Public Option Health Care Now

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

2010-01-02T19:15:00.000-08:00

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.

My Bike Helmet Saved My Life on Sunday

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.

US House Passes National Health Care Bill

2009-11-08T08:07:00.000-08:00

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.

House Comes Out With Good Health Bill, Considering

2009-10-29T21:01:00.000-07:00

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.

Poll Shows Public Wants Medicare for All

2009-09-30T12:55:00.000-07:00

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:

By Glen Ford on Wed, 09/30/2009 - 00:44

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.

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

2009-09-29T20:14:00.000-07:00

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.

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

2009-09-16T13:14:00.001-07:00

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

2009-09-16T03:05:00.000-07:00

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.

Healing from Depression While Living in (Universal Public Option) Brazil

2009-09-10T14:16:00.000-07:00

I had been feeling quite depressed much of last year and this one, after my 18 year-old step-son came to visit us for the Christmas before last and nonetheless stayed for ten months, all the while insisting that he couldn't and woudn't work, and I should find more money somewhere if I couldn't support him, his mother and two sisters on the income I had.

I finally decided that if living with my wife meant also living with my step-son, than I preferred to live alone. It
Free Pharmacy at Neighborhood Free Hospital

was a very hard decision for me, but first we separated houses and then I moved sixteen hours away by bus, and only returned a month ago, (aside from some shared vacations with my wife) when I learned that my 18 year-old step-son had moved decisively to a different region of Brazil.

This Christmas, if he comes, I'm leaving and only coming back when he's gone again. Let HIM pay the rent and other costs if he makes that decision.

Anyway, I'm feeling much better now, living with my wife and two step-daughters. I don't do very well living by myself. I get depressed more easily and more profoundly.

There is a whole different and chronic, lifelong level to my moods and personality. Unless I take a daily regime of medicines, I suffer the symptoms of clinical depression, e.g. feeling disinterested in everything and everyone around me, sleeplessness, feeling anguished with loneliness and directionlessness, and without the energy to do the things that others do to make their lives work from day to day. And when I feel like that, I become convinced that things can only get worse and the only solution is intentional and efficient self-destruction.

So, getting and taking daily anti-depressant and anti-anxiety ("anxiolytic") medication is fundamental to my feeling relief from those symptoms. The medications help me to take joy or at least pleasure in things around me, and to not so easily become angered, anxious and volatile.

This challenge is a big part of why I live in Brazil instead of in the United States. In Brazil, it's possible to get the medication I need, but in the United States it was so difficult as to be virtually impossible. For example, in the United States, when I was working as a managing attorney, but crying at my desk as I sank deeper into depression, I once called my HMO and told them I was suicidal and needed to see a psychiatrist.
Free Medicines at Free Public Clinic

They told me where to go and who to speak with and I did speak with that person for three or four sessions, before I discovered that he was NOT a psychiatrist and could NOT provide me with any medication, even though I had all the signs of clinical depression and should immediately have been referred to a psychiatrist. I felt like an idiot for not having asked him earlier, and yet I had made my needs plain to him and the HMO.

I was paying four hundred dollars a month for health "insurance" and they were playing with my health as if it were a rubber toy.

The only thing that the US's health insurance "insures" is that there will be a massive profit-centered bureaucracy between patients and the doctors and medicines that patients need. Once you're sick, if you die quickly then the insurance company avoids paying your claims.

So, how is it different in Brazil? Brazilians have medical care as a right guaranteed to them by the Brazilian constitution. Sometimes the situation at particular health clinics is precarious, but the right exists.

The pharmaceutical cocktail of nortryptaline ("Nortrip") and diazepam
works best for me.

In my case, there is a physician at a public clinic two blocks from here who will write a prescription for my antidepressants and anxiolytics, without insisting on charging me for a consultation and without insisting on charging me once again every time my medication runs out. In fact, it is illegal for anyone at these Brazilian neighborhood health clinics to charge anyone for anything. They have no cash registers and no credit card swipers. You never, ever see a dollar sign in a Brazilian health clinic. Not before, during or after. You receive no bills and there are no checks to determine if you are covered, because EVERYONE is covered to exactly the same extent - to the extent of the services that the Government is able to offer.

(In one city, health clinic workers were charging for places in line, but that was unusual enough to make the nightly national news. They were charging seven dollars to see an opthamologist.)

I've recently learned that that the effective way for me to get the medication I need is

(a) to see these doctors at the local clinc (for free) and then
(b) go to the public hospital in our neighborhood and get the medication that has been prescribed, also provided for free.

As with any bureaucracy, it takes a while to learn how the system works, what the parts are, and what each of them does. Sometimes break down and other resources have to be searched out.

My local health clinic, for example, used to have a pharmacy. But there's now a note on the door saying that the pharmacy is closed because the pharmacist has been fired. Thankfully, there are at least five other Government-sponsored pharmacies within a ten minute moto-taxi ride from here.

Today, I asked a pharmacist at a for profit how much my medication would cost if I bought it there. It would have cost seventy dollars. So, I continued walking until I found a free public clinic doctor to write a new prescription that would be honored at the free hospital's free pharmacy.

If you've read this far, you may know someone who has suffered from depression or another mental illness and who has had difficulty accessing medical care and medication. At the threshold level in this whole discussion is the willingness to take medication at all. Until I was twenty-eight years old, I insisted that all medications were inherently habit-forming and that they sapped individuals' desire to get to the bottom of their psychoanalytically treatable problems.

Then, one day during my first year of law school, I found myself crying uncontrollably on the floor of a friends house at three in the morning, repeating through desperate sobbing that I had realized that I had "always been depressed" and it wasn't going to go away because of even intense talk therapy. At that point, I was so anguished that I was willing to take virtually any medication that a doctor might prescribe, if it would bring me up and out from the pits of despair.

Since that day, eighteen years ago, I have had to try a variety of medications before finding a combination that, for the moment, takes the worst symptoms away with the least side effects, in a country where I can have access to medical care and medication even if my depression makes it impossible for me to work.

The United States was never the country for me, if only because it didn't have the good sense to understand that access to medical care can't be based on access to work. If it is, then as soon as a person gets sick and can't work, they lose their medical care as well. They only have medical care when the need it least, and when they need it most, it's gone. That only "insures" heartbreak, not medical care.

I knew I needed psychological or psychiatric care from the time I was a child, but my mother's medical insurance from the college where she taught only provided ten visits to a psychologist per year, and only covered less than half the actual cost. Here in Brazil, my step-daughter sees a speech therapist every Saturday morning, for free, at the public health clinic.

Lula Ignacio Lula da Silva is the president of Brazil and will soon have served his maximum two terms. Then the USA would do well to invite him to go to the USA and run the USA's public option medical care. Brazil knows how to do univeral free access AND medicine, but the USA has yet to prove its competence in this area, except perhaps at Veterans Administration hospitals.

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American Medical Association Abandons Republicans to Support Obama/Congressional Health Care Reform

2009-09-10T11:49:00.000-07:00

Yesterday (and for a couple of weeks before), I was damning and condemning President Obama in the most forceful and even obscene language for his ambiguous, ambivalent statements whether a public alternative to insurance companies is necessary. I was angry that he wasn't showing a commitment to set up a Government provider of health care that would compete with the private venal insurance company leeches.

Today, I'm ready kiss Obama's toes because he accomplished something that I know will turn out to be transformative: He got a letter from the American Medical Association (AMA) committing the group to supporting overhaul of the health care system as long as it includes some sort of commitment to tort reform. (Did I say health care "system"? Sorry, I meant health care "market" because we have a "market" without a system as it stands today, rather like the chaotic masses of public vegetable stands we see in films about India.)

This letter is actually more momentous than Obama's speech to a joint session of Congress last night. Any president can convene a joint session of Congress, as President Bill Clinton did before his 1993/94 health care overhaul failed even to be voted upon in the US Congress. But, as someone who has worked for non-profits and had to drive around collecting letters of support from stakeholders in order to convince a foundation that my program would have buy-in from the community, I know that it took Obama immense negotiations and diplomacy to get this letter from the AMA, particularly to release it on the day of his speech to the joint session of the US Congress.

Now, Obama has the formal support of the largest single group of physicians in the United States and, more importantly, he has prevented the Republicans from getting that support instead. The party that convinced the AMA has a better chance of winning this battle (with the AMA to help Obama beat down Republican opposition).

So, what's the Republican response to this letter of support? Are 400,000 doctors all "socialists". Are they all ignorant of how health care works and how it needs to be fixed? No, they aren't. From now on, when the Republicans and the insurance companies attack supporters of reform, they will be implicitly attacking the American Medical Association. The more they do so, the more AMA support is likely to swing forcefully behind President Obama and health care reform.

One essential aspect of what the AMA says is essential to health care reform is to, "Provide health insurance coverage for all Americans". This insistence that help care reform give everyone access to health care, and not 95%, goes further than what the Congress and Obama were planning to do on their own. And so the buy-in of the AMA could be transformative in this debate.

OK, President Obama. This "game" of working health care reform through the Congress will be a long battle, like a game of chess that takes many turns before it ends in a win, a loss, or a stalemate. But President Obama has clearly made a winning move by gaining this letter of support from the AMA. Congratulations!

President Obama's Address on Health Care to Joint Session of Congress

2009-09-09T19:41:00.000-07:00

I haven't heard all of President Obama's speech, but I heard some and I'm downloading the rest now from Youtube.

AMA Supports Broad Health Reform in Open Letter to President and US Congress

2009-09-09T13:04:00.001-07:00

The letter below, with a copy of the original here, puts the American Medical Association imprimatur on much of what the most liberal members of the US Congress have wanted in health care reform, including univeral access and Government spending to build an integrated medical system. Although the AMA includes tort reform on their list of items they support, I think we'd be getting a good deal to trade some access to courts for more access to medical care for all.

Because the AMA opposed Medicare when it was initiated in the 1960's, the Republicans surely believed they could count on the AMA to oppose health care reform now. President Obama has outmaneuvered the Republicans and turned their opposition, once more, into evidence that they are simply "the party of 'NO'!"

In this open letter to the President and the US Congress today, President Obama has achieved something that he has no doubt been seeking for at least a year now:

AMA Letterhead and Graffic

September 8, 2009

Open Letter to President Obama and Members of Congress

As our nation’s elected leaders, you have an historic opportunity to improve the health and well-being of the American public. On behalf of America’s physicians and their patients, we strongly urge you to reach agreement this year on health system reforms that include the following seven critical elements:
Provide health insurance coverage for all Americans
Enact insurance market reforms that expand choice of affordable coverage and eliminate denials for pre-existing conditions
Assure that health care decisions are made by patients and their physicians, not by insurance companies or government officials
Provide investments and incentives for quality improvement, prevention and wellness initiatives
• Repeal the Medicare physician payment formula that will trigger steep cuts and threaten seniors’ access to care
Implement medical liability reforms to reduce the cost of defensive medicine
Streamline and standardize insurance

The challenges in our health care system are many and complex. Enactment of the above policies will create the foundation for a stronger, better performing health care system, improve access to affordable, high-quality care and reduce unnecessary costs. Further, those who are currently insured, including Medicare patients, and those who are uninsured will all benefit from greater security and stability.

The American Medical Association and our individual members are working hard to improve health care delivery and quality through a broad range of initiatives to promote best practices and reduce unnecessary costs.

We reaffirm our commitment to work with each of you to adopt and implement health system reforms that will benefit all Americans.

Sincerely,

J. James Rohack MD

Association Letterhead

Tonight, Obama to Reaffirm Importance (but not sine qua non) of Public Option in Speech to Both Houses Of Congress

2009-09-09T12:55:00.000-07:00

Tonight, President Barack Obama will give a (hopefully impassioned) speech to a joint session of the US Congress in favor of moving forward with health care improvements. I say "improvements" because I really am not sure what Obama wants or what Obama thinks he can get, or what Obama will ultimately discover that he can get. I don't think any of us knows that.

I've said some very nasty things about the president over the last couple of weeks, as I have become completely frustrated with:

* Obama's seemingly listless advocacy, particularly in the face of Republican attacks;
* his seeming willingness to negotiate away virtually anything and everything, to get something I can't even describe;
* His statements that "public option" isn't essential, which is the sort of statement that makes the Left wish we had voted for Chris Rock instead;

The positive thing about Obama's advocacy is that we've been talking about health care improvement since he was elected and it has not yet definitively gone up in flames, like Hillarycare. Maybe that's because Obama has refused to make any particular aspect of his agenda a fixed target, and instead has made EVERYTHING a moving target until it becomes fixed in law. This understanding of his strategy is supported by an article in today's Washington Post, about how he cajoled a health care reform bill in the Illinois House and Senate.

So, having read that article and seeing his mushiness from a new perspective, I apologize to the President for any aspect of my criticisms that was unjust or cruelly vituperative. But, I stand behind any aspect of what I've said that turns out to be prescient and unfortunately apt.

The president's chief press liaison, Gibbs, is quoted in today's Washington Post as expressing on Obama's behalf how important a public option is.

"The public option is a way of putting a check on insurance companies," Gibbs said on NBC's "Today" show. "There can be no reform without adequate choice and competition that allows people to be able to pick and have options." Pressed on whether Obama feels "there can be no reform without the public option," Gibbs said that "the president will outline what he thinks the value of the public option is and why we have to have choice and competition in this system." WaPost

I certainly hope Obama won't abandon those obvious observations later on.

Right now I can go to my neighborhood Brazilian health clinic, get seen within a month for the most obscure specialties and within two days for the common ones, receive the service absolutely FOR FREE, and then receive any medicines the Government distributes for free. I haven't heard any indication that, after this health care "reform", I could get in the US what I now get in Brazil.

When I hear people talking about reducing costs by free markets, while not increasing the Government's role, I become afraid that "free market profiteers" are going to strangle health care reform like a cobra wrapping itself around the populous and squeezing us until our eyes pop out.

To hell with free markets and private competition. That's what got us into this mess! To hell with public option "triggers" that only kick in when doing nothing proves that the house will burn down, permitting a public health emergency that will get worse still by "trigger time", when Obama will finally act, if he and the Democratic Congress haven't been voted out yet!

I think the Republicans are only meeting with Democrats so they have more information with which to prepare their fanciful press releases damning all Democratic efforts.

Screw Bipartisanship on Universal Health Care

2009-09-07T19:57:00.001-07:00

Democratic Senator Max Baucus' health care proposal shows that he has been spending far too much time with Republicans. Look at the underlying logic of what he has proposed:

Mr. Baucus’s plan, expected to cost $850 billion to $900 billion over 10 years, would tax insurance companies on their most expensive health care policies. The hope is that employers would buy cheaper, less generous coverage for employees, thereby reducing the overuse of medical services.

So, supposedly the reason health care is so expensive is that some people are going to the doctor too often, and reducing their benefits to the level of the benefits of those who are now going bankrupt or not going to the doctor at all will squeeze enough money out of current plans to cover 15% more people.

This is the stupidest thing I've ever heard. It's a Republican rationale for why union members would be better of if they had less generous health care benefits than their negotiated plans now allow. If the Democrats go down this path, the Republican will correctly say at election time that Democrats created new taxes on benefits while also reducing coverage.

According to the Washington Post, there are some useful signs in Baucus proposal:

Another section of Mr. Baucus’s proposal would help pay insurance premiums, co-payments and deductibles for people with incomes less than 300 percent of the poverty level ($66,150 for a family of four). It would also provide some protection for people with incomes from 300 percent to 400 percent of the poverty level (up to $88,200 for a family of four), so they would generally not have to pay more than 13 percent of their income in premiums.
Mr. Baucus’s proposal does not include a “trigger mechanism” of the type recommended by Ms. Snowe, who would offer a public insurance plan in any state where fewer than 95 percent of the people had access to affordable coverage.

Senator Olympia Snowe has been pushing for a public option that would only kick it in we discover that 15% of Americans don't have insurance. Haven't we discovered that already? The only reason not to do something now is Republican hopes that the can take over the House and Senate before the "trigger" is pulled that would make real health care change kick in. So, it's helpful to learn that Baucus has rejected that subversive idea, while also proposing to help many middle class families pay their insurance bills.

