MEandering - Single Payer Health Care

They convinced me!

nospam@example.com (Annie Gabston-Howell) — Wed, 30 Sep 2009 21:03:47 -0600

Protect Insurance Companies PSA from Will Ferrell

"No one should die because they cannot afford health care...

nospam@example.com (Annie Gabston-Howell) — Fri, 04 Sep 2009 22:47:28 -0600

I confess, I consider Facebook to be a waste of time. The status update request,

"No one should die because they cannot
afford health care, and no one should go broke because they get sick.
If you agree, please post this as your status for the rest of the day"

came to me as a part of reading random news articles because my Facebook friends list is so short that none of them had yet jumped on the bandwagon.

It occurred to me that maybe it is just simple enough that it may convince a few more of we-the-people to see that the real issue is not that complex. National health care is all about providing health care to the nation in a fashion that is available to everyone. The "debate" is really complex, but the issue is not.

My Facebook status has been updated, and now so has my blog. Maybe I will add it to my email signature line also.

Tom Daschle GETS It!

nospam@example.com (Annie Gabston-Howell) — Fri, 21 Nov 2008 19:53:52 -0700

Health care is a complex topic, but myths should not cover up a simple truth: We are wasting money by paying top dollar for mediocre results.
Tom Daschle (See full article)

The quotation above is taken from an article written by the gentleman who has probably been chosen as our new Health and Human Services Secretary. I have not yet read enough about his thoughts on how to get health care for every American to know whether I agree with what he thinks is the best way to go. However, the fact that he sees the situation as it is means that we-the-people may get a form of national health care that provides better medical care instead of higher profits for insurers.

Everyone Knows That We Cannot Afford National, Single-Payer Health Care

nospam@example.com (Annie Gabston-Howell) — Sat, 09 Feb 2008 06:16:52 -0700

I know that I am something of a contrarian. I have the bad habit of doubting popular opinion and this habit is not always limited by whether or not popular opinion is based on fact. My first instinct is to doubt--irregardless of subject--, when I hear the words, or even the strong implication of the words, "Everyone knows."

I have known, for most of my life, that a national single-payer health care model would be a bad thing for the United States. Or rather, I have known that 'everyone' knows this. Genetically and environmentally prone to being contrary, I have never actually believed it, but never bothered to do enough research to satisfy myself that my opinion did not merely represent another instance of my own contrary nature.

I recently decided to find out what it is that "everyone knows" on this subject and whether they know what they "know".

Asking people what they thought of the government taking over the financial burden of paying for everyone's health care, I got the expected answer. My friends--the people most us mean when we say "everyone"--mostly believe it would be a bad idea. (The exception to the 'mostly' were, by and large, those who grew to maturity in another country that does have national health care. )

Everyone knows that we cannot afford national, single-payer health care. Everyone's taxes would increase, I was told, to pay to cover the uninsured. A subset of my "everyone" believes that it might be financially feasible to have national health care if we could manage to send all the illegal immigrants away, because their care is a huge factor in the nation's health care expense. Another subset believes it would be too expensive because the government is so incompetent that any health care plan overseen by them would actually increase the expense of medical care and lead to things like taxpayer dollars paying $100 for an aspirin.

Interestingly enough, of the members of my "everyone" that I talked to, some of the "illegal immigrants drive up costs" people are legal immigrants and most of the "incompetent government would drive up costs" people are Los Angeles County employees.

This unscientific research,--conducted by asking my friends, "What do you think of the idea of national health care?" and nodding a lot to encourage them to give me the full benefit of their wisdom on the subject, --convinced me that "everyone" does indeed know that we cannot afford single-payer national heath care.

It turns out that my "everyone" does not know quite as much as they think they do.

