Public Health Care

I wonder what my opinion on this is going to be...

I shouldn't really admit this, but I actually don't always know in advance of writing these blogs. I mean. I think I know going in, but sometimes I surprise myself. Sometimes the process of writing and having to really think about what I'm going to say causes me to... alter my stance, even if just a little bit. I wonder if this is going to be one of those times. Let's find out.

Scratching my head here, but I can't think of one topic that has been more hotly debated these last several years than Public Health Care. It seems like there really is no middle ground on this debate; you're either mostly for it or entirely against it. Very polarizing. And very sad as well, for a number of reasons; most of which I'm going to talk about as we go.

But I can't just jump in all wimbly bimbly. Oh no! Because this is an issue that "everyone already understands". This is an issue where the "righteous camp" is completely obvious.

Bah! This is an issue where cooler heads never prevail and the only question people really care about is: "Where are your loyalties?"

So, we're going to need a rather specific introduction to this thing or risk simply joining the "highly principled" muck. And I don't like getting dirty...

So... here's a scenario:

Say you were helping a buddy do some landscaping - not really backbreaking labor, mind you, but some lifting, shoveling, hauling dirt around, etc. - a couple of hours worth of work maximum. Now say that not long after this your back started hurting - a lot. You decide to shrug it off as over-exertion because, after all, this is hardly your first-ever sore back.

But as the days go by it just gets worse and worse. By the end of the week you can't sit or stand or even lie down without excruciating pain. You can barely walk, you've hardly slept and you can't think straight anymore. It's time to get some help.

So off to your doctor you go. (Office visit: $100.) They do an x-ray (~$100 additional) but can't figure out what's wrong with you. So off you go to an Orthopedic specialist (office visit: $250) where they insist that they can't properly diagnose your problem without a full MRI of your spine. (MRI: ~$4000).

Now it's days later (of non-stop pain) and you're finally back for a second Orthopedic consultation. (Additional $250.) They review your MRI results and discover therein a herniated L5-S1 disc. Recommendation: immediate discectomy surgery. Estimated cost: $20,000, plus hospital costs, plus post-operative check ups, plus physical therapy, plus the distinct possibility that even after everything is said and done, you still won't be out of pain.

Pretty grim scenario so far, right? Unfortunately, it gets worse. On top of everything else, factor in the reality that you just came off nearly a year of unemployment; you have tons of debt, no savings and absolutely none of these medical costs are going to be covered by your new job's insurance due to "pre-existing conditions".

OK, okay. Pretty far-fetched, right? I mean, anybody can manufacture a sad-sounding story when they want to play for sympathy...

Except for that is exactly what happened to me in the Autumn of 2010. It turns out that a great many things are merely "interesting" or "problematic" until they happen to you. Then shit gets real.

But my story is hardly the worst I've ever heard, hardly the worst of people I actually know. This sort of thing happens all the time to all sorts of people - and it's always a big, expensive mess. A mess, I need hardly point out, that no one wants to own or clean up.

And I suppose I also hardly need to tell you that Public Health Care involves a whole lot more than just treatments for injuries and accidents. There are so many sick people needing so much care! The scope of it simply boggles the mind. What to do? What even can be done?

Hmm... maybe my opinion on this is starting to show through after all. I won't kid you; it was a tough situation for me sitting in that specialist's office being told that if I didn't have the disc surgery right away that I would probably end up with permanent nerve damage and partial paralysis of my left leg for the rest of my life. Now that... is intimidation.

And, as it turned out, also not true. But perhaps I'll save the idea of medical malpractice for another blog...

The first point I would like to go for from my little story is to ask you to consider the very serious question: What were my real options in the situation I just described? What would have happened had I decided to go ahead with the surgery recommendation?

Well, for me personally, it's a little hard to guess. Had I undergone the surgery it would have required weeks of time off work for the initial recovery. Weeks, I should add, that I didn't have any "vacation days" built up to cover. I very probably would have lost my job. (The brand new job, as you'll recall, that I had just barely started after a life-alteringly long bought of unemployment.) Obviously I didn't have the funds to pay cash for the services, so my only option - barring some anonymous gift or something - would have been to undergo the surgery anyway and then declare bankruptcy. (I.E. Lying and stealing...)

