Ave Cassanda: Lost lands

Kayaking in the lost lands of Louisiana.

Ave Cassandra means hail Cassandra, referring to the woman cursed by Apollo. He gave her the gift of prophesy, but also made it so no one would ever believe her.

That's not exactly what's happening in our world today. From climate change to our still-lousy healthcare system (yes, better than before the Affordable Care Act, but not by a lot), most of us understand that we're screwing things up. The Cassandra activists yell at us, but we're tired of hearing bad news that it feels we can't do anything about.

Most people in Louisiana know that their wetlands need to be remediated. It's going to take so much money that only the oil companies, who are responsible for anywhere between a third and most of the damage, could afford to pay for it. (The companies cut tens of thousands of miles of canals through the wetlands, allowing salt water to kill the plants. It's more complicated, but that's it in a sentence.) Check it out at ProPublica.

Why "consumers" can't drive down health care costs

Bloomberg has a great article up about how impossible it is to find out how much medical procedures cost. Mimi Ferraro spent hours trying to find the least-cost provider for an injection of cancer medication she needed. She made her decision based on information that came after numerous calls - to the insurance company, which told her it couldn't give an estimate on the cost until after she'd had the procedure (!) and then a week of waiting on the answer from her oncologist's office. It was wildly inaccurate. She paid $4,099.51 for a shot she was told would be about half that much. She could have gotten it for half that much at a local pharmacy - but it wouldn't have counted toward her deductible. Her high deductible, that is.

This kind of [high deductible] insurance is expected to help reduce health costs. Given a need to make higher upfront payments, patients may be more selective about the services they buy and keep spending low. But there is a significant flaw in this reasoning: Patients aren’t the ones who make the decisions about which tests and procedures to purchase. Doctors are. And doctors, along with hospitals and insurance companies, don’t let on how much the services cost.

Another significant flaw is that a plethora of studies have shown that people do not make good decisions about health care spending. They balk at spending for preventative measures and, when panicked, will spend far too much when it's too late. Not that they know how much they're spending.

Ferraro pulled together some studies that show no one knows what procedures will cost. She thinks that if every patient demands the cost information that she was asking for, costs will actually become transparent. I absolutely disagree. It's not in anyone but the patient's interest to make that transparent, and our for-profit system isn't set up to benefit the patient. Excuse me. I meant the consumer. I would also point out that not only are U.S. health care consumers blindfolded, this kind of treatment is emotional torture and very bad for your health.

But most Americans can tut-tut. It happens to someone else. We look for what they did wrong - like get sick, for instance - and feel reassured that it won't happen to us.

Who needs foreign-born terrorists to wreck our communities when we've got insurance companies!

Think again if you think being insured = security

Americans love to believe things that are demonstrably untrue - tax cuts equaling increased government revenue and a stronger economy, for starters. Oh, and the whole idea of for-profit insurance companies being an efficient way to finance our health care being another.

So I'm just passing this along - it's not going to make a whit of difference in the debate. The University of Arizona has found that being insured doesn't affect whether you have medical debt.

According to a study published online June 16 by the American Journal of Public Health, after taking age, income and health status into account, simply being insured does not lower the odds of accruing debt related to medical care or medications....

"On average, insurance coverage in Arizona is not protecting families from experiencing medical debt. From other studies we knew that paying medical bills is a problem for a substantial portion of both insured and uninsured Americans. This study helped clarify that the fact of medical debt is an additional and larger barrier to getting needed health care than whether a person is insured or not."

That's according to University of Arizona College of Pharmacy research scientist Patricia M. Herman.

But don't expect the Americans who are swayed by the big-business money that preaches anti-government ideology to take note. (Hell, the mainstream media didn't even take note.)

They're busy admiring Michele Bachmann's poll numbers in Florida, leaving the fact that she's a delusional liar to, at best, the papers' online blogs, to be read by the choir.

Social darwinist Bachmann is quite concerned about a mythical $105 billion "hidden" mandatory spending in the health care reform bill passed last year. That would be the most-debated bill ever passed. Right, Michele.

