jeudi 5 novembre 2009
Water pouring in
"Tu ne vas pas les laisser là?" I notice that I have heard that formulation quite a lot since I finally got married, late in life for all my childhood dreams of Prince Charming. I had to start a career first, since being Prince Charming's wife isn't a career these days. Wait. Yes it is. I thought it wasn't and got a degree and started working before moving to Greenwich to discover that I had gotten it all wrong. Or, my mother had. At least in my case.
"Pourquoi pas?"
"Ils sont dans le passage, et -- elles vont dégueulasser le tapis." He hadn't noticed what I see everyday? The carpet is already disgusting and covered with Black Lab fur all the time. I swear la femme du baron is the only one around here who notices when it is dirty, and when it is clean. I let it drop. He won't move the cushions, and I don't even want a passage there at all. I want a real living room, with furniture suitable for the life I lead.
Which it, unfortunately, is, broken down and hand-me-down and covered with Black Lab fur as it is.
What furniture do I need? Not much, for starters. The house is small. Another of my complaints, actually; another is that it has no storage space. I dream about that, you know. Audouin and Sam left this morning, while the sun shone directly into the room. Le baron kissed me good-bye and wished me a good day (he always asks if I had a good day when he comes home, even when there is no reason either of us can think of for it to have been that or anything else; they are days), and I drifted back to sleep. When I woke up again, I knew it was 9:15 am. The sun was at precisely the 9:15 am angle. I had been dreaming.
I was in a big house with two staircases. It was tall. One staircase had a window that looked over a long drive, bordered by trees in fall colors on one side, a drop into a forest on the other. I knew it had another staircase because this one felt like a discovery to me. It had been raining, rain flooding into the house through cracks between the window frames and the walls, the walls and the floors, the roof. Water was coming in everywhere. No one else seemed concerned. I told my mother-in-law, for she was there, and it must be her concern. She looked at me like a had just spoken in a foreign language of a concern that existed only for me. I headed back upstairs, maybe the first stair, which must look out over the lawn. It ought to, anyway. It would be the main stair of a large house filling with water.
I found myself in a room with a door that, when opened, led to passages and doors and doors with shelves everywhere, a huge walk-in closet, as big, it seemed, as the house. My nieces were there. I told them how wonderful this was (they didn't like the house), and they shrugged; I was in paradise, and they couldn't see it. I insisted. This is wonderful. Really.
The phone rang. In my dream, but it woke me.
Closets. I dream of closets and storage. I dream of closets and storage space in a house filling with water.
You can't have everything.
"Avant," I told my trainer in between series of abs, "j'étais heureuse et fière de ce que je faisais dans la maison, mais maintenant, je me dis que ce n'est pas pour moi de nettoyer les carreaux et lasurer les fenêtres; quelqu'un d'autre avait été payé pour le faire. Ce n'est qu'une maison. Ca ne suffit pas." I was lamenting finding myself doing the work we had contracted workers to do, finding no pride in doing it better anymore, only frustration and disgust. Working on the house is thankless. It is only one house. And, there is so little budget for it and my motivation went away with something. Something I can't put my finger on and say, "That's it. That is why I lost my motivation."
If I could, I would know what to do.
It's when I shrug and tell my husband that it doesn't matter that the carpet in the so-called living room gets all dégueulassé, and he answers, "Mais, pourquoi? Il est très bien."
Non, the carpet is not perfectly fine, "Il est trop petit. Je l'ai acheté pour qu'il serve provisoirement." I bought it at IKEA a couple of years ago thinking the entire house would be redone by now. In my fantasies, it alway looks like the houses in the ads on television, perfectly clean and healthy. There is some clutter, though, or I'd be uncomfortable. I would not walk up the stairs and see them covered with the sand from the bottom of people's shoes, people heading up to the bedrooms and the bathroom in their outdoor shoes. I haven't been able to impose Japanese standards here, but my husband does insist he does care if the house is clean or not.
How can he when he can't see the dirt?
