AN AMERICAN LIFE, AN AMERICAN DEATH

9 12 2011

My old  buddy Wally died a few days after Thanksgiving.  He had just passed his 56th birthday, but his body was worn out and his spirit was worn down.  “Wally” isn’t his real name, and I have altered some of the details of his life, just to preserve what dignity he had left.  As I reflect on how he came to such a sad, lonely, and early end, I see him both as a tragically flawed human being who made a lot of stupid choices, and as a victim of our culture’s skewed priorities.  You could say he’s the liberal-conservative debate embodied in the life of one human being.

I first met Wally about twenty-five years ago, when he was just past thirty and I was thirty-seven.  You know, they say in heaven everybody is thirty-seven forever. but my 37th year was not a good one.  I was farming at the time, growing apples, and a very late freeze that year had  turned what was going to be a bumper crop into soft, black marbles that fell to the ground and rotted.  While the orchard never provided much in the way of income, it was something, and I needed another way to earn money, pronto.  Enter Wally.

Wally was a native of a nearby town.  When he was 14, his two older brothers had given him a good stiff dose of LSD and taken him to a Pink Floyd concert.  Although he had always been kind of a weird kid–sensitive, with big thick glasses that made his eyes look huge (like me), that experience, like similar ones I had at a slightly older age, seriously altered his life course. He decided to shake himself free of the small town and small minds he had grown up with, and wandered off in search of adventure, which he found in the Rainbow Family.  His first gathering connected  him with a vegetarian restaurant collective in Boulder, Colorado, where he got to meet, feed, and hang out with such luminaries as Timothy Leary and Joe Bageant.  His next swing through the Rainbow roundabout hooked him up as keyboard player with a band called “The Tools,” and sent him to Tulsa Oklahoma, where the band financed their debut album by laying carpet and vinyl in the boom years of the Reagan administration.

But then…. the lead singer, the irreplaceable voice on which the whole project hung, left to join a well-known-at-the-time pop group,whose name escapes me–something like Journey or Foreigner, but it wasn’t either of those.  The record was never released.  That left Wally with newly acquired carpet-laying skills, a wife and a new baby, the intention of being a songwriter, and a pretty decent recording studio that he knew how to use.  Then his studio was burglarized and his marriage came unglued, and he returned to his hometown, moved back in with his mom, and found work laying floor coverings.  The situation was somewhat freelance–he worked when the carpet store owners had a job for him, and was expected to keep track of his own Social Security, insurance, and–the good part-hours.

Before his Tulsa studio was burglarized, he had written and recorded  a country song called “My Car’s a Gasoholic and It’s Drivin’ Me to Drink.”  Now that he was within striking distance of the country music capital of the world, he took it around to radio stations, who gave it some airplay.  That, however, had all happened in the early 80’s, and he hadn’t been able to get a nibble since.   The bad news was, his car was a gasoholic, and that was the least of the things that was driving him to drink.  More on that later.

Most of his Rainbow and rock’n’roll attributes had fallen away by the time I met him.   He rarely played music anymore.  (His son told me that he had only heard his dad play once, all the time he was growing up.  “He sat down at my grandma’s Wurlitzer organ and played Pink Floyd’s ‘Echoes‘–all twenty-two minutes of it–and he totally nailed it.  I was amazed.”) He had cut his hair and shaved.  He eschewed health food, saying, “Mrs. Winners is my breakfast cook,”

So, laying carpets and vinyl–that’s where I came in.  Wally needed an assistant to help him lift rolls of carpet (They’re heavy!), move furniture out of the way, and generally take care of the little things so he could do the main thing–get the floor covered.   Working one-on-one with him, sharing long rides to job sites, lunch and sometimes dinner pizzas, and the occasional joint, we got to know each other pretty well.  He derided my live Grateful Dead tapes, saying, “About half the time, they sound like a small-time country bar band on a bad night,”  but he still loved Pink Floyd–and Frank Zappa.  One conversation that came around from time to time involved him telling me, “I’d like to quit smoking cigarettes.  I’d like to quit drinking coffee.  They’re both addictive drugs that are doing me no good, especially cigarettes.  But you can’t get into a program that will help you quit cigarettes and coffee.  If I wanted to quit smoking pot, I could get into a program tomorrow–and they’d let me drink all the coffee and smoke all the cigarettes I wanted.”  He tried to quit several times in the year I knew him, but something always happened to stress him out–the toilet broke, or his wife (at the time, but not for long) went on a tear.  Hey, she smoked cigarettes, too, and had just borne him a son that she seemed ill-equipped to mother.  My wife and I both heard a lot about this, because when he married again, he moved out of his mother’s home and into our very hippie-friendly neighborhood.

Wally was very good  at laying carpets. He had high standards and a strong sense of integrity about the work he did.  He was also politically radical, passionate, articulate, and had a mordant, punny sense of humor, all of which made him a lot of fun to work with–when he was there. Frequently, we would arrive at a job, get it laid out, and Wally would announce that he needed to go get some materials that we didn’t have, and leave me to get things started.  It would take him hours to return.  Sometimes I would be able to mostly complete the job, sometimes I got to a point where I just had to sit and wait for him.  He never had a satisfactory explanation for these absences, which strung out our work days until late at night, so that the next day would be a late start, and so on.

After he died, a mutual friend told me something about Wally that I had never even suspected–he was bi. I recalled someone Wally had introduced me to, just once, a guy who ran a costume shop and limo service, two very odd businesses for such a small, mainstream, lower class, boring burg as the one where we worked.  The guy was, besides, Wally, just about the only interesting  person I ever met from that sleepy southern town.  Was he Wally’s lover?   Were trysts with this guy (now dead from AIDS, I’m told)  the reason Wally disappeared for hours during the work day?  Or was he just out getting drunk, as another mutual friend suspected?  He didn’t seem particularly drunk when he came back from his extended absences.  I guess you could say that my gaydar was poor enough, and his was good enough (sex with other guys has never appealed to me), that the subject just never, uh, came up between us.

After a year, I got tired of the long, erratic hours and low pay, and, besides, the orchard had a good crop again.  I quit working for Wally.  He found another helper, and I gave the orchard business what turned out to be one last season.  You could say I farmed ’till I ran out of money.

Around the end of our year together, I had begun to take a more active interest in following  a spiritually motivated path in life, a decision that eventually led me to Buddhism.    I brought Wally to the home of the friend who was helping me move in that direction, and we sat for an hour or two, partook of some herb, and talked about cultivating self-discipline and getting in better alignment with  our higher intentions.  Wally excused himself after a while, and left.  Next time I saw him, I asked how it had been for him   “I’ve been there and done that,” he said, “and it’s not something I need in my life anymore.”

In the words of The American Book of the Dead,

This (was) the point of no return, the macrodimensional crowbar which separates the sentient voyagers who are liberated and those who take lower rebirth.

In one single instant they are parted from one another; in that instant, infinite freedom or the wheel once again.