Do you understand what I'm saying? My options appeared to be "become a cripple" or "go bankrupt". How the hell do you choose between options like that?

But I won't leave you hanging. As closure to my little story, let me say that the $20,000 price tag scared me enough to seek out a second opinion, which was the SMARTEST THING I EVER DID. It turns out my first Orthopedist was a quack! The second one sent me instead for a fluoroscopic injection of steroids (cost: $1400) that got me out of pain - as well as no longer suffering paralysis - within less than 24 hours.

Can you freaking believe it? Less than 10% of the cost of the first guy's "recommendation" and it totally worked!

I was lucky, in several ways actually. Lucky to have avoided costs that I never could have re-payed under the circumstances and lucky to have the type of spine injury that was actually amenable to non-surgical treatments.

I spent the next several months in physical therapy, the next couple of years making $250 per month payments against my medical bills (remember, even without surgery I was already on the hook for over $6000) and the rest of my life strengthening my core and maintaining the flexibility of my spine. (It really never will end for me...)

But as I said: I was lucky. Not everybody in my situation gets off so easy. And a lot more people are faced with even harder choices than the one I had. They don't get to decide "pain" or "no pain". They have to face decisions like "Do I get this operation or do I die? Do I agree to pay for these procedures or do I let my child, spouse or parent die?"

And we're not talking about a few thousand dollars here anymore either. We're talking about hundreds of thousands, perhaps even more. We're talking about total-life-time-earnings levels of cost here.

Cost...

That's what these issues always come down to, isn't it? How much is it going to cost and who's is going to pay?

You know, back in the day these sorts of issues were much easier to deal with. Back in the day when you needed a treatment you... simply asked God for a miracle, because there were no treatments. When your fate - or the fate of your loved one - became obvious, you resigned yourself to it... and died, usually in some extent of agony, because there also wasn't anything like pain killers. ('Cept for whiskey, o'course...)

I'm not sure how many people truly pine for the "good old days". If they do, I'm pretty sure that the suffering-and-dying aspects of it are not exactly what they have in mind. (Unless they are truly disturbed individuals...)

But these days are complicated. These days we have the extreme inconvenience of "options". Although, I'm not completely sure it's accurate to call them "options" when the fine print of the matter is, should you be required to pay the whole cost of them out of your own resources, virtually no one - not even in this shiny, first-world country that we live in - will actually be able to do so. Makes for a fair few social problems, to say the least.

So let's talk about those problems a bit. And let's also talk about "goals". I like goals. Or I should say, I like the idea of goals - specifically the idea that, if you keep your attention on your goals, and not allow yourself to be distracted and diluted by... well... distractions and delusions, then you might just achieve a thing or two in this life.

So, I want to ask you a simple question: What is your goal for Public Health Care?

Does that seem like an odd question? Are you immediately inclined to answer with a rebuttal question? Something like: What're you asking me for? That's not my job. I don't have a Public Health Care goal.

You don't? Hmm... That is interesting...

I did mention that this was going to be an "amoral" blog, did I not? I want to point out that I don't play "devil's advocate". I actually don't care about most things of the sort that most people would call "moral". I assure you, there will be plenty of offenses given to your moral sensibilities here - just as many of your "moral sensibilities" offend me.

Personally, I believe that "moral" arguments have vastly and unjustifiably clouded this issue from its very inception. It shouldn't start there! (It might eventually go there, but it definitely shouldn't start there...) For any social problem there is always - ALWAYS - a natural basis to launch from. And here is the proper basis for this one:

Nature never intended the weak to survive or thrive.

Reality, friends, is a harsh thing. Do you know what happens to a wounded zebra on the plains of the Serengeti? In the morning they find small scraps of white and black. Why should we expect any different?

No, seriously, why? We take a lot of these ideas completely for granted without ever interrogating them or becoming completely clear with ourselves on why we believe what we believe, why we do what do. It's not good enough!

