One toothache away from foreclosure

This morning  Paul Krugman makes a point everyone would be well advised to consider.

He suggests, and I agree, that as usual, the traditional media missed the importance of the Trina Bachtel story.

The tragic case of Trina Bachtel should and could have been an opportunity for the media to focus on the American healthcare catastrophe. Instead all the media discussed, was  whether Hillary Clinton embroidered or altered some the details.

I'm not surprised, nor should you be, that the media cares not a whit about the collapse of the U.S. healthcare system. We are accomplices because this is all we chatter about as well.

The American people have never been privy to many of the most disturbing images about Iraq (the carnage, the bodies of U.S. service men and women arriving at Dover, the gravely mutilated and dead Iraqis). The U.S. news media also doesn't want us to know very much about the greatest domestic shames of our generation, poverty, and the catastrophic collapse of the U.S. healthcare system.

As Krugman notes:

You may think that this was an extreme case, but stories like this are common in America.

. . .But are they really preventable? Yes. Stories like those of Trina Bachtel and Monique White are common in America, but don’t happen in any other rich country — because every other advanced nation has some form of universal health insurance. We should, too.

All of which makes the media circus of a few days ago truly shameful.

http://www.nytimes.com/...

Though I might be taken to task for citing Al Jezeera as a bona fide source for news, on occasion, they are a good resource for focusing a lens into the dark corners of life in our country.

In this clip, Al Jezeera is reporting about poverty in America and our high infant mortality rate.

The theory in the United States is, if you don't show the truth, then it doesn't exist. Right? Anyone remember how shocked we all were about "hidden" poverty in New Orleans after Katrina?

Here are some hidden Americans--Americans without access to healthcare.

Meet Mike Hull and his $6000.00 dental bill.

Please click this link for another heartbreaking and disgusting video of another American family without access to healthcare and facing foreclosure.

Here is an American family living in Colorado  facing bankruptcy and the loss of their home due to a medical crisis.

The Brigham's live in Colorado, I hope they will be able to join thousands of other sick Americans at the Democratic Convention.

You can be assured that most of those inside the convention hall have access to healthcare, while those outside don't.

Few options for the uninsured to get health care

STRASBURG – What the Brigham family does have is each other, even though they have lost a lot.

"It was our dream home. It was going to be our retirement," said Jay Brigham.

The lender foreclosed on the home they designed and built after the family went bankrupt.

Their money problems started after Jay Brigham woke up one morning with chest pains.

"Sure enough, I was having a pretty major heart attack," he said.

The $120,000 in hospital bills came while Jay and Marianne Brigham were working for themselves in construction. They didn't buy health insurance because business was down and health insurance costs were way up.

"Anywhere from $500 to $800 a month, minimum," said Marianne.

Five years later, the Brighams are still uninsured because they haven't been able to find jobs that offer health coverage. Because of their age and pre-existing conditions, insurance companies rejected their applications. Even through a state program for hard-to-insure people, they were told coverage would cost more than $1,000 a month.

http://www.9news.com/...

You will learn the horrible truth about the U.S. healthcare system by watching Frontline, this Tuesday, April 15th at 9PM EST.

FRONTLINE presents
SICK AROUND THE WORLD
Tuesday, April 15, 2008, at 9 P.M. ET on PBS

FRONTLINE TRAVELS TO FIVE COUNTRIES IN SEARCH OF A UNIVERSAL HEALTH CARE SYSTEM THAT COULD WORK IN THE U.S.

FRONTLINE teams up with T.R. Reid, a veteran foreign correspondent for The Washington Post, to find out how five other capitalist democracies--United Kingdom, Japan, Germany, Taiwan and Switzerland--deliver health care and what the United States might learn from their successes and their failures. In Sick Around the World, airing Tuesday, April 15, 2008, at 9 P.M. ET on PBS (check local listings), Reid turns up remarkable differences in how these countries handle health care--from Japan, where a night in a hospital can cost as little as $10, to Switzerland, where the president of the country tells Reid it would be a "huge scandal" if someone were to go bankrupt from medical bills.

http://www.pbs.org/...

And the universal healthcare system that would work in the U.S. is not what our two candidates are proposing--and they know it.

What will work, is no different from what the rest of the civilized world accepts as normal--a single-payer system.

When will Clinton and Obama decide to lead and tell the truth to the American people?

•  Imagine, this is what it's come to . . .

  you pay for your root canal or your heart treatment and you won't make the mortgage payment and will lose you house.

  And as you head to the post office on April 15th, ask yourself how you feel about the way our government is spending our fucking money?

  Also ask yourself, does it please you that your money is paying for heavily taxpayer-subsidized healthcare for your member of Congress, but you and I can't afford a root canal?

  by nyceve on Fri Apr 11, 2008 at 05:59:44 AM PDT

  •  But Krugman doesn't tell the whole truth

    Because private run insurance will always involve trying to pass the buck to someone else. We don't need universal insurance. We need universal health care.

