Talking Trash and Health Care Reform

There is an uproar in Gwinnett County, Georgia. We, as county residents, were informed by letter that there would be changes in how our trash is picked up from our homes. Where previously we could choose our trash hauler, we are now being assigned a trash hauler—based on the zone in which we live. Furthermore, instead of paying the new garbage hauling company directly, the costs of our trash pickup will be added to our property tax statements. “Ouch!” I just received the Notice of Taxes from the Gwinnett County Tax Commissioner.

I, along with most county residents, received the notice of the impending change early last month. A few days later my new rolling trash can was delivered to my driveway. After sitting several weeks on the side of my shed awaiting the predetermined date when my new hauler would begin servicing our family and our neighbors, it has now been placed into service and has functioned in its purpose a couple of times.

The mandated change determining who would be hauling our trash has not been embraced by all county residents. Instead, some have responded with a fervor not seen around Atlanta since Michael Vick’s dog fighting activity was exposed. Why the tumult? Is it because so many of us don’t like the new plan? Or, is it more about the difficulty we often have with change? Answering these questions not only exposes the driving force behind much of the outrage in the county, but it also exposes the reasons why some Americans cannot fathom embracing any significant health care reform.

CHANGE is an attempt to improve

The letter we received from Gwinnett County stated:

This new program increases recycling opportunities while reducing truck traffic, air and noise pollution, illegal dumping, and wear and tear on our streets. It also improves safety and health and preserves natural resources. In short, the new plan will contribute to cleaner neighborhoods, more efficient and cost-effective service, and environmental sustainability.

When I read this statement I could not argue with it. Our neighborhood has had several haulers coming through our neighborhood each week. They came on differing days and at various hours. Furthermore, since receiving this notification, I learned that some residents have refused to pay for garbage haulers and were illegally dumping their trash or filling the garbage bins of local businesses. Additionally, the new plan should make good on a promise of being good for our environment by reducing fuel use and increasing recycling. I see the advantages of the new plan.

The county officials who initiated this change were propelled by facts that called for change. With health care, there are also facts that demand change:

  • In our current health system—which isn’t truly a system—some Americans deliberately avoid physical exams or medical tests for fear of losing their health insurance.
  • In the United States we fall well short of the highest rankings for the health of newborns.
  • In the United States, we have the most expensive health care with 20% of our health care dollars going to marketing, underwriting, administration and profit.
  • Uninsured Americans are more likely to get sick and stay sick longer than their neighbors with health insurance.
  • In the United States people with money and insurance get the health care they need; many others are left out.
  • Hospitals in America, generally speaking, are not required to provide medical care until the health condition is considered an “emergency.”
  • The United States ranks 47th in the world when it comes to longevity of life.

Whether it is trash or health care, some facts mandate change.

CHANGE is most difficult if “I” don’t see the need for change

I was pleased with the trash hauler I had chosen and used for years. To my knowledge, they had never failed to pick up my trash. They did their job so well I didn’t have to worry about them failing to come or worry about them leaving my yard littered with remnants of trash. They served me well. Therefore, I did not have a personal need for any changes to my garbage pickup. I liked it the way it was. Yet, this is where we often reveal our selfishness.

Should I only be concerned about how a change will affect me personally? Should I take a stand based solely on the needs of my family? To put this in context of the trash, should it matter to me that some people are dumping their trash illegally, causing others—including county tax payers—to foot the bill? Should it matter to me that our former system was redundant, noisier, wasted energy, and less environmentally friendly? As a responsible citizen of our community I believe it is my responsibility to think outside of my personal comfort and ease.

With health care, I also have it pretty good. Though I do have deductibles and co-payments, I enjoy the benefit that my employer provides by paying 100% of the insurance premium for both me and my family. I have never been refused medical treatment. Anytime our family has needed medical care we have been able to get it. Several years ago my daughter had major back surgery. Even though the total cost of the operation and recovery was well over $100,000, the cost to me was negligible. I have been blessed with better than adequate health care. Therefore, at this point in my life, I don’t have a need for change in health care; the current system provides well for my family. Yet, again, I must ask if the health care debate is solely about me.

