Health care change is inversely proportional to the length of health-care legislation

According to Robert Pear in today's New York Times ("Coverage Now for Sick Children? Check Fine Print"):

Insurance companies are already arguing that, at least for now, they do not have to provide one of the benefits that the president calls a centerpiece of the [new health-care] law: coverage for certain children with pre-existing conditions.

[UPDATE, March 31: Insurance companies almost immediately backtracked and agreed to do the right thing. I am delighted that the new law is already having good effects.]

"This is what happens when Congress passes a major bill without lawmakers being able to read and digest the whole thing," Mr Neff wrote on his Facebook wall. This is not necessarily because lawmakers are lazy. H.R. 3962, the bill introduced in the House last October, is 1990 pages long; the Senate version from December is 2409 pages long; and the amendments to those bills are 153 pages long.

Still, the length of our new health-care legislation is not the problem, it's the symptom. The problem with our new law is that it does not overhaul our seriously flawed system; it merely tweaks it around the edges. After our Democratic lawmakers gave in to unfounded fears and well-funded special interests, what we got was our old failing system with a new nose job.

Don't get me wrong. I'm delighted that Americans - at least somewhere around half of us - finally believe that health care should be readily available to all. The health-care bill is an attempt to achieve that, even if inadequately and far too slowly. I am glad the bill passed, if only because it represents the first step in a necessary journey.

And its inadequacies do not necessarily mean that all is lost. In The Healing of America, T.R. Reid quotes economist Tsung-Mei Cheng on what he calls "the Universal Laws of Health Care Systems:"

1. No matter how good the health care in a particular country, people will complain about it.
2. No matter how much money is spent on health care, the doctors and hospitals will argue that it is not enough.
3. The last reform always failed.

If our 2400-page bill turns out to be an expensive failure, maybe then our people will be humble enough to learn from countries who have made universal health care work - and who spend half what we already do.

Here's the good news: when we are finally ready to make the fundamental changes that will truly make a difference, we won't need a 2000-page bill. It is simpler to describe a good system than to emend a bad one. Last Monday I blogged about Switzerland's health-care overhaul in the mid 90s. Today I looked up the bill that transformed their system. La loi fédérale sur l'assurance-maladie of 1994, together with all of its revisions up to this year, is 60 pages long.

Review: "Rediscovering Values" by Jim Wallis

Jim Wallis - founder of Sojourners magazine and current nemesis of Glenn Beck - would like to shift the nation's conversation from competing partisan ideologies to shared moral values. That's the theme of his newest book, Rediscovering Values: On Wall Street, Main Street, and Your Street, published this January in response to the ongoing recession.

Without ever quoting Jesus' warning against the false god Mammon (Matthew 6:24) or St. Paul's observation that "the love of money is the root of all evil" (1 Timothy 6:10), Wallis argues that the free market - which, he notes, has played a major role in alleviating worldwide poverty - has become a dangerous idol that is now turning on and devouring its worshipers. The market is good only when it is subordinated to a more fundamental value: commitment to the common good. "The goal is not to destroy the market," Wallis writes, "but to understand its proper place. It is not to get rid of commerce but to build it upon a foundation of values."

The values Wallis lauds include strong families, social justice, care for the environment, concern for future generations, hard work, and contentment. He believes balance needs to be restored between "the public sector (the state), the private sector (the market), and the civic sector (our voluntary and nonprofit institutions - including the faith community). When any one of those begins to take over the others, or one is weakened and does not perform its functions, all sectors are in trouble - and so are we."

Non-wonks need not avoid this book. Full of personal stories, startling facts, and impassioned pleading, it is more like a motivational talk than a lecture on the "dismal science" of economics. It is also short, which I consider a plus in almost any book, and includes "twenty moral exercises" to help readers improve their own values ("Make a list of the priorities in your life ...").

Republicans need not avoid it either. Wallis is unlikely to join your party, but this book is about moral vision, not politics. That is probably why Wallis is now a regular speaker at World Economic Forum gatherings of CEOs of multinational corporations.

As Scot McKnight wrote, "This is Jim Wallis at his best, now softened and measured by his family life." For more about Rediscovering Values, read  McKnight's excellent review or this more detailed review by Frederic and Mary Ann Brussat.