And the shot heard round the world was fired in New Hampshire. Uh huh. Obviously memory fails us all now and then. But when a third or so of Americans begin to channel the single-minded Walter Sobchak (You're goddamn right I'm living in the fucking past!") from The Big Lebowski, it's hard to know where to begin. As The Dude says, "Walter, I love you, but sooner or later, you're going to have to face the fact you're a goddamn moron."

The scary thing is that these folks aren't just channeling film rage, they and their leaders are unwittingly channeling mass murderers. Bachmann again: “But what I want them to know is just like John Wayne, who is from Waterloo, Iowa – that’s the kind of spirit that I have too.”

As one L.A. Times commenter wrote, "I don't think she was mistaken, she was just speaking in secret code to her minions. She well intends to rape the nation like [John Wayne] Gacy [who was from Waterloo] did to his victims..."

Another commenter offered a SOP right-wing solution: "Let's go to John Wayne's Wikipedia page and change it so that she is right."

More Docs Reject Privately Insured Patients!

A study expecting to find even fewer doctors willing to accept new Medicare patients found, sure enough, a modest drop in that percentage. But the shocker was a far steeper decline for doctors willing to accept privately insured patients.
The study shows 93.3 percent of doctors accepting insurance for payment in 2005, and 87.8 accepting insurance in 2008.

The drop for those accepting Medicare coverage during the same time was 95.5 percent down to 92.9 percent. Not the huge difference the right-wing media has been harping about - and they seem to have missed completely the fact that some doctors turn away patients wanting to pay with private insurance.

I first heard of this a few years ago with a doctor in Fort Collins, Colo., who wouldn't accept private insurance. He said he did so so he could practice medicine instead of argue with bureaucrats whose primary concern was profit, not patients. The insurance companies also didn't pay him enough - and he's a family doctor, not a country-club suburban specialist.

Dr. Tara Bishop's study was in the 27 June 2011 Archives of Internal Medicine. She's assistant professor of public health at Weill Cornell Medical College and practices at New York-Presbyterian Hospital/Weill Cornell Medical Center. Dr. Bishop is concerned that the growing numbers of physicians saying no thanks to insurance companies could bollocks up President Obama's reform - which depends on everyone buying private health insurance from this deadly industry.

It's one more reason to simply expand Medicare to cover everyone.

There are economic sectors where the free market delivers most effectively, no doubt. Manufacturing computers and running casinos come to mind. Other tasks - like covering the cost of health care, fighting fires, policing our communities, educating all the children - societies that tax themselves to provide those services for all come out ahead.

Pretty simple. You want the Pakistan model or Paris?

Ave Cassandra Is Back

Back in 2007 or 2008, a marvelous guy running for state representative here in Colorado sat down and talked with me about universal health care. Joe Miklosi is a smart progressive who already knew that the U.S. system is fatally dysfunctional. So I was preaching to the choir.

But at the end of our talk, he did something no one else had. He gently touched my arm and asked me if I was taking care of myself - or if I was reopening a wound every time I shared my brother's story. Hmm. I assured him that working for health care reform was my way of working through my grief - so that no one else would have to lose someone the way we had, etc.

Hmm. In fact, I was pouring salt in the wound on a daily basis. As it turns out, I'm also very bad at organizing and activism. You have to be well organized and optimistic to be good at activism!

So I quit. And now I'm back, but just at Ave Cassandra, not at Health Care for All Colorado, a great group of activists but not for me. I'm not going to post every day, and no more salt, no more activism. I'm just going to pay a bit of attention again. And share the good stuff. And continue to urge my adult children to emigrate to a country with social policies that demonstrate concern for community, including people who are sick. WWJD and all that.

Second Amendment Health Care

Richard Verone had a growth in his chest, ruptured disks, and no health care. Typical 59-year-old American. Not the majority, but typical. He figured his care might take three years. So he robbed a bank.

Not so that he could get the cash to go to India for care, or to buy into the expensive insurance for folks with pre-existing conditions. Both of those options might cost more than the bank even had on hand, and besides, someone might get hurt. Think it through: all kinds of things could go wrong. Just the time in jail would do it, he figured. So he handed a note to the teller that demanded $1. The note said he was armed. Then he sat down and waited for the police.

