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Health Care at Last

I watched the House pass the health care bill earlier tonight. The talking heads all claimed it had the votes to pass, but I still found myself a case of nerves as the numbers piled up oh-so-slowly. The feeling of relief when the count hit 216 was palpable.

A great night for Obama, for the Democrats, for America.

Is it a perfect piece of legislation? By no means. It's deeply flawed. What we really need in this country is a single payer system, like Canada and Australia. Failing that, a viable public option. But the political realities being what they are, we could not get either of them. This small, hesitant, deeply flawed bill is nonetheless an important first step on the road that will, one hopes, eventually take this country to where the rest of the western democracies arrived several generations ago.

Pelosi and Obama both spoke about politics being personal. So true, especially where health care is concerned. Let me tell you a few of my own experiences.

I've been a full-time freelance writer since 1979, and I've been fortunate enough to do very well at it, thank you. As a result, I have health insurance. But even for me, it hasn't been easy. I remember, when I first moved to Santa Fe and went full time as a writer, I was coming off three years teaching college, when my health insurance had been covered by my job. Now I had to find my own. I was young and healthy back then... even slim and fit, believe it or not... but I didn't have a lot of money, and when I went looking for an individual policy, everything I found cost way more than I could afford and covered way less than my group insurance with the college had. To get affordable insurance, I had to join a group: the Santa Fe Chamber of Commerce. As a "small business," I joined the CofC and signed up for their group coverage. It was not great insurance, by any means, but it gave me some protection for a few years. But that was in 1980 or so. In a more recent decade, when the Writer's Guild policy that had covered me during my Hollywood years expired, I tried the same dodge... only to discover that while I could still join the Chamber of Commerce as a sole proprietorship, I could no longer get their health insurance. That was now available only to members who had two full-time employees. The insurance company had... you guessed it... changed the rules.

From 1997-1998 I served as vice-president of SFWA, the Science Fiction Writers of America, in the administration of Michael Capobianco, one of SFWA's most outstanding leaders. A LOT of freelance writers had no health insurance, and Capo did what no other president before him had been able to do: find a decent, affordable group policy for SFWA members. It was through Aetna, and while it wasn't as good as some other policies -- the WGA policy was much better --it was good enough, and certainly both cheaper and better than anything any writer could find as an individual. I signed up, as did a couple hundred other SFWAns, and for a couple of years we had the peace of mind that having such insurance brings.

And then Aetna dropped us. No particular reason was ever given. Guess we weren't profitable enough for them. They just cancelled the entire group. That wasn't allowed in New York State, where state laws required them to continue insuring policy holders resident in that state. But those of us in the other forty-nine states were out of luck. Nor were SFWA's officers (Capo and I were out of office by that time) able to find ANY other insurance company willing to step in and take Aetna's place. We were a group with fourteen hundred members, a couple hundred of whom had showed themselves willing and able to purchase group insurance (the rest, presumably, had policies from day jobs or through spouses, or were unable to afford any insurance whatsover)... and yet no one would insure us.

Like I said, I am one of the lucky ones. I was able to go back to the WGA for a few years, and from them to COBRA, and thanks to our state laws in New Mexico, I could purchase insurance through the New Mexico Health Insurance Alliance coming off COBRA without fear of being refused for pre-existing conditions. So I'm covered.

But I have a lot of friends who are not nearly so fortunate.

Many of you reading this blog today are presumably science fiction and fantasy fans. It would probably shock you to know how many of your favorite writers have no health insurance whatsover. Most midlist writers struggle to get by even at the best of times; lean times can be lean indeed. For a self-employed individual, even one who can afford the premiums, insurance can be very hard to find and obscenely expensive when you do find it... and god help you if you have a pre-existing condition, because the insurance companies sure won't.

This has all been brought home to me forcefully these past few years. A couple years back, one of my dearest friends, a great writer and a great guy, almost died of a heart attack. He had to have a quintuple bypass, and had a very difficult time recovering from it. No insurance. No money, either. Only the fact that he was a veteran saved him. He was able to get help from the VA. More recently, another old friend of mine got sick. Another fine writer, natch. No insurance, natch. No money, natch. Like the first friend, like a LOT of writers, he was just getting by. So when he started feeling sick he did not go to see a doc, no. Couldn't afford it. Took over the counter stuff, rested at home, drank liquids, got sicker and sicker. Finally went to the hospital, where he almost died. Two surgeries and three weeks later, he's finally been discharged. He's not a veteran, so the VA won't he coming to the rescue here. His surgeries, his ICU stay, those three weeks in the hospital, they will doubtless add up to about ten years of his annual earnings. Maybe more. He's going to face bankruptcy. "Well, he should have had insurance," I can hear some right wing asshole out there saying. Yeah, he shoulda. Except, even if he'd had the money to buy a policy, no insurance company would ever have issued one for him. He's had a pre-existing condition since childhood.

