Health Care, Boston and the Luck of the Draw

Submitted by: Mike Spindell, guest blogger

Asklepios.3I must begin this guest blog with a bit of a confession. When I first started posting on Jonathan’s blog many years ago I found that he had recognized me in one of his end of the year posts. He wrote words to the effect that what he found appealing in my comments was my tendency to reveal much about myself in the course of them. He had seen into the essence of not only my writing style, but also of the way I interpret the world around me. For me it always starts from my personal emotions about an issue and then I work to try to see how my personal experiences can apply to the world around me. It is the key to my empathy, which allows extrapolating my personal experience into a more global view of the world I live in. I imagine that is how it is for most people, but we all live in the isolation of our own consciousness. It is in truth not the best writing style and certainly not the most creative one, but at least limited by my own ability to be self critical, it is the most honest writing that I am capable of producing.

With that caveat in mind, let’s talk about my own health care experiences. I was genetically endowed with the predisposition towards heart disease. Both my parents and many of their siblings died in their early fifties from variations of heart disease. My Mother had perhaps four heart attacks (MI’s) and three strokes. My father had two heart attacks. As a family we were far from wealthy, struggling to maintain ourselves at the lower end of the middle-class, but my father had prescience that kept us from disaster. He always paid for good medical coverage and back then and most importantly medical coverage was affordable. Given my seeing so many medical issues as a boy my families medical insurance made a big impression on me. As a civil servant in New York City in lieu of an adequate salary I was covered by good health insurance and always elected to have the best, most costly plan. Up until the age of 36 this “Cadillac” (to use the current verbiage) plan wasn’t necessary because I seemed to be in good health, although the high blood pressure that kept me out of the Viet Nam draft was a concern to Doctors, but then I rarely needed to see Doctors. Six months after I married though at age 37, I suffered my first massive heart attack. With the help of my wife who nursed me through the recovery I seemed to return to normal. The hospital costs were huge and would have bankrupted me but for my health insurance. As my life progressed I had two more MI’s and then finally Congestive Heart Failure so bad that it led to me being put on an artificial heart device LVAD to keep me alive and finally a heart transplant to give me a new life. http://jonathanturley.org/2012/01/22/from-the-bottom-of-my-new-heart/

Thanks to my Medicare and my secondary health insurance I am alive today and nearing 70 years. My health insurance has probably paid out many millions to keep me alive and I sm grateful for that and in truth very lucky that I chose to be an underpaid Civil Servant.

My personal experience with the health care system came to mind when the Boston Marathon bombing occurred leaving so many victims with dire health care problems, many with loss of limbs. I can remember that day thinking what the costs of these patients treatment would be and how many of them would pay for it, even with the Massachusetts Health Insurance system. You see even though my Heart Transplant was covered, it is estimated that costs to the transplant patient are $30,000 for the first year after the transplant. I can’t cry poverty, but let’s say that those ancillary costs wiped out most of my savings. The loss of a limb and the rehabilitation from it can take many years and is costly. Prosthetics wear out and must be replaced. Depending on ones occupation their income can be adversely affected and their family lives severely disrupted as a consequence. While it is true that thus far some $23 million dollars has been raised purportedly for the victims how far will that money go towards allowing them to return to their normal lives? Given this what are the implications of the response to this particular act of horror in terms of the entire health care debate that is far from settled in this country?

“The price of a new prosthetic leg can cost anywhere from $5,000 to $50,000. But even the most expensive prosthetic limbs are built to withstand only three to five years of wear and tear, meaning they will need to be replaced over the course of a lifetime, and they’re not a one-time cost.

Ten days after the Boston Marathon bombing, the most gravely injured among the victims have begun the daunting road to recovery. At least 14 of those injured in the blasts had to have limbs amputated, and at least two people had multiple amputations.

Each prosthetic limb must be custom fit to every patient, and costs can add up. Once they’re fitted with the prosthesis, patients also need to attend physical therapy for weeks or months.

“Depending on what components you get on it, [the cost] can vary greatly,” said Glenn Garrison, director of prosthetics and orthotics at the Hospital for Special Surgery in New York. “They’re probably in line with a cost of a car. It can be a pricey thing to work with.”

With physical therapy, Garrison said amputees could start walking on their own within two to four weeks after receiving a prosthesis. According to Garrison, most patients will have one prosthesis for the first year, but will likely need a second one to accommodate their changing physique. After that, a prosthesis usually wears out every three to five years.”http://abcnews.go.com/Health/health-care-costs-boston-marathon-amputees-add-time/story?id=19035114#.UXqqm0pp7Xo

One minute a person finds themselves excited, on a beautiful day watching runners finish the oldest marathon in the country, partaking in a long community tradition and then the explosion, pain, blood and terror at what happens to them. Help arrives, treatment begins and for many a lapse into the peaceful bliss of unconsciousness. Hour later they begin to awake in pain and to discover what they have lost. Gradually the realization hits that it will take years to get their lives back together and in fact nothing in that life will ever be quite the same again. Meanwhile they, if lucky, are with the comfort of loved ones and friends and well cared for by the hospital staff. They are somewhat celebrities and there is great public interest in them and their plight. Money for their care has flowed in from an aroused and concerned public and the least of their worries is how much will this cost and what effect it will have on their ability to earn money. Then as with much of what is current in the media’s reportage of the “news” their individual plight falls to the background of the public’s consciousness. The donations dry up and with that the funds coming in and they are faced with an enormity of debt, pain and rebuilding their lives.

