The Uninsured Line Up For Care In Rural Virginia

This weekend was the tenth anniversary of Remote Area Medical’s free health fair in Wise County, VA. Stan Brock founded Knoxville-based RAM in 1985 to insert mobile medical teams into remote areas of third-world countries. Now over sixty percent of RAM’s work is in rural areas of the United States.

More than one thousand people arrived before sunup on Friday or camped out in their vehicles for a chance at health care they cannot afford to buy. Most are the working poor and hail from Virginia, with Tennessee a close second, followed by Kentucky and other surrounding states. Cars in the county fairgrounds lot held comforters and pillows, sleeping bags and sleeping people.

Read more at The Huffington Post.

Waiting in line for health care

Just back from a Saturday morning trip over to Newport, TN, where Knoxville-based Remote Area Medical (RAM) is holding one of its medical “expeditions.”

RAM’s head honcho, Englishman Stan Brock used to wrestle large snakes and gators for Marlin Perkins on TV's "Wild Kingdom." Brock formed RAM in 1985 to bring medical care to patients in remote areas of third-world countries. Now, sixty percent of RAM’s work is in “urban and rural America.”

The earliest patients arrived at Cocke County High School on Thursday to secure a numbered place in line for Saturday's free health care clinic. RAM expected to treat about 480 patients on Saturday and about half again as many Sunday. (They stopped accepting new patients about 9 a.m. Saturday morning.)

Most of the cars in the high school parking lot were nondescript. Some had people still sleeping in them. Others had blankets or sleeping bags inside or airing out on the hood. A few autos were missing grilles or glass and looked as if people lived in them. Some of those held animal carriers. RAM’s Newport expedition included veterinarians who provided pet services.

RAM’s patients are Americans without health insurance or jobs that provide it. Most need eyeglasses or dental care. Some exiting the gymnasium had rolls of gauze where teeth had been. One man held an ice pack to his jaw. A mother told us that while she has insurance through her job, her husband and kids do not. But adding them to her policy would take her entire monthly take home pay.

RAM does much of its work in Tennessee because the state allows doctors and dentists licensed in other states to practice within its borders for these events. North Carolina is not one of those states, Brock said in an e-mail earlier this week, otherwise residents in WNC’s remote western counties might receive a visit from RAM.

We noticed that October 3-4, RAM will be visiting the Appalachian coal country town of Grundy, VA, hometown of NC Governor Bev Perdue. Maybe the governor would support changing the rules in cash-strapped North Carolina to allow the state’s growing number of unemployed and uninsured a chance for the kind of free care RAM brings to Grundy.

[Photo courtesy of Jill Boniske.]

Good for whatever ails ya

Used to be, there was nothing that couldn't be fixed with another round of tax cuts. Now, it's More Market Capitalism.

This tidbit from the Mahablog:

I have discovered a proposal for “fixing” health care on the Cato Institute website that is an absolute hoot.

The plan (see PDF) is to eliminate employee health benefit insurance and all government health care support, and throw everyone into the private insurance market. Insurance companies would be allowed to risk-rate premiums, so that as people got older and/or sicker their premiums would go up.

However, Cato says, this doesn’t have to be a problem. The solution is ... wait for it ... insurance insurance. They call it “health status insurance,” but essentially it’s insurance insurance. It’s a separate policy you take that will insure you against catastrophic increases in your health insurance.

I’m not kidding. That’s the brilliant plan.

When the boat springs a leak, be sure to drill a hole in the bottom to let the water out.

This is from Cato's Exec Summary:

None of us has health insurance, really. If you develop a long-term condition such as heart disease or cancer, and if you then lose your job or are divorced, you can lose your health insurance. You now have a preexisting condition, and insurance will be enormously expensive—if it’s available at all.

Free markets can solve this problem, and provide life-long, portable health security, while enhancing consumer choice and competition. “Heath-status insurance” is the key. If you are diagnosed with a long-term, expensive condition, a health-status insurance policy will give you the resources to pay higher medical insurance premiums. Health-status insurance covers the risk of premium reclassification, just as medical insurance covers the risk of medical expenses. With health-status insurance, you can always obtain medical insurance, no matter how sick you get, with no change in out-of-pocket costs.