It is worth pointing out that if either of my friends had lived in Canada, or Australia, or France, or England, or any country with that old vile "socialized medicine" the right wing likes to denounce, they would never have gotten so sick. They would have seen a doctor much earlier, early enough so that their medical problems could have been diagnosed, treated, and perhaps cured or ameliorated before they required major surgery. But no, they couldn't afford doctors, and they didn't feel THAT bad... not at first... so they did what millions of Americans have done, and ignored their symptoms until it was almost too late.

So, yes, I was thrilled by what I witnessed tonight. This is something this country desperately needs. Health care is a basic human right, something every other major western democracy recognized decades ago.

Now I just hope the Senate does not screw it up.

One last thing. I think the extreme polarization of contemporary politics is both unfortunate and frightening (read some history of the Third Republic if you want to learn where such extremism can lead). Obama's efforts to reach across the aisle and make these reforms bi-partisan may have been fruitless, even misguided, but they were also heroic. And the utter rejection of those efforts by the GOP is both depressing and infuriating. I have been a Democrat more often than I have been a Republican in my life, sure, but the Republican Party that I grew up with, the party of Lincoln and Teddy Roosevelt (the first president to propose a national health program), of Clifford Case and Nelson Rockefeller, of Everett Dirksen and John Lindsay and Chuck Percy and Dwight D. Eisenhower... that party is now dead, it has become clear. The nasty campaign of fear and misinformation and outright lies that the right has waged against "Obamacare," complete with odious comparisons to Hitler (!) certainly drove that point home... though perhaps one might cling to some hope that those people were just the lunatic fringe.

But no. The fact that NOT ONE SINGLE REPUBLICAN voted against the party line is damning (more than thirty Democrats crossed the other way, by comparison). Today's GOP has abandoned all pretense of serving the people or attempting to redress the country's problems. Today's GOP belongs to the religious fundamentalists, the loonies and the haters, the lobbyists for the banks and corporations, and the very military industrial complex that Eisenhower warned against in his farewell speech. They proved that tonight.

Shame on them.



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Mar. 22nd, 2010 06:40 am (UTC)
:) I'm so happy, finally a step forward!
Mar. 22nd, 2010 06:40 am (UTC)
I heard the news of the US health care bill on the radio this morning (Europe). They said that Mr. Obama had come over personally for this.

It may indeed not be the best in the world, but it is a major advance in health care. Several of my American friends have suffered from the lack of one, so I was very happy and grateful to learn that this bill passed. Something is better than what you described.
Mar. 22nd, 2010 06:52 am (UTC)
This opens the door to pure Socialism, which I firmly believe is the intent of the bill and especially of Obama and his handlers. This will push us towards a Global government one more step.

Considering I just watched a terrific German-made film, 'The Lives of Others', just last night, which shows in stark terms how life was in Eastern Germany before The Wall came down, I am disgusted by what I see happening in this country. The will of the PEOPLE was ignored. The vast majority of Americans came down against this bill and the Democrats ignored their constituents in every case.

I respect your opinion, George, but as much as I hate to say it, you're dead wrong on this. The Bill should have been scrapped and a better solution found. If this Congress truly cared so much about doing the business of America, they would reign in Insurance companies, trial lawyers and the like that are the true source of grossly inflated healthcare costs. But no, as usual the real parasites bought our corrupt politicians and will end up coming out of this even richer.

The bottom line here is that for the first time in U.S. history, Congress has promoted a bill that will mandate what Americans must PAY for. This is completely anti-Constitutional, and this makes the vote an act of treason as far as I can see.

So, we the People will pay even more to provide Healthcare for 30+ million Americans and ultimately another 30+ million illegal aliens. None of this is free.

To make matters worse, this same US Government that took such shoddy care of my Disabled Veteran father will now be in charge of all of us to some extent. God help us.

"The Tyranny of Good Intentions."

