Health reform taking root

Forget repeal. Health reform is taking root in Colorado and forcing doctors and insurers to face the facts of their new existence. 

Take, for example, the complaint of nurse practitioner Mary Lou Hendrix in yesterday's Denver Post. In a story by Nancy Lofholm, Hendrix described the difficulties she has encountered trying to be "credentialed" by health insurers whose pregnant customers want to use Hendrix's skills without her being supervised by a doctor.

"Credentialed" means the insurer agrees to pay Hendrix for her services when their customers make a claim through her for payment. According to Lofholm, a 2008 state law allows Hendrix to operate without supervision, at the same rates as physicians. After working for doctors for years,  Hendrix opened her own practice last spring.

In late September, Gov. Bill Ritter officially notified Medicare that Colorado is opting out of a federal rule that nurse anesthetists also must be supervised by a doctor, a full-fledged anesthesiologist. The next day, the Colorado Society of Anesthesiologists and the Colorado Medical Society, representing doctors, sued the state to block Ritter's decision. The lawsuit is pending.

Both developments reflect progress and resistance toward enactment of health reform meant to improve the lives of Coloradans. Nurse practitioners and nurse anesthetists can make competent health care available to more people across the state, expanding the market for their services and providing a measure of competition to doctors. Perhaps even driving down some prices.

For nurse anesthetists, the argument for their not needing a doctor's supervision is more than two decades old. I dated a nurse anesthetist in Texas, before coming to Colorado, who had to leave Austin for Idaho in order to practice her skill in a market unfettered by rules protecting the livelihood and wealth of doctors.

But when Ritter opted Colorado out of the Medicare rule this year, only 15 other states had done the same, showing how long it takes some reforms to take root. Hendrix's continuing problems with insurers illustrates the same slow creep of progress.

Following Ritter's decision and the filing of the lawsuit, the Colorado Society of Anesthesiologists posted on its website a call for members to register their displeasure with Ritter by calling or e-mailing his office. Lorez Meinhold said the office has received one complaint since the Sept. 28 announcement; that e-mail came in on Nov. 1. 

Health care in these United States can hardly be called a revolution, despite the Tea Party's Revolutionary War custumes during the last election campaign. Evolution occurs with each dying dinosaur's extinction. One day in Colorado, the evolution of a 21st century health-care system will be complete.

Help poor, or yourself; a media no-brainer

The Denver Post would rather provide 100 million people with broadband access than 32 million Americans with health care.

I guess you can't fault the Post for editorially holding such a puzzling dichotomy of opinion, but the newspaper is a business, and business is business.

Logically, what's at stake, is the newspaper's self-interest. Supporting the federal government's expansion of broadband could benefit the newspaper's online business at little cost, while the expansion of health care to the uninsured might cost it some big money.

At least that's the impression the Post's Sunday and Monday lead editorials could give a reader.

Not surprisingly, Monday's editorial following historic passage of health-care reform denounced the action as a "single-minded quest to notch a political victory" for Democrats. The Post has opposed the health-care reform effort in Congress for most of the last six months while basically echoing facetious Republican arguments against it. It didn't much matter to the newspaper that 32 million more uninsured Americans would get health care they deserve as much as richer folks in the nation.

Yet the newspaper's main Sunday editorial hailed a national expansion of Internet access proposed by the Federal Communications Commission. It, too, will bear a cost to taxpayers including the Post. But the newspaper could conceivably benefit from such a huge market expansion because the FCC proposal -- just as health care reform does for insurance companies -- would increase exponentially the newspaper industry's potential to reach new customers, mostly those with money.

There you have it. Help the poor, or help yourself. It's a choice most businesses consider a no-brainer.

Voters mad about something

The trouble with polls is they lump everyone's individual opinion into clumps and ascribe the results as indicative of what all Americans think.

But whenever I read a news story about poll results, I remember what my first wife told me: Opinions are like assholes, everybody has got one.

That's why when I heard Charlie Rose and David Brooks, the New York Times columnist, agree the other day that the Obama administration didn't seem to fathom the angry wind sweeping the country over health-care reform and deficit spending, I shouted at my television that the pair's conclusion was wrong, wrong, wrong. I had seen no polls to support the breadth of the anger with government.

