A bit of good news

From the BBC News. A bit of good news for a change! Nice to see some progress being make in addressing prejudice and injustice.

California lifts gay marriage ban

California's ruling is expected to have an impact on the nationwide debate

California's top court has ruled that a state law banning marriage between same-sex couples is unconstitutional.

The state's Supreme Court said the "right to form a family relationship" applied to all Californians regardless of sexuality.

The ban was approved by voters in 2000 but challenged by gay rights activists and the city of San Francisco.

The state legislature twice passed laws to legalise gay marriage, but Governor Arnold Schwarzenegger vetoed them.

He said California's court system should rule on the matter.

The seven-judge panel voted 4-3 in favour of the plaintiffs who argued that the 2000 law was discriminatory.

"Limiting the designation of marriage to a union 'between a man and a woman' is unconstitutional and must be stricken from the statute," California Chief Justice Ron George said in the written opinion.

'Historic'

The decision was met outside the courthouse by cheers from gay marriage supporters.

"I'm profoundly grateful. This is a historic day," said San Francisco City Attorney Dennis Herrera, who argued the city's case to the court.

"Everybody being entitled to equal protection under the law probably carried the day," he said.

The ruling paves the way for California to become only the second US state, after Massachusetts, to allow same-sex marriage.

The decision is expected to re-invigorate the fight for same-sex marriage rights nationwide, say gay activists and legal experts.

California's Supreme Court has a history of landmark rulings that are later picked nationally.

The state currently offers same-sex couples who register as domestic partners the same legal rights and responsibilities as married men and women.

Other states, such as Vermont and New Jersey, have similar civil union provisions.

Californian voters approved the ban against same-sex marriages in a 2000 referendum. The law stated that "only marriage between a man and a woman is valid or recognised in California".

In early 2004, San Francisco became the first place in the US where gay couples were able to marry after the city's Mayor Gavin Newsom authorised same-sex marriage licences, claiming the state legislation was discriminatory.

In August of that year, California's Supreme Court ruled the mayor had overstepped his authority and nullified the hundreds of marriages.

Gay rights group Equality California was joined by nearly two dozen gay couples and the city of San Francisco in bringing the case to the Supreme Court.

Hagee Apology to Roman Catholics

Fresh from NPR. This is the same "christian" who recently apologized for claiming Hurricane Katrina hit New Orleans as God's punishment. At some point you have to wonderful what sort of faith he really has. Sounds more like anger than faith. I'm sure Jesus weeps.

Evangelist Hagee Apologizes for Catholic Slur

Listen Now [39 sec] add to playlist

All Things Considered, May 13, 2008 · Influential and controversial televangelist John Hagee has apologized to Catholics for referring to the Roman Catholic Church as the "great whore." Hagee is supporting Sen. John McCain for president, which has led some Catholic leaders to criticize McCain.

Part two of the Health Care crisis, from the Episcopal Cafe

We all paid for Polly

from Episcopal Cafe by Jim Naughton

Second of two parts

By Andrew Gerns

Recently I presided at the funeral of a woman named Polly, who I had come to know a bit in the months before her death. I was familiar with her medical care, and it struck me that in her last years almost all of her energy she spent on paying for it.

The more I thought about Polly’s situation, the more I realized that we are all at risk of the very same fate. Not just the poor and the working poor, but everyone who stays in a job “for the insurance” or who considers putting off a doctor’s visit or filling a prescription either because of the cost, the hassle of dealing with insurers, or an inability to handle growing “co-pays.”

Other healthcare systems around the world handle sick people the way we handle sick pets. No one is cared for unless they pay the money up front and even then they must bring their own food, bandages and relatives to care for them during recovery. We are in a system that guarantees a minimal level of access but which often saddles a person or family with a mountain of debt and which often does not cover the cost of providing the care in the first place.

The way we structure paying for healthcare poses serious moral questions for all of us. Namely, who pays for Polly? Because of the way the system of reimbursement is structured and because of the way the health care market works, we are all complicit in the health care mess.

Today we work under an operating principle that assumes that I will only pay for the cost of my care, and I want that cost as low as possible. Know it or not, we are all caught up in that game: insurer, employer and consumer. None of us want to pay more than what is supposed to cost to care for me and me alone.

And no one of us wants to pay for overhead.

The choices that are made because we only want to pay for own costs and no one else’s left Polly out in the cold.

When the Great HMO Experiment collapsed in the late 1990's and early 2000's, we were left with a system that contains many elements of everything that came before it. Which brings us back to how providers and insurances negotiate rates.

Each insurer group will go to each hospital or network and say "We will only pay $M". The hospital says well, we want to charge you "$X" because it really costs us "$Z" to provide this service. But at the end of the day, the provider will negotiate a "special rate" of $M and hope they make up for the short-fall on volume. But to justify this, to make "$M" really look like a discount, the published rate for any given service must be somewhere between $X and $Z.