“Cost of amputating a leg? At least $20,000. Cost of an artificial leg? More than $50,000 for the most high-tech models. Cost of an amputee’s rehab? Often tens of thousands of dollars more. These are just a fraction of the medical expenses victims of the Boston Marathon bombing will face.

The mammoth price tag is probably not what patients are focusing on as they begin the long healing process. But friends and strangers are already setting up fundraisers and online crowd-funding sites, and a huge Boston city fund has already collected more than $23 million in individual and corporate donations.

No one knows yet if those donations — plus health insurance, hospital charity funds and other sources — will be enough to cover the bills. Few will even hazard a guess as to what the total medical bill will be for a tragedy that killed three people and wounded more than 270. At least 15 people lost limbs, and other wounds include head injuries and tissue torn apart by shrapnel.

Health insurance, as practically anyone who has ever gotten hurt or sick knows, does not always cover all costs. In the case of artificial limbs, for example, some insurance companies pay for a basic model but not a computerized one with sophisticated, lifelike joints.

Rose Bissonnette, founder of the New England Amputee Association, said that the moment she heard about the bombings, she knew immediately that her organization’s services would be needed. The advocacy group helps amputees navigate things such as insurance coverage for artificial limbs. Bissonnette shared one group member’s struggle to get coverage for artificial arms as an example of the red tape some bombing victims could face. The woman “got a call from the insurance company and the person on the other end said, ‘How long are you going to need the prosthetic hands?’” Bissonnette recalled.”http://www.washingtonpost.com/national/health-science/boston-marathon-bombing-victims-face-huge-medical-bills-tens-of-millions-in-donations-pour-in/04/25/b2fd5754-add0-11e2-b240-9ef3a72c67cc_story.html

Although it is not certain, I would guess that providing the Boston victims with some financial security is a distinct possibility, since it would appear a bi-partisan gesture. Yet can we really be sure that this will be the case. We know already that many of our veterans lack the basic care their service to this country has entitled them to and we know that in the Ryan budget proposal for instance, there are severe cuts in veteran’s care. We also know that many of the victim’s families from 9/11 feel they have been shortchanged and promises broken. The vast majority of Americans, if polled would believe that the bombing victims and the veterans should be taken care of, but no one can say if this feeling will be transformed into governmental action. Then too, the same week that the bombing occurred there was yet another tragic series of explosions in Texas. Even though the devastation was greater than Boston and the explosions weren’t intentional, how much real aid will be given to the victims in Texas and to the town that was devastate by the explosions? Certainly there will be lawsuits, but how long will it be before they are settled and while pain and devastated lives are immediate.

However, these are all issues that have made the radar of the news media. Every day in this country people are being devastated by health care problems, most of which are no fault of their own. This could be a car that was rear ended, the collapse of scaffolding or possibly a congenital condition such as my own. Those that oppose the concept of a national health care system always justify their opposition by mouthing the idea of “personal responsibility” and individual choice. To my mind and to my experience that is patent nonsense. We live in a time of a shrinking middle class, of wages that have not kept pace with the cost of living and with families scraping by from paycheck to paycheck. We also live in a time where the rate of poverty in this nation has increased rapidly as the years have gone by and where many people, even with g-ood jobs have to choose priorities and frankly if you are fairly healthy putting food on the table for your family, compared to paying health insurance premiums, is a no-brainer. In the United States today at least 55 million people are without health insurance. It is easy for those opposed to national healthcare to spout inanities such as Mitt Romney’s “they can go to the Emergency Rooms” and the harsh judgment of his that 47% of Americans are “takers” and thus don’t deserve to be given any aid.

The nature of the health care system in this country is a disgrace from my point of view. The “Health Industry” has become overtaken with the profit motive and this once great country (from the perspective of quality of health) has fallen far below that which most Americans would deem minor nations. I believe that quality health care should be a right and not just a privilege. The evidence to me is overwhelming that our Health Care System is broken and outdated when compared to other industrialized countries and that is but one reason most of our citizens are being reduced to Third World status.

“More than 40 percent of U.S. residents went without health insurance or had coverage that didn’t protect them against high medical costs last year, survey results released Friday reveal.

Thirty percent of people in the U.S., or 55 million, were uninsured for at least part of the year prior to the survey, which was conducted from April to August 2012 for the Commonwealth Fund, a New York-based research organization. Another 30 million people, or 16 percent of the population, were “underinsured,” meaning their health plans offered too little coverage and exposed them to high out-of-pocket costs, the survey found.”

The quote above and the following quotes/statistics below are taken from an excellent Huffington Post article titled: Health Insurance Market Left out 55 Million Americans in 2012” by Jeffrey Young.

http://www.huffingtonpost.com/2013/04/26/health-insurance-market_n_3158280.html#slide=825346

This truly is the “luck of the draw” as my own life has proven. The needed health care a person gets is very much dependent on the circumstances into which they were born and the circumstances of the arc of their life. Mitt Romney was born into a circumstance that guarantees him a full life of excellent health care. This is true of Paul Ryan and Donald Trump. By the same token so were Michelle and Barack Obama and Harry Reid. Yet many obviously believe that this is the way things should be. Luck of the draw should to their mind determine everyone’s lives, though in truth most who believe that already have hit the jackpot.

