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."

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?

Military benefits from desperation

The Wall Street Journal blog shares a NYT article on how healthcare reform could hurt military recruiting goals. Turns out that when an illegitimate war drags on, when troops are abused, and when people realize that a war is illegitimate and troops are being abused, young people don't sign up to fight.

The NYT piece is accompanied by a chart showing that in the late '80s, 25 percent of young people figured they'd sign up for military service during the next few years. Now only 13 percent think that's a reasonable choice.

Young people signing on to military service evidently say they're partly motivated by medical need for their young families. Tricare for their spouses and children is a trade-off for signing up for Bush's war. "It seems a bit perverse that the incentives for a young person with children to join are greater than the incentives for his childless friend," writes Floyd Norris in the Times. "But that is the way it is. All that could change if the push for some kind of national health insurance program were to be successful."

Time predicts healthcare reform

Last week's Time Magazine's cover story was on the economic mess that the next president will need to clean up. The piece ends with a couple paragraphs on healthcare:

Then there's health care, which has become perhaps the biggest source of financial worry and occasional disaster among middle-class Americans. A 2005 study found that half of all personal bankruptcies in the U.S. were attributable at least in part to medical costs.

But there's real hope on this front. It is possible to conceive of a system that brings the 47 million uninsured into the fold, improves medical outcomes and costs less than what we've got now. It's possible to conceive of because many other wealthy countries already have such systems. Figuring out exactly how to make universal health care work in the U.S. is a matter better left to its own lengthy magazine article. But if you're looking for big economic change from the next Administration, this is the form it's most likely to take.

I find that comforting. It means that mainstream journalists, who aren't likely to be single-payer advocates but who are likely to be better read than the average American (not all, but it is part of the job) now get it. This writer, in any case, knows that the data is there. Other countries have shown that healthcare investment can be managed far better than we've accomplished.

There is a real chance that we'll see change in the next five years - perhaps not true universal healthcare via single-payer, but surely steps in that direction.

State-Based Health Care Reform Act

Talk about a buried lede. Or the mainstream media not paying attention to an important story. The Milwaukee Small Business Times reports that a bipartisan proposal would let states reform health care - "States could use single-payer systems, expansion of current programs, market-based reforms or adopt completely new ideas in their efforts to cover the uninsured."

U.S. Sen. Russ Feingold (D-Wis.) and Sen. Lindsey Graham (R-S.C.) are authors of the State-Based Health Care Reform Act. Sen. Susan Collins (R-Maine) signed on today.

You can read the bill at the Library of Congress's Thomas.

There's a longer article on the bill at Psychiatry Online from October 2007.

S 1169... would establish the Health Care Coverage Task Force to approve grants to states whose proposals mandate minimum requirements in coverage and quality measures and meet cost guidelines. The bill would provide about $40 billion for state matching grants to expand health care coverage, while mandating certain "cost-sharing" limits to keep the coverage affordable for beneficiaries...

Another state-based approach would authorize grants for states to create universal health care pilot programs that could become models for other states and the country. The legislation, sponsored by Sen. Bernie Sanders (I-Vt.) and known as the States' Right to Innovate in Health Care Act of 2007 (S 2031), would authorize five, five-year grants to states committed to developing plans for universal, comprehensive, cost-effective health care. The states would have to provide comprehensive benefits, including coverage for long-term care, diagnostic services, preventive care, prescription drugs, dental and vision services, and mental health treatment including that for substance abuse.

What's PNHP's position on these bills?

Low U.S. medical literacy

It's definitely not Lake Wobegon, "where all the children are above average."

In fact, by definition, half the population is below average -- in anything. Which just goes to show how ridiculously complicated and user-deadly the U.S. healthcare market is. Only about one in ten of us has the skills necessary to successfully negotiate the system and get appropriate care. The only reason we don't know it is because, for the most part, most of us are healthy.

A Medical News Today article cites a study that indicates that just 12 percent of 228 million adult Americans have those skills. The assessment is from the Agency for Healthcare Research and Quality. These skills include weighing the risks and benefits of treatments, being able to calculate health insurance costs, and understanding how to deal with complicated medical forms.