Now I have. The Washington Post reported today that their Post-ABC News poll of 1,004 randomly selected adults taken from Feb. 4-8, showed two-thirds of Americans were dissatisfied or outright angry at the way Washington works nowadays, one year after Barack Obama's inauguration. The headline over the Denver Post's story read: "Poll: Americans unhappy with government's tack." And the implication, amidst all the newstalk of the so-called "Tea Party movement," was that most of the anger being generated is a result of Obama's attempts to reform health care.

I submit much of the anger is also generated as a result of Obama's and Congress's failure to reform health care in America.

In fact, the Washington Post poll found more of those polled viewed "Tea Party" views unfavorably (40 percent) than those polled who found those views favorable (35 percent), and a full quarter of those polled (25 percent) offered no opinion at all when asked that question.

Which means the angry "wind" Rose and Brooks were describing Monday night is mostly huff and puff. Brooks noted that the president's personal popularity still out scores any dissatisfaction with his policies, and the Washington Post admits in its story that what "Tea Party" advocates advocate is almost unfathomable because the "movement" is so disorganized and disparate.

So come November, if the winds keep on a blowin', incumbents of every stripe are going to be at risk of voters' wrath. The American people want to see results out of Washington; not bipartisan incompatibility.

Hardball over health care

I come here in advance of my next intended post (RobertSchwabPoet.com: a Business Plan) to remark on the politics of Democrats trying to pass a health-care reform bill in time for the president to claim it as an accomplishment in his first State of the Union.

Hardball, to say the least.

One example: Massachusetts election officials say it might take them weeks to certify the election results of the upcoming special election to replace the late Sen. Edward Kennedy, which the Associated Press points out could preserve for Obama the 60th vote he needsin the current Senate to pass a health-care bill without a Republican filibuster.

I read about the move in an Associated Press item packaged in the Denver Post next to a piece about Colorado Sens. Mark Udall and Michael Bennet's protests of the closed-door negotiating between members of their own party to combine separate bills passed by the House and Senate.

The closed-door negotiations are as much an indication of the hardball politics Democratic Senate leaders are imposing on the negotiations, which include Obama at the White House.

Republicans complain that the non-traditional approach to melding the two bills harks to the smoke-filled rooms of lore, but they don't remind their listeners of similarly harsh tactics used by the Congress when Trent Lott and Dick Armey were ruling the roost.

It's true that opening the negotiations to television cameras would make make for a truer "Democratic" result. But no Republicans have indicated any willingness to buck their disciplined ranks to vote for a final bill, so crafting one without them seems the more efficient path.

Bennet rightly criticizes the lack of transparency. But I doubt it will keep him from voting for the historic bill. It should not.

Self-interest on parade

If you want to see how self interest is ruling the public health-care reform debate, take a look at two stories in the Denver Post today, one on the front page, and the other on the "Health Reform" page, which today is 15A.

The Page One lead story, by Allison Sherry, reports how Patti Gabow, CEO of the Denver Health Medical Center, has written metro-Denver counties asking for millions of dollars worth of compensation for care Denver Health has provided for citizens of those counties in 2008.

The self-interest of Denver Health is obvious. The health system, described by the Post in a story earlier this week as one of the best in the country, is going uncompensated for those same millions of dollars worth of care, and it wants money to cover the costs from counties where the patients live.

Sherry's story said Denver Health is asking Jefferson County for $9.8 million, Arapahoe County, $12 million, and Adams County, $11.3 million.

That's a lot of money, but only fractions of $318 million in uncompensated care Denver Health offered patients in 2008, yet Sherry reports that officials in Jefferson and Adams counties don't seem too interested in paying their fair share.

"We don't believe it's a responsibility for county government to compensate hospitals for uninsured care," Sherry quoted Mark Tandberg, a division director in Adams County, saying in response to Gabow's letter posting the bill.

That response, of course, is in Adams County's self interest. Tandberg, serving his taxpayers, takes the conservative stand in the health-care debate: Government shouldn't subsidize universal health care.

Sherry reports that Kathryn Heider, a spokesman for conservative Jefferson County, also blew off Gabow's request. "I think we probably won't be pursuing it," she told Sherry.

Sherry, in the meantime, has a little self interest in writing the story itself since she is the writer of the earlier story that lauded Gabow's operation as one of the most efficient providing uninsured health care in the nation.

Reporters live and die (literally, since their jobs are at stake) by the give-and-take of story for story with sources. Sherry writes a well-reported story about Gabow's good standing in the national debate over health-care reform, and is then given access to the more powerful story about Gabow's demand for repayment from local governments.

