Health Care Reform: Howard Dean Makes A Compelling Case

President Obama laid out the pragmatic need for health care reform in last night’s speech:

"This is a cost that now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes," Obama said in his speech to a joint session of Congress. 

Obama pointed to the increasing number of uninsured and rapidly rising health-care premiums, which he said was one reason small business closed their doors and corporations moved overseas.

Reuters reports that we spend more than $7,400 per person each year on health care in this country, which added up to more than 19 percent of 2009′s GDP.

Is this really the best we can do? No, it isn’t.

Howard Dean was on Hardball yesterday talking about health care reforms:  what that actually means in pragmatic terms, and why American businesses, individuals and doctors are drowning under the byzantine maze of hoop jumping that is our current system.

Dean made one thing crystal clear:  everyone — including folks at the Chamber of Commerce, medical professionals, and pharmaceutical companies — want reforms. The only folks standing in the way?  Insurance companies, who profit more from keeping things as they are. 

Currently in this country, 45 million people are uninsured.

Which means that communicable diseases go unchecked more frequently, meaning the rest of us get exposed. Imagine what that would mean in a national security crisis context.  

Cancer isn’t caught early, which makes it more expensive and less successful to treat.  Preventative care is next to nonexistent, which makes illnesses that much worse when they do seek treatment. Doctors are fed up with this, especially primary care physicians.

As someone with a "preexisting condition" (in my case, lupus), I am all too aware of the precariousness of my situation. My insurance comes through my husband’s work, so when he retires I’ll be SOL — we’ve actually talked about prolonging his work to be able to maintain insurance coverage. We aren’t the only ones.

I’ve picked up Jacob Hacker’s Great Risk Shift again.  Something tells me that the insurance folks who have made moolah shifting the risks back onto the rest of us while asking us to pay for that privilege aren’t going to go toward a better preventative model quietly.  

Will their lobbying money – paid for with $7,540,000 of your premiums in 2008 alone – buy them legislative love?  Or will we finally get desperately needed reforms for the rest of us?


 
109 Responses to "Health Care Reform: Howard Dean Makes A Compelling Case"
Elliott | Wednesday February 25, 2009 05:54 am 1

morning Christy, grim statistics to be sure


Millineryman | Wednesday February 25, 2009 05:57 am 2

As someone with a “preexisting condition” (in my case, lupus), I am all too aware of the precariousness of my situation. My insurance comes through my husband’s work, so when he retires I’ll be SOL — we’ve actually talked about prolonging his work to be able to maintain insurance coverage. We aren’t the only ones.

Good morning Christy. When my RA was active I wanted to change jobs but because of the preexisting condition I couldn’t. I was stuck in a job that I wasn’t happy with and stuck at really bad salary level, and had hope of advancement.

I know I’m not alone in that scenario. Being a prisoner of an insurance companies profit is not what life is about.


Millineryman | Wednesday February 25, 2009 05:58 am 3
In response to Millineryman @ 2

Good morning Elliot

That s/b no hope of advancement in comment 2.


Christy Hardin Smith | Wednesday February 25, 2009 06:03 am 4
In response to Elliott @ 1

Morning — it’s just so appalling when you begin to lay the whole thing out in front of you. And then you consider for each number, there is a human being behind it. Howard Dean does a fantastic job of making this all crystal clear in the interview — just a superb interview with him on health care.


Elliott | Wednesday February 25, 2009 06:03 am 5
In response to Millineryman @ 3

morning MM

We ALL have health and we all need care for it. I don’t see why it should be a for super profit industry


Millineryman | Wednesday February 25, 2009 06:06 am 6
In response to Elliott @ 5

Yea I remember hearing a long time ago when hospitals were switching from nonprofit to profit and thought to myself Huh? What’s that about and why should they profit from care.


BillWalker | Wednesday February 25, 2009 06:07 am 7

“Give him a piece of it.” lol


Christy Hardin Smith | Wednesday February 25, 2009 06:10 am 8
In response to BillWalker @ 7

I thought that was a hoot — and I wondered if perhaps Matthews has heard some rumor that Dean might be under consideration for HHS since the reception to Sebelius being floated out as a possibility has been so tepid, at best.


Kitt | Wednesday February 25, 2009 06:11 am 9

Christy, you wrote, “The only folks standing in the way? Insurance companies, who profit more from keeping things as they are.” Which is of course true. But I wonder how come we don’t put a few names to it. There are actual individual bloodsucking people who are profiting beyond belief. Who are they? Would it not move this along if they personally are exposed?


WarOnWarOff | Wednesday February 25, 2009 06:12 am 10

The insurance industry = la cosa nostra


Christy Hardin Smith | Wednesday February 25, 2009 06:12 am 11
In response to Kitt @ 9

You can start looking here — I linked this above as well.


foothillsmike | Wednesday February 25, 2009 06:12 am 12

While we pay twice what other countries do for health care we are ranked 37 in the world.


Bluetoe2 | Wednesday February 25, 2009 06:16 am 13

Sorry to hear about your health condition. My wife had lupus also and it took more than 10 years before she finally had the correct diagnosis. She was able to manage it with medication but it wasn’t cheap.


Christy Hardin Smith | Wednesday February 25, 2009 06:17 am 14
In response to foothillsmike @ 12

I know so many doctors who are seriously considering getting out of the medical business because they are sick of adding more and more and more staff just to deal with insurance paperwork demands.


foothillsmike | Wednesday February 25, 2009 06:18 am 15

Here are the rankings from the WHO
http://www.photius.com/rankings/healthranks.html


Bluetoe2 | Wednesday February 25, 2009 06:19 am 16
In response to foothillsmike @ 12

It’s really a travesty. Apparently the insurance companies and the Republicans are perfectly happy that the U.S. ranks 37th as long as the money keeps rolling in.


