• Reflections on Still Being Here

    • Posted on Jul 23, 2017

    Posted on Jul 23, 2017
    Here's this morning's Courier column--a bit more personal than I usually write, but seemed appropriate to my current state of mind, scattered as it is.  

    Last week I put my early old age behind me and moved into middle old age. 
     I turned 74.    

     Since wisdom has always been in short supply, and since elders are reputed to have access to it occasionally, I thought I’d share a few snippets, insights, and tidbits I’ve been pondering since reaching—uh—full maturity.

     Least to most crucial: 

    • Life is a race between obsolescence and retirement.  Keeping up with work-related technologies and new approaches was fun and challenging at first, then became routine, and finally just a chore.  I avoided Twitter, as should at least one other elder we know.  

    • Don’t underestimate sleep.  Most of us skimp on shuteye, using caffeine to wake up and dragging through the day wishing for more nap time.  When I miss out on sleep, I feel downright mean.   People easily mistake my sleep-deprived personality for a grumpy old man.  Normally I’m wide-awake and nice.  Mostly.   

    • Hydrate.  Here’s the single most important health advice we get. Humans’ bodies are mostly water, and we literally dry up quickly. Health issues from fatigue to cramps to headaches to constipation afflict dehydrated humans.  Drink up and I mean water only.  Boring but true.   

    • Many troubles from trivial to life-threatening are real but not true.  Fear of flying remains my best example.  For years flying terrified me, and I’d get off jets shaking with sweaty palms.  Crashing seemed real and imminent on every flight. I finally got over it, thanks to sheer repetition and a fearless wife. 

    • Replace religious with spiritual.  The great seers, saints, mystics, and seekers world-wide, from Jesus to Buddha to Mohammed to Confucius to Krishna, espoused personal transformations not tied to doctrines.  They were disruptors whose lives led followers to seek enlightenment and transcendence.  Rather than daily getting and spending, they understood life without religious rituals as a spiritual journey.  

    • Meditate.  It’s just common sense to quiet our drunken monkey minds.  It’s free, simple, and may add years to your life, not to mention calm to your days.    

    • Then there’s—sigh—death.  It’s the most feared event in life, at least in our youth-oriented happy-ending culture.  The older we get, the more we notice signs of the grim reaper on our trail, and avoid facing it at all costs.         The ancients certainly faced and explored it extensively, especially Tibetan Buddhists, whose “Book of the Dead” examines various stages of living, dying, and after death.                                                                                                                                               Who are we and what are we living and dying for?  Those are questions that deserve our clear-eyed attention.  There are remarkable answers, both from the ancients and from current “near-death experience” studies, which now are legion.                                                                                                                                            For a serious challenge check out Sogyal Rinpoche’s “The Tibetan Book of Living and Dying.”  It’s the most helpful and engaging explanation of death and dying I’ve found. Bardos here we come.                                                                                                                                                  

    Finally, as Leonard Cohen puts it, “When things get really bad, just raise your glass and stamp your feet and do a little jig. That's about all you can do.”
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  • Benefits and Myths Of Single-Payer Health Care

    • Posted on Jan 13, 2016
    Dr. James Young
    Scott Cawelti

    America has struggled with providing health care for its citizens for a century and more.  The argument comes down to two fundamental issues:  (1) is health care a right for all citizens, and (2) who should pay?  

     We answer the first question “yes,” as have citizens in all developed countries for decades.   Only in America do we behave as though we’re unsure whether health care should be provided to everyone.   According to T.R. Reid in his book The Healing of America, 85% of Americans agree that all citizens have a right to at least basic health care.  (220) 

    The question then remains:  how much of their health care should individuals be required to pay? If everyone has a right to health care, shouldn’t they receive it regardless of their ability to pay?     

     Americans and their representatives have been arguing about this since the New Deal (and well before, in different forms) when Franklin Roosevelt tried to implement universal health are along with his Social Security plan. 

     We now have a hybrid system, one that combines private insurance with government programs including Medicare and Medicaid.  Government now foots around fifty percent of the overall health care bill.  Creating an improved Medicare for all (also known as a “public option”) makes more sense now than ever.   
    Since the Affordable Care Act’s (ACA) inception in 2010, doubts have grown about its long-term viability. Medical providers struggle with an enormous paperwork load, and for-profit insurance companies struggle with profitability margins, leading some to pull out of the ACA altogether.  