“People earning up to four times the federal poverty level, which is $11,490 for an individual this year, were the most likely to be uninsured or underinsured. The lower the income, the more common uninsurance or underinsurance was, according to the survey.

“President Barack Obama’s health care law offers financial assistance for health insurance to low- and middle-income people earning up to 400 percent of the federal poverty level, which is $45,960 this year for a single person.

Sara Collins, the vice president for affordable health insurance at the Commonwealth Foundation, said Obamacare could mitigate some of the consequences of an expensive health care market.

“Of the 55 million adults in the survey who were uninsured during the year in 2012, more than half have incomes that would make them eligible for coverage under the law’s Medicaid expansion if they are legal residents,” she said during a conference call with reporters Thursday. “And more than one-third have incomes that would make them eligible for subsidized private plans sold through insurance marketplaces.”

The impact of the health care law’s Medicaid expansion will be blunted, however, by Republican governors and Republican-led state legislatures that are refusing to broaden the joint federal-state program to more poor people.

And while subsidies for private insurance, in the form of tax credits, will be available, they may not be large enough to offset premium hikes for some people, which health insurance companies say are partially the result of Obamcare’s benefit guarantees.”

I understand that many believe that those in poverty were destined to be there because of their lack of skill, but to me this is nonsense. Poverty, breeds poverty as many, many studies through the years have proven. The few who escape poverty do so perhaps because of their innate skills, but I believe that too represents “Luck of the Draw”. Germane too to this discussion is the fact that even if you are one of the lucky ones to receive health care coverage in this country, the system itself is not really effective and also needs fixing.

The figures disclosed by the Huff Post article linked show that the United States spends the most per capita on Health Insurance of any industrialized nation. We are at more than 17% of GDP and the next 9 countries that spend the most are around 10 to 12% of GDP, and most of those countries provide government subsidized health care. Yet the United States is 27th worldwide in life expectancy. Think about that this country that so many think is exceptional has the 27th best life expectancy rate in the world, yet spends the most on health care. Why is that? My conclusion is that the difference in expenditure is directly related to rapacious profit and it exists throughout the industry. Our huge hospital conglomerates, our drug companies and especially our health care insurance companies are gouging us for every penny of profit possible, while at the same time providing us with a lesser degree of care. For the Health Insurance companies it is the fact that their cost of providing services run at about 15 to 17%, whereas Medicare and Medicaid are about 3%. That 3% figure reflect the administrative costs in other countries and shows one reason why they spend less of GDP on health care.

The drug companies too gouge us and even Medicare and Medicaid are not allowed to negotiate with them to lower prices. An example of this gouging comes from the antacid medications Nexium and Prilosec. When the patent for Nexium ran out, its manufacturer added some non-palliative solutions to their formula and claimed it was a different drug without proof to back up the effectiveness of the new formulations. Nexium is a costly prescription drug even with a good prescription plan like mine. Non-prescript Prilosec has been shown in tests to be every bit as effective as Prilosec, since they are essentially the same. What happens too I imagine with Nexium, is that via detail people, Physicians are given bonuses of one sort or another for prescribing Nexium. This is of course merely a supposition on my part, but many have pointed out in other instances that this is a typical practice of the drug industry, with the compliance of Doctors who like “free things” after all “what’s the harm” except for off the charts healthcare costs.

Having spent much time in hospitals and seeing the bills paid by insurance it is easy to see that our private hospital consortiums are vastly overcharging for the medications and the services they give to patients. Many claim it is because of the care they must provide to the indigent, but the growth and centralization of the hospital industry belies that. Clearly there is much profit to be made.

This brings me back to the nub of my argument which is that the U.S. should be providing cheap health care to its citizens as a matter of course. This of course will be derided by some here as being socialistic, but tome that argument is nonsensical on at least two grounds. The first being of course that the Constitution is neutral on Socialism and indeed on Capitalism too. The issue is providing for the welfare of the people and in that sense the idea that this always could be done better by private industry is merely a propagandist ruse meant to fool the public. Indeed the first Social Security System in the world was introduced by the uber Right-Wing Otto Von Bismarck in Germany in the 1870’s. He was hardly a socialist, but he understood that providing for the welfare of the people is a proper role for government. In my opinion, once again, good health care should be considered to be a basic service that every citizen should receive.

As those maimed and killed found out as they joyfully watched the conclusion of the Boston Marathon, life and limb are dependent on the luck of the draw. This is true every second of every day that we live.

Death and dismemberment cannot be ended by government decree, but the effect of those “luck of the draw” incidents can and should be mitigated by the Government of all the people. That’s my opinion as one of the “lucky ones”, what’s yours?

Submitted by: Mike Spindell, guest blogger

54 thoughts on “Health Care, Boston and the Luck of the Draw

  1. This bleeding heart liberal, socialist, humanist seconds your motion for cheap healthcare for all. Single payer, single payer, single payer. In a civilized country your column wouldn’t even need to be written. Well done column though :-)

  2. Mike

    you do tend to lead with your emotions. that like a bit of socialism is not necessarily a bad thing.
    as always a good read.

  3. Mike, As always your post is right on the money. The health care system is all about the money. As a result humans at their most vulnerable are taken advantage of and abused by hospitals, insurance companies and BIG Pharma and sometimes their doctors who prescribe without thinking. Humans are also put at risk by hospitals who have forgotten the germ lessons of the late 19th century. It is now more dangerous to go to the hospital with regard to contracting hospital borne infections that it was in the 1950s. Hospital mistakes and over prescription of powerful and often unsafe medications round out the “trap for the unwary” the health care “system” has become.

