Need for Vigilance Never Ends

Last summer I was in a meeting with leaders of Colorado health care organizations. I offered that one of the problems being discussed would not be a problem if the United States had true universal health care through a single-payer system. Actually, most of the problems under discussion weren't problems in most of our peer countries, where there's guaranteed affordable health care for all. A woman who heads a Colorado health care organization, a group nominally for helping people who aren't getting needed medical care, replied sarcastically, "Right, and we'd all be out of a job."

It's possible -- probable, in fact -- that she was joking, and that she simply has really bad timing and judgment.

The fact is that we should all be out of a job, and able to move on to other things. There's lots that needs fixing in this world, if that's our passion.

And in any case, as a story on Medical News Today points out, you can't ever fix anything once and for all, any more than you can clean the kitchen once and for all.

The center doesn't hold.

In "Bush Budget Cuts Will Cripple U.S. Teaching Hospitals And Erode Medical Progress," the news links to a press release from the Association of American Medical Colleges.

Cutting indirect medical education (IME) payments by more than 60 percent, combined with other Medicare cuts affecting all hospitals, will have devastating results. Millions of Medicare patients-as well as the uninsured, the disabled, and the severely ill-rely on teaching hospitals for health care and community services. Such unprecedented cuts to these institutions will endanger their ability to provide the full spectrum of patient care and treatment, erode their fragile trauma and emergency services, and impede the progress they have made in advancing the health of all Americans through education and medical research.

Bush has said that we have universal health care because, he says, people can always go to a hospital to be treated. Evidently he wants to put a stop to that.

In the earlier days of Bush, my husband used to ask the conservative business people with whom he worked to name something that Bush had done competently. The Bush supporters could never come up with anything.

(At this point, I suppose if you were set on judicial activism -- finding more judges who would elect illegitimate presidents, for instance, always side with corporate interests, not concern themselves with personal freedom, etc. -- a person might say that Bush has done a whiz bang job of appointing Supreme Court justices...)

In any case, because it's always easier to destroy than to build, there will always be the need for health care advocates. There were in Britain during and after Margaret Thatcher -- and now, because that country is facing a lobbying assault of privatizing interests.

Canada has groups to save their popular Medicare system.

We'll still need advocacy groups. Not to worry about your job.

Are Mormons Christian?

Are Mormons Christians?

I've heard my favorite literate priest explain how come not, in theological terms, but it seems pretty academic, doesn't it? After all, as far as I can tell, most Christians aren’t Christians. That's something that becomes even more clear once you begin advocating for guaranteed health care.

It's a cliche but worth repeating: How many Christians today would have anything to do with Christ? Some outcast figure who surrounded himself with poor people, prostitutes, and tax collectors? Some guy who argued against wealth creation, who told people to leave it all behind, and go follow him to some commune or something! The megachurch and born-agains think they’d know Jesus, but I have yet to be convinced.

The thing is, see, Jesus wouldn't have that halo -- the kind Bush sometimes wears. Karl Rove, the master, realized that if you put your guy in front of a circular, golden image, and then told the photogs where they could shoot from, you’d be sure to end up with a couple halo shots. Put that together with the fact that Bush himself believes that God fixed it so he could be president, and of course that chat between him and God about invading Iraq, and voila. You've got some pretty strong indications that someone more powerful than Florida voters wanted this man to be our decider.

I talked with a woman a month ago who was just back from missionary work in the Philippines. She believed that Bush was president because of divine providence. She thinks it might have been in order to make things so bad we'd all wake up.

Thanks, God. Back atcha.

Fooled a Couple Times

Remember Bush's push to privatize Social Security?

I didn't either -- but this letter-writer did:

Good letter to ed in Mpls Star Trib yesterday:

“We should be glad that our Social Security money wasn’t in the privatized hands of Citibank, Merrill Lynch and the other financial ‘wizards’ as President Bush had so strongly urged.”

