Yeah, But Will Scalia, Thomas, Alito et al Actually Get it This Time??

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It's All a Matter of Having Your Priorities Straight ...

...and public health is somewhere much, much farther down on the list.

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A Discussion: Rational Person vs. Tea Partyer

RP: So you’re in favor of repealing the new health care reform law?

TP: Absolutely. It’s a boondoggle … nothing but big government messing in our lives.

RP: What about a 12-year-old kid who breaks an arm in a pick-up baseball game?

TP: What about him?

RP: His mother works 20 hours a week for Wal-Mart and doesn’t qualify for benefits. But she has cancer – a pre-existing condition – so no insurance company will cover them.

TP: OK, take the kid to the emergency room. They’ll fix his busted arm.

RP: If he goes to an emergency room, it’s going to cost a few thousand bucks. His mom hasn't got that kind of money!

TP: That’s not my problem.

RP: But the hospital can't just eat those costs. They’ll jack up their fees for patients who do have insurance. People like you.

TP: So what? My insurance company will pay whatever the hospital charges me. And I can afford the co-pay.

RP: But because it’s costing them more to insure you, the insurance company will raise your rates.

TP: What?

RP: You see? You get screwed. The hospital gets screwed. And, of course, the kid with the broken arm and that poor woman with cancer … they really get screwed.

TP: Fahgh! That’s just more of your bleeding heart liberal crap. All I know is there’s too much government in our lives. Down with Obamacare! Watch Fox News! Vote Republican!
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Enjoy your health care reform ... while you can.

Sunday – the first day of the New Year – is also the first day for two important provisions of the new health care reform law.

The first change will start to close the infamous donut hole in prescription drug plans. When you suddenly discover that the drug you’ve been paying $42 a month for will now will cost $197 a month until the end of the year … welcome to the donut hole!

But the second change is the biggie. It will require insurance companies to pay out no less than 80 percent of the money they take in from premiums on actual health care costs. As of Monday morning, overhead, profit, salaries and those multi-million dollar bonuses for executives will all have to come out of the remaining 20 percent.

The plain, unvarnished truth: any insurance company that hasn’t already been meeting that 80:20 ratio has been screwing its customers.

And these two provisions are part of the law that Republicans in Congress will try to repeal.
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Facts, Reason and Logic Are Useless Arguments

One of the reasons to support health care reform is that we’re already paying for the uninsured anyway. I recently had a two-day stay at the Queen’s Medical Center in Honolulu. I received truly excellent care -- for which I am most grateful -- but the cost was more than $17,000. That's just the hospital bill. The surgeon's fee is yet to come.

Today’s Honolulu Advertiser reports that local hospitals are receiving more than $14 million dollars from the feds – our tax dollars – to “help defray the cost of providing service to uninsured and underinsured patents.” Note the phrase “ … help defray … ” which clearly means these federal funds don’t begin to cover all the costs.

The rest of the shortfall is made up by those of us with health insurance. When we use hospital services, we’re charged several times more than what would ordinarily be a fair price. And the health insurance companies charge us higher premiums than would be necessary if everyone were required to have coverage.

Of course, that would be socialism, wouldn’t it!

Wait a sec … don’t we require everyone to have car insurance … and fire insurance … for exactly the same reasons? Indeed we do ... but just imagine the screeching from all those right-wingers if their car insurance premiums were doubled to cover the cost of fixing wrecked cars of people who didn’t have insurance.

But silly me ... I keep thinking rational argument will decide this issue.

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The need for health care reform hits close to home.

The arguments against our current health care system -- if you can call it a “system” -- are just overwhelming. Every other industrialized country does it better. Every damn one.

Let me give you one example of how our system fails people.

A young woman has been working in one of the local restaurants here. The owner of the place pays her partly in cash to fudge the number of hours she works. And that’s done so the cheap bastard doesn't have to pay for the girl's health insurance.

But the girl didn’t really care. What the hell: she’s young, she’s single, she’s healthy, and she’s living on Maui. Life is good.

But a week or so ago, she got an infection … scratched herself on something and just didn’t give it much thought. Then she developed a fever. Probably just the flu, she thought … no need to see a doctor … especially with no health insurance.