FACT: The vast majority of people lacking health insurance in the United States were born in the United States.
FACT: A large percentage of those lacking health insurance are employed full time.
FACT: Many of the people who have health insurance lack actual access to care because they are under-insured and cannot afford deductibles and co-pays required by their insurance provider.
FACT: Many people who are fully insured currently will lack access if they experience a serious illness when they lose insurance coverage because of a job loss or are dropped by their insurance provider.
FACT: The U.S. government already pays for much of the health care in the nation. With programs to cover some elderly and/or disabled adults, some children and some impoverished U.S. residents and with laws mandating emergency room treatment, We-the-People already are the single largest health insurance provider in the nation, providing coverage--back in 2004--for approximately 45% of the nation's health care costs.
FACT: Although the U.S. is one of the few nations in the world that does not guarantee health care for everyone, counting only U.S. government expenditures, this nation is among the top 10 nations in the world in terms of per capita health care spending.
FACT: Once we add the cost borne by employers, individuals and other non-government health care funding to the cost borne by the government, We-the-people pay more per capita than any nation in the world for health care, but--according to the World Health Organization--the care we get ranks 37th in overall performance and 72nd in overall level of health among the 191 nations compared.

We-the-people seem pretty convinced nowadays that we have to make certain that everyone has access to health care, but "everyone" seems convinced that the way to provide that access is by forcing everyone who can afford it to buy private health insurance and by paying for/helping to pay for private health insurance for those who cannot afford it.

Contrary me looked at a sample of the facts available and decided that the cheapest, most efficient way to go is single-payer. We-the-people have a responsibility to each other to guarantee heath care and the cheapest, most reliable way to do that is NOT to pay a health insurance company to pay a health care provider. We tried that already and the result is paying more and getting less for our money.

It is clear to me that we cannot afford not to have a single-payer, national health care plan.

+++++++++++++++++++

JAMA. 2003;289:1165.
It is only partially true to say that the United States doesnot currently have a national health care system. The Centersfor Medicare & Medicaid Services (CMS) estimated the 1999government share of total US health spending as 45.2% ($548billion).¹ This estimate includes funding for Medicare, Medicaid,workers' compensation, the Department of Veterans Affairs, publichospitals, and government public health activities. Thus, publicfunds directly pay for the health care of many people in theUnited States. Read the entire JAMA article.

One out of six Americans under age sixty-five lacks healthinsurance, a situation that imposes sizable hidden costs uponsociety. The poorer health and shorter lives of those withoutcoverage account for most of these costs. Other impacts aremanifested by Medicare and disability support payments, demandson the public health infrastructure, and losses of local healthservice capacity. We conclude that the estimated value of healthforgone each year because of uninsurance ($65-$130 billion)constitutes a lower-bound estimate of economic losses resultingfrom the present level of uninsurance nationally. Read the entire Project Hope article.

Wikipedia article with links to sources.

Data below from US Census Bureau, August 2007 release.

The number of people without health insurance coverage rose from 44.8 million (15.3 percent) in 2005 to 47 million (15.8 percent) in 2006.

Overview

The number of uninsured children increased from 8 million (10.9 percent)
in 2005 to 8.7 million (11.7 percent) in 2006.

Race and Hispanic Origin (Race data
refer to those reporting a single race only)

The number of uninsured, as well as the rate without health insurance,
remained statistically unchanged in 2006 for non-Hispanic whites (at 21.2
million or 10.8 percent). For blacks, the number and percentage increased,
from 7 million in 2005 to 7.6 million and from 19 percent in 2005 to 20.5
percent. The number of uninsured Asians remained statistically unchanged,
at 2 million in 2006, while their uninsured rate declined to 15.5 percent
in 2006, from 17.2 percent in 2005.
The number and percentage of uninsured Hispanics increased from 14 million
(32.3 percent) in 2005 to 15.3 million (34.1 percent).
Based on a three-year average (2004-2006), 31.4 percent of people who
reported American Indian and Alaska Native as their race were without coverage.
The three-year average for Native Hawaiians and Other Pacific Islanders
was 21.7 percent.

Nativity

Between 2005 and 2006, the number of U.S.-born residents who were uninsured
increased from 33 million to 34.4 million, and their uninsured rate increased
from 12.8 percent in 2005 to 13.2 percent. The number of foreign-born who
were uninsured rose from 11.8 million in 2005 to 12.6 million, and their
rate was statistically unchanged at 33.8 percent in 2006.

