Monthly Archives: August 2009

One Piece At A Time

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With apologies to Johnny Cash and writer Wayne Kemp who inadvertently chronicled our present health care delivery system, One Piece At A Time: Mr. Cash left Kentucky back in ’49 and went to Detroit workin’ on the assembly line. He smuggled out a piece, he smuggled out a pair, and sooner or later he had a car out there.

Well I left Kentucky back in ’49 and
Went to Washington work on the assembly line
The first year they had me puttin’ peeps on Medicare
Every day I’d watch them beauties roll by
And sometimes I’d hang my head and cry
Cuz I always wanted me one that was big and fair
One day I devised myself a plan
That should be the envy of most any man
I’d sneak it outta there in a lunchbox in my hand
Now gettin’ caught meant gettin’ fired
But I figured I’d have it all by the time I retired
I’d have me a plan worth at least 100 grand

I’d get it one piece at a time
And it wouldn’t cost me a dime
You’ll know it’s me when I come through your town
I’m gonna ride around in style
I’m gonna drive everybody wild
Cuz I’ll have the only one there is around

So the very next day when I punched in
With my big lunchbox and with help from my friend
I left that day with a lunchbox of blood smears
I’ve never considered myself a thief
But America wouldn’t miss one little piece
Especially if I strung it out over several years
The first day I found me a breast lump
And the next day I got me a freestanding birth center
Then I got me an ambulance and all the chrome
The little things I could get in my big lunchbox
Like pins and gowns and electroshocks
But the big stuff we snuck out my buddy’s mobile home
Now up to now my plan went alright
‘Til we tried to put it all together one night
And that’s when we noticed that somethin’ was definitely wrong
The insurance checks were from ’53 and
The hospital bill was a ’73 and
When we tried to put in the bolts all the holes were gone
So we drilled it out so that it would fit and
With a little help from an adapter kit
We had that hospital runnin’ like a song
Now the OR lights, they was another sight
We had 2 on the left and 1 on the right
But when we pulled out the switch all 3 of ’em come on
The back end looked kinda funny too
But we put it together and when we got through
Well that’s when we noticed that we only had 1 bed pan
About that time my wife walked out and
I could see in her eyes that she had her doubts
But she opened the door and said
“Honey, take me for a spin”
Drove uptown just to get our subsidies and
I headed her right on down main drag
I could hear everybody cryin’ for blocks around
But up there at the Congress they didn’t laugh
Cuz to type it up it took the whole staff and
The final Health Care Reform Act weighed 60 pounds

I’d got it one piece at a time
And it didn’t cost me a dime
You’ll know taxes ain’t never going down
I’m gonna ride around in style
I’m gonna drive everybody wild
Cuz I’ll have the only one there is around

Uh, yeah Red Rider this is the Cotton Mouth in the
Psycho Billy HMO, come on
Huh?
Uh, this is the Cotton Mouth and neg-a-tory on the
Cost of this moe-sheen there Red Rider
You might say I went right up to the factory and
Picked it up, it’s cheaper that way
Uh, what model is it?
It’s a 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59
patchwork blanket
It’s a 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70
holey basket.

We built our Health Care system pretty much that way. One Piece At A Time. And just like that 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70 automobile, the gas tank leaks and the engine makes funny noises.

Everybody in this discussion, from the most fervent ObamaCare supporter to the most ardent contrarian, has a good answer for patching up a rusty old car that runs on three cylinders and has two flat tires. It might keep us going to the next exit, but it won’t carry the family across the country on vacation.

The same Democrats pushing patches on the current system want to reinvent the automobile from the ground up but all they want to do with health care is find a few more people to cover and another way to pay for it.

The same Republicans opposing changes to the current system want to keep that clunker but all they can to do with health care is keep the money from flowing to Washington.

We deserve better. We need to start from scratch. And if your Congress Critter or President tries to pay this new 1,000 page tax bill with your wallet, throw da bum out.

Sing it with me now,
It’s a 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59
patchwork angina
It’s a 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70
insurance black hole.

Big Cuts or Flummery?

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“We’ll cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies that do nothing to improve care and everything to improve their profits.” President Obama wrote in the NYTimes.

Cool.

Um, wait a minute, Mr. President. Aren’t Medicare and Medicaid already government programs? Why do we need a brand new 1,000 page bill to “cut hundreds of billions of dollars in waste and inefficiency” from the programs you are already the boss of?

Why can’t we just cut hundreds of billions of dollars in waste and inefficiency out of those right now?

Disinformation?

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The White House is on a mission to clarify what it calls “disinformation” about what they call health care reform and I call two trillion dollars of new taxes.

