A Social Experiment: An Open Letter to Americans (Final Installment)
25th December 2009
She walked in. I was so glad to see her and I expressed this by sharing a smile. She returned the smile. 'I just thought I will let you know' she started. 'You know I said I was going on holiday to Spain' she continued. I nodded vaguely, clearly my memory has failed me again. 'Anyway' she said noting that I was struggling to remember our previous conversation. 'On the day my husband and I arrived there, I felt ill. I knew something was wrong. I couldn't move my hands. I felt I had had a stroke.' she continued. 'We went to see a doctor in Spain and after examination, he said I had just slept awkwardly. I didn't buy it and I immediately wanted to come back home to my doctor' She paused to catch her breathe and I took her aside. Clearly I wanted to hear where this story was leading and as we moved to the side I noticed a fresh looking scar around her neck. I said nothing. 'The airline was kind and we managed to get the next flight back to England. I felt bad for my husband as this was our only holiday for a long time. Immediately we got back to England, I saw my GP and was fast tracked to the hospital and before I knew what was happening, I was undergoing surgery to repair the artery here' She said pointing to the scar around her neck. 'I was discharged a couple of weeks ago.' she finished. 'So how are you feeling now?' I asked. 'Great' she replied. 'I just thought I'll let you know'.
Let us leave aside why she was 'letting me know', the story above is true. She just had an urgent Carotid artery repair. Carotid artery is the main artery that supply blood to the head and neck region. Any blockage or damage to this artery can be fatal! Yes fatal or lead to irreversible brain damage. She was smart and she made the right decisions. This of course, is not a story about the relative merits of the Spanish and English healthcare systems. With all the wills in the world there will be incidents of wrong diagnosis in every healthcare system. This is however the story about the trust she had in her NHS. And in this particular case, she wasn't disappointed.
You will be acutely aware of the relevance of this to the debate you are having over there. This is the final installment, to my first letter and this is going to be a long one because I wish to use it to address a number of important issues. So please bear with me. However, before I drill down into these issues, I want to use this opportunity to thank you all for the warm reception you extended to my initial letter. So that anyone reading this for the first time is in no doubt about the level of support the letter got, I have published a comprehensive statistics here. This is unprecedented for me and I did not spend a penny publicizing the letter (just my time). All I used was Twitter and Facebook. As far as a social experiments goes, this has been a success. I have met a great deal of remarkable Americans and Brits online. It is clear to me that the love that most Brits have for the NHS is real and the concerns that a great deal of you have about your current healthcare system is not imagined. Our NHS is not perfect and we can always learn from one another.
Clearly in the relative scheme of things, I am not important but what struck me before I was moved to write the letter was the insincerity of a specific faction on the right about the need for healthcare reform. Remember the orchestrated town hall nonsense(1,2,3), the blatant attempt to drag my NHS into the debate through the propagation of fallacies(4,5,6,7) and the deployment of scare tactics (8,9). For effect, they even dragged an unwitting physician into the debate(10). And yes, they found a conservative stooge, to help propagate the lies(11). He was rightly rebuked by his leader(12). What also struck me was this: Why would this section want to propagate falsehood when there are valid concerns on both sides of the debate? The only reason I can think of is blatant dishonesty on this important healthcare debate. Are these people serving you or are they taking you for a ride? You will have to decide for yourselves and whilst you do that you may want to ponder over the leadership qualities of those involved. From the little I know about your country, these acts are grossly un-American. The true facts about healthcare systems around the world soon emerged and literally pooh-poohed their irrational and dishonest stands. I wrote my letter in August and clearly the political landscape has changed. It was Harold Wilson who said "A week is a long time in politics". Five months must therefore be an eternity! Since the dark days of August, a number of you selfless Americans have rallied around Twitter and other technologies to defend the need for healthcare reform (#hcr). In the interim, Senator Edward 'Teddy' Kennedy lost his battle with cancer in August. In September when your president decided to make a speech to Kids, it was silly seasons all over again(13). The following are quotes from that speech:
"Here in America you write your own destiny" - President Barack Obama (from speech to Kids 2009)
"All young people deserve a safe environment to study and learn" - President Barack Obama (from speech to Kids 2009)
"Being Successful is hard" - President Barack Obama (from speech to Kids 2009)
"You can't let your failures define you. You have to let your failures teach you" - President Barack Obama (from speech to Kids 2009)
"You become good at things through hard work" - President Barack Obama (from speech to Kids 2009)
"You have got to practice" - President Barack Obama (from speech to Kids 2009)
"Don't ever give up on yourself!" - President Barack Obama (from speech to Kids 2009)
"Make us all proud" - President Barack Obama (from speech to Kids 2009)
What was the hoo-ha about? Whatever the issue, the wing nuts will protest. Alan Grayson may be onto something when he said: "If Barack Obama has a BLT sandwich tomorrow for lunch, they will try to ban bacon". In October, the healthcare bill sailed through its last congressional committee and Barack Obama was awarded the 2009 Nobel Peace Prize. In November, with 60 votes, the motion to invoke cloture was passed in the Senate. The debate now is not about whether you are going to get a healthcare reform, it is about what kind of reform you are going to get. Barack Obama was right when he said: "These struggles have always boiled down to a contest between hope and fear." As you move inch by inch, towards your healthcare reform (which I hope majority of you will be proud of), I will like you, for the last time, to lend me your ears.