    Veterans and their need for health care and Congress members love of war and cavalier disregard of the needs of our troops is a story whose elements sicken and amaze me. When will we, the voters, the people, ever stand up and say no more!

    Congress should have to give up their life time health care and their cushy benefits and live in the real world with the rest of us. They should have to hear NO for an insurance company when their child needs cancer treatment. It might wake them up but….

    I have just one quibble with your reference to the West, Texas industrial accident. It most certainly was intentional. The owners and operators of that death trap knew that they were putting the residents of the town in danger by their reckless conduct. Regulators, some perhaps impotent because of being gutted by corporatists who love corporations and hate people, knew the hazards were and they did nothing about it. Members of Congress who gutted OSHA and the other agencies responsible for the regulation of sites like this and the legislators of Texas and the governor should be held responsible for the deaths and injuries and the property damage.

    The health care debacle and the lack of regulation of industrial sites is the result of greed and the corporate control of our government both federal and state. It is time for a change, a real one not the rhetoric of change but of actions.

    Thanks again for your marvelous post.

  4. If the United States was not ruled by corporations, single-payer healthcare would not only be the norm but the standard for all developed countries. Unfortunately, the U.S. is ruled by corporations so single-payer healthcare is not even on the table. Meanwhile, millions of Americans are a half paycheck away from the fiscal cliff while Congress fiddles.

    Thank you for having the moral courage to stand with the people rather than the multinationals and the gilded class that stashes their ill gotten gains offshore so that governments are starved and the people are lucky if there is even cake to eat.

  5. Interesting article. However, I think there needs to be clarification on a couple of points:

    1. Single payer system doesn’t necessarily mean universal healthcare coverage. Can you have universal healthcare coverage without a single payer system? Sure. Implementing this system is whole another issue.

    2. I think that we need to have universal healthcare coverage for all, but there needs to be a few stipulations. For example, what’s the incentive-for young & middle age adults (ages 18-47)-to work or attend college, if its cheaper to stay at home with mom or grandma, and recieve full coverage health insurance with no monthly premiums or co-pays? What’s the incentive for the unemployed to work or return to work if it’s cheaper to continue to receive public assistance, and now, full coverage health insurance?

    I can hear private & public sector workers and retirees yelling at their elected officials about fairness in this process (i.e. workers & retirees are paying monthly premiums & co-pays for their benefits, but 55 million non-workers will not be paying a dime?).

    Until we solve the work incentive & who should pay and how much theory, Obamacare will be the closest health care reform policy that we will achieve towards universal healthcare coverage in America.

  6. Mike,

    Once again you’ve managed to articulate a position indistinguishable from my own far better than I could myself. Well done, sir!

    RWL,

    1. In my opinion, any viable plan should include both a single payer system and universal coverage—there are 46 other industrialized nations all of which give examples of implementations. Personally, I’d go for nationalized health care (like the system they have in England), but any plan in which basic maintenance and catastrophic care were covered for everyone would be acceptable.

    2. Are you serious? You think that single payer healthcare would provide a disincentive to go to college? First off, I think the disincentive would be trivial noise compared to that of the “education bubble” that is currently inflating. I think we’re nearing the point where the drag of student loan debt is starting to outweigh the boost in earning power of a college degree. More importantly, from a business point of view, I can’t imagine a more significant step to reduce this country’s competitive disadvantage with the rest of the industrialized world than eliminating the health care liability that is crippling our businesses (or literally their employees if they don’t provide health care). As someone who is trying to start a business, I will have to look very seriously at moving to Vermont after 2017 when they institute a single-payer health care system.

    The bottom line is that a system where any worker does not have basic medical coverage should be unacceptable to businesses—a healthy workforce is a more efficient workforce.

  7. Slartibartfast,

    I said that universal healthcare coverage, without stipulations, would provide disincentives to the unemployed to seek work & to high school students deciding to attend college (this would make an excellent research thesis or dissertation?).

    I also said that you cannot assume a single payer system will provide universal healthcare coverage for all.

    You cannot compare our political-economical system of governance & capitalism (oligarchy) with any other country in the world. There isn’t a single country that comes close.

  8. RWL said:

    I said that universal healthcare coverage, without stipulations, would provide disincentives to the unemployed to seek work & to high school students deciding to attend college (this would make an excellent research thesis or dissertation?).

    And I said that I think this disincentive is so trivial as to be irrelevant. To answer your apparent question, I think that any good thesis advisor would dissuade their students from such a topic—in any case, the benefit of a healthier workforce is likely to completely overwhelm this disincentive factor.

    I also said that you cannot assume a single payer system will provide universal healthcare coverage for all.

    And I said that (in my opinion) any viable plan needs to be both single payer and universal.

    You cannot compare our political-economical system of governance & capitalism (oligarchy) with any other country in the world. There isn’t a single country that comes close.

    While you can always compare and contrast different systems doing the same job, I wasn’t comparing our “political-economical system” (whatever that is) with other countries, I merely said that there are 46 exemplars of how single-payer health care is implemented—something which is patently true. We know that these other countries provide health care for all of their citizens—there is no reason that the US couldn’t do so as well.

