health & medicalpolitics & government

Charliecare

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Let’s say that Barack Obama dons some gay apparel, something like a viking hat and chainmail, hoists Osama’s crab-nibbled melon over his own and runs out on the West Lawn crying out like Braveheart, “Freedom! Freedom! Freedom!” This has a predictable effect, rallying the entire country to the cause of Scottish nationalism, but also whatever other plans the President has cribbed on his ipad. The hottentots in the House and elsewhere fall in to line. The institutions of international finance are also well impressed by this display of leading from the side yard; they promise (and prove to have the ability) to buy up all the T-bills we can print at around 3%. For the most part there is no effect on the media, except that Fox is given over to the closest thing white people have to Obama, Mitt Romney, making it as tractable as a gelded pony. The Bush Era Tax Rates die of natural causes next year, engorging federal revenues while not harming economic activity in the least. Likewise FICA taxes rise to no complaints or ill effect. The regulations of the insurance industry have exactly the intended effect and no other leaving it exactly as prosperous and powerful as Obama wants. In short, let us make this titanic and diverse stipulation that is far, far better than any reasonable Best Case Scenario and still we can confidently predict that Obamacare (or whatever you would like to name it…. Husseincare? How’s that sound?) will fail utterly, catastrophically and grotesquely. And we can blame it on Charlie Sheen.

Mr Sheen is not a well man. And while he does seem to have a few health problems typical of a man his age, by far the most of it is self-inflicted. Or possibly little more than a pose. So what do his father, brothers and other well-wishers advise him to do? Get into rehab. Re-habilitation, or we might call it re-civilization is a modern convenience that seems to have almost no ancient corollary except maybe the odd dry monastery. A rehab center looks like a resort that has been turned into a prison or maybe a prison hospital. To this bleak facility we send countless people, many of them teenagers, to “get clean”. Generally this does not include a thorough wash by firehose if only because the majority of the inmates, guests, patients, prisoners or whatever you call them, are there voluntarily. Charlie Sheen, if he were to go (again) would be going voluntarily, assuming there is nothing happening right now in HIS mansion hideout that could get him sentenced there. In any event, Charlie would of course go to only the finest example of the rehabber’s shop which will be luxurious indeed. An ordinary Joe would kill to get a few weeks there. Well, he would if there were booze.

But the Betty Ford Clinic and others even more chi chi are just the top of a very tall pyramid. There are rehab centers for every budget and every addiction. Charlie famously seems to be addicted to almost everything simultaneously and explains it well when he says that Charlie Sheen is high on Charlie Sheen. Yes, even this exotic malady can be treated. I’m not sure how you cure an addiction to self, to self-aggrandizement, self-deception, self-indulgence and self-abuse but the experts; doctors and fixers with elaborate degrees and fat salaries, claim to be up to the challenge. If only they could get a-hold of him. They would cloister him in their posh, hygienic cells, isolate him from bad influences, drink, drugs and smokeables. They will enroll him in group therapy sessions, remedial handicrafts, assign him duties with orphans and the elderly to expand his spirit; they will cajole and advise and massage and urine test Mr Sheen until they can plausibly deliver him a clean bill of health. Right after that they will present him with another bill.

That will be a stiffie, you can be certain. But what the hell? Charlie is making it. Or he was. Of course his prodigious income was also subject to wanton outgo so it could well be that the titanic cost of a month or two in a joint like this will impact even him. So imagine, if you will, this practice of semi-imprisonment at lavish costs expanded to the country at large. Would this be madness? Think of a country where any old Melvin can show up to work drunk for a year or more or maybe expose himself at the water cooler, claim that these hijinx were caused by addictions and get a few weeks vacation at a fancy hotel out of it. No need to imagine such a Utopia, friend. Look beneath your feet. You are standing in such a country.

Health insurance as we know it is a pretty modern invention. Back in the days of Lucy what you got was hospitalization. This paid the bills when you went into the hospital. Pretty straightforward. Back then there wasn’t a whole lot to do for your health outside of a hospital except to see that you were eating right. It was in the sixties that the prescription drug revolution really began. Prior to that, for the most part, some malady would either kill you or let you live with it. Chronic conditions were alleviated through prayer and special shoes. Patented medicines for ailments we never knew existed changed all that. Now there were continuous medical bills that would reliably get higher as you got older and consumed more and more pills. Around this time the calendar pill box was certainly invented. But also was the health maintenance organization, pretty much by Ted Kennedy. This sought to do what we expect modern health plans to do; cover all medical expenses. The HMO is a reviled beast now, the name is hardly spoken, but it was a real innovation that lowered quite radically the out-of-pocket medical expenses of Americans at large while it was supposed to control costs overall.

