Some time around one o'clock in the morning on Saturday the 22nd of August of this year, my father, struggling with knee problems, some generalized weakness, lack of appetite, and lethargy, tried to use the portable urinal he kept by his bed to limit those middle-of-the-night trips to the toilet. Sounds a little gross, but certainly not when the alternative is a 20-minute ordeal of struggling to the bathroom and wondering what in the hell you're going to do if you don't make it there in time.
But that night there was an additional problem. He was having trouble going. He tried to adjust his position sitting on the edge of the bed. Suddenly the mattress shifted underneath him and deposited him gently on the floor. He might have been in nothing more threatening than a seated position there, but with his knees as bad as they are, there was almost no chance he was going to get out of it without help. For reasons that would later become apparent, my father would pretend to himself that that wasn't true. He decided to believe that soon he'd feel better and be able to get up, on his own.
He thinks he dozed much of the night. As it got light, he realized his cell phone was within grasp and he called me, not to say he was in trouble, but only about the move we were planning for him, to his own place closer to me. He never mentioned the precariousness of his position. He had now been stuck on the floor around seven hours.
Some time in the afternoon, between the dehydration and the exhaustion, the hallucinations started. He heard my sister and her family in the hallway outside his bedroom. He could feel the vibration of the footsteps of his grand-kids running up and down. In a startling tribute to the imagination's ability to make a hallucination like this one completely self-contained and impervious, he heard his daughter say "don't bother Grandpa, he's resting." He thinks he smelled cooking. My sister and her kids were, in fact, in Rochester, New York at the time.
My Dad found himself increasingly angry and finally, sometime after midnight on the morning of Sunday August 23rd, he phoned her and demanded to know why she had been in the house without so much as giving him the courtesy of peeking her head in to see if he was all right. Only after her repeated insistences that she was 330 miles away and had been, all day, did reality regain control. My father apologized. My sister called his neighbor. The neighbor called the cops.
There was never an official diagnosis of just the one incident that night, but I have gone into such excruciating detail because of what I was told that night by the doctors at the ER at which I joined my father, and what I've been told by other health professionals since. The hallucinations almost certainly were provoked by dehydration and if not renal failure per se, then certainly a kind of temporary shut down. By the time he got there, it had been more than 24 hours since he had triggered this cascade of problems by trying to adjust the position of his body so he could urinate. And he still had not done so.
My father's kidneys were in trouble. Considering kidney disease was what killed his father, this was very bad news. We heard just yesterday about kidneys and insurance. The Waddington brothers, Travis of New York; Michael of Santa Fe. As the New York Times reported, their Dad, David, needed a kidney transplant because of a congenital renal disease.
Each of his sons was ready to donate. But they were warned not even to get tested to see if they matched. For if they did transplant or not they would conceivably be denied insurance for the rest of their lives, because they might test positive for that same congenital renal disease that threatened their father. And thus would they have a pre-existing condition.
And still the Waddingtons and their Dad and my Dad were all luckier than at least 45,000 Americans. Because as discovered in a new study conducted by Harvard University and the Cambridge Health Alliance, that's how many of us are dying, each year, because we don't have insurance.
The number is horrible. But when it is contrasted to what faced my father that night, it is unforgivable. Because as Cambridge's summary of the findings put it: "Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease." My father had less to fear that night from bad kidneys than he would have if he hadn't had insurance!
And yet we let this continue.You and I. This society. Our country. Democrats and Republicans.
This is the study Congressman Grayson of Florida quoted, about which the Republicans demanded an apology when they should have been standing there shrieking, demanding we fix this. "Uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts."
People, in short, are dying for the lack… of money. Dying as surely as they did when Charles Dickens wrote about the exact same problem. Of a boy who couldn't get sufficient medical care for his affliction. Of the underprivileged, suffering not just privation but death, as the comfortable, moved silently and unseeingly through the streets of London.
The book was called "A Christmas Carol" and the boy Dickens imagined was called "Tiny Tim" and it was published on the 19th of December, 1843, and it is 166 years later and the problem is not only still with us, it is getting worse. The mortality rate among Americans under the age of 65 who are uninsured, is 40 percent higher than among those with insurance. In 1993 a similar study found the difference was only 25 percent.
We are moving backwards! We are letting people die because they do not have insurance.
What's worse is that barring meaningful health care reform, this will only grow. The difference between the surveys from 1993 and now suggest this fatal insurance gap is growing by about one percent, per year. Your chances of dying because you don't have insurance are now 40 percent higher than those who have it.
By extrapolation, three years from now your chances will be 43 percent higher. Your chances of dying because you used to smoke, compared to those who never smoked, only 42 percent higher. You heard that right. At the current rate, in 2012, you will be more fortunate, more secure, more long-lived, if you used to smoke, than if you don't have insurance. It is mind-boggling, and mind-less. This is the country you want? This is the country you will accept?
