Health Care For All Americans, Part 3: UPDATED

Featured

Over the past few days, Dr. John and I have been having a fascinating discussion about this post from September 2008.  It is one of the first pieces I wrote for Extreme Thinkover,  before President Obama was elected, as well as at least a year before the serious work on what would become the Patient Protection and Affordable Care Act, known as “Obamacare” (but which I prefer to refer as “the ACA”) was being worked on.  It was also before Dr. John and I met and got acquainted.

I deliberately haven’t edited the post below, so our comments will make sense in the context in which they were written will make sense.  I think my readers will enjoy the back and forth between us, and I invite you to add your own comments, should you feel so inclined.

IMPORTANT: Read the comments starting from the bottom of the thread. It is where the discussion starts. And you may have to move up and down a few comments for our replies because of the way WordPress publishes them: by the time stamp of the comment/reply and not directly associated with a given submission.  Sorry for the inconvenience.

***************

Health Care for All Americans: Part 3

In Parts 1 and 2,  I discussed first, the assumptions needed from a medical perspective, particularly with respect  to the scope of treatment plans that would lead to optimizing the health of Americans, and second, how those assumptions would create a radical transformation in the health of Americans that would work its way through all aspects of daily life.  In Part 3, I now want to describe the logic that shows how the country would benefit.

We’ll start using my first assumption: Preventable diseases are prevented.

We could use any number of examples, but the format of the blog does requires some brevity, rather than a detailed White Paper or journal article.  I also acknowledge that the ideas I  present here have all been suggested by others, but this is how I choose to organize them.

For purposes of our discussion let’s call our example citizen, Larry.  Larry works full time for minimum wage, does not have  health insurance, and cannot afford to buy private insurance.  He also does not qualify for any government health care benefits.  Larry’s wife also works for minimum wage, but only 24 hours per week.

As long as his health holds, Larry can work and he has no medical needs.  He pays local, federal and state taxes and uses no special government services.

But let’s say that Larry gets pneumonia.  It is a very common viral strain, and can be treated successfully with antibiotics, and could have been avoided entirely if Larry had had a pneumonia vaccination.  Now he’s faced with a dilemma.  At first he thinks he just has a chest cold and he can wait it out.  Being a conscientious worker, he toughs it out and goes to work, but exposes his coworkers to the bug through his worsening cough.

By the weekend, Larry is really sick.  Over the counter cough medicines provide almost no relief, and on top of that, his cough is becoming increasingly productive.  He cannot sleep because of the cough and not being able to find a position in bed where he can breathe without effort and  pain.  Larry knows he needs to see a doctor, but having no insurance, he does not have a primary care physician, so he has no idea who to call.  Finally his breathing becomes so difficult that his wife calls  911.  Larry is taken to an emergency room by ambulance, but one on the far side of the city because the hospital closest does not like to take patients without insurance.

By the time Larry gets to an emergency room that will accept him as a patient he is nearly in respiratory arrest.   The ER doctor quickly diagnoses the pneumonia, but that it is so advanced that Larry’s life is in danger.  She intubates him immediately and transfers him to the hospital’s intensive care unit. It is four days before Larry’s condition has improved enough to send him to a “step-down” unit and two more days before he can be admitted to a medical unit room, and he is discharged two days after that.

Larry is fortunate that the hospital he is at has Certified RN and MSW Care Managers.  They work with him and his wife throughout  the hospitalization, develop a treatment plan and a discharge plan, set Larry up with a local medical clinic that treats patients without insurance, and provide his wife with food  vouchers and bus tokens so she can make the long trip back and forth to the hospital.

Despite all this, when Larry is wheeled out to the taxi to take him home, he has a hospital bill that is $250,000.  Since Larry and his wife together make too much money to qualify for Medicare, that bill rests squarely on their shoulders. He has no way to pay it back.  He will not be strong enough to work for at least another three weeks.  He will have not earned a dollar since he got sick, and won’t until he returns to work.  His wife’s income is not sufficient to cover all their bills,  and if they pay the rent, they will not have enough money to buy food.  The hospital sent home a week’s supply of medications, but after that, he will have to pay for them himself, and due to the damage to his lungs, he will need regular medications for at least six months.  Those prescriptions will cost over $800 per month.  Through the free medical clinic he can apply for medication cost support , but that can take up to four weeks to be approved assuming he qualifies.