The fly in the ointment is that, according to news reports, he's very likely to get just 12 months, not three years. He wasn't carrying a gun, so it's a lesser charge. Kind of unAmerican of him, now that I think about it. What - he's not in favor of the Second Amendment?

First They Came for the Uninsured

When the Nazis came for the communists,
I remained silent;
I was not a communist.

Then they locked up the social democrats,
I remained silent;
I was not a social democrat.

Then they came for the trade unionists,
I did not protest;
I was not a trade unionist.

Then they came for the Jews,
I did not speak out;
I was not a Jew.

When they came for me,
there was no one left to speak out for me.

- Pastor Martin Niemöller

Overwrought to compare that to the U.S. healthcare crisis? Perhaps. It probably feels different if you haven't lost a loved one because of it.

Pastor Niemöller's point is that if a society doesn't value solidarity - even solidarity to protect those in disagreement with one another - then we allow predators to pick us off.

Solidarity is a value often mentioned in other industrialized nations. Not at all in the U.S., where it sounds subversive - doesn't it?

Death as a Rorschach Test

After a post at Slate I realize, once again, that Paul's death is a kind of Rorschach Test.

Usually people who are in favor of healthcare reform get it, immediately - how the U.S. healthcare system failed him in a far bigger way than misdiagnosing his appendicitis.

Physicians almost always get it immediately.

People who are afraid of change, and who don't understand that our health care system is a kind of ever widening net of dysfunction - not so much. For them it's all about misdiagnosis - if they've gotten past the point where it must have been Paul's fault, because the U.S. healthcare system is the best in the world (maybe needs a slight tune-up, but nothing major) - that being the case because we're the best.

And once a group starts thinking it's the best despite all evidence to the contrary, that's the beginning of the end, whether it's a sports team, an automaker, an army or an entire nation.

The United States does a lousy job of protecting what it claims is its most precious asset - its people.

Soft Support for Reform

Back when politicians thought all healthcare reform could be was adding a few more kids to the SCHIP program, just like every other single-payer supporter I know I liked to point to polls showing that a majority of Americans knew we needed to overhaul our system, that government needed to guarantee healthcare, that it was the dastardly insurance industry's grip on our politicians that was to blame and so on.

All along there were the Celinda Lakes warning that public support for healthcare reform has always been soft, and easily manipulated by fear-based campaigns.

Like this, you think?

RX FOR DISASTER
83 MILLION OF US WON'T KEEP OUR INSURANCE

And for those who do manage to keep their current insurance -- well, it won't cost $2,500 less, as Obama promised. Lewin estimates it will cost $460 a year more because of new cost-shifting from the government-run plan to private health plans.

That's right. The $1.3 trillion House health-care bill would cause millions of Americans to lose the insurance they have now -- while the rest of us would pay even more than we do now.

It's times like this when you truly appreciate the smart analysts out there, like Paul Krugman and Ezra Klein - who quoted Steve Pearlstein today:

Among the range of options for health-care reform, there's one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant.

That's the option of doing nothing, letting things continue to drift as they have for the past two decades as we continue to search in vain for the perfect plan that would let everyone have everything they want and preserve everything they already have while getting someone else to pay for it.

They say that people deserve the governments they endure - a pretty hardhearted assessment of, say the Cambodians under Pol Pot. But when it's a democracy, and when there's every opportunity to become educated, wouldn't it be true to say that a people deserves the health care system they're too afraid to change?

I'm feeling like picking fights about this - pretty unproductive I admit.

Flurry of Pundits on Healthcare Reform

Health Reform Can Pay for Itself, by Timothy Noah at Slate

Why Health Care Reform Will Pass, by Jonathan Chait, The New Republic

More Disapprove than Approve of Obama on Healthcare, Gallup Poll

Real Consequences of Inaction, at Healthcare NOW

Will Obama Wipe Out on Healthcare?, by Howard Fineman in Newsweek

Healthcare for Dummies, by Dana Milbank in the Washington Post

Americans: OK with Inequality

Jacob Weisberg has a nice piece at Slate on the reform package. What really caught my attention, however, was this commenter:

Weisberg writes: "[The British system] doesn't cover many procedures we regard as standard, such as PSA tests for men in their 50s..."