    I’m not sure what in my response would make you think that I didn’t understand what you said, but my comments were carefully qualified and seemed pretty clear to me. If you’d like to have a discussion, you can either address my points (accept them or give an argument as to why they are incorrect) or ask me to clarify them, but telling me that I don’t understand something I clearly acknowledged seems kind of bizzarre and pointless to me.

  9. Terrific article, Mike S. And what lottakatz said. With single payer, we’d likely see a sharp reduction in stress-related illnesses and a concomitant increase in productivity.

  10. I took my half blind guy Pal to the hospital to see his doctor at the doctor outpatient office. It was about my Pal’s heart and lung problems. Half blind guy used to smoke. He was in that room “asking the doctor” about meds. When we came out the doctor followed us outside to the curb and then lite up a cigarette along with some other “health care professionals”. This is America. Watch the drug commercials on Fox Tvand listen to them when they tell you to “ask your doctor”. We need a national health care system like Canada. We need med students who are in it to provide care not to make big dollars. We need to educate our doctors in health not wealth.
    Dumb schmuck doctor had a heart attack a week after we left the curb.

  11. They regulate the dog track races why not the hospital system. A bank can charge a going rate of interest provided by competition from other banks. Hospitals charge what the set-up bears– managed care and fixed prices.
    Women pay more for a breast exam than they do for an engine overhaul on their car.

  12. Excellent thoughts Mike. I have also been followed by a life time of medical treatments, nearly from birth. Dad’s factory job was unionized so he was spared from financial disaster. I have been equally lucky to have insurance every time I needed it.In a country as rich as the US health care should not be a crap shoot, but it is the only industrialized nation where it is.

    RWL – you want hypothetical? How about this one: Whats to prevent a young person who knows he is free from the fear of being without health care from venturing out and setting up a business that is something of a ‘flyer’ and wouldn’t pay him enough in the early years to afford even the BS policies that cost an arm and a leg today? Try not to expect the worst out of everyone, they might surprise you.

  13. Thanks for taking the time to write this article. I also used to think it was ridiculous that the US–at that time the richest country in the world, per capita–did not have a health plan that covered all of its citizens. Yet here we are, many years later, poorer per capita than we are now, and health care costs have continued to rise.

    While I’m certainly sympathetic to all those who need care and lack the funds to receive it, it is also true that government resources are not unlimited, and that it is, therefore, essential to control the costs of any government program, be it health care, defense, or agricultural subsidies.

    “Non-discretionary spending” (read entitlement programs such as Medicare and Medicaid) now take up over two-thirds of the federal budget, and their percentage of the pie continues to grow. Certainly, it’s possible to continue to raise taxes, but the fact is some mechanism is needed to insure that costs don’t climb out of control, by a spending cap, for example.

    However, as we’ve all seen the US Congress is incapable of keeping its spending within the revenues collected each year–because it’s not willing to make the tough choices needed to make a universal health care system work (without bankrupting the country while _still_ increasing taxes), and because hey, we all like pork-barrel spending, right?. We all know social security will collapse within the next few decades–how do you expect a universal health care system to work if cost increases are not managed?

    So, even though what you propose is perhaps the ethical thing to do, I honestly doubt it will be successful without a much harder look at the details needed to implement it in a sustainable fashion. And taking a hard look is just not what our national leaders do, unless it’s in their own self-interest.

  14. Mike S,

    I was with you emotionally through the anecdotal, then caring-for-others, text.

    But also these segments caught my eye as I read through the honest appraisal in your post today:

    Those that oppose the concept of a national health care system always justify their opposition by mouthing the idea of “personal responsibility” and individual choice.

    The nature of the health care system in this country is a disgrace from my point of view.

    The “Health Industry” has become overtaken with the profit motive and this once great country (from the perspective of quality of health) has fallen far below that which most Americans would deem minor nations. I believe that quality health care should be a right and not just a privilege. The evidence to me is overwhelming that our Health Care System is broken and outdated when compared to other industrialized countries and that is but one reason most of our citizens are being reduced to Third World status.

    Think about that this country that so many think is exceptional has the 27th best life expectancy rate in the world, yet spends the most on health care. Why is that? My conclusion is that the difference in expenditure is directly related to rapacious profit and it exists throughout the industry.

    This brings me back to the nub of my argument which is that the U.S. should be providing cheap health care to its citizens as a matter of course.

    This of course will be derided by some here as being socialistic, but tome that argument is nonsensical on at least two grounds. The first being of course that the Constitution is neutral on Socialism and indeed on Capitalism too. The issue is providing for the welfare of the people and in that sense the idea that this always could be done better by private industry is merely a propagandist ruse meant to fool the public.

    That’s my opinion as one of the “lucky ones”, what’s yours?

    These ideas, and those related to it by our American notion of “the common good”, have been on my mind too recently (The Common Good).

    As I read through American history it became dreadfully clear that our people today are victims of plunder as much and more than they are beneficiaries of our ancestors’ purposes for ordaining “the common good.”

    An incessant plunder of public resources, accelerating exponentially during the times of war, is quite easy to track down as one fingers the plunder barons.

    We need not feel guilt for what has been done to us, but I think if we follow the prescription suggested in your post today, we can get back on track and back in sync with the wise desires of our forefathers and foremothers.

