Those of you who have been following my blog for a while should know a few things about me. I am a proud veteran, and I have Crohn’s Disease. And I have been an outspoken critic of the Veteran’s Administration, and the Veteran’s Health Care System in particular. But I try to be fair in my criticisms, and when someone does something right they deserve to be recognized. Such is the case with my recent hospitalization at the East Orange VA Hospital. Following is a letter I wrote to the Secretary of Veteran’s Affairs (Des.), David Shulkin and the Director of the New Jersey Veteran’s Health Care System, Vincent Immiti.
I am a Cold War era veteran who has dealt with the Veteran’s Health Administration since 1994. Over the intervening years, I have had my share of complaints. I have been either an inpatient and/or outpatient recipient of services at multiple hospitals: Ft. Lauderdale, Wilmington (DE), Philadelphia, New York Harbor and, of course, the Lyons and East Orange campuses of the NJVHCS. I am not writing to tell you that rainbows are blooming over the VHA – only a fool would believe that. But I feel that after years of heaping some well-deserved abuse on what has proven to be a dysfunctional system, my most recent experience is deserving of praise for a job well done.
On Saturday, January 21 of this year I was brought into the East Orange Veteran’s Hospital Emergency Room. I have suffered with Crohn’s Disease since 1994 and this was the beginning of yet another hospital stay for me. I was not looking forward to it, as my previous partaking’s of the VHA’s hospitality always left me feeling more as if I were a POW than a patient. Allow me to say, I was pleasantly (as pleasantly as a hospital stay can prompt) surprised by this admission.
It truly was a night and day experience, compared to all my previous hospitalizations. Whereas in the past, my concerns and questions were met with derision or (even worse) indifference, this time I found the medical staff earnestly answering my questions, explaining the anticipated course of therapy and being attentive to my concerns and those of my family. In past hospitalizations, medications would arrive haphazardly without any semblance of a schedule, nurses would be impossible to find, even when called, and doctors acted as if I, the patient, were a burden they would rather not deal with. The only thing they seemed interested in was prescribing high doses of pain killers and moving on to the next victim.
Hospital cleanliness was always a concern, as I could go days without seeing a mop or broom used. As you’re probably aware, Crohn’s patients in the middle of an extreme flare are prone to having accidental, violent bowel movements. In 2009, after once such episode, the nursing staff did eventually come in to change the bedsheets – but with a set of blood-stained ones. Such was the level of contempt that the overall staff seemed to have for the patients in their care.
As veterans, we do not ask for anything special. Every veteran I’ve ever met is proud of our service to our nation and would gladly reenlist should the nation need our services again. As patients, all we’ve ever asked for is to be treated with the basic respect anyone should give another human being. The anger and disgust many of us feel towards the VHA is rooted in the failure of the VHA to recognize and act upon that humanity.
But as I mentioned, this hospitalization was not only what one would expect at any medical facility, but in many ways surpassed even the highest expectations one could have of any hospital. The staff exhibited all the hallmarks of a professional medical organization: courtesy, attentiveness, compassion and competence. Nurse calls were answered promptly, and if an RN was needed but unavailable, the LPN’s explained the situation. My attending physician not only provided timely and pertinent explanations of my care – in terms a layman can understand! – but proved an exceptional coordinator with the specialists I needed (gastroenterology, pulmonology and cardio). Tests that were performed were explained beforehand, including not only descriptions of the procedures but the reasons for them. The residents, interns and medical students did not treat me as an object of fascination on par with a living cadaver, but as a suffering patient with information they needed to perform their duties. Even the orderlies, janitorial staff and other support staff approached their jobs with a general friendliness and professionalism that made the otherwise dread of a hospital stay comforting.
The change is remarkable. I was going to attempt to single out individuals for jobs well done, but then realized everyone associated with my care deserves special recognition.
I am not a medical professional. I suppose you could say I’m a professional patient, given my history, but that’s the extent of my medical training. However, my post-military career has been in operations and program management. As such, I can recognize and appreciate when an outstanding manager has taken control of a bad situation and is effecting a complete turnaround.
As I began, I’m not going to gloss over the fact that there are still major problems and deficiencies throughout VHA. However, Mr. Shulkin, upon your confirmation I can think of no better place to start turning around the system than seeking out your best, listening to what they’ve done and implementing those practices throughout VHA. Based on my recent stay, you would do very well to begin with Mr. Immiti. The change he has effected is nothing short of amazing.
I thank you for your time and again, congratulations on a job well done.
Semper Fi and Regards,
(Author’s note: I originally published this post in November, 2014. Now that the Northeast Corridor is bracing for the first major storm of this winter season, it seemed a good time to remind everyone that the problem hasn’t gone away)
On any given night, some 50,000 veterans end up spending the night outdoors or in a homeless shelter. Additionally, there are estimates that as many as 1.4 million veterans are at risk of becoming homeless.