Now multiply this basic scenario by twenty or thirty million Larrys a year. Every year. That is health care in America.

Here’s what happens.  The only good news is that Larry has survived a brush with death, ironically from a completely preventable disease.

Larry and his wife now owe the hospital $250,000.  They have no assets.  Even though they signed a promissory note with the hospital, no one is under the illusion that he will be able to pay back more than a few thousand dollars if he is a very conscientious person.

Larry and his wife owe the ambulance service perhaps $3,000.  They cannot pay it, or they will have to try to pay it off in very small amounts per year at a probably high interest rate.

Larry will lose at least a month’s income, and perhaps more if his recovery is longer than expected.  If he is very fortunate, his employer will hold his job until he can return.  In the meantime, his wife’s income is not large enough to cover their essential bills, starting with rent and food.  If Larry’s wife cannot get more hours from her current work, her only realistic option is to get another part time job, likely at minimum wage.  Whether that will at least let them pay for their basics is not certain.  It is also uncertain how flexible their landlord will be to let them catch up with their current rent.

It should be clear by now, that one simple, preventable illness has created a cascade of events that affects the economy, are extraordinarily expensive and completely unnecessary.  Yet, this is the true consequence of the current American health care system.

The hospital will have to write off the $250,000.  To compensate they will have to pass this loss, as well as hundreds of others per year, to their patients with insurance.

The ambulance company will have to spend a lot to try and recover their fee from Larry, and will pass those added expenses along to their other customers who can pay, either privately or with insurance.  If Larry doesn’t keep up with the payments, they may turn him over to collection, which will damage his credit.

Larry’s employer loses productivity from a good worker.  The company may have to hire temporary labor to fill Larry’s absence, which will be more expensive.

Larry and his wife lose essential income, which at minimum wage is marginal to begin with, and may jeopardize their ability to even house and feed themselves.

Every day that Larry does not work means that his wages do not generate taxes, local, county and federal, as well as FICA withholdings.  Multiply that by twenty or thirty million Larrys year after year and the loss is well into billions.  The impact of this loss of tax revenue and productivity is staggering on the national economy.

All this from a preventable disease that could have been stopped before it was started if Larry had had access to the most basic medical care.  Everybody loses.  The nation is weakened through attrition in ways no external threat could impose on us.   This national “epidemic” is progressive, it is close to end-stage, and we could all too easily end up with a terminal prognosis.  We may reach a point that we literally will be too unhealthy to survive as a nation.

We still have a choice.  Until the epidemic takes that away.

Professor Obama: The Presidential School of Bipartisan Education.

You may have thought the summit President Obama presided over today was all about health care reform.  It wasn’t.  Health Care Reform was the topic, but the subject was a six-plus hour seminar in front of a national audience on how to  be bipartisan led by the professor-in-chief, Barack Obama, J.D.   The pundits and bloggers, well, like, me are pounding away at their computers trying to wring every bit of meaning and nuance from the day’s-long exchange.

Health Care Reform was the topic, but the subject was a six-plus hour seminar in front of a national audience on how to  be bipartisan led by the professor-in-chief, Barack Obama, J.D.

Let’s get one thing out of the way.  How do I grade the debate on health care reform?  I give the Democrats a C, and that’s generous.  Their acting like they are close to the Republicans in the substance of the bill was stretching credulity nearly to the breaking point.  But I give the Republicans a D- and that is because they went out of their way to avoid any semblance comprehension what the summit was really about.  Just a whole day of props and talking points without as much as a single original thought.

Sorry, Mitch, John, Lamar and Eric, starting over isn’t an option.  It wasn’t about how many minutes each side gets to speak, Mitch (that has to be one of the most sophomoric gaffs of your career). You know as well as I do that it is empty rhetoric.  It’s impossible to start with a clean sheet.  The sheets in the health care debate are not paper.  They are hospital bed sheets and have over a half a century of political grime ground into them.  There are no clean sheets.  You can’t rewind history.  The perpetuation and dissemination of ideas follows the one-way arrow of time.  Health care reform does not exist in a bubble undisturbed by the flow of reality in the present environment of human medical needs.

