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Yesterday, Jane highlighted a post by Matt Stoller on the thugs who run the money side of things in our health care system.  Matt was commenting on a Krugman op-ed in the NYTimes that was great reading and that, unfortunately, was stuck behind the Times Select wall.  (Jane helpfully provided a snippet in her article, so you can get a taste there if you missed it.)

The NYTimes also highlights some differences in policy objectives and priorities between the GOP and the incoming Democratic leadership on the issues of negotiation of drug prices and on the CHIP program (the state's children's health insurance program that is vital to the medical care of low-income kids across the country), among other things, in a news article written by Robert Pear.  I wanted to highlight a bit of that for you this morning, because it ties into some discussion we had on Friday that I wanted to continue.  From Pear's article:

Within days of convening, the new Congress will return to some of the biggest battles of the last decade as House Democrats try to rush through legislation requiring the government to negotiate lower drug prices for Medicare beneficiaries and overturning President Bush’s restrictions on embryonic stem cell research.

The Medicare proposal highlights the profound differences between Democrats and Republicans over the future of the nation’s health care system, the proper role of government and the role of private markets in securing the best value for the huge sums spent on health care.

State officials say they wish Congress would focus on a more immediate problem: money for the Children’s Health Insurance Program, which provides coverage for four million low-income children, is running out in more than a dozen states.

Dr. Rhonda M. Medows, commissioner of the Georgia Department of Community Health, said, “Our program will run out of federal money in March, and all 260,000 children in the program will lose their health care coverage if Congress fails to act.”

In debating the future of the children’s health program, which has broad bipartisan support, Congress will take up proposals to cover some of the 46 million people who have no health insurance....

Administration officials suggested that Mr. Bush would veto a bill calling for price negotiations. Democrats could then exploit the issue in the 2008 campaign, as they did in the midterm elections.

So, just to be clear, President Bush objects to the Federal Medicaid program having the same rights to negotiation of prices in a free market environment as, say, WalMart enjoys currently, and would veto the bill as a means to...what? Protect the profits of the drug companies who have so richly paid into his campaign coffers? The free market negotiations by the Medicaid program are anathema to Republican political values how, exactly?

And continuing to cover children who have no access to medical care otherwise is a very, very cost-effective method of long-term health care and disease prevention.  These are children who might otherwise not receive their immunization, their follow-up care for early childhood illnesses which could then lead to complications such as asthma, hearing loss, and all sorts of things being missed that early intervention services such as the Birth To Three program and other social services options can make a significant difference in developmental progress for a lifetime of behavior and learning. 

[And, btw, every state is mandated to have a Birth to Three program.  Here's a link to the WV program's website, but if you know of an at risk child who is showing any sort of developmental delay, this is a free program paid for by the federal and state departments of health because it has been proven to decrease educational costs due to early intervention -- and you can likely find a website for your state's program with a simple Google search. 

It is a wonderful program, and they do physical therapy, occupational therapy, speech therapy and psychological intervention for kids ranging from severely autistic to down syndrome to slight speech delays to everything in between.  In WV, they work with children regardless of your income, and I have seen the folks involved in our local program work miracles with the kids they see.  Numerous studies have shown that intervention for a delay or other developmental issue within the first three years of life can have amazing results, because the brain pathways are still forming at that early age -- so if you think that a child has a delay, don't wait -- contact them and they will come to your home to do the evaluations in most cases that I know of when I've worked with them through the years.  Thought maybe a reader could use this information.]

A question for health care coverage for children is not something that should be difficult:  small children need health care, whether or not their parents can afford it -- it is not the child's fault that it was born into a poor family, and that child should not be penalized for that if at all possible.  Because we ALL end up paying even more for that lack of care over the course of that child's lifetime as a result.  I know, I have seen the long-term effects of neglect on at risk children up close and personal in abuse cases and juvenile cases, and no one who has seen these children close up could possibly say with a straight face that they deserve what they get.  No one.

Poor Americans who have no health insurance depend on exactly what Matt and Jane discussed yesterday -- emergency room medical care.  It is reactive care, not preventative, and it ends up costing taxpayers millions of additional dollars in unpaid medical expenses for diseases that might have been preventable, or more easily treated had they been caught earlier, and everything else because, like we do with so many other things in this country of ours, we fail to do the cheaper preventative steps up front that would save ill health and increased long-term costs over a lifetime.

Additionally, there have been increasing questions about health insurance companies who abruptly cancel insurance coverage for people with chronic health conditions.  A few weeks ago, the WSJ had a profile of a woman with lupus whose insurer informed her that she would no longer receive health coverage because she was sick and it was costing them too much money.  That is a far cry from the reason that health insurance pools were formed originally to spread risk across a larger pool of people to ensure that the most at risk were able to still receive adequate health care. 

The follow-up letters to the editor in the WSJ run the gamut of political positions and personal thought -- but ultimately the questions come down to this:  is the purpose of health insurance to provide health care to everyone who pays into the system, and to spread risk across a broad pool of Americans...or is its sole purpose to maximize profits for insurance companies?