The PSA is more likely evidence of what's wrong with the US system, not what's wrong with the British. It has become a standard even though there is little, if any, evidence it saves lives. Yesterday's NY Times ran a story that pointed out, "the federal Centers for Disease Control makes it clear on its Web site: there is no medical proof yet that routine screening for lung, ovarian, prostate and skin cancer reduces deaths from those cancers." But many men will suffer wretched complications from treatments in response to the screening.

But that's my minor quibble with Weisberg. The major one is this: "Morally speaking, Americans are surely more accepting of economic inequality than their European brethren. But the random unfairness that condemns the uninsured to bad health and the risk of untimely death offends the social conscience."

If only it were true that the bad health, disabilities and deaths that result from the lack of access to health care really offended Americans. Sure, there are some who are really outraged, some who are disturbed, and others who just can't be bothered to think about it. But there is also a group (large or not?) who are really satisfied knowing that there are winners and losers in American life and they are only too happy to be on the winning side. If we acted to create a more equitable system, how would they know who the winners and losers are and which side of that line they're on? Knowing that others are suffering, and believing that everyone in life pretty much gets what they deserve to get, they oppose any change that would bring relief to the suffering or make life "fairer."

Those who are passionate about universal care aren't large enough in numbers to bring about a change. Those who aren't passionate are too disturbed at the thought that reform may bring some change to what they already have to support it. And those who are happy with the way things are aren't going to support any change at all. If any reform bill passes it will have to be diluted too much to avoid imposing real change on health care providers or the currently insured. We're going to fall short again.

No doubt we'll fall short for just those reasons, although I sure hope that Obama gets us on track to a solution.

This comment makes me think about hearing some asinine Republican representative on C-Span last night pontificating on how every American has access to health care - it's just that not all of us have health insurance - two very different things, he wisely noted.

Right. Tell it to my brother. Tell it to all the American parents and children who've died because they did not have health insurance - and because they did not have health insurance they did not go to the doctor in time, and because they did not have health insurance the hospital treated them differently than had they been insured.

And I think about some commenter on a radio station saying that he sure did expect to have better health care - far better health care - because he was insured - otherwise what the hell was he paying for?

Full Court Press

It was all healthcare all the time on talk radio this morning. On the road this morning I heard some conservative literally spit into his microphone over how crazy it was for something that was supposedly free to actually cost a trillion dollars and how there's a long waiting list for programs - just as there would be once it was enacted for people to see their doctors. He also alluded to the idea that you wouldn't be able to get aspirin.

Pretty crazed stuff, but no doubt straight off the Republican talking points. Emphasize waiting, emphasize cost, emphasize a loss of personal control - all of which happen to be false, but still. Great talking points.

On to NPR where some WellPoint exec is claiming that Medicare is less efficient and innovative than private insurance companies.

Really.

On to the librul station where, without a skipped beat, Big Ed was glad that David Axelrod had finally made a shot over the bow to the Republicans that if they weren't willing to go along with the program then healthcare reform didn't need to be bipartisan.

He read this quote: "Ultimately, this is not about a process, it's about results," David Axelrod, Obama's senior political strategist, said during an interview yesterday in his White House office. "If we're going to get this thing done, obviously time is a- wasting." Both Axelrod and White House Chief of Staff Rahm Emanuel said taking a partisan route to enacting major health-care legislation isn't the president's preferred choice. Yet in separate interviews, each man left that option open.

"We'd like to do it with the votes of members of both parties," Axelrod said. "But the worst result would be to not get health-care reform done."

Paying for it will be the taxes on the wealthy - and it is curious how the Republicans can rail against that and at the same time denounce excessive bonuses - like the ones announced today at Goldman Sachs, where the average employee bonus is nearly $900,000 and top execs will see tens of millions.