The second story that puts self-interest on parade in the Post's coverage of health-care reform is the story on 15A about certain Catholic bishops in America, including Denver Archbishop Charles J. Chaput, turning against the Obama reform plans, none of which is certain as yet.

That story, by David D. Kirkpatrick of The New York Times , connects the relatively new opposition of the bishops to old and long-held Catholic opposition to use of federal funds to pay for abortions.

Chaput is a vehement abortion critic and during the election campaign last year anti-abortion campaign flyers targeting Obama were passed around the parking lots of Catholic churchs on Sundays. Chaput's book, "Render Unto Caesar," goes somewhat lightly on the issue of abortion while urging strongly that Catholics stand up in the public square and marketplace to denounce political positions that run contrary to church doctrine.

I'm going to review the book soon on Examiner.com where I write about literature, so you might look for the review there when I finally get it done. Consider that last sentence to be promotion of my own self interest.

The New York Times story quotes Chaput as writing in a diocesan newspaper column that Obama's health-reform plan is "not only imprudent; it's also dangerous."

The Times story immediately adds, "The bishops' opposition ... is another setback for Obama's health care efforts."

The opposition also, however, serves the bishops' self interest by not only boosting the church's anti-abortion stance, but also by trying to boost the bishops' personal political credibility within their own congregations.

You could say anything anyone writes boosts someone's self interest, and that probably would not be too far from the truth.

But when self-interest powers a national debate that is supposed to target a common good, specific arguments that benefit one interest over another ought to be pointed out.

Don't be idiots, America

Schwab on health-care reform: Don't be idiots, America. This is why you elected Barack Obama.

Don't let insurance companies, the special interests in health care, Republicans, who always defend the establishment because they always serve the monied interests of the nation, or whackos on the Internet (me excluded, of course) convince you that health-care reform is not in your best (self) interests.

I listened to Sen. Chuck Grassley, R-Iowa, last night on public television. He sounded like one of the nuts. He said a public-option health insurance plan was just a first step in the government plot to take over the entire health-care system in America. The first step toward a single-payer system.

That conclusion is not logical.

It is the Republican Party's national spin for senators and representatives to take back to the heartland to try to talk the U.S. population out of insisting that Congress change health care for the betterment of most people in America.

How can starting a cheaper-than-current-costs, government-run health-insurance plan, to compete against more expensive private insurers, be a step into the hospitals and doctors offices that deliver health care now -- unless you think the private health-care insurers are already there, dictating what health care to give at prices high enough to make the insurers, doctors and hospitals a profit?

Grassley and others say we already have a health-care system that works just fine. How crazy is that?

Even if you think the movie "Sicko" was all wrong, anybody with any common sense, from doctors and nurses, to hospital administrators and even insurance executives, have known and have said publicly for years that our health-care system is on its own way toward bankruptcy if something isn't changed soon. And perhaps the nation with it.

Yet Republicans are now telling the country: It works just fine.

How crazy is that?

Don't be fooled.

If you attend public meetings of Colorado senators and representatives this month you'll no doubt hear the shouts of anti-reform activists who will describe any shouts you hear from pro-reform activists as the shouts of the looney fringe.

Right now, a guy named Jeff Crank, who is described in today's Denver Post as the head of the Colorado chapter of Americans for Prosperity (meaning the rich), is launching a 13-day bus tour around the state to repeat what he told the Post:

"We're headed right now to this thing being a fringe group of people demanding that there be some kind of 'public option' versus real America that is saying we're not going to throw out a health care system that delivers fine care but is expensive and maybe has to be refined."

Don't be fooled, real America. Those last nine words are Crank's attempt to sound not crazy. And in the earlier part of his quote, you see how he's trying to define other people who support reform as "a fringe group."

But who drives a bus around the state to harangue people about crazies in government besides a crazy, himself (although you wonder what's he's getting paid to make the pitch in this otherwise era of joblessness).

Don't be fooled, Colorado. Don't be fooled America. Health-care reform is one reason why a large majority of people in this country voted for the nation's first African-American president. We voted for change, and we could feel in our bones that Obama was the political athlete who could score for us.

Don't listen to shouts on either side of the argument.

Just quietly tell your congressmen and congresswomen to "stay the course," as George W. Bush's father used to say. But make sure they realize you mean the course toward reform.

Get health care reformed in this country by the end of the year, and let it start having its beneficial effect in 2010 and beyond, if we all live that long. Too many have passed without the benefit of the best care our country can offer its citizens.

You won't hear an anti-reformer shouting out about that outrage.

You can bet on that.