That's good, but if the Government implemented a public option that directly provides care instead of merely insurance for care, then it wouldn't be necessary to provide subsidies that serve mostly to enrich insurance companies.

I'm announcing right now (to all those who are asking for my advice) that the Democrats should steam roll over Republican ideas and votes, using whatever parlimentary rules and processes availabe, and pass a health care plan based on people's needs rather than on Republican rhetoric and ideology. I'm no Independent so I'm not the kind of voter that all of the "bipartisanship bullshit" is meant to mollify. I couldn't care less whether Republicans vote for the ultimate bill or not, in committe or on the floor of the House and Senate, as long as there are enough votes to pass it.

Democrats should write a bill so pro-consumer that NO Republican will support it, so that when health care improves radically for Americans, Democrats can say, "I told you so. We only wish the Republicans could have supported what we now have too."

I'm tired of bipartisanship. It's like God trying to win the support of the Devil before making miracles in people's lives. You'd get compromises like, 'OK, this couple can be married, as long as they are miserably unhappy their entire lives.' It's better to move ahead without the Devil's input, because substantive unilateral good is better than procedural bipartisanship that turns leads to substantive bilateral evil.

President Obama's language is hardly more reassuring than that of Senator Baucus. The President said in a speech today that he wanted "health insurance reform". That's good that he wants to reform what's already out there, but he knows damned well that only a public option will bring down costs and make health care available to everyone.

Right now I'm watching the birth of health care reform, but even I can see that the the umbilical cord is around the baby's neck and his face is turning blue. If the Democrats can't deliver this baby without a "partial abortion birth", then who would trust them to do anything else.

2009-09-05T14:22:00.000-07:00

New York Times, September 5, 2009, 12:00 pm

Who Will Care for the Newly Insured?

By Michelle Andrews

2013. That’s the year everyone would have to have health insurance under the House version of the health care bill. It may seem like the far distant future — especially if you don’t have insurance now — but many experts say it’s not nearly enough time to beef up the supply of physicians necessary to care for the tens of millions suddenly entering the health care system.

Researchers point to Massachusetts, which passed a universal health care law in 2006, as a real-world example of what can happen when a swath of the population suddenly gains access to insurance and health care. A study by the Massachusetts Medical Society found that 24 percent of residents reported having difficulty getting the care they needed in 2008, up from 16 percent the previous year. Among the main reasons for the logjam: long waits for an appointment. The same study found that the percentage of family doctors who were no longer accepting new patients grew to 35 percent in 2008 from 25 percent in 2006.

Even without an influx of new patients, doctors are likely to be in increasingly short supply nationwide in the coming years. The Association of American Medical Colleges projects a shortage of 124,000 physicians by 2025. Universal health coverage would increase the shortfall by 25 percent, according to the organization.

Rural and inner-city areas will feel the pinch more than urban and suburban ones, just as they do now, according to the report. At least 21 medical specialty organizations have projected physician shortages in the coming years, including specialists in allergy and immunology, dermatology, endocrinology, neurosurgery, rheumatology, emergency medicine and child and adult psychiatry, according to the A.A.M.C. Medical specialties that address the problems of aging — like cardiology and oncology — will be severely impacted.

Primary care is expected to be one of the hardest-hit areas. Already stretched thin by the declining number of medical school graduates who choose to pursue family medicine, the American Academy of Family Physicians projects a shortage of 40,000 generalists by 2020, a group that includes family practitioners, general internists, geriatricians and general pediatricians.

Health care legislation under consideration in Congress may help ease the primary care shortage by raising Medicare reimbursement rates for primary care providers and eliminating cost-sharing for preventive services. The bills would also increase the residency training slots available in primary care and try to entice students into the field with lower student loan interest rates.

Still, shortages seem inevitable, and some researchers believe that patients will have to adjust to a system with longer waits, fewer doctors accepting new patients and less access to specialists. That may not be a bad thing. Studies have shown that across a range of issues, from mortality outcomes to patients’ satisfaction with their care, physician supply is not a deciding factor, said David Goodman, director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice, who has conducted extensive research on physician workforce issues.

More important than the number of physicians is how care is organized and paid for, he said. Massachusetts actually has more physicians per capita than any other state. As they jockey to maintain a toehold in the already crowded Boston market, for example, many work in solo or small practices, increasing the fragmentation and volume of care without necessarily improving its quality, said Mr. Goodman.

Compare that to integrated health systems like Minnesota-based Mayo Clinic or Geisinger Health System in rural Pennsylvania, where most of the doctors work in staff positions, supported by system-wide electronic medical records that lead to better communication between providers and improved coordination of patient care. Those systems typically use physician resources much more sparingly, said Goodman.

”The reality is we know the future is not going to look like today,” said Edward Salsberg, director of the A.A.M.C.’s Center for Workforce Studies. Yes, there are communities that provide high-quality care with fewer physicians, he acknowledged, but “the challenge is how to replicate those conditions.”

President Offer Republicans Oral Sex In Exchange for Health Care Votes

2009-09-04T16:46:00.001-07:00

I've never seen anything so absurd and disgusting in my life as President Obama's butt-licking attempts to win Republican votes for his healthcare plan. America elects a Democratic Congress and President in order to finally address the fact that 15% of Americans have no access to regular health care because they have no "insurance", while an additional untol millions have insurance that refuses to pay for the health care we need.

So, to whom does President Obama turn for guidance, counsel and "permission" to reform this system: He tries to cut secret deals with

the pharmaceutical industry (which charges five times as much for medicines in the US than people pay in Brazil) and
with the American Medical Association (which has never supported changes in the system even as they daily turn clients away because they don't have "insurance" or credit cards, and, worse of all,
with Republican elected officials who were elected to frustrate America's health care aspirations in any way possible.

Each of these historically intransigent parties has agreed to fight Obama less ruthlesslessly if he sticks to certain fundamental principals of capitalist exploitation of medical needs:

Obama must not use the Government to provide any additional medical care, as it does now through Emergency Medical Technicians, the Veterans Administration and the Public Health Corps;
If the Government wants poor people and the middle class to have expanded access to health care, the Government must pay exhorbitant "premiums" to health insurance companies. And they're not called PREMIUM for nothing. They're called "premium" because, as with gasoline, they are the highest available prices.
The Government must extend private health insurance to 50 million or more people without spending any more money than it spends right now.
The Government must not endeavor to increase the supply of doctors and nurses, even though 50 million new health consumers will inevitably require at least 15% more staff than we presently have, IF those who are insured now do NOT get better access to health care. If those who are underinsured now get better access to health care, then we may need forty percent more health care professionals, since we are about number 20 internationally in the number of doctors per capita.
Obama must get at least half a dozen Republican votes from a Republican Party that has voted along party lines for the last thirty years, regardless of the subject of the legislation.

With all of these bogus premises, none of which does anything to augment health care, and all of which simply present new barriers to access, Obama still has to beg and plead and offer oral sex to Republican congresspeople, who show no signs whatever of going along with him. All Obama is succeeding in doing is looking like a turn-coat to the constituencies that elected him and an indecisive bumbling clown to the entire country.

In truth, health care for all is a socialist principle that cannot ever be obtained through slavish obeisance to venal capitalist insurance companies and corporate "provider" profiteers.

After bending over backwards and giving up all of the principles with which he came to office, the likelihood is that the Democratic health plan won't get a single Republican vote, even after having been thoroughly shredded in order to achieve that fanciful and utterly unrealistic "bipartisanship" goal.

Obama has said he will make a speech to a joint session of Congress five days from now. If he lays out the same "principles" that I've described above, he will be laying the basis for massive losses of Democratic Congresspeople in 2010, and he will be conceding defeat on the very programatic cause that is most consistently prioritized by a majority of Americans.

Americans are beginning to wonder who President Obama had to copulate with in order to get the job he now holds. And the more he concedes and backpedals and signals his willingness to accept defeat on the type of health care he was elected to furnish, all supposedly to get six Republican votes in the Congress, the more it appears that President Obama would give oral sex to the Republicans who seem half-willing get on board.

In fact, the insistence on bi-partisanship looks more and more like an excuse to do what the AMA and insurance companies elected him to do: Maintain the status quo or give even more tax payer dollars to the insurance companies who are already robbing us blind.

President Obama, I never knew you.

Greg Jones Writes: My Sister Died Today, W/ Health Care Coverage

2009-09-03T13:15:00.000-07:00

Greg,

I want to express my condolences in your time of grief, and my anger that whatever medicine your sister needed would probably have been available in Brazil for 25% of the $200.00 your sister lacked. Medicine in less expensive all over the world than it is in the United States.

FLH

Please Share In Anyway You Can...Thank You.

My Sister Died Today
WITH Health Care Coverage
Could NOT Afford Life-Saving Medicine

By: Greg Jones
Blacks4Barack
National Director

Last Wednesday, my only sister was taken to emergency because of difficulty breathing. She's had a history of numerous illnesses ranging from lupus, seizures and osteoporosis but this particular visit was more related to her asthma, or so she thought. After being seen by the physician it was determined that her breathing difficulties were worse than anticipated as she was diagnosed with having a case of pneumonia. Feeling blessed to be able to get immediate medical care Karen was of the ranks of the fortunate known as the insured, meaning that she does in-fact have health care coverage which she acquired after being declared medically disabled after her thirty third seizure.

Yes, it took thirty three seizures, 5 appeals, 4 years and 3 lawyers but Karen Jones was finally declared disabled and was granted full disability which included full health care coverage, far from an easy feat but quite reassuring to Karen as she continued on through life. Unable to work due to her disability, Karen lived alone off of the $563 disability check each month as best she could, regularly robbing Peter to pay Paul, but all along able to make ends meet from check to check, and doing so always with a smile.

Even though times were really harder than Karen lead others to know she was thankful for the roof over her head, her access to medical care when needed, her monthly check and the ability to basically survive, which may be the reason that she developed the characteristic of never asking for help from others regardless of how much she may have needed it at times.

So she didn't like the fact that she had to trouble a neighbor to take her to emergency on Wednesday but she just couldn't breathe well. After the diagnosis that pneumonia was the culprit Karen signed the final papers as her prescription form was being handed to her. "Get this filled, take 4 of these per day and this will clear up your breathing" were the directions given as Karen prepared to go home, wheezing profusely along the way. The neighbor takes her directly to the pharmacy which is where Karen is told that this much needed medication will cost her $197. It's the end of the month, funds are extremely low, and Karen is far from having an extra couple hundred dollars laying around, so she goes home, takes some extra inhales from her breathing machine, and decides to toughen it out until the first of the month, just a few days away, when she'll get her next check and have the money to buy her medicine.

Being a prideful, independent woman Karen continues to tough it out each day never showing to others her true discomfort or need. All day long on Thursday and Friday Karen constantly thinks to herself how much she wishes she had been able to afford to buy the medicine as she does a mental countdown to the first of the month with every inhale through her machine. "I shouldn't have paid the light bill...I should have bought less food" are just a couple of the thoughts that haunt Karen as she figures ways she could have had the much needed money. And on that Friday night as she lay in bed she takes a few extra puffs from her breathing machine to get her through the night.

On the early eve of Saturday morning around 4:30 or so, Karen Jones, my only sister, died, age 51. Apparently, around 4:00 she had severe difficulties breathing, strained to call a neighbor who immediately got dressed and came down to the house, knocked on the door like crazy but there was no answer. Feeling great concern a call was made to the police who quickly arrived, gained access into the house, and there lie Karen, dead on the floor, beside her breathing machine.

Although we all were well aware of Karen's history of sicknesses I never expected my sister to die at such an early age. Of course I am of great sorrow and pain over the loss of my sister but I am also very angry with our health care system. I am angry, no actually in shock by the fact that my sister, Karen was declared to have full health care coverage through her disability benefits. But since it did not cover her medication, which she could not afford to buy out of pocket, my sister died with this so-called full coverage. What kind of full coverage does one really have if they are forced to pay for expensive medications out of their measly $563 monthly check ? I truly believe that if my sister had had her medication she would be alive today. It is absolutely disgraceful that our health care system has the gall to claim they are supplying full health care benefits to the disabled while simultaneous depriving them of the very medicines needed for survival.

Believe it or not, you could say Karen was actually one of the lucky ones only needing one medication compared to others who frequently need 2 and 3 medications, at costs which exceed their entire monthly check. So many who are sick, struggling and classified as fully covered are are in fact struggling helplessly, going without vitally important medications.

Throughout the health care reform debate many have argued that there is no need for strong reform of our system. Most others though do recognize the severe need to reform health care coverage in our country so that we no longer have 47 million Americans who have absolutely no health care at all. 47 million who do not have the basic right to get medical help when they are sick. This is sad and pathetic. Recently, an organization, RAM, known for offering free medical care in the Amazon has been forced to offer their services right here in our country. In Los Angeles, in Iowa and other U.S. locales, hard working Americans who can't afford health care coverage line-up by the thousands for free, much needed health care, similar to scenes in third world countries.

And while we must make certain that health care reform addresses the needs of the uncovered we must also make certain that we address the needs of the category now known as the under-covered. These are the people who have health care coverage but for one reason or another, tend to find out the hard way, usually when they are sick, that their coverage wasn't as 'full' as they thought.

Of course, it will haunt me forever as to why my sister didn't pick up the phone and ask me for the money, but folks that know her know, that's just Karen. And there are millions of other Karens out there, in desperate need and dire straits, but too independent to ask for much needed help. It is our responsibility, our duty to do everything we can to help the 47 million uncovered and the additional millions of under-covered to have the basic right to true health care coverage.

I hope my sister's passing did not include suffering. And now, even more, I hope that we all across this great land, will unite, do the right thing and pass a strong health reform bill which includes a strong public option so that we can curtail the suffering of millions more ahead. We must fight for the 47 million and the Karen Jones's of America. This is a battle that must be won !

Greg Jones
Blacks4Barack.org

####

Please feel free to share!

Is Obama Punking Us On Health Care?

2009-08-30T07:05:00.001-07:00

As I watch the health care debate through the newspapers and blogs, and the confused and confusing statements of President Obama and his authorized spokespeople, I just don't know what to think. Obama refuses to make it clear that there's anything at all that can or can't be in the health care bill that he might finally sign. He seems content to publicly let others throw whatever they want into the grinder and see what sort of hash comes out of the other side.

The ultimate test of this approach will be what Obama signs and whether he signs a health care bill at all. Perhaps he believes it's not worth wasting his breath discussing thousands of alternatives that might or might not be abandoned by their proponents before the sun goes down.

I know one thing is for sure. When the final health bill comes out, I'm going to compare it to what "Third World's" Brazil has, which is free and public health care for everyone, as a constitutional right, regardless of income, and not subject to payment except through various taxes not directly related to health care.

If Obama accepts limits on health care for immigrants based on their status or lack thereof, then he and the Democratic Congress have failed. Health care is not universal and every one of us will have to prove our immigration status before the turnicut is applied to suppress our bleeding.

If, after all of this discussion, poor people still have to prove that they are insured before they can receive health care, then the effort has been an abysmal failure. It's not universal if there are people who are not covered.

If everyone is still talking about access to "insurance" rather than access to doctors,nurses, hospitals and medicines, then we will know that the insurance companies are still the arbiters of our health care "market," with insurers holding more power to ration our care than even our elected officials have.

When there is a natural disaster in a foreign country, we do not airlift supermarkets or food coupons to the victims; we airlift food. Likewise, the medical care disaster that is America does not need insurance companies. It needs more doctors, nurses, medicines and health care.

Speaking of which, there are approximately 50 million people (roughly 16% of the population) in the United States without access to health care except through hospital emergency rooms. When these people do gain access to health care, there will be 16% more consumers overnight, but the number of doctors, nurses and hospital beds will not have changed. If supply and demand rule markets, then the price of health care will increase as the supply becomes smaller relative to the demand.

Instead of talking obsessively about how to assure the insurance companies that they will earn more under a new regime, we should be talking about how we are going to train and deploy 16% more doctors, nurses and other health care professionals. It is ludicrous to assume (or simply forget)that 16% new patients will require the provision of at least 16% more services. In fact, we should assume that demand will increase more than the number of additional patients, since many of those newly insured will have health care issues that have needed attention for years, but did not have attention for lack of access.