A day later she was worse, much worse, and was finally taken to the emergency room. They did all they could, but the infection had spread throughout her body. She turned critical and ended up being flown to Honolulu where she had surgery to replace a couple of valves in her heart.

Meanwhile, the Republicans are in lock step opposing any real health care reform. Forcing people to buy insurance is bad. Raising costs to small business is bad. Could mean higher taxes, and taxes are bad. It's all just bad, bad, bad!

Well, guess who’s going to pay for this young girl’s medical expenses? We all are … through higher hospital bills, which ultimately mean higher insurance premiums and reduced benefits.

The last I heard she was still alive, but just barely. I’ll let you know how it turns out.

What I don’t understand is, how do all those people – John Boehner and Chuck Grassley and Lindsey Graham and all the rest of those selfish, cold-hearted ideologues -- how do they sleep at night?

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Health Care Reform: One More Case History

The other day there was a heartbreaking – and infuriating – story in the New York Times by columnist Bob Herbert. It was about a man who has lost both his kidneys to a serious disease. A transplant will soon be needed … or the man will surely die.

His two sons are potential donors, but there’s a problem: Any test to determine if their kidneys would be compatible with their father’s will also reveal if the same disease is latent within their bodies. And there’s a 50-50 chance they have it.

Why is that a problem? Because their health insurance company could then claim they had a “pre-existing condition” and cancel their policies. And no other insurance company would ever insure them for the same reason.

How’s that for being between a rock and a hard place? The boys want to have the tests done anyway; their dad doesn’t want them to do it, even if he dies as a result.

How can we, as a civilized society, stand by while people are forced to make choices like that?

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These Aren't Statistics, They're Real People

One of the problems in the health car reform debate is that the dialog too often inbvolves only statistics: X number of people, Y number of dollars, etc. To fully understand what's at stake, we need to understand how the current system affects real people.

I wrote a while back about the young husband and wife who were forced for both economic and practical reasons to decided which one would get a needed surgery. What a choice! How would you like to be the husband who gets the surgery he needs, leaving his wife with her chronic gall bladder pain untreated?

Here’s another case history, sent to me today by a regular visitor to this page:

A little over three weeks ago, forgetting I'm no longer 16, I jumped off a harmless 4' wall, and my right knee gave out. Not a landing Nadia Comaneci would have applauded. Anyway, for 2 days I couldn't walk, but did improve a bit.

I went to our doctor here, and the decision was to wait two weeks and see if it got "good as new" on its own. Two weeks later I reported back and said it had indeed improved a lot, but it still didn't feel stable at all. No pain to speak of, but a sense of weakness and, specifically, a sensation it would bend the wrong way backwards. So my doctor ordered an MRI.

Aetna* refused to cover it. Seems I should have waited 6-8 weeks for “therapeutic effect”, and hadn’t had exercises to strengthen it, etc., etc. A consulting doctor for Aetna reviewed the case and gave that opinion.

I don't dare try to find another carrier. I pay Aetna $566 a month for a policy with a $3,000 deductible and am "lucky" to have that!

So much for having my doctor and me together decide what's the best treatment plan.


How can the people bragging about ours being “the greatest country in the world” allow its citizens to be treated this way?

*Remember the Aetna? Their CEO’s compensation was $25 million last year!

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Health Care in the U.S. - Two Snapshots

I have health insurance.
Three years ago, my co-pay for a routine office visit was $8.00.
Last year, the co-pay was $14.00.
I had an appointment last week. The co-pay was $22.00.

I have drug insurance.
The monthly co-pay for one of my prescriptions is $38.
But I’ve just landed in “the donut hole.”
The monthly payment for that prescription is now $218.

We need health care reform. YA THINK???

Some Very Random Wonderings …

1. Everyone seems to agree that a single payer health insurance system would reduce the cost of health insurance. So why aren’t business owners demanding it?

2. How long will it take for Manny Ramirez to get tired of La-La-Land and start sitting out games with a sore knee … and forgetting if it’s the left or the right one? (Yes, I’m a Red Sox fan, and if you root for the Dodgers, you are more than welcome to the big bozo.)

