Tag Archives: health care

Political Rants

We’re not doing this for our health

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News flash: our health care system is broken. That is to say, it is broken from the standpoint of the people who need medical treatment. From the industry investor standpoint, it’s working just fine. People are making a killing, quite literally, from COVID and other illnesses, lending credence to that line from our song Well, Well, Well: “from every misfortune a fortune is made.”

I say this on a week when women’s health is under attack to an even greater extent than usual. The Texas anti-abortion law, which the U.S. Supreme Court has allowed to go into effect, has effectively made abortion illegal in the lone star state, regardless of what their moronic governor claims. This inevitably will be followed with similar restrictions in other “red” states. But even under the best of circumstances, women have trouble accessing and affording care precisely because of the kind of system we still have.

Promises, promises

When he was running for president, Donald Trump promised that he would replace the ACA (“Obamacare”) with something much better, a plan that would cover everyone, etc. Of course, that was a transparent lie that he had no intention of even pretending to make good on. Then last year, when he was running for president, Joe Biden promised adding a public option to the ACA. No sign of that yet, either.

I don’t know what Biden’s plans are for the reconciliation package with respect to health care. What I do know is what he said during the campaign. Back then, he claimed that workers loved their employer-based healthcare and suggested that they had “negotiated” for it. I pointed out back then on my podcast Strange Sound that this was balderdash. Less than 15% of American workers (generously) have union contracts. No one other than a subset of unionists ever “negotiates” the particulars of their health coverage with their employer. The plain fact is that employers provide substandard coverage to their employees, by and large, and that it leaves tremendous gaps.

The six thousand dollar man

As some of you know, I spent about a week in the hospital at the height of the COVID first wave back in April 2020. (It was an ailment unrelated to COVID, as it happened.) After I got out, I got bills that amounted to about $6,000. Now let me be clear – if I did not have health insurance, provided by my employer, the cost would have been much higher. But with this great insurance that Joe Biden suggested I love so much, I was six grand out of pocket over an unexpected illness. I opted for a payment plan with the hospital (which, I should point out, receives a lot of public subsidy).

That is not the way it works in civilized countries. In civilized countries, they do their best to make you well, and that’s it. No bill, or none of any consequence. In Britain and France, I believe, they even give you money when you leave the hospital, under certain circumstances. Why are we not a civilized country? I don’t know. Ask Joe Biden. And every other president, for that matter.

I am fortunate that i had the resources to bear that cost with only minor sacrifices. Most people – including many with employer based coverage – are not that lucky. We need a system that works for those people, not the people who seek to profit from our misfortunes.

luv u,

jp

Check out our political opinion podcast, Strange Sound.

Political Rants

Joe’s Lunch.

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China ate Joe Biden’s lunch – that’s one of the many incoherent things Trump said during Tuesday night’s debate. The fact is, though, that Biden kind of ate his own lunch in Cleveland this past week, and it probably didn’t taste all that good. I don’t claim to be an expert on debates … and I don’t think anyone is an expert on whatever that Tuesday night clusterfuck was supposed to be … but Joe left a whole lot on the table in that exchange. Like most mainstream Democrats with their heads stuck in the “I’m not a liberal” nineties, he gave away the store to Trump on a number of points, particularly having to do with police conduct, health care, and so-called law and order.

So, okay, I’m not affiliated with the Biden/Harris campaign, but here are a few suggestions for the team on what Big Joe might say in response to some crazy shit coming from our president:

Health Care – At one point, Trump bragged about killing the individual mandate in the Affordable Care Act. That was a great opportunity for Biden to point out exactly how the administration is trying to kill the whole bill in a case that will come before the Supreme Court right after the election. That’s when Joe should look at the camera and say, “Folks, Trump’s using that to get the Supreme Court to strike down all of Obamacare. He’s trying to cancel your health insurance and take away your protections for pre-existing conditions!”

COVID-19 – Trump was happily calling COVID the “China Virus”. Biden’s rejoinder (again, to the television audience) should be, “Look, folks. More than 200,000 people died while he was saying the virus would just go away, or that it was just a hoax. For that reason alone, it should always be referred to as the Trump Virus. He likes to put his name on things, so he should be fine with that!”

Extremism – Trump was accusing Biden of not being in favor of law and order, talking about how dangerous movements like ANTIFA are in his imagination. At that point, Biden should have talked about the posse of heavily armed right-wing thugs that took over the streets of Louisville, KY, in recent days, or the right-wing teen who killed two protesters in Kenosha, WI a few weeks ago. Joe should say something like, “How is it law and order when your followers start intimidating and killing people with semi-automatic weapons? Why do you defend killers and thugs?”