    Even insured patients find themselves without care at critical times like when they get cancer and need advanced treatment.

    by FishOutofWater on Fri Apr 11, 2008 at 06:05:05 AM PDT

    •  this is absolutely true, Fish . .

      and I was wondering myself why Krugman used this language.

      We don't need universal insurance. We need universal health care.

      Maybe he's throwing in the towel in some fashion, he's conceding that we will have to accept private health insurance (as opposed to single-payer), at least at the beginning. I don't know.

      I also don't understand why he has a knife out for Obama?

      by nyceve on Fri Apr 11, 2008 at 06:12:39 AM PDT

      •  Economists hate "free riders". He likes mandates.

        However, free riders, generally healthy young people cause a tiny fraction of the costs of the health system. Economists want healthy young people to pay for the sick.

        The only fair solution is single payer, because mandated insurance will cause the insurance companies to design their plans to get those healthy young people and keep away the old and sick.

        In reality, none of the candidate's plans were very different. They are all starting points for a legislative effort.

        by FishOutofWater on Fri Apr 11, 2008 at 06:18:15 AM PDT

      •  krugman on single payer & obama

        Krugman is in the camp of single payer would be best in principle, but cannot be acheived politically. Therefore, he argues, since private insurers are with us even if we wish they were not, then only to get to 100% coverage is mandates. Therefore, Obama is fudging it when he claims his plan is universal and his ads that mimicked Harry & Louise were too much like Repuglican talking points. Similar to Obama's brief rhetoric against Edwards and "trial lawyers." And that from pure economist analysis (no politics, no real world analysis of what insurance companies actually do) mandate are only way to get to 100% coverage, if not single payer or some other automatic enrollment.

        Obamist argument would be that mandates are political poison. His plan is step in right direction. And if it turns out we need more later on, and privates have further proven to be bad, then we can take next step from a stronger position.

        Need to remember that Clinton's rhetoric and stated plans on many domestic issues IS more liberal then Obama. It's just that we don't trust her to follow through (plus on international & war she is to his right).

        by DrSteveB on Fri Apr 11, 2008 at 06:22:40 AM PDT

        •  Thanks Steve, so is PNHP . . .

          more in the Obama or Clinton camp?

          I recognize PNHP must detest both plans, but since you're tied into them, what's the word, if any, on the inside?  Of course, if you're at liberty to say.

          by nyceve on Fri Apr 11, 2008 at 06:47:39 AM PDT

          •  strictly non-partisan...

            really.
            The organization has NO leanings for either!
            Individual members all over the place...

            by DrSteveB on Fri Apr 11, 2008 at 07:17:07 AM PDT

          •  PNHP wants a single payer system, not a candidate

            PNHP doesn't like any of the candidates and for good reason... the incremental step reform strategy has a history of falling on its face.

            What about incremental reform of the health system?
            
            As a matter of policy, PNHP expressly opposes many so-called gradual steps towards single-payer. Many well-meaning supporters often push these bills as "feasible steps" to move us towards single-payer, but the history of these kinds of health reform efforts - Hawaii in 1974, Massachusetts in 1988, Oregon in 1989, Tennessee in 1992, Minnesota in 1992, Maine in 2003, etc. - shows that despite their claims of pragmatism, incremental reforms have consistently failed for more than three decades. Incremental reforms cannot garner administrative savings and redirect them to care. Hence they always founder on the shoals of cost. In addition, these reforms distract attention from the economically realistic, if politically challenging, option of single-payer reform.

            http://www.pnhp.org/...

            A Kossack by the name of Dallas Doc, I believe, made the point that under Obama's or Clinton's plan the government plan will wind up being for the poor and those with preexisting conditions and will provide much lower quality care.

            I think he described as a "medical apartheid" and given the current state of medicaid, I'm inclined to agree with him.

            PNHP makes the same argument:

            Why shouldn’t we let people buy better health care if they can afford it?

            Whenever we allow the wealthy to buy better care or jump the queue, health care for the rest of us suffers. If the wealthy are forced to rely on the same health system as the poor, they will use their political power to assure that the health system is well funded.

            Conversely, programs for the poor become poor programs. For instance, because Medicaid doesn’t serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered politically important.

            Moreover, when the wealthy jump the queue, it results in longer waits for others. Studies in New Zealand and Canada show that the growth of private care in parallel to the public system results in lengthening waits. Additionally, allowing the development of a parallel, private system for the wealthy means the creation of a permanent lobby for underfunding public care. Such underfunding increases the demand for private care.

            http://www.pnhp.org/...

            Analysis of 2008 candidates:
            http://www.pnhp.org/...

            Single-Payer FAQ
            http://www.pnhp.org/...

            After spending thousands of hours going over countless studies and the history of single payer systems around the globe, I'm inclined to agree with  them.

            Reform efforts will be a band aide approach and the rich will buy off the rethugs and DINOs in congress and they will ultimately fail.

            I know in business that if I walk into a negotiation knowing that my business needs X to survive and thrive, but I don't believe that I can get it... so I ask for half of X... what I usually will wind up with will even be less than that.

