Tuesday, December 30, 2008
But more on that later. Meanwhile...
The problem with equating our private insurance companies with European private insurance companies, is that ours are investor-owned and profit-driven, while theirs are non-profit and, in essence, not much more than private companies that are hired to administer what is in most cases a de facto government-run single-payer system. The government tells them what they will cover and what they will charge people for that coverage, and most of that coverage is paid for with taxes.
The private "insurers" that Maggie Mahar admires here, Group Health Cooperative and Kaiser Permanente, are non-profit, true HMOs and are basically miniature versions of the National Health Systems of Spain and the UK, where the government [the taxpayers!] owns the hospitals and clinics and employs the doctors and nurses and so forth. We have that here in the US: the VA system [and no, Walter Reed is an Army hospital, not a VA hospital].
The much-admired Cleveland Clinic and Mayo Clinic also operate this way, non-profits that own their own facilities and hire their personnel on salary.
All of which argues that the very best way to deliver superb care *and* contain costs is to just nationalize the whole damned system, where the taxpayers own the hospitals and employ all the nurses and doctors.
After a lot of study, this has become *my* preferred solution: open up the VA system to everybody in the country [we'd probably have to rename it though]. The VA even has a working electronic health records system already in place, for those of you who are turned on by that sort of thing.
Not everybody is up for that radical a change, and besides, I'm all for promoting small and medium-sized businesses, so I'm willing to compromise here.
Nationalizing the whole system [payers, providers, and facilities] is one far end of the spectrum of methods for providing health care [for convenience, we'll call it the left].
What we have right now is almost all the way at the other far end of the spectrum: totally privatized [we'll call this the right]. We've essentially established Medicare as our national high-risk pool, covering the elderly and disabled, as both are rather expensive groups that the private insurers don't want to have to pay for, but beyond that [and a few other imperfect safety nets such as Medicaid, state high-risk pools, etc], it's pretty much market-driven competition.
And this is where Barack Obama's plan, Max Baucus' plan, Jacob Hacker's plan, Ron Wyden's plan, Bill Clinton's plan, Hillary Clinton's plan, John Edwards' plan, [I could go on] fall down. The assumption in all these plans is that providers [doctors, dentists, hospitals, pharmacies, etc] are competing with each other for customers [patients] and that payers [insurance companies, and "a new public plan like Medicare"] will all be competing with each other for customers [individuals, employers].
The reality is that intra-group competition doesn't happen all that much. Your employer dictates who your insurer is, your insurer limits your choice of doctors / hospitals / pharmacies, and people generally pick the closest doctor from that list and go to whichever specialist or hospital that doctor sends them to.
Really, payers are in competition with providers, employers are in competition with payers, individuals are in competition with each other [for jobs] and with their employers [over who pays how much of the premium], and individuals who lack employer-sponsored coverage are in competition with payers.
To help various entities in this multi-sided argument compete with various other entities, we have:
- benefits managers [hired by employers to negotiate with insurance companies, and to explain benefits to employees]
- pharmacy benefits managers [to negotiate three-way with insurance companies, pharmacies, and drug companies]
- radiation benefits managers [presumably they do the same thing as PBMs but with imaging centers instead of pharmacies and drug companies]
- denial management companies [to help providers argue with payers]
- patient advocates [to help individuals argue with payers]
- utilization review and utilization management companies [iirc, they're hired by payers to check up on providers and patients both]
Plus, you can hire auditors to check up on all of the above. It's a terrific system for employing lots and lots of people and shoveling lots of $$$$$ throughout the economy, but it sucks at delivering health CARE.
Single payer and European-style multi-payer are right smack dab in the middle: nationalized insurance and private providers. Single payer [fully-nationalized insurance] is a bit to the left of center, and European style [mostly-nationalized insurance] is a bit to the right of center.
Getting back to the moral purity argument... neither of these centrist positions is one of moral purity, but moving to one or the other of them is going to be essential for our survival.
Single payer has several advantages over European style:
- less administrative complexity means lower costs [or more money available to be spent on actual care]
- the US is a big country with a mobile population, and one plan with every provider "in network" means fewer hassles for travelers
- why would anybody want to choose among *plans* and *payers* when we could all have the same plan and payer and just choose our *providers*?
As for losing groups like the Cleveland Clinic, the Mayo Clinic, Kaiser Permanente, and the Group Health Cooperative if we go to single payer, it's my understanding that under HR 676, such non-profit provider groups would still exist. I haven't called John Conyers' office and asked him about it though, so I could be wrong. Any volunteers?
Sunday, December 28, 2008
Monday, December 22, 2008
Healthcare-NOW! has a form letter that you can print out and mail to Senator Kennedy, but ever since the anthrax brouhaha, mail to Congress and the President has gone through a decontamination process. This has created a real bottle neck, and letters can take weeks, or even months, to reach their destination.
So, I was going to send Senator Kennedy an e-mail, when I thought: I know! I'll send him a Christmas card!
Making the card turned out to be waaaay too much fun, and I got a little carried away... If you want to send any of these cards [or make your own cards] to the President-Elect, or your Senator, or your Representative, or anybody else you can think of, now you know how.
Sunday, December 21, 2008
Wednesday, December 17, 2008
Tuesday, December 16, 2008
Saturday, December 13, 2008
Friday, December 12, 2008
Tuesday, December 09, 2008
Thursday, November 27, 2008
Actually, somebody in this household is doing quite well without them. When the dog and I got back from Thanksgiving dinner with the folks, we found the refrigerator door open.
In other news, Sparta has his own Youtube channel now, and a buddy.
New favorite blog -- Poo Zen.
Other new favorite blog -- NPR Check, keeping an eye on the right-wing infestation of NPR
Wednesday, November 26, 2008
Sunday, November 23, 2008
Back to the future, or the present, Katie and Jeff from Healthcare-NOW! dropped in to talk about single-payer activism. Check it out, and do what you can to help the cause.