The Environment – As he often does, Trump claims to want “clean air and clean water.” There’s plenty of evidence to the contrary, and Biden shouuld be loaded for bear on this. But he should also say to the audience, “Folks, this is how much he cares about clean air and clean water. He appointed a coal industry lobbyist to run the EPA. And as a result, [INSERT FACT HERE]”

Hey, Biden … dig in, man. No charge. (Who says there’s no such thing as a free lunch?) No, you don’t have to thank me. And there’s plenty more where that came from.

luv u,

jp

Check out our political opinion podcast, Strange Sound.

Political Rants

The loudest voice.

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I haven’t been watching the Democratic National Convention in its entirety, just pieces here and there. It’s no surprise that this thing is unlike any political convention we’ve ever seen before. What’s kind of astonishing is the degree to which it looks like a long political ad, with some variations in production values. A lot of it is just a crap show, putting a spotlight on some never-Trump Republicans and various center-right figures. I keep expecting some kind of technicolor tribute to Ronald Reagan, or a cameo by George W. Bush. Stuff like that makes it a bit more like drinking urine than it should be, but then I am a leftist, which means I’m just supposed to suck it up and offer my unqualified support. Still, being asked to sit through Colin Powell is a bit beyond ridiculous, in my humble opinion.

I have talked about this on my podcast, Strange Sound, so I won’t go into great detail, but my decision to vote for the Democratic presidential ticket is rooted in the notion of harm reduction, some of the contours of which have been highlighted throughout the virtual DNC. The fate of undocumented immigrants, the so-called “dreamers”, as well as refugees from both state sponsored or tolerated violence and economic hardship, hangs in the balance – a second Trump term would spell disaster for them, and very likely for so-called legal immigrants as well. It would not surprise me to see a second-term Trump move to strip legal residents of their rights, then perhaps naturalized citizens, particularly if they are members of the communities he most despises. (I can picture an Ilhan Omar-focused executive action revoking citizenship from those who escaped Trump-dubbed “shit hole” countries.)

Then there are those who depend on their health insurance … like just about everybody at some point in their lives. A second Trump term would mean a death sentence for many of those people. Hell, the first Trump term was enough to dispatch more than 170,000 unnecessarily. Single-payer advocate Ady Barkan made this case quite eloquently at the DNC in one of the better speeches. For as little effort as is involved in casting a ballot, it seems to me that we should listen to the voices of people on the edge of disaster, for whom four more years of this might amount to a death sentence. As I said on Strange Sound, we don’t need to invest in the new administration – quite the opposite. We need to be ready to push them from day one. And they will need to be pushed. The lobbyists always have the loudest voice, but we have the numbers. We can flip the tables of the moneylenders if we all do it together, but we need to have an administration that will respond to pressure. Trump won’t. Biden will.

That’s my two cents. What’s yours? Leave a comment or a question. Excoriate me. Shake your cyber fist! Always glad to hear from you.

luv u,

jp

Check out our political opinion podcast, Strange Sound.
Political Rants

Say AAAHHH!

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Here’s a little update on my health crisis from a couple of months ago: I’m still paying the price. Not physically, you understand – nothing noticeable in the way of lingering after-effects of my non-COVID illness. No, I mean I’m literally still paying the price of the hospital stay I experienced in April, the week after my birthday. I think I’ve gone over the numbers before on this blog, but let me just frame it in again so that there’s no mistake: the hospital fee – not the surgeon or anesthesiologist, just the hospital – added up to more than $50,000 for four days. The negotiated rate they charged was more like $37,500, but my portion of it was in excess of $5,000. Once again – I have employer provided health insurance … and the direct cost to me was over $5,000.

I am currently garnishing my own wages to cover this massive fee, adhering to a five month payment plan I agreed to with the hospital. Fortunately – and this is important – I am financially able to afford such an arrangement. But this is the best-case scenario in this cockeyed worker’s paradise known as employer-based health care. I have what has been termed a “Cadillac plan”, mostly because my employer pays 80% of my premiums. (Of course, I am also fortunate that I am not a woman and my employer doesn’t impose its religious convictions on my coverage or that of my wife, because apparently that’s a thing.) As I write this, I can imagine people all over Europe and the rest of the industrialized world scratching their heads over this concept of health care “luxury” – one that entails enormous contributions from the person stricken with disease or injury, regardless of their ability to pay.

