Saturday, August 17, 2013

Obama Champions Your Right to Pay

Let President Obama be perfectly clear. In the richest country on earth, you don't have the same right to health and wellness and treatment for disease as they do in other advanced countries.  But you absolutely, positively have the right to shop for your own private health insurance (which if you are lucky, might pay some percentage of your actual care.) As your president, he will defend your purchasing power to the death, with all the weasel words at his disposal, against the machinations of the Republicans. Because it's not about him, altruistic fellow that he is. It's about you, the insurance company consumers of America. From today's weekly radio address:
Your health insurance isn’t something to play politics with.  Our economy isn’t something to play politics with.  This isn’t a game.  This is about the economic security of millions of families.
See, in the states where governors and legislatures and insurers are working together to implement this law properly – states like California, New York, Colorado and Maryland – competition and consumer choice are actually making insurance affordable. 
So I’m going to keep doing everything in my power to make sure this law works as it’s supposed to.  Because in the United States of America, health insurance isn’t a privilege – it is your right.  And we’re going to keep it that way. 
Got that? Instead of saying your actual health is nothing to play politics with, he downgrades it to your health insurance being nothing to play politics with. The ability to pay for your sickness trumps the horrible fact that you're sick to begin with and that in a humane world, would not have to pay a middleman the price of getting better or preventing disease.

We'll know in a couple of months how successful or unsuccessful the big rollout of Obamacare is going to be. My overall opinion of it remains unchanged -- that it's a huge giveaway to the private insurance predators, but that a few lucky duckies (rich people with pre-existing conditions, uninsured twenty-something spawn of insured rich people, near-poor people in a handful of blue states newly qualifying for Medicaid) will benefit. So I am not calling for its repeal, as are the Republican nihilists. Because we would replace it with exactly nothing.

 And, I still hold out some faint hope that Obamacare will turn out to be a sort of gateway drug. Just as the pot-deprived of America are now turning envious, un-bloodshot eyes to Washington State and Colorado and their public hemp fests, the health care-deprived will notice how much better things are in New York and California, and demand their own medical care fixes. The insurance predators and investment class will eventually realize the profits aren't worth the headaches and sink their cash into more lucrative enterprises, like endless war and domestic surveillance. And bit by bit, we will get Medicare for All. At least, that is my pipe dream.

But that doesn't make me any less disgusted with the way Obama persists in framing this issue in free market, rather than in humanistic terms. It doesn't make me any less disgusted that the needs of greedy capitalists always trump the needs of the citizens in this sham of a democracy.

The United States has the most expensive health care system in the world, with some of the worst results in terms of morbidity and mortality. Obamacare, in the first year, is estimated to "cover" only four million people out of an uninsured population of some 50 million. Predatory private insurance bureaucracy and paperwork consume one-third  of every health care dollar. As Physicians for a National Health Program note, a single payer system would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

But remember, people. Barack Obama is fighting for your right to enrich the profiteers, all the way to the post-presidency bank.


Pearl said...

Karen, thank you for an excellent column about health care in America. I was personally aware of the differences between the Canadian health care system and that of the U.S. during the years we travelled back and forth to Florida
from Canada during my husband's retirement years. We used our U.S. Medicare coverage in Florida because the costs involved were sufficiently inflated that we could not be adequately covered by our Canadian plan. It was obvious, especially during serious needs such as surgery that the differences in costs were enormous. I am mentioning this because you had a comment in Krugman's last column that suggested "Decrease the Medicare age
until everybody is covered at birth". Since U.S Medicare is run on an
unregulated profit system in purchasing equipment, paying doctor's salaries, hospital costs, etc. it is already having to make cutbacks to the Seniors that now qualify forcing many to apply for Medicaid which is already facing financial and other problems The Canadian system is government regulated regarding physicians salaries, hospital costs, drug requirements, purchase and use of medical equipment such as expensive diagnostic machinery and
since the tax system covers costs, it is viable for all legal residents. Not
until the basis of where and how the money to cover U.S. Medicare is changed and government regulated can it provide proper medical coverage for all its people.

