Losing Patients

I got an annoying phone call from AIG yesterday. I'd been in their Hilo office the day before to renew my auto insurance with them. The caller wanted me to rate the service I'd gotten during that visit, on a five point scale from "poor to "excellent," on dozens of different points: Did the person who served me explain my options clearly? Was I greeted promptly? Did she thank me for patronizing AIG at the end of my visit?

All told, the survey took longer than I'd spent at their office. After all the questions about the visit, the surveyor still wasn't done. He had a whole bank of questions about what else they could sell me. Would I be interested in talking to an AIG agent about life insurance? Would I be interested, etc., about homeowner's insurance or renter's Insurance? Health insurance?

I'm afraid that when he reached the question about health insurance, I exploded just a little bit.
"I'd love to talk with someone about health insurance," I almost-shouted, " if they'd offer something I could afford!"

I've been watching the national debate (or yelling match) on health reform with more than a detached journalist's interest. I'm one of those millions of Americans who don't have health insurance.

Fortunately, I live in Hawaii, the only state that offers universal coverage to children, so when my son gets over here, I'll be able to get insurance for him. But that children's insurance program nearly didn't survive the state's budget crunch, too.

So I can understand why tempers run so high on the issue, at least for people like me. I have more difficulty understanding why opponents are so upset. Some of it seems to be emotional reaction to misinformation such as Sarah Palin's "death panel" remarks; some of the heat seems come from legitimate anxieties about what the bill will do to the cost of health care or the already-inflated national debt. And a lot of publicly expressed anxieties seem to be not about the actual details of the bills, but about vague ideals and glittering generalities: I've seen at least two of the town hall ranters in news reports, for instance, saying something like, "The America I know is disappearing!"

America is changing, no doubt about that. Much of the America I grew up in has already largely disappeared, and I'm only 55. The diversified family farm I grew up on, for instance, has been replaced by factory farms, feedlots and corporate food distribution. (See my essay on that subject at The Hawaii Independent Web site. I also highly recommend Food Inc. It just ended its run at the in the Palace Theater in Hilo, but I'm sure it will be showing up on DVD soon.) Most people who've lived any length of time remember places that have been transformed beyond recognition by development and local stores that have been obliterated by corporate behemoths such as Wal-Mart and Target. I can remember when you could make a purchase or cash a check without having your picture taken, and when political conventions weren't choreographed, and when airports weren't police states.

And I remember a time when even a hardscrabble family farmer could get health insurance for himself, his wife and three kids and take them to the doctor of his choice. That world started to die during the Reagan administration, when deregulation allowed both insurance rates and pharmaceutical profits to soar. Its condition deteriorated rapidly after the Clinton Administration's efforts at health reform got torpedoed and HMOs were born instead.

Big abstractions like "The America I knew" can be very dangerous. Wars get started for economic considerations (Even the American Revolution was essentially a dispute over taxes and tariffs), but get fought in the name of "Protecting our Freedom" or "The American Way of Life" or "Manifest Destiny." Bad decisions get made when ideological sacred cows get placed before the realities of daily life.

One of the biggest, most untouchable sacred cows of American life is "capitalism." It's almost impossible for someone to say, in the U.S., that capitalism is not a solution for everything, without the bearer of that news being labeled a "socialist." I am not, repeat, not a socialist, because socialism is not a solution for many things, either. But I'm just the writer of an obscure little blog, so I'm going to say what people with more to lose don't dare say: Capitalism is not the solution to everything. In fact, unbalanced capitalism is often a large part of the problem. And nowhere is that more clear than in the area of health care.

Example: you're a pharmaceutical company, and you're planning your research budget. Which drug is more likely to make you a big profit: a drug that cures a disease, or a drug that alleviates the symptoms but leaves the patient sick, so he'll have to take the drug for the rest of his life?

The answer, obviously, is the latter. I'm on three such drugs myself; they cost me about $130 a month. I'd love to get whatever's causing my high blood pressure and enlarged prostate fixed, but nobody in the medical profession is offering me that option.

If you look at the airwaves (BTW, I remember an America where prescription drug commercials weren't allowed, and companies didn't add millions our medical bills to pay for advertising campaigns) virtually every high-profile pharmaceutical commercial is for such a drug. They lower cholesterol, but only as long as you keep taking them; they cure your erectile dysfunction for twelve hours, but then you have to take another pill--and the pills cost $12 apiece. Why cure cancer, when you can alleviate acid reflux?