I spoke about this issue in a couple of episodes of my podcast, Strange Sound, focusing on presumptive Democratic presidential nominee Joe Biden’s comments regarding the supposed popularity of employer-based plans. The fact that tens of millions of people have a thing does not mean that thing is popular. A lot of people have foot diseases, for instance. And in times like these, employer-provided health insurance is a lot like a foot disease … it plagues your every step. It’s just a goddamned ridiculous way to distribute health care services, though that very formulation erroneously suggests that that is the goal of our current system. The goal of our system is not to provide people with the medical care they need; the goal is for some people to make a lot of money. The only way you can honestly analyze our healthcare system is by beginning with that realization.

With the COVID-19 pandemic raging through our country, cases on the rise in forty states, we need to seriously reassess this system. And we need to do it quickly.

luv u,

jp

Check out our political opinion podcast, Strange Sound.

Political Rants

Cashectomy.

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By rights, this should be an open letter to former Vice President Joseph Biden, a man who has nothing but good to say about employer-based health insurance. It actually dovetails fairly nicely with the first episode of my political podcast, Strange Sound, which was dedicated to that topic. As I mentioned therein, I am a subscriber to such a health plan – one of perhaps 170 million subscribers in the U.S., though that number has gone down by millions in recent weeks due to massive layoffs, furloughs, etc. I had cause to make considerable use of my coverage over the last month or so, and I am now experiencing the second wave of trauma that typically accompanies major illness in the United States: medical billing.

I’ll preface this with a brief “explanation of benefits”, as they say in the insurance game. I have what is known as a high deductible plan: health coverage that carries a $3,600 annual deductible, which means that I pay for the first $3,600 in medical charges, with some small exceptions, via a Health Savings Account. My employer kicks in about two-thirds of that. (They also cover about 80 to 85% of my premium costs, so as I said on Strange Sound, they are what makes the plan remotely affordable.) If I meet the deductible (i.e. incur $3,600 worth of medical charges), the insurance company starts picking up 90% of my medical costs; I pay a 10% co-pay until I reach another $3,600 hurdle, which is my “out of pocket maximum” of $7,200 per calendar year. After that, the insurance company is supposed to pay for everything.

Now there are various caveats having to do with out-of-network providers and the like, which I won’t get into here. Suffice to say that if I am fortunate enough to have a serious illness that doesn’t straddle two calendar years, the most my illnesses should cost me is about $4,400, allowing for my employer’s contribution. That may not seem like a lot of money to Joe Biden or Donald Trump, but in MY world, it’s close to a fortune. In fact, for most people, it’s a near-impossible hill to climb. If treatment for my illness started in December of one year and ended in, say, February of the next, I would be on the hook for at least twice that amount.

Part of the problem here has to do with how providers have structured costs around the private health insurance market. I’ve received a number of bills related to my hospitalization. The ambulance (a municipal ambulance, by the way) bill was $7,400. The hospitalization bill (minus charges from all of the medical personnel) came to $49,360. My portion of that last one is in excess of $5K, and I have yet to see a bill from my surgeon. Why does a four-day stay in a hospital (sans Doctors) plus some tests come to such a princely sum? It’s what the traffic will bear. You can see why rich people are fine with this system. It just doesn’t work for anyone else.

So, Joe Biden, what the fuck are you going to do about this broken system? And more broadly, Democratic party leadership, why are we patching this disaster with massive infusions of cash into COBRA plans when we could just be expanding Medicare/Medicaid to cover people who’ve lost their crappy employer coverage (and those who had none to begin with)?

You are going to need to be able to answer those questions if you want to win this year’s election … or at least minimally serve your constituents.

luv u,

jp

Check out our political opinion podcast, Strange Sound.
Political Rants

At the COVID Hilton.

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Spent most of the week in the belly of America’s healthcare beast. And it started with something in my belly. Suffice to say, I needed an ambulance ride to the ER and emergency surgery for something totally unforeseen, unrelated to but in the midst of the current COVID crisis.

I will tell you that the nurses, orderlies, custodial and food workers were all kind and dedicated professionals, and I couldn’t be more grateful to them. But there were some truly bizarre moments, and I want to share one of them with you.

I’m lying on a gurney in the ready room at the COVID Hilton, my gut scrubbed and primed for incision. The bemasked surgeon enters the room and asks the nurse attending me, “Where is the other doctor?”

“Jeremy is here,” she says, tapping away at the roll-away laptop next to my bed on wheels.