Saturday, November 22, 2008
Friday, November 21, 2008
Thursday, November 20, 2008
Tune in to learn about single payer national health insurance, HR 676, and [I hope] some strategizing. If you haven't registered at Corrente [or don't want to] but have questions you'd like to have answered, leave them here in comments and I'll try to work them into the discussion.
Spread the word.
Tuesday, November 18, 2008
Obama on single payer --
The New Yorker wrote, "'If you're starting from scratch,' he [Obama] says, 'then a single-payer system'-a government-managed system like Canada's, which disconnects health insurance from employment-'would probably make sense. But we've got all these legacy systems in place, and managing the transition, as well as adjusting the culture to a different system, would be difficult to pull off. So we may need a system that's not so disruptive that people feel like suddenly what they've known for most of their lives is thrown by the wayside.'" [New Yorker, 5/7/07]
Can't manage the transition?! Canada did it, we can too.
FAQ on single payer national health insurance
HR 676, National Health Insurance bill
The Senate Finance Committee hearing is tomorrow. Send an email NOW. Tell them
Monday, November 17, 2008
I read this stuff so you don’t have to, for which I will expect massive offerings of spinach pies and stuffed grape leaves at some point in the future. Anyway, since none of the progressive or liberal health policy wonks seem so inclined, I’ve now waded through the entire Baucus white paper and most of the Senate Finance Committee hearings on this health care kerfuffle.
I’m planning to inflict on y’all, in the near future, my acerbic [or otherwise] comments on the whole thing, though I’ll try to keep it cut up into manageable chunks. I was going to go through the points in the Call To Action in order, from front back, but because I
wasted spent yesterday evening hunting down JindalCare instead, for now I’m just going to skip to page 76 and say a few things about Medicare Advantage.
Medicare beneficiaries can obtain benefits through the traditional fee-for-service program or by enrolling in private insurance plans that are approved to offer Medicare benefits. Private insurance plans are paid a monthly amount by the government for each beneficiary whom they enroll. In return, insurers agree to provide coverage for the range of Medicare benefits that their enrollees need. The program allowing private insurers to serve Medicare beneficiaries is called Medicare Advantage (MA).
The Medicare Payment Advisory Commission (MedPAC) estimates that Medicare Advantage (MA) insurers are currently paid 13 percent more than the amount Medicare would pay if the same beneficiaries remained in the traditional fee-for-service program. Current estimates indicate that these excess payments will total $62 billion over the next five years, and $169 billion over the next ten years.
MedPAC has called for Medicare Advantage payments to be set equal to traditional Medicare. The health insurance industry defends these payments by pointing to extra benefits that low-income MA enrollees receive relative to traditional Medicare, like eyeglasses, dental coverage, and lower copayments. But delivering these extra benefits through Medicare Advantage is not as efficient as delivering them directly through traditional Medicare. Moreover, MedPAC reports that MA plans are less efficient at delivering Medicare Part A and B benefits than the traditional fee-for-service program. Private insurers’ higher overhead and added administrative costs — including profits — mean that fewer benefits are passed along to beneficiaries. CBO and the U.S. Comptroller General estimate the administrative costs of private plans serving Medicare beneficiaries are in the range of 11 to 13 percent, compared to estimates of 2 to 5 percent for the traditional Medicare program.
The majority of Medicare beneficiaries have multiple chronic conditions that could be treated more effectively through interdisciplinary care teams, and the insurance industry contends that private plans better coordinate care and improve quality oversight in the Medicare program. There is no solid evidence that supports this assertion. Not all Medicare Advantage plans are designed to integrate or coordinate care across the spectrum of providers, and not all use electronic medical records to better manage care. Even so, all Medicare Advantage payments are based on the same rates — whether or not the plan uses advanced methods of coordinating and delivering care.
The paper then goes on for several more paragraphs detailing the various tweaks we could try so as to maybe level the Medicare playing field so that the private MA insurers can compete. WTF?
We’ve now got years of Medicare Advantage data showing that the public, taxpayer-funded program works more cheaply and more efficiently than the private insurers can do this for. And we’re also starting to pile up data from various states’ [not just Florida’s] Medicaid programs, where experimentation with letting the private insurers in just makes things more expensive and less efficient.
So, my question here to Senator Baucus — and to Tom Daschle, John Dingell, Ted Kennedy, and anybody else who may be working on Obama’s plan — How many more of us have to be your guinea pigs before you realize that we can’t afford the insurance industry?
Medicaid program on skids, Jindal says
But wrangling persists as remedies planned
Saturday, November 15, 2008
By Jan Moller
BATON ROUGE — Arguing that “doing nothing is not an option,” Gov. Bobby Jindal on Friday proposed restructuring Louisiana’s health-care program for the poor into a private insurance model that relies on managed-care principles to control costs and improve health outcomes.
Jindal’s plan calls for pilot programs in four regions — New Orleans, Baton Rouge, Shreveport and Lake Charles — where most Medicaid recipients would be required to choose between competing managed-care networks. The state would provide “choice counselors” to help people pick between the plans, and people who don’t choose would be automatically enrolled in a plan.
Pilot regions, Medicaid recipients have to choose between competing managed-care networks, choice counselors, and automatic enrollment if you don’t/can’t decide among the competing plans — all are straight out of the Florida “Medicaid Reform” playbook.
That couldn’t possibly have anything to do with the fact that Alan Levine, formerly the director of Florida’s Agency for Health Care Administration [which oversees Medicaid in FL] and implementer of a “medicaid reform” pilot project here [back when JEB!, brother of Dubya, was governor] is now head of Louisiana’s DHH [which oversees Medicaid in LA], could it? Ha!
So, just how is that Florida Medicaid Reform pilot project working out anyway?