It doesn't tell us anything to recite from rote "because life is sacred", because it quite evidently isn't. Nor is it even close to influential to claim "because we were commanded to", because we weren't. We pretend to be principled when all we really are is well trained dogs. It's not good enough!

Of course... neither is the reverse idea. Who gives a shit what nature "intended"? Unlike wild animals, we have learning, tools, intelligence and will. It no longer has to matter what nature did or didn't "intend". We have the power to do otherwise, if we so choose. And with that power comes responsibility.

So I re-ask the question: What is your goal?

Notice that I didn't ask "What is the right thing to do?" or even "What is the most affordable?" Those points have been talked stupid already - and to no resolution. No, this needs to be a lot more basic than that. I want to know - or more precisely: I want you to know and then also tell me - what your real, honest, highest priority is.

Do I sense a little hesitation? Why is that, I wonder? Could it be that you don't know what your own highest priority is? Or is it that you simply don't want to tell me? possibly because of how your true goals might reflect upon you? Don't want to be exposed? Don't want to be judged? Don't want to be "punished"?

Bah! I'm going to go ahead and assume it's the first one; that you simply don't know.

Don't feel so bad. Most people don't actually know what their highest priority is - regardless of the subject matter - because, in the final analysis, their highest goal is always "personal comfort". And frankly, "personal comfort" really is an all-around nebulous concept.

It is a truly rare individual indeed who can specifically name their highest goal. And maybe that's why people shy away from trying at all. After all, continuing-to-breath-in-and-out is quite probably humanity's true highest goal. Not very laudable. But I digress...

So suppose instead of asking you "What are your goals?", which you can't answer, I instead give you these five agendas to prioritize from highest to lowest. Suddenly this just became a "political activity". As such, you should know that your choices will be advertised to all the world. They will know that it was you - yes you - who definitely decided: "This one is truly important." and "This one is not going to happen." Let's begin. What ordering will you choose?

• Restricting government.
• Keeping abortion legal.
• Winning the War on Terror.
• Eliminating religious messages in schools and other public places.
• Providing health care to anyone who needs it regardless of their ability to pay.

Do you find this to be a "loaded" list? (And if so, in what way do you find it skewed?) Do you feel like my little assignment is unfair? that it's some sort of set up to make you answer the way I want you to? Well... 

OF COURSE IT IS, STUPID!

The thing you don't seem to realize is that this is the same sort of tactic that your political/religious "leaders" use to manipulate you with ALL OF THE TIME. Ridiculous lists of "apples" and "oranges" when they know only too well that A) you don't like apples and B) "pears" is the actual right answer but, hell, there's just no money in pears.

So let's try again with a different list. I think you'll find this one, if anything, even less manageable than the first. But see for yourself. How will you sort these priorities?

• Providing health care to anyone who needs it regardless of their ability to pay.
• Avoiding supporting - i.e. paying money for - government programs that you don't believe in.

Not quite what you were expecting? Perhaps you object to my "over-simplification" of your options? Oh really? Well let's think about that for a bit, shall we?

Republicans hate Obama-Care (to be pronounced with a spit). It does actually have a proper name, you know? The Affordable Care Act? But honestly that just doesn't role off the tongue nearly as nicely, now does it? Nor does it have nearly the same ability to associate to-the-man acrimony. So, let's play along and just call it: Obama-Care.

And as I was saying, Republicans hate Obama-Care. But one does have to wonder... why?

Of course the obvious answer is: Because they're Republicans. And, sadly, that probably ultimately is the real reason, but let's continue to play along just a little bit longer and examine some of the "stated" reasons. (Highly paraphrased by me, of course...)

Reason 1: We can't afford it.

You know what? This is a damn good reason. Daydreaming and do-gooding aside, eventually someone has to feed the bulldog. (Or in my case: the Shih Tzu...) If you can't afford something then, by God, you can't afford it. You don't lie. You don't steal. You don't "borrow from the future". You say to yourself: "Self, I have some bad news: We can't afford this."