In a nation where politicians trip over themselves to prove how much they care about veterans, this should be impossible. Yet the facts are what they are. Men and women who’ve sacrificed years of their lives in defense of their country often find themselves reduced to begging for scraps of food and a bit of shelter. The reasons for veteran homelessness mirror those in the general population: mental health issues, substance abuse and just plain bad luck top the list. But if any subset of the population has earned the privilege of not freezing on a winter’s night, veterans should.
The VA, for all of its shortcomings, actually does a reasonable job of trying to care for homeless veterans. But funding remains an issue. For instance, there is the VASH-HUD program, which provides homeless veterans with housing vouchers and community support (such as job assistance and counseling). It has proven to be one of the best homeless programs in the country with less than 5% of the veterans accepted returning to homelessness within 5 years.
For FY2014, VA was granted funding to assist 78 homeless veterans in New Jersey. 78. For the entire year. I can go to Military Park in Newark and find 78 homeless veterans.
But there is a solution, and one that would actually save the government money in the process. All across the United States, sequestration and other budget cuts have resulted in hundreds of military bases being closed. They sit, abandoned, awaiting a government auction where the property will be sold for pennies on the dollar. In New Jersey, Fort Monmouth sits abandoned, falling into disrepair while the former megabase of Fort Dix/Lakehurst Naval Air Station/McGuire AFB occupies 10 1/2 square miles in the New Jersey Pinelands, struggling to find a purpose after the 1991 base closures. Today, it is used a training area for National Guard and reserve units, with a federal prison and aircraft maintenance wing. Fort Monmouth once housed 21,00 troops; Dix-McGuire 27,000. On both bases, the buildings sit, more intact than less.
The proposal is this: turn a portion of either base (and the dozens more around the country) into a Veteran’s Homeless Prevention and Community Reintegration Center. Rather than hiring outside contractors to maintain the buildings, grounds, power stations and the like, assign those jobs to the veteran population living there. That would solve two problems that are often at the heart of veteran homelessness: a lack of civilian job skills (infantryman isn’t exactly a skillset required on Main Street) and providing a sense of purpose. Rather than requiring the VA to provide follow-up care on veteran’s scattered throughout the state, they would be centrally located: a VA clinic could be opened there, proving treatment for medical and mental health issues. Finally, rather than spending up to $25,000/year in housing vouchers per veteran, the government would roll that money into a facility it already owns.
Everyone wins. Homeless veterans find shelter, camaraderie, purpose, services and the opportunity to reclaim their lives. The government honors its promise to “care for him who shall have borne the battle.” And our nation’s citizens can rest easy in their beds at night, knowing that no veteran needs to sleep on a sidewalk.
Begging pardon from John Mellencamp…
I have a few questions that were artfully dodged, or never asked, during this afternoon’s presser:
1. How many days was the patient symptomatic, and therefore contagious, before going to the hospital for the first time on September 24? I mean, seriously, how many people go to a hospital because they’re running a fever and sneezing? Not many I know of, at least not right away.
2. How many people did he come in contact with, total, before being quarantined? He’s apparently visiting from Liberia. To imagine he didn’t visit any stores, restaurants or tourist sites in the 4+ days we’re certain he was contagious prior to quarantine is ludicrous.
3. How did he get to the hospital on September 24? By private car, taxi, ambulance? Or worse – by public transit?
4. Ditto for September 29.
5. Dallas is, besides being a large city, also a major worldwide transportation hub. How many of those the patient contacted while he was walking around contagious, have since departed by plane, train, bus or automobile…and where did they go?
I’m sorry, but the CDC can tell us they have everything under control all they want. But until they can tell us with a straight face that they have the answers to the questions above, I feel as though they’re recreating this scene from “Animal House “…
Those of you who follow me on Twitter or Facebook know I recently spent 8 days hospitalized once again. My ongoing battle with Crohn’s Disease, one that has consumed the last 22+ years of my life, remains unrelenting. Like all of such events over the past three years or so, this hospitalization didn’t end with long-term remission of my disease activity or even the hope of a near term remission.
I could complain and I doubt many of you would be upset if I do so. But I’ve never really been one for complaining about things beyond my control, nor do I think that really accomplishes much. Certainly, venting can ease the mind but it’s only a temporary relief. I pointed out once before that life’s recent turns have, if anything, made me more reflective and this most recent turn only served to reinforce that attitude.
But reflective of what, exactly? Well, in a word: EVERYTHING.
Faith, religion, why we’re here? Yes. My personal history, my family, friends and relationships? You bet. Medicine and medical research? Naturally. My overarching view of our world, our past and our future? Certainly.