I watch sports on television. I put it on in the background, and sometimes I sit and watch it. It's physical. The spirit is involved in the body, not fighting it. You don't think. A lull in introspection, which my father-in-law (and Anaïs Nin) deplores as destructive.
I read Anaïs Nin, and my spirit rebels. The doubts come pouring in, like the water in the house that must belong to my mother-in-law. The water that doesn't even bother her anymore. It's my time in my life to face them. What have I done? What would matter if I did, or if I didn't, do it? It mattered to carve my pumpkins and make Halloween, even if there were so few groups of children, running up the street, laughing, the noise muffled by the thick walls of the house. I know what matters when suddenly I have to get up and do it.
I have been sitting, more and more.
I read Anaïs Nin, and I think again, It's 1946 in her diary, and it is the same today. Any year in her diary, and it is the same today; It's 2009, and I thought that yesterday.
We discover more, only to know nothing more.
We communicate more, only to say nothing more.
We are told so much, only to hear the same lies and continue to believe them.
I am not laughing today. I am about to stop following politics for the same reason Nin refused to follow it: it makes no difference. The only way to effect change is to do your own work and touch the world immediately around you. Imagine the future, don't lose your present reading newspapers that provide nothing more than the daily interpretation of what is happening. Create rather than content yourself with this reality.
The fall might be too strong a parallel for me this year, when my son turned 18 and will live the consequences of the decisions he makes; the autumn of my life. I have made myself clear. I have given my speeches until he could look at his watch and know precisely when he would be able to say, "May I leave the table now?" My work, as they say, is done. Soon, I won't need to be here. I won't have a legitimate reason. My husband has given me the opportunity of which many dream, to have to do nothing but what I chose with my time. I became Sisyphe.
I could take an entire spring to sift the rock from the dirt for my lawn, and do it over and over again. I could dig holes, remove the chalk and pour liters and liters of planting soil around new plants I would regret before the year was out, results that would disappoint because I had to admit that I knew less for all my learning than I needed to know. I could plaster walls and sand them, paint them carefully, finishing only two rooms, the hardest before me still. I could spend months watching the workers when they were here, and worrying when they were and when they weren't. Seven years passed, and I can ask myself, "What have you done?"
I ask myself, "What will you do?"
....
samedi 31 octobre 2009
Night watchmen, Halloween
Now I know what I needed in the pillars. Jack O'lantern niches. Actually, year 'round lanterns niches would have been lovely. Why do we have these ideas too late?
Actually, they haven't actually finished the pillars, and there are niches... not too late. Something to think about.
It's Halloween. It's my favorite -- absolute favorite -- night of the year, even here in France. Halloween is anywhere I am, with or without children in costumes, mine, or someone else's.
Mine is grown. It's the first year since he was born that he is not home on Halloween. He is in Amsterdam. With friends. They are not trick-or-treating. They are probably sampling Dutch and Belgian beers in the cafés along the canals.
I remember the first Halloween. He was just a month old. Someone had given me a hand-me-down pyjama, cream-colored with gray leopard spots. We were still at my office in Manhattan. I took a piece of gold paper and cut it in the shape of a Venetian mask and started to cut holes for his eyes as he gazed at me from his seat on my desk, alongside where I worked. I cut them quickly, with a sure gesture that startled me. What if I got it wrong? We needed to catch the train back to Greenwich. There wasn't much time to start over and get it right. I placed the mask over his tiny face, and two dark irises gazed back at me from the center of the holes. I had gotten it exactly right.
That's what comes of staring at your newborn for hours, I thought, putting the mask in my bag and scooping him up to head up Fifth Avenue to Grand Central.
At home, I got out the pyjama, tied string to his mask and put it on him. He didn't make the slightest objection. So new, and already an old hand at dressing up for Halloween; ready for any adventure I could offer. I headed out the door to take him to see all our favorite neighbors and friends. His first trick-or-treating.