I am sure I will be hearing much more about this vote in the morning: I work for a small Healthcare-related company. I'll feel the crunch sooner than most, unfortunately. That is my suspicion, at least.
Mar. 22nd, 2010 07:01 am (UTC)
I am wondering how you can read a book series written by an author whose perspective is clearly 'socialist' and therefore 'tainting' his narrative and the world he presents.
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Mar. 22nd, 2010 06:59 am (UTC)
Thank you for posting this. I find it shocking that there is no recourse for people in the States who can't afford basic medical treatment. Here in South Africa things are far from perfect, our community clinics in informal settlements often overburdened with patients, understaffed and understocked with life-saving medical supplies, and people often have to queue for more than a day only to get turned away at the last minute. But, despite all that, people can even receive government-funded treatment, even for cancer, if they are willing to wait to see a doctor. Not ideal, but better than nothing.

On the other hand, our politicians go about giving a totally different impression when they drive around in luxury German cars and take on a fourth wife... But ja... this is Africa after all. **shakes head**
Mar. 22nd, 2010 03:14 pm (UTC)
The situation here in Brazil is somewhat similar. I have insurance, but it's quite expensive (though far less than in the States), and the great majority of the population relies on the public health-care system. Some may go when they don't need, true, but the last Saturday I was with my girlfriend at a community clinic (her insurance doesn't have any hospital with emergencies, just regular stuff, exams and etc) because she was throwing up, fainting and with a enormous migraine, and I've seen a huge amount of pitiful cases. We're far from having a decent health-care system, but hell, infinitely better than in the US.

I myself am a liberal (more to left to almost anyone here, I think), and that's why I can only laugh at some comments such as "This opens the door to pure Socialism, which I firmly believe is the intent of the bill and especially of Obama and his handlers. This will push us towards a Global government one more step". "The Lives of Others" is a fantastic film - but thankfully the US is very, very far from Eastern Germany prior-1989. People have pointed before the absurdity of this argument, so I'll refrain myself from doing so.
Mar. 22nd, 2010 07:02 am (UTC)
As an Australian, it is difficult for me to even imagine a world where a hospital visit could bankrupt someone. It is even more difficult to imagine that America - land of the free, and land of the medical drama TV show that barely (if ever) mention costs - would also be a land where people are at risk of dying because of their socioeconomic circumstances.

Our system is by no means perfect - anyone who can afford it also has private cover - but at least people can get the treatments they need.

Here's to a better America.
Mar. 22nd, 2010 07:29 am (UTC)
Good point about TV medical dramas rarely mentioning cost.
The way that health care is portrayed on television in the US is a joke, totally ignoring the fact that for many, a major hospital visit--especially to the ER--means going into debt for tens of thousands of dollars. Let alone the budgetary nightmare that unfurls if you discover you have a chronic or terminal illness.

But then, when has American television ever accurately portrayed American life?
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Mar. 22nd, 2010 07:09 am (UTC)
I have to admit I really don't understand the US health system particularly, but coming from a country where I basically had free health care to another country where health care is so cheap I just can't help but wonder why it's taken the US so long to catch up to us. I mean if I am sick or have an accident I am secure in the knowledge that I can have treatment whether I can afford it or not
Mar. 22nd, 2010 07:12 am (UTC)
I am so glad this has finally happened. I'm from NZ - yes our healthcare system has flaws, but I cannot understand those people who think that our system is worse than the fact that people are dying because they do not have insurance.
Mar. 22nd, 2010 09:20 am (UTC)
people still die on our waiting list, why? becuase there is no money to get them treated in enough time.

Unless you need emergency care, you are going to wait for quite a while. upwards of 6 months for a specialist oncologist, months more for a bypass.

Our system may not have as many problems as the US one (or as many as Obamacare will have), but don't for one minute think that its some world leader.

i would not be caught dead here without health insurance any more than i would in the US, for the simple reason that if i ever need cancer treatment or a heart bypass i want it done now, not one day when the NZ state gets around to it, and i hopefully don;t die first.

Mar. 22nd, 2010 07:18 am (UTC)
My respect for you grows, sir. Even if you are a Jets fan. :-)
Mar. 22nd, 2010 01:00 pm (UTC)
My respect for you grows, sir. Even if you are a Jets (and Giants) fan. :-) - corrected

AMEN to that!
Mar. 22nd, 2010 07:19 am (UTC)
Thank you so much for writing this. I feel exactly the same, and it makes me so furious to hear modern Republicans repeating the same lies and exaggerations over and over to an audience that appears to be listening. It's angering, frustrating, and above all frightening.

