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The State of My Union Isn’t So Great
And especially for those policy folks who now say it was dumb for the President and Congress to take on healthcare reform because it's a fringe issue not as important as the other issues we face, I say you are so lucky you can see the world that way - you must be healthy or wealthy or both. Because in my real world healthcare dealings, this messed up system is draining time, money, energy and health.
This is my first state of my union address, delivered January 25, 2010.
First, forgive me for repeating myself so many times, but the U.S. healthcare system doesn't revolve around providing me care. The U.S. healthcare system revolves around making money. The state of my union as a patient is not so good.
For those in the family who carry private, for-profit health insurance, our ability to get preventative care and seek basic healthcare services when we get ill is totally dependent upon our insurance companies and the providers who have contracts with our health insurance companies. The treatment we are allowed to receive is also totally determined by our health insurance companies - not by our medical needs. That's the state of our union.
First question asked when we seek care? "What kind of insurance do you have?" and not, "What is your medical problem?" First question at the front desk of the doctors' offices? "How will you be paying your co-pay today?" and not, "How are you feeling today?" First question at the hospital admission cubicle? "May I see your insurance card and your photo I.D.?" and not, "What brings you to the hospital today?" That's the state of the union for patients, too.
For me and for my family members, our other huge concern when we may need medical care is whether or not we may miss work and thereby lose income or status or both. Most working Americans earn sick leave time - at least a little bit - every month. But most of us feel as though we dare not use that sick time. It is seen as weakness to be sick or as a lack of true commitment to one's employer or laziness, so most of the people I know go to work sick or hurt if their symptoms don't knock them completely out. The recession hasn't helped that at all. That's the state of our union every day.
One might think we have the work ethic run amok, but it's more cruel than that in working class America. It is a survival of the fittest mentality cloaked in warped Christian values (I say warped because true Christian values would be far different).
Have you been to a local emergency room on a Friday evening lately? Lots of people go there after they managed to hang on through the work week feeling pretty terrible and they just want some medical care to happen on their time off without anyone at work needing to know. Some might have called a doctor and sought some care earlier, but most doctors don't like to talk to patients on the phone anymore - most cannot bill the insurance company for a returned phone call. That's the state of my union.
Another huge issue for U.S. patients is being able to afford the medications or treatments our doctors may order if we are able to get care. Anyone who has been to an American pharmacy counter knows that people are having trouble getting their medications. Insurance companies often decline coverage or have tiered coverage so complicated that few patients (and few of our doctors) know which medications are covered and for how much. It's a crap shoot every time you step up to the pharmacy counter and hand over the script. And the out-of-pocket costs are outrageous. That's the state of our union.
For most of us, it's like being on a really shady used car lot to seek medical care in the United States. Everything is waxed up and shining, but under the hood things can be pretty bad or not. You just cannot trust that the services being suggested are being offered because you need them or because you have a source of payment and the provider needs the revenue. Even in those medical settings where we have developed a relationship, the care issues are driven by who will pay what for which service.
The state of my union is one of always feeling like I have to outsmart people who know a lot more than I do about which medical issues are serious and what kinds of treatment are most appropriate. I try to diagnose on the internet whenever possible and always check out the suggested treatments and medications before pursuing new appointments or purchases.
On a larger scale, healthcare now consumes more than one-sixth of the nation's economic activity. It's big business, and as a friend of mine often says, "The profits are dear." And unless Congress and the President act much more boldly than the recent effort showed me, the state of my union is going to get a lot worse going forward. Taxing high-cost healthcare plans isn't going to change much, I'm afraid, except to push more people into even more dire situations. Not a good way to go.
I have 10 more years to survive in this mess or worse until I can be on Medicare, if by then the Medicare program isn't thrown over for market-driven medicine by the Republicans or handed completely over to private insurance companies to skim for profit. I don't know if I'll make it.
