“'Multiple Fictions' Drive Opposition To Health Law - Kaiser Health News” plus 1 more

'Multiple Fictions' Drive Opposition To Health Law - Kaiser Health News

Posted: 19 Jan 2011 03:38 PM PST

While reading "A New Definition of Health Care Reform" by James C. Capretta and Tom Miller, I was reminded of the old adage "if one can frame the debate, one wins the debate."

The health reform debate, they say, is between those who would use government regulation to try to control growth of health care spending and those who would rely on cost-conscious consumers operating in a competitive market place. The right way to reform health care, they say, is not government regulation but rather by shifting to a defined-contribution system in which people would bear the full marginal costs of insurance they buy. Medicare beneficiaries and Medicaid recipients should be given vouchers for the purchase of health insurance. Employers should do the same with private employees. The recently enacted health reform legislation, they say, extends fee-for-service medicine. For that reason, it should be replaced.

This critique is based on multiple fictions—about what the Affordable Care Act does, about what any plausible alternative would do, and about what the real issues in the current debate really are.

First, the federal health law clearly moves the health care system in the very directions that Capretta and Miller urge—toward a defined contribution system.

• That is true for most of the 16 million people who would be covered through the newly created health insurance exchanges. Subsidized clients in the health insurance exchange will receive vouchers to reduce the net cost of a moderate health insurance plan to a fraction of their income. If people want more generous coverage, they will have to pay for it themselves. That is what defined-contribution coverage does.

• Medicaid also is moving fast away from fee-for-service care toward services provided by managed care organizations operating under negotiated contracts with states. That is how most of those newly covered by Medicaid will be served.

• The law will impose a modest tax on high-cost private health plans starting in 2018. This tax will discourage the provision of highly generous insurance plans that accommodate inefficient fee-for-service care.

Like Capretta and Miller, I wish that tax applied to more plans and started sooner. That it does not results from the refusal of Republicans in the course of the reform debate to do anything else than vote "no." The first president to embrace limits on the tax breaks for employer-financed health insurance was Ronald Reagan. Republicans have long embraced such reforms. Had they been true to their tradition and participated actively and constructively in this debate, as a previous generation of Republicans did in the debate leading up to the enactment of Medicare and Medicaid, and as Democrats did in the process leading up to the passage of the Medicare Modernization Act in 2003, there is little doubt that coverage of the tax on high-cost plans would have been broader and it would have started sooner.

The next fiction is the idea that there exists some market-based reform that would operate immaculately free of intrusive government regulation. If consumers are to exercise real leverage on insurance vendors, they have to understand the choices they face. That demands that the range of plans be limited to a manageable number, that marketing of insurance plans be highly regulated and that objective literature written in plain English must be available to customers. It also demands extensive risk adjustment of premiums and subsidies for those who cannot afford the full cost of health insurance. All of this will require heavy government involvement. Come to think of it, each of those steps is part of the health law. If a well-functioning private market place is what Capretta and Miller want, they should be celebrating the bill, not joining calls for its repeal.

No, the health reform debate is not about a fictional war between market-based health insurance and government regulation. It is about whether to provide adequate subsidies to cover the uninsured and whether to begin a process of leveraging change in the delivery and payment systems through which one-sixth of the U.S. economy is devoted to health care. Under this administration's leadership, the last Congress laboriously and narrowly pushed through legislation ending the crippling stasis that virtually all observers of the U.S. health care system deplore. Their handiwork is not perfect, nor can its full effects be anticipated. Further legislation will unquestionably be necessary—to fix provisions that don't work well and to deal with unanticipated consequences of the legislation. Making that legislation work as well as possible now and figuring out what legislation will make it work better in the future should occupy the nation now, rather than a sterile debate based on a false issue and misrepresentation.

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An Army Wife Reflects On 'When The Men Are Gone' - NPR News

Posted: 18 Jan 2011 03:25 PM PST

Heard on Fresh Air from WHYY

January 18, 2011 - DAVE DAVIES, host:

This is FRESH AIR. I'm Dave Davies, sitting in for Terry Gross.