Commonwealth's proposal

Commonwealth Fund's principal researchers and president have authored an article for Health Affairs with Lewin Group modeling that shows a path to dramatically improving U.S. healthcare. It seems far superior to the flawed Wyden plan.

Health Affairs has a firewall, but you can see a synopsis of the plan at Commonwealth Fund or at Medical News Today.

Here are the basics, from Medical News:

• A national entity known as a "connector" that would offer individuals and small businesses a choice of private plans or a Medicare Extra plan.
  
• Requiring that all applicants be given health insurance at standardized rates regardless of their health status.
  
• Tax credits to make sure premiums are affordable. Premium assistance would be available to all to ensure that premiums do not exceed 5 percent of income and 10 percent of income for higher-income tax filers.
  
• Expanding Medicaid and SCHIP to cover all low-income adults and children below 150 percent of the federal poverty level with modest copayments for health care services and no premiums.
  
• Requiring that everyone enroll in a health insurance plan-uninsured individuals who file taxes would be automatically enrolled.
  
• Requiring employers to either provide health insurance or pay 7 percent of payroll up to $1.25 an hour into a pool to help to finance coverage.
  
• Medicare reforms that would extend Medicare Extra benefits to current Medicare beneficiaries, eliminate the two-year waiting period for Medicare for the disabled, and allow adults age 60 or older to buy in to Medicare.

The Republican corporate prescription

All is revealed with the GOP's new slogan: "The change you deserve," borrowed, we now know, from the antidepressant drug Effexor.

The difference, of course, is that the Republicans don't have to reveal side effects to potential consumers.

"Are depression symptoms keeping you from where you want to be?" Effexor's maker, Wyeth Pharmaceuticals, asks in its promotions. "Not feeling as good as you used to?"
House Majority Leader Steny Hoyer (D-Md.) told reporters today that a safer remedy would "Democrats, not drugs, is what the American people need," he said. He flashed the Effexor side effects on a large flat-screen television. "Nausea, up to 58 percent," Hoyer said. "Actually it's higher than that for Republicans."
Hoyer didn't even mention the warning label, which states that patients should be watched to see if they are "becoming agitated, irritable, hostile, aggressive, impulsive, or restless."

All so true.

Also in the news today was the sad fact that relentless for-profit marketing has turned Americans into a bunch of pill-poppers. More than half of all insured Americans are taking prescription medicines regularly for chronic health problems. The causes are worse public health, better meds, and advertising. The biggest jump in use of chronic medications was in the 20- to 44-year-old age group where it was up 20 percent over six years. The chronic conditions served are mainly depression, diabetes, asthma, attention-deficit disorder and seizures.

There are some good books out on the pharmaceutical industry's success in the United States. Here are four, with their descriptions from Amazon:

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, by Shannon Brownlee
Award-winning health and medicine writer Brownlee notes that Americans spend between one-fifth and one-third of health-care dollars on unnecessary treatments, medications, devices, and tests. What's worse, there are an estimated 30,000 deaths per annum caused by this unnecessary care. The reason for what amounts to a national delusion that more care is better care is rooted, she says, in a build-it-and-they-will-come paradigm that rewards doctors and hospitals for how much care they deliver rather than how effective it is.

Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, by Melody Petersen
Much of what [former New York Times reporter Petersen] recounts — such as the glut of copycat drugs like antacids, and marketers' lavish wining and dining of doctors—has been covered in books by others, like Marcia Angell. But Petersen fleshes out these issues and names prominent doctors who, she says, are on the take. She is particularly strong on the ghostwriting of medical journal articles by advertising agencies. She also covers less familiar matters, like the environmental impact of drug residues in water.

Before You Take that Pill: Why the Drug Industry May Be Bad for Your Health," by J. Douglas Bremner
Recent scandals involving diabetes drugs, Vioxx, and many other medications reveal the serious and undisclosed risks of some of the most commonly used prescription drugs in this country. Dr. Bremner, a researcher and clinician at Emory University whose study on Accutane and depression made headlines, offers an inside look at the pharmaceutical industry, as well as a scientifically backed assessment of the risks of more than three hundred prescribed medications, vitamins, and supplements.

