TennCare Requires Enrollment on Imaginary Online System

$35 million spent for a required online system to obtain TennCare - but it doesn't exist. Tennessee politicians have made sure to fight healthcare reform at every step, no matter who gets hurt.

"The state committed $35.7 million -- $32 million of that in federally allocated money -- to a three-year contract with global cybersecurity contractor Northrop Grumman to create a new system called the "Tennessee Eligibility Determination System," or "TEDS," which will result in a new TennCare application website.

But the project, which started in December 2012, is not completed -- and there is no projection as to when it will be finished, Gunderson said."

Sen. Alexander Agrees - Domestic Violence is Pre-Existing Condition, Not Suitable For Health Insurance

I noticed this story yesterday via Enclave and again today at Silence Isn't Golden -- insurance companies in 8 states refuse to provide health insurance to victims of Domestic Violence, regarding such victims of spousal abuse as suffering from a pre-existing condition.

Back in 2006, a congressional committee took up the issue to forever change that exclusion, that being assaulted by a spouse was a pre-existing medical condition, but it failed to move out of the committee on a tie vote, with 10 for it and 10 against. Two of those who defeated the more-than-logical adjustment to health insurance were Tennessee senators Lamar Alexander and Dr. Bill Frist.

Protecting insurance companies and blaming victims for being assaulted - will that be a slogan on Sen. Alexander's next run for office?

After all, since the average cost of premiums for an family in America, tops $13,000 a year, maybe the family should save their money, separate and live in single apartments and gather only under the supervision of armed guards. Perhaps marriage itself, or even just living together should likewise be viewed as a pre-existing condition which promotes assault.


Since 1991, the cost of premiums for health insurance for a family have risen 131%.

Year	Single	Family
2000	$2,471	$6,438
2001	$2,689	$7,061
2002	$3,083	$8,003
2003	$3,383	$9,068
2004	$3,695	$9,950
2005	$4,024	$10,880
2006	$4,242	$11,480
2007	$4,479	$12,106
2008	$4,704	$12,680
2009	$4,824	$13,375

Source: Kaiser Family Foundation; Health Research & Educational Trust

Perhaps marriage itself, or even just living together should likewise be viewed as a pre-existing condition which promotes assault.

The Medical Industrial Complex

Journalist and Health Care Advocate Maggie Mahar has a new book and documentary out titled "Money-Driven Medicine: The Real Reason Health Care Costs So Much" and the documentary is starting to shake up some of the current debate about Health Care in America.

Here's some excerpts from the movie, which was featured on Bill Moyer's PBS show last week. She spends some of the film talking with doctors and others in Nashville, which is home to a large number of medical corporate headquarters. Here's some excerpts from Mahar's documentary:

"Maggie Mahar: One time Dr. Donald Berwick called a hospital in Texas and said, "We've heard you have a very good procedure for treating a particular disease. We'd like to learn more about your protocol so other hospitals can use it." And the hospital said, "We can't tell you that. It's a competitive advantage in our market that we're better at treating this disease and it is very lucrative. So this is proprietary information."

Dr. Donald Berwick: We believe in markets, right? Isn't that the American way? Well, markets mean competition. Isn't that the American way? Competition makes things come out right. Well, what does that mean in health care? More hospitals so they compete with each other. More doctors compete with each other. More pharmaceutical companies. We set up war. Wait a minute, let's talk about the patient. The patient doesn't need a war.

Maggie Mahar: The patient isn't the center of a collaboration. The patient is the victim of a competition. There's a saying in Swahili, "When…" I can't remember this one… "When the elephants fight the grass is trampled." The patient is essentially the grass.

Dr. Clifton Meador: Somebody says, "Nobody in Nashville makes anything. We just do stuff and people send us money." I've been told they never had a recession in the history of the place. This is music row. Every one of these houses is now a recording studio. There's Love Monkey Music, Flashville, Sharp Objects Music, Seasac, whatever that is. This is the heart of "music city" USA.

Here's what a nurse told me. "Tell patients to remove the foil from a suppository before insertion."

Maggie Mahar: Clifton Meador has had many careers. He's been an author, a family doctor, an epidemiologist, a health care administrator and the youngest ever Dean of the University of Alabama Medical School. Over the years, he's watched the business of health care turn into a driving force in the US economy. Much of it headquartered in Nashville.

Dr. Clifton Meador: This is Marilyn Way. Marilyn Way is a center road of Marilyn Farms. Marilyn Farms is a huge complex. The predominant business in here is health care corporations of one sort or another. This goes on and on for over a mile here and this is not called for-profit hospital row, or anything like that, but this, this is the equivalent of the music row that we went down for the recording industry.