Regions

The Midwest had the lowest uninsured rate in 2006, at 11.4 percent, followed
by the Northeast (12.3 percent), the West (17.9 percent) and the South (19
percent). The Northeast and South experienced increases in their uninsured
rates — their 2005 rates were 11.7 percent and 18 percent, respectively.

States

Rates for 2004-2006 using a three-year average show that Texas (24.1
percent) had the highest percentage of uninsured. The rates for Minnesota,
Hawaii, Iowa, Wisconsin and Maine were lower than the rates of the other
45 states and the District of Columbia. The rates for these five states
were not statistically different from one another.
Fifteen states had an uninsured rate that was statistically higher than
the national rate of 15.3 percent, while 29 states and the District of Columbia
had rates statistically lower than the U.S. average. Six states had rates
that were not statistically different from the national average.

Lucky

nospam@example.com (Annie Gabston-Howell) — Wed, 12 Dec 2007 22:30:36 -0700

Having a head-on collision with a drunk driver is NOT lucky. Having a head-on collision with a drunk driver, having the vehicle you were riding in end up looking like Ben's car in the photo above (follow link to larger view) and living to talk about it is extremely lucky.

Janette Marie and Ben are both, according to Allan--who is now in Florida,--feeling well enough to complain about being in the hospital still. The fact that they can complain about this--less than two full weeks after the accident that did this to the car around them--is a miracle.

I feel lucky.

Socialized Medicine? What a horrible thought!

nospam@example.com (Annie Gabston-Howell) — Sun, 09 Dec 2007 10:59:50 -0700

Janette Marie, high school graduation 2006

As of today, I am nominating my family as the poster family against a national, single-payer health care plan.

Last week, Janette (aka "Marie") and her boyfriend, while coming home from dinner, had the bad taste and lack of forethought, to get in a drunk driver's way as he struggled to get himself home. (Clicking on this link will take you to a small local, news article about the "accident"--is it really an accident when somebody drinks far too much, then hops in a vehicle and tries to kill other people?)

As a result, the two college students spent this past week in the hospital, instead of in class. They are now moving to a rehabilitation facility, where they will work on minor issues like re-learning how to walk. I will admit to feeling a bit of anger directed at Mr. Larson. I understand his right, as an adult, to drink to excess and get stupid in public. It is a free country, after all. However, if he had to get into his van and go for a drive afterwards, it would have been far more polite of him to have aimed it at a brick wall instead of at two kids in a Toyota. It is far easier to restack bricks than it is to put humans back together. Mr. Lawrence Larson, having had a number of alcohol-inspired "accidents" over the years, should be aware of that little fact.

However, today's poison pen is not L. J. Larson-directed. In spite of my temptation to slowly, using the written equivalent of a fingernail-clipper, metaphorically remove all the skin from his body just before carefully adding copious amounts of salt to his skinless carcass, I will, instead, write about health care in the United States. I do not doubt that I might, eventually, find Mr. Larson worthy of discussion. Today is not his day.

Today's topic is health care in the United States. For those who have not been paying attention, a bit of education about the hot-button topic may be appropriate. If you have been paying attention, as apparently most of the can-but-probably-will-not-vote public has been, just skip over the next bit.

For the rest of you: The debate is not so much about health care, but about how we should pay for it.

As a local-government employee, I have good* health care compared to many, if not most, working people in today's United States. Although my options are, as stated above, probably among the best of what is available, it is the norm for family health care coverage in our nation: It is, speaking generically, health insurance paid for privately or as a part an employer-provided benefit package. My employer contracts with an insurer to provide health care insurance for myself, my fellow employees and our families. You can, if you are interested, review the benefit packages available to Los Angeles County employees by clicking on the Choices, Options, Megaflex, or Flexible Benefit plan description links.

For a number of reasons, this type of health care coverage leaves some people unprotected against the ever-surging costs of obtaining medical care.

People with pre-existing health conditions often cannot get health insurance at any price.

People without pre-existing health conditions often cannot afford the premiums.

Many employers do not or can not pay for employee health care.

Even people, like myself, with a job and good benefits, run the risk of losing health care coverage if the job is lost.