Christy Hardin Smith | Wednesday February 25, 2009 06:20 am 17
In response to Millineryman @ 2

I’e heard that from so many people who, because of a pre-existing condition issue, felt like they couldn’t go to any other job because they’d be refused coverage. Think for a moment how insane that is — especially when you are talking about spreading the risk and costs out over lots of other insureds in large companies, but someone is still declared uninsurable?


cbl2 | Wednesday February 25, 2009 06:22 am 18

there’s a quote from a Doc a few years back – Duke University Hospital had 900 billing clerks on staff for their 900 bed facility


Bluetoe2 | Wednesday February 25, 2009 06:22 am 19

Doctors in both France and Italy still make house calls!


selise | Wednesday February 25, 2009 06:22 am 20

christy – a couple of quick points (i should be finishing up today’s list of hearings to post at oxdown):

1. it’s not just the insurance companies that stand it the way of patient centered reform, it’s big pharma also. i didn’t hear dean, but if he said otherwise, he’s just wrong.

2. some states, like MA, don’t let the insurance cos deny you coverage or even charge you more if you have a pre-existing condition. i was very lucking when i had cancer that my oncologist insisted on counseling me re insurance as well as health care.

3. the absolutely best source of info on health care reform i’ve found is PNPH (physicians for a national health program). they even have a blog. (their recent post, Jacob Hacker is a nice guy, but… might be of special interest). but their research and analysis is the real gold mine imo.


barbara | Wednesday February 25, 2009 06:23 am 21
In response to Kitt @ 9

True enough. I have a couple of family members who work for a major insurance company, and I can assure you they’re not raking in Big Buckaroos. MN’s highest-paid exec is CEO of an HMO.


Christy Hardin Smith | Wednesday February 25, 2009 06:23 am 22
In response to Bluetoe2 @ 13

Now that we’ve found medication that works better for me, it’s mostly manageable. But it takes a while to find what works for any individual. And had I been doing so without insurance coverage? I wonder how many women — because it is a disease that impacts women far more frequently than men — have had to just live with the pain because they couldn’t even afford to see a rheumatologist?

There were honestly times when Mr. ReddHedd had to help me up our stairs to bed because my legs would not cooperate to walk without excruciating pain. I cannot imagine sentencing someone to live like that simply because they had no insurance coverage. It was brutal.


Christy Hardin Smith | Wednesday February 25, 2009 06:24 am 23
In response to selise @ 20

Dean says that pharma wasn’t on board in the past but because of the current economic climate and other factors, they are now — and that ought to be part of a catalyst for jumping on this issue sooner rather than later.


cbl2 | Wednesday February 25, 2009 06:24 am 24
In response to foothillsmike @ 15

a handy chart from Dean Baker’s group –

linky
(graph not viewable in IE)


i4u2bi | Wednesday February 25, 2009 06:26 am 25
In response to foothillsmike @ 12

If I remember correctly Paul Krugman wrote about this a few years ago. The US pays twice as much and gets half the health service.


CanuckStuckinMuck | Wednesday February 25, 2009 06:26 am 26

I’m a Canadian who has lived in the US for going on 20 years. In 2006, Canada spent 10% of GDP on health care. It’s probably not a lot more than that today. Everybody in Canada is well looked after. ‘Nuff said.


WarOnWarOff | Wednesday February 25, 2009 06:27 am 27

But, but Michael Moore is fat!


barbara | Wednesday February 25, 2009 06:27 am 28

Our family physician is a solo practitioner. Think Marcus Welby. He takes Medicare and Medical Assistance patients. He spends an enormous amount of time on the phone with patients. I know this from a boatload of firsthand experience. He is not in medicine for the money. In fact, a highly paid, highly regarded specialist referred me to him. She said, “Anyone can be a practitioner. But if they don’t give a shit, it doesn’t matter. Dr. M. gives a shit.” He does. And he will not survive professionally much longer.


puravida | Wednesday February 25, 2009 06:28 am 29

Christy-good morning and thanks for the great post.

“Dean made one thing crystal clear: everyone — including folks at the Chamber of Commerce, medical professionals, and pharmaceutical companies — want reforms.”

THAT is the meme. I’ll be sending my emails to the White House urging consideration of Dr. Dean for HHS.


Millineryman | Wednesday February 25, 2009 06:29 am 30

One of the chilling moments in what I experienced was when we got an e-mail talking about changes in the new year concerning medical insurance. They said new employees wouldn’t be covered for preexisting conditions. We had good medical insurance. Once I read that I felt stuck in that position for the rest of my life.

It’s just insane on many levels.


Christy Hardin Smith | Wednesday February 25, 2009 06:29 am 31
In response to barbara @ 28

The Peanut’s pediatrician is the same way — fantastic doctor, just amazing, loves helping kids.


Bluetoe2 | Wednesday February 25, 2009 06:29 am 32
In response to WarOnWarOff @ 27

and no doubt that will be one of the arguments used by Republicans, insurance companies and big pharma to try and derail real health care reform. This is one issue that needs more than a band aid but a radical departure from the current “system.”


barbara | Wednesday February 25, 2009 06:29 am 33
In response to puravida @ 29

Yes and yes. If you will, I will.


Prairie Sunshine | Wednesday February 25, 2009 06:30 am 34

As someone with a “preexisting condition” (in my case, lupus), I am all too aware of the precariousness of my situation. My insurance comes through my husband’s work, so when he retires I’ll be SOL — we’ve actually talked about prolonging his work to be able to maintain insurance coverage. We aren’t the only ones.

Boyoboy did this resonate with me, Christy.