            Which ever candidate gets elected, ultimately it will take the efforts of the American people to keep spreading information and hammering on the politicians to get what they need.

            Ultimately, to me, it makes little difference if it is Obama or Clinton who gets elected. Any efforts that they make are going to have to be run through the gauntlet of congress and the lobbyist.

            This may be a time of sea change and congressional reform may be possible too... certainly the situation is dire enough to warrant it and the fund raising models have changed forever.

            Politicians can see that candidates can raise vast sums of money with populist campaigns across the net that far exceed what the lobbyist contribute. Open secrets.org shows that while Obama's campaign is 99% funded through individual donors, Hillary, who accepts lobbyist donations, is 88% funded by small donors.

            The old model of peddling influence inside the beltway ultimately doesn't produce as much cash as going to the people with a populist campaign. The question is... can the American people realize their own power, can they get organized and informed enough to get what they want and need?

            Those are open questions... but one thing I do know is that if you start with the belief that you can't get what you want... you probably aren't going to get it.

            by Flint on Fri Apr 11, 2008 at 10:27:45 AM PDT

        •  Exactly

          Thanks for correctly explaining why Krugman is saying this. I'm angry that both Dem candidates' health care plans do not go far enough - but so far what I hear and read is that Clinton's plan is pushing for more than Obama's plan. It is not attacking a candidate - it is attacking their health care plan.

          I'm still looking for the candidate who takes a stand like Elizabeth Edwards did. I know that I am only one illness away from bankruptcy and I think it sucks that I will lose everything because of something that cannot be helped.

          by PAbluestater on Fri Apr 11, 2008 at 07:55:55 AM PDT

        •  Time will tell

          Recently there have been some news items about how the mandated insurance program in Massachusetts is working out. I don't know how unexpected they were, but there have been problems. In particular, the cost of subsidies given to those who can't afford market rates for insurance is projected to skyrocket over the next several years.

          Ergo, by the time Obama is in the White House (humor my optimism) and puts a health care plan on the table, say early 2010, the relative success or failure of mandates may be a lot more apparent.

          by Joe Bob on Fri Apr 11, 2008 at 08:13:42 AM PDT

          •  MA is NOT about the success of MANDATES

            but about the willingness to fund subsidies and pay them to for-profit insurance companies.  And whether the regulations contain the profit margins.  

            All other western countries have mandates.  Everyone is required to be covered.  In Canada the government is the only insurer for the basic needs.  Private insurers supply the frills like a private room, etc.   It IS universal health insurance.  Doctors and healthcare providers bill the government agency, not dozens of insurance companies.  And profits are a non-issue.  

            But mandates are part of the system.

            What will be apparent in MA is whether private insurance can actually provide the healthcare needed at a reasonable cost.  

            by pioneer111 on Fri Apr 11, 2008 at 08:56:24 AM PDT

            •  Mandates = compulsory private insurance.

              But without the strict regulations required to turn that into universal health care.

              At least, that seems to be how the term is used here in the U.S.

              by SciVo on Sat Apr 12, 2008 at 08:55:14 AM PDT

        •  What "cannot be achieved politically" means:

          To get single payer, we have to wipe out the health insurance industry.  With universal single payer coverage, there will be no place for them in our economy, unless they want to start offering discount plans for cosmetic surgery or somesuch.  

          The only way we can get the health care savings we need is to eliminate their profits and admin costs.  As long as they're getting their 20%, we won't have the resources to cover everyone.

          The health insurance industry will fight single payer and fight it hard because they are literally  fighting for survival.

          by sagra on Fri Apr 11, 2008 at 08:19:40 AM PDT

          •  health insurance must be destroyed

             45% of our medical dollars are already from the government, and the murder by spreadsheet industry already claims more than half of the other 55%(!)

             We face terrible economic times and it is going to be deeply unpopular to gut that industry, but they're as much a parasite as a tapeworm and they're killing us, slowly but surely.

            by Stranded Wind on Fri Apr 11, 2008 at 09:50:26 AM PDT

          •  We need single payer.

            Period.  If that causes the demise of these health insurance companies, well, too bad.  I am sorry for the employees involved, but all this mess is due to pure and simple greed by the owners and upper, upper management.  The employees do not share in the ever increasing millions taken home each year by the CEOs, CFOs, etc. as salary and bonuses. These heads of companies are not about to take any less..they just want more.

            I don't see how having the present insurance companies involved could possibly work.  The companies will just raise their rates to make up for any disparity in their bottom line.  The government (our tax dollars)will just get charged exhorbitant prices to cover as-now-uninsurable folks and those who cannot afford basic coverage.  Guess who still pays?  We do.  We will never be able to compete with the greed of corporatism.

            The guys at the top do not care one whit about the good of the people.  As long as they are in charge, We the People are sunk.  Both candidates need to come up with a more workable plan to cover everyone. I am a rabid Obama supporter but he needs to come up with a better plan.  And...Yes, He. Can.

            by RantNRaven on Fri Apr 11, 2008 at 09:57:13 AM PDT

          •  The really inconvenient truths!