Lent on $2.50 a day

My friend Irene Groot decided to try the Lenten Experiment this year. "I recently sent off a couple of hundred dollars to a local soup kitchen," she e-mailed me this morning. "That's the money I saved taking up your challenge."

Irene lives in a pricey Northern California city, so it couldn't have been easy. "Actually, I'd heard a local reporter trying to survive on $4.00/day so I figured that was the California rate," she wrote. "What I found was that I kept my husband and myself well fed on fresh, wholesome, well-balanced meals for $2.50 - $3.00/person/day. I'd say the figure was closer to $2.50."

How did she do it?

The key to this was watching the grocery ads for three supermarkets not too far from our house. I generally used only two in any given week. Here are the sort of items I am buying on a regular basis on sale:

• Fuji apples $0.33/lb, oranges $0.33/lb, bananas $0.47/lb (all excellent quality)
• Ground beef $1.68/lb, chicken thigh + leg $0.47/lb, all other meats in the low $2.00/lb range
• Cabbage $0.33/lb
• Tuna $0.44 and I stocked up
• Cake and brownie mixes (Betty Crocker) were $0.69 and I stocked up
• Whole grain breads are regularly on sale for $1.69 - $2.50. I've snagged excellent fresh French bread for $0.99.
• Eggs go from $0.99 -$1.50.
• 10 lb. of potatoes for $0.99.
• Sliced American Cheese, 1pkg $0.99

Any other secrets, Irene?

Buy the major food groups on sale, and then figure out what recipe to use. If you go to the store with a recipe, I can't see how you could keep the prices as low as I did. Also, make soup from leftovers. Waste not, want not. It's been an interesting experiment.

Irene told me that she didn't use coupons or giant discounters like Wal-Mart or Costco. She just went to the stores closest to her home.

Irene and I did the Lenten Experiment to see if we could survive on a food-stamp budget. An increasing number of Americans have no choice.

The USDA Supplemental Nutrition Assistance Program - the program that administers what used to be called food stamps - helped to feed some 27.6 million people in December 2007. That number rose to 31.8 million a year later, and last December it soared to nearly 39 million (you can see the figures here).

Feeding America, a network of over 200 food banks, now serves one million more people each week than it did in 2006, according to their "Hunger Report 2010." They estimate that "one in eight Americans now rely on Feeding America for food and groceries." And it doesn't look as if the recession is going to end anytime soon.

Thanks, Irene, for good ideas on how to save money at the grocery store - and on what to do with the money saved.

P.S. Irene e-mailed me after reading this post and looking at the illustration (an ad I pulled off a Safeway web page): "I didn't buy the $0.75 items. Too pricey. I'm watching for better deals and stocking up."

Oh Happy Days - 15,330 of them so far

Forty-two years ago today, Mr Neff and I publicly vowed to love and cherish one another "for better for worse, for richer for poorer, in sickness and in health, till death us do part." At dinner last Saturday night we joked about what we'd be doing in another 42 years, when he's 104 and I'm 103. In spite of the fact that his grandmother and several of my great-aunts made it past 100, we decided to plan our really big celebration for our 75th anniversary, just in case we're too tired on our 84th.

But then we learned about Herbert and Zelmyra Fisher. He's 104 and she's 102, and on May 13--the day after our daughter Molly and son-in-law Byron celebrate their 20th anniversary--Mr and Mrs Fisher will celebrate their 86th. Theirs is not yet the world's longest recorded marriage--three or four other couples are ahead of them--but they are the longest married of any living couple. And they are certainly the hippest. On Valentine's Day they answered questions about their enduring marriage on their Twitter account.

Stay married long enough, and people start asking about the secret of your lengthy marriage. I'll defer to the Fishers, who are 44 years ahead of us.

How did they know they were right for each other? "We grew up together and were best friends before we married. A friend is for life - our marriage has lasted a lifetime."

What was their marriage like? "With each day that passed, our relationship was more solid and secure. Divorce was NEVER an option - or even a thought."

There you have it. A good marriage begins with friendship, is based on commitment, and grows stronger as the years go by.

Yes it does. As the Fishers pointed out, "The children are grown, so we talk more now." Also, we eat more interesting food, and we have more time to spend with adult friends. Last night while chatting with friends before dinner we discovered that all of us love the song "Oh Happy Day." Apparently based on an 18th-century hymn sung to the tune of "How Dry I Am," it took on new life as a gospel song in 1969 performed by the Edwin Hawkins Singers (and may have been the inspiration for George Harrison's "My Sweet Lord").

My very favorite version of "Oh Happy Day," though, is the 1987 cover by Aretha Franklin and Mavis Staples. Never have I heard so much gutsy joy packed into eight sweet minutes. Theirs is the happiness of a mature faith or a ripe old marriage, an ecstasy greater than newlyweds can imagine, a truly aspirational ardor. So of course I immediately played the CD for our friends, and then this morning I linked to it on You Tube as part of my Facebook update.

And then I discovered another version of the song that I offer to people who are new to commitment, people who aren't sure if they're going to make it, and people who are friends of those people. It's from Sister Act 2, and unless your boss is in the next cubicle, go ahead and watch it now. See the kid grow in confidence and enthusiasm. Notice the huge supporting cast--Sister Whoopi, of course, and also the choir, the nuns, the congregation. That boy can sing "Oh Happy Day" because he's part of a community that wants him to succeed.

Mr and Mrs Fisher know how that goes. “Everyone who plants a seed and harvests the crop celebrates together,” they twittered. "We are individuals, but accomplish more together."

Mr Neff and I know how that goes too. Thanks to our friends, families, and communities that have been and continue to be our supporting cast. Today is our happy day because of you.

And Mr Neff, try not to work late tonight.

America, Switzerland, and the scandalous 5%

Whew. The health-care bill passed. It isn't the complete overhaul we need, but at least it's a start. An editorial in today's New York Times rejoiced that, although "the bill does not quite reach full universality, ... by 2019, fully 94 to 95 percent of American citizens and legal residents below Medicare age will have coverage."

Something about that percentage sounded familiar, so I got out my copy of T.R. Reid's The Healing of America (an illuminating survey of health care in other developed nations) and turned to chapter 10, "Too Big to Change?" Acknowledging that revamping a nation's health care can seem overwhelming if not impossible, Reid tells how Switzerland did it in 1994.

The Swiss, he points out, have a lot in common with Americans. They spend "a good chunk of their federal budget maintaining an army." Their rate of gun ownership is higher than ours. They have a strong financial sector. And in the 1980s Swiss insurers, like their American counterparts, changed into for-profit institutions and began denying claims. Costs skyrocketed, bankruptcies increased, and an unacceptably high percentage of Swiss citizens began living without health insurance. The Swiss, who prize solidarity (that's a secular term for "love your neighbor as yourself"), decided that something had to be done.

Here's the shocker: the Swiss were moved to action in 1994 because five percent of their people were uninsured. Five percent was their starting point. They changed their entire system so those five percent could have health care.

We Americans have just taken step one toward reforming our broken health-care system. The media is hailing the health-care bill as "transformative," "landmark," "historic"--and it is indeed a major shift for a nation that has been resisting universal health care for a century. It is also inadequate.

Nine years from now, if all goes well, only five or six percent of our people will be without health insurance. Five or six percent--not a cause for rejoicing in Switzerland, but the shameful statistic that launched their health-care revolution!

So how did the Swiss achieve their goal of 100% coverage? By a narrow margin (there was a lot of opposition from the insurance and drug industries and much of the business community), they passed reform measures requiring insurance companies to operate as not-for-profit businesses and requiring all Swiss citizens to purchase insurance. Reid describes the result:

When I visited Switzerland a dozen years later, universal health care coverage was so firmly entrenched as an element of Swiss life that nobody seemed to oppose it anymore. Even M. Couchepin, the conservative businessman who became president, agreed. "Nobody would want to go back to the system before, when some people were locked out of the insurance," he told me. "We have a system now that means everybody, rich or poor, can have the best health care we can provide. It is accepted; it is working. We are happy that we made the changes in 1994."

Perhaps in another nine years, when only five or six percent of our people are uninsured, we Americans will have the courage and compassion to do more than nibble around the edges of our highly inefficient health-care practices. Perhaps by then we'll be as troubled as the Swiss were when five percent of their citizens lacked access to health care. Perhaps we will finally be ready to restructure our entire health-care system from the ground up.

At least now we're facing the right direction.

What we get for our health-care dollars

Soon, they tell us, Congress will or will not pass a health-care bill. Detractors think universal health care will raise health-care costs, lower health-care outcomes, and dangerously increase the power of the federal government. Those are interesting theoretical positions, but let's take a final look at what actually has happened in countries who already have universal health care.

These countries are not hard to find. I used True Cost's list of 33 developed countries as a starting point. Thirty-two of them have universal health care, "with the United States being the lone exception." The list describes each country's type of health-care system--single payer, two tier, or insurance mandate--and gives the date that it was begun (ranging from 1912 to 1995).

I then went to the World Health Organization's detailed database search page and checked statistics for 32 of the countries (Hong Kong is listed at True Cost as a separate country but is considered part of China on the WHO list). I found that

• America's adult mortality rate is better than Slovenia's but worse than that of every other developed country. 
• Our infant mortality rate is better than that of Brunei, the United Arab Emirates, Bahrain, and Kuwait; but worse than that of the other 27 countries. 
• Our life expectancy at birth is better than that of Brunei and Bahrain; the same as that of Kuwait, the United Arab Emirates, and Slovenia; but worse than that of the other 26 countries. 
• Our maternal mortality rate is better than that of Luxembourg, Brunei, Singapore, South Korea, Bahrain, and the United Arab Emirates; the same as that of Portugal; but worse than that of the other 24 countries.

For these dispiriting results, our government spends less than the governments of eight countries (Luxembourg, Norway, Iceland, Denmark, Switzerland, France, Sweden, and the Netherlands) but more than the governments of the other 23 countries. But wait--it gets worse. In addition to government funds, Americans also spend a lot of private money on health care. In fact, we spend more on health care than any other nation on earth.

What are we getting for our health-care dollars? I decided to look at the countries that most closely resemble ours in government investment in health care. In 2006--the most recent year for which statistics are available--the United States government spent $3074 per capita on health care. Nine European nations and Canada spent between $2536 and $3541. Six spent less than we did; four spent more. How do our outcomes rank?

• The adult mortality rate (the probability of dying between 15 and 60 years per 1000 population) for the other ten countries ranged from 78 (Sweden) to 124 (France). The U.S. came in last, at 137.
• The infant mortality rate (per 1,000 live births) ranged from 3 (Sweden) to 5 (Canada and the U.K.). The U.S. came in last, at 7.
• Life expectancy at birth ranged from 82 (Switzerland) to 79 (Belgium, the U.K.). The U.S. came in last, at 78.
• The maternal mortality rate (per 100,000 live births) ranged from 1 (Ireland) to 8 (Belgium, the U.K., France). The U.S. came in last, at 11.

What would happen if we devised a health-care system like one of theirs? Why do we think our costs would go up, when theirs are considerably lower than ours? Why do we fear that our outcomes would go down, when theirs are considerably higher? Do we really believe the U.S. government is less capable or more corrupt than the governments that have created successful universal health-care systems?

Well, maybe. Transparency International prepares an annual Corruption Perceptions Index of 180 countries. The United States' rank is 19--better than Belgium or France, but not as good as Sweden, Switzerland, the Netherlands, Canada, Germany, Ireland, Austria, or the U.K. A lot of us fear that we have the best Congress money can buy.

Review of Anne Lamott: "Imperfect Birds"

Anne Lamott's seventh novel features alcoholism, drug addiction, and family dysfunction. This will not surprise Lamott's fans. Her characters--including herself in her five nonfiction books--are always "imperfect birds," and some are clearly on the endangered list. Most are also sensitive, funny, intelligent, and frightened by the messes they keep getting themselves into. That's why we love them, and their author, so much.

Imperfect Birds (April 2010) continues the story of Elizabeth and Rosie Ferguson that began in Rosie (1983) and Crooked Little Heart (1997). You don't have to have read the first two books to understand the third, though a little background can't hurt. Elizabeth is the alcoholic daughter of two alcoholics. Her husband died in a car crash when their daughter, Rosie, was four. A couple of years later, Elizabeth meets James, an alcoholic would-be novelist. Eventually they marry and begin going to AA meetings. By the time Rosie is nine or ten, her mother is clean and sober, though inclined to paranoid episodes and panic attacks. As Elizabeth battles her demons over the next several years, Rosie faces her own issues--a child molester, a pregnant friend, competition and cheating, and, always, the need for independence from her hovering mother.

By the beginning of Imperfect Birds, it looks as if Elizabeth, still worrying incessantly, has maybe given her seventeen-year-old daughter more freedom than the woman-child can handle. Rosie has been on the pill for two years, is sexually active, is unreliable and dishonest, drinks, does a wide variety of drugs, and runs with a fast crowd. Elizabeth more or less knows all this (though she is unaware of the full extent of Rosie's misbehavior), but she is afraid to intervene. After all, Rosie's grades are good. She is charming. When things go wrong, she always has a plausible excuse. Most of all, if Elizabeth lays down the law, she might lose Rosie's affection, those fleeting moments of mother-daughter bonding for which Elizabeth lives.

The plot is not the reason to read Imperfect Birds: Rosie does bad things. Elizabeth, in deep denial, keeps hoping everything will turn out all right. James, whose denial is more shallow, sometimes nurtures Elizabeth's hopes and sometimes sees reality. Rosie, along with her friends Jody and Alice and Fenn, keeps on doing bad things.Until, inevitably, a crisis forces Elizabeth to see clearly and take action.

The imperfect birds--the flawed characters--are what makes this book stand out. Never have Lamott's people seemed so heartbreakingly real. Yes, I say as the mother of former teenagers: I know why Elizabeth wants to believe the best, I feel the bond she has with her wayward but charming daughter, I understand why the time for action never seems to arrive. Yes, I say as a former teenager myself: I know why Rosie needs to get away from her mother's worries, I understand why her group of friends is so important to her. These are real women living, on a grand and tragic scale, the little conflicts all of us face daily as we and our children grow up.

Still, I keep wanting to jump into the story and shake some sense into them. My heart sinks as Rosie repeatedly jeopardizes her health, her sanity, her very life. I grow more and more exasperated as Elizabeth ignores the mounting pile of evidence that her daughter desperately needs adult intervention. And yet I, the reader, know so much more about what is going on than Elizabeth does. Lamott is letting me see the oncoming disaster, not with my own limited maternal vision, but with God's eyes.

If Lamott didn't have a wacky sense of humor, reading this book might be depressing. If she didn't have an underlying sense of hope, it could be unbearable. But Lamott--herself a recovering substance abuser, the daughter of two alcoholics, and the mother of a young man just leaving his teens--is a spunky survivor, and she invests her own faith, hope, and love in her characters. As in nearly all Lamott's books, God is never far off. Elizabeth is not a believer, but Rae, her best friend, has enough faith for both of them:

Rae was Rosie's authority on all things spiritual, because her beliefs were so simple and kind. You were loved because God loves, period. God loved you, and everyone, not because you believed certain things, but because you were a mess, and lonely, and His or Her child. God loved you no matter how crazy you felt on the inside, no matter what a fake you were; always, even in your current condition, even before coffee. God loves you crazily, like I love you, Rae said, like a slightly overweight auntie, who sees only your marvelousness and need.

When Elizabeth desperately needs to pray, the only god she can imagine is "an entity called 'not me,' lowercase." Rosie believes "in something, some sort of energy field or force, like a cross between the oceans and their cat, Rascal." It is enough. Eventually truth begins to set them free.

Which is not to say that the ending is happy, or that it is unhappy. Elizabeth and Rosie still have a long way to go. This will not surprise Lamott's fans, who expect her books to be a lot like life. But funnier--even when they are breaking your heart.

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For more on Lamott's faith, see Agnieszka Tennant's delightful 2003 interview for Christianity Today magazine.