You can read the final report for year 2 if you like [big PDF], but the question I most want answered is — according to the report, 287,015 people enrolled in the program, but 111,603 disenrolled — why?
Anyways, on first reading [and second, and third, if you want to know] I didn’t find much in that report that report that could be termed actual data, though there are lots of numbers and tables scattered throughout, and none of those numbers and tables addresses actual health outcomes. It’s all stuff about utilization of call centers, and grievances, and coupons for baby diapers and children’s Tylenol given out as rewards for “making healthy lifestyle choices.”
The Baton Rouge [LA] Business Report has the best wrap-up I’ve found so far. Some excerpts from an article, Market Forces —
Gov. Bobby Jindal’s administration wants to move fast to secure a federal waiver to implement Medicaid reform in Louisiana, the idea being to improve the delivery of health services to low-income families and the disabled, resulting in a healthier population, more accountability and significant savings.
Guiding the effort is Alan Levine, Jindal’s secretary of Health and Hospitals, who oversaw a similar experiment in Florida as Medicaid adviser to former Gov. Jeb Bush. Levine says the Florida pilot projects have been mostly successful. Several critics have come to the opposite conclusion, although Levine says such criticisms have not been based on reliable data.
And though the details aren’t even close to being worked out, Levine is convinced Louisiana’s reform effort will succeed in part because of how it will differ from Florida’s.
Florida Medicaid reform is performing admirably or not, depending on whose study you believe. A July report from the Community Health Action Information Network, a patient advocacy group, says the Florida Agency for Health Care Administration vastly inflated the savings created by reform. A survey of doctors by the Health Policy Institute at Georgetown University seems to point to a decline in physician participation since reform.
Florida’s Medicaid reform pilots started in 2006 in Broward and Duval counties, and in 2007 was expanded to three more counties. A report by former AHCA Inspector General Linda Keen found problems with the pilots, however, and Medicaid reform was not expanded to other counties. Keen has since stepped down, and AHCA has a new secretary, Holly Benson, who is expected to push ahead with expanding reform.
In response to criticism, Levine cites a report by the James Madison Institute, a free-market think tank, that argues previous studies on reform are flawed and that competition in the pilot counties has been spurred and significant cost savings realized.
Levine says Louisiana’s transformation of Medicaid will look like Florida in the general sense of bringing the marketplace to bear in solving problems. In the pilot programs, residents eligible for Medicaid could choose among HMOs or other health networks called Provider Service Networks.
In Florida, the PSNs and HMOs compete against each other, with the marketing advantage going perhaps to the HMOs, which have been ensconced in the Florida Medicaid market for years. In Louisiana, individual PSNs will be managed by HMOs and compete against other PSN/HMO teams.
Levine’s agency will require HMOs to partner with a provider, which he says creates a “natural, market-based filter.” DHH will do an actuarial analysis to decide how many HMO/PSNs a given market requires. DHH will decide which HMOs get in based on metrics such as history of patient satisfaction, promptness of payment, etc. The HMOs that make the cut will compete against each other in that market. That way, the state is out of the business of setting Medicaid rates. The HMOs do it instead—which is probably not going to be music to most doctors’ ears.
If reform through managed care is not more economical than old fashioned fee-for-service, it’ll be a hard sell taking the concept statewide. Studies are under way that everyone hopes will answer that question. Doctors in the pilot counties, meanwhile, are divided on reform depending on how much bargaining power they have with HMOs or PSNs to get higher rates of reimbursement from Medicaid. Scarce specialists are likely to have more bargaining power. Primary care doctors, who aren’t as scarce, are likely to have less.
Dr. Steven Spedale is a Baton Rouge pediatrician and member of Levine’s advisory committee, representing the Louisiana chapter of the American Academy of Pediatrics. Spedale says it’s too early to know how well Florida’s Medicaid reform will work, since only three years have passed in what was designed as a five-year demonstration project.
“It’s hard to hold it out as the model to use because no one has the final numbers,” he says.
So, in Florida, a patient advocacy group says the reported savings were inflated, the Inspector General found problems with the program, but a free-market think tank says that: previous studies on reform are flawed and that competition in the pilot counties has been spurred and significant cost savings realized. Who ya gonna believe?
Oops, almost forgot this —
So it is fair to conclude that the state (again with a federal funding match available) has cut its commitment to insuring children from poor families to about two-thirds of what it was a few years ago. The problem is made worse by the unwillingness of private health insurance to cover children. Florida is tied for second-worst in the country in the percentage of uninsured children aged 0-18.
One of the arguments heard here in the US from incrementalists in the health care reform debate is that we don’t have to go with single-payer — lots of other countries have multiple, private insurance companies [see item 3 below]. We could just tweak our private insurers to be just as affordable and reliable as theirs!
Not so fast, subsidy-breath. The following is basically a c&p from an article I found at the PNHP site, but I’ve done a little editing and emphasizing of my own.
By Dr. Ida Hellander
PNHP Executive Director
Health care systems in the Organization for Economic Cooperation and Development (OECD) countries primarily reflect three types of programs:
1. In a single-payer national health insurance system, as demonstrated by Canada, Denmark, Norway, Australia, Taiwan and Sweden, health insurance is publicly administered and most physicians are in private practice. U.S. Medicare would be a single payer insurance system if it applied to everyone in the U.S.
2. Great Britain and Spain are among the OECD countries with national health services, in which salaried physicians predominate and hospitals are publicly owned and operated. The Department of Veteran’s Affairs would be a U.S. single payer national health service system if it applied to everyone in the U.S.
3. Highly regulated, universal, multi-payer health insurance systems are illustrated by countries like Germany and France, which have universal health insurance via non-profit “sickness funds” or “social insurance funds”. They also have a market for supplementary private insurance, or “gap” coverage, but this accounts for less than 5 percent of health expenditures in most nations.