And I'll be the first to sympathize with your hurt feelings when that happens. So many fine things in this life are just... out of reach. What are you going to do, cry about it? (Actually, yes.) Being practical is never fun. In fact, it's pretty much the polar opposite of happiness most of the time. (That's why people avoid it...)

But there's just one problem with this particular objection...

We already do afford it.

I'm guessing you already know that it is quite illegal to turn anyone away from an emergency room in this country, regardless of the patient's citizenship status or ability to pay. They get seen, they get treated (at least to the extent that an emergency room can treat someone) and questions of "who's going to pay" are only ever settled after-the-fact. And where does the money to pay for those "free" services eventually come from: tax dollars.

And why is that? What travesty of economics allows this intolerable situation to continue? Because the bleeding-heart liberals refuse to turn anyone away.

You know, it is absolutely within the realm of possibility that all public funding for health care end - all of it.

And it doesn't have to be just-like-the-good-old-days either. We have advanced medicine now! If you - or anyone - gets hurt or sick you can simply go to an institution of healing, in much the same way that you might go out to a nice restaurant, peruse their menu of services, decide what looks "good" (as well as what you can afford) and then either order or walk away. Simple! No harm no foul.

Well...

There is one small difference, I suppose, between ordering food at a fancy restaurant and ordering emergency medical services, which is:

Should you not be able to afford the service at one restaurant, you can still feel reasonably confident that you will be able to find another that you can afford, that in the end, no matter where you eventually end up, you will be fed.

Medical care isn't like that.

Medical care could, if one were bloody-minded enough, be considered the biggest scam ever perpetrated in the history of humanity. Consider what you "get" when you go in to your doctor's office with a complaint.

For starters, you DON'T get any guarantee of relief. You may leave hurting just as much, feeling just as ill, as when you went in. The medical profession makes no promises of "improvement". You agree to pay for the attention given regardless of the outcome.

What other profession on this planet can get away with such a non-commital business model? Amazing fees (my doctor's office fees amount to almost $400 per hour) with no guarantee of any positive result whatsoever!

(Actually, I'll tell you who else can "get away" with it: lawyers, clerics and politicians. But accurately, even they can only get away with it for so long...)

But of course, I exaggerate. Of course there is a very good reason that doctors not only can, but must, operate from that business standpoint, which is:

Unlike restaurants, who know you're hungry and have several options to deal with that, doctors do NOT know in advance what's wrong with you or, in fact, if they will even be able to help.

(Lawyers, clerics and politicians? Now they're just fucking liars...)

So, it truly is quite impossible for a regular doctor to offer a "menu of services" that has anything more on it than basic diagnostic services. Yes, they can charge a blanket fee of $100 to walk in their door and be "looked at", but if it turns out that there's anything at all wrong with you, the expectation that the initial consultation fee would cover that too goes right out the window.

I hate being so pedantic with the obvious, but I just think that, in their mad quest for "blame" and "consequences", people sometimes forget about these pesky little realities. They forget that it might just be possible that they, themselves, had something to do with the creation of the problem. (Funny how that happens...)

The point is: You might walk into your doctor's office feeling "mildly off" and exit with the understanding that you have cancer, or a heart that's about to attack, or an aneurysm that might just kill you before you reach the end of the block.

You didn't know. You didn't expect it. You didn't plan for it. You didn't save for it.

And how could you have? You expected to drop a $20 co-pay and walk away with a prescription for Lortab. Now you have to look into your pocketbook/bank account/soul and decide: "Can I afford to keep on living?..."

You think I'm just manipulating you, don't you?

Asshole! I know a woman - a seemingly healthy, athletic young woman - who suddenly discovered that she had a brain tumor - a fucking brain tumor! And, no, she didn't have anything even similar to "insurance" at the time. She had to make this exact choice. She had to decide: Do I undergo brain surgery - a procedure that there is no way on God's green Earth that I can possibly pay for, a procedure that might not even work, a procedure that itself might kill me - or do I simply do nothing and allow myself to die?

How do you like that spin on "We can't afford it"?

NOBODY CAN AFFORD IT! THAT'S THE POINT!