While the current health care system works for my family, it does not work for millions of other Americans. Should I care? Should I care that some mothers-to-be do not have access to adequate pre-natal care? Should I care that some of my fellow Americans cannot afford either the cost of a doctor’s visit or insurance? Should I care that some of us refrain from going to the doctor because we fear we will become uninsurable if we are diagnosed with a life threatening disease? If all that matters is “me” then I don’t want change. But, if I love my neighbor as myself, I am compelled to work for change.

CHANGE means someone will lose

Though we would love for everyone to experience a “win,” not every decision translates into a win for everyone. Under the new trash plan, the unincorporated sections of the county are divided into five zones, each with its own designated trash haulers. The streamlined payment system, via property taxes, will probably mean a reduced need for administrative staff. The need for sales personnel for Gwinnett will diminish. There are some losers—real losers. Increased efficiencies will translate into people losing jobs in a job market already rocked by high unemployment. The reduction in fuel usage will also mean a reduction in fuel purchased. Furthermore, many homeowners are angry over the loss of their ability to choose their hauler. Not everyone will experience this change without feeling a loss.

On a much larger scale, depending on the extent of change, health care reform will mean somebody has to lose. Some will have to pay more for their medical care. Many in the medical and insurance industry will see a reduction in profit which will lead to reduced wages and the loss of jobs. Particularly, employees working in the administrative branches of health care and insurance will lose their jobs; I could be one of them.

I work for an insurance broker in Atlanta. We assist our clients in navigating the maze of benefit plans for their organizations. We negotiate on their behalf in selecting plans. We advise them on choosing the right plans for their business and their employees. We assist them with the mounds of paperwork needed to enroll. We represent their employees in filing claims with the insurance companies. We provide an extremely valuable and necessary service within the framework of our current health care system and we help drive down costs. Yet, the key words here are “our current health care system.” We must ask, “Is this the best possible system?” From my vantage point, an efficient change in our health care system would diminish the need for many of the positions within the insurance industry and some departments within health care.

Brokers in Atlanta, like my employer, combine to spend millions of dollars every year on redundant administrative tasks and marketing. This money is spent on such activities as clamoring for new clients, completing mountains of paperwork for enrollments, Medical Health Questionnaires, Requests for Proposals, and claim resolution. This is just in Atlanta. Our current system demands it. Only about 80% of every dollar spent for health insurance premiums to for-profit health insurance companies goes toward medical care. The remaining 20% is for administration and profit. This high percentage of healthcare dollars being used on administration and profit contributes to another area where the U.S. leads the industrialized world; we lead the world in spending on healthcare as a percentage of GDP.

A correction is needed. A more efficient, cost-effective and inclusive system, however, will require that someone “lose.”

Real CHANGE requires gusty leadership

A recent editorial in the Gwinnett County newspaper called on residents to remember the trash debacle when they go the polls in November. Politicians are often faced with the difficult choices of either leading for the common good or succumbing to the pressure of the outspoken, wealthy and influential—and often, the well-meaning misinformed. It takes a gusty leader to push for change. It takes a brave leader to defend the weak, the voiceless, and the exploited. It takes an uncommon leader who is willing to sacrifice her political future for the opportunity to defend the helpless.

I have serious doubts about the prospect of real change coming to our nation’s health care because of a lack of unwillingness of many of our nation’s leaders to dance outside their political party’s lines. Instead of being willing to listen to their hearts they are stuck in riding along the rails of the appointed talking-heads of their party. The result is a prostitution of the office. Change will require a gut check.

CHANGE requires caring

In Gwinnett County there are many who simply do not care. Some do not care that a change is taking place; As long as their trash is picked up they don’t care when it happens or who does it. Others have a different type of ambivalence. They have heard the arguments but they simply refuse to care that some neighbors are illegally dumping their garbage in our parks and forests. They don’t care that local business owners are paying additional charges for trash as a result of neighbors using the business’ garbage bins for the disposal of their trash. They don’t care about the environmental advantages of the new plan. They are so focused on their personal desires they are ambivalent to the needs of others.