Sickness or social insurance funds do not operate like insurance companies in the U.S.;
- they don’t market,
- they don’t cherry pick,
- they don’t set premiums,
- they don’t set rates paid to providers,
- they don’t determine benefits,
- they don’t earn profits or have investors,
etc. In most countries, sickness funds pay physicians and hospitals uniform rates that are negotiated annually (also known as an “all-payer” system). Princeton economist Uwe Reinhardt calls Switzerland’s “sickness funds” quasi-governmental agencies**
There is no model similar to sickness funds *** operating in the U.S., although they are often confused with the Federal Employee Health Benefit Program (FEHBP), which is simply a group of for-profit private insurance plans with varying benefits, rules, regulations, providers, etc. The 1993 Clinton health plan was an attempt to regulate private insurance companies in the U.S. to behave more like sickness funds, but the insurance industry defeated it.
Bottom line: The most important point for single payer advocates is that every country with universal coverage has a non-profit insurance system. No country uses for-profit, investor-owned insurance companies such as we have in the U.S. (although they do have a small role in selling “gap” coverage).
* The three basic models are general outlines, and there are many examples of “mixed models” (e.g. although Sweden has national health insurance, the hospitals are owned by county government, a feature more common to countries with a national health service).
** Many countries are tinkering with how sickness funds operate (e.g. Germany). The most extreme change is in the Netherlands, which since 2006 has allowed the non-profit regional sickness funds to become for-profit insurance companies, and new insurance companies to form, in the hope that “competition” would control costs. After just one year of experience, the country has experienced —
- a wave of anti-competitive mergers of the insurers
- emergence of health plans that “cherry pick” the young and healthy
- loss of universal coverage
- the emergence of 250,000 residents who are uninsured
- another 250,000 residents who are behind on their insurance payments.
All of the positive data from the Netherlands (on costs, infant mortality, quality, etc) is based on the system pre-2006 (personal communication, Hans Maarse).
*** In the film “Sick around the World” five nation’s health systems are shown. The U.K. is an example of a single payer national health service. Taiwan is an example of a single payer national health insurance. Germany, Japan, and Switzerland use multiple “sickness funds” that are non-profit and pay uniform rates to providers (“all-payer”)
Sunday, November 16, 2008
Thursday, November 13, 2008
(should you choose to accept this mission)
* Link to the
* Post the rules on your blog.
* Write six random things about yourself.
* Tag six people at the end of your post and link to them.
* Let each person know they’ve been tagged and leave a comment on their blog.
* Let the tagger know when your entry is up.
Six random things about me... me me me! It's all about me! My favorite subject.
Hmmm... my work has taken me to some interesting places... I think I'll make the 6 random things work-related.
- I once lost a show-down with a possum. I was collecting sewage samples at the time.
- I used to have a security clearance of some kind, not the top one, but that's all I can remember about it. Do you get to keep these things for a lifetime?
- I know where
all someparts of the bodies are buried. I used to be a hazmat emergency responder, and once when we thought we were going to be digging up methyl ethyl bad shit, we found, um, medical waste instead.
- I like cheese. This isn't work-related [so I lied], it's an obscure TV show reference.
- I once lost a show-down with an alligator, a big one [the alligator, not the confrontation]. I was supposed to be harvesting tomatoes [collecting samples] at an experimental farm, in a plot that had been fertilized with... sewage sludge! [some days life can be really crappy] Instead, I spent the afternoon on the roof of the nearest shed, until somebody finally came along in a really big pickup truck.
- The dog and I once raised a litter of orphaned kittens. They were so tiny they couldn't go more than a couple of hours or so without sustenance at first, and they needed to be kept warm, so I snuck them into work in a plastic storage container everyday [they didn't stay a secret for very long]. And did you know that very young kittens need help with their peeing and pooping? I didn't, but I read it on the intertoobz, so I followed instructions [also, I let the dog take care of this part as much as possible].
I've been really bad about keeping up with my bloggingbuds lately, so if you saw the above kittens, consider yourself tagged.
Thursday, November 06, 2008
Unless you've been living under a rock, you know that today is election day.
You're not gonna want to tell people in 10 years that you don't remember what you did today, so if you're able to vote in this election and still don't know where to cast you vote, you just lost your best excuse for not doing so:
You can also test your prognostication ability against the pundits by entering our election prediction sweepstakes:
- First prize: one month's worth of FDL Book Salon titles.
- Second prize: a package of books, CDs and DVDs courtesy of Blue America
- Third prize: FDL t-shirt and mug, plus two tickets to the Inauguration special performance of "Wake Up World"
I'll be on GritTV with Laura Flanders at noon ET. Watch live on firedoglake.com and call in toll-free at 866-466-2961 and let us know what you're thinking.
And I'll also be on BBC World News all night until the bitter end, hopefully trying to figure out how to make House and Senate races interesting to an international audience.
If you're already voted, pat yourself on the back -- and take someone you love to the polls!
Jane asks us to take someone we love to the polls. I went one better [or worse] -- I rode with my neighbor, who is new in town and didn't know where to go, to our polling place. On the way there we argued politics, but neither of us convinced the other, and we ended up effectively canceling out each other's vote. At least we agreed on one thing -- VOTE! [how I voted]
Such is the nature of politics and friendships.
Tuesday, November 04, 2008
Oh, and 2 other notes, neither of which is likely to be useful --
Florida is 51% Obama, 49% McCain, or about 160,000 votes ahead, with 86% of precincts reporting. NB, later-reporting precincts here tend to be in the red parts of the state.
CNN appears to have called Ohio for Obama, a flip from red to blue for the Buckeye State if true. I can't remember the site where I saw the information, but whoever has won Ohio in the past 10Presidential elections has won the whole kit and caboodle. But probably it's safer to rely on your magic 8-ball for prognostication.