Hopefully the loud chorus of voices from everyone who is NOT the healthcare insurance industry–and yep, that includes you, and you, and you and me and…–will finally drown ‘em out. And the trauma surgeon in chief will be able to lead through this vital change.


barbara | Wednesday February 25, 2009 06:32 am 35
In response to Prairie Sunshine @ 34

(((Prairie))) Life-threatening illness is a bitch, isn’t it?!


WarOnWarOff | Wednesday February 25, 2009 06:35 am 36
In response to Bluetoe2 @ 32

Very much like the rethug pushback on *everything* that makes any kind of sense.


selise | Wednesday February 25, 2009 06:35 am 37

did dean provide any explanation or argument or evidence? because i haven’t seen any – and i know what big pharma has lobbied for re medicare reform and here in ma (big subsidies for them). to say nothing of the people who have been killed by TRIPS (big pharma’s earlier venture into lobbying re “free trade” negotiations).

so, if not, i stand by my first statement.


foothillsmike | Wednesday February 25, 2009 06:38 am 38

The health insurance cabal would like to have a bill that in essence is welfare for the industry. Then they would like it if you don’t tax them for the money they rake in.


cbl2 | Wednesday February 25, 2009 06:38 am 39
In response to Bluetoe2 @ 32

Christy’s “have made moolah shifting the risks back onto the rest of us ” link above details the cabal’s long standing argument . . . and it’s current prospects – teehee :D


Christy Hardin Smith | Wednesday February 25, 2009 06:39 am 40
In response to Prairie Sunshine @ 34

It’s such a tough thing to explain to folks who don’t have to deal with it, too. In my case, I had decided to stay home with The Peanut for her early years because of everything we went through in our fertility struggle and because both of us could not work 16 hour days and raise a child, it just wasn’t something either I or Mr. ReddHedd wanted for her after all we did to have her in the first place.

I started having issues about a year and a half after her birth — which is really common in women with lupus, as birth and the hormone changes involved in pregnancy, can sometime escalate an underlying autoimmune issue. I had made a choice that was the absolute best one for our family, and then was diagnosed (after 2 years of doctors and testing and pain, mind you) and I wasn’t working at the time.

Which means I had no insurance of my own and now with a pre-existing condition that could be fatal if things go a certain way, I’m likely pretty uninsurable.

I’m lucky in that I have a wonderful marriage and supportive husband. But what if I didn’t. If he left me, I’d have no insurance at all. How many people are in that boat in this country? And that’s not even counting people who have jobs with no insurance and any number of other issues. It’s crazy when you start contemplating the parameters on this.


Christy Hardin Smith | Wednesday February 25, 2009 06:39 am 41
In response to selise @ 37

It was a pretty short interview, so no, they didn’t get into specifics on that. I’m going to keep digging on this going forward, though, so I’ll let you know if I find support on that.


momodo | Wednesday February 25, 2009 06:40 am 42

I saw Sicko recently and became a convert to single-payer. I just don’t know how to get there from here.


ApacheTrout | Wednesday February 25, 2009 06:40 am 43

I’m thrilled to see people seriously talking about the drag that health care places on our economy. I started my own business in 2007 and health care is an extremely important factor in the growth and long-term success of my company. Health care in VT costs about $3600 per person for a bare bones HSA policy. Without Dr. Dynasaur, Vermont’s exemplary health-care program for children up to 18 years old, the cost of insuring my family would be approximately $10,000 per year. I’m building my business without going deep into debt, which results in a purposeful slow growth. When I hire a full time employee this year and another next year, and if I offer benefits, I’m looking at adding another $7,200 to $20,000 in health care costs. Wow.


perris | Wednesday February 25, 2009 06:42 am 44

The only folks standing in the way? Insurance companies, who profit more from keeping things as they are.

well, there are also the politicians they contribute campaign dollars to


WarOnWarOff | Wednesday February 25, 2009 06:43 am 45
In response to cbl2 @ 39

Damn my corpoRAT firewall blocks it. Thanks, corpoRAT America! Reminds me of that show on Nova last night…bloody rats.


selise | Wednesday February 25, 2009 06:45 am 46

thanks. i like dean for a lot of reasons but he’s not my go-to guy on health care reform (although he is far, far superior to many others like daschle) because in the past he’s been an apologist for the corp-friendly approach to health care reform (go slow, we can’t have single payer even if the dems control everything, etc).

hope you will find PNHP useful.


Millineryman | Wednesday February 25, 2009 06:46 am 47

I like to think in terms of human potential and possibilities. Looking at people and thinking of the liability of race, gender, religion or sexual orientation, preexisting condition, status etc does nothing to maximize the potential we have as a society. I think it’s our purpose as human beings to do so.


Christy Hardin Smith | Wednesday February 25, 2009 06:47 am 48
In response to ApacheTrout @ 43

When I was a partner in my own firm in private practice, we routinely tried to come up with better ways to cover our employees for health care — checking out various business plan offers, things from the local chamber, the state bar, the ABA — and they were all insanely expensive and none had the coverage our employees really needed. It was crazy, and it drove us nuts trying to decipher all the fine print exceptions on coverage, too.

Small businesses, by their very nature of being little mom and pop shops with only a few employees, don’t have the numbers to really leverage any negotiations with insurance companies. Theoretically, a group of businesses can band together and spread the risk across several businesses to negotiate something — which is what the chamber and other groups have tried to do with group plans — but they almost always result in something that is still far too expensive for most small businesses to afford.