The Truth About the Drug Companies: How They Deceive Us and What to Do About It, by Marcia Angell
The pharmaceutical industry, according to former New England Journal of Medicine editor Angell, is fraught with corruption and doing a disservice to customers, the federal government, and to the medical establishment itself. She explains how a huge portion of the revenue generated by "Big Pharma" goes not into research and development but into aggressive marketing campaigns to sell their product. She describes how, even though the drug companies claim that it costs them an average of $802 million per drug to develop new medicines, that figure is obscenely inflated since it factors in marketing as well as expected interest the company would have received had they invested the money in the open market. Meanwhile, most of the R & D work is done by colleges and universities funded by the government. There are also problems with the drugs themselves, since a majority are "me-too drugs", slightly modified versions of existing products which meant to address concerns of consumers most likely to spend money on pharmaceuticals. Thus, the market is filled with remarkably similar drugs to treat depression and high cholesterol while potentially life-saving medicines for diseases afflicting third-world countries are discontinued because they aren't profitable.

Colleges not covering students

One of the givens for college used to be health coverage. No more. Business Week has an article on health care falling apart for college kids as well -- probably the healthiest demographic there is. "Is your kid covered?" notes that insurance companies make big profits here, but leave some families with big bills. Those would be the families whose kids get sick.

If for-profit insurance can't even cover college kids it's worse than worthless.

More than half of the insurance plans recommended by colleges offer benefits of $30,000 or less, according to a survey published in March by the General Accounting Office, an arm of Congress. Many plans have further limits that prevent payout of even modest maximums...

The vigorous health of most college students helps make insuring them a lucrative niche, according to industry consultants. Most insurance companies, even if publicly traded, don't break out separate financial results for their student-oriented policies. But some schools disclose an indication of the profitability of policies sold to their students: the so-called benefits ratio. This shows the percentage of premiums returned to customers in the form of benefit payouts. Large health insurers typically have overall ratios of about 80%, meaning 20% of premiums goes to profits and administrative costs.

In several cases where BusinessWeek (MHP) was able to obtain benefits ratios from colleges or universities, the percentage was well below 70%. Anything below 75% ought to be grounds to negotiate a better deal, according to Eric Engstrom, president of Keeling & Associates, a consulting firm in New York.

At Palm Beach Community College, the benefits ratio for the spring semester of 2008 was 42.6%, according to reports provided to the school by UnitedHealthcare.

In previous semesters the benefits ratios dipped as low as 10.2% and 13.8%. This means the college's plan has been a veritable gold mine for UnitedHealthcare. At the University of South Florida in Tampa, which offers a plan from American Fidelity Assurance, the ratio this academic year is 35%, down from 71% and 61% the previous two years, respectively.

Did you get that? UnitedHealthcare paid out as low as 10.2% in benefits some semesters. Compare that to 97% for Medicare or Canada's universal health care plan (also called Medicare).

Now here's the key to change. Upon finishing that article in Business Week, do most readers:

a) Look into healthcare to find out for themselves what's wrong with our so-called system,

b) Protect their own kids by ensuring that Max and Jessica are still fully covered under dad's plan, or

c) Call their broker and invest in UnitedHealthcare.

Moyers covers the Cal Nurses

Take a look at this great segment from Bill Moyers' Journal, at PBS.

It brings back my favorite observation from T.R. Reid's "Sick Around the World" special: the fact that we in the U.S. don't have a health care system, we have a market. In the same way that sprawl isn't city planning. It's what happens when there isn't city planning.

Private insurance hurts U.S. businesses

Len Nichols and the New America Foundation have released a great paper, well sourced and with great charts and tables, showing the private health insurance's effect on global competitiveness.

Here's one of the charts:



Download the pdf for Employer Health Costs In a Global Economy at the New America Foundation website.

How Many Support Single-Payer?