Saturday, November 01, 2008
Long line in front of the library for the last day of early voting [I'm still waiting till the 11th hour of Election Day myself] , and I decided to treat myself to a chocolate milkshake while I was out running errands -- long line at McDonald's and I waited at the window forever before they finally decided they couldn't get the milkshake machine working after all.
I don't mind the gas prices so much, I'm a treehugger anyway and think we all ought to drive less than we do. What I really need, though, is for my food prices to go back down, or for my income to go up.
Oh, and health care would be nice to have too. Yo, Massachusettsians! I understand [some of? all of?] you have a chance to vote for a ballot initiative for a state-wide single-payer system. Far be it from me to tell y'all how to run your own state [vote YES!] but hey, how's that RomneyCare been working out for ya?
Friday, October 31, 2008
Monday, October 27, 2008
Sunday, October 26, 2008
Saturday, October 25, 2008
Friday, October 24, 2008
So, apropos of not much, I decided to drive around a few neighborhoods and [sort of] count campaign signs.
My immediate neighborhood, mostly white, is more or less working, with small pockets of solidly middle class -- McCain/Palin signs outnumber the Obama08 signs, maybe 3:1.
My former neighborhood, approximately the same economic range but about 50/50 black/white has almost no signs, but I did see a few Obama bumper stickers.
The slightly more prosperous neighborhoods around me, solidly middle class and up to the lower tier of upper middle class, again mostly white, have more Obama08 signs, about 2:1.
The definitely ritzy-schnortzy upper middle class would-be-gated-if-it-could-be-gated neighborhood just up the street is ALL white and has ALL McCain/Palin signs.
One of the poorest neighborhoods in town, almost all black, has few signs, but none of them were for McCain.
One of the poorest neighborhoods out in the county, also mostly black, has very few signs, but none of them were for McCain either.
Lots of active-duty and retired military here, but not a lot of Veterans For McCain signs. I wonder what the place would have looked like if the Obama campaign had given out Veterans for Obama signs.
Sarah Palin stopped by here a few days ago; reportedly 10,000 people from 4 counties showed up and fell in love with her.
Lots and lots and lots of signs for local elections, which is heartening, but an awful lot of them are for Republicans, which isn't a huge surprise. This place has long been of the Blue Dog and Dixiecrat stripe, so when Newt Gingrich invited them to turn Republican, they did.
Thursday, October 23, 2008
Wednesday, October 22, 2008
In response to caseyOR’s question, what is UHC? I thought I’d try to answer without getting too geeky or wonky.
This abbreviation is variously used for both Universal Health Care and Universal Health Coverage.
The word coverage is used in this context to mean health insurance coverage.
Insurance is basically a useful way to pay for catastrophic things that happen to us — whether the house gets blown away by a hurricane, or someone in the family gets cancer, or some idiot T-bones the car when they run the red light. At its most basic, insurance is when a group of people all agree to put a little bit of their money ahead of time [insurance premiums] into one pool, and as people who belong to that group get hit by something huge that they couldn’t afford to pay for on their own, they can draw out what they need from that pool.
Universal health coverage just means that every single member of a population has health insurance.
Health care, on the other hand, is the sum of all the actual services you get from doctors, hospitals, clinics, laboratories, dentists, psychologists, etc. You can pay for these services with insurance, or with your own money, or with your taxes, or with some mixture of insurance, taxes, and cash.
Universal health care means that every single member of a population can get these services, no matter what their circumstances [employed, unemployed, rich, poor, healthy, sick, old, young, etc].
Single-Payer and Multi-Payer
Single-payer just means that only one entity — be it a government or a private insurance company — takes in all the insurance premiums [or taxes] and pays all the doctor bills [and hospital, and dentist, etc].
Canada’s Medicare, our Medicare, and Australia’s Medicare are all single-payer insurance systems that are run by the respective national governments. The difference between us and them is that their Medicare systems are universal — covering every single person living in their countries — while our Medicare system only covers old people.
Multi-payer means that several entities — usually lots of different private insurance companies — take in insurance premiums and pay the bills. Our current health insurance system is a multi-payer system. Most people who have health insurance get it as a benefit provided by their employer [or their spouse’s employer, or their parent’s employer, etc] but some of us have to buy our own health insurance, usually because we’re self-employed or we work for a company that’s either too poor or too cheap to provide it as a benefit.
Our multi-payer private health insurance system here in the U.S. does NOT provide universal coverage, simply because not everyone can afford it. This is basically because our insurance companies are blood-sucking leeches.
Lots of countries have multi-payer private health insurance systems — France, Germany, Switzerland are some examples. These countries all have universal coverage because their governments basically force the private insurance companies to make their insurance plans both affordable and open to anyone who wants to join. And the companies may be private, but they’re non-profit [we used to have a lot of these here in the U.S. but now we have very few]. Additionally, these countries all provide generous help to poor people who otherwise couldn’t afford the insurance premiums.
The difference between our country and all the other multi-payer countries is that their private insurance companies are all so heavily regulated by their respective governments that to us they LOOK like they’re government-run. Don’t let the U.S. insurance industry scam you — they whine loud and long about the onerous burden of regulations here, but even though we have lots and lots and lots of regulations, those rules are all tilted to favor the insurance companies, not us real people.
Medicare and Medicare For All in the U.S.
Medicare is our government-run, single-payer insurance system to pay for health care for old folks. Medicare-For-All is the short name of the National Health Insurance bill introduced by John Conyers — HR 676 — that would expand our current Medicare system to cover all of us. PNHP [Physicians for a National Health Program] has an excellent FAQ on single-payer and HR 676.
Paying for it — can we afford to do this? Short answer — Yes.
