Tuesday, June 26, 2012

Nobody Knows Nuthin

There hasn't been this much nail-biting and speculation since the nation awaited the series finale of The Sopranos. And when that last episode ended, not with a bang but with a quick whimpering fade to black, the reaction was a mixture of "huh?" to "cop-out!" to "this was the most meaningful and epochal moment in the history of mafia dramedy."

Same for Thursday's much-ballyhooed Supreme Court ruling on the Affordable Care Act. There are as many theories on the outcome as there are pundits with too much time on their hands, so I won't add to the arcane clutter. Possible endings are all over the map. I read this morning that the jurists may even punt on the issue until right before Election Day, following that old Washington tradition of can-kicking important issues into oblivion, as well as the gimmick of the season-ending summer cliffhanger.

I imagine this would piss off the VIPs who are sticking around the swamp just to be the first to pontificate on this momentous decision instead of raising campaign cash, serving their constituents or going on their bi-monthly vacations. Wouldn't it be something if it turned out the Supremes were just a bunch of Bada-Bing teases, that they had been playing us all along with their come-hithers on health care? 

If you are a suspense junkie, do tune in to the ScotusBlog this Thursday around 10 a.m. for the final (maybe) episode. I'm embarrassed to admit I succumbed yesterday, finding myself hooked on their live clicks. It was a real tease, all right. I could just envision the politburo dancers in their black robes, casting off one decision at a time to a ravening audience of thousands. First, Arizona immigration law, next came sentencing rules for murderous youth, and in between there was that contemptuous bump and grind affirming Citizens United. And no health care! Not one little hint! Oh, the agony.

Of course, lost in the hoopla is the fact that these decisions affect real people. Hispanics will continue to be subjected to the fascist "papers please" law in Arizona, until the Supremes decide to think it over some other time. Corporations will continue to steal our democracy and not even have to tell us who they are or where they come from.

Same with health care. As much as I dislike the Affordable Care Act, I will not rejoice if it is struck down. For one thing, the insurance leeches would be absolved from refunding billions of dollars this summer in overpaid premiums that were not spent directly on patient care. For another thing, there are some people who are already benefiting from the law, such as children with pre-existing conditions. Would they be cut off from chemo without a second thought by the for-profit health insurance mafia?

The only thing we can be sure of come Thursday is the cacophany of the chattering class and the unctuous spin of the politicians. Here's what Michael Shear of the New York Times is forecasting:

But the momentary chaos could be downright dangerous for political candidates who move too quickly to embrace or condemn the court’s actions. A stray statement made before all the facts are understood could easily come back to haunt a political candidate.
In the White House race, Mitt Romney and President Obama are both preparing for any eventuality.
Mr. Romney’s top advisers have been working with Republicans on Capitol Hill to coordinate the health care message, according to senior aides. Various scenarios have been sketched out and statements prepared.
Aides say they believe Mr. Romney can benefit politically no matter what the court decides.
At the White House, Mr. Obama’s lawyers and political advisers are said to be preparing their own responses — both legal and political.
But the trick for both men will be to calibrate their statements appropriately in the moments after the decision is announced. And that won’t be easy if the court’s decision is a complicated one affecting different provisions in different ways.
And the trick for the 50 million people who currently lack health insurance will be either to calibrate a game plan for hanging on until 2014 if the ACA survives, or coordinating a more open-ended agenda for the rest of their foreshortened lives. Whatever happens, the Obama family and the Romney family and the Supreme Families and the Congressional families and crime families of all stripes will all maintain their own guaranteed health coverage today and for thousands of tomorrows.

A new report by Families USA estimates that lack of health insurance now accounts for 26,000 needless deaths every single year in this country. These are working age people in the prime of their lives. (25-64). Although this number is about seven time as high as the tally of those killed in the 9/11 attacks, their deaths simply don't garner anywhere near the same amount of attention and government response. These deaths are not a national emergency because they are mundane, protracted and lonely deaths. And our government likes its crises to be dramatic, immediate and profitable.

Sick and poor people do not have a lobby, nor a newspaper column, nor a seat on the cable talk shows. And if they're uninsured, they're dying off at the rate of three per hour. They're being whacked at about the same rate as in an average Sopranos episode.