            The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 47 million without health coverage and millions more inadequately covered.

            This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

            http://www.pnhp.org/

            You can not get around those figures... the private for profit health care insurance industry must go.

            by Flint on Fri Apr 11, 2008 at 10:42:07 AM PDT

            •  AMEN AMEN THE PRIVATE FOR PROFIT HEALTH CARE

              THE PRIVATE FOR PROFIT HEALTH CARE INDUSTRY MUST GO!!!!

              by Yearn For Liberty on Fri Apr 11, 2008 at 11:07:46 AM PDT

        •  I think this

          a great assessment. Thanks.

          by mbair on Fri Apr 11, 2008 at 09:08:19 AM PDT

      •  I'll take a "stab" at it.

        There is a big difference between care and coverage. While there are many strengths to a single-payer system this is one of them. Single-payer systems mandate minimum care requirements for subscribers. You have a right to certain services and that right extends across the boards to everyone in the system.

        Krugman is not happy with Obama and has been attacking him since early last fall on health care. He's decidedly partisan for Clinton now and often gives her the "more progressive policy" award. I recall reading about the mortgage crisis speeches from all three majors. Clinton got the Krugman nod in that column on that issue as well.

        I don't know what Krugman trying to do, if he's got an ulterior motive or not. He's written disparagingly of Obama supporters too and not in a subtle way either. Even in this column he slams them.

        And though I think that single-payer is a great choice for health care reform, I think we should recognize as a party that we're not running on that this year. We're going with the Obama or Clinton plan this time and neither are even remotely a true single-payer delivery system for care.  

        by mbair on Fri Apr 11, 2008 at 09:01:42 AM PDT

      •  It may be that he may have missed it

        himself. He may mean universal health care but also fell into the trap of calling it universal insurance/coverage.

        by TexDem on Fri Apr 11, 2008 at 12:03:16 PM PDT

    •  Well said Fish.

      We don't need universal insurance. We need universal health care.

      Right the fuck on!

      Iraq Moratorium

      by One Pissed Off Liberal on Fri Apr 11, 2008 at 06:17:46 AM PDT

      •  I disagree

        Step 1:  Put EVERYONE on Medicare.

        Step 2:  Any doctors who don't want to accept Medicare can operate cash-only.  I doubt there'd be too many.

        by Randomfactor on Fri Apr 11, 2008 at 08:17:30 AM PDT

    •  "Sicko" was exactly about this

      I remember going to see Michael Moore's "Sicko" and being livid, as were the other people in the packed movie theatre.  But, as we can see, nothing has changed.  It gets worse every day. It's about U.S. attitude--we worry about ourselves and to hell with our brothers and sisters.  Where there is universal health care, that attitude is different. The disparity in America between the rich and everyone else is striking. I consider my husband and I to be fairly smart when it comes to our future finances.  He would like to retire next year, and we would have a good income, but because he's not yet 65 and eligible for Medicare (which costs almost $300 a month if you want good coverage) he would have to pay at least $700 for COBRA from his company, and that's just for him, not me.  That eats way into our income.  I'm not complaining--we are very lucky. I cannot imagine the pain of those who are not so lucky--we ought to be ashamed, but alas, those at the top don't give a rat's ass.

      by lutznancy on Fri Apr 11, 2008 at 06:59:58 AM PDT

      •  I hope they show SICKO on TV before election

        I wish more people would watch this movie, then I wonder if any major network CBS, NBC, ABC would have the guts to televise this.

        by PAbluestater on Fri Apr 11, 2008 at 08:00:09 AM PDT

        •  Don't count on any network to air Sicko

          Just watch an evening of TV on any channel and note the number of ads for pharmaceuticals and HMOs.  

          These corporate rats will band together until the ship sinks.

          by Ammo Hauler on Fri Apr 11, 2008 at 11:14:37 AM PDT

    •  Well, it actually is INSURANCE

      No matter how you look at it, the purpose of an INSURANCE policy is to spread risk among a large group. Everyone pays a little bit into the fund, and the fund pays for the catastrofic costs to the few.

      That's how insurers work, and that's how a healthcare system works. You can fund it through taxes and administer through a federal bureaucracy, or you can fund it through private insurance premiums and administer through private insurers, or the mix of the two. It's six on one and half a dozen on the other if you remove the incentive and the ability to weed out the sick and stiff providers.

      If under the healthcare legislation any provider must accept any application - cancer or not - for a nominal fee common in a geographic area with a mandated level of coverage AT LEAST equal to Medicare, then you could go with a federal agency as the default insurer or let private carriers compete based on their customer service and perks that they wish to provide.

      You also need to revoke their ability to decline claims, except through the review by a federal appeals board (to make that point stick, require that the payment be made on demand and allow chargebacks if the appeal succeeds).

