I don't do a lot of shoe-leather journalism these days, unless chatting up an executive in the lobby of a $400-a-night hotel belongs in that category.
So on a gray Monday afternoon I took the subway to Los Angeles City Hall. It's an iconic building that has graced police badges and various city documents since the day it opened more than 80 years ago. However, its front lawn has become a little shopworn of late, as it's playing host to the LA edition of the "Occupy Wall Street" movement. I wanted to know what these people have to say about healthcare--and whether it's relevant to anyone.
My first impressions of Occupy LA were not terrific. It is a motley collection of tents and signs, many of which sport Socialist slogans and graphics--which in case you haven't noticed, have about as much traction in this country as a landfill of bald tires. The piney scent of marijuana smoke occasionally drifted into my nostrils, which I generously presumed was for medicinal purposes. Nevertheless, the word "hippies" kept on echoing in my head in the tones of Eric Cartman, the wide-bodied and narrow-minded kid from "South Park."
A man named Tony King, sporting a vest with the logo of the Columbia Management investment firm, made a blunt assessment: "Most of these people are here because they're homeless, and they can sleep here all day without being hassled," he said. But King, like everyone else I interviewed, is not what he appeared to be. More on that later.
One of the first contradictions: More than 2 million residents of Los Angeles County lack health insurance, but virtually everyone I spoke with had good coverage. Ironically, the first person I interviewed had about the best health insurance you can get in the United States. Kevin Nally, a 21-year-old studying international relations at California State University at Long Beach, is in the TriCare program due to his father being a Marine Corps officer. That plan hasn't raised its premiums since the mid-1990s.
Nevertheless, Nally is aware of his good fortune. "I feel bad for people, many of whom can't get care, while there is an ongoing debate as to whether quality or access is most important," he said.
"We could look to the European model. But we have a pride issue--that our system is the best in the world, and that keeps us from looking at other examples for care," he added. "Maybe if those who wanted to limit access were willing to invest more, it would pay off for them."
By all rights, Maureen Cruise shouldn't be at the encampment. She's a 61-year-old retired nurse, her husband's a retired attorney and they live in Pacific Palisades, one of LA's wealthiest enclaves. But she believes the healthcare industry has come under the force of what she called "financialization." That is a combination of simultaneously overspending--she noted that providers relentlessly marketed more than 6,000 new medical devices and drugs every year--while denying care.
"The insurance industry has to disappear. If you put a company in the middle that makes money denying services and care, and because they have shareholders they have to post a bigger profit every year. That leads to more denial of services," she said.
Cruise added that people tend to conflate their healthcare with their insurer. "Healthcare is supposed to take care of your well-being," she observed.
Cruise is enrolled in Kaiser, a political as much as a lifestyle choice. "It's the closest to what you would get in Europe," she said. "When the care is under the control of the payer as well, they want you to be well."
Which brings me back to 68-year-old King. His observations of the residency status of the Occupy LA are less from being judgmental than the fact he volunteers for an organization that assists the homeless. And while he is currently married and enrolled in Medicare, he is keenly aware that the vicissitudes of old age could make him one of the people he currently helps. "When you get older and unwanted, and you don't have family or ties to neighborhood service programs, you're put in the trash," he said. And of course, the "frequent fliers" who plague many an urban emergency room are usually without a permanent address--something many hospital executives are only now beginning to address.
There weren't many practical or even original solutions being offered by the people I interviewed; just worries about our healthcare system, virtually all of which are legitimate. Strip away the tents and slogans and the concerns are essentially what plague us all.
As I exited, I politely declined an offer to have my button-down work shirt stamped with an Occupy LA logo. I asked the man who was manning the ink trays and rollers his view on healthcare.
"I'm not really up on that," he told me, flashing a gap in his mouth where a front tooth was missing. "I guess the best thing I can say is 'wash your hands.'" - Ron (@FierceHealth)