What’s a Free Agent to do when she needs health care?
Being between engagements and insured only against disaster (she has the kind of insurance everyone used to have—the kind you hope you never have to use—not the kind that feels like a ticket for an all-you-can-eat buffet), The Free Agent has seen a side of American health care not often discussed—the kind you pay cash for.
Despite the impression one might get from the media that without medical insurance, an American’s only resort is infomercial books on home remedies, The Free Agent has paid cash for all manner of health care: doctor’s visits, prescriptions, routine screenings, even surgery. But to imagine that the prices of these services are subject to market forces as we think of them is fanciful. Governments spend around 50% of every health care dollar in the US, with insurance companies spending a third. Business and households spend the rest, mostly in the form of premiums and co-pays. Blessed with the constitution of her peasant forebears, The Free Agent cannot consume enough health care to compete with third party payers.
So when she had an ear ache recently, The FA decided to visit Urgent Care Manhattan. (The Free Agent has a personal physician, Dr. Gulag, but seeing him ad hoc usually requires a long unpleasant wait.) She arrived at 3:45 on a Friday afternoon to find a clean, quiet office where there didn’t happen to be a wait. The basic fee is $150 ($50 less than Dr. Gulag charges—as another physician acquaintance said, “It used to be insured patients subsidized the uninsured, now it’s the other way around.”) with additional charges if lab work or further procedures are needed. At 4:15, The Free Agent walked out the door with a prescription and aftercare instructions.
At that point, The Free Agent had the same treatment she would have gotten from Dr. Gulag, just more pleasant and convenient. But two days after her visit, she got a follow-up call from a nurse at urgent care to check on her progress. “You know if you don’t feel like you’re really getting better, call us and come in again, no additional charge.” The Gulag staff, while amply compassionate, is far too enslaved by paperwork to make such calls.
Urgent care has been around a long time, and pay-for-service is making headway in other medical practices. Direct Primary Care Medical Home (DPCMH) practices like Qliance offer health services at much lower cost, which they say is from saving the 40% a typical practice spends processing insurance claims. For between $50-90 a month, clients get unlimited primary care and cell phone and email contact with their doctors, pre-existing conditions welcome. The only thing Qliance will not do is process an insurance claim, but like Urgent Care Manhattan, they will provide information for the patient to submit. About 50,000 Americans are in the care of DPCMH organizations.
In the final diagnosis, why had this experience been so pleasant? The Free Agent wasn’t treated like a pilgrim to Lourdes, asking for a miracle. Nor was she treated like a punctured tire, an annoyance that throws one’s already busy schedule further off. What was that warm, valued sensation, even a soupçon of courtship, she felt? The Free Agent had been treated like a customer.
Charismatic, populist leader, pretty blonde first lady, intractable financial crisis masked by a cavalcade of cash, before it happened to Andrew Cuomo and Sandra Lee here in New York, it happened in Argentina.
Following the suicidal Falkland Islands invasion, reform of Argentina’s long cycle of borrowing and hyper-inflation seemed assured by the late 90s. With the peso convertible to the US dollar, Argentines had the confidence to save and invest, knowing their proceeds couldn’t disappear on the government printing press. The economy had enjoyed steady growth through most of the 90s, with promise of more.
So why did Argentina need loans from the International Monetary Fund? When The Free Agent borrows money, it is either for investment, such as her modest cottage, or to solve a short-term liquidity problem, such as she infrequently experiences at her cash-only show-tunes piano bar. While she questions whether any government expenditure since the Federal Aid Highway Act of 1956 can properly be called investment, the Argentine government had not mended its ways at all. Like a deadbeat who reforms his credit rating in order to score and default on a new and bigger loan, Argentina’s prosperity was a smokescreen. Borrowed funds disappeared into familiar sink holes—government salaries and pensions, and subsidies to the provinces. Debt and currency crises in other emerging markets in the late 90s motivated the IMF to mask Argentina’s looming default by issuing a new loan even when it was clear it could not pay the interest on its existing debt.
As a scorched-earth bonus, because debts had to be repaid in dollars but Argentines were paid in pesos, the previously functional banking system was hollowed out as the government desperately tried to satiate its lenders. (As a general rule, The Free Agent grabs her wallet when politicians start talking currency restrictions.)