We should assume that there is pent-up demand for mamograms, prostate cancer screening, diet counseling and other services that were inaccessible before because they were not considered emergency treatment in hospital emergency rooms.

USA vs. Brazil on Health Care Options

2009-08-23T23:39:00.000-07:00

Because of chronic depression and diagnosed bipolar illness, I have been an intense medical consumer for the in three countries, including my native USA; France and Brazil. But, I've traveled through seventeen countries and had opportunities to discuss medical care with many different people, including two weeks as a medical translator in Nicaragua.

Every day from Brazil, as I watch the health care debate going on in the United States, I mentally compare the US health care “market” with the Government health systems I experienced in France for thirty months (2001 -2003), and now in Brazil for the last five years.

In this article I offer statistical evidence and then first-hand experience to show readers how awful the US health care "market" is compared to what other countries offer. Although many people here are happy with their health care, few of them know what they could get overseas for a quarter of the price.

Too many people who pontificate about the terrors of "socialist" health care and the deficient care in other countries versus the wonderful care in the United States simply have never been outside the United States and therefore, frankly, have no idea what they're talking about.

They are like childless men who would nonetheless describe the experience of pregnancy and delivery in great detail, comparing hospitals to midwives. They simply have no idea what they're talking about from personal experience and probably will never bother to confuse their ideological certainty with actual statistical evidence. So, they offer their opinions and profer any half-baked "proof" they can muster to show that they know something they about which they are actually utterly ignorant (like the 68% white male US Supreme Court that determines when women can get family planning care and how and why.)

Such opinions would be considered "hearsay" and therefore inadmissable as evidence in courts and, they certainly would not qualify under the Federal Rules of Evidence to offer "expert opinions" or any opinions at all.

The Rules - especially Rule 702 - place appropriate limits on the admissibility of purportedly scientific evidence by assigning to the trial judge the task of ensuring that an expert's testimony both rests on a reliable foundation and is relevant to the task at hand. The reliability standard is established by Rule 702's requirement that an expert's testimony pertain to "scientific . . . knowledge," since the adjective "scientific" implies a grounding in science's methods and procedures, while the word "knowledge" connotes a body of known facts or of ideas inferred from such facts or accepted as true on good grounds. The Rule's requirement that the testimony "assist the trier of fact to understand the evidence or to determine a fact in issue" goes primarily to relevance by demanding a valid scientific connection to the pertinent inquiry as a precondition to admissibility. Pp. 9-12. DAUBERT v. MERRELL DOW PHARMACEUTICALS

And yet many talking heads and professional lobbyist's pontifications are having a weightier role in our health care debate than actual statistics from reliable and neutral sources.

There are all too many paid hacks who oppose public option medical care, prefering to argue baseis on their own "free market" ideology and the baseless fears, instead of looking at the experience and statistics from other countries and interviewing people from overseas to see what their actual experiences have been. Or they argue against public option medical care for patients based on the negative effect that public option medical care could have on insurance companies! Pardon me, but I couldn't care less whether my access to effective health care hurts somebody else's stock portfolio.

Television is full of pontificators, but has any reader of this article actually seen ANYONE on television from a foreign country describing how their health care system works and how it compares to ours?

If they have, it will surprise me and I would love to hear about it in the comments. It would normally be considered unpatriotic to tell the real truth about this, the truth being so sad and maddening, but I'm going to do so here anyway, based on personal experience, in the hopes that the USA can someday (if President Obama has the manhood) improve to the point where we can be proud of our overall health care even when we tell the truth about it.

I will acknowledge that there are many people who are happy with their health care in the USA, but I would also observe that (1) most of them have had no opportunity to compare it with what is available overseas for a quarter of the price, and (2) anyone can find fresh salmon in a supermarket if they are willing to pay forty-five dollars a pound for it. Those who can't pay that are the ones who either go without or eat sardines with a fork from an oval can.

I'm getting to the actual comparison, but I must also observe that in the USA there are far too many conservative and media talking heads who prefer to offer excuses (without supporting statistics) for the fact that the infant mortality rate in the USA is twenty percent higher than that of Cuba, instead of looking at what Cuba is doing and trying to learn from it.

The USA infant mortality rate is actually almost three times higher, if you compare Blacks in the American South to Latin Americans in Cuba. Yes, "We have the best health care in the world in the USA," but for some reason there are 32 countries in the world with infant mortality rates lower than ours. Actually, the truth may be worse. The CIA's World Fact Book says there are 45 countries in the world with less infant mortality (death in the first year of life) than the United States.

Nicholas D. Kristof of the New York Times observed,

Babies are less likely to survive in America, with a health care system that we think is the best in the world, than in impoverished and autocratic Cuba. According to the latest C.I.A. World Factbook, Cuba is one of 41 countries that have better infant mortality rates than the U.S.

Let's suppose that we refuse to believe Cuba's infant mortality rate as mere Communist propaganda. That still doesn't explain why 32 to 40 other countries still have less infant deaths than the United States. Is this a worldwide conspiracy to bake statistics in order to make the USA look bad - including help from our own CIA Factbook? It is worth noting that many websites look for ways to discredit the Communist success of Cuba with infant mortality, but they offer no excuses for the other three dozen countries that do better than the United States does.

After eight years of presidential advocacy for the "rights of the unborn," you would think that children actually born in the United States would be healthier, rather falling farther behind children in other countries where abortion is perfectly legal.

So, let's take a moment to compare US health care with that of Brazil, which many Americans associate only stereotypically with tree-dwelling monkeys, Rio de Janeiro prostitutes, the Amazon and the drug trade:

Public health care in Brazil is a constitutional right. Even though I am not covered in Brazil by any private insurance, and only by Brazil’s public option health care, ("Systema Única de Saude" or "SUS", which means "Unitary Health System"), the public care available to me here is better than the private care that was available to me in the United States.

I will not even bother to compare the USA to France, where I lived for thirty months, since that would be like comparing the ski slopes in Bermuda to the ones in Vail, Colorado.

Instead, I’ll just compare in bullet points the differences between two alternatives:

The USA's “free market” and
Brazil's public option “system”, which I call a "system" in all seriousness, since the USA has a health care “market”, but lacks a health care “system”.

(A "system" includes a series of integrated parts that interact to create a whole, yet no one would argue that the USA's health care includes everyone in a "system" or that the parts are integrated or that they create a whole, or that its behavior is predictable in any particular case.

Some people venerate the "free markets" but they are notoriously chaotic and unreliable, as everyone's 401k plans are now showing, and as the sub-prime mortgage market, and trading in derivatives have taught over the last two years.

If a diabetic's medical care and blood sugar swung for two years as the real estate, money market and bank stocks have, the diabetic would be in a casket right now, six feet under the grass in a cemetary.

And yet our American access to medicical care is based on just such a "free market," with insurance companies no more reliable than CNN stock prognosticators and snake oil salesmen.

So let’s compare Brazil’s public option care to the US’s private market medical chaos:

First of all, US private interests, including medical schools, the AMA, insurance companies and pharmaceutical interests have so smothered the “free market” with pro-industry federal regulations that , for example, Americans cannot import drugs from overseas that are made by the same companies but cost 75-80% less at Brazilian pharmacies;
US medical schools are not increasing the number of medical school graduates relative to the number we will need if there are 15% more people with medical insurance, requiring regular checkups. The monopoly market is assuring that the supply of doctors will not meet the demand, and therefore prices will increase when new insureds enter the market. Medical schools and the AMA control the number of doctors trained, but they clearly are not acting in the public interest.
In contrast: “The number of graduates from U.S. medical schools has remained roughly constant at about 16,000 a year since the 1980’s. But the number of new doctors has fallen as a percentage of the population. The population rose by 50 million from 1980 to 2000, according to the census.” NYT, 2009
• An increase in the number of doctors trained “would be welcome news to the Association of American Medical Colleges, which is calling for a 30 percent rise in admissions. According to a 2008 report co-written by Edward Salsberg, director of the Center for Workforce Studies with the medical association, the gap between supply and demand for doctors could be 125,000 to 159,000 by 2025, if the training of doctors fails to keep pace with population growth and a rising need for specialists catering to the aging demographic.” http://www.nytimes.com/2009/04/29/education/29iht-riedmedus.html
• Brazil is opening new medical schools all the time, and even seeing a need to block the opening of new medical schools to maintain their quality. According to Brazil’s National Institute for Educational Research, the number of medical schools increased from 98 in 1998 to 123 in 2004, which means that more doctors are available, it’s easier to get appointments and it’s harder for doctors to charge outrageous fees. Odontologia.Com.br
Meanwhile, the US is number 23 in terms of practicing physicians per thousand population, among OECD countries . OECD Statistics
No wonder we can’t get an appointment with a doctor! It is hard to justify the claim that we have the best medical care in the country, unless we acknowledge that we simply have the most expensive medical care for the 85% of the country that has any access to medical care at all, while we have among the worst care for those 15% without any sort of medical insurance.
I was born in New Bedford, Massachusetts which, last I heard, had one Public Health Service medical center and one mental health center for the 100,000 population. My sister worked there as a General Practitioner and personally delivered all of the babies in the city that were not delivered by private practice doctors. When she left the Public Health Service she said that one of her greatest frustrations was that patients for whom she painstakingly identified their illnesses could not afford the medication that would make them better. Meanwhile, private practice doctors refused to cover for her, so she worked seven days a week delivering babies at all hours of the day and night.
Now, I compare my experiences in the United States to those I've had in Brazil: I live in a Brazilian city of 100,000 population that has one free Government medical center per neighborhood. There are so many free neighborhood health centers that lifetime residents of this city literally cannot count them all. But I can say, having visited them, that within a ten minute walk from my home, there are two free medical centers; a free adolescent mental health center; two free adult psychological centers; and a free full-service hospital; all with free pharmacies; plus a free-standing Government pharmacy where no medicines dispensed cost more than five dollars per month.
The free medical centers provide dental care as well, including fillings, dentures, cleaning and other basic care. It doesn’t take a genius to predict that more free medical centers, hospitals, and free pharmacies closer to where people live will help increase accessibility and improve outcomes.
Based on personal experience, I know it is possible to visit a dentist here with no appointment in various areas of the country. Moreover, you can get a root canal or crown here for half of the monthly minimum wage, and many dentists will accept post-dated checks, and IOU’s for their services. When my step-daughter broke a large piece off of her front tooth, a dentist fixed the tooth impeccably, with no evidence that it had ever been broken, and he charged us one fifteenth of the monthly minimum wage for the service. Is there ANY service you can receive from a US dentist for 1/15 of the monthly minimum wage?
My wife had two moles which she was afraid might be precancerous. At a private clinic, we saw a dermatologist who charged us one fifth of the monthly minimum wage for a consultation. He said he did not believe the moles were cancerous and his fee would be one half of the monthly minimum wage to sample and test the cells. Instead, we went to a local public hospital where a doctor sampled the moles, sent them for testing and pronounced them noncancerous, all at no cost whatsoever. We discovered that it would cost two thirds of the monthly minimum wage to tests the moles through the private doctor. Even though the moles were not cancerous or precancerous, the Government doctor offered to remove them and did so, as elective surgery. It took about three months to complete this round of services, but the Government services were entirely free of charge.
Brazil has excellent private hospitals and is well-known for medical tourists traveling here for plastic surgery, because it is so much quicker and less expensive here than in the United States. Changing the face of cosmetic surgery, Brazil leads the plástica revolution. http://www.guardian.co.uk/world/2006/aug/07/brazil.fashion
It is not as well-known that dentistry tourism is also very cost effective and pleasant in Brazil. “The most popular and well-known place that Americans go to get inexpensive but quality dentistry is Los Algodones, Mexico, which is just over the border from Yuma, Ariz. However, Costa Rica is among the top five countries where Americans seek dental work. The other hot spots are Argentina, Brazil, and Malaysia,” says AARP.ORG.
In fact, one of the major holes in the French national health care is that it doesn’t cover dental work except extractions and reconstruction after serious accidents. In comparison, Brasil’s public option covers fillings, cleanings and dentures. But the real savings are to be had at private dentistry clinics in Brazil, where even people earning minimum wage can afford to wear braces on their teeth. When I left the United States in 2000, I had a desperate need for a crown. A dentist gave me an appointment a week away and charged me $250.00 for a temporary crown that soon fell out. In France, a dentist offered to provide the crown for the equivalent of two thousand dollars. Four years after the need for the crown became apparent, I found an excellent dentist in Brazil who installed a crown for the equivalent of one hundred and twenty-five dollars. A root canal on another tooth cost me another one hundred and twenty-five dollars. And because dentists and dental office time are far more plentiful in Brazil, I was able to have the entire process finished within one week, with the initial cleaning and ex-rays done on the very same day on which I first contacted this dentist.
Because there are more dentists in Brazil per one thousand patients and far more competition, it is possible to see a dentist and receive complete or significant care immediately. Even wealthy people cannot access care as easily in the United States.
There are plenty of stories on Brazilian television about people who were harmed by long lines and callous doctors. This occurs without doubt, but remember that these are complaints about free medical care and not about insured care whose premiums gobble up a fifth of their salaries, as is so common in the United States.

As I said above, I suffer from chronic depression and diagnosed bipolar disorder. I know what it is to need medical care and have a lot of experience trying to find it. Under no circumstances would I want to trade the access to health care that I have now under the Brazilian Government's public option for the access I had when I worked in the United States as a managing attorney and had private market HMO care, as well as other various makeshift non-profit or quasi-public options.

If you have suffered as I have trying to access consistent and acessible mental health care in the United States, I urge you to move to the South of France or Brazil, where medical care is more easily accessed and the climate might do wonders for you. If it doesn't work, you can always return to the United States. You already know what that's like.

Congress Tells Obama, Stop Waffling on Public Option Health Care

2009-08-18T10:08:00.001-07:00

Karen Hatter published an excellent article here this weekend about the many people she knows, including herself, who have suffered or even died for lack of prompt and adequate health care. Even though I am a lawyer, I am one of the people who has suffered greatly with depression and anxiety in the United States, greatly exacerbated by the lack of accessible health care and appropriate medication, as described below.

Now, with President Obama and some of his key spokespeople saying over the weekend that a “public option” was not essential to health care reform, risking leaving the public at the mercy of venal insurance companies, Democratic Party constituencies are pushing back, along with some of our representatives in the US Congress.

John Sweeney, president of the AFL-CIO, said the union will continue pressing House and Senate negotiators to keep a public plan. "The only way to force real competition on the insurance companies is a strong public plan option," he said. WaPost

The Washington Post is reporting that many Congresspeople will refuse to vote for a health care Bill that doesn’t include Public Option.

In the Senate, where negotiations are now focused, John D. Rockefeller IV (W.Va.) said that a public option, as the plan has become known, is "a must." Sen. Russell Feingold (Wis.) said that "without a public option, I don't see how we will bring real change to a system that has made good health care a privilege for those who can afford it."

House Speaker Nancy Pelosi (Calif.) said that the plan will be included in whatever bill is voted on in the House. "There is strong support in the House for a public option," she said, though she did not demand that the administration express support for the idea.

One Democrat predicted that without the provision, the bill could lose as many as 100 votes in the chamber. WaPost

Like Karen Hatter and the rest of Americans, I need regular health care. As a person who has chronic endogenous depression, I need to see a psychiatrist at least one every two months to get a fresh prescription for anti-depressant medication (nortryptaline) and an anti-anxiety medication (diazepam) that boosts the effect of the anti-depressant, the same way alcohol boosts the effects of drugs in the system.

Yesterday in Brazil, I made my bi-monthly trip looking for a doctor to prescribe the medication I need. The bad news is that I had to go to four different clinics before I found a doctor willing to write the description. The good news is that in all of these discussions I had with clinic staff, no one ever doubted my right under the Brazilian Constitutional to receive health services from the government for free, with no discussion of financial need, no co-pays, and no eligibility discussions.

