All a Big Game?

About a year ago I had dinner with a lovely couple who happened to be members of a different political party than I. It was not long before the 2008 election, and the handwriting was pretty much on the wall that it was not going to go well for their candidate. It could have been a tense experience, but it wasn’t. I grew up in a family whose politics tend to be quite different from mine, so it doesn’t surprise me that some people of good will think differently on a variety of issues than I do. And it certainly doesn’t mean we can’t have a good time together talking about many things!

At any rate, as the conversation went forward during the evening, the question of how one might choose a candidate arose. It was at this point that I was surprised. In my family and experience, candidates are chosen based on their stand on the issues and their record. At least that’s what most of us would say publicly. It’s definitely conceivable that a vote would go across party lines, though not common. We tend to be pretty independent even when we are members of a party.

However, the gentleman with whom I was dining expressed a totally different idea. He described politics as if it were a game. The analogy he used was of rooting for a college football team. In college football, the record and beliefs of the team members don’t matter. If one is a fan of, say Cal Berkeley, one cheers for Cal Berkeley. If one favors Stanford, then Stanford receives the cheers and allegiance. (These were not the colleges mentioned at the table, but to protect the innocent I’ve changed the names!) In his opinion, politics is also a game. If my team doesn’t win this round, the next starts tomorrow and I’ll do anything in my power to make sure my team wins next time.

I’ve been watching with dismay the controversy over the proposed reform of the health care system and I find myself wondering if it’s become part of the “game” of politics for some. 

There are many complicated issues that must be addressed, many differences of opinion about what services should be offered and to whom, many challenges regarding funding and affordability. Most are not being addressed. Instead, some opponents of the reform bills are circulating outright lies about the proposed reform bills and repeating them at the top of their lungs. They’re out to frighten rather than enlighten middle America. And, I hate to say it, but they seem to be succeeding. Fear wins out over reason every time!

It happened again one morning this week as I was reading the morning paper and its comics page (sacred reading in my book – generally sets the day off to a happy start). Our paper has both conservative and liberal strips, as well as the general funnies and serials. The conservative strip showed a caricature of President Obama saying that he is determined to get rid of people’s clunkers and has him holding a picture of an elderly woman. Talk about fear-mongering and outright lies! I was furious. Nothing in any of the bills comes anywhere close to proposing what the comic strip implied.

The same newspaper, the same day, included an article in the news section reporting on a study published in the Journal of the American Medical Association (about as conservative as they come). According to the article, so called “end-of-life counseling” improved the mood and quality of life for cancer patients. The study was not done anticipating the current controversy, though it’s an example of the types of studies of outcomes/best practices that are proposed in some of the bills under consideration. What is the best way to care for the ill, the elderly, the young, etc.? The author of the study, nurse practitioner and researcher Marie Makitas, noted: “They [cancer patients] seem to feel a whole lot better knowing there’s someone who’s looking at the rest of them and not just the tumor.”

Isn’t that what quality care should include? Isn’t that an issue of personal rights to decide on important questions such as who will make decisions for me when I no longer can? It seems pretty conservative and pretty obvious to me. Yet critics keep shouting words that frighten rather than discuss the deeper issues and challenges we all face.

The only way I can make any sense of all this to think that for some very powerful people, it’s either just a big game or they have a financial stake in keeping the status quo as it is. Maybe it’s both.

It’s certainly not a big game for the family that lost the rental property they expected would help support them through retirement when their son, through no fault of his own, sustained a major closed head injury in a car accident while in his early 20s. The driver who injured him was not insured and he was between health insurance policies, so his parents ended up paying full price for his care.

It’s not a big game for the woman who is battling ovarian cancer and is concerned that the company for which she works may go out of business, taking her health insurance with it. She would qualify for coverage through the HIPPA program, but it costs more and offers fewer benefits than she currently gets. If she’s out of work and/or medical leave, she’d have to find a way to pay the entire cost of the plan.

It’s not a game for the woman who doesn’t have insurance now because she has a pre-existing condition but can’t get help because there’s a small trust set up with her as beneficiary. No state or federal help for such people!  Her only option is a high risk plan sponsored by the state that offers only $75,000 in total benefits per year and costs 3-4 times what a normal, healthy woman her age would pay for $5 million in coverage!

It’s not a game for the family whose new baby will cost them over $300 per month to insure on his mother’s insurance plan. Dad’s unemployed and Mom has to return to work 6 weeks after his birth so she can keep her job. (Fortunately for that family, the baby qualified for a “big government” program – Medicaid. Thank heavens for “big government” and the vision of those who fought for Medicare and Medicaid in the 1960s.)

It’s not a big game for the family whose employer had to reduce costs and so changed the company insurance plan to a high deductible plan that requires the family to pay the deductible before they receive any real benefits from the plan.

It’s not a big game for the thousands of people who find their employers no longer offer health insurance or their doctors no longer accept their insurance plan.

In over 30 years of working in the health care arena, including design of services and facilities, translation of patient informational materials, comparative studies of rates and costs of providing services, and many other assignments, as well as over 10 years in the insurance industry, I’ve seen a lot of cases in which the existing system has not lived up to the promises and claims made for it. We’ve come a long ways towards providing care for all, but we still fall far short and the system is too expensive to be sustainable as is. It’s not a game for too many people.  

Perhaps those who are in favor of health care reform need to know that for at least some of their opponents, it may all be a big game or a question of ratings or of who will win the next election. It may not have anything at all to do with economic realities or morality or social justice or even good patient care! Is it really all just a big game?

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