I bought the pumpkins more than a week ago, the day I saw them in the big wood crate in the entry to my supermarket. They were especially beautiful this year. The French are getting better and better at this pumpkin producing thing for this hallow'd fête, one over which they shook their heads for some time, muttering something about McDonalds and the USA destroying their culture, before caving in to their own children's delight. Pagan, yes. Evil? Not near enough to disappoint eager little children, dying to dress up and go door to door asking for candy.
I dreamed of my new entry for this Halloween. I was going to have the windows alight with candles, a lantern hanging from the beams, jack o'lanterns on the benches. The gate would be open, and I would be there, wearing my crone hair and peaked black hat, feigning fright and not having to pretend any delight with the children who would come. But, no. It's not done. The work has dragged on and on, and there is still no paved courtyard, no new kitchen entry with its windows, beams, lantern and benches. There isn't even a bell to ring so that we know to run and offer the bowl of candy to the children who can't see that we are home.
I hoped the ja
"Mais tu pourrais mettre les bonbons dans un bol au portail --" I said to my husband.
"Non. Ils n'ont que de venir frapper."
"Mais! Ils ne vont pas oser rentrer comme ça. On n'a même pas de clochette cette année, et tu es allé au supermarché exprès pour acheter les bonbons pour eux." It's true. He went all the way to the grocery store, while I carved my pumpkins so the children would find candy here.
Halloween is contagious.
I am going to put some in a bowl at the gate. Excuse me.
There. I think all the kids passed through the street when he left to go to the store, but I have made the essential gesture. They trick-or-treat too early here, and too briefly.
Halloween is warm and safe. The holiday just after a new school year has begun, just after the leaves have turned all the colors of the holiday -- orange, brown, and red and gold -- and begun to fall, drifting and scuffling across the road under our feet, cloaks and bags filled with candy knocking against our legs, out far past when our parents call us home, they walk at our sides and still there is a charge of adventure in the air. This is no ordinary night. And, we are going to have candy to empty all around us on the carpet, to divide into piles of Almond Joys, candy corn and pumpkins, Three Musketeers, lollipops and the boxes of raisins the well-intentioned but hopelessly misguided give out with our health in mind.
"Did you get an apple, too?"
"Yeah. Do you think it's true? Do you think we can eat it, or is there really maybe a razor inside?" The awful tales grown-ups told on the evening news to make sure our parents were vigilant, but no one ever got a razor in their apple. Ever.
They finally admitted it recently, before my son and I left for France. Or maybe it was just after. Anyway, it was an overblown fear; it was true, no one could remember a single episode of a child biting into a razor blade on Halloween, or ever, for that matter.
But Halloween! Ah, Halloween. It is special forever, even when we are nearly grown up and ready to fall in love, bewitched. A friend left this comment on the post Evening. Ennui. as part of a longer comment. It belongs here.
Never told you how I met my Denny...if not for Halloween... We met at a Presbyterian Church Halloween party/dance in 1963. Skeletons and witches on the walls. Great cobwebs suspended in the corners of the hall. Black and orange crepe paper streamers shivering delightfully overhead. And enormous bowls of (demonic) candy everywhere.
This beautiful, blond Scandinavian guy asks me to dance. He sings in my ear as we dance.
I was bewitched. Stayed bewitched for the four years of courtship that followed--and for 42 years of marriage. I hope that, when the day comes I am with him again, it is Halloween...
....
Talking to myself
We have two.
I wish we had one.
But what's not to like about a clear stain?
Well, there are the two windows that are actually Iroko, an African wood, and they won't look the same. Not to mention the two that are in pine, as well as the pine window frames. What are you going to do about those?
I don't know. Maybe just stain them clear, too, and hope for the best? Maybe they'll be alright, and I won't have screwed them up trying to make them look like the old oak ones, or even like the two new oak ones.
Yeah, but, they're pine.
I know.
Listen, you can start with clear stain, and then if that looks wrong, you can always apply something else on top of it.
[Nodding] Yeah, that's true.
Listen, just get it done, OK? You'll feel better once it's done and you can worry about something else.
Like when the workers are going to show back up again and how miserable they are going to make me this time?
For example.
