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Health care

The State of the…Whatever-We’ve-Got-Here…

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Today’s Quora post:

What are your thoughts on Dr. Fauci telling reporters that America might still be battling smallpox and polio if today’s kind of misinformation existed back then?

Profile photo for Victoria Hay

Right on! But possibly he doesn’t go quite far enough. Not only were we not subjected to misinformation at the time the polio vaccine came available, neither did we have a President who deliberately and maliciously spread error and lies to advance his personal cause.

I grew up in the Middle East during the 1950s, in a Saudi-American oil camp. Polio was a terrifying scourge there, as it was in Europe and the Americas. If you didn’t die from it, you were likely to be crippled for the rest of your life. But polio was only one of the threats. We also had smallpox, typhus, tetanus, diphtheria, pertussis, cholera, typhoid…on and on. Where I lived, Americans had to take shots for each of these horrors once a year. Some of the shots were pretty darned painful — cholera and typhoid in particular.

Have you ever seen a person who has, by the grace of God, managed to survive smallpox? I have. He was a young man, possibly even still in his late teens. His face was so horrible it turned your stomach to look at him. Ravaged, like the skin had been burned off in a fire, but the scars were even worse than burn scars. He might have been better off to have died from the disease.

How about a person who has survived polio? Some of those folks were in the iron lung for the rest of their permanently limited lives, never able to breathe on their own again. Some escaped paralysis of the muscles that operate the lungs but never could walk normally again, or use their hands and arms normally. And polio, you know, comes back on you, even if you do recover from the initial onset. One of the best doctors I ever knew had to quit his practice and retire when a case of childhood polio flared up in middle age, after years of remission. The rest of his life was ruined.

A thousand curses upon a “president” and party who would deliberately spread the kind of lies, stupidity, and error that Mr. Trump and his worshipers have done. Their behavior has been nothing short of treasonous and murderous, exploiting the suffering, fear, and death of their fellow citizens in order to keep themselves in power.

And may we lay a thousand curses, too, upon those who have brought us an educational system that has failed to teach our citizens the most basic science. How can a grown man or woman have graduated from high school without any grasp of the simplest concepts of elementary biology? The uproar we’ve seen in this country is as much the result of pi$$-poor public education as it is of fear, of fundamentalist nuttiness, and political malfeasance. We have had a good fifty years of educational theory that puts social goals ahead of learning. Result: a citizenry that will believe any da*n-fool lie a demagogue tells them and who haven’t the simplest clue to the facts of history, science, or common sense.

Frankly, folks…as the leader of the Free World, we have dropped the ball.

Taxes, Government, the Tea Party, and America’s Way of Life

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Tea-Party-Logo

Listening to NPR’s All Things Considered during a quick grocery run this afternoon, I heard newly triumphant Tea Partier Rand Paul trumpeting on about what he thinks of as his “moderate” views on the future of American government: basically, get rid of everything that costs anyone anything. The Americans with Disabilities Act, he tells us, was “overreaching,” and businesses should be allowed to refuse service to anyone they please, including those needing special accommodations. Asked if, by that line of thinking, the Civil Rights Act of 1964 was overreaching, he backed and filled like crazy, first trying to say that he agreed with legislation intended to eliminate “institutional” discrimination. Then, when pressed by the reporter who pointed out that the Civil Rights Act said businesses could not refuse service to anyone they please, he admitted he hadn’t ever read the darn thing.

The mixed results of the current round of voting, and the silly “We’re here to take back OUR government” motto that’s being used to fine demagogic effect (hey, it’s not your government, folks…it’s everyone’s government), presage re-election of doctrinaire kill-the-beasters. These people would like to see every tax-funded safety net taken away from every American, and if possible every tax eliminated, first starting with big corporate taxpayers, them moving to the extremely wealthy, and finally focussing on the middle class. As we know, the deadbeat working poor don’t pay taxes.