Right now, if you’re employed [let’s forget about the self-employed and the few who make very humongous salaries for the moment — they’re special cases] you and your employer together pay 15.3% of your gross salary/wages to Social Security and Medicare. You pay 1.45% to Medicare and 6.2% to Social Security [this deduction usually shows up on your pay stub labeled as FICA taxes, but people also call it ’payroll taxes’]. Your employer pays an additional amount equal to 1.45% of your gross salary/wages to Medicare and an amount equal to 6.2% of your wages/salary to Social Security.
Under HR 676 — Medicare For All — your FICA taxes would go up. The amount going to Social Security would still be 6.2% of your gross wages, but the total amount going to Medicare would be 4.75% instead of the present 1.45%. Likewise, your employer would still pay 6.2% to Social Security, and would also pay 4.75% to Medicare.
This sounds like a huge increase in taxes, but overall, most people — both employees and employers — would end up paying much less than they are now. Under HR 676 you don’t have to worry about insurance premiums, co-pays, deductibles, or other out-of-pocket expenses — it’s all been paid for ahead of time in your taxes. You just walk into any doctor’s office, any clinic, any hospital, any lab, any dentist, any optometrist, any pharmacist, any health care provider, get what you need, and walk out [we hope]. The provider then bills Medicare for the services, or medicines, or medical equipment they gave you.
No worries about losing your insurance because you change jobs, or want to work for yourself, or worse yet, lose your job. No worries about being able to afford an expensive illness, like cancer, or a heart attack. You might still have to worry about buying food for the kids and heating the house at the same time, but you’ll always, always be able to take them to the doctor if they get sick.
Almost forgot this one. You hear the right-wingers scream socialized medicine !!! socialized medicine !!! socialized medicine !!! whenever the topic of UHC comes up. True, the Soviet union had ’socialized medicine’ and made a real mess of it, but that wasn’t the fault of socialized medicine, that was the fault of brutal and greedy tyrants who hijacked everything about their governments.
Socialized medicine actually works, and works well. It’s a basically a special kind of singe-payer — the government [the taxpayers!] owns all the hospitals and and clinics and labs and so forth, and employs all the doctors and nurses and dentists and ambulance drivers, etc. It’s probably the most cost-effective way to deliver quality medical care. The U.K. has this system. We do too, except that it’s only for veterans.
Two things to keep in mind about the VA —  Walter Reed is an Army hospital, not a VA hospital, and  yes, the Republicans, with their wars + their cuts in funding for the troops and veterans, are damaging what was once a very fine health care system — just one more reason to throw them all out of office.
Monday, October 20, 2008
Sunday, October 19, 2008
Monday, October 13, 2008
update, oct 19 -- i just paid $2.73 a couple of hours ago.
Thursday, October 09, 2008
Sunday, October 05, 2008
Over the course of the presidential campaign, John McCain has repeatedly emphasized his willingness to stand up to Russian Prime Minister Vladimir Putin as proof that only he possesses the fortitude and judgment to become the next leader of the free world. In his acceptance speech at the Republican convention, McCain lashed out at Putin and the Russian oligarchs, who, "rich with oil wealth and corrupt with power...[are] reassembling the old Russian Empire." McCain rushed to publicly support the Georgian republic during its recent conflict with Russia and amplified his threat to expel Moscow from the G-8 club of major powers. His running mate, Sarah Palin, suggested in her first major interview that the United States might have to go to war with Russia one day in order to protect Georgia--the kind of apocalyptic scenario the United States avoided during the cold war.
Yet despite McCain's tough talk, behind the scenes his top advisers have cultivated deep ties with Russia's oligarchy--indeed, they have promoted the Kremlin's geopolitical and economic interests, as well as some of its most unsavory business figures, through greedy cynicism and geopolitical stupor. The most notable example is the tale of how McCain and his campaign manager, Rick Davis, advanced what became a key victory for the Kremlin: gaining control over the small but strategically important country of Montenegro.
According to two former senior US diplomats who served in the Balkans, Davis and his lobbying firm, Davis Manafort, received several million dollars to help run Montenegro's independence referendum campaign of 2006. The terms of the agreement were never disclosed to the public, but top Montenegrin officials told the US diplomats that Davis's work was underwritten by powerful Russian business interests connected to the Kremlin and operating in Montenegro.
Curmudgeon cat has never been one to do anything halfway, and this is no exception, but... how is it that I have to clean the entire bathroom after he throws up only once?
The good news, more or less, is that with new food [more expensive than the old food] and new medicine [more expensive than the old medicine] he's doing fine.
Thursday, September 25, 2008
Wednesday, September 24, 2008
For immediate release
Monday, September 22, 2008
From James E. “Jim” Bryan
CONGRESSIONAL CANDIDATE JIM BRYAN TO HOLD PRESS CONFERENCE IN CHIPLEY WEDNESDAY, SEPTEMBER 24, 1:00PM, IN FRONT OF THE WASHINGTON COUNTY NEWS, 1364 N. RAILROAD AVE, CHIPLEY, FL, 32428
Speaking in Chipley, in a small county at the eastern end of a District 140 miles wide, emphasizes my determination to represent every last person in District 1. I want to get my message out to the press, and will also answer questions from anyone present.
My next press conference will be in Pensacola, Wednesday October 1, place to be announced. But this won’t be the last time I speak to the press in the eastern part of Congressional District 1.
My main subject will be the economy of the Panhandle. In Congress, I will be a strong advocate for agriculture and manufacturing -- using (and protecting) our many natural resources, our robust transportation net of truck, rail, waterway and air, and not least, the vigor and work ethic of our work force.
My hero is Democratic Congressman Bob Sikes, from Crestview, who represented District 1 from 1940 to 1972. “Uncle Bob,” as he was known to the voters, brought jobs and prosperity to the Panhandle. Like him, I will spend every minute I can with the voters; because I think knowing the needs of the District 1 will make me more effective than hobnobbing around Washington.