Although I have "insurance insurance" meaning that I pay a monthly premium to be insured against having to pay for my continued health coverage if I am injured/ill for any extended period, most people who have employer-provided coverage run the risk of losing coverage if they are off work because of an illness and cannot afford to go out-of-pocket to continue paying for coverage.

For the reasons listed above and the many that I do not list, the talk has turned to taking the responsibility of providing health care coverage from the individual, or the individual's employer to maybe creating a national plan. At any given time, more than fifty percent of the U.S. public cites health care as a concern. Even those who say that they are satisfied with their own health care say that reform is needed.

The simplest reform would shift the responsibility of paying for health care insurance from the employer to the government and to the individual--based on some kind of a means-test--needing coverage. We the people, as a group and as individuals, would continue to pay insurance companies to pay doctors, hospitals, and other providers to provide care. I suspect that this type of plan has the best chance of becoming the law of the land. It removes the cost from employers, does not injure the insurance industry, helps a few of the private citizens without coverage obtain coverage and mostly leaves things as they are.

The other talked about possible reform to health care cost coverage in today's United States would require that we-the-people shoulder the whole burden. We-the-people, under this plan, would ignore the various insurers and their various plans, and just pay the providers ourselves. I do not expect this single-payer thing to happen anytime soon.

My own family's medical-care-related experiences during the past year or so can serve to show why single-payer (also known as "socialized medicine") is un-American. My good health insurance has provided us with wonderful experiences that we would not otherwise have had the pleasure of experiencing.

Early in the year, I had a mild back injury of a type that I have experienced a few times throughout the years. In the past, though, I had always hurt my back while doing something not related to work or, because of a delay between experiencing the injury and feeling any pain, been too uncertain of the cause to be sure that something work-related caused the injury.

This last time, though, the pain started on a Friday evening, after a day at work spent loading and lifting boxes, without any matching activity at home. When the pain increased to need-drugs-now! levels, I called my medical provider for an emergency appointment. They asked what happened. I mentioned back pain and boxes at work.

"Sorry," I was told. Because it was a work-related injury, they were not allowed to provide care without authorization. My arguments about paying a monthly premium for medical care and now needing medical care fell on deaf ears. Even my explanation that I thought the injury was work-related but could not be sure because the onset of pain came hours after the activity did not move the gate-keeper to grant me an appointment. My employer-paid monthly premium pays that particular provider for non-work-related medical care. They do pay the same provider to provide work-related medical care, too, but if an injury is work-related, pre-authorization is required. It is important, for billing purposes, for the provider to not let the need to provide care interfere with making certain the bills get sent to the right place.

The gate-keeper finally provided a common-sense solution to the problem of getting employer authorization for care on a week-end when the employer is not available. "Just call back and don't mention that it might have happened at work. If you don't mention work, you can have an appointment right away."

Her explanation of why I had to call back was priceless, "I can't give you an appointment because I know already that you think it might be work-related. The next person who answers won't know, so they can give you an appointment. You won't need to lie or anything, you already told me that you're not sure it happened at work. Just don't mention any of the things that you're not sure of and you'll be okay."

Under the horrors of socialized medicine, I would have missed the extended, and sometimes very amusing phone conversations, including the one detailed above, that I had that day. These conversations took my mind off the pain I was experiencing and gave me an insight into some of the problems with Workman's Compensation Insurance in California. It was fun and educational and I did, eventually, get my appointment and, later, my drugs.

Socialized medicine, and a system where, when you are hurt or ill, you simply go to the doctor would have robbed the gatekeeper and I of the pleasure we both experienced when she had the eureka moment and figured out how to get care for me on a weekend without breaking her employer's rules.

Americans believe in finding innovative solutions to problems that appear insurmountable. Socialized medicine would have robbed me of seeing American ingenuity at work. Socialized medicine is bad.

Later in the year, Sherry--aka Doctor Daughter--needed relatively minor surgery. She is too old to still be included on my employer-provided plan and there was some uncertainty about her own plan paying. She would get the surgery she needed, but might end up with huge medical bills and no ability to pay. Friends rallied around when the news got out. They worked to get the insurance stuff straightened out. By the time she returned home, what had looked like tens of thousands of dollars in medical expenses had been reduced to mere hundreds.