Republicans: It’s time for you to step out of the way and let we Americans have access to medical care that meets our needs, covers us without regard for preexisting conditions, and sets the stage for a era of wellness through preventing those medical conditions that can be prevented.  Your ideas won’t work because your plan has an inherent stinginess to it that is, well, just incomprehensible in a nation  that thrives on being generous.

Republicans: Your ideas won’t work because your plan has an inherent stinginess to it that is, well, just incomprehensible in a nation  that thrives on being generous.

Now, on to the real subject of the summit today.  Prof. Obama led the seminar in bipartisanship.  Neither political party really figured that out, however.  They have over the past year (two? three? twenty?) been overwhelmed by the drumbeat of talking points drilling themselves so deeply into the daily consciousness of our congressional representatives, that it appears almost as if they have lost the capacity to speak in any other manner or with any independence of thought.

Prof. Obama conducted a very well run seminar in what can easily be described as a highly-charged setting.  The representatives of the two parties, both Senators and Congressional Representatives have been sniping at each other, saying  some of the most outrageous things ever entered into the Congressional Register, attacking with a ferocity just shy of out and out fisticuffs.  It’s a good thing the debates in the wells of both Houses are not near windows.  The amount of acrimonious bile spewed at each other could have led to the defenestration of any number of the members in the tradition of the Bohemians in Prague, first in the 1400s and again in the 1600s.

It’s a good thing the debates in the wells of both Houses are not near windows.  The amount of acrimonious bile spewed at each other could have led to the defenestration of any number of the members in the tradition of the Bohemians in Prague, first in the 1400s and again in the 1600s.

But neither side got it.  At least neither side wanted to be the first to admit that they got it.  As soon as they walked out of Blair House and across the street back to the Capitol, the auditory hallucinations of hyperpartisanship appear to have kicked in like throwing the main breaker on a mental trash compactor.

Regarding health care reform, the lack of substance was arguably all that could be expected.  Regarding reestablishing a beneficial and productive dialogue between the two parties, it was right there for all America to see.  The professor, behaving at his presidential best, conducted an exercise in statesmanship.  The comments, although, at times impassioned, were respectful and under the watchful eye of the Professor-in-Chief. The two sides were able to carry on a debate that did not devolve into shouting or irrational charge and counter-charges.  The summit was a demonstration of political civility on the TV screens or computer monitors for all America to see.

So, now we will see how the introduction of statesmanship into this debate will be able to work its way through the consciousness of both our elected leaders and the American people.  Will it grow over time; were seeds planted that will germinate and change the landscape of the national political scene?

Health care reform, just a few weeks ago declared dead on arrival after the Massachusetts election, has survived.  Is it healthy?  That remains to be seen.  But the recovery of  reform is proceeding in ways that could be best compared to an intensive rehabilitation program.

He left no doubt that his skills as President of the United States have grown and matured in ways that give great encouragement to his supporters and equal concern to his opponents.

The summit today, however, was historical for what it may have saved for American politics, more than the result of the final disposition of health care reform.

Professor-in-Chief Obama is undoubtedly exhausted after today’s intensive experience and exercise in democracy.  But one thing is certain.  He left no doubt that his skills as President of the United States have grown and matured in ways that give great encouragement to his supporters and equal concern to his opponents.  I have said on several occasions that America would have to get used to a very smart president.  Today, we just saw one reason why.

Quinnipiac Poll: What the Republicans Failed to Mention About Health Care Reform

A Sniffer Report: The Quinnipiac House Health Care Bill PollThe Sniffer: Always on the Job to Sniff Out Anti-Healthcare Reform Radiation

During the Senate debate on the Health Care Reform Legislation,  the Patient Protection and Affordable Care Act, a number of Republican senators referred to a op-ed piece by David Broder, Washington Post columnist, titled, “A Budget-buster in the making.”  In his column, Mr Broder quotes from a survey poll conducted by Quinnipiac University released on November 19, 2009.  Mr Broder, focusing on just one question, states:

It read: “President Obama has pledged that health insurance reform will not add to our federal budget deficit over the next decade. Do you think that President Obama will be able to keep his promise or do you think that any health care plan that Congress passes and President Obama signs will add to the federal budget deficit?”