Disclaimer:  I am not necessarily, in fact not likely, “liberated,” that’s just my intention–but Wally opted out.  A long road down lay ahead of him, but there was no way he could know that.

He had already come a long way down, in some respects.  One day, on the way to a job, he had taken me to a hilltop mansion which bore the name of one of the founding fathers of our country.  This, Wally told me, was where he had lived as a small child, with his mother and grandparents, after his father had died.  Wally was a direct descendant of that founding father, and a scion of one of the wealthiest families in our part of the state.  That wealth, however, had not been passed on to his mother, or to him.  There had been some kind of machinations when his grandfather died, and other relatives ended up with the estate, which was prime development property.  His mother now  lived in a modest home in a modest neighborhood in a nearby town.

On another occasion, we were driving down a country road.  “There used to be a pre-Civil War house in that field,” Wally said, pointing off to our right.  “It was just used for storing hay when I was a teenager.  One time, me and my friends were hanging out there, and we accidentally set it on fire, and it burned to the ground.  We got the hell out of there, and the police never did figure out who started the fire.”  In retrospect, I have to wonder if that, along with other revelations I will disclose in due course, added to the urgency of his decision to travel and see the world.

Since one of my best friends had taken up the challenge of working as Wally’s assistant, and Wally continued to live in the neighborhood, I kept in touch with him for a while.  He took too much weight the wrong way moving a carpet, and did something serious to his back, but kept on working.  What choice did he have?  Then his year-old son died. It was labelled a crib death, but one-year-olds don’t die of crib death.  Adding to the pain of that loss, the ambulance taking them to the hospital was totaled when a driver in front of the emergency vehicle came to a full stop right in front of it, causing a collision. Wally began to suspect that his wife had smothered the child in a fit of rage over his crying, but there was no way to prove it.  They split up, and he moved back in with his mom.

About that time, my own life came apart, and I moved to another state for about five years.. When I returned in the late nineties, a mutual friend told me Wally was living outside Nashville, and put us in touch.  I called him.  He sounded upbeat, with a new wife, a house on a lake, and a sailboat.  He invited me to come out, visit, and maybe go sailing.    I took him up on it.

The house was beautiful.  The sailboat was beautiful.  The lake was beautiful.  His household, on the other hand, was a soap opera.  His wife, whom he had met on-line, had an adult child who was mentally and emotionally handicapped, in a way that took up a fair amount of psycho-emotional space.  Wally and his new wife were not getting along well–they divorced not long after my visit–and Wally was drinking heavily to deal with both the emotional pain of another failing marriage–his fourth–and the physical pain generated by continuing to lay carpet with a deteriorating back.  He had tried to get out by becoming a car salesman, but in spite of his best efforts, he washed out of that highly competitive job market.  He had tried to start a new career by encouraging his previous wife (not the one I had known) to become an exotic dancer, (and he her manager), but she had left him for the club’s bouncer, who was not, as Wally was, twice her age. Wally was hurt by this.   “I shaved her pussy for her,” he complained, “and she left me.”  His current wife was definitely not exotic dancer material, and he was realizing he had made a mistake with her, too.   “When I visited her  in Boston, I discovered that she just left all her mail, bills and everything, in a pile on the table and never opened or answered anything.  That should have been a warning to me.”  His life was a mess, but there was nothing I could do to help him, not that he was asking for help.  We didn’t go sailing.  I excused myself as quickly as I could.  There’s no point in reaching out to somebody who doesn’t want to admit that they need a hand.

music:  Drive-by Truckers, “Dead Drunk and Naked”  (first link is video of live performance, second is the lyrics, which are relevant but hard to understand on the video)

I didn’t think much about Wally for the next eight or nine years, except once when I saw his name connected with a John Kerry campaign event in that same sleepy southern town where we had worked together.   The former Vietnam war protester, wealthy east coast intellectual, and reputed closeted potsmoking Deadhead didn’t resonate well with the rednecks in  our  red neck of the woods, and, while Kerry may have been cheated out of a victory in Ohio and elsewhere, he lost it fair and square down here in the South.  (A mutual friend later told me that Wally had been asked to separate himself from the local Kerry campaign because of his excessive drinking.)

Then I found Wally again through the magic of email.  A mutual friend sent out a missive and cc’d all his addressees instead of bcc’ing them, which is kind of a no-no, as it invites spam, but, being nosy, I looked through the addresses, and there was a wallywilson@yahoo.net.  Out of curiosity, I dropped him a line, asking, “Are you the Wally Wilson who used to lay carpet?”  And he wrote back that yes, he was.  One thing led to another, and I went to visit him.   His life had changed a lot.  The music, the wife, the house, the job, for that matter the ability to work–all were gone.  His two brothers, the ones who set him on the path he took, had taken a sharp right turn, become evangelical Christians, and written Wally and his radical politics out of their lives; he said he didn’t even know how to get in touch with them any more.  The sailboat, on the other hand, had morphed and grown, from a little lake boat to a 27-foot, seagoing vessel, big enough for a single guy to live in, which is just what he was doing.  But the boat was not in the water.  The boat was on a trailer, sitting in the front yard of his last employer.  Wally’s back was totally shot.  It hadn’t been so shot when he first acquired the boat, and therein lies a tale.

Wally had started drinking heavily in an effort to cope with his chronic back pain, but it didn’t help much.  He then had back surgery, which, as so often happens, didn’t help much,either  The good news was, this enabled him to qualify for SSI disability–the munificent sum of $600 and some change every month.  The bad news was, he was now taking massive amounts of prescription morphine for the pain, as well as drinking plenty of beer to take the edge off.  But the good news was, he he’d gotten several years worth of SSI checks in a lump sum, added up from the date he had first applied to the day his request was granted.  He split the award with his lawyer, and spent most of the rest of it buying and outfitting a sailboat he found online, on Long Island.  His plan was to sail the boat to Belize, where he would not be hassled for living in it, where pain meds  and living expenses in general were much cheaper,where it never got cold, and where his old buddy Joe Bageant could show him the ropes.  He set off down the East Coast, but ran the boat aground and tore up its keel near the entrance to Chesapeake Bay.  He limped up to the Washington, D.C., area, hoping to find a shipyard where he could do the repairs and a pain doctor who would rewrite his morphine prescription–but the DEA had just busted the best-known chronic pain doctor in the area, and nobody wanted to risk writing narcotics prescriptions for strangers.  Corralled by his need for morphine, he spent just about the last of his nest egg putting his dream boat on a trailer and hauling it to Nashville, where he could see a doctor who knew him.  He was hoping he could get the boat repaired, into the Tenn-Tom waterway, and back en route to Belize.

It didn’t work out that way.  He tore up his back even further trying to help his host plant a garden, and, penniless and barely able to move, resigned himself to staying where he was.  There was, he often told me, still money in the family pipeline for him, and when that came through, he would get the boat back in the water and make his getaway. He was waiting for his old uncle to die so he would get the money, about fourteen grand.  When he told me all the things he planned to do with that relative pittance, it was difficult not to tell him how unrealistic his expectations were–and when I did try to tell him, he didn’t want to hear about it.

But I’m getting ahead of myself.    I visited him at the beached boat just a few weeks before I myself fell down the health care rabbit hole, hit with a stroke while in the hospital for atrial fibrillation.  Our meeting was a friendly reunion; we emailed back and forth from time to time through the first winter of my recovery.  He had not lost his interest in politics, his radical perspective, or his desire to make the world a better place, and that gave us a firm basis on which to renew our friendship.  .Then, in May, 2009. he called for help.  His former employer had told Wally that he was getting ready to sell the farm where Wally was staying, and so it was time for him to find another place to live.  I tried to find somebody else to take him, but after a while it sank in–either Wally was going to move his boat to our place, or he was going to be out on the street, not a good place for a crippled older guy with a heavy morphine habit.  It was just for nine months, he promised–then his son would come help him get the boat water-worthy again, and he would be on his way to the Gulf coast, or beyond.  I, recently laid low by my own health issues, was glad to be able to be of some help to another human being.  He promised he wouldn’t be any trouble.

And so we tucked his boat away behind our barn, where it was unlikely to be noticed, but on a gravel pad just to give a nod to codes.  His former landlord towed the boat over, and a neighbor with a backhoe gave the boat the final push in.  It must have been a rough job for him–he hasn’t returned our calls since.  But I digress.  We ran an extension cord and a hose from the barn to the boat, and Wally had a new home.

We immediately began to realize that we’d taken on more than we’d bargained for.  At his previous location, he was in the middle of a big, flat open area, but at our place, he was in a deep valley, and the rancid smell of his beer, cigarettes, and meds-tainted body odor and urine created a bubble of second-hand smoke and nastiness that extended for a hundred feet or so around the boat.  You could literally smell him before you could see him.  In addition to his back problems, he had been diagnosed with panic disorder, for which he took Valium, among other things of a similar nature; cardio-obstructive pulmonary disease, the predecessor to emphysema, from smoking cigarettes for 40 years (and probably from inhaling glue fumes regularly in the course of laying  carpets and vinyl) ; and hepatitis C, the kind you only get from somebody else’s blood, i.e., sharing dirty needles, but he swore he didn’t know how he got it.  After he died, his son told me that Wally had been a heroin addict as a teenager.  I don’t think Wally ever told me that.  Maybe he was lying about not knowing how he got hepatitis C, or maybe it had been nearly dormant in him since his teenage heroin addiction, growing worse as he stressed his liver with alcohol.  He had also lost most of his teeth, and what stubs were left in his mouth were pretty rotten.  We don’t have lepers in 21st century America, but Wally, stooped, dazed, smelly, and nearly toothless,was as close as we get.

Once a handsome young charmer, he now seemed to revel in his ability to disgust people.  Catheterized for a while with a urinary infection, he wore shorts in public, with the bag hanging out the bottom of his pants.  Since he drank so little liquid, his spittle was thick and ropy, and formed lip-to-lip pillars when he opened his mouth.  He was skinny enough that his pants frequently started falling off what little there was of his ass, and he would be slow to hoist them.  I guess, if you’re really hard up for attention, you quit caring if you’re getting approval or disapproval.

music:  Kate Wolf, “The Hobo

But Wally wasn’t completely beaten down.  His computer and internet connection gave him a doorway into the world.   He was especially active on Democratic Underground, where he was appreciated for his heartfelt, thoughtful contributions–but from which he was eventually banned because he kept using the site to ask people to send him money.

Money was a continuous struggle for him.  He was on a dozen prescription medications, but Tenncare would only pay for five, and most of the drugs he needed to purchase were not generics.  Hey, Mr. Legislator, try buying seven prescription medications, feeding yourself, and keeping the lights and heat on, on $600 and change a month.   There were sometimes more than twelve prescriptions–his rotting teeth, which Tenncare would not pay to take care of, kept getting infected, which required frequent courses of antibiotics.  Frequent courses of antibiotics meant that the bugs in his system evolved resistance to antibiotics, which in turn meant that he had to take newer, stronger, and more expensive antibiotics.  Tenncare was willing to pay $125,000 for open heart surgery, the need for which could result from chronic gum and tooth infections, but Tenncare would not pay the thousand or so dollars it would take to pull his teeth and make dentures for him, and the SSI people wouldn’t let anybody give him the money to pay for the dental work, either.  Desperate to get his teeth fixed before the repeated infections tore a hole in his heart, he tried to borrow against the  small inheritance due him, but got the impression SSI, or at least some of the people implementing its policies. wouldn’t allow that, either.  However, when his son made inquiries about this, it started to look like Wally’s perception of the difficulties of paying for getting his teeth pulled was actually a misperception, fed on his side by his narcoticized, oxygen deprived, panic-prone mind, and by who knows what on the SSI end of the equation. By the time he finally got it together to get his teeth pulled, it would prove to be too late.

While morphine and fentanyl dulled the pain in his back, they did not stop it, or give him back the muscular strength that had atrophied.  He was so unsteady on his feet that he would fall down regularly, even with the help of a walker, although he needed that less after he was cured of Hepatitis C.  The only position in which he was comfortable was sitting cross-legged with his elbows on his knees, and that was how he spent most of his days, hunched over his computer or his meals.  The narcotics he was taking would cause him to nod off unexpectedly, and he told me he would frequently wake up with his face in his unfinished dinner, and another burn cigarette burn mark notched in the quilt on his bed, or, sometimes, his fingers.

And then there was Hepatitis C.  He had tried interferon therapy twice, but found the side effects too overwhelming, and had bailed.  His doctor told him he was nearing his last chance before the disease resulted in cirrhosis of his liver, a condition in which his liver would quit functioning and he would die.  This time, to help him get through the interferon, he found someone who would provide him with marijuana, and got his doctor’s agreement for this, although Tennessee is not a medical marijuana state.  But oops, there was another twist in the story–he was too underweight and malnourished to meet the health guidelines for the interferon.  A few months of special attention to diet took care of that, just barely–he was unable to afford the “nutrition drinks” that were recommended to him.  He asked us for an extension of his original nine month agreement, and we gave it to him,  with the understanding that his son would come through for a working visit the next summer and help him get the boat in the water.

Just now, in doing research for this story, I found out something that  I have to wonder if  Wally or his doctors were aware of.  On a website called  “Addiction Medicine,” I found, at the bottom of the page, this caveat:

When treating patients with hepatitis, one must be aware of the possibility of altered hepatic function leading to an altered metabolism of medications, especially antidepressants. The changes in metabolism could lead to toxicity. In a patient with liver disease and compromised liver function, encephalopathy can develop due to an inability to handle dietary protein. The use of antidepressants of the tricyclic class can cause impairment in the thinking processes due to their anticholinergic effects, adding to the encephalopathic impairment. A clinical picture of delirium can ensue. The use of benzodiazepines can worsen the delirium.

Wally, diagnosed with “panic disorder,” had been taking Valium, a benzodiazepine, daily. Did he get switched to something that wouldn’t clash with the interferon?  He certainly seemed to go through a change, a deterioration, really, of personality while he was on the interferon.  He became more withdrawn, more paranoid or maybe delusional (in the sense that he made up stories about why certain things happened that were not particularly based in reality), and less present.  The wild and crazy guy I had known was dissolving in a vat of chemicals.  “Personality changes” are listed as a side effect of interferon treatment.  I’d say that’s an understatement.

He made a brief comeback once he got off the interferon, cured of Hepatitis C.  We shared a feeling of triumph.  But the recovery of his personality was short-lived, and I soon understood why.  I learned that it is a widely ignored and unpopular, not to mention unprofitable, fact that our society’s highly pharmaceutical mode of dealing with mental disorders is not only ineffective, but actually precipitates greater incidences of more acute forms of “mental illness.” The drugs he was taking to balance his brain were making it less balanced, even less balanceable.

Still, Wally did his best to keep up appearances.  While he complained about the fact that my wife would only allow him in the house when she was gone, limiting his ability to take showers, he would only come in and take a shower  (and shave) when he had a doctor’s appointment coming up.  He put all the effort he could into appearing as normal as he could on those occasions, for what he feared more than anything was being declared incompetent to live on his own, and then confined to a nursing home.  Because he was on SSI, the only way he could continue to own the boat was to keep living in it.  If he left the boat, he would lose it, as well as his dream of independence on the water.  He would also, if he entered a nursing home, lose his much-anticipated inheritance.

Wally wanted to be generous, bless his heart.  He gave my wife a pretty watering can that had been his mother’s, but which was useless to my wife because of its small size.  He also attempted to pass on to her his grandmother’s sewing scissors, which may have been a precious antique with more than sentimental value, but did not work as sewing scissors.  We eventually gave them back to him, since he kept complaining that “After all the nice stuff I gave her, your wife still doesn’t like me.” He offered to bake us one of his self-described “delicious peach cobblers,” which turned out to be a (to us) inedible, over-sweetened goo made from flour, condensed milk, and canned peaches, with strong overtones of tobacco smoke.  His general preference for prepared and canned food, and use of paper plates–he said, and it was probably true, that it was too painful for him to stand up long enough to cook or wash dishes–generated mountains of bagged trash that lured raiding possums and raccoons and added to the smell around his boat.  We live a very low-trash lifestyle, and don’t have garbage pickup service, so we (including my wife’s father, who started helping us with Wally) ended up making more frequent dump trips than we would have made on our own.

The second summer, we nearly lost him.  He was scheduled for a doctor’s appointment, but hadn’t showed up for his  ride  I went around back to look for him, and found him collapsed next to the boat, unconscious and unarouseable, lying in the  full glare of the July sun.  I called 911, and an ambulance soon arrived.  Dehydration, we suspected.  As part of his anti-health food kick, he refused to drink water, imbibing only HFC-laced fruit drinks, coffee, and “cheapo cola,” as we jokingly called it.  But no, it wasn’t dehydration–it was an inadvertent drug overdose.  One of his pain medications was fentanyl, which he took as a skin patch.  At high temperatures, however, the patch delivered the drug much faster, and that, apparently, was what knocked him out.   In a few days, he was home. That was July.  In August, his son came again, and did his best to get the boat back in the water, but there was much, too, much for him to accomplish in just a month, and Wally, who was going through the interferon therapy that summer, was no help at all.  He would be with us a second winter.

He had quit drinking beer because alcohol and Interferon don’t mix, and when he wasdone with chemotherapy, he didn’t start drinking again.  He said he’d lost interest; I suspect that the medical marijuana that he was obtaining was also a far better  consciousness modulator for him than beer’s combination of alcohol and hops.

That was also the summer of the BP oil spill in the Gulf, which soured Wally on the idea of living in the water on the south coast.  (I can’t say that I blame him.)  He started to envision using his inheritance to tow the boat to the west coast instead, to be near his ex-wife and kids.  This seemed pretty unrealistic to me.  I told him I thought he could find a better boat out west for less than it would cost to tow his current vessel that far, since sailboats, a toy for the upwardly mobile,  were being abandoned at record rates as the economy deflated.  Wally wouldn’t hear of that.  His mind was made up.  He was hanging on to the boat he had.  We started thinking of him as Gollum, a being totally deformed by attachment to “his precious.”  His son found trying to work with Wally incredibly frustrating for the same reason.  Then the relationship with his ex that he had been rebuilding (at least in his own mind) collapsed, and he lost interest in moving west, too.

My wife and I began to doubt his competence.  He seemed incapable of managing the electricity in the boat.  He would put all his heaters and his microwave on the same plug, and then wonder why he tripped a circuit breaker.  Or he would not realize that he had unplugged something, and think he had tripped a circuit breaker, frequently in the middle of the night.  Then he would call us, generally just as we were getting ready for bed.  This was especially troublesome in winter,when the bill for his electric heater cost him between a quarter and a third of his income.  If the power went out and his electric heaters went off, the uninsulated fiberglass boat would not hold heat, and he would have no alternative but to seek shelter in our house, with two people whose lungs could not handle even secondhand smoke.  We had a spare room that he could have used in an emergency, but fortunately the winter passed without that crisis occurring.

As it was, I was exposed to second-hand smoke at least once a month, when I took him grocery shopping, or to a nearby pharmacy to pick up his narcotics.  That was our time to hang out together.  He did most of the talking on those occasions, except when he nodded out from his pain medications.  He generally repeated his latest version of the same monologue.  It could be difficult to interrupt him.  I had to learn to be humorously rude with him if I wanted to get a word in edgewise.  I occasionally had to do my best to intervene or apologize when he treated store employees rudely for reasons that seemed to have more to do with his need for self-assertion than the quality of the service he received.  My own disreputable appearance occasionally sparked comments on the level of, “Who’s taking care of who?”  I would laugh; Wally would at least act like he didn’t notice the question.

On one occasion, Wally was waiting for me with his groceries outside the market, when a guy in a wheelchair asked him for a smoke.  Wally gave the guy a cigarette and paid him no further mind, until he realized that his month’s supply of beer had vanished from his shopping cart and the wheelchair guy was hightailing it across the parking lot with the 24-pack in his lap.  Wally was particularly weak at this time, and using a walker.  He tried to give chase, but the beer snatcher easily outdistanced him.  We thought it was sad, but also, in a dark kind of way, very funny.  But Wally couldn’t afford to replace the beer.  I fronted it to him.  I ended up fronting him quite a bit, as did my wife’s father, when he started helping me with Wally’s errands.  Wally made some effort to pay us back, but on his income and with his needs it was a losing struggle.  That’s OK with me.  Throughout my life, I have been the recipient of a great deal of kindness, financial and otherwise, that I was never able to repay to my benefactors.  Wally was my chance to pay it forward.

When we told him that we did not want him with us through a third winter, at first he squawked, repeating his assertion that he was no trouble at all, in spite of what we might think, but then he seemed to kind of get into it–he looked forward to cruising the Cumberland in his sailboat, mooring out in places where he wouldn’t have to pay a marina fee, fishing for his dinner, maybe finding an isolated island to plant a pot crop on.  Nevertheless,  he complained about us on Democratic Underground,  posting, at the end of a note letting his  friends know he was cured of Hepatitis C:

PS, anyone got a 1 ton dually with a big engine and a ball hitch that would pull my 28 ft sailboat from Nashville to the California Delta (back Bay between around August 1st or I will arrive there without my home. I’m being evicted because the people who own the land I’m on worry about me wintering in an uninsulated sailboat, when I’ve got snug electric heat with a gas back up. Oh Well, I have little contact with them anyway and my kids arere out there.

Notice, he didn’t mention his ex-wife or the fact that his gas heater hadn’t worked in quite some time, or that when it had worked, he needed to leave the hatch open and let the heat out or he’s asphyxiate.  Also, while he thanked me profusely to my face for helping him get through the interferon, he dismissed our connection with “I have little contact with them anyway.”   Wally was very good about appearances.  Here, he was seeking sympathy (and several thousand dollars worth of somebody’s time and money, though there were no takers), and cast us as cruel and distant, in a forum of which we were unaware and thus unable to respond.

It’s true, we weren’t able to give him everything he needed, and so his feeling of disappointment was, in a way, justified.  For me, the difficulties of our relationship were lessons on the limits of my compassion and the need to draw boundaries.  I aspired to love him unconditionally, to be there for him as much as possible, possibly even to lift his consciousness enough to give him some insight into himself.  I was not equal to the task.  Wally was a bottomless pit, a black hole of human need.  Between the psychiatric drugs and  his habit of blaming his troubles exclusively on outside circumstances, there was no way I could move him.  He may have hit bottom, but he still was too proud to ask for help–which, more than his smell and appearance, was what repulsed my wife.  As many times as I tried to explain that to him, he never got it.

I started to understand what “compassion fatigue” means.  I knew what the kind, compassionate thing to do was, but I still had to grit my teeth to do it. And I wasn’t dealing with tens of thousands of hungry, traumatized war refugees, just one chronically ill borderline homeless guy.  My hat is off and my heart is out to those who can take on so much more than I apparently can! I was grateful when my father-in-law, who shared Wally’s interest in sailing, stepped in and started taking Wally on his grocery and other shopping runs.

Wally’s son came that third summer, armed with several thousand dollars and his professional boat building skills, to get ‘er in the water.  He arrived in August, expecting a Labor Day launch, but that turned out to be wildly optimistic.  He discovered that the repairs  that Wally had made on the boat were  so poorly done that they needed redoing,   Wally argued frequently with his son, bouncing between being an obnoxious know-it-all (who actually knew very little) and a passive zombie who just sat in the boat and said, “whatever.”

I had one exchange with him, which he started by complaining to me about how bossy his son was being.  I responded by telling him that the young man, in my observation, knew what he was doing, that he was doing Wally a huge favor by spending so much time and money to help a father who had been largely absent when he was growing up, and that Wally ought to be grateful for his help.  Furthermore, I told him, he needed to recognize that his own abilities and judgment were clouded by not only the drugs he was taking but the fact that due to his COPD-on-the-way-to-emphysema, his brain was probably not getting enough oxygen to function at full capacity.  He pretty much quit talking to me after that.

It was the end of October before we got the boat in the water, miles downstream from the marina where Wally had a slip rented, but at the only place in Nashville with a boat launcher big enough to handle a 27-foot sailboat.   His son traveled with him to steer the boat upriver to Wally’s new home.   It was a good thing he did.  The river was low, and, in spite of having an up-to-date cyberchart of the passage, the boat still ran aground twice.  The younger Wilson–let’s call him Lawrence–had to climb in the rowboat and row for all he was worth to get the boat unstuck, something Wally, with his compromised body, could never have done, and Wally knew it.  Wally also realized that this meant that his dream of exploring the wilds of the Cumberland was unrealistic.  Then, just as they were about to reach their destination,  the sailboat’s keel hit something hard sticking out of the bottom of the lake, and rocked so violently that it knocked Wally over.  His son did a quick dive and discovered that whatever they had collided with had recreated the same hole in the keel that had caused Wally to pull the boat out of the water in Chesapeake Bay so many years ago–but now he was stuck in a marina where he couldn’t get the boat out of the water and fix it.

I intended to go visit Wally and see his new place, but put it off, thinking he would tell me when he needed to renew his medical stash. But no call came.

Then an email arrived, in response to a “how’s it goin?” query from me:

Actually Martin,,thijngs areb niot goinng well. I’m in Sumner hosptal and needining a bail out .I’m in critical carebwith an infection and too skaky to type.call me xxx-xxxx In hve my phone

That was followed just a few minutes later with

CALL ME  EMERGENCY MEASUES NEEDED  IN CRITICAL CARE AT GALLATIN CALL ME   xxx-xxxxTHEN I”LL NEED MINISTERIAL HELP YOURB KIND OF JOB

He had included his phone number, even though he must have known I still had it.  So I called him.   He sounded weaker and more confused than he had been.  He wanted me to give him a ride back to the boat, or maybe to St. Thomas Hospital in Nashville.  Thanksgiving was coming up; I had family to deal with, and wasn’t sure when I could make it out to see him. His son gave me the code that enabled me to talk to his nurses, and they did not sound too worried.   They said  that, while he needed open heart surgery–he had a damaged aortic valve, probably from some combination of 40 years of tobacco and all the tooth and  gum infections he had had,  they couldn’t do it there and at the moment he was too weak to risk it,  but they were going to send him to another hospital where he could regain some strength and have the surgery.  They didn’t seem to think he was in any immediate danger of dying.  I figured I’d go see him after the holiday.  I told him I was thankful he had access to good medical care that didn’t cost him anything.   My recent two-day hospital stay, with no surgery involved, had set me back eleven thousand dollars.

The Monday after Thanksgiving, I put off going to see him until Tuesday. I needed a day to decompress, I told myself.  Monday night, his son called me.  Wally’s heart rate was rising and his blood pressure was dropping.  He had lost consciousness.  A couple of hours later, Lawrence called again.  Wally’s heart had stopped–they had defibrillated him and gotten a pulse going, but he had no blood pressure.  When I called the hospital Tuesday morning, they told me he had died at 11PM.   I had put off going to see him just one day too long.   I had “left it for somebody other than me/To be the one to care.”  Let that be a lesson to me.

music:  Simon and Garfunkel:  The Boxer

So, what does it have to do with the Green Party?  Why has this loser written over eight thousand words about the life of that loser?

In my view,  the snowballing tragedy that was Wally’s life could have been prevented–and Wally was just one of millions, maybe tens of millions of people in similar circumstances.  Wally critically injured his back  in order to create stupid American suburbia, the construction of millions of homes and so-called “communities” that should never have been built in the first place.   Still,better working conditions and better health care could have prevented the kind of back injury that brought him –literally–to his knees, or at least treated it more rationally than knee-jerk back surgery.  A saner societal attitude about pain management would have been a big help, as would a less pharmaceutically oriented approach to his panic episodes.  After he died, I found out that he had been molested as a small child, which may well have been at the core of his panic. But our psychiatric system is set up to medicate patients, not to talk with them or coach them on changing their attitudes and behaviors. You don’t sell as many pills if you actually cure people.

The tobacco industry took about $50,000 of Wally’s money over the forty years he smoked–that’s figuring two packs a day for those forty years–and never paid a dime that actually helped him quit or covered his medical expenses.  Tobacco is sacred to the natives of this continent.  I have no problem with people who want to grow their own and use it in the traditional fashion.  But to have a multi-billion dollar business dedicated to addicting people to a substance that will make them sick unto death seems to me to be criminally insane. And then there’s alcohol…..

In the final years of his life, Wally was squeezed into penury and misery by the stinginess of our social welfare system.  Some of the stinginess manifested in the lack of care and oversight in Wally’s life.  Back in the nineties, I got paid to do the kinds of things I did for Wally on a volunteer basis.  In the aughts, in Tennessee, money was no longer available for that kind of thing, and without me and my father-in-law, he would have simply gone without. Nobody in the system seemed to be looking out for him.  He didn’t have a case manager, somebody who could hold a long-term overview of what was happening with him. Privacy rules kept me, his only friend, from connecting with the people who were taking care of bits and pieces of his life.

Trillions for banks and defense contractors,  six hundred a month and no personal care for somebody who’s too sick to work. No dental coverage, and  only 5 paid-for prescriptions–although, in my opinion, a saner health care system would do more to encourage people to cultivate healthy living habits so that they didn’t need pharmaceuticals, and emphasize the use of simple, inexpensive, natural substances over prescription medications. But gee, that would take money away from defense contractors or insurance, pharmaceutical and hospital CEOs who really need it.

I fault our medical model, as well as our health care  delivery system.   Our medical paradigm treats symptoms.  Others, such as Chinese, Tibetan, and Ayurvedic medicine, treat the system, not the symptom.   In Wally’s case, he could have had a much more generous SSI stipend and coaching on improving his diet, and survived much longer and more happily, for a fraction of what the government got billed for hospital care in his final weeks. When Jesus said, “Unto them that have, shall be given,” I don’t think that’s what he was talking about. What it all boils down to is that Wally, and us taxpayers who covered his bills, were taken for a ride by our profit-oriented medical-pharmaceutical “industry.” We need a better way.  Like, a not-for-profit health care system, y’know?

Goodbye, Wally.  You were kind of a jerk, but you  were a well-intentioned jerk, and you didn’t deserve the treatment you got from the culture you were born into.  Next time I have a chance to help somebody like you, I promise I’ll do a better job.

music:  Jackson Browne, “Rock Me on the Water





INTERVIEW WITH THE VAMPIRE

14 11 2010

Our “Truth in Strange Places” Award this month goes to Tennessee Governor Phil Bredesen.  Long-time listeners and readers will recall that I have referred to our governor as a vampire, because he has profited so handsomely from the suffering of others.  The American health care system seems designed to make poor people out of sick people, which smells like bloodsucking to me.

So, I was startled when I found myself reading an interview with Governor Bredesen about his new book on health care, and nodding along in agreement, as he said

There are problems in the way we use insurance, but the insurance companies themselves aren’t the core problem. If we want to blame somebody, let’s look at other medical providers, like the pharmaceutical industry. In the book I use the example of [drug maker] Merck, where profits last year were equal to the earnings of all the companies in the Fortune 500 health insurance and managed-care category combined.

Well, okay, I actually rolled my eyes at the first part of that and started nodding when he outed Merck’s excessive profits.  Bredesen made his money in the insurance biz, so he’s not going to accept the blame, and I suppose in a way he’s right.  While for-profit insurance companies are primarily concerned with making a profit for stockholders and only secondarily with providing adequate benefits to policyholders, it’s immaterial to them whether medical costs are inflated or not, as long as their income is sufficient to cover those costs.  As for-profit companies, they will do whatever they have to do to stay in the black, including denying life-saving procedures.  (As more than one wag has pointed out, “America already has ‘death panels’–they’re called ‘insurance companies’.”)

So, while he’s telling the truth about Merck here, it’s also a form of passing the buck.  Sure, Merck’s (very) gross profit contributes to the excessive cost of medical care, but so did the estimated $100 million dollar fortune Bredesen amassed while running HealthAmerica.  Remember, that hundred mil is just a part of the difference between what average Joes like you and me paid in for our insurance coverage and what Bredesen’s company paid out.  You can also think of that fortune as blood sucked from the bodies of the poor and sick by a vampire….yeah, I know, Halloween is over, but ’tis still the season….

Just for the record, Merck’s estimated profit for 2010 is in the range of $26 billion dollars, so I suppose the Guv thinks his personal hundred mil is chump change…”Hey, I’m not the bloodthirstiest vampire in the crypt!”

Tell it to the people who lost their Tenncare coverage, Phil.  See if they think you’re poor like them.  See if they think you’re not just as much a part of the problem as Merck.

More on Tenncare later.   What Phil had to say about Obama’s “health care reform” was a lot more on track:

….we put a structure in place in the 1930s—an insurance-based, employer-based system—and it’s outgrown its usefulness. It’s obsolete. We’re sitting here in America with frequently inferior care which is more expensive than anywhere else in the world. You’re not going to fix that by simply adding more people to the rolls or singling out particular enemies.

….The core problem is this: if you leave health care as an open-ended entitlement, where the people providing services get to define how much service is provided and how much to charge for it, you will never contain costs. The history of the last fifty years of health care is uniform in that regard. So let’s try to find a different way of doing it, one that disengages from the insurance model. That model is inefficient and it creates all sorts of bad incentives, ones where the incentive of any doctor or provider is to do more and charge more.

What Phil recommends is the “Mayo Clinic model,” which divorces physicians’ income from the number of patients they see and the number of tests and procedures they order, thus freeing doctors to spend more time with each patient.  One study found that this simple step cuts health care costs by over 50% for some groups of patients.

And, by the way, here’s what an official Mayo Clinic spokesperson had to say about the health care plan that Obama and the Democrats passed:

“The proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite,”

Back to Phil…here’s what he said about those notorious TennCare cuts:

The TennCare experience was very painful. It was somewhat politically painful for me—I had people sitting in my office twenty-four/seven for six months. But it was extraordinarily painful for the people who lost their health insurance because of it. What we were forced to do in the end was make reductions with a broadax rather than a scalpel. And it was very painful for the people who got lost in the cracks in that. The sense in the book that the system we have is not serving the needs of some of the people who most need it comes very strongly from that experience.

The other thing that comes from my experience with TennCare is that if we indeed consider some level of health care a basic right, let’s divorce it from being charity handed out by politicians and organize ourselves deliberately and fairly and without anybody having to grovel to get it. I’d love to go back to more of what Harry Truman’s vision was, which is that there is some underlying level where everyone’s treated the same. We’ve really gotten close to that with Medicare, and there’s no reason we can’t do it with the rest of the system.