      However, to be successful, you must not allow healthy people to opt out. Anyone getting income must pay into the fund, just like Medicare. You can do it via mandates, or you can do it via taxes - except that it is difficult to coordinate the latter with private carriers, which will probably be required in one way or another to make this politically possible.

      by mgoltsman on Fri Apr 11, 2008 at 07:08:00 AM PDT

      •  universal coverage is cheaper

        because you limit so many overhead costs - profit to insurers - cost to healthcare providers (additional staff which knowledge to process - and reprocess claims)

        At least that's how it seems to me. There is so much additional overhead with insurance companies in the fray - and even more so because there are so many different insurers.

        by biscobosco on Fri Apr 11, 2008 at 08:40:14 AM PDT

        •  The overhead is not because of private insurers

          but because of the way they are allowed to operate - they are allowed to cherry-pick subscribers and then toss them to the curb when they actually need services, they are allowed to stiff providers left and right, and they have a constrained enough market to engage in implicit price-fixing.

          If regulations prevent cherry-picking, aggressively protect providers from being stiffed, and dictate a competitive environment, private players can be just as efficient as public ones. For instance, making Medicare an available option for everyone at a nominal cost will prevent any insurance carrier from charging much more without offering significant value-add.

          by mgoltsman on Fri Apr 11, 2008 at 12:16:17 PM PDT

          •  I dont believe you

            support your claims.
            You do not in any way address the problem of health care providers having to deal with a dizzying array of insurers, all with different requirements, procedures, covered expenses, etc, etc.

            Medicare part D is an example of what you mention, and it has been an abysmal failure.  It has been bloated and expensive, complicated and terrible.

            Participating Insurers must cover medicare part D clients - but there is such a proliferation of insurers, all with differing plans it is terrible for the customers, who are, by definition sick and elderly people. Insurers may not "kick people off plans" - But they can and do change the formulary in mid-stream, have customer help lines which are understaffed, have confusing sign up procedures, delay payment to providers, and in short, engage in all the tricks of the trade which keep their costs low and profits high.

            Federally mandated private insurance is a boondoggle. It causes more waste, because now you have two layers of administration instead of one.

            You have understaffed federal government attempting oversight and regulation, and you have insurance companies trying to push the rules to  the limit to make a profit.

            The "free market" has been shown over and over to be an expensive and inefficent means for providing health care for an entire nation.

            That is because health care is a complex "system" not a set of packaged goods or commodities which are interchangable.

            by biscobosco on Fri Apr 11, 2008 at 12:48:54 PM PDT

            •  Medicare D is a bad example

              That's a set of regulations written by the industry. By definition, anything passed under Bush administration and Republican Congress cannot be an example of a good public policy.

              Medicare D would be an OK system (I think - not an expert by any stretch) if the insurers were required to pay up and appeal instead of denying and forcing clients/providers to beat money out of them at considerable expense; if the formularies remained fixed; if there were some standardized procedures for interaction between providers, users and isnurers; and, most importantly, if the Medicare were allowed to compete against private insurers to make sure they don't get too greedy lest everyone defect to Medicare next year. Like I said, private providers can be functional when appropriately regulated, but please don't bring up anything signed by Bush's crayon as even an attempt at meaningful regulation.

              by mgoltsman on Fri Apr 11, 2008 at 09:05:31 PM PDT

              •  But they can't be "appropriately regulated" here

                ...because of activist judges creating corporate personhood and turning the influence of corporate money in our politics into constitutionally protected speech. The fox has a key to the henhouse. Either we take away the key or we shoot the fox; anything else is ultimately doomed to fail.

                by SciVo on Sat Apr 12, 2008 at 09:05:09 AM PDT

      •  If you fund it through taxes,

        the burden is exactly as progressive as the tax. The poor get coverage even if they are unable to pay or pay very little tax. The 20-something making $25,000 a year is paying more, but not much.

        If you use a mandate, the poor are given help, which feels like a handout. The 20ish, $25,000 guy is probably getting NO help, and the mandate is forcing him to pay money he can't afford, or be a criminal and face penalties. Penalties that no one wants to talk about. If there's no direct penalty, then the mandate is toothless. Penalty or no, the poor schmuck is a crook, and feels like one.

        Hardly six of one, half dozen of another.

        by davewill on Fri Apr 11, 2008 at 12:19:51 PM PDT

    •  Yeah. you're right

      This is the care-coverage debate that we really need to be having. And as far as the uninsured or underinsured, paying a junk policy, just look at the one issue of pre-existing conditions. The fact that denial of coverage due to a PEC is legal is one of the biggest disgraces we have in this country.

      by mbair on Fri Apr 11, 2008 at 09:05:37 AM PDT

  •  i liked this quote in his column

    But politics is supposed to be about more than cheering your team and jeering the other side. It’s supposed to be about changing the country for the better.

    And if being a progressive means anything, it means believing that we need universal health care.

    insurance companies are greedy amoebas, imho.  

    by jlms qkw on Fri Apr 11, 2008 at 06:06:52 AM PDT

    •  So is every other business

      insurance companies are greedy amoebas, imho.