And huge corporate costs? Honestly, I do not know how some of them do it the way that insurance premiums on health care have risen over the last few years. CNN reports that: “The average cost of family health-care coverage more than doubled from 1999 to 2008, from $1,543 to $3,354, according to a report by the Institute on Medicine released Tuesday.” A lot of that gets picked up by businesses, but not all of it — when you add up how much individuals and companies are paying? it’s huge. When you start thinking about how companies have to pass along that cost in their product pricing in order to cover part of it? It gets even larger still…


NorskeFlamethrower | Wednesday February 25, 2009 06:47 am 49

AND THE KILLIN’ GOEZ ON AND ON AND…

Citizen Hardin Smith and the Firepup Freedom Fighters:

Howard Dean is up to his old tricks again , that is, he’s makin’ too much sense…if he doesn’t get the HHS portfolio then we know the fix is in and Social Security is gunna be sacrificed for Medicare expansion. Am I the only one out here who has been wonderin’ why allowin’ 55 year olds to buy in to Medicare and coverin all children from birth to 18 years has not been leveraged with the removasl of the SS vap and decrease in the FICA tax? Am I the only one out here who is ready ta bail out on Brother Obama for the “interest free Social Security savings accounts that look to be the blackmail bein paid for support of health care reform?

I am here to say “fuck you” to Obama if he tries to buy off the baby boomers with this healthcare “reform” while yankin Social Security from under our kids and grandkids and transferin’ the next round of national debt satisfaction on to the next 3 fuckin’ generations of workers.

Anybody elese out there wonderin’ if Gibbs and Rahm have not been smirkin for the last few days ‘cuz the fix is in with the fascists in order to get credit flowin to the big shots again?

KEEP THE FAITH AND PASS THE AMMUNITION, DOESN’T MATTER IF YA GET FUCKED BY DEMOCRATS OR REPUBLICANS…YER STILL FUCKED!!!


TomThumb | Wednesday February 25, 2009 06:48 am 50

It’s not the 7.5 million in campaign contributions that I am afraid of. It’s the 13 billion dollars in yearly profits which the insurance companies stand to lose. What makes universal health care work in other countries are price controls on items like an MRI. The actual price of an MRI machine and someone to operate it is 98.00 for each patient served. In the US, profit taking has set the price at about 800 to 900 dollars.

Only a Medicare type of system with a low overhead and with the ability to set fair prices can lower the cost of care so that everyone can be covered. I hope this is what Howard Dean and President Obama have in mind.


foothillsmike | Wednesday February 25, 2009 06:53 am 51

If a law firm has a difficult time deciphering the fine print in the plans imagine what people that do not have legal expertise go thru and how they are being deceived into believing they have coverage until they need something.


oldgold | Wednesday February 25, 2009 06:53 am 52

Yes, we spend too much on health care. Worse, despite spendong roughly
20% of our GDP on health care, it isn’t all that great.

One thing that seldom gets mentioned in this discussion is our failure as a culture
to accept death as part of the natural order of things. Several times in the recent past, I have been involved with loved ones, who after living long and full lifes were
dying. In each case, literally hundreds of thousands of dollars were spent to prolong their lifes a few weeks. They had no quality of life and were in considerable pain.
Yet, no one, including yours truly, was prepared to say, “enough.”


TomThumb | Wednesday February 25, 2009 06:54 am 53
In response to NorskeFlamethrower @ 49

Yep. Watchin’ them like a hawk.


NorskeFlamethrower | Wednesday February 25, 2009 06:55 am 54

Correction:…”TAX FREE Social Security savings accounts…”


Christy Hardin Smith | Wednesday February 25, 2009 06:55 am 55
In response to foothillsmike @ 51

Seriously, reading through those plans is mind-numbingly painful. I can remember what a headache it was to flip back and forth and try to reconcile conflicting information and try to make sense out of it. There is no way that isn’t drafted deliberately to confuse and muddle. I get that a lot of this is done by committee, and things get added in piecemeal, but these things are not written with clarity and comprehension of the consumer in mind. At all.


bonkers | Wednesday February 25, 2009 06:55 am 56
In response to momodo @ 42

It’s been years and years just about everyone I know has complained about our “insane” health care system, yet they laugh at the idea of single-payer and start spewing Lush Limpbaugh-type talking points.

To me, this is shows exactly why replacing and/or changing BigMedia is the key to just about every issue. People get that it’s not working, but they’re so bombarded with messages, many now for their entire lives, embedded with false claims about the dreaded “Canadian system” and how there’s no other “reasonable way,” that they can’t see outside of the so-called “expert” commands.

You see Sicko. You want single-payer. Sicko is a good example as well, since these same PR/BigMedia forces (like Sanjay Gupta) worked like hell to suppress the movie and belittle it, because if a large percentage of the public saw it, we’d having single payer in the next year or two.

This same dance happens with economic issues, where John Q. Nascar’s have been voting against their own interests for decades now, and all the while sneering at us “tax and spending Liberals” who actually have solutions to all these problems.

We all must support New Media outlets as much as possible, both through financial support and word-of-mouth marketing. It’s our only hope to re-invent society in a way that works for everyone.


barbara | Wednesday February 25, 2009 06:57 am 57

When my marriage tanked many, many moons ago, I became a COBRA victim. I was a freelance writer/editor with no bennies. (Small staff meetings, though! *g*) Discovered that if I shifted to a portability policy within the same insurer (BCBS), my coverage was equivalent and premium was actually a bit less than COBRA. That was the good news. The bad news is that the premium keeps growing and growing, reaching roughly $800 a month. Now I don’t know if pre-existing condition would have nixed that. And given that there’s an outside possibility that this country may actually take this bullshit by the horns and deal with it, might not matter. But you might want to find out what your options would be, worst case. You probably already have! Just noodling.


eCAHNomics | Wednesday February 25, 2009 06:57 am 58
In response to oldgold @ 52

You can direct the person with your medical proxy that no extraordinary medical measures be taken. You get hospice treatment with pain killers and nature takes its course. My brother did that. The whole family was fine with it.


barbara | Wednesday February 25, 2009 06:58 am 59
In response to momodo @ 42

Sometimes we’re all at a loss for words! It’s okay!


