Saturday, January 2, 2010

I'm Sure Glad I Fell off My Bicycle, Landing Five Yards Below, in Brazil and not in the USA!


I had a terrible bicycle accident this week, falling five yards to the bottom of a dray and rocky river bed, and falling on my head. Had I not been wearing a bike helmet, I probably wouldn't have survived.

The Brazilian ambulance people SAMU came to help me, but they could get down to the riverbed without a ladder, so the fire department also came.

Fortunately, when I got to the hospital, on an immobilization hammock, they didn't ask me any insurance or financial questions (I have no insurance and no money) before x-raying every part of my body and treating my wounds.

In Brazil, people have a right to free medical treatment from Government Unitary System of Health Care (SUS) hospitals, clinics and neighborhood health posts.

It could have been a lot worse had I had this accident in the United States. The police might have arrived and demanded my identification, which I couldn't have provided because it fell in the water. Then the police could have demanded that I get up (which I didn't do until I had been in the hospital for 24 hours).

If I disobeyed the orders of the police, they might have tased me, even though I was floating in my back five yards below, next to my bicycle, with a broken bike helmet still on my head. The police in the USA might have "Tased" me two or three times, causing me to drown or break my back on the rocks in half a foot of water. If you have to have a medical necessity, have it in Brazil. At least the police won't Taser you, while you're flat on your back, because you are hurt and unable to follow their commands.

Two days ago, after a twenty kilometer bike ride, I was riding along a sidewalk at the edge of a seawall when my front tire hit a pit. I lost my balance and fell head-first, five or six meters to the dry, rocky bottom of a riverbed.

Based on where my injuries are -- in my body and in my biking helmet -- I surmise that that I hit the rocks head first; then another couple sharp rocks covered with barnacles sliced my left arm open in two places; my left shoulder was raked over the rocks; my knees hit the rocks; leaving two open wounds in my left knee, and then I fell flat on my back in the water (somehow), face-up, into about six inches of water, which was just enough in which to float. Thankfully I never lost consciousness.

After I fell, I was motionless for a for a moment, taking stock of my body parts the way a computer does when it boots up, making sure everything is there. I could still move my fingers and arms, my feet and legs, and roll my head from left to right. So I wasn't paralyzed. Not yet, anyway.

People gathered on the causeway above and I shouted to them to call SAMU, Brazil's mobile emergency care unit (Serviço de Atendimento Móvel de Urgência.) All I wanted was to be on a flat immobilization board, with a neck brace on, while on my way to the hospital. Failing that, I was happy to float on my back in half a foot of water, because all of my intense pains went away when I didn't try to move.


Miraculously, although I scraped and cut my left leg and arm and destroyed my helmet, I here to tell about it, just two days later, typing with my left arm in a sling.

I'm amazed to be alive, with no serious injuries. I'm amazed to be alive in spite of my recent depressive thoughts of death and suicide. But I couldn't have planned the accident I had Sunday even if had tried.


Sunday, November 8, 2009

US House Passes National Health Care Bill

I admit that I haven't read the 1029-page bill, but (or perhaps therefore) I'm very happy with the vote in the US House last night in favor of this national health care bill. It's "national" in the sense that it effects the entire nation and endeavors to provide for health "insurance" for the vast majority of people, through a variety of mechanism and mandates:
  • Creating a public insurance option to compete with the private vultures;
  • Perhaps best of all, increasing taxes by a little more than five percent on those individuals earning more than $500,000 annually or $1,000,000 annually for a family as the mechanism for paying for this plan;
  • Prohibiting insurance companies from excluding persons based on pre-existing conditions;
  • Prohibiting the sudden rescission of insurance, just as the insured is incurring medical expenses;
  • Slowly closing the "donut hole" in which the elderly on Medicare lack coverage for prescription medication;
  • Creating a new Secretary of Insurance (or something of the sort) to approve or reject proposed insurance plans and fees offered by the existing insurance companies, with the authority to govern insurance companies in multiple other ways;
  • Requiring employers to contribute to health care for their employees or pay a significant fine;
  • Requiring individuals to seek to participate one way or another, or pay a fine of up to $250,000 and spend five years in jail, which effectively gives this new system the same obligatory nature of paying the IRS and Social Security withholding, with virtually everyone participating;
  • Subsidies for those unable to pay for insurance, which effectively forces the Government to make insurance for the poor financially feasible or put them (us) all in jail;
  • Any new law that provides for imprisonment has to be viewed from a uniquely Black point of view and we have to wonder whether it wasn't created to increase the number of Black people in jail. For example, will police demand to see our insurance cards and then arrest us and hold us over for trial if we have failed to enroll, as might easily happen with poor, indigent, substance abusing and homeless people? Will all Black people follow the mandate, or will some fail to do so and end up as insurance prisoners?
Of course there are at least two things in the bill that are outrageous, one of which is absolutely outrageous:
  • The approved an amendment that prevents anyone whose subsidized from using the subsidy for to pay for plans that provide for abortions, and prohibits plans that provide abortion from participating in the health care marketplace, which has the effect of banning all abortions except the ones that women pay for themselves, effectively banning a type of coverage that some women already have through their employers;
  • The bill forbids undocumented immigrants from participating receiving subsidies to participate in any of the plans that will be offered, and may even (I'm not sure) forbid them from participating even with their own money. This is something we need to be sure about, since undocumented immigrants can be disease vectors just as easily as our own children can be.