On December 23, 2001, Argentina defaulted on private foreign lenders, and a revolving door was installed on Casa Rosada, the presidential palace. The convertibility system was ended two weeks later, by June, the peso was trading at 26 cents. In 1999, 10% of Argentines were indigent, by the end of 2002, 28% were.
Like the rural provinces in Argentina, US local governments have become addicted to handouts from the capitals above them. When local property tax revenue falls short, when homeowners short sell or abandon properties, for example, they appeal to state coffers. When states, long on pensions and other entitlements, fall short on sales and income tax (and in 2009, all but 6 did) they look to Washington. Like Buenos Aires, when Washington can’t make payroll, it has to two options—ask buddy nations like China and Saudi Arabia for a tenner till payday, or fire up the printing press.
Such is the complexity of New York’s finances that a supposed budget hawk like Mister Cuomo can nobly tilt at windmills, “Albany must give up its insistence on pleasing the special interests rather than serving the people.”, while supporting expansion of New York City’s ludicrous rent control laws. His idea for dousing the explosion in Medicaid spending will sound as familiar as Evita’s great torch song: improve delivery while cutting costs. (When Wal-Mart does that, New York’s reaction . . .well, that is perhaps for another column.)
In 1990, fifteen years after New York City’s bailout, public debt was $14.4 billion. In 2000, before debt reform was enacted, it was $37 billion. A peep inside New York’s public debt can today shows obligations of $60.4 billion. (Five years ago, it was $48.5 billion, almost exactly the amount of Argentina’s IMF loans when it defaulted.)
Without paging through, to use an arcane reference, phone-book-sized state budgets, The Free Agent will posit the single most important similarity between New York (ville et department), Argentina, and Washington. Unlike The FA, or you, or any private person or corporation, they have the ability to borrow money with no responsibility for paying it back. Forget about the debt ceiling, The Free Agent proposes a tiny adjustment to the way governments borrow money: that any non-capital borrowing must be repaid within the elected term of the borrower. Politicians get rewarded by kicking the debt can down the road, pleasing voters today and shifting the burden onto public schoolchildren whose rudimentary math skills they hope prevent them from appreciating the iniquity. The Free Agent would like taxpayers to lend money less like Fannie Mae and more like the local Italian Brotherhood.
A beautiful woman, abandoned by a man she counted on, near the end of her strength, the fires of perdition burning in the background, collapses at a split rail fence. Before it happened at the end of the new “Atlas Shrugged” movie, it happened to Scarlett O’Hara.
The Free Agent cannot really argue with the critical excoriation of “Atlas” because she cannot view it without her knowledge of the book. She had trouble finishing even thumbnail reviews citing Tea Parties, Bernie Madoff, etc., or implying Rand’s book portrays the Republican party’s Nirvana. (Oh, how those Republicans love to keep their distance from big business!) Roger Ebert, a most intelligent observer, found the movie incomprehensible and un-cinematic, “The dialogue seems to have been ripped throbbing with passion from the pages of Investors’ Business Daily.” Fair enough. It takes a bit of effort to acclimate oneself to Ayn Rand’s writing, and lines like, “Why all these stupid altruistic urges, it isn’t charitable or fair. What is it with people these days?” enter the ear canal with the subtlety of the Taggart Transcontinental.
The FA merely points out that the movie avoids the worst possible crimes—trying to up the characters’ “likeability” for instance—and that for her, watching the movie was analogous to reading the book.
It mystifies The Free Agent that women don’t tend to love Rand or Dagny Taggart, her railroad-running, competitor-smackdowning, lover-taking heroine. When she tries to emplace the character with others in the history of cinema, The Free Agent finds herself back by that other fence, the one at the turn-off to Tara, the one where Rhett mauled Scarlett (Margaret Mitchell and Rand are sisters under the skin in at least one way), then abandoned her to go fight the last five minutes of the Civil War. Finding herself unexpectedly responsible for feeding the remnants of the plantation, Scarlett brings in a cotton crop, then expands and runs a saw mill. Later, Rhett accuses her of putting her love for the lumber business above him and their child.
