Of the people, by the people, you know the rest….

Near the end of the film The American President, the lobbyist (Annette Bening) shovels through dresser drawers in POTUS’ bedroom looking for the sweater she left behind that belongs to her sister. With no success, and still seething from her conclusion that the President had sold out her legislative bill to guarantee the passage of one he and his pride had thought more important, she turns a snake’s eye to him and shouts, “Oh, fuck the sweater. She’ll just have to learn to live with disappointment.”

Today the Senate Finance Committee dismissed two versions offered on the Public Option, one by Rockefeller of West Virginia and one by  Schumer of New York. The village idiot would have expected a no from each Republican committee member, but on the public option even Democrats, under the Baucus umbrella, dealt fatal blows. Now Senator Baucus explained to his compadres that they would need 60 votes on the floor and a public option in his bill would guarantee a failure to get those 60 votes and his job was to get a bill passed.  Herein  the pragmatist steals his way into the martyr’s aura. And yet the proposal of a public option remains the core of reform, because nothing else will allow people to cut themselves loose from the insurance companies that ration their care, through premium or policy. Really, folks, who will play sheriff when an insurance company denies its customer coverage?

One of the arguments that captured bipartisan support was that the public option would mirror the reimbursement rate of Medicare, a WalMart level of appreciation for professional medicine the insurance companies could not sustain and survive.  This argument holds water and yet it is this argument against which I take personally painful issue.

For the last five years of my mother’s life, after her husband and only remaining son perished within six months of eachother, she abandoned all responsibilities for her existence save (until the last 18 months at least) personal hygiene. I paid the bills, I online-ordered the pills, and provided transportation. Since disenchantment had coupled with her dementia, my mother insisted I sit in on all medical visits to receive any new instructions. So my wristwatch told the story: for a twenty-minute appearance by her primary care physician, which included reviewing the vitals the assistant had pumped into the laptop, listening to my mother’s weakening heart and moderating a discussion between my mother’s stated disposition and my interpretation of such, should it suggest the need for new prescriptions, the medical recorders labeled this a Level 4 service and charged $222.00.  Keep the pace and that $666.00 an hour.

However, the statement I later received in the mail showed that Medicare paid $73.26.  The Medicare Adjustment was $130.43 and I owed the remaining $18.31, which brought the physician’s take on that twenty minutes to a sliver over $90.00. While many members of Congress are insulted by Medicare’s reimbursement rate, I am appalled a physician would charge so much for so little.

Want more? The last year of my mother’s life necessitated foster care and, as that primary care physican determined, Hospice.  Once a week a “skilled nurse” dropped in on my mother for vitals and conversational questions she mostly dismissed with silence. Hospice charged Medicare $245.00 per visit: but, also, Hospice charged Medicare $5,850.00 for the month. Now the foster caregiver had taken over my job of medications since state law require that the pills be on the premises, and the foster caregiver tended to all of my mother’s other needs. I merely paid the foster home $3,200.00 per month for this care, and footed the bill for diaper orders.

Medicare’s response to this was to label the nursing visits as non-covered charges but pay a total of $4,659.57 against the monthly charge of $5,850.00. This lacks sense, not benevolence. Had I or the foster caregiver received such compensation, we’d have tissue-wiped my mother’s bottom to a fine shine indeed.

How is a body to reconcile this? The primary care physician may lament the federal government’s uninspiring payment for her time and service, but note, Hospice received  funds that, leaning into metaphor, felt like an embrace into a big bosom with a home-cooked meal to boot. The clamor for health care overhaul is all about cost,  unsustainable cost. The medical world inflates the price of every service, instrument and pharmaceutical that passes under your nose, while insurance companies use premiums to feed and nourish that upward spiral of…cost. As long as we keep paying, cost will keep climbing.  The relationship between a service and its intrinsic value will disappear. The argument for a public option is so laden with logic that its dissipation physically hurts.

And ultimately disappoints. Because it forces the deduction that enough U.S. Senators leave your interests just outside their office doors.