The wars in Iraq and Afghanistan have been fought in an age of embedded reporters, soldiers' blogs and YouTube videos from overseas and the home front. But our first guest, Siobhan Fallon, employs the traditional, low-tech form of short fiction to describe the lives of soldiers and especially their families.

Fallon is a military wife, and her new book is based largely on the experiences of Army families in Fort Hood, Texas. When soldiers leave on a deployment, she writes, their spouses somehow manage. They improvise. They take the strangeness and make it normal.

In her stories, wives have to deal with oil changes and home repairs, as well as loneliness, the crises of adolescent kids and, sometimes, infidelity and even death.

Siobhan Fallon is the wife of an Army major who earned her master's of fine arts in creative writing at the New School in New York City. She will soon be leaving for Jordan, where her husband will be stationed. I spoke to her about her book, called "You Know When the Men Are Gone."

Well, Siobhan Fallon, welcome to FRESH AIR. Tell us some of the changes in sight, sound, and routine at the base that tells you when the men are gone.

Ms. SIOBHAN FALLON (Author, "You Know When the Men Are Gone"): It's pretty obvious right from the first moment that the soldiers deploy because: one, there are so many to begin with. So as soon as the brigades start rotating out, you have this eerie sort of quietness and less cars.

There aren't the long lines to get into the front gates with all the pickup trucks. And, of course, all of the fast food places, they don't have the lines at the drive-thrus or the crowds that you would see at lunchtime or seven in the morning, when they - or actually, they have to be there earlier.

When they have to go into PT, you know, there's always a traffic jam on Battalion Avenue or something, like the soldier's room.

DAVIES: And PT is?

Ms. FALLON: Oh, the physical training that most of the soldiers do at the same time. It sort of puts a halt on the entire base.

And you just start to notice that there are more women and children because you don't have the balance of, you know, the males. And the females, suddenly you are just very aware of the families that are there, and they kind of take over.

You just see them, the kids running, playing, and the wives don't have as much to do in one area of their lives, or they're not worrying about taking care of their husbands as much. So they might have more free time to get together. So you might see them outside.

DAVIES: Now you write that, of course, that military wives rely on each other for companionship and babysitting and care and empathy. And they don't mix so much with civilians even though, I mean, there is a town there, Killeen, Texas, and then Austin, which is a pretty hip place, is only 70 miles away. Why is it that they find it hard to kind of mix with civilians?

Ms. FALLON: From my experience, and especially in a place like Fort Hood, where so much of the community is military to begin with, you're surrounded by spouses who have so much in common with you that it's just easier to form those friendships instead of maybe the civilian friendships that would include the husband that you suddenly don't have.

Or, you know, your soldier's away. It makes it a little more difficult to hang out with your friends who have their spouse with them, and that reminds you that your spouse isn't there.

DAVIES: Infidelity is one of the things that comes up here a lot, which isn't surprising because, you know, fears or suspicions of infidelity are part of any long-distance relationship, and, of course, these folks are experiencing long separation with enormous stress.

And I thought I would have you read a section from a story, and this was the case of a woman. The character's name here, I believe, is Kaylani(ph). She has not heard from her husband for awhile, and so she's so concerned that he hasn't been writing and returning her emails. She decides she's going to - well, she's going to find out for herself. Why don't you just read this section and explain what happens.

Ms. FALLON: Sure. So Kaylani sat down at the computer and, convinced it was the only thing she could do, broke into Manny's(ph) email. It wasn't hard. He had used the same password for as long as she had known him: monstermanny.

She accessed his account and glanced down the page, seeing her past missives: Are you OK? Javier(ph) took two steps today. And yesterday's email: Email me ASAP. All the while feeling something grow behind her lungs, something that wanted to swallow the air inside of her.

Most of the emails had not been opened yet, but her husband had definitely been online. A message from one of his high school friends, dated just two days before, was no longer in the new mail section.

At that point, she ought to have clicked on the mouse on the little X in the corner in the screen. She ought to have leaned back in relief, certain he was fine. But she felt the thing in her chest expand, and she continued skimming over the messages that Manny had read.

