TPM depresses me
Anger and frustration are always at the core of my (all too frequent)
bouts with depression. Nothing gets to me more than knowing in my head
and in my heart that the public option is the only viable way to reform
health care in this country and that we have the votes to win if Obama
would just bully up and push for it.
Medicare for All would turn around my life and my family's. We are cursed with bad genes that have led to health problems for all of us - high blood pressure, diabetes, heart attacks, strokes, bipolar disorder and more.
Lack of health insurance was the only reason I was forced to go on disability more than 20 years ago and fear of losing Medicare and Medicaid is what keeps me on disability now. Pre-existing conditions keep my brothers in dead end jobs they hate - they can't look for something better because they can't risk losing their insurance. Inability to keep up with insurance premiums and co-pays has made these last few years of my mother's life miserable and destroyed her once-perfect credit rating, and the financial stress has worsened her heart condition.
Even my rich uncle (in my family "rich" means solidly middle class) is suffering. He has a heart condition; his wife has asthma. Thanks to advances in medicine, their health conditions are easily manageable. What causes their grief is struggling to pay more than $1200 a month in health insurance premiums and watching their life savings fly out the window with co-pays.
Knowing there is an answer out there and that it's within our reach and knowing that the president we supported and the Democrats elected to work with him don't have the guts to go after it ... all I can do is pound my fists and scream.
And every day when I come to TPM, there it is staring me in the face. Right on the front page - where it should be - and there are my fellow TPMers who know the truth but none of us seem to be able to do anything that will change the outcome.
It's frustrating. It pisses me off. Depression is setting in.
But keep up the good work, TPM. Where there's light, there's a tiny sliver of hope.
Medicare for All would turn around my life and my family's. We are cursed with bad genes that have led to health problems for all of us - high blood pressure, diabetes, heart attacks, strokes, bipolar disorder and more.
Lack of health insurance was the only reason I was forced to go on disability more than 20 years ago and fear of losing Medicare and Medicaid is what keeps me on disability now. Pre-existing conditions keep my brothers in dead end jobs they hate - they can't look for something better because they can't risk losing their insurance. Inability to keep up with insurance premiums and co-pays has made these last few years of my mother's life miserable and destroyed her once-perfect credit rating, and the financial stress has worsened her heart condition.
Even my rich uncle (in my family "rich" means solidly middle class) is suffering. He has a heart condition; his wife has asthma. Thanks to advances in medicine, their health conditions are easily manageable. What causes their grief is struggling to pay more than $1200 a month in health insurance premiums and watching their life savings fly out the window with co-pays.
Knowing there is an answer out there and that it's within our reach and knowing that the president we supported and the Democrats elected to work with him don't have the guts to go after it ... all I can do is pound my fists and scream.
And every day when I come to TPM, there it is staring me in the face. Right on the front page - where it should be - and there are my fellow TPMers who know the truth but none of us seem to be able to do anything that will change the outcome.
It's frustrating. It pisses me off. Depression is setting in.
But keep up the good work, TPM. Where there's light, there's a tiny sliver of hope.
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Depression is easy to come by, debbie. All i can offer is Perspective and The Long View. Go out and search the skies at night, the wonder of our Milky Way and the nearby planets, consider the amazing vastness of just even our local universe. You might even see the space station zipping around the earth.
We are crisis-oriented critters; this debate seems make-or-break, but there have been so many of these issues for so long now. We can only do what we can to help justice and peace and economic security for all along; there are so many big forces arrayed against it. Do focus on the comfort of yourself and your family; just dart into TPM when you have the extra strength, otherwise, take a mental health break until you are better.
I am so sad to hear of all your health problems and grotesque expenditures. It's just not right.
August 28, 2009 1:43 PM | Reply | Permalink
You've got it - it's just not right. One way health reform would save money: if I knew I had guaranteed health care no matter what, I could go out and get a job, start paying more taxes, and stop collecting Social Security. There are thousands of people in the same boat as me.
August 28, 2009 4:27 PM | Reply | Permalink
You hang in there Debbie. I just spent 3 hours out in front of my congresswoman's office holding up one side of 4' high x 8" wide banner that says Honk for Health Care Reform. One of our guys had a big poster board that said "Public Option". We've been doing this since a week ago yesterday but it's the first time we had the public option sign.
