To read this serial novel from the beginning, go here.

Land Lines

 
He couldn't sleep. Rove had let him and Marsha go "without prejudice," but something was not quite right. Cardinal sat up late thinking, but he couldn't figure out what was wrong. He reached for his cell phone, then stopped himself. With the new FISA laws, using a cell was about as safe as skywriting.

Instead he picked up his old fashioned land-line and dialed. His was a rotary phone, the model that hung in his grandma's house the day Ma Bell died. He recently installed it because an insider had told him the NSA computers had a bug that sometimes caused them to miss the old pulse dialing. The call went through, and a voice mumbled on the other end.

"Hello, Marsha?"

"Cardinal."

"I hope I'm not interrupting anything. You don't have someone with you tonight, do you?"

"You mean, am I sleeping with someone? No, Cardinal. In case you forgot, I was in Istanbul for the last 6 weeks trying to get you out of a Turkish prison. I've been in the U.S. for 12 hours and no, I haven't had time to hook up."

"Good. Anyway, I want to ask you something. Something bothers me about the way things went down today. I can't figure out what it is, though."

"You mean because Rove let us off so easily."

"That's it."

"Let's talk about it tomorrow. Remember, I am still your attorney, so our private conversations are protected. We can meet in my office. They won't bug us."

"You assume the Feds have ethics. Let's talk at a public place instead. I'll come to your office and we'll walk."

The next day, Cardinal picked Marsha up at her office and they headed over to the public library. "G-men don't read," he said. "At least not in this administration."

They sat at a desk in the card catalog room. No one under seventy in sight. "All right, here's the deal," Marsha said. "I think the government is using you as a pawn, a distraction."

"A distraction? From what?"

"I haven't figured that one out yet. They send you out on a dangerous mission, and you create all kinds of havoc. You did it twice, once with the hijacked plane, and then in Syria and Turkey. The noise you create allows them to do other things, without the public noticing. You take up all the public bandwidth, you might say."

"Marsha, the hijacking was an accident. We just happened to come across the ELFs --"

"You think so? I think the ELFs were a plant, to get you to do, well, you know, what you always do. Ever heard of the ELFs before, or since?"

"Well, no."

"Precisely. They were government. That's why we got out of the hijacking scot free. It is also how we got out of Turkey. The Feds let us create a distraction, and then when the distraction was no longer needed, they got us out."

"So you think Rove suckered us."

"I do. The question is, what was the distraction for? I've been checking the papers, looking for suspicious happenings while we were creating our diversions. During both times we got into trouble, two things happened. First, there was a major flood. Second, a blockbuster pharmaceutical was withdrawn from the market. Now, I can't see how the government could control a natural disaster, so I am thinking there is a connection with the drug withdrawals."

"Like what?"

"I haven't figured that out yet. Maybe terrorists are trying to poison people. Maybe the government has a shady deal going with the big pharmaceutical companies."

"Well, I guess we have some detective work to do."

"Yes. There is a major pharmaceutical convention going on in Las Vegas this week. I think we need to get over there and do a little investigating."

"I'm up for that. The place will be swarming with pharmaceutical reps. I hear those chicks are hot."

 

Yesterday I received a message at my office and was called to the bedside of health care reform. The patient's pupillary and gag reflexes were absent; there was no palpable pulse. Chest exam revealed no respiratory effort and absence of heart sounds. The patient was pronounced dead at the time of examination.

The cause of death? Reckless campaign promises, made by the two remaining Democratic candidates in the debate Wednesday night. This is how Walter Shapiro reported it in Salon:

Wednesday night's debate may have more lasting significance if either Obama or Clinton is elected president than it did in helping sort out the primary field. Pressed by [moderator George] Stephanopoulos to make a "read my lips" no-new-taxes-on-the-middle-class promise, both candidates took the bait. Clinton expressed this Republican-esque promise in unequivocal terms: "I am absolutely committed to not raising a single tax on middle-class Americans, people making less than $250,000 a year." Obama eagerly joined in this bidding war, saying, "I not only have pledged not to raise their taxes, I've been the first candidate in this race to specifically say I would cut their taxes."

Both of these candidates have been traveling coast to coast, promising sweeping health care reform. Now, I do not pretend to be a financial whiz, but I know enough about health care to say with confidence that it will be impossible to provide universal health care without raising taxes. Obama/Clinton may respond by saying that we will find the money to insure 47 million Americans by (1) ending the Iraq War, (2) making health care more efficient, and (3) allowing the Bush tax cuts on the rich to expire.

Hoooey. The Republicans have been foisting this something-for-nothing nonsense for decades now. It never works. Real, comprehensive health care reform will require tax increases on everyone. A mandate requiring every American to carry health insurance is, in itself, a tax. Clinton proposes mandates. Obama does not, but as soon as he looks at the budget numbers if he is elected president, he will change his mind. I don't think universal health coverage can be achieved without mandates, at a bare minimum.