Example #2: Insurance is essentially legalized gambling: the company is betting you won't get sick and you're betting that you will. Like any gambling, the odds have to favor the house, or the casino goes broke. But what if the rules allow the house to drop you like a hot potato if you do get sick? Then it's a rigged game, and the profits get much, much higher....

My ex and my son are already relying on socialized medicine, and I'm very grateful that it's available. She was a lawyer with an independent law office; when she got cancer, her insurance policy skyrocketed beyond what she could afford. The insurance company lost its bet, but it still got to keep all the money she'd paid in until she got sick. Then she had to close her law office and go on disability; now the government is paying for her chemo and my son's ADHD maintenance drugs.

Sarah Palin is worried about government death panels. What about the private ones: the insurance company rule-makers who cut cancer patients off from treatment?

My ex's case is hardly the only one. My heart goes out to the family of Kimberly Reyes, the 51-year old Waimea mother who died on July 27 after being denied a liver transplant because trace amounts of marijuana were found in her blood.

That's what happens when the goal is to maximize profits: you find ways to minimize your payouts and maximize your pay-ins. The health-care crisis, in a nutshell: too many people--doctors, nurses, medical technicians, hospital companies, pharmaceutical companies, insurance companies, tort lawyers, medical supply distributors, medical machine manufacturers, advertising agencies, unions -- are demanding the right to maximize their profit margins on our misery, and we patients have too little leverage to bargain with them.

Some things are just too important to leave to market forces alone. Health care is one of them.

A Correction, and an In-Tents Discussion

Some follow-ups on my last post:

First, a correction. In the first draft of the previous post, I mistakenly said that Brenda Ford was chairing the Hawaii County Council's Planning Committee; actually, she was chairing Public Works. I later fixed that, but not before a fan e-mailed the uncorrected version out to a few hundred other people. My apologies.

A couple of other observations about that day at the Council:

I was actually very impressed with Brenda Ford as the day went on. Yes, she's not the smoothest reader in the world, but that's more than outweighed by her thoughtfulness, especially on fiscal matters. Time after time, when other councilors were routinely going along with the administration's requests, Ford was asking good,specific, well-researched questions about budgetary procedures and cost effectiveness. In many ways, she's begun to take Curtis Tyler's place as the council's conscience, voting against things that she didn't think quite right, even if that meant she was the sole vote in opposition.

It's not surprising that Ford and Emily Naeole sometimes clash. Naeole seems intuitive and impulsive, following her gut; Ford comes across as just the opposite, critical and careful , sometimes almost nit-picky.

There was one point during the day, however, when Naeole actually thanked Ford. Naeole's bill to allow residents to camp on their land while building a permanent home was up for a re-vote. Ford offered an amendment that would make the bill temporary and experimental and would limit the tent exemptions to Puna. Naeole accepted the amendment as friendly and thanked Ford for her help in moving the bill forward.

In this case, though, I wonder if Ford was right. In offering her amendment, Ford cited an online poll in which the majority of Puna residents supported the tent bill, but an overwhelming number of respondents from Ford's district opposed it. Dominic Yagong, supporting Ford's amendment, cited similar results in his district.

That's troubling. It could be another sign of the way this island has been ghettoized. Ford's district certainly has a large number of upscale subdivisions in it: places where people who are struggling for a home can't afford to build, and people who have forked over huge piles of cash for their homes are more worried about maintaining their property values than about helping poorer families to move in next to them: prime NIMBY country. Yagong's Hamakua Coast is rapidly becoming a combination of old plantation towns and new upscale subdivisions. But Puna, thanks to the lack of foresight of certain land speculators, is riddled with substandard subdivisions that the developers originally thought they were going to sell to unsuspecting mainlanders who would never build there, because nobody would actually build on land in a high-risk lava zone if they understood what that meant. But the developers didn't count on thousands of poor and middle-class families who were just desperate enough to play the odds of a lava inundation in order to have a home.