    Undocumented immigrant children, the US Supreme Court has decided, have a constitutional right to receive a free public education, which puts children who have no access to medical care (e.g. vaccinations) next to those who do. The obvious solution is to recognize the obvious fact that everyone must be vaccinated and provide for this vaccination for everyone, regardless of their immigration status.

  • At the same time, the right to go to school seems somewhat empty if you lack the right to receive medical care that will make school attendance possible. As a matter of fact, hospital emergency rooms will inevitably continue to treat undocumented immigrants, but only when the care they need has progressed to the point of being an emergency whose treatment is many times more costly than it would have been had they gone to a doctor earlier.
This recognition of the Government's obligation to provide a mechanism for everyone in the country (except the undocumented) to receive medical care is a massive step forward for the United States of America. Although some of the details will inevitably turn out to be flawed and need to be revisited, the commitment brings the US into the community of civilized nations that recognize that health care is not an individual challenge but rather a national responsibility.

The US Senate still has to pass a bill and then that bill and the House bill have to go to conference committee, where anything can happen. And unfortunately many of the provisions of the bill that people most need now will not take effect until after the 2010 elections, when it will be too late for the benefits of the bill to help Democrats running for re-election to the US Congress.

I do understand however, that the ban on pre-existing conditions clauses will take effect sometime next year.

Fortunately, the Democratic Congress realized that there was no way whatsoever that they would get more than one Republican vote on this bill, so they pushed through a bill that had fewer compromises than if the Republicans had cooperated.

Thursday, October 29, 2009

House Comes Out With Good Health Bill, Considering

It seems to me that much of what I was hoping the House would do on health care, the House has done. They tax the rich to pay for services for the poor, expand health care through Government programs already available, and create a new Government insurance company to offer an alternative to the free market vultures.

The proof is in the pudding, whether it all functions as proposed, but had their been no pudding there could be no proof:
House Speaker Nancy Pelosi (D-Calif.) unveiled a health-care reform bill Thursday that includes a government insurance option, as well as a historic expansion of Medicaid, and seemed to have the potential to draw support from a broad range of Democratic lawmakers.

( . . . )

House negotiators were able to lower the price tag -- in part by expanding Medicaid coverage to a broader slice of the population, the equivalent of all individuals who earn about $16,200 per year. The original House legislation had sought an increase to 133 percent of the federal poverty level, or about $14,400 per year, the same level proposed in the Senate bill.

The adjustment reflects findings by congressional budget analysts that covering the poor through Medicaid -- which pays providers far less than Medicare -- is much more cost-effective than offering subsidies for private insurance policies, something the bill would provide to middle-class individuals who lack access to affordable coverage through their employers.

The main revenue sources in the House bill include a surcharge on wealthy taxpayers and changes to Medicaid and Medicare worth about $500 billion in cost savings over 10 years, according to the nonpartisan Congressional Budget Office.

Under the House bill, 36 million Americans who are currently uninsured would become eligible for coverage, either through Medicaid or private insurance purchased on a new national exchange. Most individuals would be required to purchase insurance, and subsidies would be available to middle-class families to help offset the cost. The legislation would require employers to provide health coverage to their workers or face a penalty, although firms with annual payrolls below $500,000 would be exempt. WaPost

Well done! Now we just need those idiotic Democratic "centrists" (Democratic Party Republicans) in the U.S. Senate to get in line. People like Senator Landrieu from Louisiana who has one of the states with the least people covered by health programs, and nonetheless speaks out against a public option.

Those bafoons should consider the likelihood that if a working public health plan isn't approved, Democrats will lose many seats in the House and Senate in 2010, because they'll go before the voters with nothing to show for a Democratic majority.

Wednesday, September 30, 2009

Poll Shows Public Wants Medicare for All

Glenn Ford of Black Agenda Report constantly criticizes the Obama Administration from the Left, but BAR's prescription for health care is right in line with my own, and they offer a New York Times poll saying most Americans are with us:

medicare for all?by BAR executive editor Glen Ford
President Obama attempts to depict proponents of Medicare for all as lefty health care “extremists.” But that’s precisely the kind of “robust” public plan favored by two-thirds of Americans, according to a recent poll. Obama is to the Right of the people, and the GOP is off the map.
Poll Shows Public Wants Medicare for All
by BAR executive editor Glen Ford
Most people favor a public option that is a lot more “robust” than anything the Congress is offering.”
Despite the infamous Max Baucus Senate committee’s long-anticipated rejection of even a fig leaf of a public health care “option,” public opinion remains remarkably firm in support of allowing everyone access to a comprehensive government health plan. A New York Times/CBS News survey last week provided the best polling evidence in recent months that most people favor a public option that is a lot more “robust” than anything the Congress is offering, aside from straight-up single payer.

Read more at Black Agenda Report.