We spend the most money on health care of any civilized country, yet we have the worst results in terms of morbidity and mortality. No politician can spin those stats, so they just ignore them, and campaign, and echo the words of mob boss Tony Soprano: "Let me figure out how to take care of you."


Pearl said...

Dear Karen: There is nothing I can add to your magnificent column today. The health of a nation depends on the physical and mental health of its people. By that definition the U.S. is very, very sick. I told a Canadian friend yesterday how glad I am to be living in Canada (for many reasons) when she expressed her concerns at the daily news horrors coming from our southern neighbor. Many Canadians feel like we are living next to a plague ridden country that is a threat to our stability.

Gratefully, Pearl

James F Traynor said...


Years ago, while talking to a fellow wildlife biologist, a Canadian, he expressed the same concerns. I imagine a lot of you feel this way. I suppose it's something like the Finns felt living next to the Soviet bear. The man I talked to was a refugee from eastern Europe.

Anne Lavoie said...

I just moved back to Arizona and discovered that the doctors in my city require a retention fee, 'to cover what the insurance companies don't pay'.

They will take any and all insurance plans including Medicare as long as you pay their retainer which varies, right now running from $350-$500/year as far as I can tell without surveying them widely. But it can be whatever amount they demand. It's all legal, and I don't think the ACA addresses it (anyone read all 3000 pages?). The AMA approves of course.

You still have to pay your usual deductibles, copays, etc. but they will submit their well padded bill to your insurance for you. They promise patients will get much more time with the doctor, personal phone calls, internet question opportunities, yada yada yada.

There is a bonus from one doctor for those who can afford it: If you donate $5000/year or more, you get a plaque in the waiting room and an invitation to an annual banquet for Very Special People. No kidding. I am pretty sure that if you tell the doctor you have him/her in your Will, you will get a free cell phone and hotline directly to the doctor along with free medication from the Drug Rep for life (or death).

How's that for health care reform? I'm told that this practice took hold locally about 2 years ago, right after the ACA was signed. Anyone else have this situation where they live, or is this one of those weird Arizona things?

Valerie said...


Your experience reminds me a little bit of the Soviet Union. I had a professor who grew up there. He said, sure medical care was free, but if you wanted the doctor to take the extra time to set your broken leg correctly, you gave him/her a little something extra on the side.

I often think how much we have evolved into the communist countries we used to despise. Remember how we used to spurn the huge industrial farms that went on for miles and miles, growing the same crops? We used to say how superior our small family farms were and how that way of life needed to be supported and maintained. How is industrial farming so different from the state run industrial farms of Soviet yesteryear? – Only here the profits got to a corporation as opposed to the government.

My cousin in California pays and extra $2000 a year, to get that little bit of TLC from her doctor. She can call at the last minute and get an appointment that day. She can get a phone call or a prescription pretty much on demand. Of course, she - who has money to burn - thinks it is great. But I have always wondered about the "second class" patients. Does this guy even have them?

Denis Neville said...

Only in America.

Health insurance is simple. Every other industrialized nation has figured it out, except the USA. Here it is an overwhelmingly complex issue because of the powerful forces invested in maintaining the status quo.

Obamacare (ACA) is private insurance-based “universal” (23 million still left uninsured) health insurance.

People’s wages have declined substantially and many will not be able to afford the rising deductibles and co-pays. How many young adults, who cannot find jobs and have significant college loan debts, will be able to afford the mandated health insurance?

Single payer (aka Medicare for all)? Both parties can always provoke enough mindless public hostility to kill it.

Where would the tax revenues come from to pay for single payer? Who will pay the taxes? Tax revenues are in decline. No new taxes! Can’t tax the “job creators.” In which direction will remaining tax revenues be directed by our corporate shill policy makers after they spend mind-boggling sums on corporate welfare/socialism?


Many people simply refuse to think about healthcare costs despite it being a major issue that affects them personally. They are unwilling to contribute anything for people who are not as lucky as they are. Why should we pay for them? The total stupidity of anti-big-government haters opposed to Medicare for all healthcare.

“Keep your goddamn government hands off my Medicare!”

Let Tony Soprano figure out how to take care of them.

Pearl said...