Something that needs to be said repeatedly & loudly.

Best Bushenomics article ever

Larry Beinhart's article on Bushenomics at Alternet is well worth a read. Some of his points regarding the looting of our country that's taken place under Bush:

• With privatization, one dollar out of every three for direct military operations in Iraq and Afghanistan goes to private contractors like Halliburton and Blackwater.
• Most the assets of the United States, our collective wealth, could not be sold off in such a direct manner. The administration instead borrowed against them. They cut taxes while continuing to spend lavishly, creating debt. The debt is owed by all of us, the people of the United States.
• As measured by the GDP, the economy grew by 35 percent between 2001 and 2007.
• Job creation: In the first six years of the Clinton administration, 13.7 million jobs were created. In the same period, under Bush, only 3.7 million jobs were created. Barely keeping up with population growth.
• Median income: That's as opposed to average income (If Bill Gates walks into a bar with 10 people, the average income of everyone in the room goes up by $17,5000,000. But the median income just moves up half a notch, from between the fifth and sixth person, to the sixth person's income). From 2001 to 2005, median income, for people under 65, went down $2,000.
• America's businesses: Under Clinton, the Dow Jones went up 324 percent. Bush arrived in 2001. Since then the Dow Jones is up just 10 percent.
• So where is that 35 percent growth in the economy?

• The M3 took off like a rocket after 2001. The Fed stopped publishing the M3 in 2006. (The M1 is basically cash, plus checking and "current" accounts. The M2 adds savings accounts, money market accounts and CDs up to $100,000. The M3 adds in the big CDs, Eurodollar accounts and other large exotics.)
• The administration grew the economy (or at least the amount of money in circulation), without inflation... If [Bushenomics] had created business growth -- actual business, not just financial business -- that would have created jobs. Then there would have been inflationary pressure. If salaries for ordinary people go up, even a little, the total is a big sum. But due to free trade, outsourcing, bad economic policy, policies aimed at keeping wages down, and relentless union busting, good jobs were lost, to be replaced with low-wage jobs, when they were replaced at all.
• Finally, the Fed kept interest rates down. The supply of money was increased. The price of money was kept artificially low.
• With no new boom to invest in, businesses made loans.
• The loans grew into a bubble...
• No job growth, no business growth, no stock market growth, falling median incomes, disappearing pensions and health plans, and the fall of the dollar.
• The real solutions are pretty obvious and pretty simple. First, we have to make a choice: Do we want a sound economy for all of us and a strong America? Or do we want to have a few people of unlimited wealth who use that wealth, among other things, to control the government so that it helps them milk more money from the rest of us?
• In the real world, there are no such things as free markets. In the real world, business people manipulate and conspire to control markets, and governments both control and collude with business, while tax policies and government spending have a major affect on the economy.
• Simply giving money to rich people doesn't work. Bob Novak, the conservative commentator who calls the investor class "the most creative class," is flat out wrong.
• Money has no mind of its own. It has to be directed toward areas that will generate and support business and good jobs at good wages. As it happens, our economic goals are on the same road as the social good.
• The No. 1 target has to be alternative energy.
• The No. 2 target is infrastructure.
• The No. 3 target is health care.
• The No. 4 four target is a balanced budget.
• How can all this be done? Raising taxes. On the wealthy. And on corporations. That's not class warfare. That's simple practicality.

What's wrong with Medicare

Dennis Kucinich explains: "Medicare, essentially, is built to be efficient. And it has worked for many people... (But) the Bush administration's philosophy has been to move increasingly toward the privatization of Medicare. They don't want Medicare to work ... the (federal government) is trying to drive up the costs, (and) they're limiting reimbursements to physicians to discourage them from participating in the system."

Howie's rant!

Funny how these things work — Howie Wolf, MD, a longtime board member of Health Care for All Colorado, says he's not a writer, and I'm pretty sure he wrote this in a flush of annoyance (or rage!) last weekend, never expecting to get it published.