There are only so many times a man can stare at his own mortality without contemplating the wonder and the why of it all, I suppose. Or the alternative could likewise be true: all these brushes with Death’s door may have already left me insane – in which case, you’ve been reading the rantings of a madman. We’re about to embark on a journey to find out which is true over the next few days and weeks. I’ll leave the decisions about my sanity to your discretion – which considering my readership, may be the boldest move I’ve made yet!
For a blog that spends as much time on political matters as mine, you may be wondering how I managed to leave any mention of that topic from my list of contemplations. But here’s your first point to ponder in judging my perspicacity: isn’t the political the one realm where we publicly express our personal philosophy?
Tomorrow, we begin…
Perhaps because I’ve never believed our nation is a bunch of redistributive idiots at heart, I’ve watched as the country plunged headfirst towards Obamacare with fascination. Maybe because nearly all my adult life is partly defined by my battle with Crohn’s Disease, I pay an inordinate amount of of attention to the Battle for Health Care Reform. Could be because I am even now lying in a hospital bed in the latest go-round with Crohn’s, I’m amazed at the dizzying pace of lies pouring forth from the administration of President Barack Obama over the past four weeks.
What is most sad is that a sizable chunk of the American people are just sitting back and taking it. Despite the evidence of their own eyes from the past four years, they continue to loll about and let the administration get away with the greatest government take-over of American life in history. I’m stupified by the willingness of the American citizenry to just play ostrich when they should at least get to strutting like Foghorn Leghorn.
Then it hit me.
With all the force of a Superstorm, it hit me square in the face. After 40 years of war, debt, moral erosion and political scandal, the American people are tired of dealing with it all – and longing for something they never experienced. The Founding Fathers left us a political and economic system that only works if everyone (or nearly everyone) participates. Most people don’t participate unless they have either a very personal interest in a particular program or they’re corrupt enough to look upon governement service as a way to create individual wealth.
More later. As mentioned, I’m typing this from a hospital bed. In the meantime, am I on the right track? Is the reason most Americans just don’t care because we’ve spent four generations being battered into submission?
Long time readers already know I have Crohn’s Disease. I’ve dealt with the condition for almost 22 years, and for large chunks of that time I’ve relied on the Veteran’s Administration Health Care System for medical treatment. As such, I remember the bad ol’ days – when simply signing up for medical care was nearly impossible. The program has made great strides in the past decade and medical care has improved. This isn’t to say the available care is good everywhere; it simply means that fewer VA medical centers seem to have killing veterans as their top priority. I’m also more fortunate than most vets. Because of where I live, I can actually pick and choose from four medical centers. If I lived in Montana, that option wouldn’t exist – I would be stuck with whatever quacks the local VAMC could find to staff the place.
But beyond the quality of medical treatment, there is another problem that, quite frankly, I can’t see any way the VA can correct. The Veteran’s Administration is a government agency – and as such, a ridiculously bureaucratic nightmare to navigate. Just the simple process of checking in for an appointment is a time consuming mess (it means seeing three different clerks, in different offices, before actually getting into the clinic – where you then need to fight with another clerk in order to see a specific doctor).
But there’s another aspect to the bureaucracy that most people (especially those who defend government programs as both necessary and infallible) often forget about: that bureaucracy is staffed by people whose competence is often less important to keeping their position than a host of other factors. A perfect example is what I am now experiencing. Because I’ve been dealing with Crohn’s for so long and every other medication ceased working, I’m now undergoing chemotherapy treatments. It’s a “Hail Mary” attempt at getting this disease under control and it actually seemed to be working.
Enter the VA bureaucracy. As part of the treatment regimen, I stopped the infusion therapy and was supposed to switch over to pills. Great! Fewer trips to the local VAMC, no need to hit up friends for rides, fewer side effects. The pills were supposed to be mailed to me two weeks ago. When they hadn’t arrived by last Wednesday, I spent 45 minutes on the phone to ask where my medication was. Not to worry, I was assured. Because of the holiday weekend, it might take an extra day or two for them to arrive in my mailbox. The weekend came, the weekend went and still no pills. I called back today and after another 38 minutes (most spent on hold), I discovered that somebody, somewhere, placed a “Do Not Mail” flag on my VA pharmacy account. No reason, no rhyme, no excuse – and the faceless person on the other end of the phone assured me they were incapable of releasing the flag.
But wait! It gets even better. A week and a half ago (three days after the pills were supposedly mailed), I spent another hour at the VA pharmacy to get other prescriptions. The clerks (another bureaucratic mess, you need to see four clerks to get a prescription filled – and there isn’t even a paper form, it’s all in the computer) all had access to my account. All of them saw the prescription in question was ordered, one even asked me if I wanted to wait for that one, too. Not one mentioned the “Do Not Mail” flag or offered to remove it.
