I wasn't the only US citizen who was disappointed in the final compromise provisions of the Affordable Care Act, known as Obamacare. It seems many of us are troubled by one or another aspect of the new law. Many Americans were disappointed that we couldn't find a way to include a single payer option, as a route to improve citizen access to basic health care. Many others are concerned about different aspects of the ACA. But very few of us, even the experts, have courage to step back and look at the big picture.
The media keeps us focused instead on myriad details of Obamacare. This keeps us from examining what really needs to change about our health care system. Luckily, here in Big Horn County, we have country wisdom and turkeys to illuminate the big picture.
Last month we had our annual turkey plucking and processing spree in preparation for Thanksgiving. After filling the freezer, we had nine turkeys left to get through a cold Montana winter. Grandma Bonnie and I started hand feeding these remaining turkeys to keep them healthy and close to home. I guess one could call this a turkey "welfare" system. Then one day last week, we discovered we had created a monster.
We noticed a sharp increase in turkey fighting. It wasn't the usual turkey tangle where they joust for a firm beak-hold on another's loose neck skin, and then hang on while the victim begs and pleads for mercy. This was different. It was one turkey hen jabbing her beak into any other turkey's backside who dared peck near her for the goodies (whole corn) I had thrown into the lawn for them. She had taken up the role of resource queen. She wanted ultimate control over all that I so generously provided.
This girl did not spare even her own momma from her attacks, even though her momma was the one who taught her to browse for food. There she was, aggressively pushing austerity and deprivation for the majority, trying to limit their access to the corn kernels I, the benevolent benefactor, had spread around. Earlier this fall, as fresh greens and insects disappeared, we started scattering ever larger piles of corn kernels. As a result of this bounty, a middle-management hen was born. She took on the role of turkey-feed surrogate, managing our gift of resources for her own gain instead of the good of all.
This to me represents the big picture of how health care has been managed in our country. As Americans, we assume that the only way to pay for our health care is through surrogates, like insurance-brokered health care plans and insurance-managed Medicare and Medicaid. David Goldhill, author of "Catastrophic Care: How American Health Care Killed my Father," points out that the health care industry plays by rules totally foreign to the rest of the business world in America.
Our health insurance industry rules are written for the profit of a few and designed to avoid payment of expenses related to errors, some lethal, in our high quality care. This gross irresponsibility has been happening because health care decisions are taken from individuals and their providers. Payment approval power is given to surrogates with strong political pressures to approve any and all procedures when profitable and to deny less profitable but highly effective care (e.g., preventive medicine).
The best way to bring costs down to earth is to replace entirely the current economic managers of our American medical system, both the private insurance system and Medicare/Medicaid. We need to start with understanding and disarming the secrecy forces in society that built the current system on greed and profit. We need to separate the expensive technically advanced procedures from those surrogates who would manage them for profit, and return them to people management through publicly elected representatives immune from health care industry profit influence.
As the turkeys have shown us, the best way to battle greed is to spread access to resources more evenly. We've learned that it works better to scatter a little corn widely across the gravel of our drive. Making a few big piles, wealth distribution the current way in America, just didn't work for turkeys. Now, with our reform, they have to move away from competing for the best plan/pile to find a place of access, and there's enough to go around. Our arrogant hen now simply joins in the scratching and browsing, no longer trying to be our surrogate. This works much better on our farm. Maybe a yet unnamed, unknown public health care system in America will arise from the ashes of the public option rejection by Obama, by Baucus, and by both the Democratic and Republican party leadership, including the Tea Party, but still endorsed by well over half of the American electorate, including this writer.
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David Graber
Hardin, MT 59034
graberdb@gmail.com