And just so you don't have nightmares from worry and wondering: she did get the surgery. It worked. She recovered. And as you might have also guessed, she declared bankruptcy and passed all those costs on to us. She "screwed" all of us... so that she could live. You know what? I'm glad. I wanted her to live.

But that's not what would have happened under your health-care-a-la-carte model. She would have died. And do you know what else? In the same position, even you - with your fancy job and lifestyle - would also have died.

Well, maybe not...

I mean, what do I know? Maybe you really do have several hundred thousand dollars sitting idle in your checking account at any given moment. After all, exactly how many businesses do you know who are anxious to give "credit" to a dying man? Cash - in advance - or walk. (Or crawl, as the case may be, depending on whether your legs still work...)

And undoubtedly there are some who do have that kind of cash. But how many? Is it even greater than 1%? Is it truly only 1% of humanity who actually "deserves" to live?

No seriously: you tell me. These are your goals that we're talking about. We can totally pursue the policies of "survival of the fittest/luckiest" if that's what you really want to do.

But do NOT tell me that is how it "has to be" because we "can't afford it". We CAN afford it and we DO afford it. We just resent the hell out of having to because, after all, it's "somebody else's problem".

Reason 2: Public Health Care isn't government's purview. (AKA: No "big government".)

This one is actually my favorite... because it's such utter bullshit. Every time I hear someone official making this sort of argument I watch carefully to see if their poker face is going to twitch under the complete absurdity of it all.

But since the gullible will, quite evidently, believe just about anything, let's consider the point as if it really were serious for a moment.

Here's a question: What, in your philosophy, is the "proper role" of government? I ask because, to hear some of you talk, you seem to believe that we could-get-along-just-fine without any government at all. But is that true?

Let me ask you this: Do you drive a car?

Maybe you don't have a car. Fine. Do you ride anywhere in anyone else's car? or in a bus? or on a freaking bicycle? How do you suppose that the roads under your tires got there?

Another question: Do you think it would have be "fine" to do nothing at all after 9/11? Do you think it would have perfectly acceptable for the terrorists to slink back to their camps in Afghanistan and Pakistan with no response, unchallenged by us in any way, and allowed to plan their next attack on unarmed civilians with complete leisure? Why do you suppose that didn't happen?

In fact, how do you think that electricity, gas and water actually get into your house to run your lights, warm your feet and wash your dishes? Magic? Just another one of Jesus's wonders?

No. All those things were provided by an organized, functioning government. And in fact, that's the only way they could have been provided because - just like health care (clue) - they are FAR TOO EXPENSIVE for any one person or small community to afford on their own.

I don't mean to call you unobservant, but...

You already live under - and always have had within living memory - a "big" government. It's not only big, it's HUGE! It's far bigger than even the largest of corporations, by orders of magnitude, and it has to be because that is the size of the problems that it is called upon to address.

Military, infrastructure, education, these are all  perfect examples of public problems that are far too big for any "community" to handle. If "big government" didn't handle it, it wouldn't get handled. It just doesn't get any simpler than that.

Health care is just like education. It is a fundamental national problem which can only be solved at the national level. After all, who else could solve it? Private insurance companies? They're actually the ones who created this mess in the first place!

It seems really bizarre to me that conservative folks will become terrified to the point of treason by the trumped up threat of "big government" and yet have no compunction whatsoever about the actual threats of "big insurance" and "big pharmacology". Have you ever heard the term oligopoly? Look it up. Your new dictator isn't "Obama". It's the unelected, unaccountable elite executives of the multi-national corporations.

Of course, other conservative apologists will claim: "It belongs to the States to administer Public Health..."

The States? Really?

HA! HA! HA! HA! HA! HA! HA! HA! HA! HA! 

Oh gosh! That was a good one! I needed that...

Seriously, have you seen the States? Have you seen how "well" they typically do at managing education, or employment, or civil liberties, or separation of church and state, or keeping the freaking lights on?

I really must write a separate blog on this subject sometime, but to keep things brief: States are both passé and obstructionist. Their main "contribution" - if they have one at all - is little more than creating a tiny piece of regional identity. Their main downfall is inefficiency and the creation of yet another layer of bureaucracy to be abused and siphoned off from.