Dr. Clifton Meador: This is titled "The Nashville Health Care Industry, The Family Tree 2006." Every little square here is a health care business industry or spin-off. We have 3 mother corporations here: HCA, which is the Hospital Corporation of America, spun off all of these. Hospital Affiliates, which is a spin-off of HCA, spun off all of these. And Health Trust, which is a spin of Hospital Affiliates and HCA, spun off all of these. So this is a massive, industrial health complex that's headquartered here in Nashville.

Maggie Mahar: After World War II, while other countries let their government begin to intervene in health care to make sure everyone got care, to regulate it to make sure it was good care, in this country doctors very, very strongly opposed any government involvement or anyone being involved in telling a doctor what to do. After Medicare was passed in 1965, elderly patients were getting far more care than they had been before then.

Then that's when our industrial medical complex, I would say, took off. By the early 70s, there were so much money involved that suddenly people began to say, "You know what? Medicine is too important to be managed by doctors. We all know doctors are bad managers. What we need are businessmen managing health care." And that's when health care went from being physician centered and controlled, to a large degree, by doctors to being controlled by the corporation and the CEOs of those corporations.

And, over time, more and more the CEO of the Hospital would not even be somebody with a MD. He would be somebody with a MBA. And CEOs bent on growth, bent on higher quarterly earnings, quarter after quarter, and year after year, are always pushing for more sales, more revenues, more and more and more. It produces more. But more may not be better for our health."

You can see and read more about "Money-Driven Health Care" here.

And while there is an intense and rising anger among some about the evils of a government medical program like Medicare, surveys show patients are actually happy with the program (via Health Beat):

"Medicare is the second largest health care payer in America, trailing only Medicaid. The program is very popular with its enrollees, with polls showing a higher level of satisfaction than with private insurance.

Medicare is less popular with hospitals.

Opponents of health care reform in general and of a strong public option in particular often cite hospital dissatisfaction with Medicare as a reason why the reform programs won’t work. They report that evidence suggests that overall Medicare pays hospitals less than what it costs them to provide care. Private insurers pay more, and by “cost-shifting,” hospitals use these payments to make up the losses on Medicare. Opponents worry that if a public option linked to or modeled on Medicare becomes the dominant payer for people under 65, hospitals will go broke without the “subsidy” from private insurers, and the health system will be destroyed. Data collected by hospital groups and the insurance industry suggests that this is unlikely to happen.

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First, according to the American Hospital Association itself, 42% of hospitals make a profit on Medicare overall.

In the remaining hospitals, most Medicare patients are profitable. Losses on Medicare patients are related to a minority of patients who need much more care than average because of longer stays, more complications, and underlying health problems. Since the profits on most Medicare patients are small, large losses on this small number of outliers can drive overall payments below costs.In looking at any data on payments, it is very important to distinguish between Medicare and Medicaid. Payments by Medicaid – the government plan for the poor—are significantly lower. On average, Medicaid pays 72% of what Medicare pays for the same service. Those who oppose any government plan often lump Medicaid and Medicare reimbursements together to argue that Medicare grossly underpays providers. There is no question that Medicaid needs significant revision. Medicaid reimbursements should be hiked; payments to states should cover states’ costs. The House health care bill takes a step in that direction by mandating that Medicaid reimbursement for primary care must be raised to equal Medicare payments, and by providing direct funding to cover that raise and to cover new patients enrolled as a result of reform.

However, it is true that while many hospitals actually make an overall profit on Medicare patients, at the other end of the spectrum some hospitals lose more than average.One reason for some disparities is that Medicare payments to hospitals are not uniform throughout the country. In some areas, Medicare pays far more than in other areas. The differences can be quite large, with the highest paid hospitals collecting twice as much as the lowest paid. In some cases, this variation contributes to losses and has led to political controversy. “Blue Dog Democrats,” whose predominantly rural constituencies contain many of the low payment areas, are especially concerned.

As usual, this is more complicated than partisans would like us to think. Many rural hospitals in Blue Dog districts actually enjoy better than average Medicare margins, partly because of special adjustments to payments specifically for rural hospitals. Critics suggest that much of the focus on hospital payments was at least partially orchestrated by the Blue Cross plans to try to kill the public sector insurance option that progressive Democrats say we need to keep private insurers “honest”—and to give Americans choices.

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"The other big question regarding Medicare reimbursements to hospitals is whether hospitals are spending their money in appropriate ways. Everyone agrees that hospitals need to spend the money necessary to provide high quality care. However, many hospitals spend a great deal of money that is not directly related to patient care. More and more hospitals have invested large amounts in décor and esthetics, creating marble lobbies and hallways, building large patient rooms with features that mimic expensive hotel rooms, purchasing art installations, and so on. These amenities do not contribute to patient care. A visit to most European hospitals or to most VA hospitals illustrates that excellent care can be obtained in hospitals considerably less elaborate than many “flagship” hospitals. A few years ago I had the experience of visiting a friend who was a surgeon for Kaiser in the Bay Area. When I first saw his hospital, I was startled – it looked a lot more like a Motel 6 than a Four Seasons. Kaiser is a prospective payment system, so that when the money is gone there is no more. Kaiser also has to compete, at least partly on price, with other HMO’s and insurers in its market. That obviously results in closer attention to what is essential and what is not. However, the results attained at the hospital were excellent – according to the Dartmouth Data, better than at some of the “marble palaces” they compete with.