I will also speak to the weak record of the incumbent Congressman, Jeff Miller. His main qualification, according to his web site, is that he is a conservative Republican in an area that always votes Republican. I think the welfare of America and my District are more important than party loyalty.
Being a “conservative Republican” has not made Mr. Miller effective. According to the “Power Ranking” evaluation at www.congress.org, by a company (look it up) that serves professionals in government relations and even lobbyists; Mr. Miller ranks No. 412 of the 435 members of the US House of Representatives. He also ranks No. 24 (of 25) in the Florida delegation to the House. Mr. Miller’s personal score is 5.6. To compare, 50 is a representative effective score in either House or Senate. (Very top scores for leaders are about 100,) The bottom is about zero (think William Jefferson, D-LA and Rick Renzi, R-AZ, both under indictment).
The U.S. government has been turned into an engine that accelerates the wealth upwards into the hands of a few. The Wall Street bailout, the Iraq War, military spending, tax cuts to the rich, and a for-profit health care system are all about the acceleration of wealth upwards. And now, the American people are about to pay the price of the collapse of the $513 trillion Ponzi scheme of derivatives. Yes, that’s half a quadrillion dollars. Our first trillion dollar compression bandage will hardly stem the hemorrhaging of an unsustainable Ponzi scheme built on debt "de-leverages."
Does anyone seriously think that our public and private debts of some $45 trillion will be paid? That the administration's growth of the federal debt from $5.6 trillion to $9.8 trillion while borrowing another trillion dollars from Social Security has nothing to do with this? Does anyone not see that when we spend nearly $16,000 for every family of four in our society for the military each year that we are heading over the cliff?
This is a debt crisis, not a credit crisis. Just as FDR had to save capitalism after Wall Street excesses, we have to re-invigorate our economy with real - not imaginary - growth. It does not address the never-ending war on the middle class.
The same corporate interests that profited from the closing of U.S. factories, the movement of millions of jobs out of America, the off-shoring of profits, the out-sourcing of workers, the crushing of pension funds, the knocking down of wages, the cancellation of health care benefits, the sub-prime lending are now rushing to Washington to get money to protect themselves.
The double standard is stunning: their profits are their profits, but their losses are our losses.
This bailout will not bring real jobs back to America. It will not bring back jobs that make things. It does not rebuild our schools, streets, neighborhoods, parks or bridges. The major product of this financial economy is now debt. Industrial capitalism has been destroyed.
In the next few days I will push for a plan that includes equity for every American in any taxpayer investment in this so-called bail-out plan. Since the bailout will cost each and every American about $2,300, I have proposed the creation of a United States Mutual Trust Fund, which will take control of $700 billion in stock assets, convert those assets to shares, and distribute $2,300 worth of shares to new individual savings accounts in the name of each and every American.
I will also insist that all of the following issues be considered in whatever Congress passes:
- Reinstatement of the provisions of Glass-Steagall, which forbade speculation
- Re-regulation of the finance, insurance, and real estate industries
- Accountability on the part of those who took the companies down:
a) resignations of management
b) givebacks of executive compensation packages
c) limitations on executive compensation
d) admission by CEO's of what went wrong and how, prior to any government bailout
- Demands for transparencey
a) with respect to analyzing the transactions which took the companies down
b) with respect to Treasury's dealings with the companies pre and post-bailout
- An equity position for the taxpayers
a) some form of ownership of assets
- Some credible formula for evaluating the price of the assets that the government is buying.
- A sunset clause on the legislation
- Full public disclosure by members of Congress of assets held, with possible conflicts put in blind trust.
- A ban on political campaign contributions from officers of corporations receiving bailouts
- A requirement that 2008 cycle candidates return political contributions to officers and representatives of corporations receiving bailouts
And, most importantly, some mechanism for direct assistance to homeowners saddled with unreasonable or unmanageable mortgages, as well as protection for renters who have lived up to their obligation but fall victim to financial tragedy when the property they live in undergoes foreclosure.
These are just some thoughts on the run. You will hear more from me tomorrow.
Dennis J Kucinich
Sunday, September 21, 2008
Thursday, September 18, 2008
....................................... + rebuild kit for all parts: about the same
....................................... + already rebuilt parts: $400-500
....................................... + used parts from junkyard: $300
....................................... + rebuild kit for only the essential to keep the car running parts: $200
Final cost [went with that last option]: $93 and change, parts and labor. I have absolutely the best car fix-it shop evah. Hunting down parts for a 20yo old car is the hardest part.
Look out world, I'm back behind the wheel again!
Wednesday, September 17, 2008
Monday, September 15, 2008
Right now, the GOP is executing a plan to TAKE 38 governorships over the next three years. If they accomplish this, they will have the power to shrewdly alter election district borders and steal back Congress.
Why governors? Governors influence redistricting--the redrawing of congressional district lines, and all states redistrict in 2011 to make our government more representative. But like Texan Tom DeLay, who led the underhanded, but legal, effort to create SIX new Republican congressional districts in Texas in 2003, the GOP wants to make government non-representative--to win by making it impossible for Republicans to lose.
The DGA is mobilizing right now--before the GOP plan gains momentum--to elect Democratic governors all across the nation. 11 states are at immediate risk! Will you help us now to protect our democracy? Please donate $5 or more today:
Democrats have a 28-state majority of governors. But 47 governorships will be decided in the next three years, starting with 11 in 2008. And the Republicans have already raised close to $30 million. Their plan is to use this massive war chest to pick up 16 new governorships and gerrymander their way to a new congressional majority.
This is not Democratic propaganda. Just read these words from a spokesman of the Republican Governors Association:
"We could feasibly see 25 to 30 congressional seats swing as the result of redistricting...The odds are, if it is a Republican in the governor's chair, the seat will end up in GOP hands."
