Monthly Archives: October 2013

A Simple Response to the E.R. Argument

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Has no one thought of this? Continue reading →

On November 7, 2007, Tom DeLay, the former exterminator who later became Speaker of the House of Representatives and even later than that an unsuccessful contestant on Dancing with the Stars, famously said, “No American is denied health care.” In the subsequent six years this claim has been repeated by many who are opposed to the Affordable Care Act. Mitt Romney voiced the same claim during his presidential campaign, and Governor Rick Perry of Texas has often said it, although he usually restricts his references to his altruistic constituents in Texas.

These men are presumably talking about the emergency rooms of hospitals, which by law are not allowed to deny emergency care to anyone seeking it. If someone has had a heart attack or has broken a leg, the doctors in the emergency rooms will, of course, treat them even if the patients lack insurance.

The most common argument in response to this claim of universal coverage is that relying on the emergency rooms is one of the reasons that health care in the United States is so expensive compared to the rest of the civilized world. It is much more costly to deal with medical issues in this way. The extra cost is just passed on to the people who have insurance.

This argument is true enough, or at least I have never heard a cogent response to it. If I had to argue against DeLay’s proposition, I would employ the cost argument, but by no means would it be my first answer. In fact, I would only mention it if I had time and an accurate idea of how much the additional expense was. After all, people who have insurance now are not too likely to be upset about how much they have to pay. People who do not have insurance may actually be glad to hear that someone else will be footing their bills. I realize that there is a third group of people who are facing financial ruin and bankruptcy because of high health care costs, but they are seldom the focus of the argument. The primary problem with the cost argument is that it is too nebulous for too many people. There are other arguments that are are much more concrete.

The first response should be that the answer is both factually incorrect and indicative of one of the primary problems with the American health care system. This is because DeLay used the phrase “health care” when what he meant was “emergency health care.” The difference is huge.

Consider three cases. The first involves someone who has a chronic condition such as hypertension that can be treated with prescription drugs. To begin with, that individual needs a diagnosis of his problem, something that no emergency room physician will be willing to do when he has gunshot or stabbing victims holding their guts in their hands in the waiting room. If the problem has been diagnosed, the patient then needs to obtain the medication, which is not cheap. The emergency room is not in that business either, and I have never heard of a pharmacy that provided free drugs. So, perhaps this individual is not “denied” care in the sense that someone tells him that he must succumb to his condition, but in many cases he/she is not likely to receive the care needed to live a healthy life. The fact that death from the condition is unlikely to occur on any given day is a distinction without a difference.

The second situation concerns the high percentage of health care that is not provided at the emergency room at all. For example, anything that has to do with the eyes or the teeth is subject to the free market. The first thing that you must establish with anyone in the dental or optical fields is how you plan to pay. If you cannot pay, you will almost certainly be denied care. It may be possible for poor people with no insurance to get some kind of care in these areas, but it is rare.

The last case is elective surgery. It may be surprising to discover that all of the following are considered “elective surgery:”

  • hernia surgery (600,000 performed per year);
  • cataract surgery (3,000,000 per year);
  • mastectomies (60,000 per year);
  • knee replacements (719,000 per year);
  • hip replacements (332,000 per year);
  • installation of pacemakers (200,000 per year);
  • rotator cuff surgery (600,000 per year).

I doubt that anyone would argue that any of the above should be included in the broad class of “health care,” but none of them will be provided gratis by hospitals. If you want the procedure, you or your insurance company must pay.

This was recently brought home to me by my wife’s recent double knee-replacement. We have good insurance, and everything went fine. The surgery may have been elective, but the problem that impelled her to do it was severe. Her arthritis was serious enough that, even though she took as many pain relievers as she dared, she avoided stairs entirely and never walked any farther than she needed to to get to the next chair.

What if we had not had insurance? We would have needed to foot the bills ourselves. I haven’t seen them yet, but I dare say that they would have to cart me to the emergency room in an ambulance shortly after I opened that first envelope if that were the case. At least the emergency room would probably not deny me care.

Tom Clancy and Me

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Similarities and differences. Continue reading →

I have a lot in common with Tom Clancy, the famous author of military-based thrillers and war games, who recently died of undisclosed causes.

