Time Magazine on Health Care

If citizens of the United States wanted to increase their blood pressure and heart rate, they have missed an opportunity if they failed to read a recent issue of Time magazine. The March 4 special edition was almost totally dedicated to discussing health care in the USA.

The Time article documents that we, in the United States, are not getting what we pay for.  While medical providers like to tout the U.S. as leading in the world in the quality of health care, they are not giving us, the consumers, the true picture.  Several Third World countries have a lower infant mortality rate than does the United States. Added to that, we in Texas have, on average, more uninsured children than any other state in the union--1.2 million of them--and their prospects for having health coverage in the immediate future appears to be extremely dim based on Governor Perry's political grandstanding about health care.

The recent article in the Houston Chronicle citing much of the information published in Time magazine rendered the opinion that if the amount of money paid for our medical treatment were no more than what is paid for similar treatments in Switzerland, our national debt would almost disappear in the next year or two.

The Time magazine article reminds us that when it comes to health care, sick people are generally not in a position to bargain or haggle over price.  Most of us seeking a return to good health will quickly submit to whatever is told to us by doctors, nurses, or hospital bureaucrats.  In the process, as has been pointed out time and time again, we pay exorbitant prices for procedures which oftentimes cost hospitals very little.  One example cited in the article was the charge to a patient of a particular treatment using a machine which was purchased by the hospital for only $19,000.  The patient's charge for using the machine as a diagnostic tool for one application cost the patient more than the purchase price of the machine.  Other examples were cited such as the cost of $1.75 for a single Tylenol capsule. 

A classic example of the overcharges of some hospitals, even in this area, resulted in a lawsuit which I handled a few years back.  A friend of mine had a mild heart attack and checked in one of our local health providers.  He was there only 48 hours and was charged approximately $60,000 for his visit.  He did not have health insurance and wanted, as any good citizen would, to pay his bill.  He offered to pay $1,000 a month until the bill was resolved.  This offer was quickly rejected.  After several months of haggling, the hospital finally agreed they would take $15,000.  Unfortunately, my friend did not have $15,000 cash, but again offered to pay it off in installments of $1,000 per month.  This too was refused and the offer withdrawn since he could not pay it all in a lump sum.  The hospital followed through with their threat of a lawsuit, which I was required to answer for my friend.  As part of the discovery of the lawsuit I demanded and received an itemized billing for the $60,000.  I managed to obtain a copy of costs to another hospital for the same items listed on the suing institution.  Mark up, for example, on the stints used in the heart procedure were over 500%.  Similar charges were made throughout for items costing as little as a few cents for which the hospital was charging several dollars.

Fortunately for my friend, the suit was based on what is called in legal terms a “sworn account” by which the keeper of the records of the suing party must execute an affidavit that the charges sued for were both reasonable and necessary.  When I challenged the lawyer for the hospital to submit the issue of whether or not the hospital's charges were reasonable, it seemed the urgency of seeking a trial date disappeared.  The matter lingered on for several years and eventually we were able to settle it for a small fraction of the initial demand, and my client was able to pay that smaller amount in installments.  More people need to challenge grossly over-bloated medical charges and at the same time we need to be communicating with our U.S. senators, representatives and members of state legislatures to try to do something to get a handle on overblown medical charges.  Otherwise, more of our citizens will go bankrupt, and our national debt will continue to spiral.

The Filibuster

If you seek the definition of filibuster in the dictionary, you find it has two separate meanings. The first definition is “the use of obstructive tactics in a legislative body. The second definition is “to take part in a private military action in a foreign country.” The State of Texas has enjoyed filibusters of both types.

Aaron Burr, former vice-president of the United States, attempted a filibuster (second definition) aimed at taking over Mexico by gathering privately paid troops in what was then known as “no man’s land” between the Neches and Sabine Rivers–the area now known as Orange County. The ambitious filibuster planned by Aaron Burr never got off of the ground.

Texas has experienced numerous other filibusters, primarily in the Texas Senate. The most common type filibuster known to most citizens is the effort of a member of a senatorial body to speak as long as possible in hopes the fellow senators will tire of listening to him talk and eventually vote his way.