We've always gotten lots of honking but the lines are clearly drawn with that public option sign. The grimaces are tighter and insults are louder from the wingnuts here where my 10 year incumbent House rep won with 53% of the vote last year. But the shy little beeps are now long, loud, palm reddening, ear splitting, demands.
We're gonna pass this bill. There will be a public option. The outrages of the insurance companies that harm you and yours will be outlawed. It won't be perfect and it'll take diligence on all our parts to prevent the powers that be from gaming the system in the years to come. But we will do it.
August 28, 2009 8:49 PM | Reply | Permalink
Your essay is heart felt Debbie. But it is so important that MANY PEOPLE READ THESE PERSONAL STORIES.
This is so much more important than some graph.
Thank you for sharing.
August 28, 2009 2:48 PM | Reply | Permalink
I cross-posted on my personal blog, for whatever that's worth. I should send a copy to Grassley and Harkin but I don't think I'd change any minds there.
August 28, 2009 4:35 PM | Reply | Permalink
Send the story, all we can do is put out causes; we can't second-guess the effects. It is too bad that almost none of the Congresspeople read their mail, aides just check boxes: Yes No alongside the issue. Some House members won't even let you email them unless you live in their Districts; I think all the Senators will allow it, at least that's my recollection.
Isn't it sad that all the town-hall rage isn't even about health care issues? That's what really burns my toast.
August 28, 2009 5:06 PM | Reply | Permalink
Yes, the MSM loved tellign stories of victims of insurance until just recently when there is actually a chance we can change it. It was great infotainment just a few short months ago. Now it's been replaced by fools with guns and crazies with fake birth certificates.
August 28, 2009 3:34 PM | Reply | Permalink
The MSM in its present form is worse than useless - it's destructive.
August 28, 2009 4:28 PM | Reply | Permalink
Yes.
August 29, 2009 12:33 PM | Reply | Permalink
I found this cheered me up:
http://www.lasvegassun.com/news/2009/aug/28/reids-views-overhaul-taking-shape/
Reid is coming out hard for the public option - says it's essential to a meaningful reform bill. And that's really important - he decides who goes into conference committee from the senate side to hammer out the final bill. So for me, the chances of the public option being in that final bill just went up a few notches.
August 28, 2009 3:44 PM | Reply | Permalink
Thanks to the link, Obey. It cheered me up too.
August 28, 2009 4:30 PM | Reply | Permalink
Sorry.
I wish I could say I found anything hopeful in that article. But I can't.
Reid has said he "supports' the public option for some time now as has Obama. Unfortunately, that support has not manifested itself in concrete action. Its kind of like saying I support the Steelers. Great! You can double check with Mike Tomlin but I don't think my support increases their chances of winning. If Reid and Obama don't get off the sidelines and in the game, they're just fans of the public option.
August 28, 2009 4:56 PM | Reply | Permalink
I think you're misunderstanding me, Cawley. Sure, Reid could be more vocal. But we've been waiting for him to come out with a clearer position other than 'support'. The administration, sadly, regards the public option as expendable. Reid here is using very different language - saying it's essential to the reform package. and that position is important when the time comes for him to decide who to put in conference committee to negotiate the final bill. If he picks someone like Dodd rather than, say, Nelson, you get a very different bill up for the final vote. It's one of the most important steps in the whole process...
August 29, 2009 10:38 AM | Reply | Permalink
Bookmarked Obey. Thank you for this.
August 28, 2009 5:55 PM | Reply | Permalink
I know that there was a way that you could connect with organizers during the election. Does anyone know if those avenues still exist.
Here are my thoughts. If I can connect with community organizers in my state from during the election and I can find 100 of them, and they could commit to getting 100 people to a rally, that's a decent amount of people. If I got that commitment I would go for it and make it happen. So that would mean a rally in Denver. If others duplicated in other states like IL, CA, DC, etc. and we found 100 organizers in each state to get 100 people to the rallies and we coordinated them so that the rallies were at the same time and day in each state, we can put the tea baggers to shame.