  15. HG1999 1, April 27, 2013 at 9:19 am

    While I’m certainly sympathetic to all those who need care and lack the funds to receive it, it is also true that government resources are not unlimited, and that it is, therefore, essential to control the costs of any government program, be it health care, defense, or agricultural subsidies.
    ====================================
    The cost is determined by the industry the government purchases something from.

    Crooked industry charges the government (i.e. their own citizens) $400 for the same hammer that costs $25 in the hardware store.

    The defense warmonger industry is infamous for this.

    And they do this as they chant jingoistic nonsense about patriotism and government waste.

  16. BTW – all this whining about what we can afford? Lets put this into some perspective. The US has the largest economy in the world, China is #2. The US economy is twice that of China, and we have a quarter the population. 2x the money spread across 1/4 the people yet China can afford it. So can every other civilized nation on Earth. Ever. Damn. One. Except the US, apparently we are just ‘different’.

  17. mahtso,

    Thank you for that link. The survey on Physician compensation and job satisfaction was an excellent resource for this blog and adds greatly to its perspective.

  18. “I can hear private & public sector workers and retirees yelling at their elected officials about fairness in this process (i.e. workers & retirees are paying monthly premiums & co-pays for their benefits, but 55 million non-workers will not be paying a dime?).”

    RWL,

    You need to check out the link to the survey that produce the 55 million figure. Those people are employed already but their income doesn’t allow them to be able to afford health insurance. Remember, if people are on Public Assistance, or receive Unemployment Benefits they are entitled to Medicaid Health Insurance.

    http://www.huffingtonpost.com/2013/04/26/health-insurance-market_n_3158280.html#slide=825346

  19. HG1999, Superb, intellectually honest take on this complex problem. Your logic and analysis is much needed on this topic. What many don’t understand is the important point you made “that govt. resources are not unlimited.” It appears even the folks who have chugged the koolaid will soon see the ACA is not the answer, to be diplomatic.

  20. “Non-discretionary spending” (read entitlement programs such as Medicare and Medicaid) now take up over two-thirds of the federal budget, and their percentage of the pie continues to grow.”

    HG1999,

    Your statement is one that seems to be true, but really isn’t. Medicare, like Social Security comes out of payroll taxes and thus would pay for itself if it was kept out of the “general fund” of government income. This is known as the “lockbox” and this was destroyed under the Reagan Administration, so that money that should have been kept safe was used to pay for the massive military buildup. If they take the money out of our paychecks for a specific program then it should go to that program. You are falling for a false meme that has been put out by those who believe government should only work to the benefit of corporations and the wealthy.

  21. “We are entitled to our own opinion, not our own facts.” Daniel Patrick Moynihan

    LBJ was the prez who put the Trust Fund into the general budget. The changes made by Reagan in 1984 were something most here abide. In order to help it’s solvency, he was the first to tax on up to 50% of the benefit based on additional income of the recipient. Clinton raised that threshold to 85%.

  22. Our poster is correct that the SS Trust Fund was placed in the budget for military reasons. It was for LBJ’s Viet Nam war. The truth shall make you free.

  23. Mike S,

    I read the survey, and it is either misleading, advocating for Obamacare, and/or inaccurate (someone didn’t do their homework).

    For example, the survey doesn’t even mention Medicaid Insurance. It doesn’t even mention if the 55 million uninsured and the 30 million underinsured applied for or were informed about Medicaid Insurance. The survey doesn’t even address if the 85 million Americans (uninsured and underinsured combined) would qualify for Medicaid Insurance.

    Some the individuals/households on this chart would not qualify at all for Medicaid, but some would at a reduced rate based on their income. In other words, if their income is toward the high end/limit of what of Medicaid Eligibilty, then this household/individual would pay a certain percentage for their Medicaid.

    Whoever conducted this survey must have had an agenda to promote due to the fact that the number of uninsured and underinsured Americans seems to be inflated or not examined more thoroughly (this is more evident if you look down toward the end of the survey/article, it starts to advocate for Obamacare, and how these Americans would benefit from Obamacare).

    Oh wait! Isn’t the Huffington Post a liberal-leaning media site?

  24. Clarifying the true story of which I was somewhat mistaken:

    “Q1. Which political party took Social Security from the independent trust fund and put it into the general fund so that Congress could spend it?

    “A1: There has never been any change in the way the Social Security program is financed or the way that Social Security payroll taxes are used by the federal government. The Social Security Trust Fund was created in 1939 as part of the Amendments enacted in that year. From its inception, the Trust Fund has always worked the same way. The Social Security Trust Fund has never been “put into the general fund of the government.”

    Most likely this question comes from a confusion between the financing of the Social Security program and the way the Social Security Trust Fund is treated in federal budget accounting. Starting in 1969 (due to action by the Johnson Administration in 1968) the transactions to the Trust Fund were included in what is known as the “unified budget.” This means that every function of the federal government is included in a single budget. This is sometimes described by saying that the Social Security Trust Funds are “on-budget.” This budget treatment of the Social Security Trust Fund continued until 1990 when the Trust Funds were again taken “off-budget.” This means only that they are shown as a separate account in the federal budget. But whether the Trust Funds are “on-budget” or “off-budget” is primarily a question of accounting practices–it has no effect on the actual operations of the Trust Fund itself.”

    “Q3. Which political party started taxing Social Security annuities?