Kelly Greenwell raised the issue of economic discrimination, if the bill was limited to Puna. Years ago, planning advocate Bonnie Goodell and others had talked of filing an economic discrimination case on behalf of district's residents because of the deprivation of basic services and infrastructure they were suffering, especially compared to the level of services and infrastructure in Hilo. I wonder if it's time to re-explore that issue in a full-fledged article: are the people of Puna being discriminated against? Is funneling the middle and lower classes of Hawaii into a single district, and setting up separate rules to encourage that economic segregation, legal and ethical?

Sideshows at the County Council

'Sorry for my long absence. After a couple of weeks' delay due to airline scheduling, I finally got back to Missouri to see my son and meet with people about bringing him over here when the time comes (See June 2 entry) Then, on the plane home, I was apparently riding in the same cabin with someone who was carrying some nasty microbes. I was mostly in bed for a couple of weeks (but if a job with a health plan had come along, I'd have climbed out of bed and gone). About the only writing I did was an essay about the personal cost of the industrialization of the food chain for my family and home town, which just appeared at the Hawaii Independent Web site.

Yesterday I was back in the saddle, though. I spent most of the day down at the County Council, because I've got an assignment from the Big Island Weekly to write a story about Billy Kenoi's plan to sell the county's Hamakua lands. That plan hit an unexpected snag yesterday. The council has already approved the land sale once, but had to re-vote on the issue because of the mess from its violation of the Sunshine Law in displacing liberal council members from their posts. Then some Native Hawaiian advocates claimed that the county didn't have clear title, and when corporate council Lincoln Ashida was called to the stand to assure the council that the county had clear title, the best Ashida could offer was an answer in two weeks--a performance that rather flabbergasted Hamakua Councilman Dominic Yagong.

"I think it's incredible, since the county has supposedly owned the land since 1994, that the corp counsel cannot stand before us today and say that for sure we own this land," he said after the meeting.

I'm checking out the native Hawaiian claims and other issues regarding the land sale, and will have my report in the Weekly shortly. Meanwhile, some random observations about the Council itself:

I hadn't had the occasion to attend a council meeting for a while. But I've been covering the council for over 15 years now. And I have to say that this current group of councilors is the least professional I have ever seen.

Yagong, restored temporarily to his post as chair of the Finance committee, did a good job of conducting that meeting relatively smoothly--despite some of the antics of his fellow councilors, who were sometimes chatting on their cell phones or with each other during testimony and discussion. Some of the discussion was good, but Emily Naeole seemed to be basing her positions mostly on anecdotes about Puna life (some on point and some not so much) and an idolization of Billy Kenoi. When she introduced a resolution opposing the delisting of the 'io (Hawaiian hawk) from the Endangered Species List, she said her reason was because "Mayor Kenoi asked me to." It's good that someone is still judging things on whether they're "pono" or not, now that Curtis Tyler is gone. But it's a bit frightening to see what a small part logical problem-solving plays in Naeole's decision-making process.

Despite Yagong's efforts to move the agenda along, the Finance Committee ran badly overtime and the Hamakua lands bill was tabled until the end of the day. So I went out to get lunch and do my laundry. When I got back at 4:15 or so, Naeole's Committee on Human Services and Economic Development, scheduled for 3 p.m., was just convening. That committee had almost no business, so I didn't get to see whether the fears voiced by Hoffman and others about her incompetence with the gavel were well-founded.

Up next was the Public Works Committee, chaired by Ford. She did a fairly competent job, although she was not as smooth a reader as Yagong. Occasionally she would stumble on a word as she read the agenda items into the record. Each time that happened, Guy Enriques would snicker.

Enriques seemed to be having the most fun of any of the councilors. With the possible exception of Dennis "Fresh" Onishi, Enriques probably spoke less on the record that day than any of the others, but he made several under-his-breath comments to J Yoshimoto that Enriques, at least, found humorous--especially when Ford was speaking. His biggest laugh of the day, however, came when an administration official was asked about a routine traffic bill and replied,"No comment." Enriques chuckled and snorted and sniggered over that for at least five minutes, finally prompting a "No snickering" admonishment from Ford.

Apparently somebody had brought some fruit to the Council table. Enriques was popping grapes in his mouth while the public testified that morning. During the Planning session, Naeole was sucking on juicy pieces of grapefruit. She offered some to Greenwell, who was sitting next to her.