The Daily Camera, the publication of record for what the rest of Colorado calls the People's Republic of Boulder, did well to print it. He writes:

Thank you, President Bush.... As a family doctor with more than 45 years of experience working in our disjointed, unjust and inhumane health system, your endorsement of the status quo will surely help the efforts of those of us who are activists eager for major reform. The polls indicating that 65 percent to 70 percent of Americans favor a government-funded health-care system, plus the latest ABC News poll revealing diminished support for your leadership at a mere 20 percent gives me hope that again you are on the wrong side of an issue.

Bravo Howie! Keep writing!

Propaganda vs. whole systems thinking

Ivan Miller is one of the seven authors of single-payer proposals that were submitted to the Colorado 208 Commission — the Blue Ribbon Commission for Health Care Reform. His proposal was based on an idea that he explains in his book, Balanced Choice.

He notes that initial polling often shows an 60-70 percent of the public supporting progressive measures — like single-payer healthcare, a bottle bill, or other environmental and social justice proposals for the public good. Then there’s a massive campaign against it, beginning with focus groups figuring out just what works to make people question their best instincts. The proposals typically are defeated by 15 – 20 percent or more.

It's enough to make you wish TV had never been invented. The internet may already be changing things, but not for the majority of Americans who watch substantially more television than our counterparts in other Western democracies.

In his interview on Oprah, Michael Moore talked about how we Americans are different than citizens of other democracies, that we're more about "me" than "we." It may be that we have more distrust of government and more of an individualist ethic than the Brits — but it's hard to believe that we're more individualistic than the Australians — and they have universal healthcare.

The difference may be rather that our laws are screwed up. Moore also pointed out that it's illegal for corporations not to maximize their profits. Which should be illegal — after all, we don't force individuals to maximize their profits at the expense of doing the right thing.

One of the pundits on PBS tonight explained that in regard to the current dust-up on Bush's initiative on global warming, part of the problem is that Americans just want to fix the problem, while Europeans are big on process. (It could also be that it's arrogant for Bush to swagger in and demand that the rest of the leaders line up to learn his particular dance when he's been out to lunch for years while they've been working on their steps together.)

That problem — going after particular symptoms rather than fixing a bad system — is also part of the problem in the United States regarding healthcare. George Dunn, a Methodist minister on the board of Health Care for All Colorado, points out that Americans hate systems thinking — which is another way of saying process. So we end up with piecemeal solutions.

Crappy piecemeal solutions.

Why does this look like a cartoon?

It's from the front page of the Washington Post, my home page since I fully digested how badly the New York Times has handled journalism over the past decade or so. The Post hasn't been a lot better — marginal. But you can still read the columnists at the Post.

Bono looks like a tired dad with a graying, talkative 9-year-old. Or is it Boomhauer and Hank, from King of the Hill?

White House responds to citizens group

Michael Leavitt, Secretary of Health and Human Services, has responded to the Citizens Health Care Working Group and its proposal to bring universal healthcare to the United States.

"Well isn't that nice for you?" he said. Or words to that effect.

The working group was a massive, cross-country effort to collect input from Americans about what kind of healthcare system they'd like to see. The group did not originally offer the choice of single-payer universal healthcare, didn't include it in discussions — but people wouldn't shut up about it, and so single-payer got through the door after all.

According to Leavitt, in a letter reporting to Cheney regarding the administration response to the group: "The Working Group chose an approach based on mandates and government intervention rather than an approach emphasizing consumer choice and options."

"The major areas of disagreement," wrote Leavitt "include the establishment of a national commission to define a core health benefit — an idea that the Federal Government can choose the best set of benefits for all Americans."

Leavitt returns to this several times — the insurance industry and their political toadies evidently think it's a good talking point. "The Administration believes it would be impossible for a federally appointed board to define a single benefit package that is able to address the diverse needs of Americans in their different income, family, geography, and health circumstances."