I know it's a silly rhetorical question, but if the American public overwhelmingly wants Medicare for all, independent of the insurance companies, then why are our elected officials more concerned with what's good for insurers than with what's good for the public? Yeah, I know. Insurance companies make larger contributions to campaign coffers, they are extremely well-organized with hundreds of lobbyists in Washington distributing free trips and and threatening Congresspeople with hard-fought races if they don't do the insurance companies' bidding.

And that's why the US Senate Finance Committee is more concerned with preventing new competition for insurance companies, that in many markets have a monopoly, instead of doing what's right for the millions of Americans who need to be able to rely on medical care.

What is it about the American mentality that the Medicare-for-all type systems exist in every civilized country but not in the wild western USA, where we're still sucking snake venom out of people's limbs because medical care is no more available to many of us now than it was fifty or a hundred years ago.

Tuesday, September 29, 2009

Senate Finance Committee Says a Public Option is One Option Too Many

Senator Charles Grassley explained the principal argument against offering the public the option of opting for the public option:
Senator Charles E. Grassley of Iowa, the senior Republican on the committee, said a government insurance plan would have inherent advantages over private insurers. “Government is not a fair competitor,” Mr. Grassley said. “It’s a predator.” He predicted that “a government plan will ultimately force private insurers out of business,” reducing choices for consumers. NYTimes
So, if the public had the option of the public option, the public would surely opt for the public option, which would drive other options out of business. Therefore, the public must not have the option that they would prefer so they can continue choosing between the options that they don't like.

In fact,
Republicans on the committee unanimously opposed the public option, saying it was, in the words of Senator Orrin G. Hatch of Utah, “a Trojan horse for a single-payer system” in which the government would eventually control most health care. NYTimes
So, if the public were offered the public choice that exists in Canada, France, Germany, Brazil and other civilized countries, then the public would discover that the public option is better. That's why America must never give consumers the choice in the first place. It's not that public option won't work. It's that, like an electric drill, it will work much better than a manual drill does, and manual drills will become a thing of the past. It is that from which Republican senators, and Democratic Party ones as well, are protecting us.

Wednesday, September 16, 2009

The CIA's Bay of Pigs and the Pigs of US Health Care

The above song, Playa Girón, by Silvio Rodrigues of Cuba, reminds us of the great debt to the ordinary men and women of various skin colors who expelled the US invasion at the Bay of Pigs in 1962(?).

Were it not for those valiant and determined Cuban's efforts on that critical night, Cuba would not have a program of national health care today. Instead, it would have a chaotic health care "market" in which, as Angel Parra put it, in which the wealthiest few are well-pampered while the majority go hungry:
me gusta la democracia
porque permite apreciar
el arrollador avance
del que tiene libertad
para exprimir a unos cuantos
y aumentar su capital.
Or, in English:
I like democracy
because it helps to value
The overwhelming advances
of those who are at liberty
To exhalt a small few
and augment their capital.
It's precisely because Cuba and Brazil have national healthcare that the US should envy and emulate that I feel angry when I see a US doctor write in the New York times, as a generalization, that
In poor countries around the world, private commerce rules: residents pay cash for all health care, which generally means no health care at all.
In the article, Abigail Zugar, M.D. discussed in some detail the health care programs of wealthy countries, but then didn't and couldn't bother to address the differences between poor countries with 100% "market economies" and those that have chosen to take health care out of the free market and put in within the ambit of Government responsibility. By confusing what others are doing -- in Cuba and Brazil, for example -- she makes it harder for us to evaluate what we can do for ourselves.

Even among the developing countries we can find health care systems that treat the poor and middle class much more effectively and generously than the United States of America does.

NYT Obscures Truths with Generalizations about "Poor Nations'" Health Care

In a story in the New York Times yesterday, entitled "One Injury, 10 Countries", Abigail Zugar, MD writes reviews a book about a Washington Post writer who took his painful shoulder for treatment in ten countries and can therefore recount the experiences he had and how the health care systems of those countries work.

However, there was a major flaw in the stories, that being its euroentrism. Dr. Zugar writes,
In poor countries around the world, private commerce rules: residents pay cash for all health care, which generally means no health care at all.
Dr. Zugar states this as if it were a universal truth, but it's not. Brazil has universal Government sponsored health care whose Government salaried doctors and nurses are forbidden under Brazilian law from accepting payment from patients for the services they provide. Likewise, Cuba offers free health care to Cubans as well as some foreigners, and has produced so many doctors at its medical schools that some practice in Brazil, as a favor to the Brazilian people.

Since it's clear that Dr. Zugar doesn't know of the free health care available in Brazil and Cuba, she and the author of the book, she and T.R. Reid, "a veteran foreign correspondent for The Washington Post", should just refrain from making generalizations about poor countries whose Government-sponsored health care is, in some cases, demonstrably superior to the market-based care in the United States. For example, Cuba's infant mortality rate is lower than that of the United States, and is slightly more than one third of the infant mortality rate for Black children borning in the Southern United States.

Dr. Zugar and Mr. Reid should stick to writing on subjects about which they have information, rather than make generalizations about countries of which they are ignorant.