What I do know is that the healthcare state of this union stinks, as my mom would say, to high heaven. We have to change it and make it work far better, and tinkering with some insurance regulations won't do the trick. This is one area of the state of this union we could really change if we had but the courage to do so. Join me. Let's demand Medicare for all. That would be one bold move, eh? And what a state of change and compassion this union would see.
Everybody in, nobody out -- state of the healthcare union, one and all, much improved.
- Posted in
28 Comments so far
Show AllGood for you, Donna. It's a beautiful dream and one you would think and hope everyone would agree with. That many people don't and work hard against their own interests is astounding and disheartening. I keep thinking the people will wake up but it hasn't happened yet.
A year ago I reached you Ms. Smith about organizing a 1-Day nationwide "Sick Out" for Single Payer. You were most supportive and so was Mr. Swanson at "After Downing Street". Then came the union guys who told me to take a hike and PNHP gave me total silence.
The object was to bring together major stakeholders to organize a coordinated nationwide "Action" that would not allow animals with badges to beat us in the streets, one that would have nationwide attention and SHOW them how many.
As you rightly point out, many folks are terrified in our Dickensian workplaces but many aren't. The colleges could be shut down for the day and with Union support their workers could have made a BIG impact. When matched with the Anti-War folks it could have been huge.
To this day none of the "Players" will act together for the common good so they hang separately while people who have never missed a meal feather their own nests while we DIE.
I am getting very tired of waking up every morning sick in my stomach with fear.
You have my prayers and my profound respect.
After reading yesterdays Commondreams articles (http://www.commondreams.org/view/2010/01/26-2) and discovering that 77% of Americans feel the defence budget should stay the same or be increased, I realize the public is still far too ignorant to embrace any forward looking initiatives. Americans on average feel that killing suspected terrorists in countries that they can't find on a map, is far more important than reigning in our corporate crime wave.
Unless a majority of Americans believe that the amount of tax dollars we spend on the military could be better used for programs like universal healthcare, we are headed for a corporate, neofeudal state. It's not just really bad economics (1 million a year per soldier in Iraq or Afghanistan?), but it is immoral to continue down this path. As far as I can tell, the rhetoric of Rush Limbaugh and Barack Obama still resonate with most Americans.
37% = Keep it the Same
40% = Expand it.
This is how a country dies.
Donna makes a great case for single payer but she will have to face the ruthless Obama conservatives along with the Republican conservatives who oppose it for different reasons. The Republican conservatives just like the ones here in Orlando will complain about socialism to no end. The Obama conservatives will complain that it's too extremist and try to frame the current plan passing through Congress as incremental steps towards single payer health care when the plan is a big push away from single payer. Donna, I don't know much about CA except that people are struggling to keep alive but you should see the deranged lunacy out here in Florida. The minute you talk about health care reform, the deranged lunatics will scream "SOCIALIZED MEDICINE !" to no ends. One of the burger workers I ran into complained about socialized medicine but I eyed his burger and countered his complaints by saying socialized poison. The deranged idiot only laughed hard, scarfed his burger down, and brought 4 more burgers to scarf down trying to show off and then shouted in a gruffy tone "See? I can take care of myself ! I don't want no socialist government deciding my insurance for me ! I want my freedom to decide ! Eat tough and nobody has to take care of you ! Government insurance is for sissies only !" I told him that I was a proud sissy for asking that government deliver the bang for the buck and off he went parroting Rush Limbaugh. I have had similar encounters with the Obama conservatives who would complain about single payer being extreme. One of them made this outrageous remark to defend the current plan passing through Congress. "If conservatives are shouting against Obama's plan, then it must mean he's right. Single payer is not possible and political suicide ! You just want Obama to fail don't you ?!?" Both the Republican conservatives and the Obama conservatives have united opposition to "Everybody in, nobody out" without their realizing it. With the Republican conservatives, it is obvious when they engage in childish talk with the "I'll get into it when I feel like it" attitude. With the Obama conservatives, their attitude is "shut up and accept it or let the Republicans whip you !".