“Jeremy,” the surgeon repeats, looking around. He turns to me and asks if I’m ready. I say something vaguely affirmative, but he’s distracted. He sits down at a desk across from me and takes out his phone.

The surgical nurse arrives, introduces herself to me, then starts helping the attending nurse with her data entry. “You can’t confirm the post op care plan because it hasn’t been entered yet,” she’s says. “See? They haven’t done it.”

“Where is the second doctor?” the surgeon barks into his phone, his legs up on a chair.

“Scroll down,” says the surgical nurse. The accounting system is giving them an argument. “It won’t let you confirm until you put something in here,” she says.

“When the patient dies, who’s going to call the family?” asks the surgeon.

Another guy in scrubs and hairnet arrives. The surg nurse hails him. “Jeremy! Where did you come from?”

“My mother,” Jeremy says. “Always.”

It seemed we were ready. On the way into the operating theater, the orderly sang, “We’re off to see the wizard!”

When I was discharged on Thursday, I was asked to sign an agreement that, if I were to return to the hospital with any additional problems related to this health issue, I would need to do so by noon the next day or it would be considered a second incident and, therefore, be charged separately (i.e. not be covered by insurance). This is America’s health care system in a nutshell. (As it turned out, I went back the next day at 4am. Plenty of time!)

luv u,

jp

Check out our political opinion podcast, Strange Sound.
Political Rants

The utility of experts.

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I haven’t been following the Democratic primary contest very much on this blog, as it receives so much coverage elsewhere it seems massively redundant for me to comment on it as well. When it becomes a substantive policy discussion, however, it certainly warrants comment. When Elizabeth Warren released the explanatory document on her version of Medicare for All (M4A), it was greeted with derision by supporters of the more “moderate” candidates. Morning Joe, of course, rolled out their resident fiscal policy expert Steve Rattner, who deployed a series of charts and graphs that demonstrated beyond a shadow of a doubt the very thing that the recent George Mason University study made clear: health care in America is expensive.

Be afraid. Be VERY afraid.

Rattner used a pie chart to show what portions of total health care cost would be picked up by M4A, then a line graph to illustrate how much higher federal spending would be if such a plan were implemented. He was attempting to make the point that the federal government would have to spend a third again as much as it currently does, and that …. shudder …. that’s a lot! What of course neither he nor his Morning Joe colleagues mentioned was that this money is being spent by us anyway … and that the current result is more than 80 million people uninsured or under-insured, half a million medical bankruptcies a year, and assorted other disasters. In other words, the current system is a massively costly failure.

M4A, on the other hand, would cover everyone. It would eliminate much of the cost to families and individuals, and decouple health care from employment. There would be no more medical bankruptcies, and (icing on the cake) it would cost less than what we’re currently collectively spending. With the right funding plan, it would cost individuals below a certain income level less than what they’re paying now. We can disagree over how that will play out, but M4A is the only way to ensure that health care is a right, not a privilege. When I hear the middling candidates so beloved of Morning Joe complain about single payer, it reminds me that none of them ever had to deal with inadequate health coverage. I have, and it’s a massive pain in the ass. Even the so-called good plans that people supposedly love so much are massively complicated and involve all kinds of hidden expenses.

This fight for M4A won’t be easy. We need to be ready for it.

luv u,

jp

Political Rants

Week that was (again).

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Man, this week has been a clusterfuck. Not sure exactly where to begin, but I guess the best option is just to dive right in.

The Zombie Rises. Repeal and replace is back again this week, this time advanced by GOP senators Graham and Cassidy, and it’s the predictable formula. They basically want to block grant the program, including the Medicaid portion of it, which is the Republican’s favorite target just lately. According to a study cited by the Washington Post, 34 states would lose funding, and the states with Medicaid expansion and relatively generous benefits would be the biggest losers. It will also throw millions off of their coverage – no surprise there. The only thing that can stop this now is, well … us. Call, march, occupy, whatever you can manage. Delay this vote until after 9/30 and it will be dead for a while longer, at least, and that’s the best we can manage under the circumstances (i.e. good enough).

Active crime sceneHurricane Maria. What a horrible storm, and the fact that it took such a cruel path through an already distressed group of islands is heartbreaking. Puerto Rico, already flattened by international finance, has lost power entirely, perhaps for weeks or even months. Their grid is 44 years old, due to such a constricted colonial financial situation. Where is the outrage for the ill-treatment of these working Americans, Trump supporters? Crickets.