To me it is ridiculous. We will come out in numbers for football games and concerts, and the freakin' tea baggers have gotten tons of press but we seem to be the silent, sleeping giant(in numbers) and are not making our voices heard.
Reich was talking about have a rally? I don't know what happened after that but I know that there is a way we could do something big if we really wanted to. I get that the leadership doesn't seem to be able to get behind it but I would like to do it not only to take a stand for real health care reform but to tell the tea baggers, nutjobs et all to STFU.
August 28, 2009 3:47 PM | Reply | Permalink
I have to confess the death teabaggers managed to intimidate me. I didn't go to Grassley and Harkin's town halls when they were in my area because I felt like I couldn't control myself if those if the nutjobs showed up. I would've been the one who ended up in jail.
And my congressman is Steve King. 'Nuff said, right?
August 28, 2009 4:33 PM | Reply | Permalink
And my congressman is Steve King.
You mean the congressman who compared illegals to stray cats and torture to hazing? The guy who was praying for Justices Ginsburg and Stevens to elope and run away together to Cuba? That master of clairvoyance who predicted Islamists and al Qaeda would dance in the streets with joy in greater numbers than on 9/11 if Obama was elected president?
The same idiot who made this statement? If we don't save marriage, we can't remain pro-life.
No wonder you're depressed. :-)
August 29, 2009 8:34 AM | Reply | Permalink
I call him Michele Bachmann's evil twin.
August 29, 2009 1:03 PM | Reply | Permalink
I'd contact Pat Waak; she should have the lists of emails of the organizers. Did you read that the State Republicans are demanding an apology from her for jumping to conclusions about who smashed up Dem Headquarters? Here's her email:
pwaak@coloradodems.org>
and good luck.
August 28, 2009 5:11 PM | Reply | Permalink
It's amazing how the President is being blamed for obstructing health care reform because he doesn't have the "guts". What does that mean anyway? Last time I checked it was the Republicans that weren't going to vote for reform.
Depression is also a condition I take medication for and I found that attending a town hall got me off the "Health care is going down the tubes TPM concern spiral". The nanostory lifestyle was sucking out my soul. Action was the remedy because I felt like I did my part. But, I won't pretend to know your story. People are different.
I'm sorry if this comes off as an irritable rant but, I think I'm coming to the end of my rope with people giving up on health care reform and saying it's Obama's fault. Nothing's done yet and some people are locked in on the wrong target.
August 28, 2009 6:06 PM | Reply | Permalink
I'm taking your post to heart(although there aren't strong enough antidepressants in the world, believe me!) no need to apologize that it's a rant.
August 28, 2009 6:33 PM | Reply | Permalink
Stay away from TPM if you're depressed. Too much whining, these parts.
August 28, 2009 6:10 PM | Reply | Permalink
Yeah, it is so much better to go and see your pals who are trying to get rich by saying that with "Obamacare, Senator Kennedy would have been told to go home and die."
Yeah. At least at TPM, we are honest. Which is more than you can say. What is depressing is that so many uneducated dolts believe you.
August 28, 2009 6:52 PM | Reply | Permalink
I just don't understand why democrats can't seem to discuss this issue without hyperbole. You have the winning hand as well as all the good ideas, yet the only way most respond to anything resembling criticism or even just honest questions or confusion as being the most evil or the evil neocons and should be pitched on the nearest bonfire immediately.
There is a part for Medicare to play but not as the only health insurance choice in a free and democratic republic. That isn't a partisan statement, but a statement of fact. Even most people who have Medicare don't want it as the only option. "Single payer" has polled fairly low for quite some time. Forget about anything resembling the British health service. That being the case, what is so threatening about a simple conversation on ALL the available choices we have in this country today and what must be done to fix them all?
Gently pointing out that Medicare will be broke in ten years and wouldn't be the best way to insure everyone in this country is met with derision and scorn, along with accusations of trolling for industry or of being an apologist for the GOP. The debate has nothing to do with the GOP. Their bills won't be doing to the floor. At best, they might get a couple concessions in committee.
Most comments that object to certain parts of the current legislation is not of the "Obama is going to kill your grandma!" sort. All objections don't even come from republicans. There are plenty of moderate democrats who would prefer a different solution than HR676 and the way it would implement Medicare-for-All.