....
vendredi 30 octobre 2009
Evening. Ennui.
Who knows.
I must report on Eugénie G. Toad. Eugénie is not in her toad house. She has not been seen since the first day, when she settled into a burrow and began to tunnel. I thought the hole meant she was there, but, being unable to refrain from being certain, I removed the dry linden leaves, reached in and felt the inside of the tunnel with my fingers. I was rather afraid to stick Eugénie in the eye, since they dig backwards, pushing the dirt up and out, but I felt nothing but the end of the tunnel, somewhat abruptly. Eugénie had gone.
Was ittoo hard to tunnel in that location, beneath the yew? Was it not to her liking? Whatever the reason, she is wherever she is, I'm unreasonably sad about it, and the several toadlets I removed from the skimmers and the pool, preparing to close it for the winter, didn't stay long in the toad house either. I added, by the way, another one. Both are vacant. They don't even seem very interested in the shallow pool I made for them to sit in.
In the days that I waited and hoped to see Eugénie again, witnessing the massacre of the toads trying to cross the road that cuts across the forest at the center of the boucle de la Seine, I joined Froglife, and I wrote to ask them who might be organizing here in France to do something with amphibians other than eat them.
For the record, we do not eat toads.
Also for the record, I do not eat frogs.
I received a reply from Lucy in the UK (I love that name), who offered to put me in touch with Ninon, near Rambouillet. Lucy told me that they use a system of fences along the road side and pitfall traps to collect the toads, adding that "this system is very popular in Europe but for some reason is not widely used here." This year, according to Lucy, the group in Rambouillet "helped 4,000 toads across the road!"
I love the exclamation point. I love the enthusiasm for the toad lives saved for another season, or at least until they migrate again.
Now, to contact Ninon and see who they are, what they are doing, and how I can set up a similar "toads on roads" effort here in the boucle. One reason they don't use the fencing might be the expense in setting it up and maintaining it. I read about that.
As long as Eugénie is safe out there. That's all that matters.
Peut-être je la reverrai au printemps. Peut-être.
Maybe I will carve my pumpkins tomorrow, even though Sam -- 18 now -- is in Amsterdam, and definitely not trick-or-treating (which they now do here in France, too). I still believe in Halloween, even if most of the candy of this season has been "dedicated and prayed over by witches".
Sounds good to this croan.
Just kidding you. Bwa-cacklecacklecacklecakle!!!! Funny, though, that the original blog post, The Danger of Celebrating Halloween: Spiritual Life in God, by guest writer Kimberly Daniels on Pat Robertson's Christian Broadcast Network, has been taken down from their site.
Does this mean someone over there at CBN still believes in America as we know it and has a little sense in their head? Evil children, trick-or-treating in America's exurbs with the full approval and participation of their parents. Good God. What is America coming to when parents encourage their children to participate in the work of Satan and to consume the sweets that will lead them to His ways?
I mean think about it. All the shelves in school and public libraries we would have to empty of picture books with reference to this Satanic American holiday! And -- save us! -- "The Peanuts" It's the Great Pumpkin, Charlie Brown! All the DVDs and VHS tapes that would have to be confiscated, reburned and taped over with Pat Robertson's choice of the best fundamentalist American Christian sermons of all time! And, once, invited by a family with whom my young son and I were acquainted, I attended a Halloween party for families at The Church of Jesus Christ Latter-day Saints in Greenwich, CT with quarterback Steve Young's parents present, actually condoning this holiday. Think of it, Steve Young and his wife later defied the Mormon church, actively opposing California's Prop 8 on October 31, 2008!
See? It's Halloween at fault. Now, that is ghoulish. What were the Mormons thinking?
Croak.
....
Health care reform: When history calls, what Rep. Dingell will do
Op-Ed: Numbers, not shouting, overwhelm health care debate
By Rep. John Dingell (D-Mich.)
Washington, DC — We have the best medical professionals in the world, but fewer and fewer Americans can afford to pay for the care they can provide. The trends indicate that problem will get much worse.