Yes, there are a few jewels out there but, as a rule: STATES SUCK at their job. States are just as much a part of the problem as the Pharmo-Insurance monopoly is. They do not deserve the trust this level accountability requires. They cannot do the job.

And just to round things out, I have also heard the unspeakably lame claim from certain parties that "religions" should be given the task of caring for the poor. It's hard not to simply gape open-mouthed at that level of audacity. I can't imagine any collection of self-referential egoists more un-suited to the task. Neither can I imagine funneling upwards of 20% (or more) of the national budget into the hands of any private organization, let alone one who aren't even accountable to shareholders. That is simply the worst idea I've ever heard.

But all of those observations aside, the real reason it has to be the national government - and nobody else - is because they're the only ones who can actually accomplish the goal.

You didn't forgot about the goal already, did you? You know? Providing health care to anyone who needs it regardless of their ability to pay? Remember that goal?

You forgot about the goal... again... Sigh!

It's not your fault, not really. A great many people have spent a great deal of time - and money - in the distinct and deliberate attempt to make you forget - or failing that, to make you so confused as to give up and just let them "deal with it".

If that is the case then, whether you realize it or not, your priority decision has already been made. You've already decided that "avoiding paying" is more important by simple virtue of the fact that you've left ultimate decision making power to people who have highly vested interests in maintaining the current state of business.

I guess I can't blame you. After all, avoiding paying is money in your pocket, right? (Or at least in somebody's pocket...) You can count money, measure it, use it to pay country club dues with. That's real. But "saving lives" and "alleviating suffering"? Why, that's hardly definable at all! How will you know if you're even succeeding? That sort of policy is a hole with no bottom...

There is, however, just one problem: You still wish to claim the identity of someone who "cares about the suffering of others."

Hmm... Well this is a problem...

Are you sure I can't just talk you into coming to grips with the label of "greedy, heartless bastard"? Come on, people! Help me help you! It would make my job sooooo much easier if you just would. We'd be done already!

No? Shit!...

Well, let me think...

Still thinking...

Hmm...

I'm sorry to have to tell you this, but there simply is no win-win solution to this problem. There will be no having-the-cake-and-eating-it-too. So the only "smart" thing left to do is minimize losses; the idea of profit has simply gone right out of the picture.

The only way I can think of to actually offer people medical care AND ALSO minimize cost is...

National Socialized Medical and Pharmaceutical Care.

Did I just feel it grow colder?

Look... people... you've given me almost nothing to work with here! No matter how "smart" I may be, I still can't do magic. If you want people to "receive help" then somebody's going to have to pay for it. And as I've already beaten to death, that scope of "help" doesn't just grow on trees. Treatments for single cases of severe genetic diseases can reach into the millions. MILLIONS! Can you freaking afford that?! Well neither can anyone else!

I mean, why do you think that insurance companies were invented in the first place? Believe it or not, there actually once was a time when they sincerely cared about helping people cooperatively pay for bills that none of them alone ever could. This is not a "new" idea.

But of course, that seems like such a long time ago. These days insurance companies thrive on illnesses, the more the better, in fact... for their profits.

Sounds counter-intuitive, I know, but here's how it works: The more people get sick - or the more they hear about other people getting sick and how expensive it is - the more willing they become to pay ever increasing premiums for medical insurance. But it's a bait-and-switch. They spend more but insurance doesn't cover more. It's brilliant!

No, seriously: Why do you think that Obama-Care is so vehemently opposed? Because it's "so expensive"? No! It's because it removes major cash-flow devices from insurance companies, such as eliminating pre-existing condition qualifications or the denial of coverage to certain high-risk individuals.

FOLLOW THE MONEY, people! (And try not to be such corporate tools in the future...)

And while I'm on the subject: What, exactly, is the "conservative alternative" to Obama-Care? Exactly how does the Conservative Right intend to actively address the goal of "Providing health care to anyone who needs it regardless of their ability to pay"? I personally have never heard a single meaningful suggestion from them.