This bill means a lot to me, personally. A close friend of mine is dying of cancer and is too young (63) to qualify for Medicare. Her family is bearing the burden for her treatments and medications. The irony is that she immigrated from the Netherlands over forty years ago. Had she stayed, she would already be taken care of. I hope this bill will do something to aid her and her family during this difficult time.

Anyway, no one really cares about my personal anecdotes :) thanks again for posting this to your blog. It's always nice to hear that people you admire agree with your views.
Mar. 22nd, 2010 07:19 am (UTC)
I so happy I do not live in the US. When US takes a step towards becoming a modern western country (out of the pack of dictatorships and third world countries without a health care system for other than the rich) people begin to scream about communism...

I truly amazed .. truly ...
Mar. 22nd, 2010 08:05 am (UTC)
Takes a step towards becoming a modern western country? I think you and I are reading different history books. Most of mine cite the US as one of the preeminent world powers.
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Mar. 22nd, 2010 07:20 am (UTC)
This is reality for millions of self-employed workers and independent contractors.
Mr. Martin, well-said. Thanks for speaking out about this.

You accurately describe the uncertainty and fear that millions of self-employed workers, freelancers, and independent contractors experience on a daily basis in this country.

My household consists of one freelancer (me) and one part-time hourly laborer. Neither of us can afford comprehensive health insurance. The plans that are aimed at people like us offer such meager "coverage" that there is little point for us to be on them.

We're lucky to live in a city with a decent public hospital that will see patients free of charge (after getting on waiting lists and sitting in waiting rooms for entire days--nearly impossible to do if you work full-time), but it's something we only use in emergency situations.

We don't go for regular check-ups. We deal with mysterious pains and symptoms, using the internet to self-diagnose and basically crossing our fingers that health care in the US will change before we get too old for any major illnesses to develop. Both of us have problems and risk factors in our family medical histories that we should be screened for. I constantly hope that luck will be on our side. I don't want to wake up middle-aged someday when we've finally decided to offer single-payer health care, and be told that I have some illness that could have been caught years ago.

I couldn't agree more with your assessment of the GOP's total dismissal of health care. Their threats of retaliation in the fall elections ring hollow: they've exposed themselves as out of touch with the reality of working- and middle-class people. I can't say that Democrats are much better, being generally just as corrupt and self-interested, but I do credit this success largely to Obama's tenacity and personal dedication.

You're right: his plan is flawed and needs a lot of adjustment. But without a stubborn idealist refusing to give up, we would have never passed any sort of health care reform. This country's politics are frighteningly polarized, as you mentioned--we were content to go back and forth over the bill ad infinitum until someone stepped in and, like a parent, scolded us like children. It's pathetic that it had to be passed like this.

The majority of developed capitalist nations offer single-payer health care. And they are still thriving. Their quality of living is higher than ours. Their infrastructure is better than ours. They haven't suddenly given up on capitalism and decided to reboot Communism. We're the ones with the economic crisis, the ones who spend one in six dollars on health care, the ones with the lowest life expectancies out of developed nations, the ones with soaring unemployment and overextended armies.

It's about time we confronted the corrupt, bloated health care system that is wholly antithetical to the principles of the free market.
Mar. 22nd, 2010 12:10 pm (UTC)
Re: This is reality for millions of self-employed workers and independent contractors.
You haven't been watching the news if you don't think Europe is in an economic crisis.

They are falling apart over there. Ireland, greece, spain, the UK, portugal, France, Iceland of course. Some of these countries might go bankrupt, like Argentina does every few years.

Also, do you know what the average unemployement rate is in Europe, even in good times? What we consider bad unemployment they consider normal.

Also, do you really think life expectancy == healthcare? Do you not genetics and lifestyle choices have anything to do with it?

Did you know if you factor out traffic accidents and homicides the US has some of the highest life expectancy in the world? Honest.

Single payer is great if you never need life saving care. It does really good at routine care. But because of shortages it can't handle advanced lifesaving care. Which is why when looking at things like survival rates after diagnosis or a serious illness puts all those countries below us here.