Then an agenda item came up that Ford wished to comment upon, so she relinquished the chair to her vice chair, as was proper. But nobody knew who the vice chair was. They had to temporarily adjourn the meeting while they figured it out.

It turned out that the vice chair was Greenwell, much to his surprise. He assumed the gavel, and the public was graced with the vision of a committee chair actually licking juice off his fingers while conducting a public session.

That was the least of his problems. He got confused about which agenda items and amendments were being voted on. He called on members out of order and missed the green lights that appeared on his panel when other members wanted to speak. The other councilors and the county clerk repeatedly had to remind him about the council's rules for conducting a meeting.

When he finally relinquished the gavel, Enriques told him, "You're getting better."

But perhaps the low point of the day happened back during the Finance Committee hearing that morning, when the council re-voted on Yagong's proposal to give back their hefty salary increase, and the various councilors started giving their excuses for keeping those raises, which Ford described as "obscene." Naeole told a story about giving a meal to a homeless person, and claimed she needed the money to help others.

Greenwell, of Kona's wealthy Greenwell ranch family, claimed, with a straight face, "I don't want to begin the downward spiral of this and have people say, 'The county council cut back, you can cut back, too.'"

Council Chair J Yoshimoto, with an equally straight face, claimed, "My main concern is that the county council not influence the salary commission."

Various councilors echoed Naeole's contention that it should be up to the individual councilors to voluntarily give up portions of their raises if they so chose. Somebody said that since the councilors no longer had discretionary money, they needed their raises to give to local charities and causes within their district.

It didn't seem to occur to them that their option to give to the charities of their choice might come at the expense of someone else's job, or be paid for with the sale of land that the people of Hamakua had long said they wanted for family farming. During a session when councilors were arguing over the lease of a copier and debating whether it was more fiscally prudent to hire a parks project manager for Kona or to transfer one there from Hilo, the councilors' arguments for their own pay raises seemed laden with unconscious irony.

Only Yagong and Ford supported the rollback. Kohala councilor Pete Hoffman was absent.

The TMT, the Woodland Center, and Public Frustration

It's been a busy week. I'd just completed a story about the Puna Woodland Shopping Center controversy for the Honolulu Weekly, when I got the go ahead from the Big Island Weekly to cover Protect Pahoa's protest near the shopping center site on Tuesday. Then, on Wednesday, I went to a briefing for bloggers and a public hearing, both on the draft Environmental Impact Statement for the proposed Thirty Meter Telescope. Now I'm working on a Sunday, trying to wrap up stories on those events.

Stories about the Woodland Center controversy are out in the Honolulu Weekly and upcoming in the Big Island Weekly. I'm working on a piece about the telescope for the Hawaii Independent.

One thing that impressed me about both issues is how many well-intentioned people, no matter which side of the issue they stand on, simply don't understand how the system works or how to intervene effectively.

Take the Woodland Center controversy. The permits to build Woodland Center were issued years ago. The contracts have already been signed; the bulldozers are already in motion. About all that the protesters can hope to accomplish, at this point, is "raising consciousness" for other small towns. The only hope that the public ever had of stopping that center or shaping it, really, was back before the zoning approvals and grubbing permits were issued.

Nor was either side very likely to sway the question of whether or not the Thirty Meter Telescope was going to come to this island, based on their testimony at the hearings on the Draft Environmental Impact Statement. Both sides seemed to be offering statements beginning with "I support the TMT" or "I oppose the TMT." But that just isn't what an EIS hearing is for. In the 20 years that I've been attending EIS hearings on the island, I've never seen an EIS rule in favor of the "No action" option--the option that would kill the project. EISs are paid for by the developer. Their purpose is not to stop a project or to give it the green light; they're meant to examine impacts and propose methods of mitigation--in other words to make the project better, not to kill it. The only time I've ever seen public input stop a project on this island, it was through lawsuits, administrative hearings, or public hearings held by lawmakers.