So here's the formula: "$M" = rate paid, "$X" = rate charged and "$Z" = actual cost of care plus overhead. Hospitals and providers that survive and prosper are the ones who can build enough cash reserves to operate and grow based on getting as many people as possible who can, through their insurers, pay somewhere between "$M" and "$X" and enough patients who can actually afford to pay "$Z" when the insurance runs out or won't cover what they need.

The truth of the matter is that most providers have to get by on "$M" and from that pay for staff, supply and overhead. They have to staff and deliver care accordingly. Most of what passes for cost-containment doesn't contain costs at all, but shifts the actual costs someplace else.

And neither your (or your employer's or your government's) insurance premium nor your provider's negotiated rate of "$M" fully takes into account the cost of the competing bureaucracies, the one designed to maximize collections (provider) and the one designed to minimize payments (insurer). Every time you compare an explanation of benefits and a provider bill, you are caught in between the competing bureaucracies.

In truth, a provider in a reasonably busy market will charge a wide variety of rates for a wide variety of contracts looking for that magic balance of volume and reimbursement just to stay in business. If you think that you are only paying what it costs you to get the care you got, think again.

But wait, there's more. This is where we move from craziness to immorality.

If the provider has to post "$X" as their rate, even though most of the insurers that insured patients used has negotiated "$M", does any one pay "$X?" You bet! Polly paid.

Those without the "buying" power of a group pay full freight because they cannot negotiate a “discount.” That means the uninsured. That meant Polly.

When your local hospital, be it tax-exempt or for-profit, publishes it's "charity care" numbers, a large part of what you are seeing is the write-down between what it charges its poorest clients (because those with insurance including Medicare pay at a rate far below cost) and what it can ever possibly hope to collect.

In poor rural or urban areas, the cost of the write-downs can be greater than their collections, even if they are filled to the brim with patients. Without a healthy margin (or profit if the hospital is not tax-exempt), there is not enough cash to go from day to day and that means more debt. Which means that hospitals in poor areas spend much more money managing debt than paying for care.

Of course, the insurers have to make a profit to stay in business or, if they are the government, spend as little as possible for legislative and budgetary reasons. So they will do all they can to cap, limit, direct and ration care while at the same time paying as little as they can to the ones who provide the services.

The system is ripe with immoralities. Of the many immoralities of our "system" of paying for health-care, the biggest one of all is that we have broken the social contract that says that the majority of us who have help pay for the care of those who have not.

We have broken the contract that says that we are who are healthy, or even relatively healthy, and who have resources either in terms of insurance or wealth help pay for the care of those who are sick or poor, or who need extra care. We have devolved a system which will only tolerate what it seems to cost to pay for me alone and the system tries to make up for that fact with decreasing service, increasing overhead, and evermore limited access.

Having entered the system, Polly was all but bankrupted by it. One of the other documents that she never completed was the final order declaring her bankruptcy. She did not have the money to pay the court and lawyer fees to complete the process.

Polly's health suffered because her nutrition was compromised. Her baseline health was in the basement. Her dental care was non-existent, which left her open to all kinds of new health problems. She lived in substandard housing because that was what she could afford. She avoided follow-up care and basic care for things like colds and sore feet for obvious reasons. When she could, she bought her shoes and clothes at the dollar store or the Salvation Army.

On the other hand, she used to tell me or her doctor at the filling station that she had the best exercise program on earth...fifteen blocks each way. Only one way uphill!

We have a system so weighted towards the payers who can obtain the lowest rates, that there are many with no insurance or inadequate insurance who are charged the highest, unnegotiated rates out there. We have a system in which many with insurance are bankrupted because the more specialized care they need, or the longer they are in the system, the less likely it is that they will find providers who will accept only the payment assigned to them.

This is one reason why healthcare causes the most personal bankruptcies, why we have the most expensive health related bureaucracy and why we have the most inefficient and haphazard basic care delivery system of the major industrial economies.

I am not so naive to think that Polly is alone in this. Just look around your parish. There are probably many in her shoes, but perhaps not as obvious. These are the ones who are one serious illness away from disaster.

If we as a society are going to seriously and adequately address the health-care crisis in this nation, we will have to come to terms with the moral question of how we all share in the cost of each other's care. Are we responsible for each other, or not? Do we have obligations to each other, or not? We will bear, even on the most minimal level, each other's burdens, or not?

The sad truth is that one way or the other, we all paid--and will pay-- for Polly. We just didn't help her.

The Rev. Canon Andrew Gerns is rector of Trinity Episcopal Church in Easton, Pennsylvania in the Diocese of Bethlehem and keeps the blog Andrewplus.