What does that mean? Could it be that Congressmen in Washington, D.C., after the birth of, say, a child with hemophilia, would expect his baby to be cared for, but that a poor father in Montana wouldn't want the same thing?

Or does it mean that a healthy, married Virginia socialite, after suffering major injuries in a car accident, would prefer to have all her medical needs seen to, but that a diabetic single mom wouldn't want the same?

"It would be impossible for a federally appointed board to define a single benefit package that is able to address the diverse needs of Americans in their different income, family, geography, and health circumstances."

I find it difficult to come up with the words that can express my outrage at that idea.

Unruly mobsters

SadButTrue and the rest of the unruly mobsters at Les Enragés have an entertaining layout right now, including this. Those Canadians...

This poster reminds me that in early 2001 Bush said that he saw himself as a president in the mold of Harrison Ford, in Air Force One. And you could see that in the early years, couldn't you? He was like a little boy, strutting around, pretending to be Harrison Ford pretending to be a macho president.

Medicare cuts

The NYT reports that "President Bush will ask Congress in his budget next week to squeeze more than $70 billion of savings from Medicare and Medicaid over the next five years, administration officials and health care lobbyists said Thursday."

Mr. Bush is also expected to propose changes in the Children’s Health Insurance Program to sharpen its focus on low-income families. The changes could reduce federal payments to states that cover children with family incomes exceeding twice the poverty level. Under federal guidelines, a family of four is considered poor if its annual income is less than $20,650.

What should our response be?

Marilyn Clement, national coordinator of Healthcare-now writes, "if we allow the debate to go on in the beltway this year around trying to keep Bush from cutting $70 billion dollars from Medicare or other incremental cuts or $35 billion or a few bucks less and focus all of our time on trying to keep him from cutting dollars from Medicare and the CHIPS program for children rather than getting to the central debate, then the current (new) Congress will have lost its momentum and be subject to rebuke and likely defeat by the voters in 2008 who voted for real comprehensive change in 2006, not incremental reforms."

Just say no, congress.

Clements urges everyone to call or write Pelosi and other congressional leaders, as well as our own congresspeople, to urge support for HR 676, the improved Medicare for All bill — and to call our senators to ask them to create a complementary bill in the Senate.

Texas builds on failure

The Texas Health Institute, in what looks like a project funded by insurance companies and staffed by free-market idealogues (who have bent over, however, to funnel tax dollars to those helpful insurance companies), have come out with a plan to solve the healthcare crisis in Texas.

Now Texas has the wost numbers in the country — for health insurance as well as for just about everything else. It's something that should have given the rest of the country pause in 2000 when a Texas governor cheerleader ran for president.

A full quarter of Texans have no health coverage, and the situation is worsening.

It's odd how everywhere a draconian value system of "personal responsibility" has been put into place the result has been a great tolerance for inequality — along with great inequalities, pollution, high infant mortality, low education levels, and high teen pregnancy rates.

Basically the three horses of the Apocalypse. Which may be their goal...

For the rest of us, however, it's a big Whoops.

Looks like we're social beings dependent upon one after all, and needing to be reminded of the Golden Rule on a regular basis.

In any case, the Texas group had some "surprising" findings. Surprising, that is, to Texans.

My goodness, the uninsured work. Imagine that — 72 percent of them.

And they're not all poor. Forty percent of uninsured families earn more than $40,000 a year. Of course, with the average insurance cost for families at $11,000 that would take a full quarter of their income for health insurance. You pencil it out — does it work for your budget?

The institute came up with "A Vision for Change: Policy Solutions for Increasing Health Coverage in Texas."

The report could also have been titled "Band-aides for Now."

Twelve expensive band-aides, in fact — although a couple of them are well intentioned and workable in a better system. Like encouraging expansion of healthcare centers and a primary care "medical home."