This is where the analogy of Gwinnett County’s new trash plans falls well short of the debate on health care in America. Health care is a serious issue. It is an issue of life and death. It is an issue intricately tied to quality of life and the pursuit of happiness. As I listen to the debate, I am amazed of the blatant disregard for those who don’t have the opportunity to get basic health care. There is screaming about free choice, socialism, Marxism, Obamacare and big government—all the while ignoring the reality that there are neighbors drastically in need of medical attention and can’t get it. There is ambivalence to the difficult plight of the uninsurable. As I have kept my ear tuned to the debate on health care, rarely have I heard authentic care for the uninsured expressed. Rarely, if ever, have I heard arguments against reform coupled with solutions for the uninsured.

CHANGE requires a willingness to learn and understand

It wasn’t until I began to listen to the reasoning of our county’s leaders that I began to understand why they initiated a change for our garbage pick-up. Apart from the annoyance of multiple haulers moving through our neighborhood, I did not give much thought to the garbage issues. Furthermore, I was not aware of people refusing to pay for trash and illegally dumping their trash.

Not only was this true for me regarding trash haulers, it was also true regarding my understanding of health care. Just a year ago I was defiantly against health care reform. I viewed it simply as another example of income distribution. I saw health care reform as a political issue and, most importantly, all of the orators on my political side were against reform. Yet, for reasons I cannot fully explain, my views began to change.

The change for me began as I began to ponder what bearing my Christian faith should have on my view of health care reform. Then, I began to take notice of the conversations I would overhear where one of our individual and family insurance advisors would have to deliver the news to a potential new client: “Sorry, because of your illness you are not eligible for health insurance.” Sadly, though we are able to secure insurance for many, this is a message delivered several times a week in our office.

T.R. Reid’s “The Healing of America” was also an instrumental force in the change of my thinking. Though there is no indication that he shares any of my spiritual world-views, the facts he shared and the reasons he gave for why we need health care reform were compelling. Some of what Reid wrote was new information. Much of it, however, was simply providing a description of what I was already plainly observing, but trying to ignore. Once I was willing to be honest with the facts of the plight of the uninsured in America, I could no longer refute the need for change.

Fighting against CHANGE leads to rationalization

As I have listened to the debate on both health care and picking our garbage hauler, I have heard many reasons why change is not only unnecessary, but wrong. Liberty and freedom is often used; “The ability to choose in a free market society,” it is said, “is a uniquely American solution.” While this argument has more credence in the trash debate, it falls grossly short in the debate of health care. Many Americans are not free to choose basic health care. They are not free to go to a doctor. They are not free to receive preventative care. They are not free to receive treatment until the disease has moved from curable to terminal.

Furthermore, some of the most disturbing arguments against health care reform are the arguments attempting to define who is not receiving health care. Yes, there are young people who believe they are invincible and don’t need health care. Yes, there are undocumented immigrants who tax our health care system. Yes, there are those lazy individuals who want nothing more than a handout. However, to refuse to believe that there are responsible, hard-working Americans who do not have adequate access to health care is absurd. I certainly don’t want to define who is deserving of health care, yet for those who do want to make a distinction, please know that good people need help.

I didn’t need a change in my garbage hauler. Yet, I have no serious complaints with the newly assigned hauler. I am not thrilled about having to pay a little more for garbage pick-up. Nor am I excited about having my garbage collection added in a lump sum to my tax bill. Yet, I can manage with the new trash hauling plan. The effects on my life will be minimal.

Regardless of who picks up my trash, my life will not be significantly different. Sadly, however, unless there is health care reform the lives of many uninsured Americans will not be any better. It’s time to CHANGE how we look at health care reform. It’s time to quite the trash-talking about reform and extend an understanding and compassionate hand to the uninsured.


Jack Bruce is COO of an employee benefits firm in metro Atlanta, Georgia.

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15 responses to this post.

  1. This was one of the best commentaries on how off the mark much of our society’s conventional wisdom is. Your points are logical and the wisdom in them is straight forward. If one must embrace spiritual teachings in order to call for action for the common good so be it! I use the analogy of living in a condo. If people living in the condo got sick, had no medial care and were just mulling around the premises with no place to seek medical help or couldn’t afford it – tho condo board would act and most residents would pitch in and help. When we place the same situation on a larger scale, the local municipality, we hear about higher taxes instead of ” What can we do to help those unfortunate people with no medical care! What you say about lack of vision and courage from our leaders is so true!
    Thanks for the post and it really made my day!!