There was one from his brother, a forward from another buddy from home; something she hoped was junk mail, advertising pictures of Britney Spears' crotch; and one from a name she didn't recognize, a Michelle C. Rand(ph) at usarmy.mil, titled "So Lonely."

@usarmy.mil was tacked onto every active-duty soldier account as an email address. The mouse hovered, the little arrow pointing at So. Who was this Michelle Rand, and why was she telling Manny she was lonely? Kaylani clicked open.

Manuel, are you coming over Tuesday? My roommate is on duty. We will have the whole night. I want your body so bad. Let me know ASAP, Shel.

DAVIES: And that is how this Army wife discovers that her husband appears to be having an affair overseas. So when an Army wife discovers something like this, I mean, like anyone who's rocked by this news, there are many things they can do.

They can confront their husband by phone or email. They could talk to friends. They could move out. They could talk to their mothers. One thing that Army wives can do is report them to the command, and there would be consequences, wouldn't there, particularly if it was fraternizing with someone else in the military, as this husband seemed to be doing?

Ms. FALLON: And the husband's - or the soldier's command would probably have to act, and it could go anywhere, I think, from, like, an official reprimand that would go into the soldier's record or just, you know, like a non-official talking to the soldiers involved and probably trying to separate them or transfer them to a different unit.

That's one of the lines, I think, that the Army has to walk is that they are so involved with their soldiers 24 hours a day, and they have such control over their lives that something that, to the outside world, the civilian world, you know, your boss would have nothing really to do if you're committing adultery.

But the Army has to take that very seriously because the repercussions could endanger the lives of soldiers if it's happening during a deployment. It also could wreak havoc on the social structure at home, among the wives. They really need to make sure that the soldiers are as happy as possible, as well as the wives, because it's such a tightly woven community.

DAVIES: So if she reports this to the command structure, other people know, right? I mean, probably other people on the base, probably other people in the soldier's unit. And that's something that she has to think about, right?

Ms. FALLON: Oh, yeah, exactly.

DAVIES: Do you want to say what this woman did?

Ms. FALLON: In the case of this story, Kaylani decides to do nothing, and she approaches the wife of their commanding officer and then decides against telling her.

DAVIES: Right, he returns home, and she ends up wanting to confront him but not doing so, and then she discovers he's having - you know, he's seen horrible things, and he's having nightmares at night and chooses to just treat it as an experience that he'd had overseas where a lot of things happened that might be regrettable, but they're going to put it behind them. Do you find this sort of a common way of dealing with it?

Ms. FALLON: Yeah, when the soldiers come home, the spouses want to have a fresh start. And it's a fresh start for both of them because the spouses had that long, lonely year, and they know that their spouses, you know, the soldier has been through an awful lot.

And a lot of times, the soldiers really don't want to share all of the experiences, obviously, with their spouse. When they are in the war zone, they don't want their spouse to really worry about them and know what they might be going through.

And then when they come home, it seems almost like old news, like you're starting over, and usually you can be sent to a new base. So it gives this whole feel of a new life starting, and I think it's easier, then to almost pretend that the old life no longer exists or has an impact on the return.

DAVIES: There's another interesting kind of take on this. In the opening story of the book, which is called "You Know When the Men Are Gone," which is also, of course, the title of your book.

And your character meets this woman Natalia(ph), who is different from others, other wives on the base. Explain her story, how she's different.

Ms. FALLON: Well, Natalia was someone that her husband had met when he had been deployed previously to Bosnia. So she represents a massive threat to the spouses who are at Fort Hood because she's someone that the soldier actually brought, physically brought back from a deployment to replace the wife he had had.

And she's everything they fear most about: one, like, not knowing what's happening with the soldier who's overseas and that he might find someone younger and prettier and more stylish and exotic, in their eyes.

So she starts off as a threat just because of her background of having been the mistress, and then Natalia resists all of the efforts of the wives to become one of them. Like, she doesn't attend the meetings, and she doesn't wash the cars or bake the cookies or do the other things that creates, like, a cohesive wife community.