So he’s coming mighty close to endorsing the “Medicare for all” paradigm in the book he wrote, even saying:

To pay for it, let’s give people vouchers that can only be spent on health care. That’s essentially what Social Security is, just reworked for medical care. Of course, it’s different in the sense that if someone isn’t a part of the Social Security system, you’re willing to not write them a check—whereas if they’re not part of the medical system you’re not willing to let them die in the street. But if you disburse a limited amount of money and say it can only be spent on health care, then you’re limiting the maximum amount of money that comes into the market, which creates some competition and value. Then, third, you create quality auditing systems to monitor what is being provided. What the book is about is how to do all this in a fair and responsible way.

I have to confess here that I haven’t yet read Phil’s book, entitled Fresh Medicine, so I’m not in a position to comment on what he considers “a fair and responsible way,” but what I perceive here is that, from his strongly capitalist, free market perspective, he’s trying to design universal access to health care without mandating that everybody has to buy private insurance, which, he seems to agree, is not the most cost-effective way to make Americans both healthier and less financially vulnerable in the event of a catastrophic health problem.  And sure, I’m in love with the idea of a national health service that  incorporates holistic practices, but if somebody’s got a way to improve the skewed system we’re currently stuck with that will actually get through our legislative process, there are compromises I could live with.

I’ve saved the best for last:

I don’t want to be a Cassandra, but we’re in a difficult financial situation in this country, and we’re going to have to deal with entitlements very soon. So let’s start addressing the issue now, particularly as related to health care, and not wait until China stops buying our bonds. Let’s start getting things set up so that when the whole issue comes to a head, we’ll be ready.

Got that?

Let’s not wait until China stops buying our bonds.

That thrilled me to the core.  It let me know that I am not just a lunatic fringe, nutjob doomer for thinking the US is approaching the end of our financial choke-chain leash, and the Chinese could just decide to snap it tight around our throats any time.  Our own governor, a conservative guy whom I have excoriated on numerous occasions,  sees it that way.  You can hardly get a more independent confirmation than that.  And,  with Obama and the US bankers making threatening noises about Chinese currency manipulation, it is clear that we are on the brink of a financial war, a war the US is almost certain to lose.  When that poop comes through the air intake, affordable health care is going to be among the least of our worries.

So, Phil–you may be a vampire, but you’re a lot more clear-headed than I had suspected.  Thanks for your, yes, Cassandran pronouncements–hey, I believe you.  But then, I’m a Cassandra too.

music:  Material:  “Words of Advice for Young People”





WHITE TRASH

14 02 2010

There has been good news and bad news in Tennessee in the last couple of weeks.  Some of the bad news is that our dear governor, not content with throwing poor people off Tenncare, has decided to throw poor hospitals off it, too.  Under his plan, struggling hospitals like Nashville General, and many rural hospitals, will not be reimbursed more than $10,000 for any Tenncare patient they take care of.  Now, I’m not about to defend hospital price schemes, or many hospital practices, for that matter, but overpriced and unintuitive as it is, our current medical regime works hard to save people’s lives and ease their pain. Setting broken bones is setting broken bones, whether you do Reiki on the patient afterwards or not.  Hospitals do have a legal and moral obligation to take care of people (and yes I know a lot of horror stories about what has happened when, for insurance reasons, they don’t), and if the state quits reimbursing them for that care, the net result over a few years is going to be fewer hospitals and less medical care for those on the bottom of our societal pyramid.

And, speaking of those on the bottom of the social pyramid, let’s talk some real trash, and more good news/bad news, like, the good news is, Tennessee leads the Southeast in the amount of landfill material we count as recycled….the bad news is that that appears to be the case only because we jigger our statistics, and everybody knows it, and a regional EPA representative who showed up at last week’s Davidson County Solid Waste Board meeting and at the Tennessee Department of Environment and Conservation (TDEC) review hearing said that our funny accounting makes us “the laughingstock” of the Southeastern solid waste disposal community….a “solid waste disposal community?”…who knew?  But I digress….

Tennessee claims a remarkably high percentage of diversion from landfills, which is presumed to be “recycling,” but it seems that our near-70% figure (most states are in the 25% range) has been achieved by creating construction and demolition (C&D) landfills around the state and counting material that ends up in them instead of  trash landfills as “diverted from the landfill.”  As you may remember, there’s a big quarry out on McCrory Lane that some big operators wanted to fill with C&D trash…right next to the Harpeth River.  Well, we kept that mistake from happening, but there are  over 80 other C&D landfills in the state, and more bad news–due to Tennessee’s geology, almost all of them leak, as do almost all of our regular landfills.

More bad news–guess who tends to live near landfills?  Why, poor people, wouldn’t ya know, rural poor people who get their water from wells and springs that are all too often contaminated by runoff from these landfills…so then they need Tenncare to help cover the sometimes awful consequences of imbibing low levels of serious pollutants, but, gee, the Guv just cut their access to Tenncare….round and round we go….gotta pay for those roads, y’know….

Hey, I’m not just some radical conspiracy theorist making this stuff up.  That EPA guy I mentioned, Jon Johnston, called the pattern of dump sites in Tennessee “racist.”  It seems to me that if somebody from the government says something is “racist,” that kind of makes it official, doesn’t it?  So…all the trash generated by us rich white folks ends up poisoning low-income people of color, just like all the carbon we white folks spew is baking and inundating…dark-complexioned people in third world countries….is there a pattern here?

OK, good news–it looks like TDEC has finally been shamed into closing the C&D loophole….bad news, the C&D dumps that are still open get to stay open, and will keep leaching nasties into the water table.  At least the building boom is over.

Some further peculiarities of Tennessee waste disposal law have to do with food waste and its potential as animal feed and compost.

The average grocery store discards about a thousand pounds of unsaleable produce and other over-age food every week.  Used to be, farmers could take this and feed it to their animals, no problem.  But the garbage haulers looked at this, and they had a problem.  They wanted to get paid to haul that “food waste” to their landfills, so they had the state pass a regulation that said that all food waste must be heated to 140 degrees before it could be fed to farm animals.  Farmers, by and large, are not equipped to do this, and so the garbage haulers stopped a reasonable recycling program and fattened their own wallets, as well as increasing the load on Tennessee landfills.

They also tweaked the regulations on making compost out of this material, i.e., feeding it to worms, the only kind of livestock exempted from the 140 degree requirement.  They wrote the law so that you could bring anything in to your farm, but made it illegal to sell compost, classifying it as “toxic waste.”

The good news is, it looks like a lot of this is about to change.  There’s two kinds of green consciousness involved:   Greenback consciousness, and green living consciousness.