The recent filibuster of Senator Rand Paul from Kentucky was at least a real filibuster in the true sense of the word. Unfortunately, the United States Senate has suffered by the threat of filibusters more than by filibuster. Recently, Republican Party members of the U. S. Senate have generally been able to thwart legislation simply through the threat of a filibuster. I have always felt that anyone who threatens to speak at length in the United States Senate should be held to his threat. As the experience with Senator Paul has proven, a real filibuster can last only so long and then the Senate can move on with the business favored by the majority of members.

The rules of the United States Senate and of the Texas State Senate are somewhat similar but different in detail. The key to the majority of members of a Senate defeating or shortening a filibuster are the rules related to closure. In the U.S. Senate a filibuster can be closed or prevented by 60 votes.

In the Texas Senate a filibuster cannot be preempted. Texas filibusters are ended only when the senator who has the floor gives up or is ruled out of order by the Chair. After some senator moves the previous question, and it is carried, the member who chooses to filibuster cannot leave his or her feet, cannot leave the presence of the Senate Chamber, and must maintain remarks which are germane to the subject on which the filibuster arose. Stories of senators reading from telephone books, singing hymns from the Baptist Hymnal, and other such delaying tactics will not be tolerated in the Texas Senate in that they would not be germane to the issue being debated.

A one-time record holder of the lengthy filibuster in the Texas Senate was a senator from Fort Worth, Don Kennard. Kennard was opposed to numerous measures pending in the Texas Senate and desired to take up as much time as possible via filibuster. Filibusters in the Texas Senate are most often and most effectively applied in the closing hours of the legislative session which is limited to 140 days. In order to have adequate material to discuss in order to stay germane, Kennard introduced a measure to create a hall of fame for distinguished Texans. He could then virtually read the phone book in discussing proposed candidates for membership in the distinguished body he proposed creating. He injected a little humor into his discussion by naming various members of the House and Senate who wandered in and out of the Senate Chambers while he was speaking.

Kennard once stood for 29 hours and 22 minutes filibustering in the cause of making UT Arlington a four-year institution. And although a filibustering Texas senator must remain on his feet at his desk, he can yield for questions from fellow senators so long as the yielding does not surrender him the floor. The presiding officer has the option to grant that request. It is generally granted as a matter of courtesy to any filibustering senator. Friends and people of the same persuasion of the filibustering senator can and do frequently help out by asking lengthy questions, some of which may require an hour or so even to pose the question.

The requirements that a senator stand at his or her desk during a filibuster also raises numerous other questions of personal comfort. Generally, the announcement of a filibuster on the part of a Texas senator is accompanied by the senator, or his staff, producing a comfortable pair of tennis shoes or walking shoes to wear during the period of the lengthy debate. The other questions are somewhat more personal in how the senator involved in the filibuster can choose to relieve himself in other personal matters.

The above subject of personal relief is so interesting that Dr. James L. Petry, a urologist from Port Arthur, once traveled to Austin and wrote an article for the Texas Medical Journal on urological matters related to a filibuster based on personal interviews of Texas senators.

With all of the accompanying questions related to filibusters, particularly in Texas, when exercised in the closing hours of a legislative session, they can be effective in killing legislation or requiring its amendment, making it more palatable to the opposing senator. Senators threatening to speak at length on any subject, I do not begrudge the right. But legislative bodies such as the United States Senate should not avoid voting on good legislation because of a mere threat of a lengthy speech.

Senators who threaten a filibuster should be held to follow through. While the public may experience some benefits from lengthy discussion of the merits of various pieces of legislation, they would profit even more if the members the public elected would simply wait the filibuster out, and then vote on the pending legislation.

Gambling

For many years the State of Texas was firmly against gaming or gambling in any form.  I, as a member of the Legislature, was among the opponents of opening our state to gambling.  At the time I believed,  and still believe, gambling is a sucker’s game.  The only people who really win are the owners of the gambling establishments.  

Things have changed.  Now, our state has adopted hypocrisy as an official policy of the state.  While our legislature continues to refuse to allow people to vote on whether or not to allow gaming in Texas, we are spending millions each month promoting one of the biggest sucker games of all--the lottery.