"We are giving assurance to the American families that help is on its way". -Edward Kennedy
Why you needed change?
You see, I believed President Obama when in October he pronounced: 'We are going to get this done'. And why not? When the lady I described earlier decided to come back home to England for further investigation, the last thing on her mind was: 'I'm I insured?' 'Will I get a whacking great bill at the end' The lady knew she'd had a mini stroke and if she was worried about cost to herself and her family, she might start to think twice about seeking immediate treatment. Clearly this might have resulted in critical delays with potentially fatal consequences. The stories I gleaned over the last 6 months from the length and breadth of your country is that some of your fellow citizens are delaying seeking treatment because they are uninsured. If you don't believe me, please hear them for yourselves. Click here for a raft of really moving healthcare stories.
Then another one of your citizens, a registered nurse, wrote to me about the problem she was having to get cover. Yes an uninsured registered nurse! Her name is Allie and you can read her remarkable story here.
The statistics are stark: There is a Richard Whitehead (Phd) (@stunetii), your fellow American, who lives in Norway and has been working tirelessly to bring the facts about your healthcare system to us in twittersphere. Below are some of the realities (I am sure some of it will resonate with some of you):
@stunetii: Deaths in 2005 due to lack of health insurance: #Nevada=453. http://bit.ly/6C650U #hcr #hc09 #tcot
@stunetii: Deaths in 2005 due to lack of health insurance: #Colorado=609. http://bit.ly/6C650U #hcr #hc09 #tcot
@stunetii: Kaiser FF: % of women b/w 15-44 w/o health insurance: #Maryland=18%. #hcr #hc09 #tcot #p2
@stunetii: Sen @Kayhagan: When a 52 yr old is $200k in debt due to thyroid disorder med expenses, it's time for a #PublicOption! #hcr
@stunetii: When someone with MS has no access to healthcare, it's time for a #PublicOption! #hcr #hc09 @JeanneShaheen
@stunetii: When a 62 yr old diabetic is trying 2 survive w/o insurance, it's time for a #PublicOption! #hcr #hc09 @DianneFeinstein
@stunetii: When a family forced into bankruptcy due to child birth med expenses, it's time for a #PublicOption! #hcr #hc09 @clairemc
@stunetii: CBO: US, In 1980, life expectancy at birth for wealthiest=2.8 yrs more than poorest. In 2000, this gap was 4.5 yrs. #tcot
@stunetii: PA: 2 working age ppl die each wk due to lack of hc insurance http://tinyurl.com/5ccn39 #PUBLICOPTION NOW! #hcr #hc09 #tcot
@stunetii: PA 2000-2006: 4,800 ppl btwn 25-64 died due 2 no access to health insurance. http://tinyurl.com/5ccn39 #PUBLICOPTION NOW!
