the terrorists who actually attacked us but against a country that promised the biggest economic advantage to an elite few.

How dare Republican Senators like Chuck Grassley promulgate the obscene suggestion of "death panels" when they voted for the same end-of-life consultation as part of the 2003 Medicare bill under the Bush administration? By doing so, he and his colleagues have just given Sarah Palin the keys to that tiny but noisy, hate-filled island kingdom that is today's Republican Party.

Yes, the hypocrisy of the N.O.P. knows no bounds. The same folks who now rally around states rights were champions of federalism when a white Republican was President. These people who freely call Obama a Nazi are the very same ones who staunchly declared that anyone who merely questioned President Bush on Iraq or any of his social warfare policies was committing treason. For the last two weeks, they have attended health care town hall meetings arguing about immigration and abortion and every other third rail issue. The only rational explanation is that all of this chest thumping and verbal flagellation is a facade for something deeper, more pathological, more insidious. And indeed it is shameful.

From a branding perspective, is this really how the Republican Party wants to be defined? I voted for Reagan. I voted for GHW Bush. Then the Evangelicals began slowly strangling the party in their vice-like grip. Is there any wonder that conservative stalwarts like Peggy Noonan, David Frum, Colin Powell and like-minded pundits such as George Will and David Gergen are beginning to distance themselves? God bless them. Voices of reason who speak from the roots of the GOP.

A good deal of blame needs to be laid at the feet of the Democrats and President Obama. They failed to get out in front of the health care issue, allowing it to be hijacked by the ersatz "Conservatives for Patients Rights" who launched a multi-million dollar ad campaign early and set the tone of lies and distortions which was picked up by the right wing echo chamber.

Yet, we are all complicit. Individually, we have dismissed these statements as just looney gas baggery. But hate speech -- true hate speech -- should never be tolerated in any form. We used to have standards that demanded truth in advertising, a balanced presentation on political issues and respectful discourse.

Mainstream media has done little more than loop tapes of the noise and most licentious statements which has done nothing more than stir the muddy waters and further propagate the worst of the mongering. They should be ashamed as well.

I'm a member of the media. I'm also a member of the marketing and advertising industry. I grew up on stage. You cannot tell me we cannot speak truthfully, with balance and respect and still be entertaining. Jon Stewart and Steven Colbert do it every night.

The Dangers of "Nazi" Name Calling

Wed, 12 Aug 2009 17:08:53 -0400

Carol Smaldino just posted a new blog that directly addresses the licentious and dangerous use of "Naziism" by health care reform opponents and how that really compares to what is happening in America right now.

Bullies Delight in Town Hall and Center

By Carol Smaldino, CSW

A probing and shocking book, The Nazi Conscience by Duke University Professor Claudia Koonz, examines the kind of conscience and ethical convictions that spread throughout Nazi Germany while she makes the reader feel close to the same dilemmas.

Conscience, as used here, is any set of rules based on an ethic that is not always seen by the rest of humanity as having anything to do with justice or decency. Conscience, she writes, "tells us to whom we shall and shall not do what. It structures our identity by separating those who deserve our concern from alien 'others' beyond the pale of our community." She reminds of Greek, Jewish and Christian tendencies to extend charity and care only to members of the group of inclusion throughout Western history.

During the recent town hall meetings on healthcare, we have witnessed a spate of violent bullying and psychological (sometimes physical) assault, moods of hostility and derision which has stooped to levels that defy any clear intention to act for the greater good. It is about conserving the welfare of the "us" against the "them," with "them" being perceived as unworthy, unfit and dangerous to our future. "They" are accused of trying to destroy the capitalistic way of life and of trying to take away the God given right to ownership and property rights.

One wonders which "God."

In this context, charity is reserved for exotic causes and people far from our shores and comes in packages or checks, but it surely isn't for citizens on our soil who don't comport with our concept of who counts as deserving. To trivialize Naziism as these protesters too often do, or to reduce any side of a contemporary conflict to the degradation of inflamed name calling is not only repulsive, but it is also unhelpful. The electric charge stays in the air and does only damage. I think it is nothing less than necessary to study with curiosity the human tendency to have aggressive and genocidal strains in our behavior here as well as anywhere abroad.

There is a duality in our midst, and it goes beyond polarization along political party lines. The river running through this dichotomy of values and actions also has to do with the idea of how we see ourselves. And as long as any group sees the mirror image of good and pure and innocent, there is the implied sanction to assault, eject and negate others who are perceived as "less than."

Read the rest of the article here... and learn the conclusions she draws on this important issue.

In the interst of full disclosure, Carol Smaldino is one of my clients. She has a regular blog on The Huffington Post, and I think she is terrific. From time-to-time, when I think it is appropriate, I will share her work with OS readers.

Part 3: Un-Spinning Healthcare Reform - The Economics

Fri, 31 Jul 2009 18:07:55 -0400

By Kimberly Krautter

How ironic. I caught the flu right in the middle of blogging about healthcare reform. After two days of misery, I awoke this morning to see Tina Brown on CNN talking about how, as a Brit, she has been able to go to the doctor whenever necessary without question or worry. She said that for everyone born in the U.K. or Europe this is just a normal expectation of, "living in an evolved society." And she said everyone has always had the option to "go private" for enhanced care. Can you imagine the peace of mind that must offer?

The big question is how do they pay for it? That is what Congress is wrestling with now. It seems to me they are making it way more complicated than it needs to be.

A British writer and friend named Mark has lived in Paris for the last decade. Now a permanent resident of France, he has the unique perspective of both healthcare systems. He wrote to me saying, "In the U.K. basic healthcare is covered by National Insurance Contributions, which pays for the National Health Service, as well as retirement. In other words, if you're hospitalised in an emergency, nobody asks you if you're insured or, conversely, to write a cheque. The food may be lousy, but the chances are you'll live. NI contributions are taken right out of everyone's salary on a scaled basis and you barely notice them."

According to my American friend Elizabeth who now lives in the U.K. (see her story in Part 1), a noticeable difference between the level of care in the U.S. and British systems is the hospital ward. Here in the U.S. we're used to having "semi-private" rooms wherein two strangers are housed in adjacent beds in the same hospital room with curtains for privacy. In England, multiple patients are housed in an open ward with curtains for privacy. In a culture where our sense of community has completely broken down and we no longer know our neighbors, this would definitely require a psychological adjustment. However, unless our healthcare reform is going to include the cost of demolishing and rebuilding every standing hospital in the U.S., that's just not going to happen. Thus, ostensibly, we'll have the comparative luxury of semi-private rooms while gaining the peace of mind of no longer having to fight insurance companies and worry about losing our homes while we fight the cancer that put us in the hospital to begin with.

In France, things work a little differently. Free medical care for all, including the jobless and homeless, is the guiding principle, however implementation is a little more complicated. The French national healthcare system, L'Assurance Maladie, provides for standard medical care at 100% support. If you have a trauma, you are wheeled into the hospital, you receive the same standard of care we expect here in the U.S., and you pay for nothing. You are healed, given ample opportunity for recovery, and no one from billing contacts you. Also, the doctors don't have to get permission from an insurance company to determine what procedures to provide. They just get the job done.

When it comes to routine preventive care, in France, fees for doctor appointments and dental care are reimbursed at 80%. According to Mark, you present the receptionist with the French equivalent of a Social Security Card and pay 20-50 euros. You also give the card to the pharmacist when you pick up prescription drugs. He said, "If you're lucky enough to have an employer with a 'mutuelle', or private healthcare scheme, a small amount is taken out of your wages. You send a form to your mutuelle saying how much you paid for your check-up or dental appointment, and it's reimbursed. The result: you pay nothing."

Under debate by Congress now is a tax-based system that appears to be similar to the one used in England where roughly $0.10-0.11 cents of every dollar you earn is put in a giant fund to pay for every U.S. citizen to get the healthcare they need. I don't know about you, but one thin dime for every buck you make seems like a very easy trade for being able to see the doctor any time you need to. It is certainly a very easy trade-in on all of the stress of fighting the insurance company bastions over routine denials.

But what will all of this change mean for the doctors who care for us? I consulted with another friend, Steven R. Hindes, MD, MPH of Colorado. Dr. Steve and I went to high school together. I remembered him as one of those delightful people who always had the best interests of everyone in mind, so it was no surprise for me to learn that he graduated from the University Of North Carolina School Of Medicine with both his medical degree and a Masters in Public Health. He is a board certified family physician, and he operates a private practice outside of Denver. He is also a professor of medical health economics at the University of Denver. This week, I went to school with Dr. Steve on the economics of healthcare reform.