    • He was one year older than I was, which means that we were probably brought up on the same steady diet of comic books, Mad magazine, westerns, the Mickey Mouse Club, and Walt Disney. I bet that he filled up his Big Chief tablet with stick drawings of American planes strafing German or Russian troops just as we did.
    • We both went to Jesuit high schools. He probably also went to a Catholic grade school, as I did. we were therefore first taught by the nuns how to memorize the catechism and then by the Jebbies how to think.
From Loyola's website

From Loyola’s website

  • He went to college at Loyola U. in Baltimore and graduated in 1969. I attended a debate tournament at that same school in 1968. I may have actually seen him, although he was into chess, not debate.
  • We both have myopia (near-sightedness). He apparently had a rare type that got worse as he got older. He donated a lot of money to Johns Hopkins because one of the surgeons there evidently fixed the problem when he was in his fifties.
  • We both have ties to the military. I was drafted after I graduated from college. According to Loyola’s website he was in a Ranger platoon for Green Beret training in ROTC at the university. One of his professors said that “He really was a frustrated soldier, and his eyes kept him out.”
  • I read one of his books. Well, I got to page 8 or 9 before I discarded it because I could not identify with any of the war-mongering protagonists, and I found the style very annoying.
  • Someone gave me one of his board games many years ago. It is still unwrapped. One day I hope to sell it on e-bay to one of his fanatical followers at an exorbitant price.

The legend is that Tom Clancy desperately wanted to be a soldier, but he was denied the opportunity. Maybe. My recollection is that the people who were in ROTC in the sixties got scholarships, and they did not need to make commitments until they had completed two years. I knew a guy who financed his first two years of out-of-state tuition at Michigan that way, and the only price that he had to pay was to sit in a chair and get yelled at for being a traitorous scoundrel for one entire day. I was unable to determine how many years Tom Clancy spent in ROTC.

I wonder who determined that Tom Clancy was unfit for the army and whether he was ever drafted. I searched for information about this subject, but I was unable to find anything substantive. His obituaries all address this topic using the passive voice (“he was denied the opportunity to serve”) or with an indeterminate subject such as “they.” After the fact most guys in our generation do not like to talk about how they avoided the draft even though that was by far the premier topic of conversation at the time.

Clancy graduated in 1969. The draft was extremely unpopular then, but it was still operated by local draft boards. Each of those boards had a quota to meet. How they reached it was more or less up to them. In some localities there were considerable shenanigans, or at least that was the rumor. The situation was bad enough that in 1970 the whole system was replaced by a lottery that was just as unpopular, but at least it eliminated the discretion of the local boards. Clancy reportedly gave up his college deferment in 1969. All that his graduating class had to do to avoid service was to make it to December 31 without being drafted. Whether he was drafted or tried to enlist in this period is unclear. No one else seems to think that the matter is worth researching. De mortuis nil nisi bonum.

I remember back to my own induction physical. Plenty of guys failed, but each of them (at least to my recollection) had one thing in common. They all brought briefcases full of affidavits and documentation from doctors. At the time there were physicians who hated the war and the draft so much that they would certify questionable ailments. One of the guys with whom I worked over the summer got his doctor to certify that his knees were too bad for military service. The doctor told him to be careful not to do a squat when asked to do so. This guy, who was the quarterback of his high school football team, played at a high level in every sport imaginable at every opportunity with no difficulty.

The physical itself was a joke. My feet are as flat as Donald Duck’s, and I thought that that might disqualify me. The guy running the physical did check for this. We were barefoot, and he asked us to face the wall. The guy (doctor?) performing the ritual told us: “Raise your right foot. Left. Thank you.” The whole process took less than five seconds. Half of the guys never raised either foot.

I don’t remember any vision test other than the one for color blindness. My vision has always been correctable to 20-20. I do not know whether Clancy’s vision was or not. I tried to find out if he had a driver’s license in the seventies and eighties, but I was unable to locate any information on the subject. Again, no one else seems to think that this was important.

Tom Clancy’s eulogies reminded me that in Basic Training I met a guy named Houston who happened to be from Houston, TX. He had bright red hair and glasses that resembled the bottoms of coke bottles much more than the ones shown in Clancy’s photo from Loyola. This guy Houston ran into things all of the time. He could not find his place in line. He was, in a word, hopeless. Yet, he enlisted and was not rejected. Houston apparently also brought a briefcase with him to his induction physical, but his contained an affidavit from an eye doctor that certified that his vision was sufficient for military service.