But you know... maybe I just "missed it". Maybe I got confused by all the rambling bullshit about "responsibility" and "merit" and it slipped right by me. Knowing me, it could have easily have happened. So tell me now: What is your alternative plan? What is your brilliant scheme that absolutely achieves all the same "goods" while completely avoiding all those nasty "bads"? I'm waiting to be amazed...

Um... Hello?

Are you ignoring my question? Pretending you "didn't hear" is a very childish ploy, you know?

No? Nothing?

I don't like to make too many blanket statements but, right now, at this juncture of human history...

THE CONSERVATIVE RIGHT IS COMPLETELY FUCKING USELESS!!!

And worse than useless, really, because you defend a status quo that is obviously, demonstratively, broken, and that by your own standards and values. You defend the Oligopoly! The abusers! What the bloody hell is wrong with you?!

Ahem...

Reason 3: Obama-Care is not the "right" answer.

You know what? When you're right, you're right. The sad fact of the matter is: Obama-Care is not a particularly good solution. Despite my rantings above, the truth is that Obama-Care does not, ultimately, remove control of American Health Care from the hands of insurance companies. If anything, it more firmly entrenches it, despite the additional limitations it inflicts against its profit margins. The Oligopoly continues in spite of all. The status quo remains.

But not only that, Obama-Care was written so poorly with enough loopholes for anyone - or rather: any company or even ENTIRE STATES - to "opt out" if they so desire. Thus Obama-Care is not truly a "national" policy. It has almost no ability to enforce itself. It's weak as water, and thus the goal remains ever distant, with no real hope of closing the gap.

We live in troubled times when the government of our land is willing to abdicate its obvious responsibilities to citizens in favor of corporations and their moodiness. But that is how it is. The real question is: Is that how it's going to stay?

You know, there was a third policy option that I deliberately omitted from your list of choices because I didn't want to "offend" you:

• Winning.

The sad fact, the utter human failing, is that both sides of this situation care far more about winning than either "providing care" or "avoiding paying" combined.

Do you see the level we're operating at here? Do you see the real obstacles that we have to contend with? We, as a nation, have more than enough money and resources to create the most impressive - completely free - national health care system that the world has ever seen. But it doesn't happen - and it won't happen - because doing so would be seen as "losing". And if there's one thing that Americans are not, it's "losers".

People suffer and die - and will continue to be allowed to suffer and die - because a handful of delusional elites cannot abide the perception - the perception - of having "lost" to the agenda of the people. I just don't think I can express the essence of the current situation any more succinctly than that.

But if nothing else, it's at least comforting to know that there really is "nothing new under the sun". Key individuals still can muck up the works for entire nations, and even for the world as a whole. It's inspiring in a way. It shows what really is possible when the "right person" is in the "right place" at the "right time". (And all of us? We're just jealous that we're not that "person"...)

So... people lose... And in fact, I lose too.

You see, my dirty little secret is that my spine will never truly heal. I'm living on borrowed time. Active and fit as I appear to be now, it will eventually deteriorate on me back to paralysis. I've got a wheelchair in my future.

But who knows? Maybe they'll invent a synthetic spine soon. That would be fantastic! Can you imagine how many people that could help?

But at the same time, they might as well not. Can you imagine how much it would cost to replace a spine? So much more than my life is worth. I would never be able to afford it. Neither am I willing to allow my kids get on-the-hook for it either. They'd never own another dime again. It would ruin their lives!

No, I'm afraid that neither nature - nor the values of conservative America - ever did intend for the weak survive or thrive. I cannot thwart either of their wishes. I accept my weakness. I am resigned to suffering.

I'm sorry, but that's the end of the story. I can't truly anticipate any additional closure for your curiosity.

I wonder what's going to happen now. We already have a system that doesn't work. And Obama-Care won't work. And none of these bastardized, watered-down partisan compromises will work. The only way forward that I can see is pure national health care...

Or we could just let go of the whole thing and stop pretending that it's one of our "values". It wouldn't accomplish the goal, true, but at least the honesty would be refreshing.

Sincerely,

--Geo