I am reminded of Curly in the bathtub, caged by his own plumbing repair, from "A-Plumbing We Will Go."

Bailout Bank Banks Bucks

Goldman Sachs rakes in billions:

Goldman Sachs Group Inc. set aside a record $11.4 billion for compensation and benefits in the first half of 2009, up 33 percent from a year earlier and enough to pay each worker $386,429 for the period.

The figures were released today with the firm’s record second-quarter earnings results. Revenue jumped 31 percent to $23.19 billion in the first half and the New York-based firm set aside 49 percent to cover its largest expense, compensation and benefits.

But here in downtown Charlotte, the banking center of the South, things aren't so rosy:

Just as first-time claims for unemployment insurance surged in the sour economy, final payments – made when laid-off workers have exhausted their initial benefits and all extensions – are climbing, with Mecklenburg County numbers more than double from a year ago.

[...]

Relief, in the form of new jobs, doesn't appear imminent, based on the latest labor statistics. The national unemployment rate rose to 9.5 percent in June, a 26-year high, with companies cutting 467,000 jobs – more than economists expected. Charlotte-area unemployment has outpaced the nation, reaching 12 percent in May. Economists expect both numbers to rise further before the end of the year.

Last month, the number of Mecklenburg County residents who ran out of unemployment benefits climbed to nearly 2,900 – the fourth straight month above 2,000 and more than double the number of people in June 2008, according to new data from the N.C. Employment Security Commission. Before the recession, the number of final payments in a single month never topped 2,000.

I'm just lucky to have a job again.

Still, I'm thinking of The Mouse That Roared for some reason.

So that's how it works!

Bill Cope of Boise Weekly ventures into the mountains to get some insight on socialist health care from "Badger" Bob, the socialist. Bob is both a libertarian and a socialist, so he ought to know socialism when he sees it. Bill found Bob drinking pitchers of Oly and throwing horseshoes with some buddies.

Hoot threw a shoe and it missed the stake by so far, the people on the other end ducked for cover behind a derelict Volkswagen. Then he said, rather too loudly I thought, "There's a gull-durn good reason those Republicans are trying to warn folks about socialism. Because socialism sucks, that's why!"

"Hoot," said Bob, "you didn't seem to mind those socialist roads we took to get up here. Or that socialist bridge that got us across the river. And I assume you have no objections to the socialist cops that caught the guy who stole your truck, or those socialist firefighters who stopped your shed from going up in flames last fall. And if it weren't for the socialist VA, you'd ..."

"What you saying, Badge? Them ain't socialism. Them're just plain ol' government stuff we gotta have to get by."

"That's one of the problems here. Whenever it's good for you Republicans, it's essential government services. But when it's good for everyone, it's socialism."

I thought all those guys were tea drinkers.

A very, very fluid situation

I was too busy to really comment on the Blue Dog letter story this morning, but I had noticed how minor many of their grievances with the public plan were. Rep. Heath Shuler, in particular, is one who complains about the lack of health services in our rural districts. Read on.

dday runs down and comments on their complaints:

What's interesting about the letter is how insignificant the changes actually are. Among other things, they want:

• a deficit-neutral policy, which is what every single proposal for this bill has included;
• aggressive solutions to bending the cost curve, which also is a goal of pretty much everyone;
• protecting small businesses, which every iteration of the plan has, including the employer mandate proposals that exempt certain small businesses and make them eligible for purchasing health care through the insurance exchange;
• rural health equity, a pretty small point;
• a public option that doesn't use Medicare bargaining rates, which isn't different from what, for example, Chuck Schumer has called for, although I find that to be a toothless public option, which I'll explain later;
• time to read the bill, which I support;
• bipartisanship, which is the most ridiculous of these demands, but which actually does exist in the bill on the Senate side, where dozens of Republican amendments have been included in the HELP Committee markup.

Obama himself professes to want a deficit neutral plan, so many of these points, I believe, are posturing either for political points or amendments to sweeten the cost of securing their votes, or both.