The answer: Less than one-fifth of the voters — 19 percent of the sample — think he will keep his word. Nine of 10 Republicans and eight of 10 independents said that whatever passes will add to the torrent of red ink. By a margin of four to three, even Democrats agreed this is likely.

That fear contributed directly to the fact that, by a 16-point margin, the majority in this poll said they oppose the legislation moving through Congress.

Hmm, is that so, Mr Broder?  Well, I just happened to read the complete news release from the researchers at Qunnipiac, including all those boring tables and numbers, and I came away with a completely different conclusion.

In Mr. Broder’s defense, he cites the opening statement of the report correctly:

Three-quarters of American voters – 74 percent – like President Barack Obama as a person, but only 47 percent like most of his policies, and voters disapprove 51 – 35 percent of the health care overhaul passed by the House of Representatives which he has endorsed, according to a Quinnipiac University national poll released today.

Voters disapprove 53 – 41percent of President Obama’s handling of health care.

Perhaps, though, Mr. Broder only read those two paragraphs, because just two paragraphs later is this statement:

Voters favor 57 – 35 percent giving people the option of being covered by a government- run health insurance plan, the “public option.” Independent voters approve 55 – 39 percent. The overall approval is down from 61 – 34 percent in an October 8 survey by the independent Quinnipiac (KWIN-uh-pe-ack) University. And they oppose two proposals to modify it:

* Allowing states to opt out of the public option is a bad idea, voters say 49 – 43 percent;

* Voters also oppose 47 – 38 percent the “trigger,” where the public option kicks in only if private insurance does not cover enough people.

Mr. Broder, as well as the distinguished Senators from the Republican Caucus, conveniently forgot to mention these results.  And some others, very important others, but we’ll get to those in a moment.

How should we parse these responses?  First of all, as an experienced researcher myself, the question is not very well written.  Not because of the content; it is a perfectly legitimate question to ask.  But the setup is too complex, and it borders on being a leading question.  It also should have been split into two questions:

  1. Do you think that President Obama will be able to keep his promise,
  2. Do you think that any health care plan that Congress passes and President Obama signs will add to the federal budget deficit?

Because of the way the question is phrased, we do not know to which of the two issues the respondent is answering.  Technically, the question should have been thrown out and the results not reported.

This assessment is strengthened in light of the next set of results.  In contrast to the results of the first question, the voters show considerable support for components of the health care reform.  By a margin of 55-37 percent, voters support the public option.  They oppose letting states opt out by 49-43 percent, and they oppose the “trigger” option by 47-38 percent.

Now, I don’t know about you, but these three items are among the most important in the entire health care reform legislation.  Couldn’t one, with some degree of confidence, say that from these results the American public generally supports key elements of the bills going through Congress?

That depends.  When asked if the respondents supported the House version of the bill, the split was 51-35 percent oppose, but 14 percent gave no answer.  The strongest opposition was expressed by whites, over 55 years of age, making more than $100,000, and describing themselves as conservative, and born again Christian evangelicals.   The strongest support came from African-Americans, in the 18-34 year old age range, with incomes less than $50,000 per year, describing themselves as liberal. (No data for Black religious preference was listed.)

As for President Obama’s support of the House bill, the attitude of most Americans toward him appears not to be much affected.  The category “no difference” runs consistently in the 40-50 percent range, with the obvious exception of those who identify themselves as Republican.  Since the percent of people who look favorably upon the president for his support of the House bill averages roughly 30 percent, adding it  to those whose attitude has not changed, we can’t draw too many conclusions, because the ones claiming no difference may be overall positive or negative.

The respondents, however, contradict themselves.  The next four questions all have to do with core concepts of health care legislation: the public option, states having the authority to opt out of the federal plan, the passage of a “trigger” provision that would  activate under a set of conditions where not enough people were covered by an established date, and whether or not Congress should pass the legislation this year.  On all four items, the responses are solidly positive.

But one issue they do not contradict themselves is their opinion of the Republicans and their behavior regarding the health care reform legislation.

While this survey has bad news for the President, the news for Republicans is worse:

Voters say 45 – 36 percent, including 40 – 37 percent among independents, that Obama is better able to handle health care than congressional Republicans. In October, it was 47 – 31 percent in the President’s favor.

Voters also say 59 – 29 percent that Republicans are not making a good faith effort to work with Obama and the Democrats on health care.