Health Care crisis

A sad commentary on the state of health care for way too many people in our country. Certainly Jesus is weeping at the injustice of it all.

Who pays for Polly?

First of two parts

By Andrew Gerns

We all paid for Polly.

The other day, I did the funeral for a woman. Let's call her Polly. She lived alone, worked as a cashier in a gas-station/variety store 50 to 60 hours per week saving $5 here and $20 there to "pay off" the bills she carried after a being hospitalized for a seizure. As far as we can tell, her care was very good. Care was not the problem. The problem was that she was never going to pay her bills in anything like a normal lifetime.

She died of a massive stroke. She was able to have some of her organs donated to another. We prayed over her body at her bedside and did a pauper’s ceremony after she was cremated in a cardboard box.

I saw some of Polly's healthcare bills before she died. She was charged the highest possible rates that her hospital and most of her providers could charge. I know because I carefully track my own, everyday costs—and I am reasonably healthy—and I saw the difference that the same hospital charged Polly and what they charged me and my insurance company, and what my insurance company and I actually paid.

Between the two of us, I was the lucky one. Not only do I have insurance, but generally I do not have to pay the difference between what the hospital charges and what the insurance pays, except for a comparatively tiny co-pay. Part of my premium goes to pay for the negotiating power of the plan that my church-employer can pay for. Polly had no one to negotiate for her.

The only provider who cut her a break was her physician who often wrote off his care for her. He would make sure he bought his gas where she worked so he could check on her without her going to the office. On her death, she had mounds of charity care forms that were incomplete and unprocessed because either she did not understand them, was too busy working, or was too darned depressed.

Polly's story is everyone’s story. She is not alone. She was a little luckier because she had a small circle of folks who cared for her. But her story is a story about how astoundingly backwards our so-called health care system is: how fees are structured and how contracts with providers are negotiated.

I'm a priest not an economist, but I have spent nearly half my ministry in healthcare and this is what I have learned about how we pay (or don't pay) for our healthcare and what it meant to Polly and how we all pay in the end.

Most health insurance plans negotiate the rate they will pay with the provider or network of providers they will use. This provider could be a hospital and it might also be a pharmaceutical company.

This is why someone’s insurance will tend to emphasize one or two pharmaceutical companies over another regardless of what medication is needed and why most plans require extensive paperwork and appeals if a patient is prescribed a drug that is "off-list" and why patients are often "encouraged" to use generic or "clinically equivalent" brands through the creative use of co-pays. And why doctors are forced to use a ladder approach moving from the most general drug up to the most specific, in an attempt to keep that drug either generic or on-list, but which many times ends up costing patients lots of money in co-pays both in drugs and repeat visits and in mind-boggling waste because of both the paperwork and the volume of unused prescriptions.

But the thing I want to focus on is how hospitals and other providers have to negotiate rates with insurers and how that affects both the Pollys of this nation as well as the insured. The idea is this: the insurer wants to pay as little as possible for health care services but the provider needs to earn as much as possible through the money it collects.

In the "old days," a hospital had one rate system, usually covering three distinct operational areas: "room" which paid for the care the person received while in hospital, "board" which paid for support services that made the stay possible, and physicians who were paid separately. Often other providers and specialist areas were paid separately, too. In these "old days" there was an old-style Blue Cross, which covered hospitals, and a Blue Shield, which covered physician costs.

The system was simple, but was based on several assumptions that no longer apply about how health care was delivered: longer stays, a building boom in hospitals (that was both government-encouraged and market-driven) and the fact that providers were pretty much in charge of setting the costs.

The big disadvantage was that there was no way to contain costs and no incentive either. When the revolution of medical technology really took hold and every hospital, no matter how big or small, got into a space race of having to provide all the services and technologies that a competitor might provide. Every new technology both drove up costs and increased what hospitals charged. The old system had lots of flaws and it left many people out. It was also based on assumptions about who worked where, for how long and for what kind of company that no longer apply. The whole house o' cards collapsed in the 1980's.

The first attempt to contain this was the invention of DRGs. You know: the idea that the average appendectomy or child birth costs "$X" so that's what insurers would pay. If hospitals could keep costs below "$X" then they kept the difference, and if it cost more, then they'd eat it. The hope was that over the broad average of a typical year there would be more money kept than lost. It looked good on paper but had problems in reality. Still, some version of this tool is still with us today.

The next thing that happened was that it was decided that "cost-shifting" was bad. Very, very bad.

Cost-shifting means that a provider would pay for its poorer or money losing patients (who might not have been poor or uninsured but whose DRG-related insurance did not cover the cost of care) by spreading their costs over the whole pool of all their insured and wealthy patients. In other words, thems that had coverage helped pay for thems that did not.