Salaries for hospital administrators have risen sharply in the last twenty years, with many hospital CEO’s now making seven figure salaries (and a few making eight figures,) and with lower ranked administrators paid proportional amounts. This makes its own contribution to costs.

Hospitals often invest large amounts of money in pleasing doctors who will bring them profitable patients. Many hospitals have overbuilt their angiography and OR capacity to make OR’s and angiography suites available at times when doctors prefer to operate, rather than distributing use through the day. OR’s are sometimes built to fit the personal demands of a surgeon, with side by side OR’s for other surgeons. An OR might be used only by a single surgery group or even a single surgeon and stand vacant when they are not operating. Angiography suites and their staffs might be jammed with work from eight AM to noon, but be shut down while the doctors tend their office practices, or take time off, in the afternoon.

Hospital units are customized to please doctors in other ways. Special parking garages for physicians, expensive meeting and dining facilities, and so on are all set up to attract the “right” doctors.

In the last few years, hospital advertising has exploded. In many cities you cannot drive very far, read the newspaper, or watch TV very long without seeing expensive ads for hospitals. Despite the recession, in 2008 total advertising spending by U.S. hospitals increased to more than two and one half times what hospitals paid for ads in 2001. The costs of these ads are added into hospital overhead—in other words, the charge for your appendectomy includes the cost for the ads. Ironically, this type of advertising is often the hallmark of “overbuilding.” When hospitals wind up with excess capacity, they are then forced to compete aggressively to fill the added beds. This gives costs a double whammy, first incorporating the costs of overbuilding, then absorbing the costs of advertising dictated by the overbuilding.
There is also a well documented hospital “arms race” going on in many markets. Hospitals vie to buy the latest and most impressive equipment, regardless of utilization or cost effectiveness. Relatively new and still useful equipment is discarded because of the perception that something is better. A two year old CT scanner may be replaced because a newer and shinier model is available. In a sense, this is a form of advertising aimed at both physicians and patients, trying to sell the notion that the hospital is the best and most modern.

All of this adds significantly to hospital costs without providing any real health benefit to patients."

Local Blogger Says Health Care Is No Debate - It's A Matter of Life or Death

For a woman named Beth, a single mother of two, the so-called Health Care debate is not about politics of the Right or the Left, or the endless chatter on talk radio and television. For her, it is a matter of life and death.

Beth penned an letter to the East Tennessee blog OpenPen saluting them for their coverage of the debate and of her vital questions:

"Dear Editor,

I’m writing you, in part, to commend you for your fair and objective coverage of health care reform and town hall meetings. I’d also like to urge other media outlets and, more importantly, people to also be fair and objective in discussing health care reform. Though, for some people, especially pundits and politicians, health care reform is a vehicle for political posturing or personal bias. For millions of others it is a matter of personal health. And for far too many, like me, it is a matter of literal life or death.

My name is Beth. I am a divorced single mother of two wonderful children, ages 5 & 7. 3 ½ years ago I fell gravely ill to rare and potentially deadly, but treatable, disease called, Takayasu’s Arteritis. The rarity of my disease and severity of it’s debilitating symptoms led to me being misdiagnosed for the first 2 years of my illness. It is difficult to fully explain Takayasu’s Arteritis and its symptoms, in short form. But, in laymen’s terms, at 26 years old I have the vascular corrosion, bone density loss, joint inflammation and chronic fatigue of a person 60 years my senior.

Likewise, I am also susceptible to heart attacks and strokes. It takes a daily regimen of highly toxic and very expensive prescriptions to regulate my disease. But even the treatment of my disease begets a series of daunting side-effects, including, but unfortunately not limited to, hypertension, extreme weight gain, skin thinning/bruising, hair loss, lymph node tumors, cataracts and skin cancer. The symptoms of my treatment are often as painful and debilitating as my disease itself. But, for (and with) the love of my beautiful daughter and son, I willingly submit myself to whatever it takes to be here for (and with) them.

It is in this spirit of self-sacrifice and survival that I have been rendered financially ruined, due to medical debt. I am stranded in an all too familiar conundrum for uninsured/underinsured patients: Either pay for prescriptions and treatment or living expenses, gas and food. I’ve always been a hard worker, averaging 70 hour weeks as a restaurant general manager. But maintaining the rigors of my job accelerated the symptoms of my sickness. My doctors notified me that continuing to work would jeopardize my chances of recovery and possibly lead to premature death.