@stunetii WHO: Heart disease deaths per 100,000, US=107 v CANADA=95. Soc #Healthcare can be better. #tcot #hcr #hc09 #p2 #topprog
@stunetii WHO: Heart disease deaths per 100,000, US=107 v FRANCE=40. Soc #Healthcare can be better. #tcot #hcr #hc09 #p2 #topprog
@stunetii Are ppl really unhappy with Universal HC? Gallup 2009: Pub confidence in #healthcare sys: US=56% v CANADA=73% #hcr #hc09 #p2
@stunetii Are ppl really unhappy with Universal HC? Gallup 2009: Pub confidence in #healthcare sys: US=56% v FRANCE=83% #hcr #hc09 #tcot
@stunetiiAre ppl really unhappy with Universal HC? Gallup 2009: Pub confidence in #healthcare sys: US=56% v N-LANDS=77% #hcr #hc09
@stunetii In 2006, as many Americans killed from lack of health insurance as from homicide http://tinyurl.com/mtpbtv #publicoption #hcr
@stunetii UNICEF (inf mort): For every 4 infant deaths in Italy, the US has 7. #hcr #hc09 #ocra #healthcare #iamthemob #p2
Now please consider the following surreal conversation between Jayne (@Jayne720) and myself:
I was doing most of the tweeting here but it was clear to me that the #mob (as they call themselves) are looking at strategies to unpick the support for healthcare reform. If we were talking about beach houses and bungalows(14) that is understandable but we are talking about healthcare: your healthcare. These people who call themselves the mob are playing fast and loose with your healthcare! When the bankers did the same with your money, you know how that goes. I repeat: When you loose your health, nothing else matters! Clearly you will not let them take you for a ride.
Things had to change. The change you want is one that guarantees affordable healthcare to all your citizens (The gift of health remember?). You need to tell those against change to go to hell!
What kind of change?
You have every right to be worried about change. If you don't get it right, you will set your system back many years whilst you bury more of your citizens who will die of preventable diseases. Cost has always been the stumbling block. I hear people saying 'what is this going to cost us?' Whilst a significant minority are uninsured, a significant majority are (and pretty happy with their insurance). The question therefore is how you cover everyone, without adversely affecting the quality of cover for those that are insured. And you certainly don't want to bankrupt your government as a result these changes. Actually, some might even argue that if you can afford wagging wars around the world and bailing out bankers, then you must be able to offer the gift of health to all your citizens(15,16).
The answer to this very important concern has been on the table all along but I sometimes doubt if the political will is there. In my first letter, I said I had 'no political affiliations'. I'll tell you why: Because of the concept of political suicide. Political suicide is the concept that "a politician or political party would lose widespread support and confidence from the voting public by proposing actions that are seen as unfavorable or that might threaten the status quo. A politician who committed political suicide might be forced to resign"(17). If I was a politician, I will commit political suicide everyday! Since I only have a limited number of political lives, I will be dead in no time (politically that is). Why? Because if my opposition is right, I will wholeheartedly acknowledge him/her and adopt the right ideas. The rule, I guess, in politics is that I will be digging my own grave! The issue that has been most controversial in your healthcare bill is that which relates to public option (#publicoption). However, a robust public option holds the answer to the concerns you might have about the affordability of the proposed plan. I will explain why below:
Please consider the following tweets:
RT @thedrich: What do u think? Think Progress: Triggered #PublicOption Is Better Than Existing Public Option Provisions http://bit.ly/8WHKP6
RT @stunetii It's the 'Public' Not the 'Option' in 'Public Option': http://digg.com/d31CbEO?t #hcr #hc09
Battle of Ideologies
The debate about public option has always been about providing real competition to the existing failed system. At the heart of this is the need to cover all your citizens currently uninsured. The best way to do this is to pitch the different ideologies against each other: Private Providers Vs Public Provider. You may wish to do this in two ways: Have two providers run in parallel or trigger a public option if the system starts to fail again.
If you opt for the former, then whilst they engage in the fruitless battle of ideologies and dogma, you can exploit it for you own advantage. They will want to please you of course and you can decide who is giving you the greatest value and take your insurance to them. Because this is open competition, you don't want to be giving anyone unfair advantage so you make the option robust. The government cannot be allowed to divert your scarce resources to fight an unnecessary battle of ideology. To make the option robust you will need to put some intelligent limit (A formula is possible which can be revised periodically as circumstances change!) on the amount of resources your government can deploy on this and be clear what the government's brief is: To make sure every one of your citizens have affordable healthcare insurance. There will always be trade off between what you want to provide and what you can afford to provide.