" The minute you talk about health care reform, the deranged lunatics will scream "SOCIALIZED MEDICINE !" "
And to the lunatics I reply, "You are God Damned RIGHT it's SOCIALISM. You got a problem with that?"
"You just want Obama to fail don't you ?!?"
What twisted thinking. If Obama wanted to win by a landslide in 2012 all he would have to do is BY EXECUTIVE ORDER proclaim medicare for all. There are other agendas afoot. He probably has no wish to be another JFK.
Lawton, you're so right and the bad part is that at my end, Tampa Bay Area, is just so similar. How could that be? Since I lived in Germany, I see things differently. But what really scares me is that these "wingnuts" so worried about "socialised medicine" are the ones in need of some kind of help from someone, somewhere, if they were to get seriously ill. Because in most cases, these people belong to the socio-economic demographics of being one illness shy of bankruptsy. For the life of me, why can't the majority of this country see that health care for all makes economical sense and should be a bithright of every US citizen? A sound, healthy and happy citizen makes for a productive society. Is that so hard to understand?
Make it happen by forcing the MIC to give up 30% of it's budget--no new taxes yet.
60%
Predatory corporate capitalism, with its well-paid (bribed) lackeys in the White House, Congress, and SCOTUS, will never reliquish their death grip on profits preferred over human lives.
This is true whether the case is health care, war, the environment, genetically-engineered food, or anything else where there is a profit to be made.
People are expendable.
Greed is all.
Clappity, clap, clap, clap! Woot. We are out here applauding each line of your state of the union speech. Would it be okay if the crowd did a wave, or is the occasion too somber? If only the real state of the union would have such honesty.
I salute you. From another expert who probably won't make it, while the comfortable in Washington strike a pose, signal each other and sharpen their message for the next round of boondoggle.
Doctors have to take the Hippocratic Oath but insurance companies don't. Their oath can be read daily in the Wall Street Journal.
Yes, and insurance companies have a legal obligation to maximize profits by whatever means. The USA is a kleptocratic cannibal nation.
If you think things are bad now wait'll you see the future. Suddenly he stepped back in time 1000 years ago when none of this was here, then stepped back again, and here it all was upon the earth. This time traveling is wearing me out.
Life is good. What an experience! It's always best to forgive.
One of the best articles posted here today, thanks Donna. You are too kind to the "the media wonks and policy geeks". They are simply sycophantic pundits and corporate shills.
BTW, the healthcare sector is an important component of collateralized loan obligations. It provided the greatest inflow of investment in 2009. As of May, $38bn worth of loans had been issued, representing one quarter of all CLO and the only sector prospering in 2009.
In my internet research I came across what was described as "a refinancing epidemic" of healthcare sector CLO within the next few years amid some concern that funding would not be available to meet it. The source said about $192bn worth of loans would be due and need refunded over the next three years.
All of this raises the issue of how much the financial aspects of healthcare echo the larger finance issue. At what point does healthcare finance become a price too high to pay, or will the costs, no matter what they are, be passed on to the patient and premium payer? If these schemes were - and I'm not saying that they are, just if they were - sent into bankruptcy, wouldn't that reset care cost at a lower, more affordable level? When finance is protected by government, the market - in this case our healthcare - can't adjust down. The bankers collect more fees, but costs don't adjust as it would in a free market.
And, when the FHA is buying down the cost of hospital refinance interest rates with the public paying that subsidy, is it to keep a healthy care system or to protect investment bankers? The government is going to a lot of trouble and expense to keep the business of healthcare healthy. The toughness only comes in at the retail-customer-consumer level of the patient, and even then they are only troubled when we are destitute. Then more subsidies - that accrue to the business of care - become necessary to keep the system "working."