Still, EIS hearings are a popular method of venting about a project and a way to allow lawmakers and reporters to get some sense of the public's sentiment. That's probably why the holders of EIS hearings have been actively seeking ways to make the hearings less of a bully pulpit in recent years. First the armed forces started holding their hearings in "open house" format, inviting the public to look at informational booths but accepting testimony only in written form or in a private session with a court reporter. That backfired at one hearing, where angry protesters brought their own microphone and cameras, held a noisy demonstration at the hearing with plenty of speakers, and then gave the army a tape afterward as "testimony." The TMT people tried a new variant on that strategy. There were the informational booths first, then presentations by telescope officials, then an open mike--but those who spoke at the open mike were told that their testimony would not go into the record unless they also submitted it in writing or dictated it to a court reporter. A lot of people got up and spoke anyway--and only a couple bothered with the court reporter. So they got their rants in without the TMT people having to dignify those rants with a response in the final document.

In short, the system really is rigged toward the developer, and sign-wavings and EIS hearings aren't likely to change that fact. If people really want to be effective in shaping this island's future, they need haunt the Planning Department and the newspaper's public notice sections so that they know when a new development is proposed; then they need to hit the meetings of the Planning Commission, the Board of Land and Natural Resources, the Land Use Commission, the County Council and other deliberative bodies that actually make land use decisions. And they need to give generously to the Earthjustice Legal Defense Fund so that when a court battle needs to occur, the ammunition is available to win it.

Big Tobacco Article Out

The article about Big Tobacco and local politics is out in the June 10 issue of the Big Island Weekly--and it's featured on one of the more disgusting, but effective, covers they've done, complete with an outline of Hawai'i Island crammed full of cigarette butts. Upcoming is one last campaign spending piece (for now, anyway), about a convict and some of the politicians who have accepted money from him....

A Personal Note

The tobacco story (see below) will be coming out while I'm gone to the mainland. I'll be spending a couple of weeks there with my 12-year-old son, whose mom, Susan Decker, is in the terminal stages of bone cancer. (Some of you may remember Susan; she had a private family law practice here, years ago, that specialized in helping famly violence victims. It of course went broke, because there was a huge demand for her services but the ones who needed it most couldn't afford to pay. But it was a noble effort.) While in Missouri, I'll be meeting with my son's school councilors and physician, in preparation for bringing him over here to live.

That's scary, because while this is happening, my unemployment benefits are running out (They got extended for six months, thanks to the Obama Administration, but the Hawai'i Island Journal has been gone now for nearly a year), my savings are exhausted, and the general economy and the newspaper crisis have made job-hunting in my field a masochistic exercise. Between now and when I leave, I'll need to do enough freelance work to pay my July rent when I get back. And then, somehow, I'm going to have to earn enough from freelancing to not only pay my rent and utilities, but to build up the money for plane tickets and moving expenses when the time comes to bring Aidan over.

On the good news side, I'll no longer be operating under the restrictions that the State's Unemployment Division was placing upon me (I could only do freelancing if it didn't affect my ability to accept "real" employment--i.e., from a company that pays wages, rather than awards a contract--if it happened to come along--which sort of works for where you sit in a union hall and wait for a ship to come in, but does make not much sense when the only "real" jobs available in my field have been 99.9 percent off-island.) I found that more than about eight hours a week of freelance work raised alarm bells and caused delayed unemployment checks. Now I can work 40 hours a week, or more, on freelance jobs if they're available, instead of 4-8.

All this will mean some changes with this blog--probably either moving it to another location or giving it up. Frankly, I've not gotten a single check from GoogleAds since I started this thing--and even if they actually had a check for me, there would be problems, because Google won't send a check to a P.O. Box and there's no home mail delivery in Volcano. I gave them the street address of a friend in Hilo who'd agreed to accept any checks for me, but she's now moved to Volcano, too.

From now on, everything I do has to pay--maybe not very much, but it has to pay something. So I'll be looking at other hosting sites and the possibility of selling local ads. If anybody has any suggestions, please let me know.

I still think it would be a great idea if all of us Hawai'i Island bloggers could unite under a single site, and hire a couple of the Journal's former ad sales reps to sell local ads for all of us.

Upcoming in Big Island Weekly: Tobacco and the Legislature

The tobacco story is finished, and sitting over at the Big Island Weekly. Jed says it will probably come out in two weeks. I don't want to give away the ending, but suffice it to say, I found a lot of money flowing into the legislature from America's tobacco companies, and some big rewards for them, hidden in the legislature's cost-cutting bills--but I also found out that there's a potent counter-force at work that's keeping Big Tobacco from getting its way all the time: Big Health....