      That's what we have (or should have) regulations for. The purpose of any business is to get out more than you put in, and as much more as possible I might add. Thus inevitably somebody is screwed. The regulations is what protects the business environment from excesses such as monopolistic or deceptive business practices or things harmful to the common good such as pollution environmental degradation.

      by mgoltsman on Fri Apr 11, 2008 at 07:15:38 AM PDT

      •  The reality is that there are many things that

        the private sector can do quite well. I would not like to see the federal or state government selling me a TV set. We need regulations to make sure that when I pay for a TV, I actually get what I pay for.

        There are other services that private companies don't provide as well. In the early years of this country, we had private fire companies in Phila. That did not work out well, and now we have fire protection provided by the cities. At present, private health insurance companies can cherry-pick, deny coverage, and charge large overheads. Medicare has a 3% overhead cost. That's why I favor single payer. There may be a role for private firms in areas like claims processing, but, right now, even if we had universal insurance through private companies we would not have universal health care. There are simply too many loopholes for pre-existing conditions, etc. Many folks who are bankrupted by medical bills actually have insurance.

        by blue jersey mom on Fri Apr 11, 2008 at 07:53:13 AM PDT

        •  Doesn't have to be that way

          If you mandate that all applications must be accepted at the same rate, and all medical claims must be paid, I don't really care if the pool of money and the organization handling it are public or private. What matters is the rules by which everyone plays. It would be nice to have a federal alternative such as Medicare-for-all, but I think even without it a properly regulated private medical insurance industry can be effective. What is the real poison is the mantra that regulations are bad because they increas costs and do nothing else. And that's true in every industry, just more visible in a forced-participation industry like medical insurance.

          by mgoltsman on Fri Apr 11, 2008 at 08:04:00 AM PDT

          •  Theoretically, it may not make a difference,

            but, in practice, there is a big difference. My mom is nearly 90. she is on medicare (plus a supplemental from her former job), and she has high medical expenses. I have never had a payment issue with medicare. I work for an employer that provides good private insurance. Every time I make a claim, I am forced to jump through hoops. the folks at the private insurance companies will tell you that they are just trying to protect their stock holders against improper claims, but, in reality, they are trying hard to shift the cost to someone else. An example, in 2005 my son (then an undergraduate) cut his hand moving back into his down. We made all the right phone calls. He needed stiches and went to the ER. I paid the co-pay. for the past nearly THREE years the ins. co. has tried to stick the hospital with the bill (after I refused to pay). I am not sure that regulation alone will fix this, since denying claims increases a for-profit company's bottom line.

            by blue jersey mom on Fri Apr 11, 2008 at 08:13:24 AM PDT

            •  My spouse is on Medicare

              ...and has INCREDIBLY high medical expenses.  I have seldom had any problems (we just got a bill yesterday that I believe is a mistake, because my insurance is secondary to Medicare).

              Put everyone on Medicare, outlaw Medicare C.

              by Randomfactor on Fri Apr 11, 2008 at 08:19:52 AM PDT

            •  A family member

              had open heart surgery, followed by 40 days in ICU before she died.  She was covered by medicare and by AARP gap insurance. My family paid not one dime out of pocket. Everything was covered.

              So what's the problem with the medicare model? If there is one. I don't see it.

              by virginwoolf on Fri Apr 11, 2008 at 09:13:59 AM PDT

            •  So make them pay by default

              What I suggested is they have to pay all claims and can get reimbursed by providers if they appeal to a federal appeals board and their appeal is granted. That's the only way to do it or they will string you along as long as they can just to collect interest on the pending payments.

              If the regulations are such that if the check is not into the provider by 30 days from filing of the claim there is an automatic judgement against them and a sanction barring them from making appeals for 30 days, all of the sudden they will sooner cut their dividends than miss a claim payment.

              by mgoltsman on Fri Apr 11, 2008 at 12:05:04 PM PDT

          •  public vs private matters

            private insurers are working for a profit
            public agency is working to achieve maximum coverage at minimum cost without profit.

            Because single payer simplifies many aspects of health coverage (we will put many medical billing specialists out of work, as well as many RN's who work for insurance companies denying claims  managing care)

            Maybe we can retrain these people to actually provide health care! what a concept.

            by biscobosco on Fri Apr 11, 2008 at 08:44:05 AM PDT

            •  The nurses can go back to working with patients

              to help ease the nursing shortages!

              by LucyTooners on Fri Apr 11, 2008 at 10:04:43 AM PDT

            •  I have no problem with people making profits

              by providing valuable services. If regulations dictate appropriate handling of claims and appropriate access without discrimination, I have no problem with insurers competing based on value-adds such as customer service, supplementary services and what not. The problem is not profit (although at 30% it is ridiculous) but lack of enforced standards for services provided to generate the said profit.