Republican governors = manipulated districts = 25 to 30 more congressional seats in GOP hands!
This is old-school, back-room politics at its worst, and if they succeed, our democracy will suffer for years to come.
One thing is clear--the Republicans expect to lose at the ballot box for a long time to come, unless they get their 38 governors and give themselves an unbeatable edge.
So let's give them the defeat they expect and deserve starting with this year's races.
Please join in giving the DGA the resources it needs to protect our democracy.
Let's show the GOP that we take our democracy seriously. That means the American people--in every state--get to decide.
Governor of New Mexico
Former Chair, Democratic Governors Association
update: the cat has drugs [though he's still in a bad mood and yowling about it], nobody used the magic plastic cards in my wallet [but replacements are going to take several days to get here], the car is fixable [for about $200, an unpleasant bite but doable], quantities of caffeine [and chocolate!] took care of the headache, and i have no idea if the hot water got fixed yet, but who cares? the rest of it will be ok. oh yeah, the contract that puts food in teh kittehz dishez [and litter in their boxez] got extended for another year.
update tuesday night: hot water fixed. yay.
Friday, September 12, 2008
Militant vs. Predator
By Daniel Politi
Posted Friday, Sept. 12, 2008, at 6:45 AM ET
The Los Angeles Times leads with word that the Bush administration is sending Predator aircraft "equipped with sophisticated new surveillance systems" to target militants inside Pakistan. This new technology was apparently a key weapon in the fight against Iraqi insurgents and now drones with this special equipment are being pulled from other areas and sent to help out in Pakistan. This is yet another example of how the Bush administration has decided to pursue more unilateral attacks in Pakistan instead of trying to cooperate with the Pakistani government.
So, next they'll be arming those drones with death rays maybe?
Thursday, September 11, 2008
Update: the sample ballot, see if you can spot the Democrat. But hey, it's not going to matter anyway --
None of the 82 counties have published their ballots, Hosemann said Friday. Only three counties - DeSoto, Lee and Yalobusha - use voting machines with paper ballots. The other 79 counties use electronic machines.
Update: Bryan, formerly in law enforcement himself, was kind enough take a look and opine on the situation here.
Monday, September 08, 2008
Tuesday, September 02, 2008
Four weeks ago, tourists had to be evacuated from Baffin Island's Auyuittuq National Park because of flooding from thawing glaciers. Auyuittuq means "land that never melts".
Two weeks later, in an unprecedented sighting, nine stranded polar bears were seen off Alaska trying to swim 400 miles north to the retreating icecap edge. Ten days ago massive cracking was reported in the Petermann glacier in the far north of Greenland, an area apparently previously unaffected by global warming.
But it is the simultaneous opening – for the first time in at least 125,000 years – of the North-west passage around Canada and the North-east passage around Russia that promises to deliver much the greatest shock. Until recently both had been blocked by ice since the beginning of the last Ice Age.
Monday, August 18, 2008
More accurate that way, they said.
Sunday, August 17, 2008
Wednesday, August 13, 2008
On August 1st, I delivered to Speaker Nancy Pelosi; a petition bearing the names of over 100,000 Americans that, like us, feel that the President must be held accountable for abusing executive power and disregarding his Constitutional obligations.
Your voices have been heard and your support continues to send a powerful message to lawmakers. That is why I call on you again to help us in a new effort to deliver 1 Million signatures to Speaker Pelosi on September 10, 2008.
Together we can:
- Urge real Congressional action to hold President Bush accountable now
- Reinstate the authority of our Constitution
- Document crimes committed by President Bush for historical account
- Facilitate post-Administration law enforcement and prosecution
- Reset the standard for the incoming and future administrations
- Demand justice for the over 3,000 who died on 9/11and whose deaths were tragically exploited to take us into an illegal war in Iraq
- Demand justice for the estimated 30,324 U.S. military personnel who have been injured/wounded
- Demand justice for the estimated 4,138 U.S. military personnel who have been killed or died
- Demand justice for the 1 Million innocent Iraqis who have died*
- Avert another illegitimate looming war – this time against Iran
We need your active participation to deliver 1 Million signatures to Congress by September 10, 2008.
Please give at least ten of your friends the opportunity to stand up for our country – the way you and I have, by inviting them to sign the impeachment petition online at www.Kucinich.us. Send your friends an email invitation to sign the petition by clicking here.
Together we can make September 10, the day before the world changed, a day we change the world!
Thank you for your active and ongoing citizenship.
Tuesday, August 12, 2008
Monday, August 11, 2008
You Are Lightning
Beautiful yet dangerous
People will stop and watch you when you appear
Even though you're capable of random violence
You are best known for: your power
Your dominant state: performing
Sunday, August 10, 2008
Just so we’re all clear, here…
- The police can kill the family pet with near impunity. But threaten a police dog that startles you, and you’ll find yourself in jail with a $100,000 bond.
- If the police invade your home, even on a mistake, they can kill your dog with impunity. But if an escaped police dog wanders on to your property and threatens your family, you have to just let it continue to threaten them. Shoot it, and you’re looking at a third-degree felony.
It's scary enough that in the oh-so-successful War On Drugs we have to worry about no-knock police raids at the wrong addresses, generally with SWAT teams or their ilk, but apparently it's common practice to shoot any dogs in the house. As the human companion of a largish fluffy black dog that looks very much like one of the breeds that everyone is afraid of, I don't expect my best friend to survive if my home is ever mistakenly raided. I've even considered posting a sign on the front door: Please don't shoot the dog.
The latest outrage on my "representative's" website
Update, about 5 hours later: 720 votes, 'yes' and 'undecided' are at their same percentages, NO has gained 1%. Cool. Thanks, y'all, and keep up the good work!
Also, need help making up your mind? Bryan has done my homework for me and listed some of the reasons why we don't want, or need, offshore drilling here.