Other movie heroines have had jobs, of course. Most were undertaken while waiting for a man or coping with the unexpected loss of one, and the plurality pursued the safely feminine occupations of actress, secretary, and waitress. Once in a great while an entrepreneur appears, frequently—weirdly—expanding on her knack for baking pies.
What Dagny and Scarlett share that no reviewer of “Atlas” seems to apprehend is the raw love and pride in production. Stephen Sondheim expressed the creative drive with supreme economy: “ . . . I made a hat/Where there never was a hat.” Dagny and Hank Reardon get so aroused riding on the John Galt Line they copulate. Scarlett, who never really has a soul mate, closes her eyes and revels in the smell of her lumber rebuilding Atlanta.
Perhaps the productive drive is too rare to resonate with reviewers.
Because it is joyous building, productivity, the reaffirmation that reality is real, that “Atlas Shrugged” exalts. The Free Agent assumes the producers, cast, and crew wallowed in it while delivering Part I, against long odds and short money.
She fervently hopes the rest of the trilogy will not suffer stillbirth.
“The nation is not broke, my friends. Wisconsin is not broke. Saying that the country is broke is repeating a Big Lie.” While The Free Agent certainly doesn’t count herself among Michael Moore’s friends, she cannot help but be intrigued by the speech he gave in Madison supporting intractable state workers and their enablers in the state assembly, given her recent exposition on the same subject. Also, The Free Agent herself faces financial embarrassment she would prefer to avoid, hence she reads on, “The country is awash in wealth and cash. It’s just that it’s not in your hands. It has been transferred, in the greatest heist in history, from the workers and consumers to the banks and the portfolios of the uber-rich”
Let us blink our eyes at the implication that before the federal bailout (and oh, how The Free Agent hates to find herself agreeing with Mister Moore!) the nation’s economy was to his liking. He goes on to claim that the wealthiest 400 individuals in the United States own half its wealth.
The Free Agent has never been able to grok the relevance of this how-many-control-how-much measurement. (She recently read a book wherein the author bemoaned the destabilizing effect of the widening gap between rich and poor, the timeframe being 1559-1715.) Mister Moore supposes .0000013% of the population controls approximately $95 trillion (it’s difficult to estimate total wealth; this is a lowball derived from the most recent Federal Reserve Board’s Z1: Flow of Funds report); more planet-earth-oriented sources place the number at 1%, or 3,000,000 people, owning approximately 43%, a figure that has hardly changed since 1981. Yet whatever the particulars, The Free Agent’s eyebrow remains unarched. Would Mister Moore prefer a more ‘democratic’ (his ne plus ultra) distribution, such as China’s? The bottom 90% of the population owns 60% of its wealth. The FA invites Moore to experience the relative economic justice first-hand.
But Mister Moore’s point was that America/Wisconsin, and by extension, The Free Agent, aren’t broke because wealth still exists somewhere in the country. Using this logic, The Free Agent owns a Honda CR-V because one sits in her neighbor’s driveway. All she requires is the, ahem, ‘democratic’ means to acquire a set of keys.
The Free Agent’s economic worldview is founded on only a few principals learned at her accountant-mother’s knee: if you live beyond your means for too long, you will go broke. If you make financial promises you can’t keep, you will go broke, and possibly to jail. If you are digging yourself into a hole, you should slow the digging (chuck the Quality Paperback Book Club catalog) and try to fill it up (pick up an extra shift at the mall). If you’re going to steal, embezzle. That one is a bit of a surprise if you know The Free Agent’s mater, but she never condoned theft, so that branch of the decision tree will never be climbed.
Mister Moore, unencumbered by similar moral education, sees the situation differently: in order to perpetuate the state government of Wisconsin’s living beyond its means and paying off ludicrous unfunded retiree benefits, it is merely needful to rouse the rabble to vote themselves someone else’s bank account. In short, Mister Moore, like most politicians, is a graduate of the Willie Sutton school of economics. Mister Sutton, you’ll recall, when asked why he robbed banks, replied, “Because that’s where the money is.” This is a gentleman in whose company you should not wear your good watch.