About 17 percent of our $14 trillion dollar economy is dedicated to health care. We pay more for health care than we do for food. Too much of what we spend on our care does nothing to improve our health. We pay for our highly bureaucratic and unwieldy health care system not just with dollars, but with the lives and well-being of millions of Americans. The Affordable Health Care for America Act will reform our health insurance industry so companies prioritize policyholders’ health instead of investors’ profits.
The insurance industry has done everything possible to make you think otherwise. This summer’s massive disinformation campaign – exposed by Tim Dickinson in Rolling Stone magazine last month – has distracted millions of honest, engaged citizens during this debate. During two town halls in my District this summer, I witnessed first hand how fear hijacked a much-needed serious conversation.
But the facts scream louder than even the angriest protester – and the data tells us the current system could literally destroy our way of life. Consider these statistics:
• The top ten health insurance companies made $8.2755 billion last year and they stand to make more when medical costs go up.
• The average annual premium for employer-sponsored health insurance is $13,375 for family coverage.
• Approximately 45,000 people die each year because they lack health insurance.
This is why we must ignore pressure from the health care lobby, now spending $1.4 million a day spinning its story in Capitol Hill offices (that’s chump change when you consider the top ten health insurance companies saw profits soar 426 percent between 2000 and 2007).
This is not a time to give into fear. I say this to both the general public and my Democratic colleagues. Our party lost control of Congress in 1994 after voters watched Democrats cower in the face of massive pressure from the insurance industry. We must learn history’s lessons or again face questions on whether Democrats deserve to lead.
Reform is neither easy nor cheap, but the cost of inaction is far greater – in terms of lives lost, quality of life, and dollars. Make no mistake, if we don't reduce costs we face certain economic disaster. My father was one of the first members of Congress to fight to change the private insurance system in place today. His fight began in 1943, 66 years ago. If we go another 66 years with costs continuing to rise at the same rate they have over the last three decades, estimates project health care spending to approach 100 percent of our GDP. This is simply not sustainable.
On the other hand, President Obama has said slowing the growth of health care costs by just one-tenth of one percent each year could reduce our deficit by $4 trillion over the long term.
According to the Congressional Budget Office (CBO), the House Democrats' health reform bill reduces the deficit by $30 billion over 10 years, costing less than $900 billion over that time and meeting the benchmark set by President Obama. The President asked for a deficit-neutral bill and we gave him that and then some. It is a reasonable price when you consider the Democrats’ bill will fix the current system which has left so many Americans without proper care and/or bankrupt.
And just how is the health insurance industry spending your money?
• In 2007, each American paid more than $500 to administer health insurance. The U.S. health insurance industry spends roughly 20 cents of every dollar it pays for “nonmedical costs, such as paperwork, reviewing claims and marketing,” according to T.R. Reid, author of “The Healing of America.” This figure is often referred to as “medical loss ratio” or the money spent on actual care versus the money spent on non-medical costs.
That $500 you pay funds a small army, about 463,000 people (more than the active military in Iran today), employed by the health insurance industry. Many of those employees spend their days looking for ways to slow payments or deny your claims.
• No other country has a medical loss ratio close to ours. Our administrative costs are more than double any other country, including France, where Reid points out everyone is covered by non-profit, private insurers. The French spend just 5 percent on administration, while Canada, with a single-payer, government-run system, spends only 6 percent. The McKinsey Global Institute estimates that $91 billion a year is excess insurance administrative costs due to complexity.
Look again at the previous points and replace "health insurance industry" with "government". If that was government waste there would be protests in the streets. So why is it okay when your money is wasted by corporations? As I will explain later, Democrats are prepared to fix it, despite the best efforts of the insurance industry to stop us.
So what are we getting for our money?
• Better health? No. A 2008 London School of Hygiene and Tropical Medicine study looking at deaths that could have been prevented by access to timely and effective health care placed the U.S. last among 19 countries. If the U.S. had performed as well as the top three countries (France, Japan, and Australia) 101,000 deaths per year would have been prevented.