I want to mention that I am an American citizen living in Canada with my Canadian grandchildren. It makes it even sweeter for me to appreciate it here than
those Canadians who take for granted what they have always known. There are also movements afoot here politically that may well get rid of the Conservative government not too long down the line. The New Democratic Party in Canada which I am a member of (although I can't vote here) represents everything I wish the Democratic Party in the U.S. would be like and I am seriously thinking of becoming a Canadian citizen so that I could vote for some truly decent people here who may run in coming elections.

A note to Ann: Your personal medical experiences prove what I have said here and elsewhere about the private health care organizations and personnel making
their own financial decisions for potential patients and circumventing any regulations the administration might want to implement - even regarding
whatever the Supreme court's decision about the Affordable Care Act might be.
The private sector knows how to manipulate the system. Very difficult to do in Canada. Several organizations that set up their own American style health
centers in Canada could not survive the competition of the Canadian system and lack of patient support.

Ann: I would not recommend that anyone in their right mind, even jokingly,think of putting their doctor in their wills in order to gain favors, for obvious reasons!

Denis Neville said...

@ Ann Lavoie – It’s not one of those weird Arizona things.

I have seen and experienced this in the Midwest.

Physicians started opting out of Medicare, or not accepting new patients with Medicare coverage, because the paperwork was too much of a hassle and reimbursement rates were too low. When they opt out they can charge whatever they want, but they cannot bill Medicare, nor can their patients. Supplemental insurance policies usually will not provide coverage when Medicare doesn’t, so the entire medical bill is then the patient’s responsibility.

When I became eligible for Medicare, I was able to remain in the care of my internist until he converted his practice to concierge or “boutique” care. He still accepted Medicare and my supplemental insurance, but charged an annual retainer of $1,800 (which I chose not to pay) just to get in the door. So I had to find another internist who would accept Medicare assignment, which wasn’t that easy. There is a shortage of internists and many are increasingly unwilling to accept new Medicare patients. Many baby boomers, becoming eligible for Medicare, may find the insurance rug jerked out from under them.

For those on Medicaid it is even worse. Even more physicians will not accept new Medicaid patients. The fact that around 16 million more people will have Medicaid under the Affordable Care Act is a recipe for disaster. Currently Medicaid under-reimburses, but if the ACA holds, Medicaid reimbursement rates will be more like Medicare, which will be much better.

Valerie said...

I wonder, Denis, if it will be like subsidized housing. When I taught in a very low socio-economic school, I became friendly with a couple of the parents and even delivered lessons to students who were home sick (because I knew their parents would work with them at home). I was shocked at the condition of the apartments - filthy carpets, dingy walls, kitchen and bathroom floors with missing and broken tiles - or ancient lenonlium that was peeling. But I was even more shocked at the prices that were being paid to these slum lords. The government was shelling out more for these apartments than I was paying in my nice, updated, immaculate apartment across town in a higher socioeconomic neighborhood. I wonder if doctors who will deliver sub-standard care or treat patients like cattle, five minutes in and out after waiting for an hour in the waiting room, will become the norm for people on Medicare and Medicaid.

Pearl, So glad to hear that Canada might be ditching their conservative government. And yes, I think you should get Canadian citizenship. Not only because it will offer you some protections and rights you might need later on, but because it is important to take part in ones political culture, particularly when ones vote still counts for something. I plan on getting my Australian citizenship at the earliest possible time for all the above reasons. - BTW - So glad to have you joining us at Karen's Salon de Sardonicky.

4Runner said...

A few good blogs on Canada: The Galloping Beaver, Balloon Juice and Cathie from Canada. Thanx to my Canadian wife.

Denis Neville said...


I also had similar experiences doing home health visits to low income areas. The living conditions were appalling because of unscrupulous absentee slum lords. Slumlords try to collect as much of the rent in unreported cash as they can and then abandon the property after it has been finally milked dry. They not only destroy buildings, but neighborhoods and the lives and hopes of their poor tenants and their children. People with disabilities have an incredibly hard time finding affordable, decent housing.

Patients are already being treated like cattle, five minutes in and out after waiting for an hour in the waiting room. The prevalence of managed care (HMO's) changed the way doctor treat their patients, pitting physicians against patients, spending less time with patients, with less care being provided. The HMO model became a "cash cow" and the patients became cattle. Patients with low-paying plans are treated the same way.

Pearl said...

One more point to round out the discussion on how people are short changed in the U.S. health care system. When my husband was diagnosed with a terminal illness some years ago, we were living in Canada where he had spent his academic years, but we would travel to Florida during the cold winters when he retired. He had a choice of where to get final treatment since he had worked in the U.S. before coming to Canada and we both qualified for U.S. Social Security and Medicare coverage. His Canadian doctor advised him to stay in Florida for treatment since the U.S. had recently approved various chemotherapy procedures which was not in place in Canada yet. During this time, he had excellent care in the local Florida hospital, and a great oncologist which kept him going for quite awhile. However, there were several emergencies where he had to be transported to the local hospital and unfortunately the emergency ward was jam packed with people and one had a fairly long wait to see a doctor. The last time this happened I had to tell the receptionist that my husband was close to dying and could they please see him as rapidly as possible. This was done, but I called the hospital administrator the next day and asked him why there was such fine care in the hospital when my husband came in for chemotherapy, but the emergency room was a disaster area. He told me that the emergency ward was funded by the Federal government and therefore they had to take in anyone walking in regardless of their circumstances. Indeed I saw several people who were very poorly dressed and looked like they had come in from the street. He said funds were limited and he apologized profusely but said there was nothing that could be done. I read later, that the emergency wards in Florida and elsewhere had become the final refuge for medical care for many people who could not afford doctors or pay for HMO's and the like if they were not eligible for Medicare.

Evidently this situation has worsened and become a serious problem for many hospitals and health care centers. Needless to say, by the time many people get to the emergency ward out of dire necessity, their illnesses have often become progressively worse and more costly to get the care they need. Besides, the stressful ER situation does not permit enough time to assess and offer continuing supportive care or follow up.

In all fairness, we also have a problem in Canada with overcrowded ER's but this is not due to people not being covered for medical problems, but funding for hospitals has to keep up with the demands of an aging population plus the continuing increase of the population and immigration from many countries and we are challenged in Canada financially as elsewhere. These are worldwide problems and it is obvious that the U.S. will have more and more difficulty dealing with this increased demand for medical care affecting emergency centers which they are not even remotely prepared for or accounted for in the health care bill.

Denis Neville said...

Awaiting the Supreme Court’s ACA decision, “corruption touches even the ermine of the bench.”


“The conditions which surround us best justify our cooperation: we meet in the midst of a nation brought to the verge of moral, political, and material ruin. Corruption dominates the ballot-box, the legislatures, the Congress, and touches even the ermine of the bench. The people are demoralized; most of the States have been compelled to isolate the voters at the polling-places to prevent universal intimidation or bribery. The newspapers are largely subsidized or muzzled; public opinion silenced; business prostrated; our homes covered with mortgages; labor impoverished; and the land concentrating in the hands of the capitalists. The urban workmen are denied the right of organization for self-protection; imported pauperized labor beats down their wages; a hireling standing army, unrecognized by our laws, is established to shoot them down, and they are rapidly degenerating into European conditions. The fruits of the toil of millions are boldly stolen to build up colossal fortunes for a few, unprecedented in the history of mankind; and the possessors of these, in turn, despise the republic and endanger liberty. From the same prolific womb of governmental injustice we breed the two great classes - tramps and millionaires.”

“We have witnessed for more than a quarter of a century the struggles of the two great political parties for power and plunder, while grievous wrongs have been inflicted upon the suffering people. We charge that the controlling influences dominating both these parties have permitted the existing dreadful conditions to develop without serious effort to prevent or restrain them. Neither do they now promise us any substantial reform. They have agreed together to ignore in the coming campaign every issue but one. They propose to drown the outcries of a plundered people with the uproar of a sham battle over the tariff, so that capitalists, corporations, national banks, rings, trusts, watered stock, the demonetization of silver, and the oppressions of the usurers may all be lost sight of. They propose to sacrifice our homes, lives and children on the altar of mammon; to destroy the multitude in order to secure corruption funds from the millionaires.” - Ignatius Donnelly.

[preamble of the Populist Party’s 1892 platform, adopted at its first national convention in Omaha on July 4, 1892]


A bottom-up democracy insurgency is needed in our nation!

Neil Gillespie said...

"We spend the most money on health care of any civilized country, yet we have the worst results in terms of morbidity and mortality."

- just another example of American exceptionalism, corporate style.

This story in the American Bar Association Journal shows some of the legal arguments proposed in The Patient Protection and Affordable Care Act, arguments which show more about our arcane legal system than anything else.

"Critics say the Obama administration failed to appeal to conservative justices when it portrayed health care as a unique marketplace that could be regulated under the commerce clause."

"Instead, some observers say, the administration should have referred to early legislation in an effort to show the framers accepted regulation similar to the health law's insurance mandate, the Washington Post reports. One law, signed by President George Washington, required able-bodied men at least 18 years of age to buy a musket and ammunition. Another law required ship owners to buy medical insurance for their sailors and required the sailors to fund their own hospital insurance."


Meanwhile, while we are considering a law by George Washington requiring the purchase of a musket and ammunition as somehow relevant to healthcare, the world is passing us by.

FRONTLINE, in its series Sick Around The World, shows how five other capitalist democracies - the United Kingdom, Japan, Germany, Taiwan and Switzerland - deliver health care.


This was followed by another FRONTLINE series, Sick Around America.


Today is the final day of this year's term for the U.S. Supreme Court, and their bags are packed for trips to Malta, Austria, Italy, and Hawaii.

"Chief Justice John G. Roberts Jr. announced yesterday that the final day of the term for the U.S. Supreme Court will be Thursday. That removes much of the uncertainty and anxiety that have gripped court watchers over the last few weeks.

Now interest groups can do their last-minute honing of their prepared reactions to the Affordable Care Act ruling. Activists can plan to convene outside the court. The justices, meanwhile, can confidently know that they can get out of town after Thursday’s decisions and a final private conference in the afternoon."


Zee said...

@Denis and @All—

I had promised myself that I would not spend any time on the computer beyond checking e-mails while on vacation, but I am anxiously awaiting the Supreme Court decision on ObamaCare while Mrs. Zee sleeps in (long motorcycle ride yesterday), so I thought I would look in on Sardonicky. (Does this make me an addict?)

Denis, it’s interesting that you should cite David Cay Johnston regarding corporate socialism. I read his book, Free Lunch, and the top of my head blew off. Still, if Johnston is vehemently anti-corporate socialism, he is still very much a capitalist, though certainly not an “unfettered, laissez-faire, every-man-for-himself-and-devil-take-the-hindmost” type of capitalist. I think that he would oppose government socialism just as much as he opposes corporate socialism, though I could be wrong.

Regarding “The total stupidity of anti-big-government haters opposed to Medicare for all healthcare,” well, as we have discussed before, I am not opposed to Medicare For All, but neither am I a fan of Big Government. I recently finished Throw Them All Out! by Peter Schweizer (sp?) and anything that remained of my head after reading Free Lunch was blown to smithereens.

The larger government becomes, the more corruptible and less accountable government will always be, as—with increasing size—more and more opportunities for self-dealing inevitably present themselves to politicians. I believe that our Founding Fathers understood this, which is why they created a small government composed of three independent branches, and having only enumerated powers. They understood human nature all too well, and, I believe, they would be horrified at the rambling, controlling behemoth that we have allowed the federal government to become.

Yes, yes, I know the modern argument: If we can just put enough watchdogs, laws and processes in place, we can have Clean Big Government. Well, I’ve worked in a bureaucracy, and I’ve also worked closely with Feds on a few occasions. Processes are no better or effective than the people who implement them, and, when no one is looking, even “watchdogs” are quite corruptible.

As long as only a little over 50% of eligible American voters are regularly engaged with their government to even bother to vote—and many of them are “low-information” voters at that—it is my humble opinion that Big Government will always be a threat to the existence of democracy in the United States. The ultimate watchdogs are asleep on the job.

@Pearl—Welcome to Sardonicky. I have appreciated your remarks on the Canadian health care system. You mentioned that several efforts to offer “private” health care in Canada have been unable to compete with the single-payer system. I would be eager to learn more about that.

Gotta go. The Supreme Court decision has just come in.