Socialized medicine would have robbed her and I of the very heartwarming experience of knowing just how much her friends care about her. Seeing how much people were willing to do to help her, not just with recovery, but with anything she needed was an amazing experience that we might have missed. For me, there is a level of discomfort in not living next door to my eldest. That is still there, but now I know that those who are in close proximity care enough to take care of her when mommy can not.

Americans believe in helping each other. Socialized medicine would have robbed me of some of the feeling of community that experience gave me. Socialized medicine is bad.

Now there is Janette in a hospital in Florida. Were it not for the distraction of insisting that my health-care provider, located on this coast, fulfill the guarantee of providing emergency care where ever emergency care is needed, my husband would not be nearly as calm as he is managing to be over the situation.

Instead of spending all his time worrying about Janette, he has the pleasure of arguing with the provider when they tell us that it is unreasonable of us to expect us to consider physical rehabilitation after an accident to be part of the emergency care provision and think that they would pay for rehab in Florida.

They told us that they would authorize the needed treatment, but we would have to go to Florida, pick up Janette and bring her out here for rehabilitation. The fact that she was to be released from the hospital providing emergency medical care immediately after the accident at a point where she was still unable to sit up, let alone walk, was not relevant according to those originally speaking on behalf of the provider.

When he managed to get past several low-level gatekeepers who refused to authorize treatment to a decision-maker who fairly quickly agreed to Florida rehabilitative treatment, he felt that he had been able to do something, even from so far away as Los Angeles.

Once rehabilitative care was authorized by the provider, the question of the cost of the 90-mile or so trip from the hospital providing emergency care to the hospital providing rehabilitative care came up. It turns out that my provider simply does not believe in providing medical transportation from one medical facility to another unless greater care is required. (Ignore those news articles that accuse them of paying for transporting indigent patients from the relatively high level of care provided in a hospital setting to the somewhat lower level of care available on a skid row street corner.) They insisted that this was our problem, not theirs.

The cost being within what we can manage, we did not argue and paid the charge. Another opportunity for us to do something for the loved one who is so far away. During times of worry, doing something is, most often, of greater relief than standing around wringing your hands. Socialized medicine would have robbed us of the ability to engage in showing love by opening a checkbook.

The community thing comes up here again. People keep offering to help and providing help. Friends and family, people we do not know well and some people that we do not know at all are rallying around on both coasts to help with anything that comes up. Many of the offers, both those we accepted gratefully and those we declined with gratitude are directed towards helping out financially. Everyone knows that, even with good insurance coverage, a medical emergency creates a financial hardship that can devastate a family.

Socialized medicine would have robbed us of a lot of the positive feelings that we are experiencing during this, very negative, event. Socialized medicine is bad.

I have known for many years that socialized medicine is a bad thing. I have known this because, for as long as I can remember, the reaction to any real suggestion that the United States develop a national health care system has been met with, "That would be socialized medicine." and the suggestions have gone nowhere. Until now, I did not have any information to tell me why it was bad. Now I know and am willing to let my family serve as poster children for the campaign to, "Say no to socialized medicine."

My experiences, this year, have convinced me that if we had in place a comprehensive, single-payer, national health care system, I would have missed many of my most positive, life-affirming experiences. Things that I will remember, and be grateful for thoughout the rest of my life would not have taken place if getting, and paying for, health care was simpler in America.

Funny. As grateful as I am for all the good that has come our way for no other reason than because we do not have socialized medicine in the United States, there is a nagging part of me that wishes we-the-people would change our minds, eliminate the middle man and shift the burden of paying for medical care from individuals and employers to the collective us, the we-the-people.

*Very, very good if you work for Walmart or many other employers in the United States. Providing health care insurance is expensive for any employer. Some cannot provide decent coverage because their bottom lines will not allow it. Other, highly profitable, employers opt not to provide decent coverage because their huge profits would not be quite as huge if they did. The number of employers who provide coverage at a level to match what is available to my family is steadily shrinking. My coverage, that I readily admit is far better than what most people have, is greatly reduced from what was available to me a couple of decades ago when I began working for the County.