At the third clinic I visited, the very helpful receptionist made sevaral calls, found a willing doctor, and sent me to that doctor’s office, where I received the needed prescription. The entire process took me three hours.

The further good news for me, that is shocking from a US-based perspective, is that the medical consultation, the prescription and all of the medications were provided to for free by Brazil’s public option health centers. I spent more money on a moto táxi than I did for a two-month prescription of the medications I needed.

Some people think it's "socialism" for people with medical illnesses to receive treatment without paying by cash or credit card, or working through a third party that skims 30% off the top of all health care provided. I don't care how they characterize the system that provides me with the medical care that is essential to my survival. Anyone who would argue against Americans receiving the medical attention and medicine we need is a person who needs to be ignored, no matter what spurious arguments they put forward.

I certainly wish I could see a psychiatrist this quickly in the United States, get a prescription this quickly, and get free medication this quickly. But, I know that I cannot. And since life and death medical care must come first, even before continued participation in the profession for which I was trained, I have decided to live in a country where my medical needs can be met within the institutions that are available to me. I discovered almost a decade ago that the United State is not that country. Ironically, in light of the relative wealth of the United States, the country where my needs are best met is the “Third World country” of Brazil.

Today and every day, I watch the “Public Option” negotiations in the US Congress with great interest to see if (some day) I and other Americans can receive in the United States of América the care and medication that I count on here, today, in Brazil.

In my opinion, the US Congress is now deciding whether the US will have a deficient sub-Third World health care system, guided only by the profit motive in a market designed to make doctors and medical care scarce and expensive, or whether the US will improve its medical care standards to that which is available now in the Third World.

I also read polls reporting that most people in Virginia are happy with their medical care (except the 15 % who have no access to health care at all). That's like saying that people who can swim are content at beaches and swimming pools that have no lifeguards. What about the people who can't swim, or those who can but still get into trouble in turbulent waters? That person might be you, regardless of what health "insurance" you believe you have today. I don't want and I don't think we need "health insurance"; I want and I think what many of us really want and need is health CARE, without the intermediaries.

You, Too, Are At Risk When Neighbors Lack Access to Health Care

2009-08-16T09:57:00.000-07:00

First posted at NowPublic.Com

Karen Hatter published an excellent article here today about the many people she knows, including herself, who have suffered and even died for lack of prompt and adequate health care.

It is a superb article and much that is very important has been said in the comments.

I share Tina's bafflement that Americans will turn their interstate highways and national defense over to the federal government but are desperately afraid of national solutions to national health care problems.

Roy says in comments, once again,

What angers me is to hear others tell me that I am, in effect, bad because I don't want Washington, D.C, in charge of a 300 million people system that will guarantee care to illegals, for example.

What I find baffling about this attitude is that, as a US citizen, I have received excellent and free government health care in France and Brazil, and yet there are Americans who would deny the same care to others that these Americans would receive if they went overseas. Are we so cheap that "what's mine is mine and what's yours is ours"? Is simple reciprocity really so foreign to us? If you are hit by a car in Paris, do you want your critically mangled body to be flown eight hours back to the US before treatment because France doesn't treat illegals? Luckily, France and Brazil would never treat us the ways we would treat them under similar circumstances.

If the current international spread of the H1N1 virus has taught us anything, it should be that our neighbor's lack of access to diagnosis and treatment of contagious diseases constitutes an imminent risk of disease in ourselves and our children, regardless of our neighbors' immigration status.

Self-interest alone dictates that everyone present in America must have access to health care, lest they make your food at McDonald's while coughing tuberculosis bacteria into your french fries and hamburger. Would you like to have someone working next to you in your office with highly contagious swine flu that has not been diagnosed, because you have insurance and they don't?

Would you like your child to contract AIDS, herpes, or another sexually transmitted disease because they have sex with someone who is not eligible for an AIDS test, not eligible for herpes treatment and counseling, and can't afford to buy the medicine to kill the bacteria in their sexual organs? Your child cannot be safe unless everyone of his/her sexual partners has access to modern medical diagnosis and treatment for sexually and orally and airborne transmitted diseases.

Let's agree on this: Anyone who has ever provided a service or product to you in the United States - directly or indirectly - should receive health care when they need it. If everyone without a legal immigration status left the United States tomorrow, our health care would be in even greater a mess that it is today, because many of the people who clean our hospitals, wash us and our hospital bed linen, and clean doctors' offices are from Guatemala or Mexico, without any legal immigration status here. Would you prefer dirty bed linen?

A study was once done to determine whether people would like to receive ten dollars as a gift. Of course, everyone wanted the ten dollars. But when they were told that they would only receive the money if someone of another skin color also received the money, then people became much more ambivalent. Many people didn't want the ten dollars if someone with brown skin was going to receive ten dollars as well.

As for health care, some of us would rather die for lack of care than see "illegals" get care. And that is precisely what often happens. Because every time someone spends two hours in an emergency room proving their right to receive medical care, or negotiating a way to receive it without insurance, there are many others - many who DO have insurance - who nonetheless wait while the insurance status of others is checked for a particular procedure. Unless EVERYONE is covered then EVERYONE will wait in long lines while the human resources of our doctors and nurses are spent dickering with insurance companies.

Here's an analogy: How many houses would burn down if firemen had to check homeowners fireman insurance before firemen put out fires? How many houses of insured people would burn down while firemen were checking on the insurance status of the uninsured.

Somehow, we are all able to understand that unless everyone has access to public firefighting efforts than no one is safe from fire. Perhaps we understand that because fires once spread from house to house, burning entire communities down.

Here's another analogy. How would you like it if you called the police to report a break in at your house, and then the dispatcher asked for your police insurance number, social security number, date of birth, employment and credit card data? Wouldn't all that data that is irrelevant to the risk you face increase the risk that police dispatcher lines would be jammed and many people would go without immediate service in serious emergencies?

Well, today the child in your child's school who lacks health insurance is going to give your child Swine Flu. Swine flu spreads from person to person regardless of insurance or non-insurance status, just as fires once spread from house to house, before free, public firefighting became the norm.

If your neighbor cannot depend upon the fire department then your house and his might burn down together. You can't protect your house except by putting out the fire that is inflaming your neighbors house. And that is why America needs universal insurance, even for the "illegals" who are making our hamburgers at McDonalds and washing the dishes at Italian Garden while they cough with tuberculosis, are feverish with salmonella, giardia, cryptosporidium, rotavirus, E Coli,

If the "illegal" immigrant who prepares your food doesn't have access to health care, then you're more likely to need health care yourself.

8 ways reform provides security and stability to those with or without coverage

2009-08-15T05:43:00.001-07:00

I have a sibling who is a medical doctor supporting Barack Obama's health care reform. My sibling forwarded the following e-mail message to me for guidance as the health care debate rages on. It seems to have been prepared by President Obama's folks as key talking points in the health care debate.

8 ways reform provides security and stability to those with or without coverage

Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

Learn more and get details: http://www.WhiteHouse.gov/health-insurance-consumer-protections/

8 common myths about health insurance reform

Reform will stop "rationing" - not increase it: It’s a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.
We can’t afford reform: It's the status quo we can't afford. It’s a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.
Reform would encourage "euthanasia": It does not. It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.
Vets' health care is safe and sound: It’s a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.
Reform will benefit small business - not burden it: It’s a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.
Your Medicare is safe, and stronger with reform: It’s myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors.
You can keep your own insurance: It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.
No, government will not do anything with your bank account: It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you – and the same rules of privacy will apply as they do for all other electronic payments that people make.

Learn more and get details:
http://www.WhiteHouse.gov/realitycheck
http://www.WhiteHouse.gov/realitycheck/faq

8 Reasons We Need Health Insurance Reform Now

Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more: http://www.healthreform.gov/reports/denied_coverage/index.html
Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. Learn more: http://www.healthreform.gov/reports/hiddencosts/index.html
Roadblocks to Care for Women: Women’s reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care. Learn more: http://www.healthreform.gov/reports/women/index.html
Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more: http://www.healthreform.gov/reports/hardtimes
Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more: http://www.healthreform.gov/reports/helpbottomline
The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more: http://www.healthreform.gov/reports/inaction
Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more: http://www.healthreform.gov/reports/inaction/diminishing/index.html
The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform. Learn more: http://www.WhiteHouse.gov/assets/documents/CEA_Health_Care_Report.pdf

US's For-Profit Medical Care and Obama-Care Are Antithetical

2009-08-10T22:29:00.001-07:00

Cross-posted at Now Public .

First posted as a more limited discussion
at the Francis L. Holland blog.

[Update:] Someone at an Obama health care forum asked the President "where the nation would find the additional doctors and nurses it needs," which is a supply and demand problem that has hardly been discussed at all in recent debates.

For-profit health care is simple: you can only get health care if you can find providers who can make more money providing health care to you than they could earn providing health care to somebody else. It's like a car auction: the auctioneer publicizes the auction and then sells the cars to the highest bidders.

With US for-profit health care, the rules that control the auction are written by the sellers while the buyers have input on . . . virtually nothing at all. It's like a mall at Christmas time. Pay up or leave the goods on the shelf. Except that the demand for health care never decreases after-Christmas, there are no after-Christmas sales. The demand is constant and the price just keeps going up.

The United States spends a lot on medical care, but that’s directly related to the low number of doctors we have per capita, compared to many other countries. According to the Organization for Economic Cooperation and Development,

The United States also ranks far ahead of other OECD countries in terms of total health spending per capita, with spending of 5,635 USD (adjusted for purchasing power parity), more than twice the OECD average of 2,307 USD in 2003. Switzerland and Norway come just after with spending of about 3,800 USD per capita. Differences in health spending across countries may reflect differences in price, volume and quality of medical goods and services consumed.

( . . . )

Despite the relatively high level of health expenditure in the United States, there are fewer physicians per capita than in most other OECD countries. In 2002, the United States had 2.3 practising physicians per 1,000 population, below the OECD average of 2.9. http://www.oecd.org/dataoecd/15/23/34970246.pdf

It stands to reason, based simply on the laws of supply and demand, that in a market-based medical system that hás fewer doctors than other systems that are not market-based, US doctors and medical institutions will increase their prices, have no incentive to curb profitable waste, and there will be little or no competition in the market to keep prices in check.

In 2008, 18,000 new students matriculated at US medical schools, compared to 17,000 in 2005 and 16,600 in 2004.Table 1. U.S. Medical School Applications and Matriculants by School, State of Legal Residence, and Sex, 2004 The number of enrollees increased by about 1,500 (9%) over a four year period, or an average of 3% per year.

While that may seem reassuring in terms of the ration of doctors to patients, nonetheless the elder population in United States is aging and will need more consistently more medical care.

The increase in median age from 32.9 years in 1990 to 35.3 in 2000 reflects a 4-percent drop in the number of persons between 18 to 34 years old combined with a 28-percent increase in the population between 35 to 64 years of age. http://usgovinfo.about.com/library/weekly/aa051801a.htm

So, the demand will continue to increase, but medical schools are not increasing their enrollees sufficiently to meet the increased demand. (Why would they when their exalted role and compensation in our society are based partly on the scarcity of doctors?) If the laws of supply and demand operate as expected in a market based system, the cost of medical care will continue to increase and the cost of Government expansion of access to medical care will increase Government expenditures more still.

To curb this cycle, the US Government should encourage medical schools to enroll more future doctors, through, e.g. by providing more research funding and other support to schools that are educating more future doctors.

Unfortunately, the plans in the US Congress seem to do little or nothing to address this problem of lack doctor supply and stampeding patient demand. Therefore, the cost of health care will continue to rise, and the rise of universal health care will make supply scarcer still, spreading what few doctors we have among 15% more patients (those now uninsured).

If it takes us six weeks to get an appointment with a dentist or psychiatrist now, imagne how long will take with 15% more patients in the market.

This is not to say that we shouldn't implement national health care. Rather, the point is that far more fundamental changes to US health care culture will be needed to make even the present level of care sustainable, much less increasing the number of patients.

Medical schools can no longer make doctors rare in order to increase the prestige and lucre involved in practicing medicine. We need to encourage doctors to enter the field when they do so to provide care in exchange for a salary, and we need to encourage venal medical entrepreneurs to go to business school instead.

Medical schools need to graduate more doctors. The obvious market-based solution to high prices for services is to increase the number of professionals providing those services so that competition will drive the prices down. So far, in spite of statistics showing that we have less doctors per capitã than many other nations, I have not heard a single source suggest that we simply need more doctors.

Meanwhile, competition among insurance companies (which are monopolistic, with no end in sight) will not change the fact that fewer doctors means longer waits and higher fee for services prices. In all likelihood, doctors will offer shorter waiting lines to those who pay in cash, and even those with “good” insurance will find waiting times greater and greater, if there is someone will to pay the doctor more in cash than the insurance company will pay.

An alternative would be for the Federal Government to underwrite the medical educations of future doctors who want to work on a salaried basis, creating and expanded Public Health Service which already operates on this basis.

The Government could further assume the hundreds of thousands of dollars of educational loans that many doctors are in exchange for doctors working on a salaried basis for government-sponsored medical facilities. (I personally know doctors who hate having to ration services and medications based on patients’ ability to pay. Many physicians would much prefer to be salaried than to be medical entrepreneurs.)

In exchange for these doctors working on a salaried basis, the Government should provide free malpractice insurance for these doctors and patients should be compensated not with huge awards but rather with a legal right to medical care that corrects mistakes, as well as income and replacement, just as we now have under the Worker’s compensation scheme that limits lawsuits against employers in exchange for income during times of illness and medical care even when workers are too sick or disabled to be covered by employment-based medical insurance.

Here's another observation: Unless medical care is a right for all, then even those with excellent medical insurance will have to wait in line behind others while nurses dicker with insurance companies over the cost-effectiveness (for the insurance company) of the care that patients need. I even one person is in line having that experience EVERYONE in line has to wait while that question is resolved.

I’m afraid that without fundamental changes such as these, the current plans are bound to succeed only in demonstrating that fundament changes are really the only practicable solutions.

National Health ID Promotes Patient Health and Savings

2009-08-06T11:48:00.000-07:00

This article was first published at NowPublic.Com and is reprinted here by the author, me.

NowPublic participant Peter.Sande has pointed out in an article here today that one of the health bills moving through the US Congress would:

'enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card'

I agree with the idea of a national health care card. I had one when I lived in France, and now I have one while I live in Brazil. I just show it to the person at the desk of the medical clinic or hospital I visit and they give me the medical care I need.

It is a tremendous waste of our nation's medical professional resources for a nurse to do a new intake form for every visit to a new doctor, when that information could easily be stored and brought up on a computer screen, just like we do at banks and with our cars at Midas Muffler.

However, the MOTIVE for this card - determining an individual's financial responsibility - is strictly prohibited by law in Brazil, where Government health workers at Government clinics and hospitals are forbidden from asking for payment for services provided. In the private market in Brazil, such a card is already used to cut down intake time, determine which tests have already been done and what the results were.

In France, the Carte Vitale allows health professionals to bring up the patient's information on any computer and determine how much the co-pay should be, what tests have already been done and what the results were.

People who oppose keeping medical records on a computer should instead keep all of their medical records in their wallet, including X-rays, and old vials of urine. The absolute waste that comes from starting from scratch at every medical visit is waste that ALL OF US have to pay for. We pay for it with higher premiums and we pay for it with a chaotic system that can't afford medical care for everyone because it wastes so much time searching drawers and wastebaskets for the medical records of the few who have medical insurance.

And moreover, if you don't want your information recorded on a centralized computer, then:

* Don't get credit (your information goes to the credit bureaus);
* Don't take your car to Sears, Midas Muffler or Firestone, because they keep national databases on what has been done to your car, how much it cost and how much you still owe;
* Don't apply for college, because you have to put your academic data and financial data on three or four national systems just to be admitted to college.
* Don't apply for a job, because your prospective employer is going to Google your name and find every public mention of you in a public record or published newspaper;
* Don't register to vote or respond to the National Census Bureau, because your name becomes part of a public "street list" that shows the names and ages of everyone living in your home, and may even identify you by party affiliation, as well as provide information on the elections in which you did and did not vote, and "street list" tells whether you are registered to vote for not;
* Don't ride in an airplane or buy a bus ticket, because they often keep permanent records of passengers names and ID.
* And don't get a Social Security card, because your name goes in a national database that identifies you by name and number.
* And don't get a driver's license, because your every driving infraction is digitized and saved;
* Don't apply for any security clearances, since the information developed in the process is stored and digitized.
* Don't have pizza delivered to your home, because pizzerias enter your information into their databases, and then caller ID tells them who you are, what kind of pizza you want, where you want it delivered, and the form of payment you usually use.