  2. I must admit, this is an interesting topic to me…

    No doubt, the trash collection plan is good, everyone will have dependable collection. Those who had two cans will have to manage with one. Less trash, less polution, no payment collection problems since the government will tax you for the fee.

    I was daydreaming and thought that we could extend this line of reasonong to other areas of life. I propose that drycleaning be handled the same way. I hate going to get my shirts and taking them too. If everyone were assigned a drycleaner (say one per county) and charged via tax bill we would likely see drycleaning charges go down, good for the economy and also good for a few drycleaners. I suspect that $80 per month would suffice for starched shirts for two famly members plus reasonable cleaning of suits and dresses. To save fuel and wear on the road system, service should by home delivery and pickup by laundry truck, maybe one per 2 weeks.

    Drycleaning is perhaps not as much of a “right” as trash pickup. However if we ar moving down this road, I suspect that if one large drycleaner would offer to contribute several million dollars to various political figures, we could have the system in place by next November.

    Perhaps drycleaning should be “fixed” later. The logic should be that the greatest rights get “fixed first”. The right to eat is a higher right than health care and should have been taken over prior to healthcare. It be wise to start there? We should abolish grocery stores… They just use capitalism to sell us expensive food, and resturants (which just cater to our desires to buy unhealthy food) should be bulldozed (McDonalds first)… charge everyone through their tax bills for 2000 calories per day and let out a bid for those calories. The Obama administration is working to force body mass indexes be a part of your new government medical data base, we could use that to adjust the caloric allotment of each person to reduce the weight problem that we have.

    Weekly deliveries, find those who can’t afford it, charge those who can more and more until everyone has food paid for by the government. Problem solved. Oh, no cheating, it must be made illegal to grow your own food.

    We are already doing this (almost) with electric golf carts up to $11,000 each. Pick one up, fill out the forms, the gov will send you a check and add just a bit to everyone’s taxes. There is even a company that will buy them for you, lease them to a country club and send you not only the check for the purchase, but a monthly lease payment.

    I ordered 20.


    • Posted by David Jones on July 23, 2010 at 11:26 am

      While what you say theoretically could happen if you follow the logic of the trash collectors to its extreme, there is a key difference. Trash collection and storage is an infrastructure issue, which local governments have always been responsible for managing.

      Dry cleaning (and food purchasing) are consumption choices. Some people never dry clean. Some dry clean weekly. Some wash their clothes at home. Most fall somewhere in the middle.

      Same with food consumption. The government already works to try and ensure everyone can at least provide the minimum standards of nutrition with the Food Stamp (Card?) program and WIC. These make efforts to provide basic food requirements in the poor, but the individual still must make their own food choices (within guidelines, esp. for WIC).


      • Posted by Brad Hobbs on July 31, 2010 at 4:40 pm

        Some of us want high deductable insurance, some can afford to self insure, many would like a simple low cost plan that covers large problems only and not every thing known to man. Those are consumption choices. Individuals should have the ability to decide how they spend or don;t spend their health care dollars.

  3. Posted by duffonline on July 20, 2010 at 6:12 pm

    My dry cleaner doesn’t charge me extra for a pre-existing condition. She hasn’t raised her rates by 25% or more per year every year for the past five because I am diabetic, even though I am extremely healthy otherwise. She has never refused to clean my clothes because I am too big of an actuarial risk. Some things, like healthcare, really do need a broader perspective. The free market is a great mechanism for most commerce–it’s great for dry cleaning–but it hasn’t brought down costs, increased access or delivered better, less expensive healthcare. These will only come about if there are more people like Mr. Bruce who are willing to look at healthcare differently from their dry cleaning bills.


  4. Posted by Brett on July 27, 2010 at 2:47 pm

    What you have failed to address is the fact that it is not the role of the federal government to provide “health care” to its’ citizens. The solution to the health care problem is to stop government interference in health care.


    • Posted by jackwbruce on July 27, 2010 at 8:35 pm

      Brett, thanks for commenting. I would be interested in knowing what you believe the federal government should be providing. Schools? Agricultural guidelines? Police & Fire? Transportation? Communication? Where do you draw the line on what our government should and should not be providing?