Guess what, Donna. Nothing will change when you get Medicare, except that your inability to find health care will not cost you anything. They'll still want your insurance card first thing. Your specialist (that guy who dresses up like a doctor and comes to work in his BMW) will still be thinking more about reimbursement codes while he is examining you than about your well being as a patient. Even if we had succeeded beyond our most dizzying liberal expectations in getting congress to ok universal single payer insurance, we would have a health care crisis. Doctors themselves have been ruined by this ghastly system. Medical ethics is getting to be a joke. The cost to our society won't come down until we get tort reform. (Insurance companies aren't the only greedy bastards out there. There's us and our creepy lawyers waiting for any opportunity to nick whoever we can for whatever we can get. Health care needs reinventing from top to bottom.
We are neither brave enough nor imaginative enough to think our way out of this mess. We need to hire France. Until we muster the humility to do that, we'll just have to suffer the just and appropriate consequences of our intransigence, the embarrassing drop in our life expectancies, the rise in our infant mortality, the dumbing down of our children, on display for all the world to see as we race to close the gap between ourselves and the Republic of Congo for self imposed misery.
"We are neither brave enough nor imaginative enough to think our way out of this mess"
I'd have to respectfully disagree. We haven't even TRIED to think ourselves out of this mess. If we were thinking, we wouldn't "hire" France, but we would have sent a delegation to France, and to all the other countries that have more sucessful medical outcomes than we do, and taken the best from each.
A bit of a differentiation is necesary: the "We" here on CD, like Donna Smith, have it figured out, no problem. The "we" in Washington, well that's just the first two letters of weenie, as in hot dogs and dicks, what Washington is full of. It's the weenies who aren't thinking.
To see this blatantly false Republican talking point on a progressive site at this late stage of the game is disappointing.
From the LA Times:
"...The truth is that medical liability isn't a big driver of health costs overall. Studdert estimates the cost of malpractice litigation, in court and through defensive medicine, at roughly 2% to 3% of all U.S. healthcare spending -- in other words, no more than $50 billion out of a total annual bill of $1.7 trillion. (You'll hear estimates as high as $200 billion from outfits like the American Medical Assn., which is the antithesis of an objective source.)..."...
http://articles.latimes.com/2009/oct/01/business/fi-hiltzik1?pg=2
Additionally, Texas capped malpractice awards at $250,000 and insurance premiums haven't come down.
From Dallas News:
"...Their conclusion – "Tort reforms have not led to health care cost savings for consumers" – was published in the December issue of Health Sciences Review.
"It's had a really small effect, or else it doesn't seem to change defensive medicine," said Michael Morrisey, a professor of health economics and health insurance and the director of the university's Lister Hill Center for Health Policy."...
http://www.dallasnews.com/sharedcontent/dws/bus/columnists/jlanders/stories/DN-Landers_21bus.State.Edition1.9be351.html
Thanks, Cygnus, for clarifying the role of medical malpractice claims in health costs. Indeed, trial lawyers are probably the only segment of society with enough clout left to sometimes win against corporations that rip the little people off, make them sick, injure them and destroy their environment. Other than a few bad apples that the political right makes much of, trial attorneys are the peoples' superheroes. Which is why, of course, the right attacks them relentlessly.
Also, getting to 65 and qualifying for MediCare will not help those of us who have adult children who are uninsured and who get sick or injured. Most of us would spend ourselves into bankruptcy to try to save the life of our child.
Thanks for pointing out the red herring on malpractice costs. With the current emphasis on sickness care for profit instead of health care for a healthier society conventional medicine creates an enormous potential for the legal profession, and yet the costs of malpractice lawsuits are a drop in the bucket when compared to total medical costs.
Tort reform is not the answer (see cygnus, below). But you are right about the greedy pigs. The cost will not be much affected by tort reform but it will come plummeting down if we reform the FDA so they can't take perfectly safe treatments off the market just because Big Pharma doesn't want the competition; and the AMA stops harrassing and threatening doctors who go off the reservation, i.e., cure people.
You know, We the People pay good money for this executive Ass soul to Already HAVE DELIVERED the promises he made to deliver US upon his election! No more speeches, Unka Bomb!! DO IT, NOW!!! Start with SINGLE-PAYER.