Bluetoe2 | Wednesday February 25, 2009 06:59 am 60
In response to bonkers @ 56

Agree 100%. The corporate media does not represent the interests of the American public. They are the biggest hurdle to true reform on a variety of fronts, from health care to trade policy. The media represents the interests of the status quo, Republicans and the on air rich celebrity news readers.


barbara | Wednesday February 25, 2009 07:00 am 61
In response to selise @ 46

I think the past informs our present. Surely slow-go is not an option any more. Not only in theory, but in practice. What think?


foothillsmike | Wednesday February 25, 2009 07:05 am 62
In response to eCAHNomics @ 58

You can also do a living will which my folks did.


Raven | Wednesday February 25, 2009 07:05 am 63
In response to eCAHNomics @ 58

I have understood that no matter what you have in writing it often depends on where you are and who the attending MD is.


ThingsComeUndone | Wednesday February 25, 2009 07:07 am 64
In response to NorskeFlamethrower @ 49

Yeah what Norske said!
Me I am hopeful that Obama will change his mind and give us National Healthcare the poll numbers of his speech shows that he does have the political capital if he just goes out and talk to Americans.
So he has no excuse:)


Blub | Wednesday February 25, 2009 07:08 am 65

“Currently in this country, 45 million people are uninsured.”

Far worse as a proportion of population for certain segments. Last year 34% of 20-somethings were uninsured (since they think they’re invincible, they’re less willing to spend exhorbitant sums on self-paid insurance), up from 29% in 2007. This number may now be near 40% and will jump again by mid-year since college/university grads are graduating into almost certain unemployment. Over 60% of this segment are “at risk” of being uninsured according to one actuarial expert I spoke with a few months back.

Meanwhile, its all fun and games in lalaland… borrowing medicine, persuading doctors to prescribe medicine to insured friends to pass on, etc.: http://www.nytimes.com/2009/02…..nsure.html


foothillsmike | Wednesday February 25, 2009 07:08 am 66
In response to Raven @ 63

Think that depends on state laws.


barbara | Wednesday February 25, 2009 07:09 am 67
In response to oldgold @ 52

I have walked this walk recently. Death is indeed part of the natural order of things. Where this gets gnarly is when it’s not a natural thing at all. Where the dying person is not an aged one. Even in David’s last hospitalization, it was almost impossible for me to grasp that the time for dying was at hand. I think society cannot do much to prepare us for what turns out to be the inevitability of death in certain circumstances. I brought David home. We engaged hospice. He was totally aware of what was happening to him. I was so immersed in his daily care that I had almost no time to think of what was going on. Even holding him as he died was insufficient to pound into my head the full reality of the year and a half that had preceded all of that. My point is that I’m a reasonably tuned-in person. I thought I understood a great deal about cancer and death. But when your heart is breaking, it’s difficult (though not impossible) to make painful decisions.


WarOnWarOff | Wednesday February 25, 2009 07:09 am 68

Jane’s up.


bonkers | Wednesday February 25, 2009 07:10 am 69
In response to bonkers @ 56

Ha. As if right on cue, the very serious business “expert” David Leonhardt writes a 4th grade level civics lesson about how the economy and taxes work together. Because no amount of lipstick can cover this Palin of an economy anymore, Those That Know Better are finally admitting some simple facts, yet it’s still filled with subversive tripe to belittle anything Liberal:

This is a point on which serious Democrats and serious Republicans agree, even if they do so with euphemism. “We are on an unsustainable path,” says Peter Orszag, Mr. Obama’s budget director. Judd Gregg, the ranking Republican on the Senate Budget Committee, has said, “Revenues are going to have to go up.” Douglas Holtz-Eakin and Dan Crippen, budget experts who advised the McCain campaign, have quietly acknowledged the same.

http://www.nytimes.com/2009/02…..bjhu7w1PTg

Notice Judd Gregg and Doug Holtz-Eakin are “serious” in Davey’s world (WTF is Eakin doing in there anyway…who gives a shit what he thinks about this?). This is laughable. I guess Nobel Prize economists aren’t serious enough compared to Doug Holtz-Eakin. What a joke.


lokywoky | Wednesday February 25, 2009 07:10 am 70
In response to momodo @ 42

There are some ways to get there from here.

“Close the Gap” plan. We already have ’single payer’ at both ends of the spectrum of life – Medicare for seniors, and SCHIP for children. SCHIP needs to be expanded to automatically cover every child the minute they are born. And no child should ever ‘age out of the system’. This means that the gap will be closed one-year at a time as each new cohort of kids is born. It would take 45-50 years to close the entire gap if you only do this portion. However, it would allow time for funding to catch up, and for the insurance industry to re-tool for other stuff or to be phased out. Canada still has private insurance – it is just not as widely used as here.

The second part would be to lower the age of Medicare eligibility by one year each year. This would take 45-50 years to close the entire gap if you only do this portion.

If you implemented both at the same time – the gap would be closed in 20-25 years.

Of course, there are some things about Medicare that MUST be reformed in order for this to work. Part D in particular, must be taken out of the hands of private insurers and the government must be able to bargain for drugs – the same as the VA. Secondly, as this plan gains acceptance, private and employer paid premiums would need to be replaced with a simplified payroll tax. This will generate lots of screaming from the right wing and the anti-taxers. But it would need to be presented as the less-expensive alternative to the comparative price of private insurance premiums and/or the employer funded ones. Either way, everyone will be paying their own premiums – the same as social security. If this is presented correctly, people do not mind paying for something if they get value in return.