Come on. You're not in favor of taxing that?

Public not so keen on the Public Option

People really do have an amazing font of ability when it comes to ignorance.

Once you understand something - like, for instance, that single-payer health care works, or that the U.S. is the only country in the world to allow private industry to act like racketeers in regard to citizens' health - there's often a sense of surprise that other people still don't get it.

Really? You don't get that? That the earth orbits the sun? That the moon orbits the earth? You weren't aware of that?

On the radio this morning comes a segment about Rep. Ed Perlmutter (D-CO), who is educating folks on the public option. (Thanks Ed - you're leading. It's appreciated.)

He invited some 5,000 of his Colorado constituents to chat with him about health care and the public option. He invited people who get his newsletter, presumably slanting Democratic, and then people randomly selected from his district. Questions at the chat included one guy noting that it's just common sense that if you cover everyone it must cost more, so how can single-payer proponents claim otherwise?

A poll on whether people were in favor of the public option found 54 percent against.

Defending the Indefensible

The case of a rejected potential mate came up in conversation with friends over the weekend. This loser's biggest fault? She was Catholic - which led everyone around the table to enthusiastically agree to hating the Catholic Church.

I was silent though I usually speak up at such moments. It's been infinitely more difficult to defend religion in general since Bush was elected... OK - it was always difficult to defend a group that raised the fetus to the point of idolatry, where abortion - rather than faith or personal sacrifice for justice - became the sine qua non for believers. At my weekend table I had to also wonder if the whole bit weren't some kind of passive-aggressive hostility aimed at me, since everyone there knew I'd worked for the Church for 16 years.

Instead of speaking up I was thinking of the editor at the Catholic Sentinel, my old boss, saying that Catholicism was the last bastion of respectable bigotry. It's no longer acceptable to hate African-Americans, Asians, gays, Islam, Judaism, or paganism, but it's OK to hate the Church.

Now that's a bit over the top, a bit Bill Donohue and Catholic Leagueish - after all, if someone vehemently disagrees with a powerful organization's policies because those policies do quantifiable harm, it's disingenuous to put that criticism down to prejudice. Eric Alterman and other critics of Israel's policy towards the Palestinians are not anti-Semitic. For crying out loud, Alterman is Jewish. As the Israeli state increasingly became identified with its wall and settlements, however, it became harder and harder to criticize those policies without sounding anti-Israel in general. Especially since Israel's defenders themselves evidently defined Israel by those policies. The same is true for Republicans, the anti-government, don't-believe-in-global-warming, Christianism party, and for the Catholic Church, the church of anti-contraception and no-abortions-even-to-save-the-life-of-the-mother faith.

Shouldn't Israel, Republicans, and the Church be more than that? It seems like they should do their part in helping those of us out here who would like to come to their defense in a fair-minded way.

Then there's the related problem of in so doing becoming aligned with frothers who insist that the entire Democratic Party is anti-Catholic. Right. Pelosi, Kennedy, et al.

Someone else over the weekend, in a completely different conversation (this one about the Church coming out strongly in favor of the coup that ousted Honduras's leftist president), said that they really didn't like this current pope's leadership.

Now that's a fair criticism.

Americans support a public option

A New York Times/CBS News poll shows overwhelming support for a public option - 72 percent of all those polled were in favor, with 20 percent opposed and 7 percent clueless.
Half of Republicans were in favor (39 percent opposed).
87 percent of Dems were in favor! (9 percent opposed).
73 percent of Independents were in favor (22 percent opposed).

And yet Senate Dems are not on board.

What is wrong with this picture?

Contact your senators! Here's an Howard Dean petition - there are others as well.

Public Option Good Politics

Robert Creamer has an article at Huffington Post on Four Reasons Why Giving Consumers Is Great Politics.http://www.blogger.com/img/blank.gif
He cites the popularity of such a program:

In a poll taken earlier this year by Lake Research, 73% of respondents favored a health plan that gives them the choice between a private plan or a public health insurance plan. Only 15% preferred to have only the choice of a private plan. And the preference for a choice between public and private health insurance plans extends across all demographic and partisan groups, including Democrats (77%), Independents (79%) and Republicans (63%).