If refusing to allow gaming in Texas would stop Texans from losing their money, or becoming addicted to gambling, I would probably still be opposed to having the Legislature submit a proposed constitutional amendment for the people of Texas to vote on.  Unfortunately, we are not preventing gambling with our current state of affairs in Texas, but only stopping our gamblers from gambling in Texas.  A recent study by a group called “Let Texas Decide” has revealed approximately $2.96 billion are being spent by Texans in Louisiana, New Mexico and Oklahoma.  We are not saving our people from gambling, we are only forcing them to donate their money to adjoining states.

'Way back, when I was a member of the Legislature, the Christian Life Council was a primary opponent to the legalization of gambling.  Although they did not participate much in elections directly, they were devout in their opposition to taking advantage of people foolish enough to gamble away their money and wished to protect Texans from such sinful conduct.  In recent years, however, it is not the Christian element which forms the greatest opposition to legalization of Texas gambling.  It is those gambling interests from adjoining states.  

I know for a fact that gaming interests from Louisiana have spent thousands and thousands of dollars on lobbyists fighting legalization of gaming in Texas.  I am also personally familiar with a group of lobbyists employed by the Indian gaming interest out of Oklahoma who do what they can to make sure Texas does not compete with Oklahoma for gambling dollars. 

I once thought the best way to promote good government and intelligent voters was for our media outlets to widely publish how members of the Legislature voted.  I am now satisfied, however, that on most important issues, anyone who listens to any television news or occasionally reads the newspapers knows pretty much how the various elected officials vote.  At this point, if the news media would now publish who gave our elected officials how much and when, the general public would be much better equipped to make intelligent choices.  

Billions of dollars are being spent by lobbyists in each election cycle, both at the federal and state level, and were the voting public to be fully aware of the source of such funds I daresay it would change many attitudes about why some issues pass and many issues fail.  The influence of money on public policy has only gotten worse with the Supreme Court’s decision of Citizens United.  The last presidential race set a record in money spent on any election--perhaps in the whole world--and will only get worse with super-pacs and rich folks scrambling to see who can buy which politician.

Save the Goats

In looking over recently introduced measures in the current session of the State Legislature, I have discovered H.B. 1819.  The bill was offered by Bryan’s state representative Kyle Kacal. The bill provides a cause of action if a homeowner harms or kills a goat. Although it seemed appropriate from the representative from the area of Texas A&M, I am given to wonder why the Legislature appears to have more concern for animals than for many of the people of Texas.

Texas has more children without adequate medical care than any other state in the union--more children living in poverty than any other state in the union. And yet, Governor Rick Perry, our Senator John Cornyn and newly elected Senator Ted Cruz held a joint press conference attempting to explain why they would turn down a deal which would fully fund Medicaid expansion for three years and pay 90% after that. Under Obama’s Affordable Medicare Act, this deal would allow 1 million people in Texas to get health insurance as well as create thousands of Texas jobs and provide needed relief to local taxpayers and those of us who pay out of our pockets when we go to the emergency room for treatment.  

Not only is our leaders’ refusal to accept the provisions of this Act harming Texans in need of medical care, it is also a wrong-headed view of how to save money. It seems some of our leaders only care that they don’t get accused of increasing state or national taxes. This claim is patently phony because currently the State Legislature is using federal funds intended for indigent care at UT Medical Branch of Galveston and UT Tyler to help balance their budget and avoid new taxes. The problem is, they are diverting funds intended for sick people to other causes which seem less pressing. 

Business leaders in Texas and many health providers continue to urge Rick Perry and other state leadership to accept the funds, the lack of which is causing a serious strain on many local taxing units. A grand example of this is the hospital district in Bexar County, San Antonio.  Leaders say turning down the federal funds being offered will cause a 20% increase in the taxes needed to support the Bexar County Hospital District.

Our state leaders, who seem to be in a race to see who can condemn the federal government the most, appear to be as the Bible says, “Straining gnats and swallowing camels.”  Not a word has been said by any of these so-called leaders in the current session of the Legislature about the $37 billion in give-aways in the form of corporate welfare.  

Two flaming examples of how we, the ordinary taxpayers, are being hosed by our leaders are, first, the fact that country clubs pay a substantially lesser rate on their property taxes because they claim to be “green belt” areas which supposedly are great perks to the general public of Texas.  If you believe this, try taking a stroll or having a picnic one afternoon on the grounds of the River Oaks Country Club which enjoys thousands of dollars worth of tax benefits at your expense.