You know what happened. Demand for this now essentially free good took off like a scalded cat. Costs for particular treatments fell but the array of available drug or therapy regimens exploded so overall medical costs ramped up as we know them to have done. But one would think that even if we are indulging outright hypochondriacs and applying every available remedy to every diagnosable ill, we will eventually hit the limit, right? How much disease can there be in a population? And if medical progress continues as it seems to do, surely with prevention, early diagnosis and expanded options we will all be less sickly. There are two problems with this. One is the simple fact of time: live long enough and you will die of something probably at a great expense in the last few months even if you’ve never been sick a day in your life. Medicare is meant to address this so for now, let’s say it has. We still must contend with Charlie Sheen.

Not Charlie Sheen the Charlie Sheen. He is of course paying his own way. If he has a healthcare policy it is certainly gold plated in its benefits and its cost. Rather the problem is the Charlie Sheen Phenomenon. Do you think only Charlie Sheen is Charlie Sheen? Oh no. There is a bit of Charlie Sheen in everyone. Everyone. And almost certainly you have your inner Charlie Sheen all wrapped up in a straitjacket inside your mind and maybe you can even have a drink or patronize a strip club and do it quietly enough to sleep in your own bed but Charlie Sheen cannot. Or he will not. And there is a Charlie Sheen in every office, factory, store, restaraunt and of course the bars are full of ’em. And guess what? Sheenism is covered. Oh, yes it is. The rehab industry is truly gigantic and like healthcare generally, the people it accepts as customers or whatever they are, do not pay the bill. Nope, if you come in one day to find the next cubicle empty, and they whisper, “Oh, Joe turned up drunk again. They are putting him in rehab.” Guess who is “they”…. Why, you knew it all the time that it was YOU! You and Joe are both on the company insurance, right? Now, you were concerned that you might bust your ankle mountain biking or that you might be unfortunate enough to inspire a Movie of the Week, catching lupus or whatnot. And that is fine but you must know that a little concept called “parity” has made Joe’s habit of smoking whiskey and drinking cocaine a moral and legal equivalence with your more prosaic medical demands. Yep, all psychiatric care is to be handled by the insurers exactly like any other claim. But while you with your sprain will go to the emergency room, maybe an orthopedist, take a few days off and be done, Joe’s Sheenism is a chronic condition. He will be put into therapy on open-ended terms to be released when he is considered cured. And when is that? What’s the expression?

When the insurance runs out.

Many a youngster who was troublesome in any way whether it involved drugs and drink or not has been committed by their folks to a good drying out that somehow always extends to the maximum payout from the insurer. It’s almost miraculous and it is much the same with Our Joe. But here is something MORE miraculous. It is now illegal to have lifetime or even annual limits on payouts. So if you are in there until the insurance runs out, friend, it is illegal for the insurance to run out. So you have a life sentence to foosball and communal TV. That is just not possible, is it? No, and this is a big reason why the insurers call out that they are dying, waivers are only good for so long. Fans of Obamacare of course say, good riddance. We will default to the government doing it all and we will finally have our Single Payer, the Holy Grail in the field.

Only Obamacare has the same problem. The laws requiring parity are at the State level and they have been put into place by powerful and well-heeled professional organizations representing shrinks and chiropractors and counselors and not a few regular old doctors. They aren’t going anywhere. Knowingly or not Obamacare has signed on to cover the rehabilitation for every Charlie Sheen in the country with infinite funds forever. In effect, the purveyors of medical financing miracles are betting on the relatively easy and reliable cure of Charlie Sheen from his addiction to tigerblood. If it were as simple as keeping him from tigers it might be possible but no, the project intends to save Charlie from himself, the one thing we can’t keep him from.

And even the greatest triumph in whatever sphere doesn’t make this any more possible. Sorry Mr President. Good job on the pick but Osama’s head over your mantle is not changing math, medicine or Charlie Sheen.

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