According to an NPR report, "Republicans argue that upward of 100 million Americans would opt out of private insurance in favor of a public plan if such a plan were available."

And yet the story is being spun that Congress would never pass such a thing. Haven't we gotten to the point where nearly everyone understands that our healthcare system sucks, that other countries do it better, and that they do it better because there's a government guarantee of healthcare?

Lincoln was for govt-financed health care

James Nowlan, a Republican at the University of Chicago, has a column in today's Chicago Tribune. It's notable both for what it says and what it doesn't say.

"Abraham Lincoln declared that government should do only that which the people cannot do so well for themselves -- defense, highways, public safety, education. And government has done a good job of fulfilling this compact with the public. In recent decades, we have been adding health care to the compact, in increments: first the elderly with Medicare, then the poor, and more recently, children, both through Medicaid. If you're not in one of these categories, you scramble for health care. Everyone in my rural area hustles to find the shelter of health-care coverage. Farmers' wives take jobs at the school in town -- for health coverage for the family. Whenever a job change is contemplated, the biggest question is: 'Will there be benefits [health coverage]?'"

Nowlan addresses the irreconcilable tension between Americans believing that their taxes are too high and at the same time believing that the government should make sure everyone has health care.

Then, as if he can't quite help himself, he points out that Medicaid and Medicare are the biggest chunk of government expenditures on health care - something that is misleading because it doesn't note the other government expenditures on health care, such as the tax breaks for companies that provide health insurance and the cost of paying for private insurance for all municipal, county, state, and federal workers, including the military.

He notes that the cost of Medicare and Medicaid have gone up 7 percent a year, "far outstripping inflation," without noting that the rate of increase of private insurance puts Medicare and Medicaid increases in the dust.

Even so, the quote from Lincoln was nice. The experience of other industrialized democracies fairly proves that government does a better job of managing health care financing than does the private sector. (If, of course, you factor in health of the population as being at all important. If you're willing to write off a substantial portion of your work force - the Darwinian cost of doing business - then our system clearly is more profitable and therefore better, capitalistically speaking.)

Then again the right has so vilified the competence of the American government that it's possible that people think that whereas the Swedish or German or Taiwanese government can competently manage health care financing, our own government cannot.

The question then becomes "Why does the right wing hate America?"

Baucus says he shouda listened

Well yeah. Politico reports that "Senate Finance Committee Chairman Max Baucus (D-Mont.) told leading advocates of a government-financed health care system that he made a mistake by not giving their proposals more consideration in the reform debate, according to participants in a meeting Wednesday."

Bernie Sanders (I-VT), a single-payer supporter, arranged the meeting with David Himmelstein, MD, and others.

Those involved in the health care negotiations say single payers have been elevated precisely because Baucus excluded them. Baucus has been able keep almost every interest group involved in the process from speaking out against the ideas under consideration. But because they are not involved, single payers have been one of the only vocal constituencies hammering away at Baucus.

The virtual shut-out has emboldened the movement.

After being left off the invite list for the White House health care forum in March, single payer advocates alerted the media and won a seat at the table. They disrupted each of the Finance Committee’s three roundtables on health care in April and May.

How many are underinsured?

Commonwealth Fund has just released a stunning report on underinsurance in the United States. "Insured But Poorly Protected: Number Up 60 Percent in 4 Years", finds that, "Rate of Underinsured Triples for Middle and Higher Income Families; Underinsured Go Without Needed Care and Face Medical Debt."

It's great to have these figures - even though they understate the problem. The report found that there are 25.2 million underinsured Americans - "based on their out-of-pocket health care costs relative to their incomes." That leaves a lot of underinsured people uncounted.

Here's the full text of the Health Affairs article, and here's an interview that the report's lead author, Cathy Schoen of the Commonwealth Fund, did with PBS. There's both a video and transcript there - and links to resources like this - U.S. vs. other nations.

Podemos con Obama