At the Wonk Room, Igor Volsky notes:

More importantly, the letter contains an inherent contradiction: the Blue Dogs want to find more savings within the system — they’re asking for Delivery System Reforms and “maximizing the value of our health care dollar” — but they’re also asking the bill to spend more on rural health and physician reimbursement. And they are reluctant to support any legislation that moves us towards that goal, causes providers to lose revenue, or regulates the system to improve efficiency.

Consider their objection to a “Medicare-like” public option that reimburses providers 5 to 10 percent above Medicare rates. According to MedPAC, Medicare rates are adequate and consistent with the efficient delivery of services. In fact, over-payments by private insurers to health-care providers drives up overall costs. “Hospitals which didn’t rely on high payment rates from private insurers ‘are able, in fact, to control their costs and reduce their costs when they need to’ and ‘combine low costs with quality,’” Glenn Hackbarth, the chairman of MedPAC, said during recent testimony in front of the House Ways and Means Committee. Moreover, if the public plan pays bloated market rates, it will fail to offer lower premiums within the Exchange, and would cause the government to spend more money on subsidies. [Emphasis mine]

Also today, more Blue Dog news:

More than 60 Democrats signed a letter authored by freshman Rep. Debbie Halvorson of Illinois and second-term Rep. Heath Shuler of North Carolina asking Waxman to jettison his plan to reinstate drug price controls to help low-income seniors. Instead, they are asking Waxman, Rangel and Education and Labor Chairman George Miller (D-Calif.) to support the drug industry’s offer to spend $30 billion help cover those costs – a deal that is backed by the White House and the Senate Finance Committee.

Waxman wanted to reinstate the price controls to save the government tens of billions of dollars over the next decade – money currently paid to prescription-drug makers – so that he could plow those savings back into the system and close a sizeable gap in the current government-funded prescription-drug program. The industry was hoping to avert such controls by pledging $30 billion to help seniors and another $50 billion to help pay for health reform.

$30 billion and then another $50 billion? Out of the goodness of their hearts? Whaddya figure these public-spirited drug makers would rather spend $80 billion and take hefty tax deductions on those costs rather than take the hit to their gross incomes from Waxman’s cost controls? Screw saving taxpayers billions in drug costs up front. That’s the small-government, free-market way. Thanks, Heath.

But wait. Just in, some of the New Dems (DLC-type centrists) are going in another direction:

A band of 22 New Democrat and Blue Dog lawmakers say they support a “robust” government-run health plan, boosting chances of moving healthcare reform with a public insurance plan through the House.

Democratic centrists remain the biggest obstacle to House Speaker Nancy Pelosi’s (D-Calif.) ability to pass a healthcare bill with a public plan, and many conservative Democrats oppose a public option as unfair to private insurers.

But the letter from the 22 New Dems and Blue Dogs indicates opposition from this group is far from universal.

[…]

The 20 New Democrats on the letter represent nearly one-third of the 68-member caucus. It is signed by two Blue Dogs and three members who are both New Dems and Blue Dogs.

See Blue Dog Rep. Loretta Sanchez comment on why she opted out of the letter:

This situation is very, very fluid.

Essence of Palin

Dahlia Lithwick over at Slate distills Sarah Palin into a single paragraph [Emphasis mine.]:

It's too easy to characterize Sarah Palin as an irrational bundle of bristling grievance. But I think it's more complicated than her simple love for playing the victim all the time. If you think of Palin as someone who never felt herself to be fully heard or understood, not truly politically realized in the eyes of the American public, her rage toward the country, the media, and those of us who fail to love and understand her is easier to comprehend. Think of an American visiting France who believes that if he just speaks louder, he will be speaking French. Palin has done everything in her power to explain herself to us, and still we fail to appreciate what she is all about. I'd be frustrated, too, if I thought I was offering up straight talk and nobody was getting the message. Especially if I held a degree in communications.

I've used that "speak louder" idea myself to describe the frustration many liberals feel in trying to communicate with conservatives. As with Palin, if your audience is not getting you, maybe the problem is you.

“Thar's no Jack S. like our Jack S!”