The big sticking point for most Americans, including Congressional Blue Dogs and RINOs, is how to fulfill President Obama's pledge that reform will be "deficit neutral." First, we need to understand why the deficit exploded in the first place. Presidents Clinton, Bush and Obama (sorry Dems, there's ample blame to go around on this one) abandoned the Pay-Go law that prevented Congress from approving any new expenditure until a tax was increased or a different expenditure was eliminated in order to make the new spending budget neutral. Add together the long list of unfunded mandates including Medicare Part D, the Iraq War and the Wall Street and Auto Industry bailouts, and we have the fix we're in today. One of the few programs in decades mandated to be deficit neutral is healthcare.

As a physician, Dr. Steve says that a public healthcare option that is "administered as efficiently as Medicare" is favorable. While the argument that a government option will drain consumers off the insurance company rosters has been used as a negative, Dr. Steve says this will be a positive effect. The reason: private insurance is currently way over-priced. Proof is how quickly premiums have outpaced cost-of-living and wages in the last decade. While he accedes that supply and demand per se doesn't work in health care, the fact is that supply drives demand and leads to excessive and redundant treatment with no benefit outcomes.

This is what the President speaks about often. "When these expensive sources are controlled and only used as truly needed, then the total billing goes way down," wrote Dr. Steve. "If someone wants to get the test or procedure even when it has been deemed not medically necessary, then they can pay for it themselves with their own money but the taxpayers will NOT pay for it." (His emphasis.) Critics spin this as "rationing." Truthfully, it is an end to CYA medicine a.k.a. "defensive medicine" that is done simply to avoid malpractice claims. Tort reform is essential.

As a family doctor, Hindes says that increasing the financial incentives to go to primary care and to get preventive services will reduce the high cost of specialist services that can be just as well handled by primary care physicians. This echoes what I learned a few years ago when I provided P.R. consultation to the Georgia Academy of Family Physicians. Our national addiction to specialists has made it economically infeasible for our front line physicians to practice in most rural areas and low income zip codes.

Another thing Dr. Steve believes will truly impact the cost of healthcare in reform is the elimination of direct-to-consumer advertising for medications which he says drives inappropriate demand and inappropriate use.

"When the uninsured have insurance, they will be seen early and fixed early," Dr. Steve wrote to me. "Now they wait until they are very ill, go to the ER, need advanced care and don't pay, so the hospital shifts the cost onto the next patient who walks in the door with good insurance and jacks up the bill...This is cost shifting, and it makes care seem extraordinarily expensive for those who are insured." Dr. Steve says that when everyone is insured, then preventive care is incentivized. That way when someone does need advanced care, the cost for those high-end services is spread across everyone, not just across those who happen to get sick.

Now that sounds like healthy economics.

Part 2: Un-Spinning Healthcare Reform

Wed, 29 Jul 2009 14:07:46 -0400

By Kimberly Krautter

The need for healthcare reform has been a brewing storm for decades. It became an emergency in December, 2007 when the U.S. economy entered into the worst recession in seventy years because of the disastrous economic policies of the George W. Bush administration. Their policies not only inflicted a class warfare, several unfunded deficit-bloating mandates and a war of choice on taxpayers, but their penchant for de-regulation institutionalized greed to Biblical proportions. Add to that a stubborn refusal to recognize signs of impending disaster, and you had an economic firestorm that doubled unemployment and caused millions of Americans to lose their healthcare.

I daresay that 80% of Americans would appreciate it if President Obama would ask Congress to reduce their 5 week vacation by one week so that -- as a team -- they could focus on nothing but healthcare reform. Order pizza or Thai takeout. Roll up their sleeves and bang this bill out.

That said, let's give credit where credit is due. In the last 36 hours -- even since I posted Part 1 of this blog -- the House Democratic Leadership and the Blue Dog Coalition have made an earnest effort to really move this ball forward. It proves the point that deadlines do make a difference. Perhaps if they all agreed to just keep this positive momentum going for another week, we might actually a worthy bill in the House and a worthy bill in the Senate so that all they have to do is reconcile the two when they return in September.

Yesterday, in this blog we began to un-spin the healthcare reform debate, examining some of the hyperbole and wild claims that are being circulated in the press and through advertising. We continue that dialogue today. (Again, the last names of some sources are withheld as a courtesy.)

The Best System In the World: Can we risk reducing our quality of care?
The Claim: People all over the world flock to the U.S. for healthcare because it's the best in the world. Sure it has problems, but the government is not the answer.
The Truth: Technologically, the U.S. has the best care, but only for those who can afford it.