              by mgoltsman on Fri Apr 11, 2008 at 12:09:58 PM PDT

  •  1/2 to 2/3 of bankruptcies tied to health costs

    prior to the current mortgage crisis, the data was showing 1/2 (2/3?) of bankruptcies tied to families out of pocket health costs, with most of those folks HAVING insurance... but coverage to crappy to really cover what they needed when disaster struck.

    by DrSteveB on Fri Apr 11, 2008 at 06:15:38 AM PDT

    •  Even with the change in bankruptcy law

      with catastrophic medical expenses it is still your friend and usually the only way to keep a home.

      by snackdoodle on Fri Apr 11, 2008 at 06:41:07 AM PDT

      •  Bankruptcy Court

        IS the Bush Administration's federal program for medical coverage.

        by Randomfactor on Fri Apr 11, 2008 at 08:20:28 AM PDT

    •  Along with the bankruptcy

      Your credit history is ruined.
      That makes it hard to get a job.
      You lose your house.
      They check your credit to rent.
      It becomes a vicious cycle.

      And, forget disability or Workman's Comp

      All doors are closed.

      by redtex on Fri Apr 11, 2008 at 09:49:41 AM PDT

  •  I don't have to imagine.

    Been there, done that.

    Couldn't afford the t-shirt.

    by xxdr zombiexx on Fri Apr 11, 2008 at 06:48:41 AM PDT

    •  Still there, doing that

      Got the toothache. Luckily no mortgage to foreclose on.

      by kyril on Fri Apr 11, 2008 at 10:28:03 AM PDT

  •  Thanks for this, nyceve.

    This topic all too often gets caught up in partisan (and intra-party) politics.  I'm guilty of this myself.

    What we fail to understand when we view this from a partisan lens is that while we debate, real people are being affected every day.

    I hope whoever is the next Democratic president uses stories like this in Congress to push the health care agenda forward.

    We're in an age now where it isn't just the poor or homeless that are uninsured.  There's some middle and upper-middle class creep, and it's going to get worse.

    Thank you for continuing to bring this to everybody's attention.

    Tipped & rec'd.

    by DemocraticOz on Fri Apr 11, 2008 at 06:50:19 AM PDT

  •  Thanks, Eve.

    Great work, as usual.

    Hope you get a chance to check out Elizabeth Edwards' when she is writing on health care at her bew blog:

    April 8, 2008

    The Center for American Progress today announced that Elizabeth Edwards, New York Times best-selling author, attorney, and advocate, will be joining the Center as a Senior Fellow.

    Mrs. Edwards will be working on health care issues and will also write occasionally for the "Wonk Room," the Center for American Progress Action Fund's newly-launched, first-of-its-kind policy rapid-response blog. "Elizabeth is a woman of extraordinary talent, knowledge, and grace," said John Podesta, President of CAP and CAPAF. "She has proven herself to be one of the most effective, tenacious, and caring spokespeople for progressive policies in the country and it is a distinct honor to have her join the Center for American Progress. We are thrilled to have her bring her talent and commitment to CAP."

    Mrs. Edwards commented on her new position; "As many can attest, I have an opinion on everything. But I am particularly concerned about the state of health care in America and I am grateful to CAP for giving me the chance to continue to advocate for universal and quality health care coverage for all."

    In addition to blogging for the Wonk Room, Mrs. Edwards will host policy forums to discuss issues important to hard-working Americans and central to the public policy debate.

    I bet you can have a great conversation with her on that blog.

    by TomP on Fri Apr 11, 2008 at 06:57:01 AM PDT

  •  I'm constantly re-surprised at how many

    patients I see in the ER for dental complaints. A small percentage are malingerers looking for narcotics, (which makes life difficult for the rest of them, since some of my colleagues are suspicious of anyone who's main complaint is pain,) but most of them are victims of the high cost of dental care. Having Medical Assistance doesn't help much, since the reimbursement is so low that virtually no private dentist will take new MA patients.
         There's only so much I can do in the ER...I can do a dental injection to numb the area for 8-12 hours, I can prescribe antibiotics which will, in a few days, cool down the infection that brings on the severe pain and buy them a few weeks or a month, and I can prescribe pain pills. I can't fix the underlying problem, and I have to tell people that it's the same as if their car broke down. They simply have to find the money somewhere for the dentist. There are a few clinics around that accept MA from those who have it, and the University of Minnesota's Dental clinic, two hours away from here, does payment plans and charity care, but that's about it

    We are men of action; lies do not become us.

    by ER Doc on Fri Apr 11, 2008 at 07:24:05 AM PDT

    •  that was my son's experience yesterday

      except we were able to find a dentist to see him for the preliminaries.  Costs for an impacted wisdom tooth:

      initial exam  178.00
      two scripts:   82.00

      est. for oral surgeon  350-450 w/o sedation (add 250 for sedation)

      follow-up w. dentist for prophylaxis and periodontal cleaning estimate 357.

      total: 967.-1,067

      He makes about 12,000/year as a cook working all available hours.

      I would gladly pay it for him, but on SSDI, my income is only slightly better.

