“I don’t know what alarms me more, the state of our health care system or the fact that we accept it the way it is.” Thus spoke a friend of mine as we discussed the health problems of those dear to us. What follows is less of an essay and more of a series of vignettes that raised my blood pressure recently.

I was in the lobby of our local hospital recently, on my way to visit a friend who had broken his ankle rather badly. There was a large sign in the emergency room that said that the hospital is legally required to treat you even if you don’t have any money. There was another like it in the main lobby. This goes under the second clause of the initial quotation above. The fact that this isn’t simply understood by everyone tells a story about how hoodwinked people are about our basic human rights.

The friend who uttered the opening quotation also told me about an interview she heard on a British radio show. The guest was an American woman who had been diagnosed with cancer the day after her insurance had lapsed due to a clerical error by her employer. The woman spent a tense few weeks trying to rectify the situation, literally a life or death effort. Apparently the British interviewer had to keep reminding her to define her terms. “What is a co-payment? Our listeners wouldn’t know.”

Then there is the story of another friend who spends time in two different states, one in the east and one in the southwest. Her health insurance only works when she is in the eastern state. If she were to get sick in the southwest she would be on her own.

Getting back to the friend with the broken ankle, I was recently looking into bone growth stimulators. There is a class of devices that emit low intensity ultrasound directly into the affected place and stimulate bone growth. These are especially useful in cases where bones fail to heal rapidly.

I found one made by a company called Smith and Nephew. The Exogen 4000 appears to be a standard electronics box about 3” by 4” with an LCD screen and a cord leading to the small cylinder that emits the ultrasound. Apparently it retails for something between hundreds and thousands of dollars, depending on the source. This price spread is weird in itself. The real outrage, though, is how they power the thing. It has a non-rechargable, non-replaceable battery. The purchaser gets about 350-400 uses out of it and then it is junk. Used devices show up on eBay, with the sellers noting how many times it has been used and how many cycles should be left. It’s akin to buying a disposable laptop computer. It’s obvious that the device could be rechargeable or have a replaceable battery, or could even be plugged into the wall. However, Smith and Nephew, in its corporate greed, decided that profits should win out over affordability, effectively denying the use of their device to a class of uninsured. No way are these things going to be passed on from patient to patient indefinitely. It makes perfect sense financially, and it is a perfect crime against society.

Meanwhile, on the Vermont end of things, we put the call out through the neighborhood for various necessities for someone with a bum ankle, including a walker. Emails and calls came in and we found a couple who runs a free medical appliance exchange out of their garage. These good people spend their spare time maintaining and distributing walkers, wheelchairs, crutches, and the like. We all pitch in around here.

It’s a bright spot in the gloom, but not a solution. It looks as if the nation’s bought and sold “representatives” in Washington will do the bidding of the insurance and drug industries. Vermont will have to navigate its own path to a rational health care system and let the rest of the country follow along.

In the meantime, try not to get too sick, ok?

Update: Just when my blood pressure was returning to normal, I read about another symptom of the recession. Some companies are cancelling their employee's health insurance plans without telling them. The first that people know about it is when they present their insurance card to the nurse and it gets handed right back.

President Obama held yet another one of those pointless town hall meetings in Montana recently. It did allow him to respond to some of the absolute mythology that the health insurance industry has been promoting, but the format itself is the folksy equivalent of a show trial. There is only the illusion of discussion and thought. Television viewers get the vicarious satisfaction of seeing their views expressed, pro or con, and the president gets to make his case to the .02% of the population as yet undecided.

Here’s one exchange:

Q My name is Mark Montgomery. I'm from Helena, Montana.

THE PRESIDENT: Great to see you, Mark.

Q I appreciate you coming here. It's great to be able to do this.

THE PRESIDENT: Thank you.

Q Mr. President, I make a living selling individual health insurance. (Laughter.) Obviously I've paid very close attention to this insurance debate. As you know, the health insurance companies are in favor of health care reform and have a number of very good proposals before Congress to work with government to provide insurance for the uninsured and cover individuals with preexisting conditions. Why is it that you've changed your strategy from talking about health care reform to health insurance reform and decided to vilify the insurance companies? (Applause.)