Is it incompetence? Bureaucratic overlap? A simple failure to communicate? Whatever the cause, the result is the same: another dissatisfied and confused customer. On the surface, an example of how the Veteran’s Administration can screw up a simple task. At a deeper level, it’s a perfect metaphor for why the less government does, the better.
For my friends wondering how I can simultaneously avail myself of a government program and decry government programs, you can find extensive arguments in my archives. But this is an earned benefit, through my prior service to our nation. And for myself and the millions of my fellow veterans, the VAHCS can be done away with by simply issuing us medical insurance that allows us to see private physicians. (Yep, it would cost the government less, too).
If you spend any time on Twitter or Facebook, you’ve undoubtedly come across the “#Defund” hashtag. If you follow the news even cursorily (and odds are you follow it more closely than that, if you’re reading this) then you also know the House of Representatives voted yesterday to continue funding government operations until December. Everything, that is, except the Affordable Care Act – more popularly known as “Obamacare.”
The President’s reaction? He’s taking the CR personally, certain that the motivation behind it cannot be ideological in nature. “They’re not focused on you. They’re focused on politics. They’re focused on trying to mess with me. They’re not focused on you” he stated during yet another campaign speech yesterday. (As an aside, why is he campaigning? I thought the election was last November.) While my personal dislike for the the man in the Oval Office has grown considerably over the last five years, my disdain for Obamacare hearkens all the way back to its inception. Trust me on this one, Mr. President. My opposition is nothing personal – and neither is it for the people with whom I’ve conversed with on the subject.
I support the defund movement, because it is our last, best hope of getting rid of the “train wreck” (Max Baucus, the guy who helped write the ACA, called it that) and replacing it with something that actually addresses the rising costs and failed delivery of health care in the United States. I support the defund movement, because the economic impact of even a temporary federal shutdown would be far less than realized from your weapon of Mass Economic Destruction. Finally, I support the defund movement because the American people have had about all they can take of Obamacare.
Let’s start with that last point first. That you’ve always a had somewhat regal view of the Presidency is certain. Since early on, you’ve complained that you aren’t a dictator, or king, or emperor, or president of China. The actual concerns of the average American were hardly the thing that kept you awake at night; why else the dozens of “pivots to the economy” over your 5+ years in office? Over the past year, overwhelming evidence was exhumed that you consider yourself above the American people. From the failure in Benghazi, to the IRS crackdown on conservative and libertarian groups, through the revelation that the NSA is spying on everyone, to your recent attempt to force the nation into an ill-conceived war in Syria, said evidence is damning. You really did think for a while there that you are a de facto dictator.
Obamacare was our precursor. Yes, the American people wanted something done about health care. But what we wanted and what we eventually got are two very different things. Instead of reform that lowered costs and made delivery easier, we simply got told we had to go buy health insurance – or else. No matter, we were assured countless times since: once the law rolls out, you’ll love it! Why, didn’t Nancy Pelosi tell us that in order to find out all about the wonderful goodies in the ACA, Congress had to pass it first? The sycophant press quickly dubbed the new law “Obamacare” and you ‘begrudgingly’ accepted the name. FDR had the New Deal, LBJ had the Great Society, BHO had Obamacare.
Never mind that your signature piece of legislation has never been popular with the very people it is supposed to help. Polls show what support existed at passage has slowly slipped away. It’s your signature piece of legislation, by golly! So of course you’re right to be mad at Congress for attempting to undo the damage done, for seeing it as a personal attack and a personal affront. Never mind that the CR defunding Obamacare is actually more popular than the law and never mind that it enjoys popular support (and not just among the Tea Party). Never mind that it’s very passage is regarded is the single most important reason your party lost control of Congress in the 2010 mid-terms. If you refuse to sign that CR, then it’s the Republicans’ fault that the government runs out of operating cash on October 1. Not your own pigheadedness, not your own wanting to be a dictator – or failing that, being seen as the most “transformational” President since FDR.
About that threatened federal shutdown. We’ve been down that path a few times and quite frankly, they aren’t that scary to most Americans. There will be an inconveniences, of course. For instance, I won’t be able to track a flight on the NTSB’s website. I won’t be able to call the IRS with a question about my taxes (which, by the way, I’d probably sit on hold for 20 minutes and then be told to ask my tax professional). But we already know from past experience that essential government functions will continue: the Army won’t be disbanded, the FBI will keep hunting bank robbers, grandma will still get her social security check. Even progressive economists admit the actual economic impact would be minimal, resulting in a reduction of less than 1% of GDP.