      As it is, I robbed PEter to pay Paul yesterday; he can come up with the necessary amt for the oral surgeon within the next month; and we hope he'll be able to come up with the remaining amt for the follow-up by mid-summer.  But basic health care (which includes dental health) should not be priced out of the ability of low income workers.

      However, I've also come to the conclusion that nothing is going to change until health care is beyond the financial means of those earning above the median income.

      We're getting closer to that breaking point.

      by keschen on Fri Apr 11, 2008 at 08:05:37 AM PDT

      •  Interesting prediction about the tipping point

        That's an interesting prediction about the tipping point. But isn't it possible that when that happens, they'll just make sure anyone above the median income can get healthcare? I mean they can keep it just below boiling point in order to spend the least amount of money on people.

        Somebody said recently that the US will not be a great country until it starts caring more about people than about money. We've been about money since nearly the day we were founded; the Boston Tea Party wasn't about human rights, it was about colonists not wanting to pay taxes. I don't know that it's possible for a majority of Americans to care about people more than money.

        A word after a word after a word is power. -- Margaret Atwood

        by tmo on Fri Apr 11, 2008 at 08:14:55 AM PDT

        •  Notice

          why we have decimalized currency but not decimalized measurement (metric system, preferably SI)?

          by movingforward on Fri Apr 11, 2008 at 09:09:21 AM PDT

        •  fatalistic me

          doesn't believe I will live long enough to see any change in our health delivery system--if any change should ever occur.

          I latch on to such theories in the hope that the future of my children may be somewhat less a crap-shoot.

          I do believe that if enough of the complacent I-ve-got-mine-screw-you population discovers the falsity of their belief that they are, indeed, covered by "health insurance" to the extent to protect them from losing all, then change has a greater chance of happening; however, I have no idea how large a percentage of the total population that needs to be.  I suspect the on-going melt-down in the overall economic health of the nation will escalate the perception that all is not well in Hooterville.  The flipside of that, of course, is that nation will have nothing but increasing debt left.

          Depressing as hell ...

          by keschen on Fri Apr 11, 2008 at 09:13:16 AM PDT

      •  The only thing standing between me and a kidney

        The only thing standing between me and a kidney is dental care.

        I need a kidney transplant, and I can't get one until I get a dental sign-off saying I'm free of infections. This means, in practice, that I actually have to get all my dental work done before the dentist will sign off on my statement. It's not just a matter of going to get an exam and being told I don't have any infections. No, I need to spend over $2500 out of pocket at the dentist first before I can get that kidney.

        I have dental insurance, and it's considered "good" since it pays almost 50% of some of my expenses up to $2,000 a year. REAL dental coverage is impossible to find. The university dental school isn't any cheaper, either; I've checked. The only way we are affording this is to put it on a line of credit, which I consider putting our future into hock.

        by Kitsap River on Fri Apr 11, 2008 at 10:02:27 AM PDT

    •  Unfortunately, some

      of us have no more options as to just where to get that money.  It's not a matter of being able to find it somewhere.  It's not anywhere.

      NO dentist I called would even accept payments.  They wanted me to get a "Care Credit Card", a dental/medical credit card.  Problem: People with less than good credit are not approved for this card.  

      I have a crown sitting in a dentist's office that I cannot go have put on because I can't yet afford the final amount owing.  Most dentists will not do root canals; they want you to go to an endodontist who can charge $2000 per tooth.  

      It is simply obscene.  Israel, which spends 50% of it's budget on the military, does better than this.

      by KibbutzAmiad on Fri Apr 11, 2008 at 08:09:32 AM PDT

      •  I'm in the same boat

        Luckily we already had CareCredit because of taking a dog for a very expensive vet bill (a week in the ICU) two years ago, and it was paid off.

        by Kitsap River on Fri Apr 11, 2008 at 10:04:39 AM PDT

    •  I think it's fascinating

      (in a most terrible way) that dental and optometric services are not considered "medical." Add to this the link between gum disease and heart disease.

      by elfling on Fri Apr 11, 2008 at 09:37:06 AM PDT

  •  Eve- That's where a Lot of credit card debt comes

    I had a similar situation and had to put $4,000 on a high interest credit card. I had to go back. I begged poverty so I got two fillings and a root canal for $362.00 from a nice Iranian Dentist.

    She was very good too. We are going to barter banners for dental work in the future. (Bomb Bomb Iran McCain needs to use is own Health Care plan)

    I have seen many people put medical bills on credit cards because the bill collectors for providers are just ruthless. Its a way top make the phone stop ringing. Unfortunately that situation become untenable as Credit Card thieves ratchet up rates to nose belled levels.

    As far as the candidates- they won't tell the truth because the truth is we have a corrupt congress who feels absolutely no motivation to turn down the 2.8 Billion dollars the Health care industry hands them.
    Granted there are some that are clean, but not enough to get through any major reform. Unfortunately, The Candidates can't call congress corrupt now especially since they are all SDs.

    They tend to blame lobbyists. But Lobbyists wouldn't exist if there was a willing counter party in congress.