As one might expect, neither Mr. Broder nor the Republicans, reading the same industry-supplied script they’ve been parroting for months, mentioned anything about this part of the survey.  In the spirit of fairness, the voters aren’t all that favorably disposed to the Democrats either, but  out of Pres. Obama (45-36% over the GOP), Democrats (36-55%) and Republicans (31-58%) , the GOP  comes out dead last.

The quest for universal health care continues, strongly braving the winds of opposition blowing at hurricane strength.  The storm may increase, but the gale will not deter us.  All storms blow themselves out.  America will have universal health care.  A new blessing of Liberty will be enshrined in the Great American Experiment.

We All Deserve Health Care

There Will Never Be Another Tax Cut

Huh??  What do you mean there will never be another tax cut? Congress can vote to cut taxes anytime it wants.  Have you lost your mind, Waggoner?

Consider this statement:

Using tax levels consistent with the past half century in America, then subtracting entitlement payments as currently promised for Social Security, Medicare and Medicaid, The Heritage Foundation (another conservative think tank) estimates that sometime just before 2020, there won’t be enough money in the federal treasury for anything but the entitlement programs.

It was written by Bruce Brattain, owner of Wisdom River Partners, who, among his many talents, is an elder care consultant.  Now, don’t roll your eyes over the word “consultant.”  Start reading a few of the pieces in his blog, aninconvenientbruce, and you’ll instantly realize, this is one very astute observer who has his finger on the pulse of a number of national issues.

And, just to entice you more to go read the entire article from which this quote was taken; it’s not what you think it is.

Now.  Please. Go read what Bruce has to say.  Oh, and be prepared to not only to have your assumptions challenged in a classic Extreme Thinkover manner, get ready to be entertained by a guy with one wicked wit!  Click here.

Then come back to my post for this:

Post Script:  I just watched PBS’s The News Hour:

In an ongoing series of conversations on health reform, Jeffrey Brown speaks with Robert Laszewski, a former insurance executive and skeptic of a public insurance option.

Laszewski, in this interview, lays out the manifesto for Big Medicine’s opposition to health care reform.  He is articulate, clearly believes in his cause, and goes over their case against the public plan point by point.

And proves the argument for implementing a public option in the health care reform legislation so beautifully, I almost jumped up from the couch to give him a standing ovation.

Huh?   Two times in one post?  Read the interview of Robert Laszewski, former insurance executive and Big Medicine consultant by Jeffrey Brown.  Click Here.

How the Texas Long Horns and the TCU Horned Frogs Saved Health Care Reform

I just finished watching clips from NBC’s Meet the Press, which featured Sen. Charles Schumer (D-NY) and Sen. Orrin Hatch (R-UT) discussing the status of the “public option” in the health care reform debate. It wasn’t much of a debate, despite host David Gregory’s best effort to provoke something other than party-line blather from either senator.  He wasn’t having much success.

But then, seemingly out of nowhere, Sen. Schumer made a comment that snapped my attention to full alert. He compared the public plan competing against private health insurers with public and private colleges and universities.  (If you watch the clip, it comes right at 2:00 minutes.)  I had to back it up and watch it again to confirm I actually had heard him correctly.  Gregory didn’t catch it, which he should have; Sen. Hatch, if he caught the comment, either had no response, or was so close to dozing off, he just kept mumbling the same old script.  I couldn’t really tell.

Schumer’s statement was a new characterization; I hadn’t heard it before. I’m not sure he even recognized the significance of it.  But it is an intriguing way to look at the public option. And since my PhD is in Higher Education, this is something I actually know something about.

Every state in the country has private and public universities.  Take Texas, for example, where the idea of the public option is more anathema than the Long Horns losing to Oklahoma.  The University of Texas in Austin is a public university.  Texas Christian University (TCU) in Ft Worth, where I earned my Master of Divinity degree, is a private university.

Hook 'em Horns.  University of Texas Football

Hook 'em Horns. University of Texas Football

According to the prevailing dogma of Republican and Free Market devotees, the government should never be allowed to compete against free enterprise and the private market, because the government will always do it worse, waste vast amounts of money in the process and destroy competition, thereby threatening the American Way of Life.

