When Paul Ryan was a teen, he fell in love with Ayn Rand. It appealed to his narcissism, as it did mine at that age. The difference between us is that I grew up and recognized the reality of the world around me. Paul Ryan still obsessively believes that if you got it, you deserve it. And if you don't, it's your own fault.
That spunky can do attitude defies the reality of living in capitalist America, where if you got it, you get more, and if you don't, it has gotten increasingly less likely that you ever will.
But Ryan is surrounded by like-minded haves, and like so many of our current members of Congress, just doesn't have any patience with the whiners and the takers who think they deserve things like housing and health care. To that end, he is determined to prove that what we all need is tough love, forcing us to choose whether we are going to survive. That philosophy has been echoed "bigly" by our incoming moron-in-chief, who believes he made it on his own, by virtue of his big brain and not his wealthy father and Vladimir Putin.
Republicans in the House have been chomping at the bit to get rid of Obamacare, and since they have been back in session they have shown a greater work ethic than they have for some years. They have detailed plans on how they can do away with the Affordable Care Act, in conjunction with the Senate and the Orange-Haired Idiot, who babbled at his press conference about how the bill would be repeal and replace, at the same time, maybe within a month, maybe within a week, maybe within the hour, maybe time traveling to 2010, you get the gist.
Way back in 2009, at the end of the last era in which Americans hung their hopes on an idiot with a clever and duplicitous campaign, the state of health care was shameful. To the point where Keith Olbermann, on MSNBC, had been highlighting and fundraising for Free Health Care Clinics. I recall my horror that so many were uninsured that -- in America -- they waited in hours-long lines to see a doctor. That so many diseases that could have been easily treated were left to fester, so many people made sicker and even left to die out of the greed and neglect that the wealthy and the corporate powers exercised.
A couple of weeks ago, I heard some privileged cretin (a republican member of Congress) talk about how we were just spoiled by being able to get health care whenever we needed it, because we never had to face the cost. He told the harrowing tale of his son falling and hurting his arm, and he and his wife deciding they would just ice the injury and wait a day to see if they needed to bring him to a doctor. What a guy.
A guy who has never had to watch a loved one get sicker, hoping that the tide will turn and they will get well without the exorbitant costs of medical care. A guy who is pretty damned out of touch with the extent of out of pocket costs involved with health care today. A guy who could get really fine medical care the next day if he chooses to wait to get his son looked at.
For that matter, there is a myth regarding all of us great mass of unwashed Americans that says that we demand to see a doctor whenever we feel a windchill. That we have nothing we would love to do more than wait in a waiting room at a doctor's office or a hospital, so we can suck up medical expenses. That it is our self-indulgence, and not the greed of the pharmaceutical industry, the mismanagement of our hospitals, the fact that many of us are forced to wait until a common condition becomes an expensive medical emergency, that has caused health care costs to skyrocket.
And people like Paul Ryan have swallowed the lies and distortions in order to continue to live in the pockets of their corporate donors.
Meanwhile, as Ryan and the right wingnuts work to take away health care from millions of Americans, they continue to carry the best taxpayer funded health insurance the country has to offer.
So why not insist that members of Congress be forced to accept whatever plan they chisel out of their rigid dogmatic principles? Of all of us, they can certainly better afford it. It may be a challenge to their fact-free ideology, and it might be tough for them to be living in the trenches having to make some of the same decisions the rest of us live with on a daily basis. But getting in touch with the unbearably high cost of private insurance just might convince them that the "r" word they are looking for is not "repeal" but "regulate."
If you have Obamacare, or insurance from the health care exchange, or from the Affordable Care Act, you may not know that they are all the same. This was one of many of those sleights of hand that republicans managed to pull off, while Democrats thought getting the work done for the people would be enough. I will assume that if you are reading my blog, you know these are all the same thing. But there are an awful lot of people out there who do not. And they will be tragically surprised to learn that the guys they voted for have taken away their health care. Right now, one of our tasks is simply to spread the word that whatever they call it, they are going to lose their affordable health insurance. Unless they speak up. And those rate hikes that incredibly happened just before the election? Democrats never let them know that it was a much smaller increase than we have seen before the ACA. Ooops.
In fact, this could be a great time to let people know how much better and cheaper single payer health insurance would be. If the Democrats would only. Because as long as the republicans are offering "repeal and replace" the thing to do is to offer Americans a "replace" that would work. Of course, it won't happen while the party of profit and destruction is running things, but if they heard some enthusiasm building up for a single payer plan, maybe backing off on the "repeal" wouldn't seem like such a bad idea.
Showing posts with label Single Payer. Show all posts
Showing posts with label Single Payer. Show all posts
Friday, January 13, 2017
Friday, December 6, 2013
Obamacare and the Rose-Colored Glasses
It's time to pause in my cheerleading for Obamacare and entertain a little reality check. Yes, Obamacare is better than nothing, but is it right that here in 2013 that should continue to be the mantra of the U.S. healthcare movement?
Once upon a time, on Long Island, I was a psychologist. As has been my pattern in my life, I was in the right place at the wrong time. The year I began my private practice, managed care was threatening to take over, promising false promises of great savings in healthcare costs and improved treatment. Psychology stood in the front lines of the managed care firing squad. By the time they were done with me, I had decided the only moral choice for me was to quit the couple of remaining groups I was in and just accept sliding fee scale payments. After that disastrous cut in income, I could afford to retire my practice and move south, and with relief left the field I once loved behind.
What I learned was that the insurance industry would always find a way. The government was always too many steps behind, and had too many naifs on one side and too many corrupt on the other. Medicare eventually was plundered to the point where there are now premiums, co-pays and in the end requires supplemental private insurance, a sweet deal for private insurers. Doctors and hospitals did not sit innocently by back in the Medicare heyday. If they could raise costs and collect more from Uncle Sam, they quickly did.
Medicaid has never, not ever, been more than a band-aid, and one that doesn't quite cover the wound. Back in my psychologist days, when private practitioners were charging up to $100 per 45 minute hour, Medicaid was paying out $20 and requiring a full 60-minute session. Along with the time it took to do bookkeeping and note-taking, and resubmitting all the claims that they had screwed up, lost, or otherwise refused to pay out. The end result of that, for me, was that I had my pick of patients, because no one else could be bothered. Hard work for little pay, just like Walmart and McDonald's.
So when President Obama and I insist that we must expand Medicaid, at least one of us knows that this is an insufficient solution to providing health care to Americans. And when we all scream about protecting our Medicare, our backsides are still unprotected from the insurance industry that has made additional coverage necessary.
As long as we in this country are unwilling to agree that health care is not a for-profit enterprise, we will continue to have inadequate, too expensive protection. And even when the government pays out, our tax dollars are going toward the fat and inefficient health care machine.
Do doctors make enough money? I don't know. I do know that on my insurance claim statement, the same Blue Cross that Congress has access to, the amount billed is considered the fantasy charge. Since the days of managed care, the insurance industry has been free to invent its own "customary charge" which sometimes reflects a more realistic amount, and sometimes is taken from billing structures from ancient history.
Do hospitals charge too much? It seems to me that a well run hospital is going to cost a lot of money, but what we have today is hospitals that cost a lot of money to run with inadequate staff on one side and ridiculous waste on the other.
The only reason that medical tests, medical instruments and pharmaceuticals cost as much as they do is because they can. Our government watches helplessly, when they are not colluding with all kinds of medical corporate interests, as industry gouges doctors, hospitals and consumers. They parrot lame excuses about the cost of research that don't seem to apply to most other consumer products, where research and competition go hand in hand. Our government resists providing much needed oversight and regulation for the same lame reasons.
So where does that leave us? With too many uninsured and the hope that we can at least let them have a band-aid for their troubles.
What should we do? Strong and common sense federal regulation has to happen for costs to go down. We have to get private industry out of health care. I believe that health care will work best on the state level, where there is real concern for the health and well-being of its citizens.
Vermont is taking the challenge. They have approved a single payer plan to be fully operational by 2017. Everyone covered, no premiums, co-pays or deductibles. A slight rise in taxes.
Cynical as I tend to be, I am feeling hopeful about this solution. This small state has its heart in the right place. They have Independent Bernie Sanders in the US Senate, and he is as progressive, outspoken, and uncorruptible as they come. When that works, I know that other states will be quick to come on board. Not my state, but still, it's a start.
Once upon a time, on Long Island, I was a psychologist. As has been my pattern in my life, I was in the right place at the wrong time. The year I began my private practice, managed care was threatening to take over, promising false promises of great savings in healthcare costs and improved treatment. Psychology stood in the front lines of the managed care firing squad. By the time they were done with me, I had decided the only moral choice for me was to quit the couple of remaining groups I was in and just accept sliding fee scale payments. After that disastrous cut in income, I could afford to retire my practice and move south, and with relief left the field I once loved behind.
What I learned was that the insurance industry would always find a way. The government was always too many steps behind, and had too many naifs on one side and too many corrupt on the other. Medicare eventually was plundered to the point where there are now premiums, co-pays and in the end requires supplemental private insurance, a sweet deal for private insurers. Doctors and hospitals did not sit innocently by back in the Medicare heyday. If they could raise costs and collect more from Uncle Sam, they quickly did.
Medicaid has never, not ever, been more than a band-aid, and one that doesn't quite cover the wound. Back in my psychologist days, when private practitioners were charging up to $100 per 45 minute hour, Medicaid was paying out $20 and requiring a full 60-minute session. Along with the time it took to do bookkeeping and note-taking, and resubmitting all the claims that they had screwed up, lost, or otherwise refused to pay out. The end result of that, for me, was that I had my pick of patients, because no one else could be bothered. Hard work for little pay, just like Walmart and McDonald's.
So when President Obama and I insist that we must expand Medicaid, at least one of us knows that this is an insufficient solution to providing health care to Americans. And when we all scream about protecting our Medicare, our backsides are still unprotected from the insurance industry that has made additional coverage necessary.
As long as we in this country are unwilling to agree that health care is not a for-profit enterprise, we will continue to have inadequate, too expensive protection. And even when the government pays out, our tax dollars are going toward the fat and inefficient health care machine.
Do doctors make enough money? I don't know. I do know that on my insurance claim statement, the same Blue Cross that Congress has access to, the amount billed is considered the fantasy charge. Since the days of managed care, the insurance industry has been free to invent its own "customary charge" which sometimes reflects a more realistic amount, and sometimes is taken from billing structures from ancient history.
Do hospitals charge too much? It seems to me that a well run hospital is going to cost a lot of money, but what we have today is hospitals that cost a lot of money to run with inadequate staff on one side and ridiculous waste on the other.
The only reason that medical tests, medical instruments and pharmaceuticals cost as much as they do is because they can. Our government watches helplessly, when they are not colluding with all kinds of medical corporate interests, as industry gouges doctors, hospitals and consumers. They parrot lame excuses about the cost of research that don't seem to apply to most other consumer products, where research and competition go hand in hand. Our government resists providing much needed oversight and regulation for the same lame reasons.
So where does that leave us? With too many uninsured and the hope that we can at least let them have a band-aid for their troubles.
What should we do? Strong and common sense federal regulation has to happen for costs to go down. We have to get private industry out of health care. I believe that health care will work best on the state level, where there is real concern for the health and well-being of its citizens.
Vermont is taking the challenge. They have approved a single payer plan to be fully operational by 2017. Everyone covered, no premiums, co-pays or deductibles. A slight rise in taxes.
Cynical as I tend to be, I am feeling hopeful about this solution. This small state has its heart in the right place. They have Independent Bernie Sanders in the US Senate, and he is as progressive, outspoken, and uncorruptible as they come. When that works, I know that other states will be quick to come on board. Not my state, but still, it's a start.
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