Most of the measures, though, have to do with state money for private gain:
• like employer tax credits or
• replacing the state's current reinsurance program — lowering insurance companies' risk;

or with mandating private money goes to insurance companies;
• like mandating college students buy insurance;

or expanding charity dollars:
• like removing barriers to the Child Health Insurance Progam and
• expanding access to Medicaid to poor parents.

The solutions all require increased bureaucratic oversight and maintain the fractured, inefficient essense of what already doesn't work.

The report also recommends that the state keep accurate track of the situation — something that hasn't happened up to now. That's good: Without measuring benchmarks, the foes of change will always be able to diminish the failure of the current system.

Even with benchmarks, however, idealogues will simply say "See? Reform failed. Only the pure free market can fix this." And then they'll bask in the glow of their own private Idaho.

Reich is for single-payer

Robert Reich, Secretary of Labor from 1993 to 1997, one-handedly applauds Bush's healthcare plan, which I called the Catastrophic Bush Health Plan. Reich likes it because it would decouple employment and healthcare, which would indeed be a good thing. He doesn't mention that Bush's plan would throw people into the individual insurance market, the least efficient, most discriminatory, most costly healthcare system in the world. A lot of people would die before things got so bad that we kicked the bums out and instituted a single-payer system. But single-payer is what Reich is for, noting that if it's good enough for Congress it should be good enough for you and me.

"Note I said single payer, not single provider. Americans want to keep their choice of doctor and hospital. But a single payer – either through Medicare or the federal employee’s health insurance program – would avoid the current insanity by which private insurers spend hundreds of millions of dollars a year advertising and marketing to younger and healthier beneficiaries, and seeking to discourage older and riskier ones, or people with pre-existing medical conditions. America now has the only health-insurance system in the world designed to avoid sick people."

Starr's dialectics

Dialectic is one of the classical three liberal arts that Western culture inherited from the Greeks. It means the exchange of a thesis countered by an antithesis. Take for example:

"Healthcare is a human right in civilized societies, because healthcare is sometimes needed for life itself. " vs

"Health care is just another consumer item, like a Lexis, for those who can afford it."

Thesis and antithesis. Philosophers or the guys at the corner bar pick it apart and come up with some kind of synthesis that is closer to the truth than the originals.

How about: "Although more money will always buy more of it, healthcare is a human right and should be universally accessible."

Now the conversation has changed direction, and we can go on to the next level — unless there are libertarians or other obstructionists in the room, at which point we're back to "is too," "is not," "is too."

Dialectics got a bad rap because most of us learned about it in school in terms of Marxian Dialectics and communism. It was something about class struggle and things getting so bad people will revolt — according to Wikipedia, "a framework for development in which contradiction plays the central role as the source of development." In other words, things getting so bad people will revolt.

Paul Starr, who wote The Social Transformation of American Medicine, the 1983 Pulitzer Prize winning history of how American healthcare system has evolved over the last two centuries, thinks that things have to get worse in American healthcare before the people will revolt. Or at least the contradictions and true costs must become more apparent to people before we'll demand a single-payer or some other universal healthcare system. He's in favor of Bush's plan for that reason.

He writes in Bad Plan, Necessary Step in the American Prospect that it would be better to go ahead and get employers out of the health insurance business, because they've hidden the true cost of healthcare. The middle class doesn't understand how much their employers and the government spend on their health insurance. Starr sees the conservatives behind Bush's plan believing: "that it would lead Americans to accept lower insurance coverage and higher out-of-pocket costs and, therefore, would slow overall cost increases. I think they have misjudged the public reaction. Clarifying the full cost of private health insurance is going to make Americans much more likely to support a public alternative."

"In a world where health costs have been submerged, liberals have been at a huge political disadvantage. In the world conservatives want to create, liberals would have a much better shot."