August 29, 2009 9:12 AM | Reply | Permalink
You are accusing US of hyperbole? That is rich!
"with "Obamacare, Senator Kennedy would have been told to go home and die."
"Death Panels"
"Encouraging soldiers to commit suicide"
Get real, Jason
August 29, 2009 10:47 AM | Reply | Permalink
Let's stick to the actual statement itself that I called hyperbolic.
Such rhetoric is counter to attaining anything resembling progress on this issue. Everyone who disagrees with democratic positions on this are not "uneducated dolts" out to derail health care reform, but that is how you approach the subject.Most of the objections to some of the proposals being offered have zero to do with any of the right fringe statements you throw as an excise for your own partisan behavior. The left loses all credibility when it employs the same tactics it deplored when the right did it.
August 29, 2009 1:12 PM | Reply | Permalink
Actually, Jason, if you are going to accuse me (and the LEFT) of hyperbole; I disagree that you get to choose one statement when there are so many that actually go beyond hyperbole to actual lying, which I gave an EXTREMELY small sample of.
Again --- get real
August 29, 2009 8:22 PM | Reply | Permalink
I could cite chapter and verse, all day long, every day about the hyperbolic rants at this site by members of your team. You don't want to hear any of it, because everything that is wrong with the country is the republican party's fault.
It could never possibly be the democratic party's fault for failing to properly explain the reform efforts being pursued. Instead, each misunderstanding or questions is met with aggressive tactics modeled on those liberals found so abhorrent on the right these last three decades or so.
Get real indeed.
August 30, 2009 10:48 AM | Reply | Permalink
This is not a time for "moderate" Democrats to define the terms and debate -- we know what the "Blue Dogs" are and stand for. Our politics has for too long skewed too far right-of-center -- for so long that some mistake it for the center.
It's no wonder the far-right lunatic fringe actually gets away with characterizing even genuine conservatives as "Leftist," and so many swallow that lie and believe it.
Progressive is LEFT of center; and that is the emphasis that is needed, not the lame rightist pablum you are preaching.
August 29, 2009 1:24 PM | Reply | Permalink
Again, the right-left structure fails to define what being progressive really means. The definitions have been polluted.
I see the Blue Dogs as a necessary component to ensuring that the legislation that emerges is something that a good portion of the country who distrusts Washington can get behind. I think they are necessary to ensure there isn't too much grassroots opposition to whatever the final bill happens to be.
It is the first step on a long road that will take at least all of Obama's first term to fix. Trying to once again cram every needed reform into a single bill makes it impossible to manage the message that is being conveyed to ordinary voters. Contrary to popular belief, the wing nuts we see on TV are a pathetically small percentage of the country as a whole and most of them can't be bothered to vote.
It is the fans of the incumbents in both parties that turn out to send their guy back to Congress every two years while the majority wonders why the "real election" in November is always a lesser of two evils thing. This is why I maintain that the current make-up of both parties needs to be more reflective of the majority of the country, which I think would take the whole construct back to the left.
Unfortunately, though, it can't be forced. We need to evolve back to sanity just as we slowly became insane these last forty years.
August 29, 2009 1:41 PM | Reply | Permalink
Oh, debbie, i got to thinking about one possible way to get cheaper meds for your family. Find out the company that makes the ones they need, go online to their websites and search for subsidies for low-income families, sometimes even free meds. I'd imagine it's a hassle, but it may net some relief. Big Pharma is trying to look more compassionate...but really, some of the Biggies have done it for years, or at least say they do. You can also order from canada, but i haven't kept up with the legalities on that. Maybe someone here knows.
August 28, 2009 6:18 PM | Reply | Permalink
I've tried to do that for some of our patients. Problem is, to qualify you have to be at the level of extreme poverty, which would qualify you for Medicaid anyway. For the working poor, or even the lower middle class, who have to choose between rent, food, clothes, and school supplies vs medications, those programs don't even come close.
August 28, 2009 7:43 PM | Reply | Permalink
Paying for meds isn't the big issue for anyone in my family. My income is low enough to qualify for Medicaid - between that and Medicare, my copay is usually $3 or less per Rx. If a drug I need isn't available in generic, I'm SOL.