Do those other people in this country have meaning to you, or are they just extras in your movie, backgrounds in your painting, choruses in your solo? Without access to insurance for all of us and the only way we get it is with the government supplying the gaps, just like it does in flood insurance for God's sake that fatal gap will just keep growing.
A 45 percent higher likelihood of death for the uninsured compared to the insured by 2014.
By 2022, the figure will be 53 percent higher. Fifty-three percent! In the 1840s, as Dickens wrote a "Christmas Carol" - in a time at which we now look back with horror, the city of Manchester in England commissioned a crude study of mortality among its residents. A Doctor P.N. Holland categorized the sanitary conditions of the houses and streets of Manchester into three classes.
And when he compared the death rate in the First Class Houses in the First Class Streets, to the death rate in the Second Class Houses in the Third Class Streets, he found mortality in those worst locations was 53 percent higher. If we do not reverse this trend, in fourteen years' time we will not be living in the America of 2022. The shadows of the things that may be, tell us, that we will instead be living in an insurance-driven version, of the Dickensian England of 1843!
God Bless Us, everyone.
I told my father the other night that the insurance I really want to get for him and me is called Corporate-Owned-Life-Insurance. "COLI" — like in E. Coli. How fitting. With or without your consent, your employer is permitted by law to take out life insurance on you. It can, in fact, take out life insurance on everybody who works for it. Who gets the money when you die? Your employer does.
Dad pointed out that theoretically this would give them motivation to kill you. That, of course, would be for the same reason, as Michael Moore points out in his new movie "Capitalism: A Love Story," that you can't buy fire insurance on the house of the guy who lives next door to you. Golly gee, that's right, suddenly you'd have a motive to burn down his house and the world is already too much like that symbolically to make it like that in reality.
No, it's really unlikely that even the most evil corporation would think of killing you to get a payout from the COLI insurance plan. This exists for a much more mundane and passive reason. You're going to die anyway, and the tax laws of this country are such that if your company has a hundred thousand employees, it can take out small whole-life policies on everybody and just let the actuarial tables do the work for it. Ten thousand dollars here, $20,000 there, maybe $50,000 back here and all of it tax-exempt.
Oh and your employer can borrow the money to pay the premiums on the secret insurance it has on you. And the interest on that loan is tax-deductible. And your employer can, in essence, over-pay the premium it has on you and your fellow drones, and the extra money in the kitty is called "Cash Value," and it can be stuck into a pension-benefit plan or other product of the mad world of accounting. And "Cash Value" is also tax-deferred. It can be returned to your employer as a tax-free loan. And if your employer goes bankrupt, the Cash Value of those insurance policies is protected by the tax-laws - from creditors!
In short, your employer can get a tax-deductible loan to buy insurance on you that until this past June he didn't even have to tell you about, and the money is first tax-deferred and then tax-free, and when you die, the payoff it gets is tax-exempt, and when the company dies, the boss still gets to keep the money away from the creditors even if somehow you, the guy on whom your boss has surreptitiously taken an insurance policy - happen to be one of the creditors.
And even though it's based on insurance on your health and your life, all of that tax-free, tax-exempt, tax-deferred money not only doesn't go to you, it also doesn't go to the government. And so if we really are ever going to do anything about federally-supported health care as an alternative to these private insurers, there's that much less tax money to do it with.
And some of the money that isn't going to you, and isn't going to the government, is going to strengthen the already monolithic insurance companies!
And just in case this isn't a sweet enough deal, the government is almost silent about telling that employer of yours about what kind of health insurance it must give you. And year after year, the companies get smarter and more audacious about either cutting what your health insurance covers, or cutting the number of employees the health insurance covers, or both.
And if that still isn't enough, there is something called the National Association of Insurance and Financial Advisors. And it has a Political Action Committee, IFAPAC, and last year IFAPAC had one million, $492,000 worth of campaign money with which to buy politicians. And you'd be amazed how many of them you can buy with even one million, $492,000.
And these are the same people who are not only influencing the health care debate, spending more than a million dollars a day to defeat reform, they are also the same people, who by raising your premiums and cutting your reimbursements, who by manipulating prices at hospitals and doctor's offices for everything from tongue depressors to enemas, who by influencing health care in this country more effectively and more selfishly than a dictator could ever do these are the people who decide what kind of health care you get, how much you pay for it, and whether or not they'd rather not see you get it.
It is your skin. Literally. And it is in the hands of people, insurance companies, who can still make money by betting against your good health. There is only one comfort here and it is cold indeed. Profit while you can, insurers. Sickness and death wait not just for your customer. They also wait for you. And they are double-parked. The doctor who treats you and the pharmacist who makes you pay through your nose are not your enemies in this. It proves they are as much victims as you and I are. And the time has come to realign the battle here, so that it is not just us versus the entire medical and health care establishment, it is us, and the doctors, and the nurses, and the pharmacists, and maybe even some of the hospitals, against the real enemy: The insurance companies... the Insurance companies who are right now at war against America! That's where I'll pick it up when this Special Comment continues.
To be continued...
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