But the economic impact of Obamacare is already being felt across the economy. Nobody has a full accounting thus far, but in the past week alone nearly 500,000 people have had their hours cut to 28 or fewer and their existing health coverage terminated. Another 35,000 have lost their jobs completely. Although you love to tout the million jobs created in 2013, you have yet to acknowledge the fact that 1.2 million of those jobs are part-time, without health coverage. Those are real economic impacts directly attributable to your signature legislation. Here’s another impact you may not want to acknowledge: those workers are not only facing a drop in income from reduced pay, they are now going to be hit with a new expense: mandated health coverage. Sure, there’s a subsidy headed their way (provided Obamacare is fully funded) – but those subsidies won’t cover the full cost for health insurance. A government shutdown might reduce GDP by 1%. But Obamacare is easily dropping GDP farther than that and will cause it to crash even further. All this was avoidable, but neither you nor your progressive friends apparently live in the real world, the one in which businesses aren’t going to spend a dime more than necessary. You were warned by everyone from the Chamber of Commerce to (gulp) Donald Trump, but still you refused to listen. The economic mess your signature legislation created is wholly owned by you, as well as the Senators and Congressmen you bought off.
Finally, there is the train wreck. I could list everything that has gone wrong so far with getting this mess in place, but I did that a while back. To that list I add three more fiascos: the doctor shortage, the uninsured and one I’ll keep you guessing about until the end.
The doctor shortage was known and supposedly addressed in the ACA. Simply put, there aren’t enough primary care doctors available to cover everyone. Getting an appointment to see your doctor is already hard enough (and let’s not forget the wait times once you’re in the waiting room). The AMA now anticipates that wait times are going up by about 6% – and nobody anticipates getting an appointment will get easier. Will we see British-type difficulties in getting an appointment, with waits as long as a month? Will they be more like typical waits in the VA system, where it can take up to 6 months to get an appointment? Nobody knows, but the alarm bells should be sounding: in the New York metro area, a recent study found that time to appointment was now ranging from 6 to 61 days, with an average of 24.
The uninsured? When Obamacare was trotted out to the public, we were told that all but a few, perhaps 3 million, of those without insurance wouldn’t be covered. In March, CBO blew that apart with a new estimate: 7.5 million. Last week, that get shattered again, when DHS announced that because of the rollbacks, waivers and deferments, that as many as 30 million people still would be uninsured come January 1, 2015. That would mean we went through all these gyrations over the last 36 months to insure an additional 2 million. Call me what you will, but that amounts to the second biggest load of crap ever handed the American people from Washington DC.
The biggest load of crap ever? Well, here’s the caboose of the Obamacare train wreck. Mr. President, you have promised us that “If you like your health plan, you can keep it.” You’ve pummeled the American people with that line for over four years, even though as far back as June, 2009 you admitted yourself that the statement WAS A LIE. Now millions of Americans are finding out what a monstrous pile of horse manure that line really is. Insurance companies, because of the regulatory morass that this demon child legislation created, are gutting health plans and informing their customers that come January 1, 2014 their current insurance will no longer be available.
In short, I’m supporting the #DEFUND movement because really, what other choice does our country have?
“The natural distribution is neither just nor unjust; nor is it unjust that persons are born into society at some particular position. These are simply natural facts. What is just and unjust is the way that institutions deal with these facts.” ― John Rawls, A Theory of Justice
Recent events in my own life have forced me to re-examine some of my most deeply held convictions. During the time I’ve been absent from this blog (wait – you didn’t notice???), four events in particular gave rise to self-reflection:
- Crohn’s Disease, with which I’ve done battle for 22 years, once again reared up and forced me to the sidelines
- My eldest son, who was born with a developmental disability, is now caught up in the nightmare that is the state mental health system
- I’ve rented a room to a family that is emblematic of all that is wrong with the way government abuses good people
- Another of my tenants passed away during the night
You’re probably wondering why I would spend the time to ponder what one prominent politician describes as “esoteric debates” when life brings such immediacy. You’re probably wondering further why I would take the time to write about that internal debate. The answer is that such internal debates are neither esoteric nor a thriftlessness exercise. It is by determining if our views are malleable to the events in our lives that we discover if our core values are the result of dogma or the sound exercise of judgement.
The overarching theme of President Obama’s tenure is that of “fairness.” Only, in Mr. Obama’s world, the fairness is defined by outcome; one in which those aggrieved receive what they deem to be their just share. This doctrine is exemplified in the policy objectives of his administration. Be it the underlying argument for Obamacare (that the only fair medical system is one in which everyone has health insurance), economic policy, the tacit embrace of the Occupy Wall Street movement, the management of foreign policy (attempting the equal embrace of islamist and democratic ideologies abroad) or dozens of other initiatives pursued, Mr. Obama is clear in how he defines “fair.” Further, his actions (including his insistence on defending the possibly unconstitutional and certainly intrusive domestic spying program) demonstrate a certainty that governmental institutions are the best method of obtaining this measure of fairness while denigrating the roles of other, traditional venues.
