The Great Desert Healthcare Debate

                                  The Great Desert Healthcare Debate



      The large red “R” on the sign became the first letter in Rosy Skies RV Ranch. Red paint flakes and red rust chips had accumulated at the base of the sign pole like the talus at the bottom of a bajada. It was here that Osgood Stanch maintained his single bedroom manufactured home in Surprise, Arizona.

    Today, sitting around in lawn chairs talking, were Stanch, Delbert Shue and William R. Dangle. Dangle had been state assemblyman to the Arizona legislature, representing the Gilbert district. When the congressman introduced himself as “Will Dangle,” Delbert hooked his index finger over his nose tip, to hide, with his fist, the snicker smile his mouth was betraying.

    Dangle was new to the resort. He had had to use the restroom on his RV and pulled over to do so, only to find out his black-water waste tank was full. He pulled off at the first opportunity to empty it. Rosy Skies charged $12 for an overnight hook-up. Dangle was determined to get every nickel’s worth out of the stay. While the tank emptied, he drew up a lawn chair. He had a broad face with a hooked nose which was the only distraction from an otherwise handsome face. He had a frothy mane of white hair upturned into a pompadour, with plenty of hairspray to give it a plastic consistency. It was a face made to smile congenially out of a re-election for State Senate poster.

            Osgood Stanch had been a high-school history teacher. He considered history the study of failed political ambitions. Dangle disagreed, as he did with most things enunciated by Stanch. Lively discussions ensued.  Stanch had inherited the face of a pig. His once blond hair was now sparse with only a few wispy strands covering his ample pate. His skin was smooth and pale pink, his ears slightly pointed. He didn’t tan in the Arizona sun. His eyes were unnaturally small, squinted and too close to each other. He wore a constant scowl, and his up-turned nose gave the final touch to the hoggish image.

    Delbert Shue had been a draftsman at a boiler factory in Perdue, Indiana. He had an elongated face with still-black hair, and a prominent Adam’s-apple. His glasses, he kept perched on the end of his nose. He tried to avoid having opinions. His wife’s name was Suzanne—Suzy Shue, whom everyone naturally called SuzyQ. They lived in the commodious fifth-wheel, with slide-outs, three spaces down from Stanch. Their pickup, with the attachment “wheel” in the bed, was long ago sold, and the RV’s front rested on a perpetual tripod. They got about town in a Toyota Prius.



    Now, Osgood Stanch had seen a news program on CNN, called the Jack Cafferty File. People e-mailed the jacket-less Cafferty with plaints of all sorts and he read them on air with his mellifluous voice.

    The one that had Osgood Stanch in such a tizzy was from a female engineering student at M.I.T. It read:



    “No one should die because they can’t afford health care, and no one should go broke because they get sick.”



    “Think that’s true?” said Osgood, beginning a sure argument.

    “Got to consider the source,” said Delbert Shue. “Just a poor little girl with no medical experience. Her heart’s in the right place.”

    “Hmm, people do die with all the money in the world. Take, for instance, Teddy Kennedy, from her own state. He had that brain tumor, and the gilt-edged health insurance congressmen enjoy, plus an unlimited family fortune, but he still died.”

    “Nobody lives forever. Besides, when did medical treatment become a right instead of a privilege?”

    “Believe Ted Kennedy, himself, declared that.”

    “Go back fifty years to 1960; going to the doctor had to cost something. Docs were paid with goods during the depression: a sack of pecans or a chicken for Sunday dinner. Didn’t see any impoverished doctors, either.

    Then some smart union man got the idea that his workmen would be better off if they paid the doctor with before-tax money. Now that was a genius idea in some ways. The union, instead of asking the company for a couple of cents raise for their membership, decided to put those pennies in a ‘pot,’ and from that withdraw funds to pay medical bills. The union members didn’t suffer, even though they were not receiving a pay-raise in their Friday evening check. They had an important bill paid for them. The management didn’t mind, they were prepared to give a certain amount for the annual request for a raise, anyway. And it seemed like a good cause. Instead of a shop-worker spending the raise on alcohol or cigarettes, he got a medical ‘benefit.’”

    “What ever happened to that idea?” asked Delbert Shue.

    “I’ll tell you what happened,” said Osgood Stanch. He always liked to preface some statement with “I’ll tell you . . .”

      “The unions were corrupt. The money poured into a bank account the union had set up: a few cents per hour, per employee. At the end of the first week it wasn’t much, but neither were there many withdrawals. People weren’t used to having somebody else paying their bills. In a few months, there was a substantial amount in the fund. Then, the bills from MD’s came due. It soon overwhelmed the union’s secretary, so they hired a few more gals to do the disbursements. They had to be paid a salary, of course, but there was plenty in the account. So much in fact, that in a little while, union officials who had access to writing checks began to issue them to travel agents for trips to the Bahamas and such. Somebody, a government overseer of union doings maybe, found out.

    They had to put a stop to this and searched around to find a suitable replacement for the secretaries and somebody trustworthy to write the checks to the docs. Of all the industries, it was the insurance companies which stepped forward. They had clerks who were used to writing checks; they could collect the ‘cents-per-hour-per-employee’ and call it a ‘premium.’ They could also take that big wad of money that was accumulating in the union coffers and put it out for interest. Most insurance companies operate ‘for profit,’ after all. So the Medical Insurance Company was born.”