On Friday, I did two articles on poverty in America -- Part I and Part II -- talking about the need for a more comprehensive conversation about poverty and its attendant issues.  In the comments of the posts, there were a few comments that summed up so much of what I have seen that is wrong with how things are today, and I wanted to share the personal side of the health issue with everyone, because I think that is so often what gets lost in all the policy wonkery.  The first comment snippet:

Perhaps poverty needs to be spoken of as a matter of what’s truely good and right,what it says about our morals and values,in the REAL sense of that,not in some idiotic GOP talking point sense.

I have always believed it is immoral not to make it a given that each and every child has food,clothing,shelter,medical care and a quality education. It’s investing in your people and your nation,it’s not BAD or wrong or weak to give a damn about people,especially your own.

The reason I feel this way is because I know what it takes just to feed yourself for one day if you aren’t able to afford to. I have skipped meals so my kids could eat. I have been homeless. And I can attest how much energy goes into finding food for you and your family,how stressful it is,how much TIME it takes out of a day to get that when you are poor.

You make sure,because it’s morally right to do it,that people are born into a world where the basic essentials of life are there,and then you have a nation of people who can do AMAZING things because they don’t have to fight for just the simplest means of staying alive.

And then this second comment snippet:

You mention the cuts in mental health services that we have seen over the years. I have struggled all my life with depression — it runs in my family — and knowing how debilitating chronic depression can be, I can’t even begin to imagine how someone without either health insurance or the money to do without it could function if they didn’t have the money for therapy and/or for anti-depressant medication.

I am incredibly lucky enough to be middle class (although often hanging on by my fingernails, which is another story) and to have had access to both (therapy and medication). Class status is incredibly significant — not just in terms of money to pay for the help you need, but also in terms of knowing how to finesse times when you don’t have the money.

Example: For several years after my divorce, I was struggling financially in extremis. For a while I had to get my food from a local food pantry, and I had no money to pay for expensive anti-depressant medication. But my therapist at the time was willing to see me without charge (on the understanding I would pay whenever in the future I could), and she also suggested to me that I could get free samples of my medication from my doctor. Doctors are deluged with free samples from pharmaceutical companies all the time, but I would not have thought of doing this if she had not suggested it. My doctor ended up giving me enough free samples for THREE MONTHS. And I know she would have given me more had I needed it.

My point is, how many poverty-stricken people living in Appalachia have access to the kind of medical resources that I had? How many have even one psychology practice near them, much less dozens? How many have access to someone who can tell them about doctors’ free samples?

And finally, this third comment snippet:

Middle class, upper middle class and wealthy citizens of America really do not have a grasp of poverty and what poverty causes. I mean, sure the company they work for has a charity fund they give money to, and once a year they have a good neighbors day, helping the less fortunate. For these people, to get a full understanding of how poverty affects them, I am sorry, but you’re going to have to slap them up side the head. And here is my reasoning. I work as an engineer at a major corp., I was talking to a couple of my Republican friends and of course they started to raze me about free government cheese. I am a Democrat. Unfortunately this just happen to be a bad day for me, so I asked them. “Have you ever have any of that government cheese?” This stunned them into silence. “Ever been on welfare?” “Ever use food stamps?” After I said “I have, I grew up poor, I grew up on welfare.” Looking at their jaw dropping, stupidified expression for a moment, I went back to work. They could not understand the concept of being poor, that poor people do not want to live in poverty. That some times people just need a hand to help them out of a bad situation, was a foreign concept to them. So unless you have worked with or been poor, how much do you really understand what they are going through. I purposely left out the lower middle class because they are only a paycheck or two away from being poor. One last thing, the “So unless…” and on statements, are a generalization and is not always the case.

Most people in America live paycheck to paycheck, and that means that they are one paycheck away from being homeless. Some of that is due to budgetary idiocy and living way beyond their means. But in a whole lot of cases, it is a whole lot of families working two and three jobs trying to make ends meet after the plant laid a whole shift off or someone's lifetime job got outsourced to Bangladesh or what have you.  Or folks who have had to deal with the aftermath of a divorce where the parent who left fails to pay any child support.  Or a catastrophic illness.  Or any number of other disasters that can befall you at any time.

The thing that everyone needs to realize is that the stories that you hear about folks who have to sell everything to pay off catastrophic medical bills or to feed their kids after they lose their job...it could be you next.  No one is immune from this.  No one. 

And because our health care system is set up to provide maximum profits to the folks who manage paperwork for insurance companies, to the insurance companies themselves and to a whole lot of folks in between -- but not set up to provide the best possible care from the start of someone's life forward in preventative medicine -- we are all staring a the potential for medical problems rearing up to bite our budgets into tiny little pieces.

So let's all drink a toast to our respective health...unless some real conversations get started on fixing the whole mess, and not just bits and pieces, we're gonna need a whole lot of luck in the health department.