Right now, people pay astronomical amounts of money in some cases – and then when they get sick – they are denied coverage. Or they are stuck in dead-end jobs (reducing their lifetime earnings) because of pre-existing conditions. Taxpayers in general (out of general revenue) DO pay for all the care received by the uninsured – or failing that, hospitals and doctors wind up eating all those costs.

Cost savings are readily available. Anywhere from 10-35% of insurance premiums are spent on insurance company administrative overhead (and shareholder and CEO compensation). The Medicare system spends less than 3%. Providers would no longer have to have more billing clerks than doctors, since billing would be on a single form, and completely automated rather than the hand-filling out of forms currently in use today.

Just my thoughts on how to get there from here.

BTW, I have a pre-existing condition that has made me uninsurable since the early 1980’s. The condition all but precludes employment because of this since my presence in the workforce will guarantee an increase in premiums for everyone else who works there beginning the month after I am hired. That is another thing that this insurance crap causes – although I could work, I am prevented from doing so by my inability to have affordable health care. So, I can work for someone who doesn’t provide insurance, or I never get hired at all.


oldgold | Wednesday February 25, 2009 07:10 am 71
In response to eCAHNomics @ 58

Yes, I know that. My point is that it doesn’t happen with enough regularity and the result is we spend more health care dollars on people during their last 90 days than we have on their first ninety years.


barbara | Wednesday February 25, 2009 07:10 am 72
In response to Raven @ 63

I think that’s accurate.


eCAHNomics | Wednesday February 25, 2009 07:11 am 73
In response to Raven @ 63

That may be the case. IANAL so I don’t know. But you can probably figure that out in advance and switch docs. In Rochester, where my brother lived, there is a whole infrastructure for people who make his choice. He got hospice care in a nursing home, but there are also separate hospices.


Raven | Wednesday February 25, 2009 07:11 am 74
In response to foothillsmike @ 66

Yea, I’m sure. When my dad went in for the last time in Phoenix they “thought” he had a shot so they did heroic stuff that he had said he did not want. I had to get a nurse off on her own and ask her what the score was. The WE made the decision to pull the plug. I guess all-in-all it wasn’t a bad way to do it.


Raven | Wednesday February 25, 2009 07:14 am 75
In response to barbara @ 67

I hear you. My cousins kids were in a horrible wreck and they gave them zero chance of recovery. When he gave the go-ahead to disconnect one of them hung on for days. It’s never easy I guess.


oldgold | Wednesday February 25, 2009 07:16 am 76
In response to Raven @ 74

Raven, what you did is what I should have done. To my discredit, I let them try the heroic stuff.
I noticed during my weeks in the hospital that my conduct was the rule rather than the exception.


Millineryman | Wednesday February 25, 2009 07:17 am 77

I have a 93 year old aunt under hospice care now. Her life savings are being drained very quickly due to the fact she’s bedridden. Her insurance won’t cover in home care, and with the amount they would cover for a nursing home is minimal. She could be draining her life savings by staying in the only house she ever knew, or she could be draining it in a lower level nursing home.

So now we have to get a lawyer involved for her (my siblings and cousins, she never had children), because her sister is being difficult about the the power of attorney being changed.

All the public agencies are so overwhelemed that it’s hard to find anyone who
can be a true advocate for her.


Bluetoe2 | Wednesday February 25, 2009 07:17 am 78
In response to barbara @ 67

Very nicely said, barbara. Your comments mirror what I experienced with my wife as well.


Raven | Wednesday February 25, 2009 07:18 am 79
In response to oldgold @ 76

You cannot second guess yourself, you do your best and that’s it. Be gentle.


ApacheTrout | Wednesday February 25, 2009 07:18 am 80

It’s a complex process by design so that we either hire someone (another cost) to understand, explain, and handle it for us, or we just fork over $ without knowing exactly what we’re buying. It’s such a terrible business model that ends up transferring wealth from individuals to insurance companies. Unreal.


TomThumb | Wednesday February 25, 2009 07:18 am 81
In response to Blub @ 65

Yes. That’s a favored conservative/Republican meme: That the uninsured are irresponsible or just a bunch of irresponsible “invincible” feeling kids.

That doesn’t pass for accuracy here. Health insurers have made themselves unaffordable.

The uninsured include many people who are older, unemployed, sick, poor, and who certainly do not feel invincible. How sadistic and irresponsible it is for the NYT to write that crap.


Raven | Wednesday February 25, 2009 07:19 am 82
In response to Raven @ 79

I guess mean you should try not to second guess yourself. . . we all do it.


barbara | Wednesday February 25, 2009 07:21 am 83
In response to Raven @ 75

One of the big problems with advanced cancer is trying to find the line between reality and hope. David needed to believe there was some hope, not of beating the beast but of bullying it into something more manageable. I don’t know how anyone can endure radiation, chemo, blood-letting, etc., etc. without some hope of an at least marginally positive outcome. And so the primary caregiver lives a life of cognitive dissonance throughout the ordeal. He’s going to die. But I need to let him hope. He’s going to die. And all of that feeds the eleventh hour decision making. Because it involves having to do a kind of 180. Not so much about overcoming denial as it is finally taking away the patient’s hope. Tres tragic.


barbara | Wednesday February 25, 2009 07:24 am 84
In response to Bluetoe2 @ 78

I’m so very sorry. And deeply conflicted. I want to be understood, and yet I want no one to have to experience this. I’m so very sorry, Bluetoe.


barbara | Wednesday February 25, 2009 07:25 am 85
In response to ApacheTrout @ 80

transferring wealth from individuals to insurance companies.