Greenback consciousness is about all the money it’s costing to bury recyclables in landfills.  Bruce Wood, who has devoted decades to advocating for saner solid waste policies, estimates that a quarter of what is “thrown away” in Nashville (and I put that in quotes because there is no “away”), a quarter of Nashville’s solid waste is compostable, and another quarter is paper.  Composting and recycling this material, Bruce calculates, would save Nashville thirty thousand dollars a day in hauling and dumping fees, as well as creating useful, valuable compost and paper that doesn’t come from sacrificing trees. Thirty thousand dollars a day…that’s a hundred and fifty thou a week, someplace around seven and a half million dollars a year…like I said, greenback consciousness has a certain leverage.

Let me put this another way to help you understand the scale of this.  A thousand tons, two million pounds, of compostable materials enter Nashville’s waste stream every week.  Handled properly, this could produce about 330 tons of finished compost per week.  Wouldn’t that make this city’s gardens grow!?

More good news.  The solid waste folks have confessed that their stringent regulations on composting are based on sewage sludge handling procedures, and that there needs to be a separate, much looser category for “vegetative compost.”

The problem with sewage sludge isn’t from what you’re supposed to put in your toilet, although mixing that with water does make it nastier than it has to be.  The problem comes from the myth of “throwing things away,” and all the toxic substances that people “throw away” that end up at the sewage treatment plant.

Out of the toilet and back to “vegetative compost”–it looks like we’re not just talking theory here.  Recycling activist Glenn Christman, who has been working to get a municipal composting operation off the ground (well, on the ground, really) for several years, reports that Metro’s Public Works Department has offered him five acres for a pilot program, and that TSU, while still reeling from being used by the Maytown Center gang, is ready to launch a program that will compost all the University’s food waste for use by the school’s ag department.

Meanwhile, Waste Management Incorporated, which has been the bad guy behind the restrictive regulations I have been describing, has realized that there is money to be made in compost, and has become a major investor in “Harvest Power,” a company that is planning to set up and manage municipal composting operations all over North America.  I’m not clear why this needs to be done by private, for profit industry, but  in a capitalist economy it’s a good sign, as long as the boys from WMI don’t start putting their competitors through the compost choppers….

music:  Drive-by Truckers, “Puttin’ People on the Moon”





HEALTH INSURANCE FRAUD

13 05 2006

Governor Bredesen has been showing his for-profit health industry stripes in his treatment of the Tenncare issue. After dropping 220,000 people from the program, many of whom were uninsurable, he is now proposing to create a program for the healthiest, most insurable of those individuals and their families—who are willing and able to pay for a barebones insurance policy that will not cover a lot of the things people buy insurance for. It won’t cover maternity or newborn babies; it won’t cover disabled dependents of the insured individuals; it won’t cover diabetes self-management (but it will probably cover diabetes-related amputations–but hey, that’s a lot more expensive than prevention, it’s a good thing they’ll cover it, right?)

The premium level is also high enough to make it only marginally affordable to low-income workers, and completely unaffordable if you lose your job, because then the cost doubles. Isn’t that thoughtful?

Well, it’s a nice election-year sop, not that Phil needs to worry too much about getting re-elected. Republican main contender Bob Bryson is flailing so badly that the Green Party’s Howard Switzer may out-poll him. Switzer is the only candidate who can credibly claim to speak for the hundreds of thousands of low-income, underprivileged voters in the state who need a government that’s genuinely on their side.

Meanwhile, I recently found out that Blue Cross Blue Shield of Tennessee has over a billion dollars in its contingency fund and pays its director seven hundred thousand dollars a year. I’ve talked before about the importance of turning health care into a not-for-profit enterprise, but I’m going to have to amend that by saying A WELL-REGULATED not-for-profit enterprise. The last Tennessee legislator to call for an investigation into Blue Cross bloat found himself facing a well-funded opponent and lost his seat. Gee whiz…you don’t think they….? Naw, they wouldn’t do that.

And Bill Frist—our fine, upstanding Senator—his family paid a 1.7 BILLION dollar fine for defrauding Medicare not long before he bought a US Senate seat here in Tennessee. When asked, Frist said he didn’t think the country could afford universal health care. Why, his FAMILY could afford to take care of a sizable portion of the country’s health needs—especially if we’re not paying bloated executive salaries to for-profit health providers. Private health care providers commonly pay abut 15% for administrative expenses, while Medicare does what is generally considered a good job on 4%. That 11% difference could amount to between two and three hundred billion dollars a year in savings. No wonder the Frist family could afford to give back a measly 1.7 billion. Ain’t relativity wonderful?

We need to draw back from the immediate anguish of those who are getting shafted by their inability to afford the cost of the American medical system, and change the system itself if we really want to do something about health care in this country. A recent study comparing American and English health and health care brought that into sharp focus. Average health care expenditure in the U.S. is about $5200 per person, while England spends about half that, but the English get a lot more bang for their buck—or is it pull for their pound? Anyway, the study compared Caucasian Americans with Caucasian Britons, to eliminate distortions due to racial differences, and found that half again more Americans than English are overweight and, and half again more Americans also suffer from heart problems—and we’re just talking physical heart problems here. Americans are twice as likely to be diabetic, 25% more likely to suffer from high blood pressure, and nearly twice as likely to be diagnosed with cancer. The study found, predictably, that richer people tend to be healthier than poor ones, but still, the wealthiest Americans have more health problems than the poorest Britons.

Researchers think this may relate to the more stressful nature of life in the US, although part of England’s stress relief program is its much better health safety net—that costs half what ours does. Another reason cited for the less stressful nature of life in England is that the standard of living has risen across the board in England over the last thirty years, while here in America only the wealthiest 20% of the population has seen their real income rise.

Some of that lucky 20% are in the upper echelons of the health care industry. In his book, Hostile Takeover: How Big Money and Corruption Conquered Our Government – and How We Can Take It Back, David Sirota points out that

In 2003, HMOs nearly doubled their profits from just a year before, adding $10 billion to their bottom line. That year, top executives at the 11 largest health insurers made a combined $85 million in one year. In the first three quarters of 2004, HMO profits increased by another 33 percent. The sheer numbers behind these profits are staggering: In 2004 alone, the four biggest health insurance companies reported $100 billion in revenues. That’s $273 million a day, every day, 365 days of the year.

That’s why there’s such an effort being made to blame the Tenncare shortfall on its victims, and ignore the real perpetrators of this crisis—the bloated health care industry. Sure, diabetes, high blood pressure, and acid reflux, the most common problems treated by Tenncare, are “lifestyle diseases” that a prudent person could avoid; but the entire force of the American economy, from the food we are urged to eat to the rents, taxes, and mortgages we have to pay to the cars we have to buy and drive and the jobs and low wages we have to put up with, is designed to get us to make imprudent choices.

It’s not enough to try and cover everybody’s insurance needs under the current system. It’s not even enough to switch to single-payer coverage. We need to create an economy that promotes the health of its citizens over the wealth of its corporations, and that is going to take a radical, nonviolent revolution in thought and government to create. That will be difficult. The alternative—for the current situation to devolve still further—would be much more difficult. Let’s roll, eh?

music: Greg Brown, “America Will Eat You”








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