All of this is by way of preface to the point of this diatribe. I was actually in the army. Clancy got all of his information second-hand from gung-ho lifers and contractors. I wonder if he would have spent a lifetime extolling these guys and their lethal toys if he had actually had to wear olive-drab for a few years.

I had very little respect for any of the lifers whom I met in the army. A few of the junior officers were OK, but to a man (I did not meet a single female officer) they were just there to avoid the draft. Each draftee and most of the enlisted men always knew exactly how many days they had left and could not wait for their term of service to end. They just wanted to get on with their lives. The lifers, on the other hand, were mostly insufferable jerks who probably would be failures on the outside. They reminded me of the characters in Catch 22. Believe it or not, there was even a naval officer named Commander Commander. The Army general who commanded our base in Albuquerque was uniformly deemed incompetent if not senile. The Air Force colonel who eventually replaced him rode around in a jeep listening to the police radio even in the middle of the night.

I almost made sergeant even though I was only in the Army for eighteen months. I owed my rapid advancement to my platoon sergeant in MP training, who was a real piece of work. Unless it was his turn to lead the company’s marching, he shot pool all day while we went to training. He never talked to us. Never. At the end of the seven-week period we had to prepare for inspection by the lieutenant. The sergeant gathered us together and told us that if anyone asked us if we had been checked out before the inspection, we were to tell them that he had. Twenty or thirty minutes later he came over and looked at my locker. Then he asked me if anyone had checked me out before the inspection. I said, “Yes, sergeant.”

He asked, “Who did?”

I replied “You did, sergeant.” He took down my name, and I was nominated for promotion the next day. None of my friends were.

One day when I was at my first permanent duty assignment in Albuquerque, Sergeant First-Class Edison, the highest ranking NCO in the outfit, came into the office in which I worked. He announced that he was pretty sure that at least one or two people in the MP Company were using drugs. The fellow who worked with me and I reacted with mild shock without looking up from our work. After the sergeant left we both burst out in uncontrollable laughter. Dozens of guys in our company regularly used drugs. A few of them were stoned virtually all of the time. I swear that one guy who lived on the University of New Mexico campus had a pair of eyes that never were in focus during the ten months that we worked together.

I also had a little first-hand experience with the weaponry of the age as well. I helped some guys in another training company with their M-16’s, which were continually jamming. It took me ten seconds or so to realized that they had been oiling their guns but not cleaning them. They were full of a muck that resembled molasses. I was later qualified to carry a .45 even though I was a horrendous shot. I was afraid of that hand cannon, and I knew that I could not hit anyone with it anyway. I therefore kept my clip in my pocket unless someone was going to inspect me. In Basic Training someone demonstrated a shoulder-borne antitank weapon and launched one missile. It was cool, but we were not allowed to touch it. I also had a close-up view of the aircraft used by the Blue Angels when they buzzed the UNM golf course one day in preparation for their exhibition.

On the other hand I got to play a lot of golf and whiffle ball when I was stationed in New Mexico. I had an air-conditioned single room. I can’t complain too much. I never had to go to Vietnam. I met only a few guy who had been there. One of them wanted to go back. He thought that he could make a fortune selling drugs.

I hated every second that I was in the army. I felt that it was an inconscionable waste of my time, and I was bitter at Richard Milhouse Nixon from stealing it from me.

During the decade after Tom Clancy left college, on the other hand, he sold insurance. If he had had an experience like mine, I wonder whether he would have still devoted himself to writing about this imaginary world in which the enemy is both dangerous and ruthless and where the “good guys” are confident, clever, resourceful, and armed with flawless weaponry. Somehow I doubt it. The people who served with me all became jaded quite rapidly. The famous people who beat the war drums in the last three decades have almost all been chicken-hawks who somehow avoided serving during the Vietnam era. I do not hold it against them that they dodged the draft. I just wish that they would keep their mouths shut when it comes to national security decisions. Clancy blamed the Democrats for 9/11 because they allegedly gutted (!) the CIA budget. Most of the rest of the chicken-hawks for some reason blamed Saddam Hussein and invested hundreds of billions of dollars and thousands of lives to replace him with people with close ties to Iran.