Do pundits and politicians misstate the facts or lie about single-payer and the U.S. healthcare system? Is it because they're uninformed or because they figure they can get away with it?

Steven Maviglio writes about "Single-Payer Dreamland" that "single payer polls in either single digits or low double-digits when Californians are asked what type of health care system they want. Its proponents are vocal, yet few."

Does he also think there were WMDs in Baghdad and that global warming, if it exists, is caused by sunspots?

A number of polls show something quite different than such low support both nationally and in California. Here's a national one by Gallup.

It showed that in November 2007, 41 percent of Americans were in favor of "replacing the current health care system with a new government run health care system," and 48 percent favored "maintaining the current system based mostly on private health insurance." 11 percent weren't sure.

In 2006, it was 39 percent wanting a government system; in 2005, 41 percent; in 2004, just 32 percent; in 2003, 38 percent; in 2001, 33 percent. Those wanting to retain our current for-profit system have declined from 61 percent to 48 percent, with "don't know" rising from 6 percent to 11 percent.

The bigger changes came not between 2001 and today, but rather between 1987. In 1987, answering the open-ended question of what was "the most urgent health problem facing this country at the present time?" only 1 percent said costs. (68 percent said AIDS/HIV.) Today 26 percent say costs. Then, nobody mentioned access as a problem. In the November 2007 poll, 30 percent came up with access.

A number of other resources as well show it's either uninformed or dishonest to suggest only a tiny minority of Americans support single-payer.

101,000 excess deaths in U.S.

A recent study published in Health Affairs show that there aren't just 18,000 deaths a year because of our idiotic system, there are actually 101,000 excess deaths annually. France, Japan and Australia rated best and the United States worst. The study focused on preventable deaths due to treatable conditions in 19 industrialized nations. The U.S. health care system's shortcomings resulted in 101,000 more deaths than if we'd had a system based on care rather than profit.

Researchers Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine tracked deaths that they deemed could have been prevented by access to timely and effective health care, and ranked nations on how they did.

They called such deaths an important way to gauge the performance of a country's health care system.

Nolte said the large number of Americans who lack any type of health insurance -- about 47 million people in a country of about 300 million, according to U.S. government estimates -- probably was a key factor in the poor showing of the United States compared to other industrialized nations in the study.

"I wouldn't say it (the last-place ranking) is a condemnation, because I think health care in the U.S. is pretty good if you have access. But if you don't, I think that's the main problem, isn't it?" Nolte said in a telephone interview.

Spain was fourth best, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, Britain, Ireland and Portugal. The United States comes in last.

Good comment on this at Cronespeaks:

As a Canadian, I do not want to see the USA get universal health care or free universal education. Much of Canada’s increasing economic advantage comes from the malaise and stupidity of directly competing demographic areas in the USA; and we are winning because of our healthcare and educational advantages.

Recently, Toyota chose Ontario Canada over Alabama as a site for their largest manufacturing site. Why?

Toyota cited a much more highly educated workforce and the savings in healthcare costs as the deciding factors in choosing Canada. Please keep your present system in the USA — it’s “Merkan, so it’s gotta be the ‘best’!

It could be that Stuart Butler, Canada's anti-Michael Moore "brilliant" filmmaker, Stuart Browning might sign her on to help him... You think he'd go for that?

Bravo, Ootpoot!

Krugman and excuses

Paul Krugman looks at healthcare excuses by the reigning kings of unaccountability, defenders of the U.S. healthcare system.

In it, he points out that in fact one in three Americans under the age of 65 was uninsured at some time in 2006 or 2007.

Healthcare in Norway for conservatives

Merete Cunningham, a Health Care for All Colorado supporter, wrote earlier this week for the Fort Collins, Colorado, Coloradan about single-payer healthcare in Norway. Despite the drums of fear from the right, it doesn't sound too scary.

She wrote, "My parents (my mother was a Conservative member of the Norwegian Parliament) lived and died under this system. As they grew old, I could not ask for more humane and decent treatment, at no cost to them, and without the need to sell off their assets. They were able to leave their estate to their heirs while living in a state-run facility. This is what I would like to see here, because I know that it is possible if the profit motive is removed.