3. Why don’t the people ranting about “socialism” check out the actual meaning of the term? (Oh, wait … I forget … they don’t care what it means as long as it keeps the ditto-heads frothing at the mouth.)

4. Republicans like Knee-Jerk John Boehner are automatically against everything President Obama proposes. Wouldn’t it be helpful if they had some alternative ideas?

5. Why don’t the people responsible for the SpellCheck programs fix it so “Obama” isn’t flagged?

Got Health Insurance? Think You’re OK? Think Again!

The current issue of TIME magazine has a cover story on health care in this country. Read it!

There are several case histories that will break your heart. These are not rare occurrences, either. An illness or accident can leave you destitute and an empty pot for your heirs.

A couple of years ago, Harvard did a study of some 1,700 bankruptcies from around the country. In more than half the cases, medical problems were the major cause. And – get this! – 75 percent of those people had health insurance!

A big part of the problem is deceptive marketing by many of the insurance companies, lulling people into believing they will be adequately covered in the case of a serious medical problem.

One case mentioned in the article will make your blood boil. Here's a brief summary:

A man bought an insurance policy which he renewed every six months for several years. Toward the end of one of those six month terms, he complained about some symptoms to his doctor. A few months later -- he’s now in his next six-month term -- he was diagnosed with a serious illness. But the insurance company refused to pay on the grounds that the illness was a pre-existing condition. How can that be, you ask? Well, every time this poor guy renewed his policy, the company considered him to be a brand new customer.

For the record, the name of this miserable company-without-a-soul is Assurant Health, and they, according to their web site, are providing “peace of mind … at a price you can afford.”

Wrong on both counts!

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Lack of Health Insurance Impacts the Economy

I recently wrote how hospitals treaing patients with no health insurance are forced to pass along those costs to the rest of us, thus artificially (and, some would say, unfairly) driving up the cost of our health insurance.

On that same general subject, I came across an enlightening column in The New Yorker magazine which contained the following interesting and sobering paragraph:

The accumulating failures in the country’s health-care system are a cause of profound weakness in the American economy; unaddressed, this weakness will exacerbate the coming recession and crimp its aftermath. A large number of the country’s housing foreclosures in recent years appear to be related to medical problems and health-care expenses. American businesses often can’t afford to hire as many employees as they like because of rising health-insurance costs; employees often can’t afford to quit to chase their better-mousetrap dreams because they can’t risk going without coverage. Add to this the system’s moral failings: about twenty-two thousand people die in this country annually because they lack health insurance. That is more than the number of Americans who are murdered in a year.

Steve Coll
The New Yorker
Nov. 10, 2008

Forty-seven million Americans without health insurance is a national disgrace. But it is also stupid because, clearly, the most expensive choice we can make on this issue is to do nothing.
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Flip a Coin, Throw a Dart and Pick a Drug Plan.

Between now and the end of the year, I have to decide if I’m going to keep the prescription drug insurance plan I’ve been using or switch to another one. So I sat down yesterday to figure out which of the available choices would give me the best coverage for the lowest cost.

I spent well over an hour at the computer plugging my medications and dosages into a program that promised to help me select the best plan for my needs.

Guess what: There are no less than 65 plans available to me here on Maui and they all have different annual premiums that range from almost $400 to more than $1200.

But with each of these plans, my out-of-pocket cost will be different for the medications I take. For example, the co-pay for a 30-day supply of one particular pill was $18 on one plan and $98 on another.

Some plans cover all the drugs for the whole year; other plans stop coverage when you reach a certain level, then resume coverage after you hit another threshold.

In all honesty, I could spend hours on all that and still not be sure of which is the best plan for me. And, of course, everything would change anyway if the plan I choose increases premiums or if I have to change medications or start on a new one. We have the lobbyists for the private insurance companies to thank for this.

One more thing: We’re not permitted to legally buy prescription drugs from Canada where the cost is a lot less because – wink! wink! – they might not be safe … even though many of the drugs we get from our local pharmacy are manufactured overseas anyway. And we have the lobbyists for the pharmaceutical companies to thank for that!

Folks, we are being screwed and it’s a damn outrage.


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