You've heard the numbers: "46 million people are uninsured." Do you realize that is 15% of the U.S. population or roughly 1 in every 7 people you know? As we discussed yesterday, millions more are inadequately covered, and they subsist only one serious illness away from bankruptcy. Match these facts with some more: The United States ranks 30th in the world in life expectancy, behind Jordan, South Korea, Bosnia and nearly every European country. We rank 33rd in the world in infant mortality rate.

By every measure, our current system clearly is not the best in the world.

Conversely, it is definitely the best system for physician specialists who can command extremely large fees for their services and high tech diagnostic and surgical technologies. Of course only the very wealthy or those with "Cadillac" insurance plans can afford to consult with such specialists.

On the one hand, considering the stratospheric costs of medical training and the continuing education that is required to maintain proficiency, why shouldn't these doctors charge high fees? The problem is not these few highly specialized physicians as much as it is the gaping maw between the few zip codes where they practice and the rest of the country. This is the real class warfare.

Meanwhile family physicians and OB/GYN's--the primary care providers--cannot afford to operate practices in rural areas where lower population densities and lower household incomes make it economically unfeasible to run their business. And yes, although a benevolent one, medical care in this country is a business. It is a cultural distinction that significantly keeps our chronic diseases high and our life expectancy low. Couple this with the exorbitant debt from medical school with the cost of malpractice insurance, and you cripple the doctor while sending the cost of healthcare out of the stratosphere into orbit somewhere around Mars. No wonder healthcare costs $6500 more per capita in the U.S. than in Europe. The burden of malpractice insurance is even more onerous when you consider that only 0.4% of all cases result in a malpractice claim.

In both the U.K. and in France, malpractice insurance is taken out of the equation. One of the major benefits of a single payer system is that the government, as the care provider, is the party at fault, for lack of a better term, when medical malpractice is alleged. A lawsuit is brought before the government appointed review board which determines if compensation is warranted. If the judgment is awarded to the plaintiff, the award is drawn from a national compensation fund. Of course the gonzo multi-hundred million dollar awards are not given, but the patient is well remedied, and the doctor in question loses his license. By taking that burden off the doctor, it frees her up to invest in advanced personal or staff training and to deliver ever higher quality of care (or just leverage the malpractice insurance savings as revenue).

Rationed Care: Is it less costly just to let some people die?
The claim: Government bean counters will limit the kind of care you can receive based on your age and prior health. Old people are allowed to die rather than getting the care they need.
The truth: That suggests government ordered euthanasia. It is ridiculous.

Here's a tale of two English octogenarians and an American colon. John Winchurch of Cornwall, England shared these stories with me. He lives in a rural village, and one of his neighbors is an 87 year old man with a long history of heart problems. Each time he experiences arrhythmia, the first responders arrive right away, and when needed, an air ambulance is sent to immediately dispatch him to the nearest cardiac care center. Every life saving and sustaining effort that we would expect in the U.S. is provided to this man. And, as it was pointed out yesterday, because he is covered under the National Healthcare System, he suffers no charge for any procedure or prescription. His limited income is not threatened, and he is able to return to the pleasantries of his life. He never has to choose between food and medicine.

John also shared the story of his 83-year old cousin who recently collapsed at the beach. The life guard and other first responders immediately resuscitated him (a process that was required three times), and they kept him alive until the air ambulance arrived. At the hospital, a battery of tests was run by the neurological and cardiac M.D.s (as opposed to non-physician staff as some would have us believe). A nutritionist even consulted on the case to determine if an adjustment could be made in his diet to help him improve his health.

Sadly, unlike John's neighbor, his cousin died. But he died of natural causes and not because he was allowed to die as some of the most egregious anti-healthcare reform rhetoric would have us believe.

By contrast, in the U.S. rationed healthcare happens every day. My friend Claudia lives in Manhattan. Her father is dying of colon cancer, thus a regular colonoscopy exam is critical to her health. When she had her exam this year, the technician was unable to get the scope through her colon, and the doctor recommended she that receive a virtual colonoscopy. Her insurance company has refused to approve or pay for the virtual colonoscopy even though it is a medically necessary procedure in her case. Thus, her healthcare has been rationed by insurance company bureaucrats.

Tomorrow I'll share insights on Healthcare Reform from a doctor who operates a family practice in Colorado and who teaches medical health economics at a university there. We had some good movement from the Blue Dog Dems since yesterday. Perhaps another bran muffin to their brains, and we'll have even more progress on this issue by tomorrow. One can only hope.