From Roll Call:

Senate Democratic leaders have stepped up the pressure on their rank and file to unify on procedural votes after finally gaining a filibuster-proof majority, but centrists who have long been headaches for the leadership are so far refusing to commit to the strategy.

[...]

The message to Democrats, Durbin said, is: “Don’t let the Republicans filibuster us into failure. We want to succeed, and to succeed we need to stick together.”

[...]

But Durbin said that moderates, such as Bayh and Nelson, have voted with Democrats on procedural issues many times before.

“They may vote against final passage on a bill. They may vote with Republicans on amendments,” he said. “But on this idea of allowing the filibuster to stop the whole Senate, I think, we have persuaded them more often than not that they shouldn’t let the Republicans control our agenda. We ought to control our own agenda.”

Add Mary Landrieu to that group.

Al Capp's Sen. Jack S. Phogbound would fit right in.

Flailin' Palin

Read Richard Cohen in today's WaPo:

Naming Palin to the GOP ticket -- a top-down choice by McCain -- was the most reckless decision any national politician has made in the longest time, and while it certainly says something about McCain, it says even more about his party. It has lost its mind.

And it gets better...

Eugene Robinson elaborates:

The reasons she gave for stepping down are not just contrived or implausible but literally nonsensical. She can most effectively serve the people of Alaska by ceasing to exercise the powers of chief executive? She worries that as a lame duck she would somehow be compelled to waste taxpayer money on useless junkets? In her "Don't Cry For Me, Alaska" news conference announcing her departure, the folksy non sequiturs -- "Only dead fish go with the flow" -- were like nuggets of Cartesian logic amid a tub of mush.

But I'm stating the obvious. The thing is, Palin's unsuitability for high public office has been obvious all along. Tina Fey got it right; the rest of us were far too reluctant to state plainly that the emperor, or empress, has no clothes.

Bill Kristol, compares Palin favorably to George W. Bush:

It's silly to claim Palin has no chance to win the nomination or the presidency.

[...]

The hostility of the GOP establishment may be an obstacle to her success. On the other hand, given the performance of GOP operatives and pols over the past few years, maybe their opposition isn't a bad thing.

In any case, this is the same GOP establishment that rallied behind first-term governor George W. Bush in 1997-98 and then propelled him to the nomination in 1999-2000. Had Bush accomplished more than Palin at that point?

Texas has a lot more people than Alaska does, but the Texas governorship is a weaker office -- and some of Bush's first-term initiatives went down in flames, while Palin's have largely succeeded.

As one of their finest under-performers, Kristol is supremely qualified to critique other "GOP operatives and pols." Aren't they supposed to object to affirmative action hiring?

Those wild and crazy Stompers

An e-mail arrived today from Asheville City Council candidate, Cecil Bothwell, which included this note:

Those wild and crazy Stompers
Thunderpig is on the loose again. Our volunteer video crew posted a YouTube version of Mayor Leni Sitnick's speech at the Grey Eagle campaign kick-off event, June 12. Because the team used a sound feed from the sound board, that is, from the stage microphones, the sound dropped out when Leni had to pause for applause from the capacity crowd. So our intrepid amateur videographers spliced in some applause from elsewhere in the recording so Leni's pauses "made sense."

Well, the Carolina Stompers, those ever vigilant defenders of all things radically right, took note and decided to mock our efforts. Good on you guys! We've reposted the original video here.

In response to the Stompers' critique, the blogger who goes by the name Thunderpig put together a new version of Leni's talk. Click the laugh track below for his version of her great speech. (Thanks to Thunderpig for helping to publicize this campaign and thanks again to Asheville's best mayor ever for endorsing me!) Heh heh heh heh heh heh heh

The Stomper-doctored Sitnick video (in sepia-tone) and the pointless effort that went into it reminded me of a story.

An old friend of mine - an upstairs neighbor, Chris - used to have a blue tick hound named Blue. No lie.

Blue was a hunting machine ... except Chris didn't actually hunt. But Blue loved to chase squirrels.

Chris and Blue would be out in the yard and, just for fun, Chris would call Blue to attention and snap, "Blue! S-q-u-i-r-r-e-l."