In other words, forget about privacy that comes from avoiding digital databases. That toothpaste has been out of the tube for decades. The only question is whether we're as willing to use digitalized information to maintain our health as we are willing to use it to maintain the mufflers and the brake shoes in our cars. I think staying healthy and rapid access to medical information in an emegency is at least as important as all of the other reasons we allow our information to be digitized and readily accessible.

However, if you enjoy the one hour intake procedure that you go through every time you check into a hospital or see a new doctor, then by all means call you Congressman and INSIST that doctors, nurses and hospitals start from scratch every time you need medical help. And don't complain about the long waits at the doctor's office. The nurse is budy filling out intake forms with a pen and paper, which will then be filed where no one can find them. And your doctor is on the phone with your insurance company, trying to determine whether you have insurance or are eligible for the help you need.

Manic Attorney Demands Psychiatric Treatment

2009-07-25T22:30:00.000-07:00

Here's a harrowing and painfully personsal first-person account of struggles trying to obtain medical care in the United States. This was first published at DailyKos in 2006 and surely merits a second look now, in the context of the current battle to reform medical care market in the United States:

Manic Attorney Demands Psychiatric Treatment

by manic lawyer

Sun Jun 04, 2006 at 10:11:54 AM PDT

"Of all the things I've lost, I miss my mind the most." I am a lawyer, but I don't practice law any longer; the struggle was too great. I'm manic depressive and have been most of my life. I had hoped I could overcome it. Now, I wish I hadn't done many of the things I did, but I can't take them back. If only I could've gotten psychiatric care earlier, I think things might have been different.

Beginning when I was eight years old, I had unpredictable fits of rage and cried in the closet, chanting "nobody likes me". At ten, I progressed to rages in which I broke out multiple windows of our house and threw dishes against the walls.

I knew there was something desperately wrong with me and I asked my mother - a college professor - to take me to a psychiatrist. But my mother's college's health insurance included only three visits per year for psychiatric help. With five children to feed, my mother had no money left in the weekly budget for payments to a psychiatrist.

My mother was a working professional with a home and a car, yet she was helpless to get her boy the psychiatric help he needed, so I was on my own and my problems progressed.

My father was an alcoholic with his own mental problems. Once, when I was five or six years old, he wrote with his own blood, "I got a job" on the wall of our bathroom. (His alcoholism and mental illness made it very hard for him to find and keep employment.)

But, I was recognized as a child prodigy. I started college when I was thirteen years old, attending classes alongside other students who assumed I must be four years older than I actually was.

I think I was ten years old when I first heard the words, "I want to kill myself" ringing over and over in my mind. Once, when I was eleven, I came "this close" to getting professional help, when my mother put the cost of care aside and took me and my brother to see a psychiatrist at a prominent children's hospital.

But, as my mother later explained to me, she simply didn't have the money for us to enter into weekly psychotherapy. So in spite of the horrors we had recounted to the psychiatrist, we just went right back home afterward to the same dysfunction.

By the time I was sixteen, I had a driver's license and my suicidality finally had an outlet. I began driving on the highway with my eyes closed, counting to ten to see what would happen. I was attempting suicide on a daily basis.

Quite understandably, no one wanted to ride with me. I knew I was a danger to myself and others. (In my now-ended driving career, I hit four cars from behind and intentionally caused countless accidents simply because I was depressed and I wanted to die.

I know I shouldn't have behaved this way, but I couldn't help it. All sorts of thoughts of self-hate would invade my head, and I just pushed the gas peddle down harder as the thoughts got worse. Finally, when I was be driving over a hundred miles an hour, I would be distracted enough to transform my self-hate into . . . what?

I had so many fantasies of killing myself: I would drive to New Hampshire and hang myself from a tree . . . In my mind, I built a guillotine in my backyard and was only prevented from severing my head by the curious and meddlesome neighbors. But, when I went to a psychiatrist's office with these thoughts, the first question was "What insurance do you have?"

Years later, I learned that Trazadone, the anti-depressant, miraculously relieved me of this compulsion to speed. Had I know this before, the roads could have been much safer much sooner.

I desperately wanted help. When I was 21, I found a clinic in B[xyxztp] that offered free psychiatric care, but I had to drive 60 miles to get there and 60 miles back, twice a week. Although the meetings relieved my desperation in a transitory way, it was a questionable trade-off for all the other drivers on the road. I think the whole State would have been safer had my town had good mental health care closer to my home.

At 22, I finally got a full-time job and had health insurance, but I still had to commute 70 miles per day to get back and forth to work. My work-based insurance covered less than half the cost of therapy and was exhausted after ten visits anyway, practically before the therapist knew my name and address. I also joined some anonymous programs and attended meetings between seven and fourteen times a week.

The only way I was able to work was to find therapists who would help me for less than their going rate and who would let me run a tab. (Sixteen years later, I still owe one of them almost a thousand dollars.)

I was struggling to keep afloat, so it took a while for me to consciously attempt suicide. I was 27 years old before I made a noose to hang myself and then swallowed a bottle of aspirin. By now, I was a college student with health insurance, so I could afford to attempt suicide. Afterward, I drove myself to a hospital emergency room. (Insanity is crazy!)

This, too, will sound crazy because it is: By the time I was 26, I had found just two things that could momentarily relieve my depression: (1) unrelenting sexual pursuits (otherwise known as "sex-addiction") and (2) a lofty and unattainable goal combined with my absolute determination to achieve it. By pursuing such goals assiduously, I learned the difference between what was "impossible" for me and what was "merely highly improbable". With a commitment to a long-term goal larger than my anguish, I had at least one reason not to end my life.

So, after graduating from college magna cum laude (which turned out to have been merely highly improbable but not impossible) I decided to go to law school. I hoped that I could nurture the side of me that wanted to help people while killing the side of me that wanted to self-destruct.

I think few people knew what I was going through. After I graduated from college, I worked in the governor's office, responding to constituent mail and proofreading executive orders. I wore a suit and wing tipped shoes. How could I be a lunatic?

It was very hard to achieve in that excruciatingly difficult first year of law school while my every waking moment was spent trying to seduce my female classmates and the women I met on the street. My motto then: "Anything worth doing is worth overdoing."

Somehow, I succeeded academically anyhow. I think that spending five weeks in a sex-addiction treatment center helped me to reassess my priorities. I realized that I would have to be crazy to value sex addiction more highly than I did my law school career. Talk about obsessive compulsive disorder!

For a full year, I abstained from all sex and even from talking to women so that I could get my life in order and focus on graduating from law school. It was my hardest year ever, during which even the most beautiful and available women were off limits to me. I had become convinced that even one slip might be my last.

My psychiatrist had me try various different medications to treat the depression I was in. One combination made me so sick that I had to stop one of my legal internships halfway through.

In spite of the emotional trouble I was in, the school health insurance provider had not wanted to pay for my hospitalization and each meeting with a psychiatrist had to carefully document the need for continued care.

At night, my mind raced with thoughts of the horrors that might befall me, so I prayed to God for a reason to live and a way out of my troubles. Only when the college's chief medical director called the HMO and said I was imminently suicidal did the company relent and pay for me to be hospitalized.

Even though I was a full-time student with a full scholarship and much federal aid, there was little mental health care available to me, unless I could pay for it. So, my mother cashed out the annuities she had been saving for my retirement, and I spent her life's savings on antidepressants and psychiatric care.

During law school, when I had access to college medical insurance and psychiatrists, I discovered after grueling experiments that Prozac chilled my depression while Trazadone (anti-anxiety, anti-depressant) miraculously made if possible for me to drive at the speed limit.

These two medications combined with therapy worked even where my own willpower and dozens of successive speeding tickets and license revocation had failed. And I graduated from law school!

I learned some other important lessons the hard way during this period. I discovered that trying to have sex with all women led only to repeated hospitalizations. And by working with a psychiatrist, I learned that graduating from law school was merely highly improbable. Things that are highly improbable for insane people (like graduating from college and holding a job) can often be achieved nonetheless, with diligent effort and adequate psychiatric resources.

I have also learned that, for a person who is manic depressive, the improbable can become possible, with twice-weekly psychiatric therapy sessions and an adequate medication regime.

After I passed the bar (another feat I was sure was impossible), I achieved a measure of success professionally. I had a small staff, began to teach, and the media began seeking out my expertise. I supplied newspapers with op-ed pieces and wrote articles for professional journals, mentoring law students and serving on professional committees. I maintained a public demeanor appropriate to my activities, and limited my insanity to my after-work hours, to the extent possible.

When I was depressed, sometimes I got very frustrated and swore in front of my clients and even their children. On other occasions when I won difficult cases, I still felt depressed and I cried in front of my clients, blaming my teary eyes on the cold wind and rain. I knew there was something desperately wrong with me and so did the close friends and colleagues in whom I confided.

When I started working as a lawyer, I hoped my access to healthcare would improve, but it didn't. It actually got worse. My employer's insurance did not cover psychiatric care, so I went to state-sponsored clinic. We met twice a week and since I couldn't afford the medication he prescribed, he sometimes provided manufacturer's samples. But just when my therapy was succeeding and I had spent months without wanting to kill myself, and had even passed the bar exam, the psychiatrist said I seemed healthy and didn't need his help anymore.

My boss thought I needed help, but that carries little weight in the current US health care regime. Employers pay for our health care the need to return employees to work healthy rarely takes as high a priority as saving the insurer's bottom line. I think the only reason so many psychiatrists helped me was that I spoke engagingly and even shockingly honestly about my own lunacy, but I also wanted desperately to get well. They saw my great potential and didn't want it to go to waste.

Sometimes when I most wanted to kill myself, I thought about the clients who needed my help. I reminded myself of the difficulty they would have finding another attorney with the same skill set and willingness to make the services available.

But, my psychiatrist's boss was leaning on him to treat patients who were more needy, instead of treating practicing lawyers. As the medical care vise tightened around me, it squeezed what little sanity I had achieved right had back out of my head.

I was hired by a reputable national organization and quickly promoted and moved to a new state, where I had intense new responsibilities and no established psychiatric care. I quickly became overwhelmed, so I discreetly inquired as to our company's health insurance benefits. And that's when my health insurance nightmare began again in earnest.

The employer had an HMO with severely limited number of providers who were listed in no particular order in a large telephone book. They literally just handed me this phone book when I told them I needed psychiatric care.

When I independently contacted the professionals to whom I was referred by friends and specialists, the answer was always the same: "I don't deal with HMOs; they're too much trouble and they pay too slowly." Psychiatrists charged $100.00 per hour, so I knew couldn't afford the two visits per week I needed to work successfully.

Ironically, while at work, I supervised a budget of over $12,000,000, with hundreds of clients and a dozen employees, yet after work hours I was medically destitute. I took calls from the New York Times and appeared on cable news by day, while at night I went to Home Depot for a rope to hang myself.

Still, I couldn't pay for good psychiatric help and my employer's HMO refused to pay. When they finally referred me to a psychiatric management agency, I believed I would be meeting with a psychiatrist who could evaluate my immediate need for medication. I was suicidal.

But after two meetings, I became suspicious of this "doctor" and insisted on knowing the therapist's credentials. Only then did I discover that he was not a medical doctor at all and could not prescribe medication at all. He was just a gatekeeper for the medical establishment, trying to dissuade me from getting treatment in order to save money for the HMO. He had no intention of referring me to a psychiatrist.

The fact that I was a practicing lawyer only heightened my humiliation since I was still powerless in the face of the capitalist medical bureaucracy. Certainly I could have paid for some care out-of-pocket, had only I been willing to surrender all of the disposable income that had attracted me to the law profession in the first place.

During this period, I organized and drove a group to Washington to lobby on a piece of legislation. But I felt so depressed the whole way that I kept imagining causing a head-on collision, which seemed the only way my emotional nightmare could end.

Unable to affordably access the care that had helped stabilize me in the past, I was depressed and suicidal again. I even talked to a minister, but he told me to see a psychiatrist.

Soon, I lost my job and spent the rest of my savings on $100.00 per visit psychiatric visits and medication. My student loans fell into default. When my money ran out and the therapy visits stopped, I alternated between hiding in my house and driving on the expressway at 105 miles per hour in the breakdown lane. (I well remember my velocity because it was the maximum my new Honda would do while traveling downhill.)

I had four auto accidents during this period, involving seven other people, and all caused by my own wanton suicidality. It's a miracle that no one was hurt or killed in those accidents.

In our mental health market, you must have mental health to get mental health care. The very mental disability that drives one insane also makes it hard to keep a job or stay in school and thereby maintain health insurance. So, when you're depressed, can't work, and need help the most, you are least able to get it.

With all other avenues seeming closed to me, I decided to move - to France. I reasoned that if my mind could do nothing else successfully, at least I could learn another language, for all the good that might do. I applied for a passport and began to study French.

But, meanwhile my driving and suidality made an imminent "danger to myself and others", so I went to a hospital emergency ward and demanded to be admitted. I was intensely confused and sleepless, but without health insurance, I was quickly released and was on my own again.

Then, I found a really good therapist and psychopharmacologist who seemed able to help me, but only if I payed them a total of $1,000 per month. I did until my money ran out, and then I got on the highway to drive my pain away, weaving in and out of traffic in an unsuccessful campaign to kill myself.

A few months later I was working again, but at half the pay. One day, when I was taking the day off to have my car serviced, I proceeded to the City Clerk's office to request a gun license. I had decided to shoot myself in the head and quiet my demons once and for all. Yet, a question on the form about past hospitalizations stopped me cold: If I lied on this form and did NOT subsequently kill myself, might I be still be prosecuted and so lose my license to practice law? I could not rely upon myself to die, so I had to consider the possibility that I might live.

I walked across the street to a doctor's office and asked for their help instead, sharing with a therapist that the last remaining single remaining interest in my life was to go to France and learn French.

With all alternatives exhausted, she encouraged me to get going, insisting that I return to her office in a week with an action plan. (I love directive therapists! Anyway, this was one plan I could implement before my therapy budget ran out.)

I knew that simply moving to the French Mediterranean would not cure my depression permanently, but at least it gave me a short-term goal and a plan. At the time, any distraction from my inner turmoil seemed reasonable in comparison.

To live in France, I would need a visa status. So, although I had never taken a course in French and I spoke no French at all, I applied for a student visa and enrolled in a French doctoral program for international law. What better way to immerse myself in French culture? Plus, enrolling in a doctoral program helped me to explain leaving my latest lawyer position after only two months on the job.

Surprisingly, the move made an immensely positive difference in terms of my access to medical care. Even as a foreign student, for just two hundred dollars I was able to enroll for a year in the French national health care system. How very ironic it was to receive medical treatment overseas for free that I could not obtain in the US even as working attorney.

Although I had been denied Medicaid in the United States after I lost my job, I had a French Carte Vital within a month. This universal health card assured that doctors, hospitals and pharmacies nationwide would provide me the help I needed. (Except, ironically, the American Hospital in Paris, which doesn't accept government reimbursements.)

In France, I was finally diagnosed as manic depressive, bipolar. In France, medical diseases that are particularly severe are covered for all necessary treatments at all hospitals and with no co-payments. Since manic depression is defined by the government as a "particularly serious disorder", all of my associated costs were covered 100%. In France.

My psychiatrist treated me twice weekly without ever asking me for payment. We tried a number of medications without the fear that the one I most needed might be beyond my financial means. I tried lithium for the first time, but it didn't work for me. Still, I felt much less desperate knowing that I would always be financially able to see my psychiatrist and take the medications he prescribed.

The most difficult part of fleeing to France was foregoing the practice of law. I wanted so desperately to live the middle-class ethos of consistent work and respectability. Yet I finally accepted that pretending to be sane was more work that I was able to do. Although I had managed to render service to my clients and make a professional mark, yet the emotional burden was more than I could continue to carry.

Because of effective and consistent treatment or for whatever reason, I never had a car accident in France and never received a speeding ticket. But, as the war in Iraq drove up the US deficit and drove down the value of the dollar, I found I couldn't afford to live in France anymore. I couldn't work and I sometimes had no food to eat beyond a croissant and a glass of orange juice. I found myself living in poverty, unable to pay even my most pressing bills. The desperation and anger came back and I didn't know what to do.

I came back to the United States and tried to apply for Medicaid, but after submitting ten times as much paperwork as had been required for success in France, I was rejected in the US as having too much income, even though I was living at the poverty line.

Today, I've made what peace with all of this that I can make. I live in one of those third world countries where the dollar goes further. Although there is no national health care here, the very same medications that cost $200.00 per month in the United States are available here for just $30.00 dollars per month, which is seven times less.

Today, I still can't afford psychiatric help. But I'm happily married, the weather is warm, the food is good, and psychiatric intervention hardly seems as necessary anymore. I have all of the daily challenges I did when I was a practicing lawyer.

I don't drive anymore, so now the world is a much safer place for me and everyone else. I wish I had never been as insane as I was.

Sometimes I wonder if I could return home to the United States and practice law if necessary. But, I know I couldn't work and succeed in the US without consistent psychiatric help and medication, and I know those won't be available in the US until there's a program of national health care. Since providing health care to all Americans is considered "communist" and anathema to the American spirit of individualism, I have little hope of ever returning home, and many readers might think that's just as well.

Sometimes I'm horrified to think how many psychiatrically ill people just like me are locked away in prisons because the chances they took turned out turned out worse. How many suicides, broken families and addictions might have been prevented if doctors asked "what help do you need?" instead of "how much money do you have"?

I can't pay my student loans. I may never again formally use my $150,000 legal education for which my mother and other contributors paid so dearly, but at least I won't drive from doctor to doctor, searching desperately for affordable psychiatric treatment.

Online Sites Rate Doctors While Doctors Hide Crucial Information from Patients

2009-07-21T08:43:00.000-07:00

An online article in yesterday's Washington Post points to the growing popularity of websites where medical patients can rate their doctors and advise the public to use these doctors or "run as fast as you can" from them.

In the past five years more than 40 Web sites, among them RateMDs.com, Angie's List, Yelp, DrScore and Vitals.com (motto: "where doctors are examined"), have begun reviewing physicians, providing information about one of the more difficult and important decisions consumers make routinely. WaPost

Some doctors criticize these sites, saying that the aesthetics of an office and the demeanor of the doctor are not necessarily representative of the actual outcomes that people receive, which are most important.

"Not only can't patients judge doctors, other doctors can't judge doctors," Caplan added. Without knowing a doctor's mortality, complication and infection rates, rankings reveal "just a piece" of the data consumers require.

Levin agrees that outcomes data are badly needed, but he thinks ratings sites can be useful. "What you need to look for is consistency and a certain number of ratings," he said. "It's one piece of a total picture . . . WaPost

If doctors don't think they are objectively rated on these sites, then why don't THEY set up a public database to gather and publicize objective statistics about doctors, such as "a doctor's mortality, complication and infection rates," complaints registered against them, judgments, legal actions, fees or specific services, like consultations, and other crucial decision-making data?

The fact is that doctors are just as reluctant to accept public accountability for their practices as record labels are to allow their music to be downloaded for free. And so, in the case of doctors, consumers with First Amendment free speech rights have to step into the information vacuum.

Ironically, the United States Government is one of few in the developed world that does not even bother to gather statistics about the effectiveness of various treatments and medical devices, like artificial joints. So, these treatments and devices are sometimes on the market in the US long after their ineffectiveness and/or harmfulness have been proved statistically overseas.

The fact is, doctors as a community want to be held harmless for the damage they do, adamantly fighting the disclosure of formal complaints filed against them and the results of these complaints. They also have codes of conduct that prevent doctors from publicizing and advertising the cost of specific services, and this makes it impossible for patients to engage in comparison shopping.

Now, patients are providing for each other what doctors have refused to make public: news and views about doctors practicing medicine. If doctors don't like the sites set up by patients, they should set up better, more objective and more reliable sites that compare outcomes, prices, and other crucial information.

If You Really Need Medical Care, Move to France

2009-07-19T10:18:00.000-07:00

When I was employed by a large corporation and had HMO medical care in the United States, for which I paid hundreds of dollars a month, I discoved that I couldn't choose my doctor. I asked my friends and associates who the best doctors were, and I discovered that none of those doctors was on the HMO's list of approved providers.

When I met with the insured providers, the care they offered promised to be like the difference between being represented by Johnny Cochran's team or being represented by one overworked public defender.

In that situation, I decided that I couldn't afford the good care providers and I wouldn't benefit from the bad ones, so I just put off getting the medical care I needed until I was a student in France, where national medical care system (that even covers foreign students) does allow patients to choose their doctors.

If you're facing a very serious medical condition that you're afraid will leave you with years of debt, I suggest that you enroll in college in France and buy into the French system for as little as $400.00 per year. That might seem like a convoluted solution, but it's not nearly as complex as trying to receive good and continuous and affordable medical care in the United States.

Congressional Budget Analysts Announce the Health Care Reform Will Require Health Care Reform

2009-07-17T07:12:00.000-07:00

The US Congress' budget analysts are saying that paying insurance companies to cover the uninsured will not constitute money-saving reform, but will only multiply the current inefficiencies in the system according to the number of people currently uninsured, which is 47 million and rising, as people lose their jobs.

Congress's chief budget analyst delivered a devastating assessment yesterday of the health-care proposals drafted by congressional Democrats, fueling an insurrection among fiscal conservatives in the House and pushing negotiators in the Senate to redouble efforts to draw up a new plan that more effectively restrains federal spending.

Under questioning by members of the Senate Budget Committee, Douglas Elmendorf, director of the nonpartisan Congressional Budget Office, said bills crafted by House leaders and the Senate health committee do not propose "the sort of fundamental changes" necessary to rein in the skyrocketing cost of government health programs, particularly Medicare. On the contrary, Elmendorf said, the measures would pile on an expensive new program to cover the uninsured. WaPost

Now, I hope the US Congress will not conclude that reform is impossible because it requires . . . reform. Let's face it. Everyone and his brother has a vested interest in the exagerated prices of services that cost two hundred dollars in the United States and ten dollars in Brazil. It may actually require everyone in the United States being priced out of the medical market before enough people realize that revolutionary reform is required, not glacial evolutionary reform.

Unfortunately, just as the Foundering Fathers made more provisions for the ownership of guns than for medical care for those accidentally shot, they made no provisions for health care in general. And just as there are many homeless people in the United States, we may well arrive at a point where no one at all has insurance and everyone relies on the "free market", which is what Republicans would favor in any case. Insurance, after all, is a form of socialization of risk and ALL socialism is, of course, intolerable, no matter what essential necessity it provides that can't be provided any other way.

Unfortunately there may come a time when the vast majority of Americans can only receive the health care that they can pay for on their credit cards. That, effectively, is the message our Congresspeople have received from the budget analysts, if we keep on doing what we've always done, but simply multiply it by 115% in order to cover the uninsured.

Those Who Have the Most Money Should Contribute the Most to Health Care for All

2009-07-16T02:59:00.001-07:00

There's something uniquely American and wrong about the approach that the nation is taking to the reform of health care: The United States already spends fifty to one hundred percent more per capita on health care than other countries that have health care for all. And now, the US plan to cover everyone will cost five hundred billion to a trillion more dollars, which will make it perhaps 150% more expensive than our nearest rival.

There are a lot of reasons for this, but the primary one is deference to medical entrepreneurs and corporate players. Some physicians order twice or three times as many CAT Scans because they own a CAT scan machine and have to find a way to pay for it. And that's something I haven't heard directly addressed. Some hospitals charge two or three times more for the same operations as others do, without providing better and sometimes providing worse medical outcomes. That reality, to, is one I haven't heard directly addressed.

While the Brazilian Government provides medicines for free, by focusing on bulk purchases or manufacture of brandless drugs, the US's health care plan will extend from six years to twelve the number of years that a drug remains under patent and cannot be purchased as generic, which will make the price as much as ten times more.

The massive bureaucracy associated with individual mandates to purchase insurance, and mandates for employers to purchase insurance will effectively double the bureaucracy that now exists at the IRS, as well as the paperwork for employers, for the purpose of collecting tax receipts that pay for national programs.

And so I'm concerned that the health care "reform" that's on the table will accept the most wasteful aspects that make US health care so expensive and spend more money on them. Instead, the US Congress should raise taxes on the wealthiest one percent of Americans to a level sufficient to pay for the whole program, which would be fair because those who are making the most money and have the ability to support health care would also pay the most.

I rarely agree with arguments made by members of business groups, but I do agree that there are some large and small businesses that are barely viable financially now, and adding a new tax to them, regardless of their ability to pay, could hurt jobs and the recovery. Instead, as Congressman Charles Rangel has proposed, those individuals who demonstrably ARE making the most money should shoulder the burden for this reform. That way, those who make the most money out of the health care system would also be those who pay the most to keep its inefficiencies as they are.

Certainly the Republicans will argue in the next election cycle that Democrats implemented new taxes for Americans, but this argument will be more easily countered now, as during the Clinton Administration, if Democrats can say that only the rich are paying more while the working class and middle class (the vast majority of taxpayers) are reaping the benefits.

The Rich Must Pay More Taxes if Everyone is to Have a Right to Health Care

2009-07-10T23:29:00.000-07:00

It's absurd to argue whether the US should have a public option health insurance or not. The real question is whether the for-profit insurance companies should have a captive audience or not.

The US already has public options for many people, but on a smaller scale than is necessary through the Community Health Service and the Veterans Administration Hospitals. I think the Government should rename the VA "The Veterans and Patriots Hospitals", make the hospitals available to all Americans - not just veterans.

To meet the increased need for services, the Government should purchase underfunded hospitals that have been closing in inner cities and rural areas, reopening them to serve anyone and everyone who presents with a health need.

Is this "big Government". No, it's "sufficient public health care" for a nation with a population of three hundred million people and growing. Anything and everything designed to meet the needs of a third of a billion people will inherently be big and to pretend otherwise is quaintly foolish and silly. New York City has 39,000 police officers and 11,000 firefighters, but I don't hear anyone complaining about "big government police and fire services," except those who would prefer that their houses burn down.

The deparments are big because they serve a city with over eight million residents. I would certainly hope that if Republicans ranted against the big police and fire departments of New York then residents would ask these politicians if THEY would like to put ouf the fires and make the arrests themselves.

If we want extra around-the-clock security, then we each can buy that. But, we all have a right to police and fire protection without paying a separate premium for each of these services, and now what we need is a right to health care as well. Lord help us if the first person we talk to when we call the police or fire department is an insurance adjuster who wants to know if we're covered or not.

So much money and bureaucracy would be saved by making health care a right and making its provision a collective national duty, as it is in Brazil. It would be less expensive if only because the Government wouldn't need hordes of bureaucrats for means testing and other hordes to collect individual premiums.

I'm frankly disgusted to hear politicians wanting to "mandate" that individuals buy insurance, as if individuals don't want to be insured. That's like mandating that people individually purchase access to police and fire deparments. Is there anyone who doesn't want the police and firefighters to come when their called? What individuals don't want is to have to go out and each pay bribe to police officers and firefighters in order to access these services. They don't want to pay individual premiums that they know they can't afford.

Meanwhile, police and firefighters don't want or need the responsibility for "point of service" fee collection. A system like that would prevent these public employees from doing the jobs that they're paid to do.

Individual mandates are absurd. If individuals refuse to assume five hundred dollar per month payments, what is the Government going to do? Send the insurance police out to get them? Oh, that will be VERY popular! If they don't have insurance, one very reasonable explanation is that they simply cannot afford it. Ridiculous discussions of tax breaks for individuals are like tax breaks so that people can pay for fire and police protection. Just the collection of such taxes would double the cost of the service provided.

Insurance companies would LOVE such a mandate, particularly without a public option, because then insurance companies could jack up their rates even more, with all of America unable to leave the used car lot without buying one of the crummy used cars.

We already have a way to get money from people for health insurance based on their ability to pay. It's called the IRS. Because we already have the IRS to collect taxes based on ability to pay, we have no need to create an entirely new bureaucracy for determining and collecting individual health premiums. And our society does not need the transaction costs involved in each of three hundred million Americans selecting insurance from among dozens of incoherent and incomprehensible "options". What people need is the assurance that their health needs will be met regardless of what they are, with no deductibles, co-pays, or yearly limits.

I'm so glad to hear Charles Rangel, Chairman of the House Ways and Means Committee finally coming to his senses and discovering that we mut pay for health insurance for all by taxing the rich as we did before the series of Reagan/Bush tax cuts. That was always the obvious solution.

We may all remember when, shortly after the election last year, Obamacrats announced they would not increase taxes on the rich now and would wait for absurdly generous tax breaks to expire in 2011. With this pronouncement, Obama put himself unneccessarily in a box early on - a box wherein the money for national health care could only be found by new taxes on the working poor and the middle class.

Health insurance became unworkable on that day and only now is being revived with the realization that people who have gotten rich in America must help to pay for the health care of those who have not. That's the way it works in Brazil. If that were not the case, then Brazilians would not all have the assurance that they can go to a doctor, hospital and pharmacy as the need arises.

Finally! Dems to Tax the Rich to Pay for Health Care!

2009-07-10T16:41:00.001-07:00

After debating all sorts of convoluted taxes on health care benefits (that would have doomed the Dems to defeat in 2010), Charles Rangel's Ways and Means Committee has finally decided to do the obvious: tax the rich to pay for health care.

Let's face it: The rich have more money, so they're an obvious source of revenue:

Democrats on the tax-writing Ways and Means Committee agreed to a new surtax that would start with households making $350,000 a year and begin in 2011, said the committee's chairman, Rep. Charles Rangel, D-N.Y.

It would raise some $540 billion over 10 years, about half the cost of Obama's ambitious plan to reshape the nation's health care system and provide care to the 50 million uninsured. However, lawmakers could not provide an exact price tag of the overall bill.
( . . . )
Rangel said the new surtax would be graduated, starting with households at $350,000 and then rising at $500,000 and again at $1 million. Cuts to Medicare and Medicaid would raise about $500 billion, according to the Congressional Budget Office. Fees paid by companies who don't provide insurance to their employees would push the amount of the bill even higher.
"Instead of putting pieces of different revenue raisers together the best we can do is a graduated surtax," Rangel said.

Rangel didn't describe details, but one official said the surtax would apply to individuals with adjusted gross incomes over $280,000 a year, and couples over $350,000. A senior House aide said the surtax would be 1 percent for the first group of high earners, those households making $350,000 or more. The levels for the other two groups, those above $500,000 and $1 million in annual income are still being determined, said the aide. Yahoo News

Duh. Why try to cobble together a dollar here and a dollar there when there are all of these rich people who don't know what to do with their money, and whose tax rates are perhaps 15% less now than they were in 1980, not including the offshore accounts that hide all or most of their wealth, some of them, from being taxed at all. With this source of revenue, EVERYONE who lacks care can be covered.

It's an obvious fix and it increases both the likelihood that health care will get passed and the likelihood that that vast majority ofAmericans will support the funding stream for it - taxing the rich - in the future, with no "shoot ourselves in the face" tax Democratic increases on the working poor and middle class.

Of COURSE Republicans are saying that tax increases should be related to health care, so that they can campaign in 2010 saying that DEMOCRATS voted to increase the cost of health care. Democrats would be well advised to ignore this unfriendly advice and consider the source instead of accepting it at face value.

Earlier, there was a boneheaded "proposal to tax soda" and other sugary drinks, which would have been a regressive tax because the poor spend more of their income on soda than the rich do. If you tax bottles of Coke and Pepsi, you might as well put a special tax on sex and Hamburger Helper; the real bill would come due for Democrats on election day.