• More care? No. In Japan, citizens average an astounding three times more visits to doctors’ offices than Americans and twice as many MRI scans and X-Rays. Even with all these visits, the Japanese still spend less than half as much per person on health care as we do. Life expectancy and recovery rates for major diseases there are much better than ours.
• Fiscal health? No. In 2006, our economy lost as much as $200 billion because of the poorer health and shorter lifespan of the uninsured.
• Premiums for small businesses are up 129 percent since 2000. And the insurance industry is quoting increases of 14-15 percent for the next year.
• The high cost of health care causes a bankruptcy every 30 seconds. In 2007, 60 percent of U.S. bankruptcies were due to medical costs. Reid points out medical bills force 700,000 Americans into bankruptcy, while there are ZERO medical bankruptcies in France, Britain, Japan and Germany.
• Security and Stability? No. The Kaiser Family Foundation reports last month “one third of Americans (33 percent) say they or someone in their household has had problems paying medical bills over the past year.” That’s up nine percentage points from August and represents the highest level in nearly a year.
• Health coverage for all Americans? Not even close, and believe me, the uninsured are costing you money. This year, every insured American family will pay the health insurance industry $1,017 -- and insured singles will pay $368 -- in premiums just to cover the medical expenses of the uninsured. This "Hidden Health Care Tax" will total $42.7 billion this year.
View Slides of graphs illustrating health care comparisons (click each thumbnail to enlarge)
And there are signs the future could be worse. Employees’ premiums and out-of-pocket charges will go up 10 percent – with the average employee paying $4,023 – next year, according to the benefits consulting firm Hewitt Associates. An Aon Consulting survey of employers found 70 percent plan to increase employee contributions, while 67 percent expect to raise deductibles, co-pays, coinsurance or out-of-pocket maximums. About three out of every five Americans under 65 get their insurance through their employers.
Acclaimed Princeton economist Uwe Reinhardt says if current trends hold, total health spending by or for a typical family of four will hit $36,000 a year in 2019. In 10 years, half of all American families will have to spend more than half of their income on health care.
That’s the future for those lucky enough to keep their health care. More than four Americans lose their coverage every minute. According to the think tank Third Way, the coverage for 88 million Americans dealing with factors like pre-existing conditions, expensive premiums, or high out-of-pocket costs could be at risk without reform. New findings from the Urban Institute indicate the number of uninsured could rise as high as 65.7 million in 2019 and the cost of uncompensated care could go up as much as 128 percent - that leads to higher premiums and taxes for all of us. So it is not enough just to create new policies, they have to be better than what exists and push other insurers to do better.
Our bill will boost the nation’s economic well-being and protect the pocket of patients and doctors
Under the Democrats bill, you can keep your plan and your doctor. The House bill will also create an insurance exchange with affordable options covering 96 percent of all American citizens, including millions currently uninsured and underinsured. Perhaps PricewaterhouseCoopers, in a report that was NOT paid for by the insurance industry, summed it up the best:
“Broader coverage, particularly if paired with an individual mandate, could reduce the cost shifting that increases medical costs to private payers.”
Other measures in the bill will put money back in your pocket, including:
• Ending co-pays for preventive care;
• Implementing a year cap on your out-of-pocket expenses with no caps on what insurance companies pay;
• 50 percent discounts on brand-name prescriptions for Medicare Part D beneficiaries and shrinking out-of-pocket costs by $500;
• Elimination of the donut hole (the gap in coverage that leaves beneficiaries on the hook for the cost of prescription drugs when the cost of their prescription drugs passes $2,700 in a year) by 2019; and
• Phasing out wasteful spending for Medicare Advantage (MA) – which costs beneficiaries an extra $1,000 per enrollee. Paying for the MA subsidies costs a couple using traditional Medicare an additional $78 to $90 a year.
Steps like this will strengthen Medicare, keeping the program solvent an additional five years. Medicare is one of the most successful government programs in our nation’s history. Without reform, large numbers of doctors, who face a 21 percent cut in payments next year, would certainly drop out. Already, physicians are burdened with both outrageous malpractice insurance charges as well as meeting insurance companies’ demands, which cost them on average 142 hours – worth $68,274 - a year. We’ve simultaneously introduced a separate bill which will prevent that 21 percent cut.