These are the reasons I have impassionedly campaigned for a public option. You will note rightly that I don't much care for these battle of ideologies. It is not the ideological stands that deliver great healthcare service in my humble opinion. It is the leadership qualities of those who run the system that is imperative. That includes the government, your doctors, your pharmacists, your nurses, the insurance providers, the pharmaceutical companies and you. If you let anyone in the healthcare provision chain get away with 'murder', you will end up with a crap healthcare system. Hitler was a great leader, so also was Gandhi.
The glaring question which may be playing on your mind is: Why then can we not make the current healthcare system better instead of changing it? It is possible but frankly your insurance companies don't deserve it. The sharp practices that has been well documented (18,19) will return in no time. They had power and they abused that power. That is why you have to change the game by introducing a robust public option.
Your politicians on both sides of the debate need to know that they will commit political suicide if they do not adopt the public option. And you need to tell them. You need to do so clearly and firmly. If you don't and the bill passes without a robust public option, a significant majority of your fellow citizens (including yourself, probably) will suffer a great deal of pain in proceeding years. When that pain start to bite really hard, everyone will be looking for a scapegoat. Some might argue that it is the fault of the healthcare reform, others will argue that it is the fault of the previous systems which allowed so many people to be uninsured or uninsurable. The only reason for that mess will be that your political masters failed to pass a robust public option with this healthcare reform. #hcr without #publicoption is like fighting a war with one hand tied to your back!
I now see that the Senate has decided to give the insurance companies another chance (20). That is very noble of them. I am not convinced that the insurance companies will not return to their old ways. The reason? The motivation for insurance companies are different. They probably still see healthcare as profit machine. I bet they still don't understand the moral imperative of healthcare. Why do we have phrases like: "Social-conservatism" or "Third way (centrism)" anyway? In any case, the supporters of #publicoption should not be disheartened. This process has been very useful. In going through this process, and understanding all the facts, you have a #publicoption trigger in your hands. You don't need the approval of congress or senate. You already have the #publicoption trigger. You now need to go after those taking undue advantage of your healthcare. Scrutinize their profit margins, Scrutinize how much they are paying their directors. Make sure everyone who works within your healthcare system are accountable. Your doctors, pharmacists and governments are accountable to you. Hold them to account. They will need to know that working in healthcare is a privilege not a right. And when insurance companies fail (I unfortunately have no doubt they will), you can radically change your system. I will have to agree with Victoria (@lavika) who tweeted: "Sometimes: must let ppl do stupid stuff so EVERYONE can see it's stupid...then act decisively. Not good to stop it early w/o concensus." My only regret is the pain that could have been avoided. The pain will be shared all round. It will be shared between all who currently have a satisfactory health insurance and those who must now have an health insurance with a private provider. However, you have nothing to worry about right now because they will want to keep you sweet and hope that sometime in the future you will take your eyes off the ball. You wouldn't would you?
Whilst a robust public option will address the cost issues and keep all the providers honest, it does not address other issues which are exciting a lot of passion. Notable amongst these are matters of faith.
Some people are genuinely concerned about these issues and others are using it as a smoke screen to oppose the public option elements of the healthcare reform. I clearly don't have time for the later but I have a great deal of time for the former. Let me point out the duplicity inherent in the later's argument: A public option by virtue of its definition, is a government run program. Because you are in a democracy (and a matured one at that), you have the right to choose your decision makers. So you hold a degree of influence over those that rule over you. Let us assume the government fouls up, you can kick them out at the next election cycle. So if you have any genuine concerns about any aspects of the government run program, you can campaign and lobby the ruling class. In any case you already have a government run program and the seniors, the very people the #mob are trying to scare, say they like it(21,22,23,24). By using these issues as a smoke screen, they are tacitly campaigning to take away your right to express legitimate concerns about these issues you are passionate about. If you know anyone who is using the above issues as a smoke screen, you need to tell them to go to hell with their rectal oratory (#rectaloratory).