That may be so, and if it is, we have a problem. How many progressives have the stomach to knowingly go along with a disasterous plan because it will make things better in the long run? It's like sending men to their certain deaths in a battle, knowing that the sacrifice will, probably, help win the war. Actually it would be even trickier, because it would need to be done in the political arena instead of on a comparatively straightforward battlefield.

We face the same problem, albeit less starkly, with state proposals like the one in California that may help more people, yet at an unsustainable cost. Do we support them because they may save lives next year? Or do we stand against them, because they're unaffordable and inefficient, and may give a talking point to ideologues who will say, "You see? We can't afford universal healthcare."

As long as private insurance is in the picture they're right, we can't afford it. Every other industrialized country, however, shows how very affordable universal healthcare can be if done right.

Starr is, by the way, Professor of Sociology and Public Affairs, and Stuart Professor of Communications and Public Affairs, at Princeton University; and co-founder and co-editor of the American Prospect.

Endorsing single-payer

How many newspapers have endorsed single-payer healthcare?

This is from today's St. Louis Post-Dispatch's editorial on Bush's state of the union:

"The president showed an admirable willingness to address the nation's growing health insurance crisis. But his diagnosis of what has caused the problem is wrong, thus his prescription to fix it is wrong, too....

"That leveling would be accomplished not by improving coverage for people buying insurance on their own, but by making it more expensive for companies to provide adequate insurance to their workers. That's a step in the wrong direction. The right direction is toward a single-payer national health care plan."

The irrelevant president

Joe Conason writes that, regarding Bush, we’ve heard it all before, and that his speech was irrelevant.

"At no time in recent years, for instance, has there been such broad consensus, in the business community as well as the labor movement, and among citizens of all political persuasions, that we must reform the American health-care system to contain costs and provide universal coverage...

"Yet the health-care schemes floated by the president and his aides would achieve little except to damage the present system of employer coverage without building a viable replacement. That is why the advocates of universal care will scarcely bother to deconstruct the Bush plan, which was dead on arrival."

I'd just add that quality is the third suffering element of U.S. healthcare, in addition to out-of-control costs and unjust access.

Commonwealth & Bush

Karen Davis, president of the Commonwealth Fund, has a column explaining why the Catastrophic Bush health plan won't help the people who need it most — the low-wage uninsured without the discretionary income to buy insurance. That group is the majority of the uninsured. Davis says the biggest winners with the catastrophic Bush plan would be those now buying insurance through the individual market. Forty percent of that group make more than $50,000 a year. Lower-income families and the uninsured would not be helped.

Here's the breakdown of the uninsured and taxes:
• 55% are in the 0% tax bracket
• 16% are in the 10% tax bracket
• 23% are in the 15% tax bracket
• 5% are in the 27% tax bracket
• 1% are in the 30-39% tax bracket

"Moreover," writes Davis, "the plan could cause employers to drop their health benefits, especially in parts of the country where premiums are highest, in industries that disproportionately cover older workers, and in the small business sector."

Which is probably the point.

Isn't that nice for you?

At times Nancy Pelosi applauded Bush’s State of the Union words on healthcare. At other applause breaks, she politely rested, a look on her face like that of the Southern lady who answered, “Well isn’t that nice for you?” when the boorish guest said something outlandish.

After all, Bush is nothing if not boorish, and what he proposed on healthcare was outlandish.

That was predictable.

What’s not predictable is what will happen now. Will we all be distracted, as we were in 2005, when Bush rolled out privatizing Social Security?

Congress should ignore Bush’s plan this time. Both he and it are irrelevant when it comes to finding solutions to this country’s problems.

The plan would allow a federal tax deduction of $7,500 for individuals and $15,000 for families who buy health insurance, on their own or through an employer. People who buy more expensive plans would pay income taxes on the excess.

Healthcare policy wonks across America are scratching their heads over the plan giving those deduction amounts ($7,500 or $15,000) to everyone who buys a policy even if it costs far less.

So younger, healthy workers who buy a rock-bottom policy — the equivalent of a liability-only auto policy — will get a tax windfall. Older, less healthy workers pay more.