THE PRESIDENT: Okay, that's a fair question, that's a fair question. First of all, you are absolutely right that the insurance companies, in some cases, have been constructive. So I'll give you a particular example. Aetna has been trying to work with us in dealing with some of this preexisting conditions stuff. And that's absolutely true. And there are other companies who have done the same.

Now, I want to just be honest with you, and I think Max will testify, that in some cases what we've seen is also funding in opposition by some other insurance companies to any kind of reform proposals. So my intent is not to vilify insurance companies. If I was vilifying them, what we would be doing would be to say that private insurance has no place in the health care market, and some people believe that.

I don't believe that. (Applause.) What I've said is let's work with the existing system. We've got private insurers out there. But what we do have to make sure of is that certain practices that are very tough on people, that those practices change.

Now, one point I want to make about insurance: Some of the reforms that we want for the insurance market are very hard to achieve, unless we've got everybody covered. This is the reason the insurance companies are willing to support reform, because their attitude is if we can't exclude people for preexisting conditions, for example, if we can't cherry pick the healthy folks from the not-so-healthy folks, well, that means that we're taking on more people with more expensive care. What's in it for us? The answer is if they've got more customers, then they're willing to make sure that they are eliminating some of these practices. If they've got fewer customers, they're less willing to do it.

So it's important for people -- when people ask me sometimes, why don't you just do the insurance reform stuff and not expand coverage for more people, my answer is I can't do the insurance reform stuff by itself. The only way that we can change some of the insurance practices that are hurting people now is to make sure that everybody is covered and everybody has got a stake in it, and then the insurance companies are able and willing to make some of these changes that will help people who have insurance right now. But thank you for the question. I appreciate it. (Applause.)

Sorry, Mr. President, but that was anemic. Here’s a preferable response.

THE PRESIDENT: Okay, that's a fair question, that's a fair question. First of all, I am vilifying insurance companies because they richly deserve vilifying. In fact, when you look at their behavior over the past few decades, you’ll see that they deserve prosecution for fraud. In some cases they probably deserve prosecution for murder, when denial of coverage could easily have been predicted to cause the death of the insured person. Where’s the Tarpeian rock when you need it? Whoops, any classics scholars out there? (Laughter) In ancient Rome they pitched murderers off a rocky cliff, and at least figuratively that’s what we need to do to the health insurance industry. (Applause)

They are playing at cooperation with reform efforts right now. I guess that with the Blue Dog Democrats in their pockets they expect to write in some more subsidies for themselves. They certainly aren’t acting out of the goodness of their hearts, because, well, there’s no goodness in there. Just raw profit motive.

There is ample evidence that they have groups of employees whose sole purpose is to exploit any tiny loophole in their complex contracts to deny people the coverage they paid for and that they deserve. The whole industry is based on suckering people into signing flawed contracts and then breaking those contracts when they think they can get away with it. That’s fraud. It’s also downright immoral. The executives and upper management should consider themselves lucky if they don’t end up behind bars. Once they are in prison I’d make them pay out of pocket for their medical care. (Laughter, Applause)

So, Mr. Montgomery, I consider you the equivalent of a minor errand runner for an organized crime family. Perhaps you do your job with the best of intentions, but thousands of Americans die every year thanks to the efforts of your employers, and millions more suffer pain and hardship. Tens of thousands go bankrupt. If I have my way you will be looking for a new job soon, one that doesn’t involve contractual fraud and sucking the lifeblood from the American people. I hope you enjoy your new anus. I enjoyed tearing it for you. Okay, time for one more question – back there…

In my dreams. Now it seems that the White House is backing off from the public health insurance option. The insurance companies will continue their dominance in the sole industrialized nation without a public health care program. We’ll keep forking over the money and fighting for our benefits. It’s the money, folks, the campaign money.