    “And God-help-us after that!”

    “At first, the medical insurance companies were looked on as inanimate objects—institutions, without a soul. It became OK to cheat an insurance company. If a patient went to the doctor and he charged fifty dollars, it was supposed to be that the patient paid that first fifty bucks. This was the ‘deductible.’ Patient, however, was under the impression that he got ‘free’ medical care and was reluctant to pay. Doc comes up with the solution: he bills the medical insurance company 100 dollars. They subtract the deductible and send him a check for the remaining fifty. Doc is happy, he got his fifty; patient has paid nothing so he’s happy. Only the insurance company is out fifty dollars, but they don’t know it. . .yet.

    The insurance companies caught on quick. They began to institute ‘procedure codes.’ Every ailment has a diagnosis code and a treatment code. Then the company only pays so much for each code. Doc can charge whatever he pleases, but the insurance company is only going to pay so much and nothing more. This turns out to be very advantageous for the insurer. The company is not willing to upgrade payouts any time too soon. Then they institute percentages they will pay for certain treatments. One hundred percent for preventive stuff. These don’t cost much anyway, and it appears that the company is doing something altruistic. Then only 80% for more routine things, and those ‘elective surgeries?’ Only 50%.”

    “How’d they get away with all that?”

    “Lobbies, mostly,” said Will Dangle. “Go to any city and the newest, fanciest skyscrapers are owned by Aetna, Cigna, Prudential and Blue Cross. They’ve got plenty of money and that means power.”

    “Yeah, but then something else hit the medical profession: litigation. Doctors were being sued—not for ‘malpractice,’ but for ‘mal-occurrence.’ Malpractice insurance premiums soared and docs learned ‘defensive medicine.’ They began running routine tests on everybody. They ordered x-rays and CAT-scans and MRIs for everything, in order to document their actions. Insurances paid for these basic procedures, and so docs made some money to pay those insurance premiums. This is how medical costs began to sky-rocket.”

    “OK, so this is when our MIT student says: ‘. . . nobody should go broke when they get sick.’ Think she was referring to government-run health care as being ‘free?’”

    “Suppose we did have congress pass some health-care bill. Doubt if it would work,” said Will Dangle. “Take as a metaphor, transportation.”

    Here a prolonged digression began:

    “Our society is pretty much dependent on the automobile, right? Roads and highways for cars are the infrastructure that propels all commerce. Everybody, except the remotest farmer on an unpaved lane, lives on a street somewhere. What if a senator suddenly declared car ownership a right? Then the government becomes responsible to provide everyone with an automobile. What kind do you think you’d get? A Mercedes? A Cadillac Escalade?” Will Dangle was being intentionally facetious, much to the chagrin of his listeners who had lost his train-of-thought.

    “We’d be lucky if we got a golf cart. Say, that’s not a half-bad idea! They wouldn’t cost much each. It would solve the oil crisis, and our dependence on Middle East crude. There wouldn’t be as many fatal accidents with vehicles that only travel fifteen miles-per-hour.”

    Delbert Shue took off his shoe and threw it at Dangle. “Git back on the health care subject,” he said.

    “My point is that government-controlled anything means inferior quality.” This was a very broad statement, indeed.

    “The insurance companies invented a term for themselves: ‘Third Party.’ There was the employer, who paid premiums, and the employee, who received the benefits, and the insurer—three parties. But they forgot about the medical professionals, what they call the ‘providers.’ If medical care is reduced to the bare bones, cost-wise, who’s going to provide? Already talented young men and women are shying away from attending Medical School. Too long, too costly, not enough rewards for all that. If the government takes over and institutes a system like civil-service ranks, who decides when the doctor gets a raise? I’d be afraid the good quality care you assume will happen, ‘cause the government is paying for it, will never materialize.”

    Unseen by the three men, the sun had been rolling around in the sky, like a number 7 Slazenger circling the lip of the cup, but not falling in. Then it took a dive for the jagged mountains in the west and the sky took on a yellow hue.

    “Other countries have socialized medicine and they have good doctors.”

    “Hmmm, not sure about that,” said Dangle. “Scandinavian countries have that cradle-to-grave government benefits system, but they also have income taxes of 110%. How does a person pay more than he earns, in taxes?”

    “Great Britain has had socialized medicine since right after the War,” said Stanch. He said it in such a way that the other two realized it was a capital ‘W,’ and referred to the Second World War. “There’s a class system in England. No matter how hard a person tries; it is very difficult to break into a different echelon in society. If your father was a shopkeeper, you will be in the merchant class. Nothing you can do about it. Some of the laziest, stupidest people are born to the noble class and enjoy all them privileges, but never earned a one. The only class that can be attained on your own merit is the medical profession. Gain a seat at medical school, and there is a special place in the doctor class. People don’t so much become doctors for the salary, but for the prestige.”

    Now it was getting truly dark. The saffron sky had diminished to aubergine. Delbert Shue got up and stretched. “Time for my dinner,” he said.

    The discussion had not reached any conclusions. A wheel-barrowful of explanations had been thrown about, but nothing substantive. Tomorrow the sun would come up as usual, unobstructed by clouds. They could continue then, after all they were retired. The three slumped off to their own RVs, tailbones sore from prolonged sitting. It was, simply, another day closer to a congressional vote to decide the future of health care in America. Another day when uncertainty remained in the forefront of so many discussions.