Alas, like so much we have lost under the oligarchy, The Free Agent has just been informed she no longer owns the CR-V. It’s going to an Affirmative Action Coordinator in Oshkosh.
As she has said before, The Free Agent may number few among her peers, but is catholic in her associations. An ex-colleague and native of America’s Dairyland, posted this joke on Facebook:
This joke is too good not to share… A unionized public employee, a teabagger, and a CEO are sitting at a table. In the midele of the table there is a plate with a dozen cookies on it. The CEO reaches across and takes 11 cookies, looks at the teabagger and says, “Look out for that union guy—he wants a piece of your cookie.
Setting aside for a moment the positioning of the Tea Party adherent as a witless dupe of big business, the more intriguing question about the underlying assumptions of the joke is what exactly are the cookies?
At first blush, the cookies would seem to be the zero-sum pool of wealth too many politicians still believe in. (Using this logic, Cro-Magnon man had sufficient resources to reach the moon but they were tied up in spearhead production and the NECP, the National Endowment of Cave Painting.) The Free Agent chooses to give the wag credit that the humor is subtler than merely random scapegoating. Elsewise, the joke would work as well if we substitute “Brad Pitt” for “CEO”.
The most likely explanation is the cookies represent tax dollars. That, after all, is the cheddar over which Governor Scott Walker took to the hustings last year. Then a veteran Milwaukee County Executive, Walker campaigned for the nomination as governor thusly, “It’s what I call a bit of brown bag common sense – based on three simple principles: Don’t spend more money than you have. Smaller government is better government. People create jobs, not the government.” Like many governors, Walker immediately realized public employee pensions and other benefits were a vast bog of Cheez Whiz, threatening to suck Wisconsinites into bankruptcy like quicksand. Public employees, disoriented perhaps by his ‘walking the Walker’ even after he was safely elected, and their Democratic supporters in the state house are now approaching the month mark of obstructing a vote on a balanced budget.
Union supporters like President Obama mourn the termination of collective bargaining rights the bill contains. But it’s more correct to say that by eliminating union force, the bill restores the right of employees to not bargain collectively, to independently contract with their employers, to accept buy-out offers, and generally to negotiate for wages and benefits packages that suit them, rather than those union overlords have chosen for them.
Mister Obama also Rodney Kinged it up in a radio interview, pleading, “ . . . I think it’s very important for us to understand that public employees, they’re our neighbors, they’re our friends.” The Free Agent reassures the president that Governor Walker is not asking for his friendship bracelets back. He is trying to put employees of Wisconsin’s taxpayers on a more equal footing with their bosses. Over time, the stewards of tax money across the country have generally inflated public employee wages and work rules far above those we, who pay them, receive.
But The Free Agent has not succeeded in explaining how, if the cookies are tax dollars, the CEO gets 92%. Perhaps it is a variation on the age-old demonize-and-marginalize after all. ‘Then they came for the CEOs, and I didn’t object…’
Like most decent people, The Free Agent was brought up never to deface property. One cannot, however, live in New York without appreciating a certain frisson of anarchistic thrill at the sight of a particularly subversive graffito. It is a tradition that goes back at least to ancient Rome, when frenzied fan girls were known to record their sexual fantasies concerning gladiators on the walls of the Coliseum.
Likewise, there is a strong tradition in the New York subways of defacing movie posters by scratching out eyes, scribbling on beards, glasses, uni-brows, and in The FA’s home turf of Brooklyn, of sketching the male, ahem, wedding tackle, protruding from the lips of particularly handsome leading men. While this is an affront to people who make movies and spend money to advertise them, Ryan Reynolds, for example, has not raised his voice to take personal offense at his picture’s defacement.
Which brings The Free Agent to the lawsuit against her beloved Hippy Week. The gentleman who owns the local sports franchise, the Injuns, is suing for malicious intent he believes motivated a recent cover story. In addition to three factual errors he believes the story contains, part of the owner’s lawsuit claims that the cover illustration:
As the saying goes, “get three Jews together and you get four opinions”, and each side has lined up rabbis to support their interpretation of the picture. Rabbi Abraham Cooper of the Wiesenthal Center in Los Angeles, to whom the owner later promised any proceeds he may win from the suit, sees clear evidence of Hippy Week’s intention to ignite an American Holocaust. It is, “inappropriate and unacceptable when a symbol like this – associated with virulent anti-Semitism going back to the Middle Ages, deployed by the genocidal Nazi regime, by Soviet propagandists and even in 2011 by those who still seek to demonize Jews today – is used on the front cover of a publication in our Nation’s Capital against a member of the Jewish community.” (The article did not mention the owner is Jewish.)