What, really, would this mean? A few days ago, Jim at Bargaineering ran a post in which he mentioned, in passing, USA Today‘s report that American tax rates are lower than they’ve been in 60 years. He also pointed out that those scary-sounding tax brackets do not even vaguely represent the typical American’s actual ratio of tax to income; after deductions and credits, he observes, “very few people pay anything close to their marginal tax rate.”

This engendered a lively round of screaming and wailing from Bargaineering’s readers. I left a half-baked yelp there, myself, which I’d like to refine a bit today.

You know, the American middle class exists not in spite of the government, but because of it. The affluent lifestyle that has been enjoyed by the majority of our citizens since World War II is an artifact of government protectionism and social programs that date back to the 1800s. The amenities we enjoy and that are envied by citizens of other countries, even in the developed world, were put in place by our taxes. As scholar Michael Lind remarked a few years ago, our middle class has “been invented and reinvented by the government.”

How, I wonder, do the Tea Partiers, the Kill-the-Beasters, and the chronic complainers think we get roads built? Bridges built? Airports constructed? Air traffic controllers trained and in place 24 hours a day?

Where do they think schools come from? Do they really believe it would be better for all of us to home-school our kids, or to rely on private entities with customer service like, oh, say Qwest‘s or Comcast‘s, to educate our children? Did none of them watch last week’s Frontline report on the quality of education delivered by for-profit “colleges” and “universities”?

Have they never used a public library? Have they never put their kids in a summer program run by their town or city’s public parks program?

Where does the water that flows out of the taps in their kitchens and bathrooms come from? Who works to make that water as safe as possible and keep it coming, clean and steady, day and night, year after year?

Is each and every one of them ready to pick up an automatic rifle and defend his home against an invading army? And who among them will be the general and who the privates in the unfunded militia that will protect our country against those who hate us?

And do they never go to professional football or baseball games, held in enormous arenas built at taxpayer expense for the benefit of private entrepreneurs? Do they not watch television, an amenity developed and delivered to us at taxpayer expense?

Did they all go to private colleges and universities, paying the vast tuition for places like Princeton, Yale, and Stanford out of pocket? Maybe they went to lesser schools, like Carleton College or Lewis and Clark—no problem sending the kids there with the savings from all those taxes not paid to support public universities and community colleges.

Maybe these folks, the Joe the Plumbers Sarah Palin pretends to speak for, can afford to put their kids in private or parochial schools. But most people can’t. What do they think will happen to America when 70 or 80 percent of the families in this country, absent public schools, cannot afford to educate their children?

One commenter at Bargaineering says about the claim that taxes are now historically low: “You forget to add into taxes things like social security, state and local fees and also real estate taxes.” Oh, the pain. I weep, I do.

Were it not for Social Security, after a lifetime of hard work and with a bouquet of graduate degrees, I would be sleeping on the street and blogging from the library. Oh, wait! No, I wouldn’t. There wouldn’t be any libraries without local taxes. I would not be blogging at all.

Nor would I be eating.

When I was laid off from my job—the micro-local consequence, we might add, of lax regulation of the financial industry and misguided theories about economy and government—I was forced into unwilling retirement because I am too old to get another job and do not know how to wait tables or stock shelves at the local WalMart (which wasn’t hiring anyway). I could not even get a job driving the tourist train at the zoo. Without Social Security, which now represents more than half my income, I would have lost my paid-off home because I could not have paid the utilities or the cost of basic maintenance. I would not have enough to to buy food or clothing.

If Social Security did not exist, my son would have to take me in and care for me through my old age, or else I would be on the street. And all those Tea Partiers would be doing the same for their parents.

Were it not for Medicare, I would not have any access to health care. Even with a better-than-average medical track record, my age, an evening in the ER with a stress attack pushing my blood pressure through the stratosphere, an incorrect diagnosis of a heart murmur, and a single hairline wrist fracture (signaling nonexistent “osteoporosis” to one insurance bureaucrat) render me ineligible for health insurance at any rational cost. If I could get an insurer to cover me, I could not afford it. For the health plan that cost $36 a month while I was working, COBRA charges $500. One early retiree I spoke with earlier this week said that he and his wife, both cancer survivors, are each paying $2,200 a month for health insurance!

That is more than my monthly gross income. It is $666 more than the 2005 average monthly income for Americans.

Medicare is pretty stiff, too: 8.33 times what I was paying on the job, where my employer footed most of the bill. The largest part of the individual’s cost of Medicare goes to private entities: Medicare Part D and Medigap are provided by the same insurance companies that rip you younger folks off; the only reason you can get full coverage in these programs—assuming you move fast and get yourself a policy the instant you become eligible—is that the federal government requires insurers to cover you without prejudice.

Taxes don’t just evaporate into the air. They buy essential services.

Those services keep our country safe, make commerce and communication possible, build and maintain the world’s best land and air transportation system, keep our food and water reasonably safe, give us a record high life expectancy (if you were born in 1900, when taxes were nil, you could expect to live just under 50 years), make it possible for us to educate our children for nothing or nearly nothing (have you priced private grade schools and high schools lately?), and relieve us from having to support our aged and infirm parents.

Among other things.

So please. Let’s get a little common sense!

Images:

Chicago Tea Party logo: shamelessly ripped from the Internet, without tax payment
Deutche Truppen am Arc de Triomphe, Deutches Bundesarchiv, Wikipedia Commons

Government Long-term Care Coverage: Better than nothing?

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We’re being told that one of the future benefits of the new health-care plan (assuming it survives the Republican onslaught and general hysteria) will be an opportunity to buy long-term care insurance at an affordable price.

That’s a much-needed program. But one has to wonder: apparently the average benefit will be about $50 to $75 a day. That’s as nothing: in Maricopa County, where Phoenix resides, typical cost for a nursing home is over $200 a day! And that’s just the base rate: everything, but everything costs more. If you  need a wheelchair, you have to rent it. Any therapy or special care beyond just leaving you sitting there and maybe wheeling you down to the dining room is extra. At that rate, a $50/day stipend won’t hold off bankruptcy for long.

We’re told it may be enough to cover adult day care, which apparently ranges in cost from $20 to $75 a day, depending on where you live. This arrangement, which essentially entails institutionalizing an infirm senior during the day but allowing her or him to return home at night, would require someone to schlep you to a day care center every day. You have to possess all your marbles, be continent, and be mobile, a combination that doesn’t necessarily describe most elders who need daily care.

In-home care, which might keep you out of an institution or at least stave off the evil day, costs $112 to $192 a day, only a few dollars less than the average $205 a day for a private room in a nursing home.

The Congressional Budget Office estimates that for the program to break even, premiums will have to average $1,477 a year. That’s $123 a month.

My long-term insurance with Metlife costs just under $80 a month, and it will pay up to $128 a day for nursing care for an unlimited number of years, plus caregiver training, respite care, durable medical equipment, and installation and maintenance of an emergency response system.. The cost is relatively low, compared to the CBO’s estimate for the federal program, because I bought in when I was fairly young.

So, by comparison the government plan will be expensive and its benefits skimpy. Given that nursing home care can quickly bankrupt you, even a little help would be good. But if you’re on the hook for $150 a day even after having paid $128 a month for coverage over many years, you’re looking at drawing down $4,500 worth of your assets a month for nursing care. That’s $54,000 a year.

A $50/day benefit comes under the heading of too little, too late.

Good-bye to all that…

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Here’s another volley in the endless blitz of retrograde comments from Republican congressional representatives, reported by The Wall Street Journal:

“When it comes to some health-care summit that’s nothing more than a photo op designed to pave the way for Obamacare 2.0, the answer is no,” Rep. Mike Pence (R., Ind.) said Friday at the Conservative Political Action Conference. Still, they plan to attend and highlight public opposition to the bills and to spotlight their own ideas. “If the president is sincere about moving forward in a bipartisan fashion, he must take the reconciliation process—which will be used [to] jam through legislation that a majority of Americans do not want—off the table,” House GOP Whip Eric Cantor (R., Va.) said Friday.

“Obamacare.” How that term rings of partisan nastiness and intransigence! What on earth is the matter with the Republican party—one I once belonged to and was proud to serve? When did the Grand Old Party come to represent downright backwardness? I’m afraid that’s the word that comes to my mind (well—one of the words) as I watch members of my former party dig their heels in the sand and do every cussed thing they can think of to derail any positive action of any kind that might make life better for Americans…for no other apparent reason than stubborn hatred.

Not for one moment do I believe the GOP is even faintly interested in “the reconciliation process.” Actions speak ever so much louder than words. The actions we have seen have revealed extreme right-wing dogma and loyalty not to America but to well-heeled corporate supporters and their accomplished, amoral lobbyists.

The issue has little to do with universal health care coverage. As Megan McArdle writes for The Atlantic, we don’t even know for sure whether access to health insurance really does save lives—whether it has any long-term effect on mortality at all. No one has seriously asked that question during the fruitless “debate” (one might call it “impasse”) that we have watched over the past year or so. No. The issue is that the American political system is grinding to a halt, hung up by a kudzu-like bloom of stubbornness, dogmatic hostility, flowering greed, and grotesque thinking that the Founding Fathers could never have anticipated would take hold in America.

Politicians used to be self-serving now and again, but at least most could manage to get past their short-sightedness to function in their country’s interest. As we have seen, that is no longer true, particularly of the GOP. When Congress ceases to function—which is exactly what is happening—then America ceases to function as a free republic.

What a sorry spectacle!

Earth to GOP: Define health-care “rationing”…rationally, please

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I see the Republicans’ latest maneuver to obstruct Obama’s health care plan is to flamboozle us senior citizens into thinking a public option for health care will mean “rationing.” It would be awfully nice if the GOP would explain, please, how it is that we don’t have health care rationing right now.

If you’ve had any ailment more dire than a runny nose, about your only option for obtaining health insurance is through a full-time job with a company large enough to afford a plan for its employees, or through marriage to someone who has access to such a plan. This lets out self-employment; it lets out buying an individual policy on the open market; it lets out working for most small businesses. Sometimes you don’t even know a “diagnosis” exists until an insurer informs you it will not cover you.

Refusing to cover people for this, that, or the other ailment—or setting up an obstacle course that causes people to avoid seeking medical care for fear of putting a metaphorical black blot on their records—amounts to health care rationing. If you can’t get insurance, you can’t get health care, because no one but the very wealthy can afford to pay out of pocket for a trip to the doctor.

A while ago, the State of Arizona offered only one health plan, which most of my doctors would not accept. Because I did not care to go to just any quack some company bureaucrat ordered me to see, I decided to buy an individual policy.

A year or so prior to that, I had visited my doctor for a routine physical. Delivering the usual clean bill of health, he asked if anything that we hadn’t covered was bothering me. I reminded him of the supposed neuroma on my right foot and remarked that I was tired of the choice of footwear the chronic pain left me: hiking boots or Dansko clodhoppers. He sent me to an orthopedic colleague, who had the foot X-rayed, did an examination, and said there was no evidence of a neuroma, nothing that he could see was wrong, and I should just learn to live with the foot discomfort.

So, a year or two later when I went to apply for this insurance policy, Blue Cross informed me that it would not cover me for any broken bones or for any back problems of any kind.

Say what?

Asked why, their bureaucrat said it was because I had “osteopenia.” I said I’d never heard of any such thing, no one had ever made any such diagnosis, and I didn’t even know what it was. He said there it was in my records.

Looking into this, I discovered it had been stuck there by the orthopedist, who thought the X-ray of my foot showed a slight thinning of the bones. Osteopenia is considered to be a precursor to osteoporosis, although that opinion is dubious.

At this point I trotted to my gynecologist, since at the time I was premenopausal. He ordered a complete body scan. When this returned, he said I did not have osteopenia, and in fact, my bones were stronger than those of most women my age.

By then, open enrollment had passed, I’d missed the chance to get private insurance, and I was forced to buy a health plan through GDU that I did not want and that did not cover the doctors of my choice.

So what we have here is insurance companies telling you…

• you will not be covered (therefore can not have medical care) for certain issues, whether or not those issues are related to the “diagnosis” the company dislikes;
• this limitation is based on a decision made by someone outside the doctor-patient relationship; and
• you may only go to certain doctors, none of whom are doctors of your choice.

If that’s not rationing, I’d like to know what it is.

If you’re older than about 50 and lose your job or decide to start your own enterprise, you’ve got a snowball’s chance of obtaining healthcare coverage. Whatever policy you can land will except every ailment even remotely related to any symptoms that have appeared in your doctor’s records, and the cost of whatever policy you can obtain will be prohibitive. Because of the costs, you likely will be herded into an HMO, where you will have no choice of doctors, where the doc who does see you will have about 10 minutes to make a snap decision about any problem that arises, and where some bureaucrat will say what treatment options you have and don’t have and what medications you may and may not buy.

The Republicans are trying to convince us that we don’t already have health care rationing, when obviously we do. Then they’re trying to whip up hysteria by telling us that the precious full choice we supposedly have now is going to go away. Evidently they think enough of us are morons that spreading stupidity will block any progress toward meaningful health care coverage for all Americans—and given the number of people who bought into that idiot Palin’s “death panel” fantasy, they may be right.

How did the Republican Party become the party of jerks, fools, and scoundrels?

I used to be a Goldwater Girl, believe it or not. Barry Goldwater signed my first straight-A report card at the University of Arizona. I’d just received it in the mail, and as I reached the top of the stairs coming up from the Student Union’s basement mailroom, there was The Man himself, strolling through the building with only one or two sidekicks in tow. In an instant’s whim I barged up to him and asked if he’d put his autograph on it. Amazingly enough, he did.

If Barry Goldwater were alive today, he would be so revolted by the state of the party he would change his registration. Indeed, near the end of his life, he was heard to use the a****** word about the faction that was then just beginning to assume power in the party, whom he regarded as “a bunch of kooks.”

How right he was.

😀 In our hearts, we knew he was right. 😀

Of interest, along these lines
And this update

Health Insurance: Is your employer paying its part?

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One of M’hijito’s good friends, a young newlywed who had just purchased a house, was sideswiped by a fifth-wheel while he was on his motorcycle. Because he was wearing a helmet, the young man survived. However, he’s lost a kidney and his spleen, and he broke three vertebrae. He’s still in the hospital, a very sick puppy indeed.

As you might surmise from the fact that he and his bride qualified for a mortgage in these tough times, he had a good job with good benefits. Or so he thought.

Well, come to find out: his employer was not paying the employer’s half of his health insurance premiums. That means he’s not covered. He’s now relying on the state’s half-baked indigent health-care system to keep him in the hospital until he recovers enough to roll home in a wheelchair. The bills the kid has racked up will ruin him and his wife financially just as they are beginning their life together.

Lawyers say the employer is apparently broke—this is why he was welching on the health insurance policy—and they hold out little hope of getting any blood out of that turnip. The kids probably will have to declare bankruptcy, and that won’t get them out from under a mortgage that likely requires two paychecks.

I have no idea how a young person in good health who generally stays away from doctors would find out whether an employer really is paying its part of the health-care premiums, especially if it’s a small business with no HR department. Probably you could call the insurance company and confirm that you’re still on its rolls. Given the nature of our deprecession, if you have no recent confirmation that you’re enrolled in your health plan, it might be a good idea to check.

And please. Stay off motorcycles!

Suzuki photo byRich Niewiroski Jr.