     Indeed, some doctors have set up their own “boutique” practices, where they dispense with insurance paperwork altogether, and others have opted to work only with Medicare and Medicaid patients.   Moreover, with co-pays and deductibles rising, usable health insurance has become less and less affordable.  
    The upshot: we believe that the ACA in its current form is unsustainable. Medicare (for seniors) actually works the way it is supposed to, and Americans are reasonably happy with how it is administered, as well as costs and benefits.  

    Therefore we believe we must move toward creating an improved Medicare for all—a single-payer system.  

     For an excellent overview of issues and solutions, see the documentary film “Fixit: Health Care at the Tipping Point” by Vincent Mandillo and Richard Master.  It’s available for free from their web site: www.fixithealthcare.com.  
    Either Jim Young or I (or both) would be happy to view and discuss it with you.  Contact me at cawelti@forbin.net or Jim Young at jyoung@cfu.net.  

    1. All American citizens would be insured.  Though the ACA has added 17.6 million Americans (as of September, 2015) to the number of insured, there are still millions who live with no health insurance at all, and must depend on emergency care for health needs. This is unacceptable, both for health care providers and patients.  Moreover, in the most developed and wealthy country on earth, it’s unnecessary and shameful.    

    2. Costs will be lower for everyone.   Currently health care costs for insured Americans are on the rise, so much so that citizens may well decide to return to being uninsured.  Deductibles and co-pays make truly usable insurance more and more rare.  With a single-payer system, rates will stabilize and can be controlled more easily.  

    3. Care will be better.  Countries with single-payer systems, such as Canada, Great Britain, and France all provide better care to their citizens than the U.S.  We are currently ranked last among 11 developed countries  (see http://www.commonwealthfund.org/publications/press-releases/2014/) Here is the full quote: New York, NY, June 16, 2014—Despite having the most expensive health care system, the United States ranks last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity, and healthy lives, according to a new Commonwealth Fund report. The other countries included in the study were Australia, Canada, France, Germany, the Netherlands, New Zealand Norway, Sweden Switzerland, and the United Kingdom. While there is room for improvement in every country, the U.S. stands out for having the highest costs and lowest performance—the U.S. spent $8,508 per person on health care in 2011, compared with $3,406 in the United Kingdom, which ranked first overall.

    4. Care will be given more efficiently.  Some doctors, as shown in the documentary mentioned above, “Fix It: Health Care at the Tipping Point” have now opted to see only Medicare and Medicaid patients, since this successful single-payer structure is simplified, predictable, and requires relatively less cost and paperwork to administer.  The current system of multiple insurers, each with different plans and coverage, make for daunting, inefficient, and expensive administration. 

    5. Prices will be fair for everyone.  Because prescriptions will be based on a
    formulary, they will generally be less expensive unless patients opt for brand names.  Currently, the Veterans Administration pays 41% less for drugs than the rest of us. Also, “Canadians pay one-quarter to one-half the price Americans pay for the same pill made by the same drug company.” (T.R. Reid, The Healing of America, 135) 

    6. Coverage will be more comprehensive. Currently, insurance companies make health care decisions based on cost/profit for their company.  They must show profitability, and therefore accountants and actuarial data play a major role in the company’s decisions of what and when to cover.  With a single payer, coverage will be comprehensive and decisions made by medical personnel.   

    7. Money now spent administering can be better spent on improving quality and availability of care.  The system could save billions that are currently spent on administration.  This is because approximately 20% of premiums go directly to administering health care—far more than in any single-payer system in the world.  (Administrative costs for Medicare run around 5%.) 

    8. No rationing of health care.  Severe rationing of health care occurs now in the current system based on ability to pay. We have the most rationed health care system in the world—with insurance companies doing the rationing based on their profit margins.   Wealthier citizens with more costly insurance get better care, while some citizens get little to no care at all. Such inequality is growing intolerable, and a single payer system would offer treatments based on need, not cost or ability to pay.   

    9. No bankruptcies due to health care costs. Of the one million bankruptcies in the U.S. yearly, 60% are due to health care expenses.  Around 700,000 Americans per year now declare bankruptcy due to medical costs. (T.R. Reid, The Healing of America, 22) This compares to none in other developed countries.  