Unlike many of the President’s critics, I do not think he is an uncaring ogre bent on instituting a draconian new way of life on the American people. Although we disagree on most issues, I certainly applaud his efforts to afford all people equal protections under the law. I think it is indicative of his nature, in that he actually cares about the quality of life afforded ordinary Americans. I think most of my fellow countrymen have that same feeling and that underlying belief in his nature is the ultimate reason he won re-election – even though most of us remain opposed to his specific action plan.
I also think that more than a difference in political philosophy, we have divergent views on reality and possibility that slice to the core of our differences. The President is what might best be termed a government interventionist. Government Interventionism infects both the modern liberal and conservative movements. It is characterized by a belief that not only can the government positively effect outcomes, but that it should. While conservatives and liberals often have different goals in mind, they agree with the principle of a results-based system. As anyone who follows me on Facebook or Twitter is well aware, I have never subscribed to this view of governance.
My introspection of the past weeks has called me to wonder if, perhaps, this approach is best. One of the criticisms of Libertarians is that we are a callous bunch, uncaring about how life’s travails affect our fellow men. Those who know me personally know this isn’t the case. Of the root causes for my self-reflective journey, two involved people that I know cursorily. Yet, they are people who strike me as somehow getting less from life than their character would indicate they deserve.
Allow me to begin with the woman who died in her room last Wednesday. Although I knew her only a few months, what I did know belied her situation. She worked full-time (a rarity in today’s economy) and was well-respected by both her coworkers and employer, she had a large and close-knit family and she was outgoing, gregarious even. Yet, she died alone in rented room, the victim of a long battle with a chronic illness; in her case, diabetes. From what I could see, it was not a pleasant or painless death. She must have known she was in desperate trouble – I found her collapsed at the foot of her bed, in a position indicating she struggled to get to her door, with her phone fallen from her outstretched hand and smashed into bits. If we live in a results based society, why did she die in this manner? What could society have done differently that would have ensured that at the very least, one of her family would have been with her in her time of greatest need? At her funeral on Saturday, meeting her family and friends and seeing the outpouring of grief that overcame them all, I wondered why a woman so beloved by so many, who had done all society asked of her, should have been subjected to such a terrible death?
The week prior to her passing, I rented a room to a family of four. One room, four people, sharing a kitchen and bath with three other tenants. These are decent people, again doing all society says they should do. Both parents work and the mother attends nursing school; the children are incredibly well behaved (I wish mine had been so well behaved!). But they are victims of governmental bureaucracy as much as anything. The father openly admits to making mistakes when he was younger, which resulted in a felony conviction two decades ago. Since then, he’s done the things we tell him he should do: work to support his family, avoid the drama of street life, return to school and complete his GED. He would like to continue his education, but supports his wife as she works towards getting her degree. This is a family, in short, that is playing by all the rules our society dictates – yet they are reduced to living four to a single room, because it is all they can afford. The welfare system, the one that liberals tell us prevents this type of thing from happening and conservatives insist is too generous, is unavailable to them unless the father abandons his family. It is his decades old prior conviction that denies them access to it. Somehow, this result doesn’t seem fair to me.
Along the same lines, my personal struggle with chronic illness – in particular, a 22 year battle with Crohn’s Disease – has become much more difficult over the past two years. Over that time, I’ve had to shutter a business, spent nearly 8 months (cumulative) hospitalized and watched my family’s wealth get drained until we were destitute. I’ve rebounded some financially, but am in no way near the same fiscal position I was in 2011. Most of those around me think it unfair that my life has taken such a drastic turn, or that my reality is I’m likely wheelchair bound within the next two years and probably blind in less time than that. Certainly I wish there were a better prognosis.
Finally, there is my oldest son, Dennis. Some of my long-time readers are aware that he is what society euphemistically calls “developmentally disabled.” His reality is that he will never comprehend things the way you or I do. His IQ is 54; intellectually his development is equivalent to a second grader, emotionally he is at roughly the same stage as most 13- or 14-year olds. So while physically he’s a strapping 25 year old young man, his mind has yet to catch up to his body. Odds are that the two will never be in sync. This is the crux of his current problem. Because of his condition, he finds it difficult to express his feelings, except to occasionally blow up the way most 14 year old boys will. About 6 weeks ago, he found himself in a situation where he was being teased (not an uncommon situation, unfortunately) and lost his temper. The police were called; they followed protocol and brought him to the emergency room for observation. Which is where the nightmare began. Rather than checking his medical records, the hospital diagnosed Dennis as a violent schizophrenic and packed him off to the closest mental hospital. The doctor (I use the term in deference to his degree, not his competence) there confirmed the diagnosis, again ignoring his medical condition. A competency hearing was held, in which the doctor amplified his diagnosis to include the term “homicidal.” And so my son sits in a mental hospital, not understanding what’s happening or why as we fight to have him moved to another facility and have a new diagnosis issued that accounts for his disability. I’m not sure who would consider this outcome “fair.” If the President thought the justice system was ultimately unfair to the family of Trayvon Martin, I can’t see how he could consider this fair.