    A3. The taxation of Social Security began in 1984 following passage of a set of Amendments in 1983, which were signed into law by President Reagan in April 1983. These amendments passed the Congress in 1983 on an overwhelmingly bi-partisan vote.

    The basic rule put in place was that up to 50% of Social Security benefits could be added to taxable income, if the taxpayer’s total income exceeded certain thresholds.

    The taxation of benefits was a proposal which came from the Greenspan Commission appointed by President Reagan and chaired by Alan Greenspan (who went on to later become the Chairman of the Federal Reserve).

    The full text of the Greenspan Commission report is available on our website.

    President’s Reagan’s signing statement for the 1983 Amendments can also be found on our website.

    A detailed explanation of the provisions of the 1983 law is also available on the website.” http://www.socialsecurity.gov/history/InternetMyths2.html

    The first set of question and answer details the real state of Social Security and I would assume Medicare. It was an accounting trick added to the budget in the Johnson Administration as Nick reported, which no doubt was some sort of accounting trick related to the war.

    What I did remember was the Reagan Administration taxing Social Security. This occurred with the assistance of scared and/or Corporatist Democrats. It also coincided with a doubling of the SS tax and Reagan’s partner in this was the late (and to me unlamented) Democratic Senator from NY, Daniel P. Moynihan. Playing with SS has been a bi-partisan affair, but mostly a Republican/Conservative initiative, where cowardly Democrats cave-in to their corporate campaign funding. The doubling of the SS tax was directly related to accounting tricks used to fund Reafan’s unprecedented military buildup in peacetime.

  25. “For example, the survey doesn’t even mention Medicaid Insurance. It doesn’t even mention if the 55 million uninsured and the 30 million underinsured applied for or were informed about Medicaid Insurance.”

    RWL,

    You are obviously not reading the article fully since it does deal with Medicaid insurance and extensively so.

  26. “I’m certain that was difficult, kudos.”

    Nick,

    Not difficult at all. I have a long, written history here of admitting when I’m wrong and a lifetime of doing the same.

  27. Mike S,

    I was implying that it doesn’t go into the level of detail as I delineated earlier. It does talk about expanding Medicaid coverage, but it doesn’t address my concerns outlined above. For example, there is one sentence about expanding medicaid, but the survey/article doesn’t address if any of the 85 million Americans qualify, applied and paying a reduced rate, applied and were denied, or even knew about Medicaid under the current Medicaid program.

  28. I forgot to add: the survey/article does not state if the 85 million were on Medicaid for the previous years (in & out of the system), and kicked out of the Medicaid program due to fraud, federal or state budget cuts, or tedious bureaucratic mismanagement of clients’ paperwork (in Missouri, the process can take up to 30 days to receive coverage & a card, after you have been deemed eligible from the first visit).

  29. I also want to add: look at the charts; it includes households, for a family of 4, with incomes of $55k-$90k and more. According a chart/article by SWM, some of THESE HOUSEHOLDS ARE CONSIDERED MIDDLE CLASS. I grew up poor, and I know if you have $60-$90k a year coming in, and you don’t have quality health insurance, then, what are you doing with your income? Living beyond your means? Not prioritizing what is more important? Is having 2 car notes more important than having 1 car note and quality health insurance? Is having a monthly cable, internet service, & cell phones more important than paying for quality health insurance? What are we doing with those tax refunds? Taking trips to disney world? buying new clothes, shoes, furniture,down payment to a vehicle or jewelry, etc. instead of purchasing quality health insurance?

  30. When they do insurance allocation or socialized medical care they ought to have two pools. The shallow end should be for drug addicts including tobacco users. The deep end for heathy, stealthy and wise. Tax each pool based on their requirements but never the Twain shall meet unless in Cairo Illinois where Huck was supposed to go up the Ohio.

    Part Two of my smoking doctor story: My half blind guy Pal started smoking the day of the doctor visit I mentioned above. The next day FartinDog, who also lives in the assisted living apartment with us, stomped his cigarette pack around on the carpet and then took a dump on it. Pal quit smoking. Hopefully he will live past our dog years. He is a great guy but listens too much to his doctor, the one who smokes.

  31. The decades-long debate about healthcare coverage is important, no question – but equally important, and arguably more so, is the growing amount of evidence that the Boston Marathon terror was another inside job – with the most critical on-the-ground work managed by Craft International
    Private Military forces and the FBI. No big surprise if the Boston Bureau
    was involved, given that offices’ long history of corruption.

  32. bill mcwilliams,

    Conspiracy theorists like yourself are despicable. You callously denigrate the victims and viciously smear those you deem “responsible” with your baseless allegations.

  33. Hear, hear. Emotions serve to cement the soul in place while aboard this… vehicle…Thank you, Mike, for your kind attention to this very important matter!

  34. Great post, Mike. Thank you so much. Personal experiences with the healthcare industry are the most forceful tools we have for spurring meaningful reform. Hopefully you’ll continue sharing your hard-gained insights because they’re powerful and will likely inspire countless others to do the same. A shocking number of people are suffering and dying because they’re too proud to ask for care they could never hope to pay for, whether insured or not. Costs of both treatment and coverage have become wildly unmanageable. Only a single payer system could bring sense to the out of control, purely profit-based situation. Unfortunately, we are living in an era that will be remembered as the Age of Greed.