Brazilian Government Offers Free Pharmacies All of the Public

2009-07-07T15:01:00.000-07:00

The sign above the window says
"Pharmacy for Basic Health"

Yesterday afternoon in Brazil, I went to a Brazilian Government public pharmacy (see above) to fill receive the medicine prescribed for me last week by the doctor at the Government's free neighborhood medical clinic.

When I saw that there were about twenty people in line, I was afraid I might have a long wait ahead of me. Instead, the three workers dispensing medicine were business-like, courteous, and I was in and out in fifteen minutes. (The white paper sign to the left in the above photograph says, "Open Monday through Friday, 7:00 AM until 4:00 PM.")

Unlike in the United States, Brazilian Government employees providing free services are not universally condescending and rude to their clients, if only because most of the recipients here are working-class Brazilians whose aggregated tax dollars are paying for the services they receive.

Because the Government buys or manufactures these medicines in bulk, it can afford to give medicines away, even though Brazil is considered to be part of the "developing world". It makes one wonder what is wrong with the government of the United States, where Congress plans to spend trillions of dollars on the medical system and still will not provide free medications to those who need them, without needs-testing, obligatory premiums and co-pays.

Who wouldn't wait in line
to fill their precriptions for free?

It really is a shame that America is willing to look beyond it's borders for petroleum and consumer goods, but is unwilling to look to other countries that have functional health care systems. One need only look at the mortgage and housing markets to see that market-based solutions will never provide consistent, affordable health care.

If fancy adjustable-rate mortgages leave consumers wondering how they will stay in their homes, then how will market-based medical care provide consumers any more certainty about their health care needs, now and in the future, than they now have about their mortgage payments?

When Congress and insurance companies propose exotic new ways for us to receive health care in the United States, we should ask them to do what I have done above: show me a couple of photographs from somewhere in the world where that system actually works.

Can the US Provide Free, Public Medical Care Like Brazil?

2009-06-29T05:46:00.000-07:00

FOR IMMEDIATE RELEASE

Contact: Atty. Francis L. Holland
Public Option Health Care Now
http://public-option-health-care-now.blogspot.com
55 (73) 9992-4127
Skype: fazinformatica2005

African America Finds Public Option
Health Care in Brazil

Free, public neighborhood health clinic in Brazil
where treatment is provided to all
as fundamental right.

This morning in Brazil, I went to a Government public health clinic in my neighborhood, made an appointment to meet with a doctor tomorrow morning for a consult and prescription, and I will be charged $0.00 (zero) for this service, because health care is a right in Brazil. The system is called the Unitary Health System (SUS) and its neighborhood clincs, hospitals, and pharmacies are available nationwide. There is also a national free ambulance service called the Emergency Mobile Attention Service (SAMU). Since fifty percent of Brazil is afro-descendant, these systems have major benefits for a half-Black population.

When I scheduled an appointment this morning at my local health center, I showed proof of address (because people must go to the health clinics in their neighborhoods - the clinics that are closest to them) and I showed proof of my identity (incidentally as a foreign permanent resident). I also showed proof that I am up to date with my vaccinations, which are provided for free at the same clinic. (This requirement guarantees that anyone who acceses the system for any reason will also have all of the necessary vaccinations to avoid getting or spreading preventable illnesses.) Tomorrow when I get the prescription, the medications will be provided for free.

There's still one question that an American really wants to ask here: Where's the cash register? At these clinics, there are no credit card swipers, cash registers, and no calls to any insurance companies or Government bureaucrats to confirm whether the patient is covered for one service or all services.

At seven in the morning,
patients line up to schedule appointments
which may be from a day to a month away.

Crucially, there isn't even a check within Government records to confirm a patient's right to be served. Since Government-provided health care is a right for all that is not means-tested and is provided by the Government itself, there's no need to confirm people's insurance status. Health care is actually more of a right in Brazil than voting is a right in the United States, because there is no need in Brazil to show that you have "registered" to participate in the free services. And there is no crime a person can commit that would result in the loss of the the right to participate in the Government system.

The existence and operation of the free health clinics, hospitals and blood work laboratories is Brazilians' "insurance" that health care will be available to them. The government buys or manufactures medicines in bulk and provides them for free, either at this clinic or at the hospital downtown, and also has a national Popular Pharmacy program that sells medicines at a fraction of the prices paid at typical pharmacies in the United States, according to one national drug and price list.

While waiting in line to schedule an appointment this morning, an elderly woman mentioned in passing that, in addition to having a home in this town, she also owns a summer cottage and land in the countryside. It doesn't matter here. Yet, if she said the same thing at a Medicaid office in the US, she would probably carried out by armed guards, tasered and/or arrested and charged with fraud.

And yet, even with the absolute guarantee that patients have a right to Government health care through this nationwide system of free clinics and hospitals regardless of income, assets or ability to pay, (some people sue the Government for failure to provide expensive care or new and expensive medicines for unusual conditions) there are still private insurance companies, doctors and hospitals for people who have conditions for which the state system isn't equipped to provide excellent and immediate care, and/or for people who want the "Cadillac" service that we really all should get wherever we are.

To make health care more affordable in the US, setting up a national system such as the one in Brazil, or in the Seattle / Puget Sound area, where all of the medical, nursing and administrative staff work for salary rather than as entrepreneurs, is the surest way to keep costs down. Along with doing away with the bureaucracy involved in means testing, charging individuals for insurance, making sure that they have paid, etc.

With this health care alternative, the crucial part is not that Government control all medicine, but that Government set up a national system of Government-owned clinics, hospitals, pharmacies and laboratories where anyone and everyone can receive the care they need.

Contact: Atty. Francis L. Holland
Public Option Health Care Now
http://public-option-health-care-now.blogspot.com
55 (73) 3288-1716
Skype: fazinformatica2005

http://portal.saude.gov.br/saude/

http://189.28.128.100/portal/saude/visualizar_texto.cfm?idtxt=30301&janela=1

http://189.28.128.100/portal/arquivos/pdf/tabela_farmaciapopular_abril08.pdf

http://189.28.128.100/portal/saude/visualizar_texto.cfm?idtxt=23972&janela=1

http://portal.saude.gov.br/saude/area.cfm?id_area=456

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RE: Single Payer is Not Necessarily the Best or Only Option

2009-06-28T20:04:00.000-07:00

Dear Health Care Advocates:

I just listened to the YouTube video of Dr. Anne Scheetz of Progressive Democrats of America, entitled, "Single Payer and the Public Option," advocating for Single Payer. I listened to it as an example of the arguments for Single Payer vs. Public Option. I listed to this YouTube video as an example of the arguments for Single Payer.

I find a few of serious problems with Dr. Anne Scheetz's contentions, based on my experience with the health care systems in France, Great Britain, Brazil (and even Sandinista Nicaragua):

1). She says,

There is no country that has anything like universal coverage that has for-profit insurance companies. There is no such thing.

This is simply not true. I lived in France for thirty months as a foreign student who was covered 100% by the national health system because my medical problem was recognized as particularly severe. Others with less serious medical problems had co-pays, but no one that I know complained about those co-pays. However, the co-pays were based on income and those with lower incomes had lower co-pays. In fact, many people bought private insurance for the purpose of covering the co-pays.

When I was in France, the medicines I needed were 100% paid for by the French government. For this coverage, and including my yearly tuition at the university, I paid a total of about nine hundred dollars per year. My yearly insurance premium, based on my income, was about $3 to $400 dollars. Again, I never heard any complaints from French people about their Government medical system, which wealthier people supplemented with private plans.

One of my ex-girlfriends, who is unemployed, virtually penniless and not a French citizen, just had a baby in France and she had not a single complaint about the medical care she received under the French government's national health care system.

France does not have completely nationalized medical care; the Government pays private practitioners to provide much medical care according to set rates.

Some of the most important features of the French system are not strictly financial but have a great impact on the cost and feasibility of providing excellent medical care. In France, all health billing is done by computer and doctors can see a patient's complete medical records on their desktop computers. Charging the government for a medical service less complicated than buying a book at Amazon.com. The savings from taking the bureaucracy and wasted person-hours out of the system are spent on medical care instead.

Based on my experience during thirty months in France, and all that each of us has read, I think everyone acknowledges that French people are as happy with their Government-provided insurance as most anyone in the world. In France, Government-provided insurance exists alongside for-profit insurers, but it is entirely possible there to get one's medical needs taken care of, even as a foreign student, without buying private insurance.

2). Dr. Anne Scheetz summarizes her argument by saying,

"We say, we can only have universal coverage for everyone if we eliminate the private insurance industry."

I do not believe that is true (particularly based on my experiences in France and England).
Moreover, I know that this is not true based on my present experience in Brazil, whose Government offers a comprehensive Unitary System for Health (SUS) as well as a comprehensive mental health system (CAPS), including an array of free psychiatric and psychosocial alternatives and free medications, and this system exists alongside private insurers which are not much better than those in the United States.

The Brazilian system's quality depends on the commitment of local prefectures, but provides care everywhere in Brazil. Wealthier people who want better or faster care self-insure or buy private health coverage.

Politically, I do not believe Single Payer is feasible right now in the United States, even if we elect a socialist president and Congress. Does anyone actually believe that the present US Congress is going to vote to eliminate the private insurance industry over the next few weeks? If anyone in Congress had any intention of doing that, wouldn't we have heard about it by now?

I am a socialist and have no ideological problem with eliminating the private insurers. But elminating the entire private insurance industry simply is not going to come out of this Congress. And so (between you and me), this simply has no chance of happening and we have to demand what we want while accepting the best we can get under the circumstances.

As a matter of strategy, demanding the elimination of insurance companies may be an effective way of getting a more comprehensive government plan that provides a better alternative to the insurance companies. So, advocating for single payer is good in that respect. But ideological rigidity is not good and the best may be the enemy of the better in this case.

3). I also spent a two weeks stay in England, hosted by a middle-aged professional couple who had various medical issues. What I observed personally in England and to a much lesser degree in France that the Government plans do not cover any meaningful dental maintenance and so, particularly in England where dentist are harder to find and costs are higher, the condition of even upper middle class people's teeth is often abominable. I met an English physician whose teeth appeared never to have been taken care of at all.

While I was in England my hosts explained to me that the costs and waits for canal work and crowns were nearly overwhelming. It is very difficult and expensive to get dental care in England and equally expensive but otherwise not as difficult in France. Any Government plan must cover comprehensive dental care or it fails to cover the person's whole body.

In comparison, Brazil has many excellent dental schools that turn out a steady stream of excellent dentists. The fact that they are plentiful keeps down the cost and increases the temporal availability of dental care, and so many Brazilians have teeth in much better condition than people in France and Great Britain. The key is to produce more dentists who compete with each other. In any case, be it Government option of private practice, it will not be possible to take care of the nation's teeth unless the nation has more dentists and correspondingly lower wait times, particularly in England and the United States.

Finally, the difficulty with convincing Americans that Single Payer is the only good option is simply that Single Payer is NOT the only effective option and Single Payer would require the nationalization or purchase of all of the insurance companies, whose stock holders will not be happy or pliable unless their return on investment from nationalization is higher than it would be while continuing what they are doing now. Even while virtually nationalizing GM, the Government has not proposed to make cars and cut private investors entirely out of the loop.

Let's be realistic, and intransigent perhaps as a political strategy, but realistic as a political necessity.

Francis

Leftists Pressing Democrats to Pass a "Public Option"

2009-06-28T07:08:00.000-07:00

The Washington Post reports that liberal voters and organized groups of voters and spending money advertising in the states of Democrats who have expressed public ambivalence or opposition to national health care, e.g. public option. The WaPost says:

In the high-stakes battle over health care, a growing cadre of liberal activists is aiming its sharpest firepower against Democratic senators who they accuse of being insufficiently committed to the cause.

Any Democrat who refuses to vote for a public option is refusing to help President Obama make good on his campaign promise of national health care. Leftists and liberals and everyone who needs health care at one time or another SHOULD impress upon the Democratic House and Senate members that now is the time to ante up or lose your Democrat card and become known as "the Senator from the Insurance Companies."

Public Option isn't hard to understand. In fact 75% of Americans support it. But if you ask them the question in a different way, e.g.

Would you support public option even if it meant that your left leg would be infested with fleas for the rest of your life and the Devil would turn your dog into something out of a Thriller video, and all your of children would become homosexual, bisexual, asexual cross-dressing rapist pedophile priests?

Then support among some voters decreases to only slightly better than sixty percent of all Americans who still support public option.

Public option simply means that the Government will find a way to give you the health care that you can't get now, and voters understand that. So, the Republicans, the insurance companies and some bought-and-paid-for Democratic House and Senate members are trotting out every conceivable cannard to convince Americans that they don't want and cannot afford the medical care that they're not getting at present.

This is no surprise. They did the same thing with the nomination of Sonia Sotomayor:

Would you support Sonia Sotomayor for the Supreme Court even if you knew that she is a woman whose parents came from Puerto Rico and who values her Puerto Rican heritage and believes, incredibly, that the US Supreme Court would be wiser if it had more women members like her?

Well, the polling is in and sixty-six percent of Americans STILL support Sonia Sotomayor, even knowing all of the above about her. So, now they are looking for ways to strangle her before her nomination can come to a vote, just like the want to strangle public option health care.

Pass Public Option or Prepare for Primary Challenges in 2010

2009-06-27T21:14:00.000-07:00

As I read Ruth Marcus' absurd arguments in the Washington Post today against a public option for health care, and as I follow the debate in other articles doubting that a public option is politically feasible, I become angry. Marcus says,

I'm ambivalent on the merits of including a public plan in the exchange. But I think its advocates are wrong in elevating the public plan to litmus-test importance.

Perhaps Marcus fails to understand that Americans want Government intervention because experience tells them that private insurance does not work.

Nonetheless, perhaps because the insurance companies don't want any competition, the US Congress will bend to their wishes and insurance companies won't get any new competition. Instead trillions more of our tax dollars will be exclusively directed toward the same for-profit entities which Americans already do not trust.

In fact, the reason that the public option appears so expensive is that it is conceived as government purchasing insurance to pay private practitioners the same exhorbitant fees for medical services and medications that have bankrupted too many Americans already.

If the government is not going to begin offering health services itself, as governments offer police and fire protection, then it would be better to do nothing at all about insurance and to focus on issues like medical records, research and epidemiology where consensus can be reached and where additional government expenditures might actually do some good.

The government should greatly expand programs of training for nurses and doctors wherein medical education would be free in exchange for a number of years working as a salaried staff member in a government clinic or hospital.

If the US Congress cannot do what countries all over the world do, which is to guarantee services or payment for services for all Americans, then they should simply admit that they have failed and that they are beholden to insurance interests and doctor's lobbies. They should go before the voters in twenty months and admit that they were unable to do anything meaningful and cost-effective about the voters' principal priority.

I believe it may be time for President Obama to belly up to the table and tell the US Congress to either pass a public option or stop wasting America's hopes and dreams on a system that will simply lard insurance companies coffers with tax monies without producing significant increases in the availability of medical care.

President Barack Obama should announce that those who oppose a public option are those receiving the most money from insurance lobbies and he will not campaign for their reelection in 2010 unless they pass a meaningful government program of health insurance in 2009. If this is what a Democratic Congress does with our health care dollars, Americans may well prefer a horrid Republican Congress in 2010, to put the brakes on wasteful spending that doesn't accomplish the real reform Americans are demanding.

American Man Moves to Brazil for Affordable Medical Care

2009-06-27T07:35:00.000-07:00

Because of the cost in the United States of the medical care I need, and the medicines, I have discovered that I simply cannot come back to the country of my birth. Fortunately, Brazil has a lot to offer, including free medical care and medicines.

Every two months I need to be seen by a doctor and get a new prescription for the medication that I need to survive. Sometimes, I need weekly visits to health care professionals depending upon my condition.