In reflecting on these incidents, each with an outcome which seems disproportionate in outcome to circumstance, I wondered if the results would be different were the fairness doctrine imposed by society replaced by libertarian values. Chances are that in three cases, the results would be the same but the perception would be different.
- In a Libertarian society, we would acknowledge that the young lady who died chose to live her final days alone. While there still would be sadness accompanying her death, it wouldn’t be considered unfair that she had neither friends nor family with her in her final hours.
- For the family renting the single room, society wouldn’t consider it unfair that a hard working mother and father would resort to housing their family in these conditions. In a Libertarian society, they would be celebrated as examples of how to face adversity.
- As for my health, nobody would consider it unfair that I’m sick and fated to becoming sicker. Unfortunate? Unlucky? Sure, those sentiments would be common. But the choices my family made in previous years were our own and left us in the financial position we find ourselves. I knew my health was precarious before launching my last business; it was our choice to take that route as opposed to my taking a job in what is a poor economy. Using Libertarian values, we took a calculated risk that proved unwise. But in the interventionist society we live in, we demonstrated incredible recklessness and need to be saved from ourselves.
Libertarians believe that fairness in opportunity is far more important than fairness of outcome. After all, if everyone is free to pursue their life’s goals – if they are truly at liberty – then the outcomes are inherently fair. Differences in outcome will have more to do with natural ability and desire than anything a government can do. While the odds are that the above situations would not be dramatically different than in a Libertarian society, there is one important way in which one of those situations would be better. The people above would be less constrained by a restrictive society. The family in one room may well be much better off, since Libertarians tend to look at most drug laws as counter-productive – meaning no felony record for the father. He would certainly have better employment opportunities without that black mark.
As for my son, a Libertarian society would probably mean all the difference in the world for him right now. Without the modern police state in which presumed innocence is nothing more than a tired cliche, it’s doubtful he would be where he is now.
So, yes, I’ve reflected and pondered. You’ve read my conclusions. You may not agree with them, but I end this period of introspection confident in my core belief that the equitable outcomes can only be guaranteed by the one truly fair system ever known to humankind. That is, that by believing in the individual and providing them with the liberty to achieve to their individual potential, a government does its best service to the governed.
Some of you may recognize the title of this post as part of a quote from Winston Churchill:
“Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”
Although Sir Winston was talking about the Battle of Egypt, the same could be said of Obamacare today. Since this is a holiday week, there is a good chance that you missed the announcement from the Treasury department on Tuesday afternoon. The Obama administration unilaterally decided to delay implementation of the employer mandate part of the law until 2015. Never mind that this is another example of a President who repeatedly decides which laws he’ll enforce (in direct contravention to the Constitution). That’s a another post for another day. No, this is yet another example of what was supposed to be the greatest thing since sliced bread is actually what a whole bunch of us realized it was from the beginning: in military parlance, a BOHICA SNAFU. (For those of you unfamiliar with military terms, this is a family blog. Feel free to use a certain search engine to look it up).
How bad has this been? There are bad laws and there are poorly executed laws. But this law was less about the stated intention (revamping the American healthcare system to provide easier access, with lower costs, for all Americans) than it was about a political power play between the two major parties. The result was a poorly conceived law, rammed through an indifferent Congress by a power-hungry administration, crammed full of pork and incapable of actually working. Every day seems to bear out the fact that nobody read the ACA before the final vote (even if they had, it would have taken a year more just to figure out the details).
To date, there have been 10 instances where the Obama administration has been forced to admit defeat on a particular program in the ACA. The reversal on the employer mandate is the latest, and one of the most critical. The reason they gave, that businesses needed more time to figure out the paperwork, is as believable as the tooth fairy. The real reason is that businesses already figured out how to avoid the paperwork completely: keep workers under the 30 hour limit which would trigger the mandate. Friday’s jobs report, which showed that more part-time jobs were created than full-time jobs, underscored this.
Score one for those of us who warned that Obamacare was an economy killer.
Unfortunately for the American worker, the individual mandate is still in place. The removal of the employer mandate means that some 36% of Americans are now going to be forced into purchasing private medical insurance. The employer mandate proved politically unworkable in practice, I suspect that by October (when everyone needs to start shopping) the individual mandate will prove even more politically impractical.