  5. Posted by Brett on July 27, 2010 at 9:44 pm

    I want the federal government to provide only what is prescribed in the U.S. Constitution. Period. As citizens of the U.S. we should expect very little from the government and MUCH more from the individual. The government does it’s citizens a great disservice by offering them dependence. Make no mistake, dependence on government equals control of the individual. This evolution of government encroachment into our lives is the cancer that ,is destroying our Republic. I do not desire government “health care”, “education”, “retirement”, etc. I believe that I am better equipped to handle these aspects of my life and I fear a government that would break the law of the land to provide it. What do you think?


    • Posted by jackwbruce on July 28, 2010 at 5:31 am

      Brett, You make a good point in that YOU “are better equipped to handled these aspects of [your] life.” Consider yourself blessed. Unfortunately, many people in our society today do not have the opportunity you have. One of the major points of this posts is that I want to look outside what is best for me and think of my “neighbors.”


      • Posted by Brad Hobbs on July 31, 2010 at 11:48 am

        Traditionally neighbors have helped neighbors, doctors have given treatment for free or at reduced cost to those who could not afford it, churches, charities provided assistance etc.

        The Fed Gov has taken over much of that in a way that is massively less efficient, often it costs us 2 bucks to give away 1 dollar. In doing so they discourage private giving, alleviate the consciences of those who don’t give, and reduce the pool of those able to give even as they increase the numbers of people in need. In its efforts to find more money to redistribute, the current administration is reducing the charitable deduction, i.e. taking away money that would have gone to churches, etc and stuffing it in their pockets. There are proposals to eliminate it entirely, and even to require that x% of every dollar given to a church go to various types of politically selected organizations (I won’t list them for fear of being branded “intolerant”).

        It’s a simple choice, do we drink the milk forever, or do we kill the cows and eat steak for a month?

      • Good point, and it is certainly a valid concern. Mr. Hobbs has done an excellent job of explaining why the government has made it increasingly difficult for neighbors to help their fellow neighbors, so i will not attempt to reiterate what has been well said. I will say this however, our system is broken. Our elected officials care not for the law of the land. They are not statesmen, they are truly politicians. Herein lies the problem. Our Constitution provides the individuals of this nation the ability to solve their own problems IF the Constitution is adhered to, but due to our lack of vigilance this is, sadly, not the case. So what are we faced with? The government solution. My argument is that this government solution is unacceptable for a free people. The acceptable, reasonable and logical solution is to let the INDIVIDUAL take care of himself and his neighbor.
        America is the most charitable nation of the face of the earth. Do you truly believe that if our citizens were able to work and conduct their business with minimal interference from the government that we would let our neighbors die in the streets from lack of medical care? I don’t. In fact, I am quite sure that if it were up to the individual, charity medical care would equal, if not surpass for profit medical care and the U.S. would be the envy of the world when it comes to health care. This can only happen if the government allows it to happen (isn’t it AMAZING that we must be permitted by our government to properly take care of our neighbors?) and our current batch of politicians are more interested in power and control to ever let this happen. So, to conclude my rant, I fully agree with you Jack that our social responsibility to our neighbors is one that cannot be overlooked. We cannot however, allow our freedoms to be eroded in order to achieve this end. I would prefer to be my brother’s keeper as opposed to the government being mine and your’s keeper.

    • Posted by Brad Hobbs on July 31, 2010 at 11:13 am

      BRAVO! Brett… You are right on so many levels.

      The law, basic fairness, simple economics for example – Each new welfare “right” results in wealth confiscation from the jobs producing segment of the economy. As citizens become dependent on the new, always growing, always inefficient, always over-budget, welfare (retirement, healthcare, medicine, schools, God help up if food shows up); the economy shrinks relative to what it could have been. More confiscation is needed… The programs go broke eventually (Social security, Medicare, Medicaid, Obamacare will too). A helpless dependant citizenry, lacking a productive economy and sucking on the dry teat of the government will go without. …and no doubt, rediscover the wisdom of the Founding Fathers’ list of enumerated powers in the Constitution.


  6. dry cleaners come in handy specially if you need your precious clothes to get cleaned very fast ,.,


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