Does the public university “system” in the country drive out the private schools by being too competitive for them to survive? They could in theory, because student tuition in the state schools is subsidized by taxpayer dollars (although that has been shrinking dramatically over the past twenty years–the states all too often are short on cash), attracting more students than the private schools. For example, UT is a lot bigger than TCU (50,000 vs 9,000!). But private colleges, which were the original American academic institutions (Harvard was founded in 1636), continue to compete and flourish, despite the apparent advantage the public schools have. The typical model for what we think of as a state college or university did not come into being until after 1862 with the passage of The Morrill Act.

TCU Frog Fountain and Campus

TCU Frog Fountain and Campus

There are a lot of reasons, but the one relevant to our discussion about health care is that federal financial aid creates portability and allows students to choose (in concept) to attend any school in the country. I have two degrees from private schools and two degrees from a public school. Why did I choose those schools? Because in each instance it offered the academic program I wanted to pursue. Federally funded financial aid guaranteed that I had a choice. That is higher education’s equivalent of a “public option.” (now this isn’t the place to argue about the issues in financial aid such as student loan debt, etc–it is beside the point for this discussion).

We come up with this formula, thanks to Sen. Schumer’s insight:

Federal F/A= Choice + Access + Desired University (public or private) + Academic Degree

So when we look at America’s higher education system, a combination of private and public institutions that arguably is the best in the world (granting it has its own imperfections and needs for reforms), which allow the schools to provide their services in a competitive but mutually beneficial market, and provides students (as consumers) a huge amount of choice, both in program and in cost, it is just plain wrong to say that “government” can’t do anything right and to assume that a public option would destroy competition in the health care market.  The success of higher education contradicts the assumption and renders it null.

We Horned Frogs are justifiably proud of our private Texas Christian University. But if I was a bettin’ man, I wouldn’t place a red-cent on a wager that a University of Texas grad, dead-set against the public plan in health care, would admit that his/her “government education” was inferior in any way, shape or form!

Therefore, applied to the Public Option, the formula becomes:

Federal Public Option= Choice + Access + Desired Coverage (public or private) + Appropriate Medical Care

Responses anyone?

TCU Horned Frog Mascot

TCU Horned Frog Mascot

Go Frogs!

The Myth of the Free Market Health Care Reform

I offer my readers two examples of why the “free market” system alone is systemically incapable of creating or sustaining any semblance of real health care reform:

  1. The free market requires that any product related to health care for real human beings actually is designed to make a profit for the owners/shareholders of that business.
  2. The free market requires that any product related to health care for real human beings actually is designed to make a profit for the owners/shareholders of that business.

That is not a typo.

“Hunter,” one of the contributors to the Daily Kos, wrote a letter to the President making his case for free market health care.  Here are his concluding paragraphs:

So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company’s list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company’s claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company’s crack cost-review and retroactive cancellation and denial squads, my insurance company’s executives and board of directors, my insurance company’s profit requirements, the shareholders, my employer, and my doctor.

Anything else would be insulting.

Hunter didn’t make this up.  This is, indeed, the reality of health care in the free market.  I urge you to read the complete letter.  You’ll love the part about the gold-plated utensils and its vital relationship to your health care dollar.

Paul Krugman, Nobel-winning economist and New York Times columnist, however, just puts the nails in the free market myth coffin:

There are, however, no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn’t work. And people who say that the market is the answer are flying in the face of both theory and overwhelming evidence.

I urge you to read the complete post from Dr. Krugman’s blog.

It really comes down to this.  If you are chuckling, you understand that health care reform is about real people needing real medical care when they need it, without the cost or lack of access costing them their lives or livelihoods.

If you are experiencing blustery consternation and wanting to call me a socialist, communist, or worse (none of which apply, because I am a dyed-in-the-wool capitalist), you need to make a decision.  Do you want to live in a country that is healthy and prosperous because health care is delivered through a collaboration of the government, mission-driven non-profit organizations and private enterprise, or…

Well, do you want to or not?  The myth that free market health care reform will be achieved is dead.  As Paul Krugman points out there are many things the free market can do very well.  Health care is not on that list.

I care enough about you as a person and as an American to support a portion of my taxes being spent to ensure you can get the medical care you need when you need it, because I know in the long run we will be better off–you, me, and 300 million of our fellow Americans.