Succinct and profound.


Raven | Wednesday February 25, 2009 07:25 am 86
In response to barbara @ 83

I know it’s so difficult. My mom’s husband had progressive supranuclear palsy. He was lucid but deteriorated physically for years. I don;t think any of us in the family really understood the toll it took on her but I do think it cost her 10 years of her life.


barbara | Wednesday February 25, 2009 07:28 am 87
In response to Raven @ 86

Is she still living now, Raven?


foothillsmike | Wednesday February 25, 2009 07:30 am 88
In response to Raven @ 86

When my first wife died it was very sudden and unexpected. I have often wished we had had the time to make our goodbyes.


selise | Wednesday February 25, 2009 07:31 am 89
In response to barbara @ 61

Surely slow-go is not an option any more. Not only in theory, but in practice. What think?

i think the D leadership is trying to thread the needle – to get some kind of reform, but to not challenge their corp sponsors. they are in a tough position and i don’t envy them. but i think that’s where the slow-go comes from.

so where do we stand? with the D leadership or with the people who need healthcare?


Raven | Wednesday February 25, 2009 07:35 am 90
In response to barbara @ 87

No, three years now. Both my and my wife’s mom’s died in their sleep and we were with our father’s.


barbara | Wednesday February 25, 2009 07:36 am 91
In response to foothillsmike @ 88

I’m sorry. So painful. But you know what? Even having time isn’t enough. Can’t explain it, exactly. But I have deep regrets about being so caught up in David’s physical care that I lost sight of his spirit. Makes me cry right now. Death sucks, barbara. Deal with it!


selise | Wednesday February 25, 2009 07:37 am 92

just want to leave a thank you to everyone for this thread, and especially those who have shared their experiences. my own experience supports raven’s statement @63 – wildly different when i had to make medical decisions for my mom and my dad (in MA and IL respectively).


barbara | Wednesday February 25, 2009 07:40 am 93
In response to selise @ 92

FDL. Where political snark and personal pathology come together. *g* Thanks this amazing community. Just…thanks.


Blue | Wednesday February 25, 2009 07:41 am 94

I don’t know, I’m a little sick of the ‘American people not being ready for universal healthcare meme’ and it strikes me that Obama’s plan might make things worse economically. He wants to expand coverage (mandatorily) but without removing the largest component that results in our spending tremendous financial resources and getting naught for it (insurance industry). People don’t want healthcare insurance, they want healthcare.


TomThumb | Wednesday February 25, 2009 07:44 am 95
In response to NorskeFlamethrower @ 49

Norske,

Here are your new taxes and also implied threats to raise SS age and decrease benefits.

http://www.nytimes.com/2009/02…..dt.html?hp


Ann in AZ | Wednesday February 25, 2009 07:45 am 96

To preserve our long-term fiscal health, we must also address the growing costs in Medicare and Social Security. Comprehensive health care reform is the best way to strengthen Medicare for years to come. And we must also begin a conversation on how to do the same for Social Security, while creating tax-free universal savings accounts for all Americans.

This was the single least appreciated paragraph in the President’s speech, I think. I do not quite understand what a “tax-free universal savings account” is. First of all, it does not say tax-deferred, it says tax free. It doesn’t say whether they are talking about medical savings accounts. It doesn’t say whether they are talking about setting up an annuity type of account for retirement. It doesn’t say anything about risk or how to avoid it. To me, this is the single biggest potential booby trap in the entire speech from last night.

Aside from this, though, I am on Medicare, but Medicare pays my insurance company a premium each month to handle my healthcare. This is necessary because Medicare only pays 80% of your medical expenses and has no pharmacy coverage aside from part D, which causes the need for supplemental insurance. The same insurance company provides my presciption drug insurance under section D of Medicare. I would imagine that healthcare choices will be along the same lines if you opt for Medicare as your insurance provider.

I sure hope that Obama exercises good judgement and picks Dr. Dean to be his HHS person. I really believe he would be the best person for this position.


shootthatarrow | Wednesday February 25, 2009 08:05 am 97

Being in good health and having access to reasonable healthcare services should not be subject to any profit motivated business models. The morals and ethics of mixing profits and peoples health are truly suspect and perverse.

Perhaps a way forward would be to reset what the bottom 50 million Americans are now getting regarding healthcare access. Those not part of the current healthcare regime. Being the current healthcare regime has no vested interest in this group anyway they should be the easy group politically to move into a American single payer healthcare plan.

Get the basics done first. Cover the physicals. Cover basic doctor and clinic care. Cover the basic treatments and meds. Cover the basic lab and follow up testing.

Give this to the current group without healthcare coverage.. Establish a floor.

Then move it up to the next 50 million Americans based on income,current healthcare system failure to cover adequately. Complete the reset for this bottom 100 million Americans.

The top half of American income earners likely will be/are able to make choices above and beyond the bottom half of American income earners regarding healthcare no matter what. Let them choose and do as they desire. Politically if they want to resist being in Single Payer American HealthCare let them. But cover the bottom half for starters.

Medicare and Medicaid are two templates that offer models to work out from.

Take out the profit motivation. Take out the jigsaw puzzle gaming. Take out the failure.


PJEvans | Wednesday February 25, 2009 08:05 am 98

I can get insurance through my company … if I can translate the 90-page PDF file (written by insurance lawyers, I think) that’s supposed to explain what each of the three plans is offering. And all of the plans have been in legal trouble in the last couple of years. It’s not a choice I can make comfortably, so I’ve been doing without. Fortunately I’m reasonably healthy, for now.