  35. nick spinelli 1, April 27, 2013 at 12:22 pm

    Our poster is correct that the SS Trust Fund was placed in the budget for military reasons. It was for LBJ’s Viet Nam war. The truth shall make you free.
    ====================================
    Subsequent presidents have followed the warmongering, not the honor.

    If only they would also not run for a second term when they see the error of their ways.

    Doubling down is the new honor in place of not seeking another term, as LBJ did.

  36. Hi slartifartfast,

    Here’s a tiny part of the BOSTON conspiracy, the truth about which you
    obviously know nothing nor have the desire to know much about:

    Dzhokhar Was Unarmed:
    Feds Lied About Boat Shootout With ‘Suspect 2′

    by Fintan Dunne, BreakForNews.com 25 April 2013 @ 9:30pmET

    According to officials, as reported by CNN, no firearm was found in the boat where Dzhokhar Tsarnaev was holed up.

    Yet the criminal complaint states that there was: “a standoff between the boat’s occupant and the police involving gunfire.”

    That’s a finely crafted choice of words: the police assault on the boat “involved gunfire,” but it seems only the police were armed.

  37. Dredd, LBJ stepping down had NOTHING to do w/ honor for chrissake. He was the consummate political animal and knew there was a landslide coming. Geez!

  38. bill mcwilliams,

    I don’t know if you can go as far as to call it a conspiracy, but there is something about to happen-on a massive scale (meaning: civil or international war)-in America:

    Since early this year, the Elites have signed into law the right for law enforcement (FEDs) to check your emails, internet accounts, phone records, etc.; issued a ‘decree’ that if we (American civilians) even think about stepping out of line, then the FEDs/Elites have to right to issue drone attacks;

    Boston Bombing, Texas Explosion (why would you bring an ATF swat team, after the ‘incident’ was declared an accident, even before a thorough investigation was conducted?), Ricin letters to President & Congressional leaders, North Korea “threat” (even though former NBA player/turned porn star Dennis Rodman was having dinner with the Korean Leader/President at the time of supposedly missile threats aimed at South Korea); Canadain Officals ‘thwart’ another bomb threat for the US-all of these events transpiring in less than 3 weeks combined?

    It doesn’t add up. Something is about happen. Something big………or maybe they (Elites) are trying to distract us from the only threat: Another Revolution on US soil.

    For some reason, every ‘terrorist act’ have been committed by individuals or groups of Islamic faith? We (US) seem to find a way to blame Muslims for the weapons that we sold to their countries’ leaders; then, we act surprised if they (countries’ leaders) use the same weapons against our soldiers (the same soldiers who were given orders to destroy & occupy Baghdad since 2003: the 2nd largest Muslim city-also, known as the Mecca City for Islamic culture & heritage)

  39. RWL claims, “It doesn’t add up. ”

    Maybe it’s your internal adding machine that does not function. This is much more likely outcome than your conspiracy “dabblings,” since you lack even the desire to label your own unsupported wanderings as “a theory.”

  40. Brilliant, Mr. Knauer. It’s obvious that you are extremely well informed, deeply insightful, and overflowing with the milk of human kindness.

  41. Bill McWilliams whines weakly, “…and overflowing with the milk of human kindness.”

    When you bring ugliness to a mirror, please do not pretend to be offended at the sight of ugliness.

    Your conspiracy “theories” are utterly without merit, and your dwelling on them does not make them any more true.

    “It doesn’t add up” is not evidence.

  42. Just put your head back in the sand – and continue taking your TEAvee’s advice, Mr. Knau Nothing.

  43. Thanks Mike, like so many stated well written and thought out. It does take the experience if being there to really “get it”
    When my trigeminal neuralgia started I had no idea my father had BC/BS insurance on me (I was 25, we had never talked about insurance. I had never had to deal with being billed for medical care, it went directly to him/through the insurance.)
    I could not work and had to go on assistance, which included medical assist. I could only afford to be seen by a clinic. The care was sometimes very good, when you had something difficult or strange, and an attending would be called in, and equally bad when yo had run of the mill problems.
    I found oit I had the private insurance months later and suddenly I was in private doctor’s offices, the care on a much better scale – even when compared with seeing an attending at the clinic.
    Medicare is a godsend for me, as is my bs/bc supplemental which Is draining my savings.
    Single payer seems to be the way to go.
    In the meantime how much money would be saved in Medciare (and soc. sec. too) if they really went after the fraud and also had bid contracts as opposed to the no bid that still favors company over beneficiaries.

  44. “I found out I had the private insurance months later and suddenly I was in private doctor’s offices, the care on a much better scale – even when compared with seeing an attending at the clinic.

    Medicare is a godsend for me, as is my bs/bc supplemental which Is draining my savings.”

    Lee,

    You speak truly, because you and I with our different yet critical illnesses have both been there. There is a distinct difference in health care for the insured. As you also point out, since we both are/were in situations that were medically interesting the health care people took more of an interest and the care was better. My recent hospital stay gave me a luxe private room because as a post transplant person I am immuno-compromised and having Medicare and a good secondary I am well-insured. I appreciate my good fortune. Is it so wrong to believe that everyone’s health care should not be a matter of “luck of the draw?”.

  45. Mike, No it is right to believe it should not just be the luvck of the draw and the lucky (or seriously ill/interesting) Reminds me of the Chinese curse (just googled it, neither Chinese nor proverb or curse but what the heck) May youlive in interesting times. In the case of health care if you are poor you need to hope you live in an interesting body.

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