DAVIES: In your experience, do military wives talk about these threats of infidelity with each other? I mean, there's a moment in one of the books where someone says, well, there's so-and-so who's a female abroad in a support role in a unit, and she's a home-wrecker. Was there a lot of talk like that?

Ms. FALLON: I think it's definitely a fear, and it was actually one of the positive things about having a soldier in the infantry. And so some of the wives that I knew, we would joke about how lucky we are that there weren't women, and it was one of the only things we didn't have to worry about with our soldiers being deployed.

But when your soldier's away for an entire year, you're going to imagine the worst of everything that could possibly happen. It's just one of the many things that I think spouses would seize upon. And it's something that you could blame another person, you know, and it's something we would fear in ordinary American society.

So it's almost easier to imagine than the more horrific things that could happen to your soldier. So I think it was fed because it was part of the common experience versus the situations you wanted to avoid thinking about completely that might happen to a soldier deployed.

DAVIES: We're speaking with Siobhan Fallon. She's written a collection of short stories called "You Know When the Men Are Gone." We'll talk more after a short break. This is FRESH AIR.

(Soundbite of music)

DAVIES: If you're just joining us, our guest is Siobhan Fallon. She is a military wife who has written a collection of short stories about the experience. It's called "You Know When the Men Are Gone."

One story that you write, "Camp Liberty," the one that is set in Iraq, you're really following not a military wife, you're following, you know, a soldier, a sergeant who leads a unit in Iraq.

And the descriptions are very detailed and very evocative. I mean, I really feel like I'm in the Humvee with this guy and inside his head. I think I'd like to have you read a piece of your description of this soldier.

So this is a section where you're writing about a sergeant, a guy who had been an investment banker. His name is David Moguson(ph). In his civilian life, he was called David, but in the Army, they call him Mogue. And you're describing what he experiences after coming back from some time on leave, and he was sort of discontented, and his nose was running, and this is the description of when he's back with his unit.

Ms. FALLON: (Reading) His runny nose immediately dried up, and he felt alert again, awake at dawn to the call to prayer that reverberated around the base. It was as if his body had grown dependent on the 120-degree days and the 40-degree nights, the long-sleeve camouflage uniform and the heavy lace-up boots, the weight of the helmet and the 40-pound Kevlar vest, the tinny water fed to his mouth by a warm tube from the camelback slung over his shoulder, the churned-out high-calorie but tasteless eggs at the chow hall in the morning, the dried-out MRE bags in the afternoon, sleep-deprived nights of helicopters landing or mortars ringing with the usual bad aim against the perimeter of the base.

His body thrived in the desert. His Mogue thrived, while the weak little David crawled deeper into hibernation, and Mogue was seized with a terrible thought: What if, after all of his longing to get out and get on with his life, in his comfortable middle age, he would look back at this time and realize that his years in the Army were the most vivid, the most startling real of his entire life? Maybe he should not be getting out after all.

DAVIES: And that's Siobhan Fallon from her book of collective short stories, "You Know When the Men Are Gone."

You have a lot of photos of Fort Hood on your website, and there's one - which are really interesting to look at, by the way.

Ms. FALLON: Thank you.

DAVIES: They add a lot to story, if one wants to read the book. But there's one that - you have a picture of a sign at a parking area, and it says: reserved parking for a gold star family.

Ms. FALLON: Yes.

DAVIES: Explain that.

Ms. FALLON: Well, gold star is the euphemism for a family who's had a soldier die. It would be one of the parking spots at the very front of, you know, a commissary or BX. And it's kind of a scary reminder.

So all of the - you know, you drive by, when you go get your groceries, and you see that gold star spot, and you're just praying that you will never have to use it. And then, of course, it refers to other benefits, too. Like, gold star families are how we refer to families who have lost a soldier.

DAVIES: Yeah, I have to say it makes, you know, what for a lot of people is a private kind of pain very public.