When looked at micro, it seems unfair that my insurance rates should be higher because somebody else could not pay their bill. Cost-shifting became anathema in the era of the infamous Reagan "welfare queen." It was a rhetorical flourish describing a reality that never really existed but surely won votes! Cost-shifting was deemed to be bad because it seemed to encourage waste, fraud and personal irresponsibility.

But on the macro level, the end of cost-shifting meant the end of an important social contract that all of us together would share our resources to care for those who have fewer resources available to them.

The inability to address that basic social contract is the elephant in the room when it comes to talking about paying for health care today. The question comes down to this, who pays for Polly?

Tomorrow: Confronting the moral questions.

The Rev. Canon Andrew Gerns is rector of Trinity Episcopal Church in Easton, Pennsylvania in the Diocese of Bethlehem and keeps the blog Andrewplus.

I wonder what Jesus must think

It is sad indeed. I don't agree with all of the MadPriest's comments after the article, but it should make us think. How would Jesus react?

"Then a few people destroyedwhat many created with so much joy."

from Of course, I could be wrong... by MadPriest

From THE LOCAL (Germany):

A Munich gay group filed charges this week after unknown vandals took a paintbrush to the city's first gay-themed maypole. Spattered with grey paint were depictions of gay life in Munich's Glockenbachviertel neighborhood, where hundreds of gay and straight residents gathered last Thursday to erect the maypole, said Conrad Breyer, spokesman for the Gay Communication and Culture Centre of Munich (SUB).

"It could have been a stupid youth prank, but everywhere there were gay motifs - like a rainbow - exactly those points were painted. One could assume it's an anti-gay act," Breyer told The Local.

SUB organized the maypole with the cooperation of neighborhood officials, commissioning artists Robert C. Rore and Michael Borio to decorate the tablets that hang from the pole's crossbeams. Following local tradition, other organizations were to commission tablets in coming years until the maypole is full.

The project required city permits and cost more than €1,000.

"We are upset to an inordinate degree about this act of vandalism," SUB Director Lars Fröhlich said in a statement on Monday. "Five days ago the entire neighborhood - not just gays and lesbians - was putting this maypole up together and celebrating it with a party. Then a few people destroyed what many created with so much joy. This is totally unacceptable and makes us sad."

The grey paint cannot be washed off, Breyer said. Organizers are weighing whether to ask Rore and Borio to paint the tablets again or to leave the vandalism intact as an object lesson.

COMMENT: Homophobia and the need to destroy that which is beautiful go hand in hand. Within the Church, homophobes exclude, and if they don't get their way they tear the church apart by schismatic actions - their actions are never positive, they are never loving. They say that God's creation is beautiful, but they lie, they see no beauty. They prefer dry, uninterpreted text to art. That is why so many evangelicals are homophobes. They have the same mindset as the Iconoclasts, the puritans and the nazis.

They are jealous of beauty and hate the joy it brings. When they see beauty their overwhelming urge is to destroy it.

Sad news from our United Methodist sisters and brothers

Methodist delegates vote to reject same-sex unions

By TERRY LEE GOODRICH

Star-Telegram Staff Writer

FORT WORTH -- Delegates at the United Methodist Church's General Conference voted Wednesday to adhere to the church's position that marriage should not include same-sex unions and that homosexual acts are not compatible with Christian teaching.

Those guidelines are included in church's Social Principles, which do not have the force of church law but are to instruct the denomination's 11 million members. The nearly 1,000 delegates at the international conference at the Fort Worth Convention Center are struggling with social issues at the conference that ends Friday.

While affirming the existing guidelines about sexuality, delegates also approved a resolution Wednesday opposing homophobia.

Numerous delegates at the crowded session spoke into microphones placed around the convention center floor. One man from Africa said that "we love homosexuals, but we detest what they do."

Others said condemnation of homosexual behavior conflicts with Jesus' message of love and acceptance.

The church must guard against "denying companionship and intimacy in loving relationships just because there are differences of understanding," a Texas pastor said.

The Methodist Book of Discipline says all people are welcome to become members and receive sacraments, and at past conferences delegates have reaffirmed that gays and lesbians are people of "sacred worth." One man, who said he is gay, said the church is a "safe place. ... That should not be sacrificed."

A woman suggested that the Social Principles should be modified: "Let's just say we are all faithful Christians and agree to disagree."

WEDNESDAY'S VOTES

Approved, 517-416, keeping the statement that the practice of homosexuality is incompatible with Christian teaching.

Rejected, 574-298, a measure that would have changed the church's definition of marriage to include same-sex unions.

Approved, 544-365, a resolution opposing homophobia and discrimination against lesbians or gays.