Italian Politics

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Ten years of confusion. Continue reading →

I got interested in all things Italian about ten years ago when we were planning our first trip to il Belpaese. I spent much of my leisure time learning Italian, and I read extensively about Italian history, politics, and mores. The more that I read the more confused that I became. Consider these facts:

  • From 1946 through 1992 Italy had fifty-one different governments.
  • Italy has more than one mafia. The Cosa Nostra in Sicily, la ‘ndrangheta in Calabria, and the Camorra in the suburbs of Naples all ran wild during the postwar period. They even murdered government officials and judges.
  • A violent extremist group, the Red Brigades, committed outrageous acts of terrorism in the seventies and eighties. It was so bad that the period was called “the years of lead.”
  • Through all of this Italy’s economy was booming — the fastest growing in all of Europe!

I still do not understand all of this, but I have come across a few things that make things a little clearer. Italy’s democracy, for one thing, is much different from what Americans are accustomed to. In the first place there are dozens of parties, and they are in a constant state of flux. Secondly, there is nothing like the American House of Representatives, whose members are regularly subjected to electoral review. The Italian Chamber of Deputies, which has 630 members, is elected by region, of which there are twenty. Each party nominate a list in each region. Depending on the number of votes that the party gets, it receives a proportional number of seats. This approach insures that the top names on the lists of the big parties are virtually certain of being elected each time, and the lower names, regardless of party, have almost no chance. The laws have been recently changed so that the coalitions that win are awarded a large number of additional seats. There is also a Senate that contains 315 members. The rules for the Senate are similar to those of the Chamber, but some people have been designated senators for life.

The President of the Republic is the head of state, and he invites the leader of the coalition with the most votes to form a government. If he (no major party has ever been headed by a woman) can work deals with smaller parties so that he has a majority in both houses, he becomes the Prime Minister (although his official title is President of the Council).

There are too many parties to attempt to keep straight, and, to make it worse, they are usually referred to by their initials. However, some of the major parties or categories of party are worth knowing:

  • The Christian Democrats have usually been the favorite of the Church. They were the dominant party for several decades. They won a plurality of the votes in every Italian election during the forty-five years of the “first republic,” but they never achieved a majority. So, they invited all the other parties — with two consistent exceptions — to join them in the government. The ministers in these governments would come from different parties. Usually, but not always, the President of the Council was a Christian Democrat.
  • The Communists have always been a force in Italy, and, although they are now fragmented, they still wield considerable clout. They were one of the two parties not allowed into the government. Because the Communists had played such an important role in the resistance movement (called “the Partisans”) in World War II, they were a major threat to win some of the elections. The pope excommunicated anyone who voted for them, and for the first few elections the U.S. stationed gunships in the harbors in case the elections went the wrong way. In an effort to influence the 1948 election, the U.S. posted ten million letters, broadcast short-wave radio propaganda, and distributed literature warning Italians of the Communist menace. The CIA also funded the center-right political parties and was accused of publishing forged letters discrediting leaders of the Italian Communist Party. On March 28 General Marshall warned that economic aid would be terminated if the Communists won. Nevertheless, 31 percent of the voters favored the Communists.
  • The Neo-fascists, including Mussolini’s daughter, were the other party that was excluded from all of those governments. They still have some influence, but for tactical reasons most of the people have joined other parties.
  • Silvio Berlusconi’s party, which is currently called “People of Freedom,” took advantage of the massive scandal of the early nineties known as Tangentopli (corruption city) that crippled nearly every major politician in the country. Berlusconi, who owned (and still owns) all of the private TV networks, the A.C. Milan soccer team, and several magazines, used his unbelievable clout in the media to become the dominant figure in the country for two decades.
  • The Northern League’s main objective is for the northern part of Italy to secede. It is stridently anti-immigrant. Americans might be surprised that an openly racist party controls the local governments in many of the towns in the north of Italy. The League has consistently allied with Berlusconi. Incidentally, this idea of an independent group of northern Italians is about nine hundred years old. At first they rebelled against Frederick Barbarossa.
  • A tenuous coalition of left-leaning parties has recently attempted with a modicum of success to form a Democratic Party.
  • A new party, Five Stars, is headed by comedian Beppe Grillo. He thinks that all the parties in Italy are a joke. His primary idea is to remove all of the career politicians, regardless of party, from power and start over. He did surprisingly well in the last election.

When the collapse of the Italian credit rating caused Berlusconi’s most recent government to resign, it was replaced by a government headed by an economist, Mario Monti, who was not really from any party. He stood for election in 2013, and his ad hoc party did not do very well. Now the government itself is in limbo because even with the bonuses no coalition seems to be able to gain a majority in both houses. Nobody really knows what will happen.

Sound familiar?