The fact is, healthcare is not an unlimited resource. Anymore than science fiction books are an unlimited resource or starbucks coffee is an unlimited resource.

You can ration it by price, or you can ratio it by waiting, or by quality. You cannot magically wave a wand and have more MRI machines exist, more interventional cardiologists exist, more chemotherapy centers exist. Someone has to pay for all of that, it is a limited resource. Unless... of course.. you simply want to enslave everyone who works in the healthcare industry from people who manufacture medical equipment, to build hospitals, to doctors and nurses.... good luck motivating them to do good work if you enslave them. But assuming you don't want to go the communist route, then someone has to pay for it.

The point is, if you want everyone to have coverage, then you need to increase waiting, decrease quality, or increase payments. Now you don't see any politicians talking about increasing medical reimbursements do you? So the 85% of people in the US with medical coverage should expect to end up seeing more waiting and less quality.

Also, by the way, the US does not only spend on the rich. Statistically as a country we spend more per capita on healthcare for the poor, than the rich. Look it up. As I recall it is something like 9k per year vs 11k.

Mar. 22nd, 2010 07:22 am (UTC)
Haven't watched the news yet so your blog is actually the first place where I read the health care bill had passed. Congratulations, all you Americans! :)

I'm not even an American but somehow this feels a little bit like a relief to me too. Maybe because of me being pretty shocked by all the outrage I saw in American citizens on tv, many of them people that actually could make really good use of such a health care system, screaming of communism and acting like it would be the end of the world.. all about a system that would help SO MANY people, I even dare say a system that would help pretty much everyone in the country. It is really, really inconceivable to me how anyone could object to it, at all, or for that matter think that their country will become communist (?!). The rest of the western world has health care systems like this too, and we're fine... we're still free, and hey, everybody gets quality health care whenever they need it. It is a good thing, and I feel very privileged to live somewhere where such things are available to me.

Congrats, again, and I hope the weird fear for it will pass.
Mar. 22nd, 2010 07:27 am (UTC)
Money talks
As sad as it is to say, here in the US making a profit is more important than making sure someone is healthy. Be it a child, parent or an elderly person.

I am a person who has been in and out of jobs where health care isn't provided either out of the pure expense of it to the employer, or too small of a company to be able to afford it. I am 26 years old, and in the 8 years that I've been working since 18 only one company has even offered any healthcare benefit.

I like working for small companies where everyone knows each other more than I like working for mega companies, but small companies (I've never worked for a company with more than 50 employees) cannot really afford to pay for health care coverage. The ironic part about all of this is the one company I did work for that covered health care was a small civil and environmental engineering firm that did a lot of contract work for .... the government.

Yes, this is going to be a very costly endeavor for the US to take in a weakened economic state, but it is one that we can and will overcome. We aren't on top of the world in financial resources because we refuse to spend money and are penny pinchers. We're on top of the world financially because we spend so many resources on bettering ourselves.

I am sorry to hear that the writing industry has been one that has been so... lacking in taking care of its own. When our creative minds go what will be left?

Cheers Mr. Martin.
Mar. 22nd, 2010 07:34 am (UTC)
And thank you for this post, Mr. Martin. As a long time fantasy and sci-fi reader, occassional writer, armchair political pundit and academic, it's just good to see an author whose political philosophy aligns with mine. Not that I have to have people I agree with in this world, but the viewpoint of the author will always come through. (I doubt Orson Scott Card could write a positive gay atheist pacifist character, for example.)

Although authors are not their books, their views and values shape the sorts of worlds they create and the characters they present as negative and positive role models. So hey, like I said, it's good to know that there's an author I not only enjoy, but also respect - there are many other authors who I read for enjoyment, but occasionally cluck and shake my head over the philosophical aspects of their world.
Mar. 22nd, 2010 08:07 am (UTC)
But Orson Scott Card did write a pretty compelling book on the excesses of the American political system. Empire. I'd recommend you check it out. It's very thought provoking.
Mar. 22nd, 2010 07:42 am (UTC)
How wonderful for all my American friends :)

I am so grateful to live in a country like Australia where (with admitted problems) our health care system manages to provide everyone with necessary care.

Should move here George, our pizza may not be as good but the weather is better :P
Mar. 22nd, 2010 02:17 pm (UTC)
If you guys would make it a little easier to immigrate!
I'm so there.

Needs to be another GRRM series, set within quasi Austria.
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George R.R. Martin
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