The president went to in Portsmouth, New Hampshire, on August 11 to sell his plan to the voters. He had a great crowd. Unlike the House member “Town Halls” that Nancy Pelosi says Republicans pack with “un-American” hooligans, ABC noted the Democrats packed the President’s gathering with yes-men while outside was packed with the (disenfranchised) nay-sayers.

In selling his plan, President Obama said, “the American people will be glad we acted to change an unsustainable system.” Too bad the news reports refuted that.

Nobody in Washington — not even the President — listens. “The problem is people become frustrated because they can’t get their voices heard,” Corey Lewandowski, of the activist group Americans for Prosperity said. The President apparently still believes even the frustrated people will be glad.

In selling his plan, President Obama said, “We have the AARP on board” to endorse the bill. Too bad AARP refuted that statement.

“Indications that we have endorsed any of the major health care reform bills currently under consideration in Congress are inaccurate,” an AARP statement said.

In selling his plan, President Obama said, “Under the reform we’re proposing, if you like your doctor you can keep your doctor. If you like you health care plan, you can keep your health care plan.” Too bad our experience in Vermont refuted that claim, too.

ABC News aired a periodic “Fact Check.” It didn’t dig deeply enough to see the expectation (born in Vermont) that insurance companies would flee.

Reporter David Wright supported the president. “Opponents of health care reform claim that the proposed changes would put private insurance companies out of business,” he reported. “That’s false.” Wright went to the bill itself to to show that insurers will continue in business. Section 102 of the current House bill actually says “Insurance companies have five years to comply with new government standards.”

They won’t.

See, Vermonters have a little experience with voluntary compliance with government standards. In 1992, then-Governor Howard Dean signed into law a program to force universal health care on Vermont by 1995. (Governor Dean opposed a competing single-payer plan as too expensive. “Their package would have cost $500 million in a state with a total budget of $1.3 billion,” Governor Dean said at the time.) His new law banned “cherry picking” and enacted many of the rules present in the current House bill.

Strangely, insurance companies did not flock to Vermont.

In fact, Vermonters found just the opposite happened.

In 1990 the state had more than a dozen companies writing health insurance for Vermonters. By 1995, the state had three companies writing health insurance for Vermonters.

The current House bill also includes tax breaks and mandates to keep employers from exercising their free market right to drop existing (expensive) insurance plans. Mandates may make good sound bites; they don’t work if no one sticks around to obey them.

What have we learned today?

Maybe, just maybe our trust that our politicians could tell the truth should match our expectation that used car dealers ever tell the truth.

Like Mom Used to Make

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While rooting around in a kitchen cabinet this morning, I found my mother’s flour sifter. Way in the back. A little dusty. A bit forlorn.

My mom was a terrific cook. She never trained at Ecole du Cordon Bleu, the oldest international cooking school in Paris, or the Ecole Ritz Escoffier although she did make a mean Peach Melba. She learned to cook and bake from her mother on a coal stove in the big kitchen of our Pennsylvania farmhouse. She later trained in the School of Irma.

Irma, of course, was Irma S. Rombauer, author of The Joy of Cooking, one of the world’s most-published cookbooks. That book has been in print continuously since 1936, the year my mom was graduated from high school. A staple of so many kitchens, I have hoarded three of them — one the 1946 edition my mom received as a wedding present, one a duplicate I bought, and one a “modern” 1962 edition I gave to Anne when we married.

I don’t remember not having an electric stove when I was tagging-toddling along in that kitchen but I do remember the last day the coal stove operated in earnest. Back in the olden days before the advent of automatic ignition in pellet stoves, all solid fuel appliances had to simmer all the time. If you let the fire go out, it simply took too long to bring the stove back up to temperature to cook. We kept that fire going winter and summer not only to cook but also to heat the household water; the stove had a modern coil and a hot water tank attached. I filled the coal scuttle twice a day in the cellar and carried it up the stairs to the kitchen.

You can imagine the sheer joy of keeping a fire going through a humid Pennsylvania summer.

A wood or coal fired oven does bake the best breads and cakes, though, because the temperature remains constant. Our coal stove had a warming oven that meant we never, ever ate from a cold dinner plate.

My mom baked cakes from scratch, first in that coal stove and later in an electric oven. By hand when I was a kid, but she very quickly discovered the joy of an electric hand mixer.

She refused to use a cake mix. “A cake should be just dry enough and just sweet enough to complement its frosting and the ice cream you serve with it,” she said.

Cake mixes, particularly the boxes with “pudding in the mix,” are sweet. Although they have no high fructose corn syrup, sugar shows up as the number one ingredient by weight or volume. I think Americans crave way too much sugar.