Mexico Quake. There’s a sickening regularity to this recent crop of disasters; a hurricane coinciding with an earthquake in Mexico. Again, suffering piled on top of suffering among a populace singled out by our president as the source of all of our woes. And as is so often the case, the lack of public investment in communities makes the disaster more serious than it needs to be. Such an outrage.

Hello, World! Speaking of the source of all of our woes, Donald Trump made his “debut” at the United Nations General Assembly, and duly threatened North Korea with total destruction. Withered talking heads like Joe Scarborough and David Ignatius found some encouraging themes in this poorly-wrought mad man’s tirade, but that’s just residual affection for the American empire. Trump waved the bloody shirt and threatened the world from that podium, and the threat was lost on no one. No doubt about it: Cheney’s back in charge.

Vietnam Revisited. I could write a whole column about Ken Burn’s latest effort to retell history, but suffice it to say that he appears not to have strayed much from the mainstream “bungling efforts to do good” narrative. Another lost opportunity to clarify this loathsome episode.

luv u,

jp

Political Rants

Victory dance.

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Okay, can we all agree on something, people? Try this: the President of the United States is a remarkable dolt who knows nothing about anything outside of – perhaps – real estate and licensing his trademarks. His grasp of American history is tenuous at best and indicative of illiteracy at worst. He always seems to return to the subject of slavery and the Civil War, perhaps because he is surrounded by crackpot white supremacists who fill his empty head with their hateful opinions and convenient factual inaccuracies. The comments about Andrew Jackson are just the latest example, though when he talks about people like “Sharpknife” Jackson he seems actually to be talking about himself.

Spot my useless congressmember.It’s not at all surprising that Trump thinks that he himself could have prevented the Civil War. As a master-level narcissist, he thinks himself capable of anything. And even when he can’t accomplish anything, he celebrates and brags about it like he did. This week, when the House of Representatives passed their latest version of the Affordable Care Act repeal and replace debacle, Trump had the GOP House caucus come to the White House for a little victory dance. (My own representative, Claudia Tenney, could be seen in the second row, right behind the doltish Kevin McCarthy, taking selfies with another Republican congresswoman. Watch for that in an opposition campaign ad next year.)

Okay, so maybe that just proves that Republicans – including the massively overrated pseudo-wonk Paul Ryan – never watched Schoolhouse Rock and maybe they really just don‘t know how a bill becomes law. (They haven’t passed a real lot of them since taking control of the House.) Or maybe this is just Trump’s way of rubbing our faces in the fact that he got his way this time. It’s the kind of tactic Trump is famous for, of course. I suspect if he ever stopped bragging about himself, he’d fly around the room like a toy balloon someone let loose. The facts don’t matter – this is an attitudinal presidency, running on gall and braggadocio, tossing steaks out to the base pretty much every week.

It’s not a joke. The policy implications of this president will be enormous, maybe irreparable. We’re obviously going to have to fight for every inch, and this week the prize went to them.

luv u,

jp

Political Rants

Like they care.

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One more shot at this Affordable Care Act issue, and then I’ll shut up about it for a while. It irritates the hell out of me, to be honest, that I have to defend this product of a conservative think tank, but that’s the crossroad we find ourselves at. Just a few points:

Denying working people healthcare since 2008People losing health insurance. This is a shocker, but people have always been booted out of their health plans. This is nothing new. Sure, Obama didn’t qualify his claim that people could stick with their policies if they liked them. But the media’s claim that this amounts to the President’s “Katrina moment” is simply ludicrous. All of the examples of people who have been forced off of their substandard plans have involved people who can generally afford better. One brought forward by NBC was a freaking attorney in Washington. Come on!

People never getting health insurance. While the G.O.P. and the entire mainstream media have had their hair on fire about the attorney lady who lost her catastrophic health insurance, their political allies in statehouses across the country have done everything they can to ensure that the ACA is a failure. A key component of this is refusal to expand Medicaid, which is keeping millions of working poor people from getting coverage. The reason for this is purely ideological. Louisiana governor “Bobby” Jindal complained about having more people in the cart than pulling the cart, implying that Medicaid expansion would only help the unemployed. Sure it would (and it should), but it wold also help millions of working families – people who work a hell of a lot harder than he ever has.

I’m beginning to think that Bill Clinton should have climbed aboard the ACA-type plan the Republicans were proposing back in the nineties, before they went entirely insane. At least that would have been in place, and there would have been some opportunity to improve upon it since.

As it stands now, the G.O.P. have no concrete proposal to provide health coverage to every American. Their only plan is to shoot the ACA down before it gets some traction.

luv u,

jp