Subsequently, I could no longer hold employment. Which meant I lost what health insurance I did have through my job. I initially qualified for TennCare; but was ultimately denied, due to a cluster of state guidelines and regulations. Moreover, because I have a pre-existing condition, no private insurance company will insure me. Effectively, I have been shut out of every feasible resource on a state and private level. Without a federal ‘public option‘, I will quickly descend from shut out to shut down, literally.

With a ‘public option’ I would be able to purchase an insurance plan that would not only provide adequate treatment, but allow me to purchase my prescriptions at a much more attainable cost than the current overwhelming prices (which I can no longer afford). It pains me to see the ‘public option’ be battered about in consideration of only the ‘option’ (resources) aspect of the term, but not the ‘public’ (people) part. And isn’t that what this whole debate is about? The people? Is the primary focus of health care reform to save money or save lives? I understand that it’s not a strictly either or proposition. There is a give and take. But ‘how much money are we willing to give’ seems a much more reasonable and humane question than ‘how many lives does it take before health care reform is a must‘.

Personally, I went form an upwardly mobile, gainfully employed, tax paying citizen to a patient who will likely never have good credit again, nor a bank account/savings, a house or any significant possessions or assets of worth to leave to my children… an especially heartbreaking dilemma considering my faltering health and uncertain treatment resources. I want to leave them something more than medical debt, antagonistic bill collectors and a jaded sense of being let down by a system I’d so willingly paid into when my health provided me the ability to do so.

This is no way for a young mother to live or die in America. This is no way for anyone to live or die in the richest country in the world and most successful democracy ever established. There is no shortage of hyperbole, partisan rhetoric and political propagandizing now polluting the health care reform discussions in the mainstream media, blogosphere and town halls. My plea will likely not influence those who most voraciously feed off cacophony to be more responsible or constructive in the dissent or support of health care reform. But to anyone who is willing to adhere to reason, I ask you, please stop shouting. Yelling a lie does not make it anymore truthful. And the truth is no less true in a whisper.

Blogger Southern Female Lawyer also posted a video on YouTube of her recent Town Hall conversation with 1st District Congressman Dr. Phil Roe:



Some background on what Rep. Roe referred to as an "Associated Health Plan":

"The big problem is that AHPs would be allowed to operate outside of the requirements of the state’s health insurance law and so create two separate and very different markets for health insurance. One would be made up of AHPs, each of which would be rated on its own experience and operate outside the requirements and protections of the current small employer health insurance law. The second would consist of all other small businesses and individuals, whose experience would continue to be merged. The effect will be to pull lower cost and better risk employers into AHPs, leaving higher cost and higher risk groups and all individuals in the merged market, with higher premiums.

More Conservative Lies about Health Care In The U.K.

Via The Week magazine, this article by Robert Shrum:

"Opening an Atlantic front in their summer campaign of lies, conservative opponents of health-care reform have targeted the British National Health Service as a care-denying, euthanizing, broken-down caricature of "socialized medicine"—a portrait that bears no resemblance to reality or to President Obama’s far more limited proposal for reform."

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"For unadulterated obscenity, however, it’s tough to beat the suggestion of Iowa Sen. Chuck Grassley—one of the "reasonable" Republicans allegedly negotiating reform in good faith—that due to his colleague Ted Kennedy’s age, Kennedy would not be given treatment for his brain tumor in countries with "government-run health" like the U.K. It’s bad enough to exploit the illness of the leading champion of health reform to assail that cause. It’s even worse when, as Kennedy has said, the purpose of his—and Obama’s—reform is not to ration care, but "to ensure that someday, when there is a cure for the disease I now have, no American who needs it will be denied it."

Undeterred by facts, the disinformers have taken their fraudulent assault to the airwaves. The oxymoronic Conservatives for Patients' Rights, working with the PR firm that marketed the Swift Boat libels against John Kerry in 2004, have produced a series of fear-mongering TV ads about the British health system. One of them asserts: "If you have cancer in the U.K. you are going to die quicker than in any other country in Europe." The claim is based on flawed data; international trials show British cancer patients do just as well as those in other countries. A British woman who appears in the ads says she was duped into participating. She’s not in favor of dismantling the NHS, she says, but of providing it with more resources.

The deception shouldn’t be surprising. The founder of Conservatives for Patients' Rights is Rick Scott, a man the media too often fails to identify as the former CEO of Columbia Hospital Corporation, a giant HMO. He was forced to resign after FBI agents raided the company, which subsequently paid a $1.7 billion fine—the highest in history— for Medicare fraud. Rick Scott is for patients’ rights like Dick Cheney is for open government.