We don’t bake cakes from scratch any more. I guess we deplore all that sifting. Even my mom had started using Mr. Hines’ (the author of Adventures in Good Eating, not the Confederate spy) varieties although she always complained that they were too sweet and too moist.

I fibbed. We do still bake one cake from scratch — the pineapple upside down cake. Every yellow cake on the market overpowers its sweet pineapple topping. Or is it bottoming? It requires a good, heavy, cast iron fry pan of which we have several. They were my mom’s too.

ONE EGG CAKE
2 Cups Flour, sifted
1 Cup Sugar
1 Egg
1/2 Cup Butter, beaten until soft
3/4 Cup Milk
2 Tsp. Baking Powder

Resift all dry ingredients, then mix together with the blended butter and liquids. Pour over the goopy, caramelized pineapple. Bake for 40 minutes or until toothpick comes out clean.

I wonder if there is any market for a cake like mom used to make instead of a cake mix like Hostess used to make?

Is It Murder?

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Two area men denied their role in the fatal alcohol and drug overdose of a Vermont teen last month. The men, one from Sheldon Springs and the other from Highgate, each pled not guilty of manslaughter for the death of 19-year old Jeremy Chapple. who died after guzzling the booze and Lorazepam they sold to him in an apartment in Swanton Village.

Local police know that apartment as a juvenile gathering place.

According to the St Albans Messenger, one of the men charged “only has one forgery conviction on his criminal record.” The judge released that man without bail or curfew although he can’t leave Franklin County without court permission.

The second man is currently serving house arrest for armed robbery. The Corrections Department is unlikely to release him now.

Lordy, Lordy™.

The paper reported that the first defendant sold four tablets of Lorazepam to Mr. Chapple for $1 each. The other defendant bought him a jug of Jack Daniels. Depressed after breaking up with his girlfriend, Mr. Chapple consumed them in a couple of hours.

Sad story. Sad ending.

But it might not be manslaughter.

It might be murder.

“The death of Jeremy Chapple on June 8 is a tragedy of the highest degree — in other words, an avoidable tragedy,” Franklin County Caring Communities, Rural Partnerships, and the Grand Isle County Clean Team, the primary drug and alcohol coalitions of northwestern Vermont, said in a statement after the court proceedings. “Those who think the only danger that comes from underage drinking is an alcohol-related crash need look no further than this case to see otherwise. Those who believe that supplying an underage individual with alcohol will not lead to trouble for themselves can also learn an important lesson from this. Finally, this death should serve as a clear need for swift action in all our communities when it comes to prescription drug abuse.

“It is our sincerest hope that today’s arraignments will be an important step down a path that helps our whole northwest Vermont community learn important lessons about teens, alcohol and prescription drug abuse, and the need to be ever-vigilant in the protection of our children and young adults. The story of Jeremy Chapple is a story every parent should pay heed to and use as an opportunity to discuss such issues with their children in age-appropriate ways.”

Learn important lessons?

That politically correct statement is too long on hand holding and education and too short on responsibility.

Contrast those semantics with the actions of crusading Nassau County District Attorney Kathleen Rice who charged a drunk driver with murder. “He had a completely depraved indifference to human life,” she told 60 Minutes, “because he acted so recklessly others were likely to die.”

Drunk driving kills more than 13,000 Americans every year despite the publicity, the education campaigns, and the apologetic hand wringing by drug and alcohol coalitions.

7-year-old Katie Flynn was a flower girl at her aunt’s Long Island wedding three years ago. That beautiful day ended in tragedy when a 24-year-old insurance salesman with a blood alcohol content more than three times the legal limit drove three miles the wrong way on the highway before crashing head-on into the Flynns’ vehicle. He killed their driver and tore little Katie’s head off.

The same year Katie Flynn died, Forbes Magazine named Nassau County “the safest region in the United States, with the lowest crime rate.”

District Attorney Rice charged the insurance salesman with Murder, Vehicular Manslaughter, Aggravated DWI, and some lesser included charges. The jury decided that that drunk driver didn’t need hand holding. The jury decided he didn’t need education. The jury decided he needed to take responsibility for decapitating a 7-year old child while he was drunk. Convicted, he got 25 years to life in prison last week. For murder.

Mr. Chapple was an avid outdoorsman who loved hunting, fishing, trapping, four-wheeling, dirt bike riding and playing basketball. And, apparently, alcohol and drugs.

Were the Vermont defendants any less indifferent to Mr. Chapple’s likely fate than the drunken salesman was to Katie’s?

Who will take responsibility for his death?

Full Disclosure: I helped found, chaired, and still volunteer for the local Franklin County Caring Community chapter. I strongly endorse its mission but I also know there can be no learning without accountability.