Or, second, how about the fact that the State Legislature continues to fund multiple millions of dollars in subsidies via tax breaks to poor old Shell Oil, British Petroleum and others who are now making record profits? Supposedly, the tax breaks were given several years ago to help prop up the flagging drilling industry which is now going wide open and producing large fortunes for the big oil companies.

It continues to boggle my mind how fairly intelligent Texas voters will continue to condone leadership which will slam the courthouse door on people seriously injured through medical negligence, while at the same time, creating a new cause of action for injured sheep and goats.

Well Versed in History...

Harry Truman once opined that anyone who wanted to be seriously involved in political governance should be well versed in history. President Truman said that given the same or similar circumstances, no matter what the timing, people, including those holding office, would react in pretty much the same manner. A review of history indicates Truman very likely was right.

Though George Washington was unanimously selected and revered as the wisest of presidents and the logical choice to lead a fledgling nation, in his farewell address he warned against a partisan spirit that could divide the nation.

Early in our country’s history, Thomas Jefferson was beset with partisan divisiveness in Congress. Jefferson was moved to say, “You and I have formerly seen warm debates and high political passions, but gentlemen of different politics would then speak to each other...  It is not now so. Men who have been intimate all their lives cross the street to avoid meeting and turn their heads another way lest they be obliged to touch their hats.”  (Letter, Thomas Jefferson to Edward Rutledge; Philadelphia, June 24, 1797).

Alexander Hamilton, then one of the leaders of the Federalist Party, believed too much democracy would weaken a nation to the point it could not survive in the then world of governments. On the other hand, the Republican Party, led by Thomas Jefferson and others, was convinced the Federalists had secret plans to try to turn the United States into a monarchy. Some even suggested that, rather than retiring as president, George Washington should be named the first king of the United States. Given those differences, it seems history has a longstanding tendency toward division.

Even in Texas divisive politics is not new to modern-day elections or governance. In reading the history of Sam Houston’s political career, one will discover not only was there free-wheeling debate on real issues but also, on at least one occasion, in a public debate, participants even drew their weapons and threatened a duel on stage. Sam Houston, departing from discussion of serious political issues during a campaign, once accused his opponent of having robbed a bank and dropping the safe from the bank into the river!

Fortunately for America, Thomas Jefferson and John Adams, bitter enemies at one point, eventually managed to enter into what apparently is abhorred by our current leaders in Washington–compromise. Jefferson and several leaders of the Federalist movement put aside their differences and managed to move forward with provisions which enabled a young American nation to ward off threats by France, England and hostile Indians to wield and mold America into the world power of its time.

The ingredient missing in Jefferson’s time which appears to be a serious impediment to compromise and the adoption of common-sense measures to move this country forward is money-- money-wielding influence through highly-paid, highly-skilled, well-connected lobbyists. In Jefferson’s time I daresay members of Congress outnumbered those attempting to influence legislation and the will of Congress. Sadly, the same is not true today. Congress is out numbered probably at least five or six to one by well-paid lobbyists who, since a Supreme Court’spronouncement that corporations are people, may spend unlimited amounts of money to influence government.

Members of Congress will quickly argue they are in Congress to do great things-- but they will be unable to do things of any magnitude unless they are there. Being there requires re-election, and with the Supreme Court’s ruling money is becoming more and more important to our process.

If any Texan doubts the power of money in politics, that person should go check the list of campaign contributions to our current governor and compare them to appointments to important and strategic boards or administrative positions. I will say without fear of contradiction that any careful investigation or comparison of campaign contributions to appointments would reveal that more appointees to boards of regents, administrative bodies and judge-ships will be found to have contributed upwards of $100,000 each to Governor Perry’s election efforts, both as candidate for governor and for president of the United States. Most of the beneficiaries of the over $800,000,000 in “slush” funds have given large contributions to Governor Perry.  It is only with an alert, involved and investigative electorate that politicians at all levels will be forced to recognize commonsense measures and return our governing bodies to a sense of cooperative spirit which will be in the best interest of our country.

The future of real republican-style government in the United States depends on what the average citizen is willing to pay in time, study and effort to overcome the greed and avarice of those with unlimited funds.  Otherwise we will get what they pay for.