    1. It’s a government takeover of health care, and therefore socialist.  “Socialist” has been demonized as a term from its association and history with the Soviet Union—Union of Soviet Socialist Republics. Most recently, it has been called “statist” because it evokes images of an all-power state in charge of everything.  Yet these are not accurate terms for a single-payer system, which simply means a not-for-profit organization that operates in the best interests of all its members rather than shareholders.   Medicare and Medicaid are the closest examples of this system.  Instead of a private, for-profit system, whose main goal is maximizing profit for its shareholders, these agencies exist to maximize health care for citizens. 

    2. It will be an inefficient bureaucracy.  We have one of the most inefficient bureaucracies running health care now—a competing group of insurance plans, each with thousands of employees who are paid to do nothing but administer health care.   Twenty cents of every health care dollar goes to insurance bureaucracies.  

    3. We have best health care in the world; why change it? Our current health care system works well for the wealthy, who can afford whatever health care they prefer, and for seniors over 65 on Medicare—a single payer system.  For those under 65 with moderate incomes, it’s among the worst in the world.  As T.R. Reid asserts in The Healing of America, “ . . .every industrialized country has fairer access to health care and lower costs for health care than the United States . . .Most of the world’s wealthy countries have longer life expectancies than we do, too.” (252) 

    4. Doctors will be under the control of non-health care centralized bureaucracy.  Not true.  Independent physicians and hospitals will continue as is.  It is only the payment mechanism that will be centralized, resulting in major savings.

    5. Patients will not be able to see the doctors of their choice.  Again, not true.   Patients will be able to see the doctor of their choice.   The narrow physician choices (“in network”) currently offered by some insurance companies will no longer exist.

    6. Doctors will lose income and emigrate to other countries to make better incomes. Though doctors in the U.S. are among the best paid in the world, there is little evidence that doctors are seeking to move to America to enhance their incomes.  Because they enjoy more control over patient health and are burdened with far less paperwork, and because they pay little to nothing for their extensive medical education, and far less for malpractice insurance, they are happy to remain where they are.  (See T.R. Reid’s anecdotal information throughout The Healing of America.) 

    7. It will result in long waits for crucial care.  Actually, urgent and emergent medical problems will be treated quickly, as they are now.  In Canada, a "single payer" country, there are some waits for non-emergent services (e.g. knee or hip replacement) but not so for emergent problems.  By way of contrast, a Commonwealth Fund study found that in 2014, 66 million people (36% of Americans) reported delayed or foregoing medical care due to cost.

    8. It will remove the patient’s responsibility for personal health care.  Currently, patients are often delaying or foregoing care because of cost.  Increasing deductibles or co-pays (both increasing with current insurance products) only make this worse.

    9. It will lead to rationing of health care.  We currently have the most rationed health care in the industrialized world.  Insurance companies dictate what procedures and tests they will or won't cover.  This means that insurance company bureaucrats choose who gets what treatments, not medical professionals. Added to this, those without insurance are severely rationed for all but emergency care. 

    10. Private for-profit insurance means competition in the marketplace, therefore lower prices.  Competition between insurance companies has done little or nothing to control insurance costs.  In a state like Iowa, where one company controls roughly 75% of the market, there is little incentive to keep rates low.  Even with more competition, for-profit insurance companies must make a profit, keeping health care costs higher than they need to be, and currently higher than any other country in the developed world.  

    In conclusion, three facts about our current health care system stand out: 
    (1) Americans suffer an enormous number of bankruptcies or at least financial hardships due to personal medical expenses.  This does not happen in other developed countries.   
    (2) In overall quality of health care, America ranks 47th in the world in terms of life expectancy at birth, and 24th in terms of “Disability Adjusted Life Expectancy,” or DALE. We sit far below other developed countries on both of these measures.  See T.R. Reid, The Healing of America, Appendix.
    (3) Between 20,000 and 45,000 Americans die each year due to a lack of health care insurance. (See “Facts About Obamacare” website.  These people would probably be alive if they lived in other developed countries with single-payer health care systems.   

    Dr. Jim Young is a retired family practitioner who practiced in the Cedar Valley for 32 years. 
    Scott Cawelti is a retired English Professor who taught at UNI for 40 years.  
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“Even before the advent of the Internet, Cawelti’s columns went 'viral' in the Cedar Valley… the role of a columnist is to be thought provoking, to take tacks that shed a different light on an issue or possibly cause a reader to reevaluate a position. At the very least, it should bring clarity to a particular perspective, whether you buy into the commentator’s worldview or not.

Scott's work does just that.  Enjoy this collection of his writing.”

-Saul Shapiro, Former Waterloo-Cedar Falls Courier Editor
Read Shapiro's entire introduction.


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