By the way, here are the 9 previous ACA failures:
- The CLASS Act: a long-term care insurance program that died last year. The reason? The law, as written, couldn’t be funded. The supposed budget savings amounted to 40% of the total deficit reduction attributed to the ACA.
- Federally mandated insurance exchanges: States were given literally unlimited funds to set up insurance exchanges that would allow uninsured folks to shop for coverage. The problem is that only 17 states have bothered with setting up the exchanges and the law requires HHS to set up exchanges for any state that doesn’t. But the ACA failed to foresee that states might not want to bother with the regulatory and administrative nightmares in trying to create a health care exchange and provided zero funds. HHS estimates it will cost at least $1.5 billion dollars to get the exchanges up and running. Good luck with that.
- Small business exchanges: along the lines of the individual exchanges, these were intended to allow small business employees to access the same rates enjoyed by employees at major corporations. They aren’t dead yet – but like the employer mandate, they have been delayed until 2015. The problem isn’t political here, though – it’s a real-world issue. Namely, how do you get the same actuarial certainty for an employee at a company with 10 employees as one who works with 1,000 other people? (Trick question: you can’t do it. But remember, the math geniuses in Congress who dreamed this up also raise government spending, then call it a “budget cut.”)
- 1099 reporting: This was a major funding tool for the ACA that was scuttled because it amounted to both a new tax and a reporting headache for every employer in the country.
- The Great Waiver Debacle: a provision in the ACA allowed HHS to issue waivers to organizations that could prove they needed them. Lo and behold, the Political Patronage and Payback Machine kicked into high gear. Over 1200 waivers have been granted (nobody knows for sure, because HHS stopped reporting the numbers a few months back). But if you gave to the Obama campaign or the DSCC, it looks as if you got a waiver. Funny how a law that was supposed to benefit everyone has proven so incredibly unpopular in core Democratic Party constituencies.
- The Pre-Existing Plans: great idea, on paper. Anyone who has a preexisting condition knows how difficult it is to find medical insurance. But once again those Congressional mathematicians didn’t realize how much it would cost to insure everyone – and the program has already run out of money. No more people are being accepted, even though HHS estimates that only 30% of those eligible are covered.
- Children Only Plans: under the ACA, if an insurance company sells child-only healthcare plans they need to offer coverage to kids with preexisting conditions. Somebody forgot to tell Congressional Dems the way the marketplace works (that companies do not willingly increase costs without some future benefit). The child only plans have virtually disappeared from the marketplace, a casualty of Obamacare.
- The “Basic Health Care Plan”: What’s that you say? You’re in perfect health, you’re young and you really don’t want to pay for full coverage that you can’t afford, even with the promised subsidies? Well, not to worry: the ACA mandated that states offer a basic plan – or essentially, catastrophic coverage-only. Except, as with the other mandates, it has proven unworkable and pushed back to 2015.
- “If you like it, you can keep it”: I saved the best for last! The greatest example of marketing hucksterism exhibited by the Obama administration was the President’s repeated assurances that if you liked you current health coverage, you would get to keep it after the ACA was passed. It’s pretty clear at this point that either the President is as dumb as rock when it comes to market economics or a bald-faced liar, because millions of Americans no longer have the health insurance options they had 4 years ago. Heck, HHS expects that some 126 million Americans will see a “significant” change to their health coverage as a result of the ACA.
The administration and Congressional Dems keep telling us that we’ll love Obamacare once it fully takes effect. They insist the law’s problems have more to do with poor marketing and Republican obstructionism than any basic flaws. But the record on implementation has more failures than successes and the law keeps proving to be more and more unpopular across all demographics.
Here’s a suggestion for the President. Admit that the latest reversal is, in fact, proof that the ACA is a disaster. Politically, it swept your party out of power in 2010 and is threatening to reinforce those losses in 2014. If you are truly interested in your legacy, which seems to be the general consensus among the DC elite, then do something no President has done.
Declare that your “signature accomplishment” is failing to deliver on the promises it made. Ask Congress to repeal it, scrap it and consign it to the dust heap of history. Ask Congress to work together to craft a healthcare reform package that actually works to improve delivery and reduce costs. In short, take ownership and command the respect true leadership creates.
This is the beginning of the end. The only question at this point is whether the President can rewrite the script and create a happy ending. If the past 5 years are any indication, he is politically incapable and (more importantly) personally unable to do so – and the nation will suffer as a result.
You may not have seen this (it certainly isn’t getting any play in mass media), but apparently the President thinks issuing an executive order will fix what ails the Veteran’s Administration’s approach to mental health issues. Or maybe it’s a cheap ploy for votes…nah, no politician would stoop that low, would they? The funny thing is, the 24 hour standard he’s ordering is actually worse than existing VA guidelines – and which the IG notes the VA meets less than 50% of the time.