Ms. FALLON: Yeah. Yeah, and that story of mine, "Gold Star," that's the issue that the protagonist is dealing with, whether she ought to take the spot or not because she knows as soon as she pulls into it, the entire parking lot will immediately know everything, which is almost everything her life has become at that point with her soldier having recently died.

And she has to weigh the importance of, you know, whether she wants to find a spot on a very busy day at the commissary or keep her grief to herself.

DAVIES: You know, you write that a military wife really has different lives that they live, you know, when the soldier is deployed and when he's not. And, in a way, you're busier, too. I mean, you're a single parent. You've got to balance the checkbook, and if there's a leaky faucet, either fix it or find somebody to fix it and, you know, change the kids' schedules.

And then a year later, the husband comes home. What are some of the adjustments that that requires?

Ms. FALLON: You know, it's pretty wild. I know, I've been through three deployments, and each time, I would assume they'd be easier because it's something I've done, but I just have - each time, I forget how much I would depend on my husband for these small details in my life that I didn't even realize he was doing and the things that he would naturally take care of.

And then suddenly he was gone, and I would have no idea what plumber we used or, I don't know, how to turn off the furnace or turn it back on or reset it, just these things that I can't call him to even find out.

So it's definitely a tremendous readjustment when your soldier leaves, and it's almost as big of a readjustment when he returns because after a year, you've actually finally figured out how to be independent and do everything that you need to do for your child or for yourself.

And then your soldier returns, and suddenly you both have been so independent, and now you need to become dependent on each other. So I think it's natural that there would be a little tension in that situation.

DAVIES: Right, and his head is, in some ways, still in, you know, life-threatening situations he was in and camaraderie with the unit that, you know, was primal.

Ms. FALLON: Right.

DAVIES: One of the interesting things that you write about are pamphlets that the Army gives soldiers on how they should behave when they return. Do you want to share some of the advice they give?

Ms. FALLON: The Army has really been trying very hard, I think, to handle all sorts of situations. And one of the things they make the soldiers do before they return is they have them fill out all of these surveys to pinpoint problems that they might have and that the soldiers might not even be aware of.

And then they return, and they all have to go to a certain amount of counseling sessions, and I think that's actually fairly new. My husband's most recent return, I remember he had a few days that he had to go to these long, long classes.

And, of course, you want your husband home, and then suddenly he's got to report in to work like the day after he returns. But I see the value in that, and I think it's - I mean, we all have that wonderful image of the reunion, and we think only that far. We don't really think beyond that.

DAVIES: I wanted to share some of the tips in a pamphlet that you write about in the book. These are things a soldier should remember, from this Army pamphlet when they come back:

No cursing. Your family members are not your men. They are not your squadron or platoon. They do not have to obey your orders. Your wife has been handling finances, disciplining the children during your absence. Don't expect to suddenly walk in and take over. Work with her, be patient. Tell her you appreciate the job she has done. Take time to be charming.

And then this fascinating one: Psychologists recommend that you do not engage in intercourse with your wife immediately upon return. Wait a few days, until she shows signs of responding to you. Be patient. Good advice?

Ms. FALLON: Yes, I think so. Most of that was actually taken from an Army pamphlet. So that's definitely advice that we're told.

And again, it's just something you kind of need to be reminded of when you have expectations that might not be met and from both points of view, you know, for the spouse, as well as the soldier. So it's good to know that there's a readjustment stage.

DAVIES: All right, well, I wish both you and your husband safety and good travels.

Ms. FALLON: Thank you.

DAVIES: Siobhan Fallon, thanks so much for being with us.

Ms. FALLON: Thank you, Dave.

DAVIES: Siobhan Fallon is leaving soon for Jordan, where her husband will be stationed. Her collection of short stories is called "You Know When the Men Are Gone." You can read an excerpt on our website, freshair.npr.org. I'm Dave Davies, and this is FRESH AIR.

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Fiction

Rabu, 19 Januari 2011

“'Multiple Fictions' Drive Opposition To Health Law - Kaiser Health News” plus 1 more

“'Multiple Fictions' Drive Opposition To Health Law - Kaiser Health News” plus 1 more

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