Many doctors will also applaud efforts to move away from the fee-for-service system. Over the summer, we strengthened incentives for the development of “accountable care organizations (ACOs)” which have lowered costs and improved care in several communities. Doctors and administrators at providers like Geisinger Health System in Pennsylvania and the world famous Mayo Clinic haved used such systems after deciding they could do better by shrinking insurance-driven incentives. They instead make more money by keeping costs down and meeting quality-of-care indicators. ACOs are run by doctors and hospitals with no government role whatsoever. CBO scored the ACO provisions in our bill and found savings of $2.6 billion through 2019.
These doctors and hospitals have shown a real commitment to bending the cost curve. I wish I could say the same about the insurance companies.
Better Corporate Behavior = Savings for Consumers
Currently, insurance companies do not compete to offer better plans, cheaper rates, or even better customer service. "Successful" companies are those best at shedding risk. Our bill will stop discrimination against people with pre-existing conditions and rescission – the practice in which insurers search for problems with patients’ policies while they are waiting on the gurney for emergency care. Three insurance company executives acknowledged during an Energy and Commerce subcommittee hearing this summer that rescission saved those companies $300 million by canceling about 20,000 policies over five years.
Watch Video of the subcommittee hearing here
There may be no number that can state how many families have lost a loved one or were financially decimated by these practices. But it is clear that without reform, the companies will go on with these kinds of practices. It will be business as usual unless the government steps in.
But new health insurance industry regulations would only prevent the tactics the industry employs now. Americans need more choices to allow them to fight back against new forms of rascality, especially while insurers enjoy almost near monopolies in dozens of states. I believe a marketplace with increased competition, coming from a public health insurance option, will push the insurance giants to behave better than even increased government oversight could.
The public health insurance option would have leverage to force insurers, pharmaceuticals, and hospitals to bring their prices down.
As promised, back to medical loss ratio: when California state lawmakers tried to require insurers to spend at least 85 percent on medical care, hundreds of industry lobbyists worked to kill the effort. Our bill includes a two-year fix establishing the ratio at 85-15. That will deal with the immediate concern while in the long-term, the public health insurance option and other safeguards will force insurers to be more efficient and cut their administrative costs on their own. A public health insurance option would likely have administrative costs similar to those of Medicare, which operates at 3-4 percent. This kind of competition is the best way to drive insurers to spend our money wisely and more efficiently.
As for fears the public option would crowd out other healthcare providers, the Congressional Budget Office (CBO) has estimated fewer than 5 percent of Americans would sign up for it.
Without the public option, what you have is 47 million more people being added to the marketplace that the health insurance industry can charge whatever price they want. It's a wonderful way to drum up business for the insurance companies. How can we ask doctors, hospitals, drug makers and all other stakeholders to make enormous sacrifices without asking the same of the insurers?
The loyal opposition has provided no help. Neither the Republican leadership of the House nor of the Senate has offered comprehensive health care legislation for consideration. While they decry our efforts, they offer no alternative even though – as National Journal has reported – nearly half of the House Republicans (84 of 178) come from districts where the proportion of the uninsured exceeds the national average of 15 percent. Without a bill of their own, Congressional Republicans’ intractability is simply a thinly veiled defense of the status quo. Conservative think tanks cry for deregulation, but this to me is like trying to get a fox out of the hen house by letting in more foxes. The CBO said a 2005 bill allowing plans to be sold across state lines would have caused about 1 million people to lose employer-sponsored insurance. More bad plans and fewer people insured sounds like a step backwards to me.
In a recent Reuters poll, 63 percent of respondents said they’d pay higher taxes to get serious health care reform. I believe they realize this is one case where investing in reform now could put more money in their pockets later. They know the screaming should stop and reasonable discourse must rise above the rancor.