The mounting falsehoods have annoyed the British. When they launched a "We love the NHS" campaign on Twitter on Aug. 12, it was the most talked about topic on the service and has stayed near the top ever since. What had finally set the British tweeting were attacks on the NHS from one of their own, Daniel Hannan, a Conservative elected to the European Parliament who’s become something of a fixture on (surprise!) Fox News, where he toes the network’s anti-health-reform line.

Hannan was rebuked as "eccentric" by the embarrassed Conservative Leader, David Cameron, who insisted that he himself was "100 percent behind the NHS." The last thing Cameron wants is to revive the impression that Conservatives are hostile to the NHS, an attitude that has doomed the party in past elections.

The British aren’t indignantly championing a system that neglects their needs. As their Department of Health noted, life expectancy in England is a year longer than in the United States and mortality among children from birth to age five is a third lower. In a 2007 survey of health care in five advanced nations—Australia, Canada, Germany, New Zealand, Britain, and the United States—the U.S. ranked last. Yet every one of the other countries spends less than we do per capita on health care—in Britain about half as much.

The British would never willingly surrender their NHS. Nor will Americans retreat on health care once reform survives the current perils and passes into law. When families see that their care isn’t rationed and that their coverage can’t be canceled; when costs are brought down; when seniors find that their Medicare is not only safe but strengthened, then the fear-mongers will be punished at the polls. By 2016 at the latest, Republican candidates will be pledging, much like their conservative counterparts in the U.K., not to undermine national health coverage.

Of course, we won’t have a system like the NHS, no matter how relentlessly conservative critics may invoke it. We won’t even get the system Obama first proposed. Instead, we’ll likely end up with a compromise—provided it’s not defeated by a self-righteous reaction from the Left. In the end, I don’t believe it will be. As Sen. Kennedy has argued, the plan can be improved in the years ahead. Bill Clinton agrees: "We need to pass a bill and move this thing forward," he said.

Amid the torrent of falsehoods and the tumult of town halls, there came a twittering of truth from across the Atlantic. The Brits fought back over there. Once Barack Obama and the Democrats win their fight over here—and they will have to fight very hard—our system will still be different from Britain’s. But finally, Americans, too, will have a health-care system we can be proud of."

Health Care In America - A Reality Check

Please read through the two following blog posts on the debate (or lack of it via Our Modern Media, which instead aims their cameras at train wrecks rather than dig into the facts and figures of a handful of proposed bills -- and recall that None Yet Have Been Voted On By Congress) --

First, some Facts:

"Pathetically but predictably, the health care reform debate is not focused on health care or reform, but rather on imagery meant to trigger our reptilian responses. In another article, I shall address what the "debate" should really be about (hint: improved health!), but in the public interest, in the hopes of lassoing crocodile frenzy before it totally consumes its young, I offer help for those struggling with friends and family who may be shaken by what has occurred during our own August recess.

"This is not to suggest that those who already believe that health reform is designed to kill Granny, or that the government just wants to "take over" Medicare are salvageable. Rather, that there may be increasing numbers of people who do not buy the inflammatory rhetoric, but do not know how to respond (to themselves) otherwise.

Here's a little primer on addressing some of the most absurd claims:

1. The government -- i.e., not private enterprise -- wants to kill Granny. Let us get this straight. The government wants to kill Granny and, by implied contrast, private enterprise, that we all learned in Economics 101 exist for the sole purpose of caring for each and every citizen, will look out for Granny's well-being.

Is this the same private enterprise that sells death (cigarettes), needing to addict 15,000 new children per month just to maintain revenues? Or, is it the same private enterprise that resisted selling safe cars? Or, perhaps it is the same private enterprise that would never pollute our air or water, or, if they did, rush to clean it up before they hurt anyone? Or, maybe they mean the private enterprise that imported toxic toys for children? Or, the private enterprise that so generously donates candy and soda pop machines to public schools?

We actually do know the private enterprise they mean -- it is the private insurers who try not to insure people who are or may get sick, try to drop them from their rolls when they do, and deny every claim they can when they cannot drop you from their policies. That's the private enterprise that has been caring for you for years.

And what about the government? Perhaps the evil government they refer to is the one that determined cigarette smoking caused lung cancer in the first place; or the one that established pollution controls and standards for clean air and clean water; or, perhaps it is the evil government, out to kill Granny, that administers Medicare with less than a 5 percent administrative cost compared to 25-30 percent for private enterprise; or, the evil people at the Food and Drug Administration that ensure the integrity of the food supply and the safety (and potency) of drugs people take to combat illness?