The rest of my family has private insurance that covers drugs fairly well. It's the cost of the insurance that's hurting them and the copays for doctor visits, tests, labs, hospitalizations.
My mom, for example, is on Humana. Every time she goes to the hospital, she has a copay for each doctor who sees her or reads an CT scan or interprets a lab, as well as separate copays for ER and for inpatient.
The biggest problem for all of us is the trap we're in. My brothers are stuck in their jobs and I'm stuck on disability in order to maintain the insurance that we have now. Plus their premiums keep going up and their coverage keeps going down.
August 28, 2009 8:32 PM | Reply | Permalink
A big part of the problem with people opposing the public option is fear. Fear. Plain and simple. They are afraid that whatever they have will be taken away and they will have to stand in line for health care.
They are so afraid they can't open their eyes and see that they are a paycheck away from being without health insurance, thus becoming "one of those others."
Somehow the repubs have been able convince regular ole people that those who don't have insurance, don't have it because they haven't worked for it, somehow don't deserve it. They either don't know, or don't care that 1400 people a day are losing their health insurance due to job losses, employers dropping the benefit or getting bounced out of their plan because they dared to get sick.
Education is the ONLY way to change their minds. They need to see other "regular ole people" hurting, so they can empathize. Sad, but true.
August 28, 2009 6:21 PM | Reply | Permalink
It's because anytime anyone on the left talks about the "public option" it quickly becomes a discussion about "Medicare-for-All" instead of what the legislation is actually about which is regulating insurance companies, improving the efficacy of the procedures being used for various conditions and a new IT infrastructure to help eliminate malpractice and other expensive mistakes.
Even this blog makes the mistake of discussing the solution as being single payer when we are bound to be headed for a heavily-regulated, public-private hybrid of some sort.
I think that is a good thing, too. Medicare-for-All will not cure what is wrong with health care in this country. In fact, absent some fairly significant reforms, Medicare and Medicaid will be broke inside of ten years. In addition to that unfortunate truth is the fact that their negotiated rates and 80% payout of billed charges adds the 20% delta to the rest of the system in various ways.
Ultimately, though, the way we eat is the single most important part of why our costs keep rising - high demand always equals high cost - because more people are getting sicker with chronic diseases from the types and amounts of food they eat. Not a single person in authority is even discussing that equally unfortunate truth.
The real gorilla in the room isn't the health insurance companies. It is the food manufacturers and their toxic products.
August 29, 2009 9:28 AM | Reply | Permalink
The real gorilla in the room isn't the health insurance companies. It is the food manufacturers and their toxic products.
C'mon, Jason. Health insurance companies are about the bottom line, not health care. Period. As far as single payer goes, what about it are you against?
August 29, 2009 4:21 PM | Reply | Permalink
I am not going to continue repeating myself about the Medicare-for-All legislation as outlined by HR 676.
Beyond the fact that it would never work, I don't think most people want to replace the public-private hybrid we currently have with a single government-run program. They aren't doing all that great insuring a third of the country, so I am not sure what putting the other two-thirds of Americans into a government program will do to solve the problem.
As to the quoted material, I am not sure what you are taking issue with. Unless America changes its relationship to food, no health care reform will ever keep the system from bankrupting at some point in the near future. Our lifestyles ensure we will continue getting sicker, meaning the demand for health care continues going up.
The only way to reduce costs is to reduce demand and the only way to reduce demand is to change the way we live. Anything less is sublimation at best.
August 29, 2009 8:04 PM | Reply | Permalink
Oh, give me a break. The other developed countries who have universal health care are not bogged down by CORN and other "toxic products," to the point that it is bankrupting their health care.
This is a fact: Once health care becomes Universal, the other problems become "problems to be solved." Without a system that applies to every citizen there is no way to approach systemic problems.
In Canada they acknowledged the problem with long wait times. They already had a universal system in place, so they problem-solved, and improved the services within the system that was in place. Until we have a "system" every problem becomes a mish-mash of stuff -- flu shots at CVS. Students with flu -- stay wherever they are -- break your back - better hope you did that falling down the stairs at Nordstroms rather than in your own back year -- knee replacement -- you better have never had a knee problem before, or your insurance will drop you like a hot potato!