"When a for-profit company in the United States is in charge of your health care insurance, company and health care goals must clash. A company's dedication to maximize profits is in direct opposition to its claim to provide health care for its members.... They are doing a great job for their shareholders. However, they are doing a horrible job of providing our health care. Nobody should profit from illness and death."

The first comment was an anti, ranting on about something about Lasik eye surgery. Thank God for Lasik eye surgery. If it weren't for Lasik the right would have nothing to point to as an example of why the free market will save medicine in the U.S.

Nothing.

What she has learned

Heather Bennett, a daughter of Larry and Donna Smith, was in "SiCKO" along with her parents. It was her house in Denver that the couple were headed to at the film's beginning — Heather's husband on his way to Iraq to do "some plumbing," as her son explained. Heather describes herself as "the proud daughter of Larry and Donna Smith." She's right to be proud, because her parents have done this country proud by not shutting up, not resting, but instead relentlessly leading and speaking out. They've done that despite the uncomfortable label of "health care system victim" that catapulted them into what might seem to be a catbird's seat. In fact, both Donna and Larry are more akin to being transformed into canaries in the mine.

Those of us who have been hurt by the despicable U.S. healthcare system have a duty, as Christians, Jews, Muslims, atheists, Wiccans, mothers, friends, and most of all as human beings, to speak out. The private health insurance industry will hurt you too. And if that doesn't outrage you, like the bumpersticker says, you're not paying attention. Heather's family understands. Here's Heather's column.

What I have learned...

By Heather Bennett, proud daughter of Larry and Donna Smith

My parents are featured in the Michael Moore film, "SiCKO." I am one of their six children and I am the daughter who volunteered her home when they had no place to go. I offered my home out of love and understanding that this was what I could do for them at the time. I could not erase the years of financial burden placed on them by their health care woes, but I could offer a soft place to land. For them, the opportunity to tell their story in this movie has been uplifting, dignifying and — and admittedly difficult at times. What people do not know — what people cannot see - is the private struggle behind the scenes for them and for their adult children.

It bothers me that our family did not feel comfortable sitting down and having this conversation together. Perhaps it is too idealistic to think that families do that today. Do adult children know how their parents have planned for the future? Do parents talk about health care concerns and needs? Or are we so caught up in the “me” and in keeping everything private that we don’t stop to talk about it? What is the emotion behind this? Is it fear, embarrassment or shame?

When people ask me why my parents are in the film and why I think this is so important, I answer that my parents are an example of what a couple might have to go through even though they are both working and are fully covered under multiple insurance plans. What I have come to understand over the past few weeks is that the importance of this movie is even simpler than that. It is about having the conversation and then doing something about it.

Inability to have conversations is a big part of the problem in America today. We are so careful about what we say, how we say it, when we say it and to whom we say it that often we decide it is easier not to have the conversation at all. As Michael Moore asks in this film, “Who are we?” My answer is that we are lots of individuals or small family units that are pretty uncaring and unconcerned for those around us. I would argue that Moore’s statement about the “me not we” ideology has bled past our every day dealings with the outside world, straight into our family lives. I know that I myself have learned things about the struggles they have faced by watching them give interviews or reading my mom’s eloquent words posted on a blog or a newspaper article. I also know that I feel utterly unprepared to assist as my parents age.

We live in a different time. Gone are the days that families stayed close together, generation upon generation living in the same community - taking care of each other. In our family, discussions on health care issues, financial issues and independent living issues rarely take place. What is the source of the stubbornness that stops these conversations from happening? How can we regain that connectedness?

If you are the child of an aging parent, I urge you to sit down with your parent(s) and have this discussion. Talk to them about their health. Talk to them about their healthcare. Ask the tough questions. What will happen if there is a major illness? What will happen if that illness is so debilitating that assisted living is required? Would your parent be able to survive the financial drain that a health issue can cause?