Let us concede, however, that the government does deliberately kill people. It is called the death penalty. And, although the goal is not to have our own people killed, war usually does a pretty good job of ensuring people die. So, if Granny refrains from committing a capital offense, and does not -- like the Limbaughs and O'Reillys and Bushes and Cheneys and Kristols and Lowrys and Buchanans and Chamblisses who love war so long as they do not get called to fight it -- volunteer for the armed forces, it is not the government she needs to fear for her life.

2. We cannot afford it. Here's a shocker--we are affording it today, paying for it now. Hospitals, doctors, pharmaceutical companies are not giving away treatment and medicine for free. They are not printing their own money (although the word "scrip" is indeed in prescription). They are getting paid.

Now, how can that be? Well, if you are among the 260 million Americans who have health insurance, you are already paying for the 47 million who do not. Health care providers overcharge you assuming a predictable percentage of bills will go uncollected. You see, along with your insurance exec's Gulfstream, you pay for the uninsured with your premiums for those higher charges.

But, you don't mind, do you? Because they never called it a "tax."

If we get universal coverage, there will be no unpaid charges. Charges per item or service could come down and, therefore, insurance premiums could come down -- unless of course the insurance execs wants a company yacht along with the Gulfstream, or just to report higher profits, then they won't. Wonder what a competing public option would do? Hmmm....

And, by the way, there are huge savings to be had just from improved efficiencies of a system in which total costs count more than the cost of one procedure or drug or intervention.

The secret reason they never called part of your premiums a "tax" is that if we ever got health care reform, and premiums declined, or at least did not increase more rapidly than other parts of the economy, then we might have called it a "tax cut." And one of the "Old Rules" is the only the right wing gets to say the word, "tax cut." (Are you listening, Bill Maher?).

But, they are correct that health care costs are spinning out of control and that one of the purposes of reforming the system is to reduce those costs. One of the best ways of reducing costs is improving outcomes. More on that in another article.

3. Let private competition solve everything: Imagining a world without Medicare

Ok, to test that hypothesis, let us examine what our world would be like without Medicare. One possibility would be that the elderly would be insured privately and randomly in the same plans as the rest of us. Care to guess how high your premiums would be if your plan carried those higher risk seniors?

Or, suppose no insurance company really wanted to insure the elderly and they were without insurance. Then Granny gets sick. Who pays? Do you let Granny go untreated? Does Granny "allow" you go bankrupt, and deprive your kids, her grandchildren(!), of their college funds, to pay for her care?

Or, suppose there are insurance companies only covering the elderly? Their insurance premiums would be ... oh, doesn't seem to work does it? Very few would be covered since it would be unaffordable, so we are back to no coverage.

How about this? Your children can be covered to the age of 18 under your policy. What about your parents getting covered under your policy once they hit 65? Think we are back to sky-high premiums with that one.

I know, I know, I know (says Newtie), let's give each Medicare recipient a lump sum, and let them go out and buy private insurance with it. For starters, about 20-30 percent of that is no longer going into actual care, but into "administrative" costs, so their coverage would decline.. Then again, if a person is ill, the insurer may not wish to cover him; if there were a law against such discrimination, we are back to both skyhigh premiums few could afford and the contribution coming from Medicare being insufficient.

Now, for the most likely scenario without Medicare. Granny is covered, premiums are higher but not outrageously. Why? Because when Granny does get ill, the insurance companies will deny coverage, or drop her. So, you can have the wonderful experience of paying higher premiums and then going bankrupt a bit sooner, all while Granny is wondering how she could allow herself to do this to you, and her grandchildren. Now that would really kill her.

4. The free market can solve everything, and at lower cost. No, it cannot. First, and most convincingly, it has not. Since most systems tend toward equilibrium, it might have been surmised that, after all these years, everything would have already been solved. The purists would say that there are government programs around (like Medicare) that have distorted the system so that free markets cannot reach an equilibrium solution. But, that is nonsense. See # 3 above.

Secondly, though, free markets are genetically incapable of providing high-quality, low-cost, health care for all. Why? Because most people incur most of their health care costs when they are old. By the time they are old, health care prices have risen (even if at a normal rate), whereas their incomes were earned way-back-when wages and salaries were not nearly as high. Hence, even if they had saved prudently for the inevitable rainy day, it is unlikely most people would have enough saved from wages during their youth and middle age to cover the costs that they are now charged in their old age.

In addition, the costs of an illness can be, and often are, catastrophic to individuals, and only the very wealthy would have the money to pay for the total costs of care.

Ok, the free-market-solve-everything crowd would say, they would all purchase insurance. But, that is today's system, not everyone purchases it, not everyone can afford it, and private markets in search of profits do what would be expected: they weed out those most likely to add costs.

5. Your health care will be rationed. Don't know how to break this to you, except to say it in a whisper -- your health care is rationed today. Insurance companies do not cover everything, and, when they do, it is often just up to a point. Medicare likewise has certain rules about the level of nursing care required to qualify for reimbursement.