Matters of faith
A number of you are legitimately against allowing abortion on a government run program(25,26). Your argument is clear: 'I do not wish for my tax dollars to be used to support abortion'. I understand and sympathize with your position. I say this from a position of some insight into why the Papacy, for example, choose to take this stance on abortion. That is a debate for another day. I will say this though, the role of the government (and a good one at that) is to represent the interest of all its citizens who incidentally will have varying views on a specific issue. Let us consider a scenario where the bill passes with a proviso that contraception and abortion is not allowed under the scheme. You have a young lady on the government run insurance scheme from a deprived background and suddenly become pregnant. She considers her situation and decides she will be better off terminating the pregnancy. Money is tight and her insurance doesn't cover the procedure she needed. So she gets it done in a back street somewhere with life threatening consequences. What do you do with her? You can (1) Let her die; (2) provide cover for the life threatening consequence of the botched operation; or (3) provide cover for her in the first instance that might have prevented her from going to the back street; or (4) support her with advise and knowledge which might have prevented her from getting pregnant in the first place. I am posting this letter on the 25th of December and the implication of that will not be lost on you. This is clearly a 'what will Jesus do?' moment. If you are in any doubt, please try and rationalize it with your spiritual leaders or just go directly to God or whoever you pray to. The most obvious best answer is (4) but because people have free will, they can choose to accept or reject your advise. That free will, is a special gift which neither you nor I can give or deny. If you are a religious person, your job is to work doubly hard at answer 4. That however, is not the only responsibility of any government run scheme. A government run scheme must cover 2, 3 and 4 and resources alone will determine the scope. Sure you can lobby the government on where the emphasis should lay but campaigning for the denial of cover is tantamount to taking away her free will. Now, will Jesus do that?
You might think I am a fantasist, concocting up these stories to fit my narrative. Well read about the experiences of your fellow citizens here. Maybe that is what Robert Thurman was describing in his TED lecture on "expanding your circle of compassion"(27). We should all try and expand our circle of compassion and I will have to say I affirm the charter for compassion(28). You will have to wonder why some "Catholics support healthcare reform, including coverage for abortion"(29).
Throughout this journey, I amassed a lot of quotes from your prominent citizens dead and alive. Please click here to read these. I will like to congratulate those that have campaigned day and night for the necessary changes to your current healthcare system. You can find some of them on my "connections" list here. Well done: You put your feet in the right place and stood firm. You are on the right side of history. God bless you. Some of you opposed the reform because of the misinformation - Well a faction of your political elite screwed up. Thank you for allowing me to talk to you. There are those of you who still oppose the change, genuinely I might add, even when given the facts. I will say this to you: because the information I have given to you is the truth, I will be right today like I will be right tomorrow. My comfort lies in the fact that you cannot now say you don't know. To those who know the facts, know the arguments I have presented to be true but still oppose the change for their selfish gains: Well! well!! well!!! Read my lips: Why don't you rot in HELL!!!
My final and most important remarks are directed at you, my American friends. With all the will in the world, no healthcare system will be able to cover everyone appropriately. We live in a world where there are competing demands for limited resources. That is why, your first choice is to stay healthy. Not everyone will have that choice. If you are in the fortunate position of having that choice, please exercise it judiciously. When your healthcare professionals tell you smoking is bad for you, there is good evidence to back that up. You may think you have the freedom of choice to choose to smoke but the cigarette, is a chemical way of denying you your choice. So please stay healthy, eat healthily and take regular exercise. Always make healthy choices.
I understand that I have taken a great deal of your time. Thank you for the opportunity to put across my viewpoints. My only motive when I wrote my original letter was to defend my NHS and to highlight the lies that were being propagated. I have done this using the limited resources available to me and I feel it has been successful. But you will have to be the judge of that. As you sit down to have your christmas dinner, my hope is that your legislators will put all their differences (political or otherwise) aside and just for one day and just for one issue(healthcare), come up with an healthcare system you can all rally round and call your own. I will now retreat to the relative obscurity of helping my patients get the most out of their medication. God bless your new healthcare system and God bless my NHS. God bless America and God bless the Queen.
Thank you all for the support you have shown for my letter. I will continue to keep track of the progress of your healthcare bill. The openlta twitter page and the Facebook page will remain active and I will continue to follow anyone who follow me. Healthcare is a big area and I am sure there will always be areas we can maintain constructive dialogue on. In any case I have grown very fond of some of you. You cannot shake me off that easily. Maybe, just maybe, we can meet up for drink at some point in the near future.
This page will remain active for the foreseeable future until I decide what happens next. I have however, decided to make a project out of the whole journey. If you are in anyway interested in what happens next to this project, please go to http://www.openlta.org for more details.
The page will now self destroy! Well, not really -:) Take care.