Evidently the deduction amount will increase over time, but it wouldn’t be pegged to actual changes in healthcare costs.

The plan would also allow states more “flexibility” with their citizens’ share of Medicare and Medicaid dollars

The Treasury Department says that Bush’s plan could bring health insurance to 5 million more Americans, fewer than one in nine of the uninsured.

No word on what it will do to the quality of coverage.

Like the Social Security “reform,” the plan is intended as a diversion from the Iraq fiasco as much as a real policy proposal.

They’re also hoping to divorce employers from the budget-busting business of covering employees — something that has sapped our global competitiveness because of the inefficiencies of our system.

We'll still have the most inefficient system in the industrialized world, with healthcare eating up 16 percent of our GDP and rising fast.

Compare that to countries with universal health coverage, either through a single-payer system or something close to it where healthcare costs are an average of 11 percent of GDP and rising less quickly.

This plan would instead reduce the healthcare people get for our dollars.

The logical reform is to move people from thousands of employer-based risk pools into one, single-payer pool, eliminating the insurance middleman, thereby lowering costs and protecting everyone. This plan would end employer-based insurance by instead dividing us into 300 million individual insurance droplets. Costs will rise and we’ll end up with less healthcare.

How much leverage, after all, will each of us have against premium increases and coverage decreases once we’re completely on our own?

In a perfect conservative think-tank world, the Catastrophic Bush Health Plan might instead play out like this:

Health insurance will become more like home or auto insurance, something for catastrophic events. Sure, you could file for that broken leg but your premiums would skyrocket. And don’t even think about insurance paying for doctor’s check-ups, calls to the advice nurse, physical therapy, or medication. That would be health coverage, not insurance.

Your premiums, which you will pay, not your employer, will, however, cover your catastrophic $250,000 treatment for cancer. (Unless you happened to buy a plan that didn’t cover that. But never mind.)

In this conservative la-la land, costs will go down because people will get less treatment. We’ve been over-utilizing our medical resources because a third party has been paying for them.

No doubt a lot of medical providers will go out of business since they’ll have fewer patients. Oddly enough, that aspect of this paradigm doesn’t get much play from conservative bloggers, pundits or think tanks.

They do like to talk about how costs will also go down because there will be more transparency.

(Never mind that oversight could bring transparency far more easily in a single-payer system.)

You would get a cost printout before treatment for that broken leg, for instance. After learning that the cast alone is costing you $450, you could opt to just stay in bed.

Once the plaster-makers understood that people were refusing to pay their outrageous cast costs, they would lower prices to something more reasonable.

(Never mind those “wink-winks” here between conservatives selling this plan and the businesses providing casts and other medical equipment. The prospect of earning fewer dollars AND selling fewer units isn’t usually a draw at the Chamber of Commerce. Never mind.)

(Also never mind that single-payer healthcare systems negotiating with plaster manufacturers — and pharmaceutical companies — actually have a track record of bringing prices down. In this worldview, that is seen as unfair.)

We’ll all be out there haggling on our own with doctors, nurses, hospitals and all the rest for the best prices we can get.

(Never mind that patients can choose any doctor they want in single-payer systems.)

There’s no incentive for the common good in the plan — no incentive for people to pay that extra $100 for a cancer screening that pays off for public health when millions of people are screened, but feels more like a matter of luck or hypochondria when it’s just you.

If over-utilization is part of rising health costs, bet that speculative screening would be among the first to fall.

There’s also no regulation to guarantee a minimum of coverage or cap profit-taking.
There will have to be an expensive reinsurance addendum for this plan, to cover people who couldn’t get insurance.

The clear winners?

Insurance companies, who could keep raising rates, knowing that the states would cover their firefighters.

The losers?

American families.

Write your legislators and tell them to ignore this catastrophic plan, and get on with the business of solving America’s problems.