For example, we now know that highly intensive, properly guided physical therapy can restore motor function in people after strokes. A different part of the brain is trained to take over motor control. Here is a real-life case: A professor had a stroke. He is otherwise young and vigorous, formerly a champion-level athlete. But, his insurance will not cover the costs of 12-16 weeks of the highly intensive physical rehabilitation required to recover motor function. He gets just 3 weeks, only one hour on alternate days, but not even at the facility closest to his home, he has to go to one the insurance company approved.

One of the benefits of a comprehensive system is that treating this man for 12-16 weeks so that he can recover his motor function is not only better for the patient but, in the long run, is also much less expensive than forcing him, because of lack of coverage, to remain partially paralyzed. For any given insurance company, however, it is not less expensive, because he is likely to get passed into a different company. Thus, outcomes are worse and costs are higher.

6. Medicare is bankrupt ... or will be in 2042.

Name the private insurance company who is funded for all the healthcare expenses it will have to pay for the next 33 years, and I'll buy you 3 cheeseburgers, freedom fries deep-fried in beef fat with all you can drink Mountain Dew."

Meanwhile, Vibinc voices a more urgent reality:

"I know this whole “death panel” thing has been going on for weeks now, but I’ve gotten to the point where I want to slap someone every time I hear them talk about Government pulling the plug on granny because she’s too expensive. What bullshit.

We already have death panels you douchenozzle, they’re called INSURANCE COMPANIES.

As The Memphis Liberal points out the Supreme Court has ruled that

Inducement to ration care is the very point of any HMO scheme.

The argument on the right is that you can sue an insurance company. Perhaps, but you’re still dead if you don’t get the treatment you need because some corporation hedged their bets.

It’s not like it’s ever happened before or anything.

Oh, and how does a lawsuit play with conservative notions that tort reform will magically fix what’s driving up the cost of healthcare. Come on people be consistent.

Nope, the reality is we’re talking about two different cultures. One that believes corporations are going to do what’s right for people and that the government can’t do ANYTHING right, and one that believes government’s role is to provide an equitable foundation for all Americans and that corporations are more interested in protecting shareholders than doing right by regular folks.

Which one sounds more realistic?

Seriously, conservatives have been working for 30 years to protect shareholders and corporations far more than help regular Americans. Their perspective is that if the corporation benefits, somehow so does everyone else. From the union busting that the Reagan Admin. engaged in, to trade deals that have sent American jobs hither and fro, with the help of conservative and largely southern Democrats that have served as compliant enablers, the conservative ideology has destroyed America’s manufacturing base and left us in a position where good jobs for regular people are going the way of the dodo. All the while this same “Conservative ideology” is largely responsible for a tenfold increase in the national debt over the past 28 years.

Somehow, this is supposed to provide a better quality of life for all us little people. But aside from making really affordable “cheap plastic crap” made in places most people couldn’t find on a map, the only real benefit has been the availability of second rate goods to people who used to make a first rate version of the same damn thing.

So when we apply this ideological difference to the healthcare “debate”, if that’s what you want to call it, you have some people talking about healthcare, and others talking about something else entirely. Sobeale hit on this back in June when talking about the difference between the left and the right on the healthcare debate.

Progressives want to give everyone healthcare. The other side wants to give everyone health insurance.

Healthcare. That’s what I’m talking about, not insurance. Insurance is the ONLY thing in the world you buy and pray you don’t have to use. Healthcare is something EVERYONE NEEDS, but that a growing minority of working Americans DON’T HAVE ACCESS TO. Sure, they can go to the doctor or the hospital, but if it’s something serious, they’ll likely go bankrupt. That’s the reality, and 50% of the people who go bankrupt every year are in that situation.

So now that the Healthcare industry has dumped some $130m since April into putting the kibosh on any plan that includes a “public option” by stirring irrational fears and mobilizing a vocal but largely uninformed group of people to disrupt anything and everything that might further the “public option”. The debate has shifted from providing healthcare to all Americans to providing Americans with insurance, something they don’t want to have to use.

This is just plain madness.

The right wing reactionaries that show up in force at Town Hall meetings across this nation are grounded in the same ideology that has helped bankrupt this county and millions of it’s citizens. They are not there to debate, they are there to debase the process, to incite fear, and ultimately, deny you a right to affordable treatment when you need it most.

This is not the huge movement that the media would play it up to be. They are not taking to the streets demanding that things stay the same. They are a couple of hundred people per district, out of some 600,000+ constituents, mobilized to make a good show of strength for a very short period of time. It’s media manipulation at it’s worst, and the media is playing the role of compliant enabler, just like those conservative Democrats who are paralyzed with fear anytime someone proposes a change that they might have to defend.