Not only do these conversations need to happen within families, but we need to take those discussions and turn them into action. Start with your State Representative, your Congressional Representative and your Senator. Where do they stand on universal health care or a single-payer plan. Have they taken money from the health care lobby? If so, why? Pledge your support for a bill in Congress - HR 676. Challenge each of the Presidential Candidates for 2008 to really explain their health care plan. The voices that rise up from our families, to each state House to the halls of Washington should be filled with anger and outrage at a system that is failing so many. For every day that we do not take action, 50 more people will die.

I wish that I had asked these questions earlier. I wish that I had been engaged in discussions with my parents on an entirely different level. In America, we must get back to a focus on “we”. It starts with asking the questions and planning for the future. Parents must feel no shame or loss of dignity in telling their children what they might need to survive a major illness. Children need to be prepared before something happens.

I urge you to see this movie - parents and children together. Start the conversation and then take action. When you start the conversation, you may be surprised at what you learn. I know I have been.

HCAC vs. Ave Cassandra

I'm taking another go at Ave Cassandra, hoping to find a way to balance the work I do for Health Care for All Colorado and this blog — oh, and my family. Sorry, family. Being program administrator for HCAC is stretching me to my limit — the organization is doing great, and there's enough work for half a dozen staff people.

Good grief, between Health Care for All Colorado and HCAC Foundation you could give a couple dozen people enough meaningful and crucial work to fill their days. HCAC and HCACF volunteers fill a lot of the gap, but a lot of essential work simply does not get done. If single-payer had adequate funding, just a couple years of adequate funding for education, outreach and lobbying!, we'd have single-payer. No doubt about it.

I'm thankful to have one of probably a dozen or so paid jobs in single-payer advocacy and education in the country. I'm working on delegation and prioritizing skills.

Envy of the World...

Thanks to SadbutTrue of Les Enragés for the heads up on this cartoon — and he found it at Josh Marshall's video site, Veracifier.

It really is Sicko, but a package arrived today

Donna Smith, who describes herself as "one proud American appearing in Michael Moore’s newest film, Sicko," wrote up this story about the time of her 31st wedding anniversary earlier this month. She and her husband Larry lost their home after both becoming ill around the same time. They're scraping by these days, walking wounded with him, after three heart bypasses, arguing the need for him to go back to work and her arguing that he mustn't. Donna, a newspaper editor who understands how unlikely it is that she'll ever work in that capacity again since taking up the cause of healthcare justice, wrote this up last week. Sicko opens June 29. Go see it that first weekend.

A package arrived today at my home. It was a welcome sight. It came from a friend, a SiCKO soul mate, who knows what it is to go without medications so that others might have theirs and because there just isn’t enough cash to go around.

Over the past several weeks, I have been weaning myself off of one of my most important medications, my Advair. It is the asthma inhaler that helps my lungs stay open and free from asthma attacks. And I have taken it for almost four years.
Advair is expensive. But even as the doctors in Cuba, where we went with Michael Moore, were taking me off of five other medications, including the beta blocker they said no asthmatic should ever take, they all agreed, “Take your Advair. It is perfect for you. It makes you better.”

But the doctors in Cuba don’t understand. No matter how perfect a medicine or a treatment may be for an American with health issues, unless that American has the cash to pay for the needed item or care, their body will go without.

I first started on Advair four years ago after a debilitating obstructive asthma attack that landed me in the hospital for three days. The pulmonary doctor who saw me then thought I might be helped by the inhaler, and he was right. My lung function dramatically improved with the medicine and my need for the short-acting inhalers to stop acute asthma attacks dropped to almost nil.

It seemed that within a few short months, my lung status was changed from one I feared every time I was outdoors in the cold or near one of my asthma triggers or – heaven forbid – I caught a cold, to one of a nearly normal person. Advair was a miracle for me.

But it' s pricy. Even at the local mega-discount chain pharmacy, Advair in my strength can be $200 a month.