Likewise, Obamacare and new special provisions which involve the private
insurance sector are unworkable with future changes and delays already
happening. We should be pushing for Universal health care and believing that supporting Obamacare will lead to that result is not feasible. It is obvious from the responses by citizens to various articles and reports on medical costs and coverage, that there is a great deal of anger and frustration
going on which I hope will eventually force major and basic changes. But
that may be a long time coming unfortunately, as long as we are saddled bylow level leadership of a president and Congress in power.

Zee said...

@Karen and @Pearl--

I am not sure that I understand the “ins-and-outs” between Medicare and a Canadian-style, single-payer system. But I do know that the current American health care system—with its third-party, for-profit, insurance company “intermediaries”—is broken. Health care is one of those things that is just too big for the American people to handle on their own with the “he'p” of private, for-profit, insurance companies.

Like you, Karen, I'm not hoping that the Republicans—Conservatives in Name Only—will defund or repeal ObummerCare. I'm hoping that they will actually force it to proceed full-throttle as the law requires and that it will collapse under its own weight of regulations, poor planning, high premium costs, and state-to-state disparities.

I am not at all confident that people will look at New York and California with envy when they see their dwindling choices and escalating costs. From what I read, more and more major companies are pulling out of the exchanges, and those that remain are going to the hated HMO model to keep costs down. You WON'T be able to choose your doctor, and whatever QUACK you may have the bad fortune to be assigned will be your gatekeeper for any further services. (I've seen someone die at the hands of a so-called “doctor” who insisted that his patient did not need antibiotics for a sinus infection, or referral to a specialist. Gargling with aspirin was all that was really needed to fix things. Until the sinus infection turned into a brain infection, and our friend died. Doctors are not gods; they are just oft-flawed technicians.)

While I am thankfully NOT in an HMO-style plan, those of my peers with families who elected such a plan in order to lower their costs have generally, and, often deeply, regretted it. The disparity in “gatekeeping” from doc to doc is horrendous.

We'll see how this goes when it “goes national.”

As I understand it, under both Medicare and the Canadian system, one can at least choose one's own physician, even if waiting times for crucial services can be unconscionably long under the Canadian system. And as I further understand it, Canada is reluctantly experimenting with private, supplemental insurance, just as Medicare allows.

Correct me if I am wrong, Pearl or Jay.

Patricia said...

My real problem is that healthcare is an INDUSTRY, that makes a profit from SICK PEOPLE. How disgusting is that? I haven't been able to afford health insurance since my husband died 12 years ago. I am probably one of the working poor that Obamacare might help. But I am not betting on it, as I still don't know what Governor Christie will do, since he's too busy spending Sandy money on tourism ads with his face on it.
I talked to a doctor I know about the ACA, he said pretty much what you did Karen, along with something else. He will not take Medicaid patients and he won't take any ACA patients either. He did say that there would be more "Medicaid mills" with substandard care. The reason doctors don't like it is because it pays too little. I guess we're all going to have to take our medicine, no matter how disgusting it tastes.

Zee said...


The comments that you provide from your discussion of Obamacare with a physician acquaintance are really—and sadly—illuminating. PPACA will be a disaster for all concerned, even those who are newly insured owing to poverty or pre-existing conditions, and including the much-touted government “subsidies.”

I actually am somewhat sympathetic to doctors who have decided not to accept Medicaid and PPACA patients “because [they] pay too little.” When a physician graduates from med school with a median debt of between $119K and $150K, and possibly even higher,

well, making money becomes a priority, doesn't it, especially after all those long hours, hard work and future professional risks?

It is simply human nature that physicians will expect some kind of extra remuneration for their efforts—and for the increasing requirement of infallible performance on the part of their patients. (Think: Malpractice insurance and ruinous, frivolous lawsuits.)