On the home turf, Washington Rabbi Danny Zemel sees what The Free Agent sees, run-of-the-mill defacement of the exact nature in which an Injun fan would delight. “I don’t think this is anti-Semitic. I think it’s highly juvenile.” Zemel said, also noting the absence of stereotypical details like a long beard, hat or hooked nose.
It all depends where you start from. The Free Agent’s friend, Nude Eel, sees “everything is anti-Semitic until proven otherwise,” but was then unable to elaborate on evidence he would accept to prove the negative. And perhaps he was having The FA on a bit.
In a day when thoughts can be crimes, and in this case, when the actual existence of Hippy Week could be threatened (it will probably win, but could go under fighting the war), it’s important to extend to others the toleration and presumption of benevolence we want for ourselves.
After all, this is the man who passionately defends his team’s name against, and dismisses the opinions of, people who think it’s racist.
The Free Agent has observed that the frequency of the nostalgia wave is about twenty years. In particular, Generation-Whatevers look upon twenty years before whatever year it is as a time when people wore funny clothes and didn’t have real problems like we do nowadays. (When The Free Agent was a toddler, the rage was for the 1950s—school dances were sock hops, girls dug through their mothers’ closets for the ol’ poodle skirt and boys gelled their shag cuts into DAs.) In that spirit, you are invited to don a plaid flannel shirt, tie another plaid flannel shirt around your waist, and revisit Things We Complained About in the 90s.
Ross Perot’s “giant sucking sound” of jobs moving Mexico-ward as a result of the proposed North American Free Trade Agreement. NAFTA took effect January 1, 1994, in December, Mexico suffered a currency crisis, muddling the statistical waters quite a bit. But comparing total employment in Mexico between 1993 and 1998, sure enough, its economy added over 3 million jobs, a 20% increase. But during the same period, the US added nearly 15 million jobs, for an overall increase of 14%. U.S. gross domestic product grew 32% during those five years, in Mexico it rose 15%. If there was a sound, it would seem to have been caused by significant increase in prosperity for both countries. A fact Mexico might well be reminded of, now that it hears a sucking sound from China and India.
But what was the nature of those jobs? The Free Agent recently received an Internet chain letter suggesting we demand to speak to an American customer service agent when we detect a foreign accent on the phone, repatriating “our jobs”. Ignoring the anti-competitive impact higher wages would have for US employers, in the 90s, we disdained exactly this type of work as soulless, low-wage, service sector McJobs. Increasing total employment, decreasing total employment, alluding to the 1970s again, “it’s always something.”
Remember when Barnes & Noble, Borders, Waldenbooks and B. Dalton were the enemies? When we worried about Starbucks’ opening too many stores? When gentrification was evil? All of those trends have reversed, to no one’s clear benefit or injury.
The Free Agent concludes her musings on a sober note. In the waning months of the 90s, she marched with fellow Washingtonians in protest of NATO’s bombing campaign in Yugoslavia. It was hardly a frenzied, Vietnam-caliber protest, by June 5 it was already clear the campaign would end in a few days. But we objected to the idea that bombing could be an easy, or clean war, cashing in on the US’s technological strengths with little exposure to loss of our lives or treasure. Since Yugoslavia/Kosovo’s European neighbors seemed uninterested in risking themselves to impose an end to the war, why should Washington override them?
Yes, The Free Agent’s complaints about the 90s concept of clean wars seems as quaint as a tuna boycott now that her country is ensnared in at least two eye-level wars, consuming both treasure and her countrymen’s lives. She wonders if in 2031 if she’ll wax nostalgic for Iraq and Afghanistan. What events would have to transpire for that to happen, she daren’t contemplate.
* Danielle Steel wrote 20 of the 100 end of year top 10 novels from 1990-1999