I have insurance, but that doesn’t solve the problem. That same pulmonologist that first prescribed my Advair quit seeing me because we declared bankruptcy in 2004, and his practice group wanted cash up front from me (and then they suggested I submit my own insurance claim). I was devastated since my insurance carrier had always paid handsomely for my care and the only amount this clinic in Rapid City, SD, lost was $200 that had to be listed in the bankruptcy action. So, I couldn’t see him anymore.
I waited until spring of 2007 in Havana, Cuba, to see a lung specialist again. I never got to see an allergist in South Dakota either. The only one my family doc would refer me to was in the same practice group with that “no-dirty-bankrupt-persons” sign on the door.

But over the years, I did manage to talk my way to a continued Advair prescription from whichever doctor I was seeing at the moment. I knew it was helping me, and I knew I had to take it.

Then the bottom fell out of our lives. Insurance premiums topped $600 monthly, and something had to give. Though I was deeply grateful to be participating in the Michael Moore project, that wasn’t going to fix the problems that made me perfect fodder for the film.

When I returned from Cuba, the Advair ran out. My new insurance has a deductible to meet, and it so happened that my Advair was the medication next up on the refill queue for us. My husband takes eight prescription medications for his coronary artery disease, peripheral artery disease, and other conditions. Though I had come off several meds in Cuba, I still needed four – including my expensive Advair.

One local doctor gave me a sample that lasted two weeks, and then offered a sample of a lesser drug. I took it. But as the days wore on, I could feel my lungs starting to tighten again. The pain I had lived without returned. Climbing stairs once again became more taxing; my sleep issues worsened. My asthma was back.

And the shame is all there too. How do I tell the world that I am still a failure – SiCKO “star” and all. I cannot even manage to spring loose $200 to meet my deductible and get my medicine.

The rent, the utilities, the food, the gas for me to get to work, the insurance, the loan payments… my husband’s medications… all must be paid. And my lungs will keep hurting, and all the ground I gained over the past four years will be lost for the lack of $200.

Ask for help, you say. Borrow the money, you say. Get another job. I did but it isn’t helping enough just yet. I’m sure it will if I work a little harder. Stop whining. Buck up, buck up… this is America where if you want it bad enough you can do it.

But how do you admit that no one close to you wants to hear any more health-related trauma? They’d rather buy you dinner or almost anything else than hear you need help to buy Advair.

Grown children might send you a Mother’s Day card, but do not want to help with a prescription. And it isn’t cruelty, it’s denial. Denial that the problem with health care really is as bad as it is in America and denial that your mother is a failure at solving it.

Folks want to hear about the potential fame and notoriety of a film part. What they cannot stand to face is the reality of the situation for me and for many Americans. Thousands and thousands of people will go to bed without their meds tonight.

Being a part of a film with so much potential did not adjust reality for me – not this part of the reality. It’s going to take work and compassion and intelligence to do that over time. Whether a new president will actually tackle the issue is by no means a given, and no one has yet explained to me in a way I can comprehend why the current Congress, including so many of these presidential candidates, cannot and will not act on behalf of the Americans like me who are sinking fast.

But then a package arrived today. My SiCKO sister, more a sister than she can know, sends me the Advair samples she can no longer take. This woman, this friend, stood at ground zero on 9/11. She was made sick by it… very, very sick. Her lungs hurt as mine do, but Advair doesn’t relieve her pain. So she gave it to me.

We also lack the political and moral will to care for her – and thousands of her fellow 9/11 workers. We make them beg for benefits and fight at hearings planned months into the distance. They were our heroes held up to the world yet now they apparently are our albatrosses. Dead weight. It is incomprehensible to me that one of our elected officials does not simply stand up and honor these people by demanding they be cared for compassionately and completely. No explanation suffices for the system failing my SiCKO sister.

The health care system that brought about this chain of events is making many of us sicker than we need to be, and it is costing us so very much.

I will spend, with my SiCKO sister, the next however-long-it-takes fighting for change. The health care system in this nation must change. And it should start today, not with the next presidential election. No, Senators Obama and Clinton – and all of the rest of you — not by the end of your first terms. That’s not good enough.

But for now, I cradle my gift given with only love and complete understanding for what I am going through. Tonight I will inhale my Advair, and a few weeks from now I will breathe easier again.