If I had worked that hard, I would expect to live in a nice(r) house and drive a nice(r) car, too, as compensation for the attendant risks. Instead, I chose a physical science that involved much less work and much less professional risk, where nothing more litigious than a piece of rock, ceramic or powder ever got “injured.” (And I still got a nice-enough house, car and pension.)

If Medicaid and PPACA don't meet those financial expectations as a trade-off against the risk, well, the docs will mostly prefer (unless they are all related to Mother Theresa) to accept patients covered by more lucrative group insurance provided by private insurers, and, perhaps, Medicare. Though I have read that increasing numbers of physicians no longer want to accept Medicare patients, either, owing to the ridiculous paperwork requirement; remuneration evidently is not at issue, there.

Stories conflict as to how much those covered by subsidized individual “PPACA exchange policies” will cost. In her article, Karen suggests that those who live in New York, California, Colorado and Maryland will be happy with the outcome.

Yet in this same forum I cited a New York Times article recently that, I maintain, showed what a ripoff the individual exchange policies will be compared to private group insurance or Medicare, while factoring in the government subsidy—in New York State:

No one challenged my calculations, so I think that they were correct. So which is it? Depending upon where one lives, will one really be happy with PPACA, or not-so-happy?

I'm with Karen. I hope that PPACA will be a “gateway drug”—to single-payer.

Meanwhile, good luck to those who will be subject to ObummerCare, something that is so “wonderful” that our Congresscritters and their staff have run from it like the plague—with Obummer's dispensation.

Zee said...

And so, the "secondary" harassment starts:

"Glenn Greenwald's partner detained at Heathrow airport for nine hours...

David Miranda, partner of Guardian interviewer of whistleblower Edward Snowden, questioned under Terrorism Act...

David Miranda, who lives with Glenn Greenwald, was returning from a trip to Berlin when he was stopped by officers at 8.05am and informed that he was to be questioned under schedule 7 of the Terrorism Act 2000. The controversial law, which applies only at airports, ports and border areas, allows officers to stop, search, question and detain individuals...

Miranda was released, but officials confiscated electronics equipment including his mobile phone, laptop, camera, memory sticks, DVDs and games consoles...

Schedule 7 of the Terrorism Act has been widely criticised for giving police broad powers under the guise of anti-terror legislation to stop and search individuals without prior authorisation or reasonable suspicion – setting it apart from other police powers.

Those stopped have no automatic right to legal advice and it is a criminal offence to refuse to co-operate with questioning under schedule 7, which critics say is a curtailment of the right to silence"
(My bold emphasis.)

"Schedule 7" sounds like something straight from the Gestapo!

We truly are doomed.

Zee said...

Oops! Wrong link:

Jay - Ottawa said...

The Affordable Care Act is a mare’s nest, another empty accomplishment for Obama’s legacy. Pity the administrators and health care workers forced to work within its confusions. Pity the patients, full of false hope, who will be searching for some way through it to receive timely and proper care.

A single payer plan, which has worked so well in other advanced countries, would have been simpler, cheaper and more effective, but the care and feeding of giant private health insurers was the main priority for this Administration. Instead of being trashed, the deplorable existing system was expanded and made compulsory. It is one more mechanism whereby the elite siphon money from the middle class to the superrich and giant corporations.

Statisticians within “Physicians for a National Health Program” (PNHP) reported that in 2001, about 50% of private bankruptcies were due to medical debt. Furthermore,

“Families in medical bankruptcy suffered many privations. In the 2 years before filing for
- 22% went without food
- 30% had a utility shut off
- 61% went without needed medical care
- 50% failed to fill a doctor’s prescription”

In recent years, private bankruptcies due to medical debt have climbed to at least 60%. The ACA is not geared to drive those figures down.

Noodge said...

Off topic, but........

Would you be a dear, Karen, and provide us with a link to the UMass study you cited in your excellent response to Krugman this morning?


Karen Garcia said...


Link to study: