The Numbers of a Miracle: 220-215

One step closer.  Not done, but one step closer.  Plenty of  opposition still left.  The Sniffer will remain vigilant.  AHIP, PhRMA, Big Medicine, U.S. Chamber of Commerce, the Anti-Reform PACs and Astroturfers.  Probably not their best day.

The House of Representatives voted, 220-215, and the Affordable Health Care for America Act, H.R. 3962, passed.

Universal Health Care took its closest step to being a reality in the history of  the nation.  We stand at the threshold of being a  healthier people.  Those determined individuals who through choice or calling have dedicated their lives to being healers today were honored.  Yes, honored.  A doctor, a nurse, an aide, a therapist of any stripe, even the chaplain, administrator, clerk, or support staff.  Even those in Big Medicine who dedicate their lives to creating the best medical care possible, despite the the greed that has held them hostage.  Today they were given a new legitimacy, not in what they do, they’ve always had that.  Yes, I know there are those who take advantage of the trust they’ve been given, or reach a point of compassion fatigue where they lose their edge. And make mistakes.  But that is not the point.

Tonight we celebrate the majority, who work and work and work that the sick and injured are given the chance to have their lives back, or to be given a life for the very first time.  Tonight, in America, the healers have a new identity.  Or nearly so.  Like the subtle change from night to twilight, that just perceivable shift from sky black to the dimming of the stars, the new dawn of medical vitality is just over the horizon.

The Caregivers’ dawn is rising.  America the healthy will soon rise right along with them.

Dawn with Star Pike Pictures UK

Dawn with Star. Image Courtesy: http://www.pikepictures.co.uk/prints

1,935,960 Minutes Later: The Free Market’s Failure to Uphold the Right to Health From Day One

Correction: Bad math strikes again.  Please read the comment  submitted by Tyler, he correctly points out that my math in the title is wrong.  The number of minutes should be 116,157,600.  I decided to leave the post title as is (so this correction comment will make sense), but change it in the text.  And I have to admit, 116 million minutes is way more dramatic to the point! Now, on to this serious topic:

The United States Constitution will celebrate its 221st Anniversary on June 21, 2009.  It was ratified on June 21, 1788.

The Preamble of the Constitution declares,

We the People of the United States, in Order to form a more perfect Union, establish Justice, ensure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

On June 21st, 116,157,600 minutes will have passed since it became the law of the land.  That is how long the Free Market System has had to figure out how to create a health care system so that every single American can live the healthiest life possible, out of which directly flows “the general Welfare, secure the Blessings of Liberty to ourselves and our Posterity” for each individual citizen.

At the time of the official first census in 1790, the population of the United States was 3.9 million people, of course, not counting all the people they didn’t count.  Health insurance did not exist, although it had been conceived by an English doctor in 1694. Health care, prior to the modern age had been almost exclusively fee-for-service.  Today, after 221 years, the Free Market System has sucked up such huge chunks of the health care market into its for-profit maw, 50 million Americans cannot only not afford the fee-for-service for a visit to the doctor, they can’t afford insurance either.  And that appears to suit the aims of the Free Market System just fine.

In their minds they have succeeded.  They are the American Disease Industry.  Pain, suffering, disease, chronic medical conditions, a public clamoring for relief.  Pills, pills, procedures, tests, pills.  Newer, always newer.  Cutting edge–procedures must always be cutting edge.  Americans grows unhealthier by the year.  That’s the growth part of the plan.  It makes no difference that millions can’t afford care.  That’s a problem for the non-profits to handle.  How they must smirk in their Board Rooms at the not-for-profits.  Unfettered by any meaningful regulation of their industrial juggernaut, they know they are the medical messiahs of the modern age.  They have the advertising campaigns to prove it.  The drugs must flow.  All hail the Free Market System.

So, 116 million minutes later this system is anything but free.  It is an engine for unfettered greed exercised by a few, distorting every good potential of free enterprise into power for themselves, privilege for themselves, and domination over all others.

It is a great business plan.  With one exception.  The American Disease Industry made one critical error.  They cured too many diseases.  And over the past forty thousand days or so, here and there, now and then, individuals realized they could be healthier.  And Americans have this thing about talking to each other.  Freedom of speech and all that.  But more importantly communications technology, advancing at a rate unprecedented in history.  Radio.  Television, Telecommunications, Satellites, computers, cell phones, fiber optics.  The Internet.  All over the world, people just like us were figuring this out.  They got healthier as we got sicker.  That had to change.  It’s not the American way.

We the People figured it out.  We could be healthier.  We wanted to be healthier.  And we didn’t want to continue to be the serfs of the American Disease Industry.  And we realized:

The Unfettered Market System, led by those who duplicitously espouse it as the purest manifestation of the Ideals of this Preamble, has failed utterly to fulfill its demands, to ensure without exception the rights it promises to every citizen to live in this “more perfect Union.”   These rights are not mere constructs of a clash of cultures in which Capitalism and Socialism battle for supremacy to the destruction of the other.  These rights are virtually what define us as human.

The Unfettered Market System has driven us back to the epoch of tyranny, to that moment before the Constitutional Clock began, not for the blessings of Capitalism, where profit flows like a great current feeding the abundant life in the ocean of time, but to a new and insidious feudalism, crushing the very People for whom that Preamble was written, the ones whose blood was shed in sacrifice for the Blessings of Liberty, under an economic millstone of debt, disease, subservience and corruption.

The Constitutional Clock still runs, no longer the notch of gears, but with the seething quantum foam of Cesium atoms.  So, too, We the People no longer will tolerate our rights being ground away by the Houses of Greed, old and festering, oppressing us as they did to untold generations for under the banner of the Divine Right of Kings, Robber Barons or faceless Global Megacorps.

We are people of the Light, riding the very photons that power the universe, shrinking our globe’s girth to micronic seconds, a web of bioluminescence that no tyrant of institution or government can control.  We the People, knowing we are the stuff of stars, knowing we are of a Most Splendid Spark, knowing within our minds is the brilliance of a pulsar, knowing within the form that makes me, me, and you, you, that our right to Life is the right to Health.

116,157,600 minutes into this great constitutional experiment called the United States of America, we claim our right to health.  And this minute is as great a victory over tyranny as the very first one!

The Fight of Our Lives for the Fight For Our Lives

Here it comes: the fight of our lives for the fight for our lives:  Universal health care.

Despite the incredible amount of evidence that health care in America is a disaster, a terminal disease on a social scale unprecedented in history, that annually millions of lives are ruined, physically and financially by lack of access or restricted access to health care, what I call the Hegemony of Profit Before Health is preparing to attack without mercy.

Listen carefully to the rhetoric that the Hegemony will blast at you in the coming days and weeks.  It will not be about health.  It will not be about solutions for the common good.  It will not be how to create the healthiest America possible within a generation.

No.  The rhetoric will be  about frightening you into resisting changing the status quo.  The rhetoric will be about confusing you what the real issue is:  denying your inalienable right to be as healthy as possible.  The rhetoric will be about preserving a diseased system that holds you in its grip to the enrichment of a few–and sustains a diseased population to guarantee that enrichment flows in perpetua.

This is the fight of our lives.  This is the fight for our lives.  This fight will likely determine if America remains pre-eminent among the nations: more important than the fight against terrorism, more important than saving the economy, and just as important as protecting the environment.

The fight for universal health care will determine whether or not you, your children, and your children’s children will be among the healthiest people in the world with America as its strong and sure leader, or relegated to third world status, of ever declining health, a land held hostage like cattle in a factory farm, weakened by design to sustain the Hegemony of Profit Before Health.

My life is at stake.  Your life is at stake.  I choose life.  I choose a healthy America, strong into the future, the standard for health care in the World.  I choose universal health care.

Health Care Now–Paul Krugman, NYT. A Reply

If you are a regular reader of Extreme Thinkover (here’s a shoutout to Eddie and Micki, two of my colleagues), you know one of my passions is health care reform and universal health care insurance.  We need it and we need it now!

This week Paul Krugman, who writes for the New York Times published, in his January 29th column, “Health Care Now.”

It’s a good piece, not only because he agrees with me, but that he presents a concise description of what is holding up getting started on the health care reform legislation in the new Obama administration, and then gives a Nobel-winning prize economist’s perspective why sooner is really necessary.

There is a bit of a mystery, though.  When the column was published over 350 people, including me, posted a reply.  After so many hours, the comment section was closed, which is standard NYT practice.  But then by the evening of the next day, the comments link was taken off-line.  Nothing from Krugman or the NYT as to why.  However, since I back up all my posts, and planned to put it on Extreme Thinkover, what follows is my reply to Dr. Krugman’s column.

^^^^^^^^^^

Paul–For some of us in the medical industry, the tsunami you call the looming health care disaster has already crested.  The hospital I work for, part of a Catholic health care system, incurred $66 million in uncompensated care last year (FY08).  That’s not waste or bad management.  That’s the amount of money we spent to treat every person who came to us, for which we could not recover a single dollar.  There are no golden parachutes or corporate jets in our health system.  And the administration says we are already $3 million ahead of last year.

Our mission is to treat the sick.  Anyone who thinks that not having access to health insurance or basic health care is overblown rhetoric or too expensive just needs to spend one day with me.

I cannot urge the Obama administration strongly enough to initiate their health reform legislation.  Nothing short of universal health care will work in the short or long run.  During the election I studied the various plans being touted (AARP, AMA, both candidates, the Catholic Health Association), as well as the legislation being introduced by various politicians.  I support the plan by Sen. Max Baucus (D-MT). Be assured, I have written him several times, urging him to act quickly.

I know the financial crisis needs immediate attention, but there is no reason for the groundwork not to be laid now to push hard for health care reform and universal health insurance in Congress as soon as possible.

We need it now.  We needed it for all those patients who came to us last year, requiring  immediate medical care, but who had no way to pay for what collectively amounted to $66 million to just one hospital.  They got the care they needed, anyway.  That’s what can happen when you believe that health care is a human right.  It would just be nice for those people to have insurance so they are not prohibited from exercising that right.  It wouldn’t be bad to get compensated for that care either.

Health Care: My Most Extreme Idea. Ever.

Wherein, I bite the hand that feeds me.  But for the common good.

In the November 17, 2008, issue of Business Week, Catherine Arnst writes:

Health-care reform is crucial to most U.S. corporations as they recalibrate for an Obama Administration.  The reason is obvious: About 60% of Americans receive health insurance through  their employer. . .But for business, extending coverage to the 45.7 million uninsured is secondary to to bringing down the cost of health care, which adds up to 16% of U.S. gross domestic product and rising. . .The cost of insuring employees will increase by almost 7% this year, with no relief in sight (Italics added).

“Bringing down the cost of health care,” for Business, is the primary issue.  Believing that there is some magic bottom line that constitutes enough “bringing down” to include the uninsured is just that: magic, or at least, magical thinking.  That moment of acceptable cost does not exist.  Setting a percentage is meaningless.  Setting a maximum that a given employer would have to pay to cover their employees is equally meaningless.  And using that as the criteria for when to add coverage for the 46 million Americans without health care insurance returns to magical thinking.  It has no rational solution for solving America’s need for radical health care reform and universal coverage.

It will not work.  Period.  Yet, as stated in Business Week, that is what Business believes is their only solution.  The real solution, however, is simple in concept but admittedly complex to implement.

The solution is to extend health care benefits to all Americans over a very short period, say one year. I’m quite aware that this is a defibrillator approach, but it is the only strategy that will give policy makers and the health care industry a true picture of the scope and financial support that will sustain the program over time.  And health care in the United States is close to going into cardiac arrest.  The symptoms from the “disease process” can no longer be sustained.

Any other approach will create a implementation nightmare and waste billions of dollars.  For instance, if a ten year plan is created, who gets onto the plan first and who decides that, and by what rationale?  You might exclude those who already have health insurance, but then you still have to decide in what order the 46 million uninsured will be admitted to the coverage.  That’s a lot of people, and those who can’t get in early will be in an uproar.  Undoubtedly, an army of lawyers will take up their cause and sue all the way to the Supreme Court.  That process alone, coming from every state in the Union, will cost millions of dollars coming right out of the taxpayers’ pocket.  And not one dollar of it will have gone to providing health care to a single American.

What about letting the states come on line over a predetermined period of time with the coverage?  But how do you decide which states get to go first?  The big ones, like California, Florida and New York?  In terms of population that would create the big expense hit to the coverage early on.  In the mean time do you give the states waiting in queue supplements to their health plans, or the money to create one, until their number comes up?  Since the United States is in a recession, each state is in a recession to varying degrees.  Their legislatures will howl with indignation over having to put up part of the money to get some health care coverage to all their state residents until the federal program kicks in.    The pressure on Congress, even those in the right wing who hate the whole idea to begin with, will be enormous, to get their state on-line ahead of the others.  Think of it as a pack of 50 hungry dogs biting and scratching for a piece of meat.  That would not be pretty.

There is good news, however.  Senator Max Baucus (D-Montana), Chair of the Finance Committee, has decided to move full speed ahead on getting health care access for all Americans.  In the November 12, 2008 New York Times, Baucus is quoted:

“Every American has a right to affordable, high-quality health care,” Mr. Baucus said. “Americans cannot wait any longer.” Far from being a distraction from efforts to revive the economy, he said, “health reform is an essential part of restoring America’s economy and maintaining our competitiveness.”

Sen Baucus states precisely what I have been advocating since I began this blog: A healthy America will produce a nation of unparalleled personal, social, and economic strength.  The Times also reports in the article that the pending Obama administration has voiced support for the idea even as they prepare to grapple with the financial crisis.

As of this writing, I have not yet had the opportunity to read Sen. Baucus’ plan, but once I do, you can be sure I will post my analysis of it.

But a dark storm still covers the health care industry landscape.  The annual rising cost, that Catherine Arnst points out above, will be at least 7%.  The question I have not heard addressed is, in a contracting economy, how can the health care industry justify that kind of increase to its consumers, which, is basically all of us?  All sectors, the AMA, pharmaceuticals, health insurance, durable medical equipment, expendable medical supplies, medical technology, hospitals and care facilities (both for-profit and not-for-profit) and all other medical services are being hit equally hard by the economic meltdown and the growing recession.  What is the rationale to continue this out-of-control inflationary cycle?

The answer, in my opinion, is that the health care industry has a dirty little secret.  Just like the financial sector, they believe the bubble will never burst, and, are practicing the same kind of extravagant managerial compensation practices just like the AIGs have been.

The critical question is, how much of that 7% (and all the annual increases for decades in the past) is a true reflection of needed development in the industry and how much has been to support managerial salary excesses?   Just like the banking and monetary trading industry, because there has been little accountability and oversight to the public, i.e., their customers paying the bills, and no transparency for their actions, health care executives have been living high-off-the-hog by hiding in plain sight.  Unbridled corporate greed, no different than Wall Street’s.  Another blessing of strangled regulation laid bare.

Since I am a capitalist and not a socialist, and I understand that companies are in business to make a profit, and that, in fact, that profit positively supports our economy, the solution must strengthen the health care industry across generations so they can effectively serve the health care needs of all Americans.

The health care industry, however, must make sacrifices to contribute to the common good.  They have no right to complain or insist on an exemption, so that everyone else has to play by the rules while they go about their merry way.  They should be working with Congress and aggressively working on a new paradigm that will transform the way they do business, where their first obligation is to the health of America. Period.  That includes the American Medical Association, whose plan I have criticized in previous postings because it does not come close to the needs of that new paradigm for health care reform.

My radical idea is that health care costs be frozen until the new universal health care system is in place and implemented as close to 100% as possible.  Accompanying this freeze would be acceptance of a new set of regulations, similar to those being developed for the financial industry, that creates reasonable accountability and transparency, but also supports new avenues to make profits to benefit both the companies and their shareholders.

The billions of dollars that would be saved by all sectors of the economy, would provide a chance to adjust to universal health care, be a huge benefit to large and small businesses by controlling their costs during the transition, be an equally huge benefit to individuals and families trying to survive the economic impact of the recession, reduce hospital and health care facilities’ expenses, and medical service providers costs, allowing them to catch up and also adjust to the changes brought about by universal care.

Nobody gets to sit on the side lines and pretend the world has not changed.  The health care industry is the cornerstone for the foundation to build a new, health America.  They have to be fully in the game and play by the new rules that are essential for the health of the nation, both its people and its economy.

Getting Ready for the Real Work: Health Care After the Election

Twenty-four hours from now we will know who the next President of the United States will be.  That will be the moment the real work for bringing health care to all Americans begins.  Obama’s plan or McCain’s?  The AMA’s “Voice for the Uninsured” or AARP’s “Divided We Fail?”

If you have been a regular reader of my blog you know that I have reservations about all of the above.  All of them have a fundamental policy flaw: they begin with trying to control the cost of health insurance, but without a clear strategy for how to first establish national goals for a healthy America.  As a result, I am convinced that these plans will never work as promised, and in the end, cost us billions of dollars as well as come nowhere close to the medical and health needs for a healthy America across generations.

One nationally-based organization has designed a plan that parallels my primary assumptions for health care.   That organization is the Catholic Health Association, which is the voice for most Catholic-related hospitals and other health care facilities.  Now, don’t go squeamish on me, just because you might not agree with Roman Catholic theology and doctrines relating to contraception and abortion (or even if you do).  Instead, I invite my readers to thoughtfully consider the principles put forth in what they call the “CHA Vision.”

Disclosure: I work for a Catholic hospital that supports CHA principles, but is not a CHA-system hospital.  I am a member of a Protestant denomination.

Here is CHA’s promotional PowerPoint.  (Of course, you’ll need at least PowerPoint viewer to open this)  (CHA Vision courtesy of Catholic Health Association).

chavisionpowerpoint1

As always, I invite your comments.

And be sure you vote!

AMA’s Health Care Plan: McCain’s Plan on Steroids, UPDATED

The Great Debate over how to fix America’s critically ill health care system is being microscopically examined throughout the media.  As the world anxiously watches to see if the major “bailout” surgery by the U.S. government performed on Wall Street has saved that patient, health care has returned to the crucially important attention it demands.  The question is, will the emergency care Americans need to produce a  revolution in health care be enough to save this patient?

In the time since I originally wrote this post, the presidential candidates have revised their talking points about access to health care for Americans, but their overall plans have not changed.  What has, is the public’s demand for a solution that will actually provide access to medical services while not threatening the financial survival for those who have health insurance, or the very lives of those who don’t.

One thing is certain.  The status quo is not acceptable, and whichever candidate takes the White House better move quickly to implement what he has promised.  That plan will determine the degree of medical access for years to come, virtually determine the level of health Americans will be able to achieve, and whether we will be able to compete economically and socially, through the 21st Century.  Failure to take this action would  be the equivalent of political suicide for the new president, his administration, and his party in Congress.

My hypothesis for what constitutes the most beneficial health care system is simple: Each healthy individual adds to a healthy community, which adds to a healthy society and nation, which provides for a higher quality of life and, therefore, allows those individuals to optimize their personal potential and creativity, reducing the cost of health care by hundreds of billions of dollars across generations and generating trillions in productivity.

If I can figure this out, not being a physician, one would think that the American Medical Association, combining the experience and insight of tens of thousands of doctors would have a plan for health care reform that would be medically astute, financially creative, in short, a work that reflects the highest possible standards for evidence-based patient care.  The AMA calls their plan “Voice for the Uninsured.”  Here’s the link: http://www.voicefortheuninsured.org/.  Read what they state in the synopsis: In short, the AMA advocates a clear role for government in financing and regulating health insurance coverage, with health plans and health care services being provided through private markets, as they are currently. The AMA proposal gives patients more control over our nation’s health care dollars, while increasing affordability and choice. It reflects important social values and traditions, such as assistance based on need, freedom of choice, market innovation and fairness.

When I read the AMA’s full statement my immediate reaction was “we’ve been here before.”  Look at John McCain’s proposal for his health care policy: John McCain Believes The Key To Health Care Reform Is To Restore Control To The Patients Themselves. We want a system of health care in which everyone can afford and acquire the treatment and preventative care they need. Health care should be available to all and not limited by where you work or how much you make. Families should be in charge of their health care dollars and have more control over care.

When you read the AMA’s proposed plan, “Voice for the Uninsured,” the similarities between it and John McCain’s is undeniable.  McCain’s proposal (at least as presented on his website) is very short on details, but it’s no particular problem for him because the AMA’s plan provides that detail, and so, all he would have to do is bring in the AMA lobbyists and in one afternoon it would be a done deal ready to send to Congress.

But what astonishes me is that the AMA program, despite its provisions for wellness and prevention, still focuses first on the cost and not on a coherent set of health goals for all Americans.  There is little evidence that the logic behind their plan even approaches or improves on my hypothesis.  And why is that?  My assessment is that this plan, like most others, is designed to impose as little change as possible on their slice of the industry.  It appears that the AMA and its thousands of physicians propose a plan that forces change on everyone else while protecting themselves from the amount of change required to radically and effectively create a health care system that would truly move Americans toward specific goals for health. It doesn’t lend to one sleeping well at night if you are one of the 46 million (according to the AMA) without health insurance.  My vote is that I prefer not to have the AMA be that voice for me (and I have health insurance) or for the 46 million. The AMA, looking out first for its own, fails to uphold that sacred trust given to the physician to be the healer to all who are in need.