Thanks Donna. Nothing new that most people here don't know. I recently saw an interesting chart from National Geographic comparing healthcare costs of industrialized countries on a per capita basis on one side, and life expectancy from birth on the other.
http://blogs.ngm.com/.a/6a00e0098226918833012876a6070f970c-800wi
What just jumps off this chart are three facts.
1) The US spends far, far more for healthcare than any other country in the world. Almost double what Switzerland spends, the next highest in cost per capita.
2) Our life expectancy is below the average.
3) We are one of only two major industrialized countries NOT to have universal health care. The other is Mexico.
What these facts say to me is that the healthcare system in the US is embedded within, and is an integral part of a crime syndicate. There is really no other rational explanation for these wildly disparate numbers compared to other countries. Obviously there is an incredible amount of "skimming off the top."
Eventually, increases in healthcare costs will bankrupt the country (in addition to the hundreds of billions, if not trillions spent on imperial resource wars). I read recently that costs were projected to increase by over 7% per year, which is roughly a doubling of cost every decade. Pretty soon now, the parasites will kill the host, and with it, themselves.
It is not just the insurance companies. Today it costs $324 to have a tooth pulled. Before the advent of "dental insurance" it cost far far far less than that. Greedy doctors are every bit as responsible for this crisis as "health care" insurance companies.
I will never understand this country - no matter how hard I try. I firmly believe we have lost the willingness, if not the ability, to do things for the greater good of "we the people". We instead have fixated on the flawed theory that "what it best for the marketplace is best for the people" for all things. Therefore, that is how we treat something as critical and necessary for the quality of human life - if not for life itself - as guaranteed healthcare for all our citizens. In effect, we have decided that healthcare should be nothing but another for-profit consumer commodity - available to only those who can afford it and for whatever price the market will bear.
Donna's comments on the typical initial questions we face when we actually DO try to gain access to healthcare are spot on. Any actual questions about our medical problem(s) are secondary to those about our ability to pay. This in and of itself says volumes about what actually is the primary goal of our healthcare system. It also says volumes about the morality of America’s healthcare profession.
We have tried for over 60 years and at thru least 6 different presidential administrations to finally join the rest of the major industrialized societies in this world and provide quality healthcare to all as a basic right of citizenship - and apparently we have just failed again. I really didn't realize just how immoral and backward our system was until I read T. R. Reid's book - "The Healing of America" the other day. This one book (and I have read many on this subject) drove home the absurdity and immorality of our healthcare system(s) better than anything else I have ever read. It is a "must-read" for every citizen of this nation who has simply formulated his or her healthcare system opinions based solely on television, radio, or the newspapers. It is truly sad that the vast majority of our citizens fail to do ANY independent thinking, research, or reading on something as important as healthcare - especially when a book as great as this one is readily available for thoughtful consumption.
I must be suffering with a curious case of deja vodoo, because I just reread THE JUNGLE by Upton Sinclair, and felt strangely that history was repeating itself. Maybe that's because my employer called me in and said I deserved a raise, ( it was 15 cents) but then proceded to cut my hours, and make me hourly. My raise became a raze!
I am now paying for my own health insurance, and being insured to DEATH! Oh, maybe that's the plan. I do wonder what will become of America, when the banks own all the houses, and car loans become 10 years long, and everyone becomes hourly, with no sick days or vacations. it's like living in early 20th century America. Yep, don't get hurt or sick or you'll be replaced, and don't complain because you'll be blacklisted.
I'm glad I don't have any student loans left....as even imitation sheepskin is not very tasty. Sorry, I'm waxing non-phiolsophical....I'm feeling rather sad as I want to support so many groups ( environmental, legal, and on and on, but when so many of us now make so little, what will happen to the voices of resistance who can't support the fight against the robber barons? Did the Supreme Court actually wear black hoods along with their robes? However, on the positive side, Cogito ero sum....at least, so far!
I designate you the poster person for the citizens screwed to the wall poster. Hey Obey, draw that one.