Blue would take off like a shot and tear around the yard, running around tree trunks, glancing up and down and sniffing, looking for the squirrel. Eventually, Blue would slow down, stop, and look back at Chris quizzically as Chris slapped his thigh and laughed.

Stompers! D-e-m-o-c-r-a-t-s.

Inoculated at Birth

South Carolina’s Gov. Mark Sanford is contrite about his extramarital affair. He plans to tour the state asking constituents for forgiveness. In South Carolina, he will probably get it.

In Southern Baptist-steeped South Carolina, public repentance is a tradition. Weepy evangelists, altar calls, redemption pageants and encounter weekends are deeply rooted in the culture.

There is a joke southern towns share about having a church on every street corner. It is also a competition – several claim the informal title of “Buckle of the Bible Belt.”

In this culture, it is a time-honored ritual to answer a tearfully delivered altar call at the end of the church service. The repentant rise slowly from their seats and shuffle humbly to the front of the church – or stadium, in the case of a Billy Graham crusade – for a humiliating public cleansing, to shed their own tears and accept Jesus as their personal savior. Or to accept him again. Or to receive forgiveness, prayers and the laying on of hands after “backsliding.”

Church audiences love testimonies, sordid, public confessions of a life ill-spent before finding God. Personal testimonies featuring all the forbidden fruits – alcohol, sex, drugs, and rock and roll – allow them to vicariously partake of guilty pleasures right out in public.

In church, even, and without taking their clothes off.

Returning to the faith after some really good sinning was entertainment in these parts long before the VCR.

Decades ago, I caught a piece of a late-night, AM gospel talk radio show out of somewhere in Georgia. The host was interviewing Demond Wilson, the actor from the 1970s TV sitcom, “Sanford and Son.” After the show went into reruns, Wilson had become a minister and was on the radio to talk about his new ministry.

But the host didn’t want to hear about that. He wanted to hear about Wilson’s life as a rich Hollywood celebrity. What about the wild parties? the host wanted to know. What about the sex and the drugs?

Wilson explained that he and his wife weren’t really party people. He played tennis, he said, with some star (whose name I can’t remember). But basically, he went to work and they had largely kept to themselves.

The host kept at it. He kept pushing.

You could hear the anxiousness in his voice. He’d expected some really quality sinning, but this more was like coitus interruptus.

“But when did you really hit bottom?” he asked a couple of times. This guy hoped to hear how Wilson had found Jesus after coming to in some strangers’ bathroom after a drunken orgy, a needle still in his arm. You know, a really good testimony.

He never got it. Wilson just decided one day that he would rather give up acting and serve God. The radio host was audibly disappointed.

What has any of this got to do with Gov. Mark Sanford’s Argentine junket? Inoculation.

For conservative politicians, the testimony has morphed into “inoculation politics,” e.g., falsely accusing opponents of personal failings they themselves share. Accustom the public to your neighbors’ faults so as not to look as bad in case you are caught indulging them yourself.

“For all have sinned, and come short of the glory of God,” Paul wrote in Romans 3. Anybody who has ever been to a revival meeting knows that one.

Sinning. Everybody does it. But unlike a godless liberal, a good conservative who confesses his sin publicly is eligible to be welcomed back into the fold. Just one of the boys.

“Hallelujah, brother!” as Dwayne Hickman once said.

Southern-strategy Republicans learned that lesson well. Man is sinful by nature. The Mark of Cain. It's old news.

Soon enough, Sen. John Ensign of Nevada (and of the Promise Keepers) will be old news. South Carolina Gov. Mark Sanford (of The Fellowship), too.

But unlike Rep. Mark Foley’s (R-FL) men’s room affairs, Mark Sanford's Argentine junket sounds like really good sinning. Already, fleets of tabloid photographers have arrived in Buenos Aires, hoping to give us a glimpse of just how good.

Thus, when Sanford contritely strikes out on his political redemption tour of South Carolina, pious sinners anxious to hear all the details will probably forgive him his sins. They've already been inoculated.

Published as a "letter" in the July 2009 issue of the Asheville Daily Planet.