In Brazil, these bi-monthly or even weekly visits are free. In Brazil, even if I wait until the last day of medicine (which I sometimes do, unfortunately), I can still get an appointment at a free and public neighborhood medical clinic within a week, or I can go to a free emergency room and try beg a doctor to write a prescription on the spot. At least in Brazil, I have a constitutional right to free medical care and free medicine.

Once I have a prescription from a doctor, I can receive my medications for free at the hospital or clinic where I have seen the doctor, or for a maximum of five dollars, for a two-month supply, at a government-owned pharmacy, if the hospital or clinic's supply is low.

However, if I returned to the United States today, I know what I would find. I would have to apply for Medicaid. The last time I did this, in 2004, they told me I was "over-income" and ineligible. I could have appealed the decision, but that might have taken months. Even if I were successful, at any time the legislature and governor of the state I might live in could decide to change the eligibility requirements and refuse me medical care. That's a risk I cannot take.

When I left the United States for Brazil in 2004, I tried to get the vaccinations that are required for travel to Brazil. I discovered that the least expensive alternative in my area was to pay $850.00 dollars for those vaccinations. Instead, I decided to come to Brazil without the vaccinations (foregoing obviously necessary medical care, as so many US citizens and residents do everyday.)

Fortunately, I discovered that the same vaccinations that would have cost me $850.00 in the United States are available for free at any neighborhood health clinic in Brazil.

Brazil does not have single-payer health care system; it has a national public option, but also has private insurance companies competing to insure those who want or need to see private doctors at private clinics and hospitals. Sometimes private clinics are a better option and I have spent about eight hundred dollars at private clinics and hospitals over the last five years, for a surgical procedure and two-day hospital stay for my wife and eye and ear exams for myself.

I have also spent about seven hundred dollars or so on dental crowns, fillings and canals here that would have cost me five to ten thousand thousand dollars or more in the United State. When my daughter fell and chipped her tooth, a dentist fixed it impeccably for twenty dollars in one visit.

Because all medical care, public and private, is exponentially less expensive in Brazil, even from private practitioners, my wife and I so far have been able to self-insure, paying out of pocket when we need to see private practitioners for us or our three children. A friend who is a physician here tells me that, like in the United States, private insurance companies here often refuse to pay for expensive medical care when the patient needs it most.

So, my physician friend was not able to recommend any private insurance I could buy here that would be worth the premiums I would pay. Better to rely on the national public system of neighborhood health clinics, hospitals and pharmacies, where care isn't always perfect but it's always free.

Needless to say, I am glad that I have become a permanent resident of Brazil. If Brazil is a "third world" country, I'll take "door number three," thank you.

Health Care & Congress: Public Option or Public Masturbation?

2009-06-25T16:03:00.000-07:00

The government picks up our garbage at the curb, educates our children unless we want to put them in private school, builds roads and bridges, and watches the skies to forewarn us about impending hurricanes. Because health care is a need that we all have and that none of us can prepare for alone, the Government should assume this common responsibility as well.

Likewise, the National Centers for Disease Control nationalize the job of watching out for and trying to prevent disease, instead of requiring each of us to have sufficient knowledge and resources to do this ourselves.

Now, I don't hear large corporations arguing for the disbandment of the US Armed Forces on the theory that the US Military competes unfairly with Blackwater! Nor are they arguing for the disbandment of the federal highways on the theory that national highways compete unfairly with with for-profit commercial airlines, helicopters and speed boats.

No one is arguing that the Government built Brooklyn Bridge competes unfairly with rowboats and professional canoers.

Let's face it: The Foundering fathers got a lot of things right, as when they made provisions for a national army, a national postal service, and a national foreign policy. What they did not foresee was that there would be immense advances in the practice of medicine and that these scientific advances would far outstrip the ability and authority of any one company or group of companies to meet the medical needs of a highly mobile and national populace.

Had the realized that health care would become as ubiquitously needed and as complex and burdensome as delivering mail to every address in the country, then they would surely have provided for a national health service, just as they provided for national mail service and a national army.

Luckily we have it within our power as a nation to address this issue with an act of Congress, and no Constitutional amendment is required. The US Congres need only announce that the inability to obtain portable medical, as well as state-based medical care provisions that exclude out-of-staters are unacceptable burdens upon interestate commerce under the Commerce Clause, as well as burdening the right to travel.

A national health service that meets everyone's needs if they present themselves for care will serve this purpose and, like the Armed Forces, NASA, the National Park Service, the Weather Service and the coast guard, the new national health service should be paid for out of the federal budget generally. (We don't require fishing boats to purchase Coast Guard Insurance and we don't require international shippers to pay Navy Seal Coverage.premiums. Likewise, the availability of health care to individuals should be completely divorced from any requirement that they, as individuals, have purchased that care.)

That's the way forward and anything less is simply an orgy of public legislative group masturbation.

Color of Change Requests Black Public Support for Public Option

2009-06-25T00:27:00.001-07:00

President Obama is trying to reform our broken health care system, which has left more than 45 million Americans uninsured¹ and millions more with insurance that won't provide the treatment they need.²

Some in Congress are with Obama. But the insurance industry, with help from Republicans³ and so-called centrist Democrats,⁴ is leading the charge to kill a key part of his plan -- a government-run insurance plan that would increase the number of Americans covered, called the "public option." Industry groups are spending millions -- $35 million in lobbying costs alone⁵ -- to convince people that they won't be able to choose their doctor, that government will be making their medical decisions, that they'd be forced to take the government's plan, and that the plan is part of some socialist plot -- all lies. In reality, the insurance industry is trying to protect its enormous profits on the backs of everyday people.

For Black folks, the stakes couldn't be higher: we are twice as likely as Whites to be uninsured, we have more than double the rate of infant mortality, we face more than twice the rate of diabetes-related deaths than Whites -- and the list goes on.⁶

While the fight rages in Washington, our voices are simply not at the table. You can help change that. Join us in telling Congress that we believe every person in this country should have equal access to affordable health care, regardless of race, income, or any other factor. And please ask your friends and family to do the same. It takes just a moment:

http://www.colorofchange.org/health/?id=1780-175369

Americans understand the idea of the public option and overwhelmingly support it -- three out of four people want the federal government to offer insurance coverage.^7,8 But powerful lobbying groups like America's Health Insurance Plans, Pharmaceutical Researchers and Manufacturers of America, and the American Medical Association -- representing the insurance industry, the drug industry, and doctors -- are doing everything in their power to maintain the status quo.⁹

Several organizations have pushed back, including MoveOn.org -- a key partner of ours in this fight -- but it will take all of us standing up if we want to win.

A public option makes sense for the country as a whole, and it makes particularly good sense for Black folks. Many of us make too much to qualify for Medicaid but either aren't eligible for or aren't adequately covered by private, employer-based plans. Overall, 21% of Blacks are uninsured, compared to 12% of Whites.¹⁰

We need a public insurance option, but that's not the only thing we should be fighting for. We need to push for equity in all aspects of our approach to health care. Every community deserves quality medical treatment, research and resources. That's not what we're getting now, and the numbers prove it:

22% of Black women say cost keeps them away from the doctor's office, compared to 15% of White women¹¹

Black women have the highest rates of new AIDS cases, cancer mortality, obesity and low-weight infants of any ethnic or racial group¹²

There are 13.6 Black infant deaths per 1,000 live births, compared to 5.7 White infant deaths per 1,000 live births¹³

There are 47 Black deaths from diabetes-related illness per 100,000 people, compared to 22.5 White deaths per 100,000 people¹⁴

There are 60.1 new AIDS cases per 100,000 people among Blacks, compared to 6.7 new cases per 100,000 people among Whites¹⁵

Our opportunity to address the disparities that keep too many of us from enjoying long, healthy lives is now.

Take a minute to tell our lawmakers that the first step toward improving our health care system is including a public plan that makes good health something everyone can afford. And when you do, please ask your friends and family to do the same:

http://www.colorofchange.org/health/?id=1780-175369

Thanks and Peace,

-- James, Gabriel, William, Dani and the rest of the ColorOfChange.org team
June 25, 2009

Help support our work. ColorOfChange.org is powered by YOU -- your energy and dollars. We take no money from lobbyists or large corporations that don't share our values, and our tiny staff ensures your contributions go a long way. You can contribute here:

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References:

1. "Five basic facts on the uninsured," Kaiser Commission on Medicaid and the Uninsured, 9-16-08
http://www.kff.org/uninsured/7806.cfm

2. "25 Million Americans Are 'Underinsured,'" U.S. News & World Report, 6-10-08
http://tinyurl.com/n2f3k7

3. "GOP Senators Send Letter Opposing Public Plan," CBS News, 6-8-09
http://tinyurl.com/l4ndwv

4. "Blue Dogs Backsliding On Health Care," Huffington Post, 6-8-09
http://tinyurl.com/m5h8y7

5. "Lobbying boosted as health care debate heats up," USA Today, 6-12-09
http://tinyurl.com/m59ur5

6. "Key Health and Health Care Indicators by Race/Ethnicity and State," Kaiser Family Foundation, 2009
http://www.kff.org/minorityhealth/upload/7633-02.pdf

7. "Obama Boost: New Poll Shows 76% Support For Choice Of Public Plan," Huffington Post, 6-17-09
http://tinyurl.com/mpo97j

8. "Poll: Most Back Public Health Care Option," CBS News, 6-20-09
http://www.cbsnews.com/stories/2009/06/19/opinion/polls/main5098517.shtml

9. "Why the Critics of a Public Option for Health Care are Wrong," Robert Reich, 6-23-09
http://tinyurl.com/lxpm3v

10. See #6

11. "Putting Women's Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level," Kaiser Family Foundation, 6-10-09
http://www.kff.org/minorityhealth/upload/7886ES.pdf

12. Ibid.

13. See #6

14. Ibid.

15. Ibid.

Additional resources:

"Many in Congress hold stakes in health industry," The New York Times, 6-13-09
http://www.nytimes.com/2009/06/14/us/politics/14cong.html?_r=1

"The isolationism of health reform," Slate, 6-15-09
http://www.slate.com/id/2220534/pagenum/all/

Brazil has public option with universal inclusion.

2009-06-24T12:20:00.001-07:00

In Brazil, if you want care, you go to a public neighborhood clinic or hospital and they treat you with no discussion whatsoever of insurance, enrollment or payment. It's illegal for anyone in the system to request or accept payment.

Many common medications are also provided at these clinics and hospitals immediately after the doctor has written the prescription - FOR FREE!

When people ask me why I've left the United States for "third world" Brazil, I describe the US health care market to them and I explain to them that the health care options they depend on in Brazil simply don't exist in the United States.

The United States has a health care system worse than exists in many "third world" countries, because the costs of care are so high in the US that virtually no one can pay out of pocket, whereas in Brazil health care is more affordable and paying out of pocket is real option, even for surgery. My wife spent two days in a private hospital for a completely successful surgical procedure, and the whole thing cost me less than a twenty-inch color television would have.

If Brazil is "third world" then I'll take "door number three", thank you.

The Problem with Health Insurance Is the Concept of Health Insurance

2009-06-23T13:54:00.001-07:00

There are some roles that the federal government plays because they simply cannot be delegated effectively and efficiently to others, and even to try would be dangerous. If the Government had waited for each individual to pay for the construction of roads to wherever we needed to go, nd then charge others for access to these roads, then the right to travel gauranteed by the United States constitution would have been frustrated before the nation became a nation. Indeed, it's doubtful the nation's states could have unified at all. The assent of each owner of a piece of road would have been required before any new state could effectively join and interact with the rest of the nation.

That's where we find ourselves with healthcare. We have a national need, but the owners of the individual pieces refuse to come together to meet that need. Instead of a constitutional government obligation to create a national system, we have a constitutional individual right to frustrate a national system.

Brazil's "Public Option" Health Care a Model for USA

2009-06-21T19:04:00.000-07:00

Pardon me for sounding confused, but I just cannot understand the talk about requirements that people have health insurance. Here in Brazil, there is a "public option" that consists of community health centers in each neighborhood as well as at least two public hospitals in cities under 100,000 population, with more public hospitals in larger cities. Anyone, even a tourist, can go to these clinics and hospitals and it is unlawful to request or accept payment from clients.

In addition, common medications are given out for free at these clinics if they are available, with the only requirement being a prescription from a doctor, public or private.

No one is required to purchase this assurance that their medical needs will be taken care of. Instead, the program is paid for through various government taxes. It's worth pointing out that in Brazil people are tax-exempt until their income reaches three times the minimum wage, so it's fair to say that many of those receiving the benefits of the service are being entirely subsidized by other wealthier people who may use the public system or may prefer to use private doctors.

In light of my experience with this system, it seems rather absurd to me that we should require people in the US who are sleeping under a bridge to buy health insurance when they cannot even afford a cup of coffee. Government promises to provide such people with subsidies just make me think of a tidal wave of new bureaucracy to determine who needs what level of subsidy and who has paid their premiums and who hasn't. A public option designed this way may have all of the expensive bureaucracy of a welfare department, with an equal likelihood that many people will fall through the cracks when the need the care the most.

What the United States needs is what Brazil has: a system of public clinics and hospitals where anyone and everyone, regardless of their ability to pay, can come and receive treatment with no discussion whatever of their financial circumstances. In such a system, Bill Gates might lie in a hospital bed alongside Bill, the streetsweeper, each receiving from their Government the care they need without the bureaucracy they would abhor.

Support Obama's "Public Option" Health Care Now!

2009-06-14T08:08:00.000-07:00

As I pointed out back on May 29, 2007, Black bloggers need to take a position and join the fight for a significantly stronger government role in assuring health care for all Americans, because this is one of the most important issues of our time, particularly for Blacks, whose infant mortality rate in the US South is almost three times the overall rate in Cuba.

President Barack Obama is fighting for a "public option" health care alternative, where those who are not happy with their current health insurance options or simply cannot find any health insurance will be able to rely on the Government plan. (I am one of those people. When last I discussed health care with a state agency distributing Federal Government health care funds, the state agency me that I was ineligible because my income exceeded the cap by fifteen dollars or so.)

And so, I remain without health insurance in the United States, from the Government or from anyone else.

Link to source of graphic w/article.

Thank goodness I've moved to Brazil, where everyone is provided health care at federally-sponsored clinics operated by local governments and funded by federal monies, and everyone is eligible, regardless of their income. Although this will seem incredible to people in the United States, Brazilian government-sponsored health clinics NEVER ask about a patient's ability to pay and never accept any payment. It's illegal to do so.

Obama is promising and planning to implement a "public option" medical insurance plan that everyone can afford, to compete with private insurers who often deny coverage or offer it only at astronomical rates.

Link to source of graphic w/article.

Robert Reich, who was Secretary of Labor under the Clinton Administration but supported Obama over Hillary last year, says Obama faces a myriad of forces arrayed against his health care plan:

The big guns are out and they're firing. All major lobbying firms in Washington -- many of them brimming with ex-members of Congress -- are now crawling all over the Hill. Lots of money is on the table. AMA's political action committee has contributed $9.8 million to congressional candidates since 2000, and its lobbying arm is one of the most formidable on the Hill.
Meanwhile, Big Insurance and Big Pharma are increasing their firepower. The five largest private insurers and their trade group America's Health Insurance Plans spent a total of $6.4 million on lobbying in the first quarter of this year, up more than $1 million from the first quarter last year, and are spending even more now. United Health Group spent $1.5 million in the first quarter, up 34 percent from the $1.1 million it spent in the first quarter last year.
Aetna spent $809,793 between January and the end of March, up 41 percent from last year. Pfizer, the world's biggest drugmaker, spent more than $6.1 million on lobbying between January and March, more than double what it spent last year. It also spent nearly $3.3 million lobbying in the fourth quarter of 2008. Every one of them is upping their spending.
Some congressional Democrats are willing and able to stand up to this barrage. Many are not. They need cover from the White House.
The President can't do this alone. You must weigh in and get everyone you know to weigh in, too. Bombard your senators and representatives. Organize and mobilize others. And let the White House know how strongly you feel. This is one of those battles that define a presidency. But more importantly, it's one of those battles that define the state of American democracy. Robert Reich at Salon.Com

I hope posting this blog will encourage others to join the fight for health care that Americans can afford here, and not just in Brazil.