At any rate, whichever health care reform is proposed, it is completely irresponsible for any candidate to promise that he or she can make it happen without broad-based tax increases. No other industrialized nation manages it without some kind of tax, be it direct (via income) or indirect (with mandates). It can't be done.

From my perpsectivie, health care reform is DOA on the Democratic side without taxation at least on the negotiating table. Let's assume Clinton is right and reform can be financed purely through savings from requiring everyone who can afford it to buy coverage. This is a big if. To put such reforms on the table without at least a backup plan for financing is ridiculous.

People who are serious about health care reform will admit it will be expensive and may require new taxes. People who won't are candy salesmen.

All this talk about who has the courage to answer the phone at 3 AM,and neither candidate has the guts to tell Americans universal health care is going to cost them money. Well, maybe we'll find someone serious about reform in 2012. 2008 is already history, as far as I am concerned.

Tax day seems like a perfect time to talk about another tax problem, one that threatens health care in the state of Mississippi. As America's poorest state, Mississippi enjoys the distinction of having a high percentage of citizens that qualify for Medicaid. Mississippi hospitals see a lot of Medicaid patients, with the largest burden falling on the state's 10 publicly-owned hospitals. At our local hospital, about 25% of hospital charges are billed to the Medicaid program.

And most of it is never paid. This is a serious problem.

Medicaid, as most readers know, is a federally funded program that provides health care for the poor. It is administered by the states, with federal matching funds. Each state gets matching funds based on its per-capta income, and the match ranges from 50% for relatively wealthy states like California and Connecticut to 80%, the highest in the nation, for Mississippi. What this means is that in Mississippi, for every dollar the state spends on Medicaid, the federal government gives 4.

In the past, states, being states (that is, always looking for a free ride on the federal government's credit card), employed a clever workaround for the matching dollar issue. Instead of raising taxes for Medicaid dollars, the states paid nothing and simply instructed hospitals to put up the money themselves. The accounting worked this way: A hospital seeking Medicaid money would put up its own money, and the feds would match it. In Mississippi, that meant if a hospital had $2 million in Medicaid charges, it would put up 20% of that, and the federal government would then pay the rest.

That changed in the late 1990s when Washington decided this dodge was not the intent of the law. Congress then passed regulations to gradually close this loophole, requiring states to actually raise revenues to pay their percentage of Medicaid. Which is where the trouble began.

Most states have scrounged around and come up with revenue plans to pay their percentages out of pocket. Some states have adopted hospital bed taxes, in which hospitals pay a percent of revenue earned by each hospital bed. Others have raised excise taxes, including cigarette or alcohol taxes. Arkansas levied a one cent tax on soft drinks.

Mississippi, as a very conservative and tax-adverse state, has so far done nothing, instead allowing hospitals that care for Medicaid populations to fall into insolvency largely over unpaid Medicaid charges. The state government is considering action, with all the urgency of a bunch of frat boys moving to complain that the kitchen sink is running hot and cold Budweiser.

Our dear Governor, Haley Barbour, favors the bed tax. Key members of the state legislature favor cigarette or alcohol taxes. Unfortunately, there is a standoff because neither side will support the other's proposal. Private hospitals are lobbying legislators against the bed tax, because they only see a small number of Medicaid patients (less than 5%) and would rather do without the Medicaid than pay a new tax. The governor is against the cigarette tax, probably for two reasons: (1) He made a fortune as a Washington lobbyist before becoming governor and doesn't want to burn old bridges by offending the tobacco industry; and (2) he is angling for a cabinet-level appointment should John McCain win the presidency in the fall and doesn't want a tax hike on his record. (For the record, the cigarette tax in Mississippi is 18 cents a pack.)

So while these two groups selfishly duke it out over Medicaid funding, hospitals that provide care to the poor suffer with unpaid Medicare bills. A few weeks ago, the public hospital in Natchez declared bankruptcy. Another hospital in the Mississippi Delta is considering defaulting on its bonds. A third, in Hattiesburg, declared a $32 million loss last year and instituted wage cuts and layoffs. That Hattiesburg hospital may also be looking at bankruptcy.

This is the human suffering political stubborness has wrought. The standoff between the Governor and the Legislature is like two groups of sailors on a sinking ship arguing whether they should use plastic or metal buckets to bail the water. They posture while several of the state's most important hospitals go down to the bottom.

The worst part is that, with the 80% match, a dollar raised for Medicaid results in a $4 bonanza for the state. If I could find an investment that yielded a 4 to 1 return, I would be hocking the hubcaps on my car for investment money. It is irresponsible that our representatives in Jackson would jeopardize one of the largest industries in the state for their own political gain.

And by the way, the standoff also hurts patients, and their access to quality medical care. But I forget myself. This is Mississippi. We don't give a damn about the poor.

I apologize for the scarcity of posts as of late. Don't blame it on me, blame it on Uncle Sam; I have been doing my taxes.  A few times I have been tempted to post about the injustices of the tax code, but I try to keep whining off my blog.

I know, I am only partly successful with that.

I have several chapters of the Blistering coming, and hope to say something about health care reform in the presidential election. But not before April 15. Happy Tax Day.