I want single payer. Soon. For everyone.


selise | Wednesday February 25, 2009 08:12 am 99
In response to shootthatarrow @ 97

we don’t have to reinvent the wheel – it’s HR 676 and it has a ton of support already in congress. our job is to get it more.


Ann in AZ | Wednesday February 25, 2009 08:15 am 100
In response to Blue @ 94

A few years ago I had an incident wherein I went to the emergency room with what I thought was an upper respiratory illness on top of emphysema, but it turned out to be a heart attack and I was not released until after I had a quadruple heart bypass. When I was in the hospital, I got health care, whether I wanted it or not. What I needed was healthcare insurance. Luckily, the hospital knew how to get me insurance that I didn’t have, and the insurance paid all the bills. The program that paid all six digits of that bill, including hospitals, doctors, pharmacy, etc. is a program of medicaid. We have already socialized a lot of our healthcare problems and risks. Now it’s time to put the younger, healthier folks on the roles to deflect costs. The larger the group, the lower the cost. At least, that’s my opinion and I’m stickin’ to it.


Christy Hardin Smith | Wednesday February 25, 2009 08:37 am 101

FYI, there’s a fresh post up top if anyone wants one…


jdavidf | Wednesday February 25, 2009 09:56 am 102

As someone with a “preexisting condition” (in my case, lupus), I am all too aware of the precariousness of my situation. My insurance comes through my husband’s work, so when he retires I’ll be SOL — we’ve actually talked about prolonging his work to be able to maintain insurance coverage. We aren’t the only ones.

All too aware myself. I “lucked out” by purchasing private insurance (my previous employers’ insurance was so crappy it was laughable) about two months before being diagnosed w/HIV. At the time, my premium w/Blue Cross was $215.00/month.

I just received a letter from them explaining how great they are and that, I guess due to their greatness or something, my premium will go up to $550.00/month on March 1st. Oh joy.

I’ve been forced to up my deductible, co-pay and Rx in order to get the premium down to a manageable amount. And the kicker? If I decide I’d rather pay a higher premium and go back to my previous plan? I have to answer their stupid health questionnaire and let them decide if I have any pre-existing conditions. Jerks. Wonder how the recession is affecting their execs?

Not a complaint or a whine. It is what it is, and I’m among the fortunate who do have coverage – but by the skin of my teeth and I am definitely at their mercy. I have nightmares that I’ll miss (or be late on ) a payment and they’ll unceremoniously dump me right then!

David


BargainCountertenor | Wednesday February 25, 2009 09:59 am 103

Ah. P.J. I feel for you, but pick something in the next open season for your health plan. Going naked is sometimes necessary, and if you’re a young adult you can usually get away with it. But life is what happens when you’re making other plans. All manner of accidents happen. If it’s an auto accident there’s a decent chance that somebody’s policy is going to cover it, but what about a broken leg at a softball game? Concussion from a soccer game?

Young adults are a piece of the jigsaw puzzle in the health care finance problem that no one has figured out what to do with. The insurance companies haven’t helped matters by cherry-picking. Young adults are cheap to insure, so their individual policies are (relatively) cheaper. But it’s only relatively cheaper, and the way prices have gone in the last 10 years many have opted out of the system.

Mandated coverage with penalties is one way to go. Universal coverage is better, in my opinion.


Ann in AZ | Wednesday February 25, 2009 10:02 am 104
In response to jdavidf @ 102

From your comment, it’s obvious that the Insurance company is treating you, as the patient, as if you are an addict! They will continue to up the premiums until you can no longer bear the cost, or until you are too sick to work, so you cannot make premium payments anymore. That seems to be the name of the game!


wmd1961 | Wednesday February 25, 2009 11:18 am 105

I’ll put out my personal data point again:

2008 COBRA health insurance premiums: $497/month, eligibility ended Dec 2008. Claims for 3 office visits, splint, 2 cortisone injections, one prescription refilled 10 times. $5467 in premiums, less then $1,000 in claims. I was profitable for my insurance carrier in 2008.

Not eligible for an underwritten policy at ~$360 per month. Guaranteed issue policy premium is $730/month.

I’ll cease being uninsured shortly, although it is at a pretty high cost. I’d gladly pay a higher Medicare tax rate when I’m working again in order to guarantee insurance to everyone.


jdavidf | Wednesday February 25, 2009 11:22 am 106
In response to Ann in AZ @ 104

No kidding Ann.. I did neglect to mention that, at least, they’re covering over $1000 in prescriptions a month with no qualms – of course, that just makes me more paranoid about missing a premium payment, which is why it goes on a credit card every month. At least Visa won’t cut off my insurance!


Ann in AZ | Wednesday February 25, 2009 11:40 am 107
In response to jdavidf @ 106

Yeah, but that also adds whatever your interest rate on your Visa is to the cost of your insurance!


Leen | Wednesday February 25, 2009 12:32 pm 108

Dean was great on Hardball. Chris has had him on quite a few times. Really liked when Chris lobbied for Dean “I hope you become chair of the HHS. Mr. President if you are watching this is your man”

Matthews ‘we’ve been dicking around with this years”
Matthews “people love medicare”
Dean “rearranging the options”
Dean ” When you include Medicare you make enemies. In this case the enemies are insurance companies”

I will never forget watching Hillary Clinton present her health care plan in was it 93 or 94 in front of congress. Standing ovation the whole 9 yards. I thought to myself she is going to get her ass kicked. She did. They have learned. Now is the time


recoveringlurker | Wednesday February 25, 2009 02:10 pm 109

Another angle. I know two couples in their sixties who are separated but remain married because only one in each couple has health coverage — in one case this is very long-term. When the spouses without coverage reach Medicare age, they will both divorce. Nice system.


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