Let me close with a personal note. I make an effort to treat each class of Congressional interns to a lunch in the Member’s dinning room. During that lunch, I take questions about any topic they want to discuss. Almost every time, these interns – many of whom regard Ronald Reagan as ancient history – ask me about votes like the Gulf of Tonkin Resolution and the 1964 Civil Rights Act. In my more than 50 years here, I’ve cast ten to fifteen votes which are repeatedly revisited by the general public, both young and old, because they have such a dramatic impact on the world we live in today. And while public mood may color their sentiments or the way they ask the question, the basic premise behind the interns’ questions are always the same:
When history called, what did you do?
Without a doubt, the vote on this bill will join the list. I will tell my fellow members, when you explain a vote like this one to the generations that live with the consequences of these decisions there is no poll, not even an election result, that can justify your decision. You will be asked about this vote until the day you die. Years from now, none of these things we put so much stock in now will matter. All anyone will want to know is: did you do the right thing when history called on you? It is time for health care reform. We can’t afford to wait. We can’t afford to think small. We can’t afford to fail.
Democratic Rep. John D. Dingell has served Southeast Michigan for more than 53 years in the U.S. House of Representatives, making him the longest serving congressman in U.S. history. He has introduced and fought for legislation that would create health care coverage for all Americans since 1957.
Links to studies, stories and documents cited in Op-Ed:
• Affordable Health Care for America Act - U.S. House of Representatives
• "The Sick Business of Health-Care Profiteering" - Vanity Fair
• The World Factbook: The United States, October 2009 - Central Intelligence Agency
• Accounting for the cost of health care in the United States - McKinsey Global Institute
• Employer Health Benefits 2009 Annual Survey (PDF)
• Projected Health Care Spending When Excess Cost Growth Is Assumed to Continue at Historical Averages - Congressional Budget Office
• OECD Health Data 2009: Statistics and Indicators for 30 Countries (2009) - Organisation for Economic Co-Operation and Development
• Current Employment Statistics, July 2009 - Bureau of Labor Statistics
• "The Asian Conventional Military Balance in 2006" (PDF) - Center for Strategic and International Studies
• "How Health Care Reform Can Lower the Costs of Insurance Administration" - Commonwealth Fund
• "Improving Incentives in the Medicare Program" (PDF) - Medicare Payment Advisory Commission
• "Health Care by the Numbers" (PDF) - House Democratic Leadership and Committee Staff
• "Private Health Insurance Administrative Costs per Person Covered, 1986-2007" - Kaiser Family Foundation
• The Hidden Health Tax (PDF) - Families USA
• "The Case for Public Plan Choice in National Health Reform: Key to Cost Control and Quality Coverage," (PDF) - Institute for America's Future
• "Cost Estimate of H.R. 2355 Health Care Choice Act of 2005" (PDF) - Congressional Budget Office
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mardi 27 octobre 2009
Health Care Insurance Monopoly
Don't leave it to the states"The state Departments of Insurance in six of the seven most concentrated markets for health insurance—including Rhode Island, Alabama, Maine and Montana—have taken no significant consumer protection actions against health insurers in the past five years."
-- Dave Balto , Stephanie Gross, Center for American Progress
Progressives? Are you there? Ms. Maddow (and I, most humbly, not wanting to even suggest that I might be even remotely in the same league as this wonderful woman), right along with all our friends at Firedoglake, and everyone else who is going to wake back up again after the lull of getting the appearance of a win (ps: I contacted Dodd's office, my senator who isn't the evil one saying he will join the Republicans -- Wait! Didn't he already do that? --, and filibuster the Reid plan to tell him that contrary to what he claims in his latest email seeking contributions, to tell him that, no, this is not a "big win") and get back to work.
We've got a real public option that is not optional, limited to the uninsured, nor up to the states to decide.
Here's one place to start today (thanks, Q):
Lieberman's phone is (202) 224-4041.
Check out his lobbying/contributors at OpenSecrets.org.
CT News Media contacts here.
Hm. Lieberman. Connecticut. Hartford. Insurance.
I wonder --
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