Most OK Effort to Fund Kids Health Insurance

State funding for health insurance for children of low income families is set to expire by month's end, though a temporary measure to keep it active has been approved by Congress and the President. Blending together health care costs, higher cigarette taxes and the 2008 elections, this issue is one of rewards and perils for politicians. Full funding for the SCHIP program, which may be renamed CHIP, is a priority for Americans and GOP supporters too, not just Democrats, according to several recent polls and studies.

"Republican pollsters Fabrizio McLaughlin & Associates found that by a 2-1 margin, (62 percent to 31 percent) GOP voters favor reauthorizing and strengthening SCHIP. The poll was a national sample of 1,000 Republican voters taken on behalf of First Focus, a bipartisan advocacy group for children and families.

The poll also found that GOP voters, by a 4-to-3 margin, are less likely to re-elect members of Congress who oppose the legislation.

In another First Focus poll of 800 "very likely" voters, GOP pollster Frank Luntz found that by nearly a 4-1 margin (66 percent to 17 percent) respondents were less likely to re-elect senators or congressional representatives who oppose legislation to cut the number of uninsured children."

Paying for the increase in enrollment would come from a 61-cent increase in tobacco taxes. No increases in funding for the program, as well as allowing it to expire will also cost Americans big bucks:

"The Institute of Medicine estimates that a lack of health insurance accounts for 18,000 unnecessary deaths a year and that taxpayers foot 65 percent of health care costs for the uninsured through subsidies to hospitals and clinics. Uninsured children are also four times more likely than insured youngsters to appear in emergency rooms with avoidable illness, said Rich Umbdenstock, president of the American Hospital Association."

Comments from those who see the program as another Evil Step Into Socialized Medicine claims the bill's passage will give benefits to families who earn over $80,000 a year - but that is not true. That amount is only applicable in New York state and only if their request on the increase is approved:

"The bill essentially sets an income ceiling of three times the poverty rate [defined by the Census Bureau as $20,650 for a family of four] for a family of four - $61,950. Beyond that, the federal government would not pay a state its full SCHIP match, which averages about 70 percent. New York state is seeking a waiver that would. allow its residents to qualify if their income is not above four times the poverty rate - $82,600 for a family of four. The current administration or future administrations would have to approve that request. New Jersey would still be allowed to cover families with incomes three and one-half times the poverty rate - $72,275 for a family of four."

Tennessee Rep. Zach Wamp (R) is promoting his plan to extend the program for 18 months and try and resolve some kind of compromise in the interim, and which would provide the chance to push this entire debate out and away from next year's elections:

"That is why I co-sponsored the SCHIP Extension Act to extend and fully fund SCHIP for an additional 18 months and increase the federal funding for the program by 33 percent."

A Rasmussen poll worth considering shows that Americans want changes aplenty in healthcare costs:

"Forty-four percent (44%) of American adults say that health care services should be made available for free to all Americans. A Rasmussen Reports national telephone survey found that 39% disagree and 17% are not sure.

Fifty-two percent (52%) say that reducing health care costs is a higher priority than making sure everyone is insured. Thirty-nine percent (39%) take the opposite view.

The survey also found that 47% favor requiring everyone to buy health insurance. Thirty-three percent (33%) are opposed. Democrats favor this approach by a three-to-one margin. A plurality of Republicans are opposed while a plurality of unaffiliateds are supportive.

Fifty-one percent (51%) say that if someone can’t afford health insurance the government should match payments to help pay their premiums.

Sixty-seven percent (67%) of voters rate health care as a Very Important Issue for Election 2008. Fifty-one percent (51%) trust Democrats more on this issue while 35% trust Republicans."

Health Care Maze of Mystery

Some provocative debate has been prompted by the movie from Michael Moore, "Sicko", though just about any person in the country could reel off stories of high comedy and tragedy so one need not be a filmmaker to have some intense opinions about the state of healthcare.

A fascinating exchange between Moore and CNN was highlighted here by R. Neal (Moore really lays into CNN and Wolf Blitzer, with much reason) and Neal also has some thoughts on how or if health care might be improved here. Some of the ideas there require you to think and consider how we can effect change for the better. It gave me much to ponder.

I have no solid answers to the dilemmas of outlandish behavior via insurance companies, giant hospital corporations, pharmaceutical companies or the curious twists and turns created by state and federal government regarding health care.

I do know that urging realistic debate is far more important than jingoistic blather about reform. Specifics are needed, not platitudes of "we are working on improving" blah blah blah.

Also, the link in Neal's first post above contains a link to Moore's rebuttal of some of the wild distortions and claims made against "Sicko". One fact is clear -- medical bills are a key cause of bankruptcy, and many in this most prosperous nation can be financially decimated by medical costs alone.