I could go on, but unless you are in an exceptionally obtuse mood, you will get my point. The system we have is set up to screw normal people who have the bad luck to get sick. Insurance companies roll in the money they collect from those of us who pay thousands a year (my case was over $7,000 last year) and pay almost nothing in benefits (which they identify as "losses") Why not use this "shared risk" for the benefit of all of us rather than give these creeps millions of dollars of "salaries" which they "earn" by denying claims? Why, Jason?
August 29, 2009 8:15 PM | Reply | Permalink
Please see my discussion with Purple Sate below. Our health care costs will continue to go through the roof whether we have a public or private system because we keep getting sicker and more people are using the system. High demand always equals high cost, no matter what industry you are talking about.
The costs could be monetary by way of higher charges by providers or opportunity costs in longer wait times because we would have a country of chronic over-eaters with access to guaranteed health care. How many Americans just magically stop eating less on their own? Hell, how many Americans stop doing anything that brings them pleasure and is widely available? Our food is toxic AND addictive.
Canada is way healthier than we are and has a tenth our population. It is much easier to make on-the-fly adjustments in such a system. Especially one that enjoys wide-spread support from a fairly homogeneous population. Comparing our two health care systems and the people they have to cover is like comparing apples to orangutans.
As to insurance companies rolling in profits from the death of their clients, that is only partially true. They do make money by denying care and that should be stopped. Though some companies administrative costs are through the roof, the average is 16 percent. The profit margins in health insurance are not higher than companies of a similar nature. In fact, many services companies are substantially higher.
Before you accuse me of being an "apologist" or obtuse, I am simply pointing out that many people get great service from private insurance companies. For every horror story, there is a person who had a plan that saved their life. Or the life of a loved one. I understand your position and agree that some sort of non-private plan should be available to give people an option to private coverage when having some sort of health insurance is mandated for the entire country.
Getting a "public option" in this legislation will be tricky now that it has been positioned as a Trojan horse to single payer, which most Americans do not support, even if they would see a true public option available.
I think the democratic party could make a smart strategic play by giving up the public option completely on this first round, including nonprofit coops. But do it in a magnanimous way. As if it is a huge concession. Coops would be a waste of money given that a true public option is already there to be used. Shift the focus to ensuring the reforms that remain solve each and every problem with the private insurance industry, as well as establishing the enforcement mechanism to make regulation work.
Once that victory is complete and Obama signs the most progressive health care reform legislation in a generation, immediately put forth a bill to reform Medicare/Medicaid by way of making it the public option. The only way the system can become stable is by changing the dynamic of the coverage populations. By giving every American the right to participate at a full level at premiums based on a percentage of their income could actually plug the holes. Making Medicare follow the rules and pay 100% of agreed to care will level the playing field as well.
I am not sure what the final solution will look like. I am simply pointing out areas of locking in bipartisan support by way of broad grassroots acceptance of the offered solutions. Most Americans of every political stripe want to ensure Medicare is there if they or someone they love needs it. They also want the private insurance companies stopped from committing fraud, waste and abuse. I believe there is a chance to accomplish both with a minimum of resistance given the right pitch.
August 30, 2009 10:30 AM | Reply | Permalink
That is like saying that it doesn't matter if you eat all your meals in restaurants because food is getting more expensive anyway. People talk about the Public Option as though it is a big black hole that only tax money gets poured into. The whole point is for it to be far more affordable, and so people can pay their own way who cannot now.
And please don't come up with that tired old canard about how once the insurance companies are competing, the premiums will go down. There is nothing keeping them from competing now, but they have continued to raise premiums as much as 35% in one year, simply because they have a stranglehold on people who have insurance. As long as they can get rid of sick people, as they have done, they have been "competing" for the healthy ones, whose employers subsidize their fees.
They haven't competed on prices; they haven't competed on service; they haven't competed at all, because they don't WANT people who currently can't afford their prices; that would defeat their entire purpose. Now that there may be a mandate, and more $$$$ in the pot, they show up like pigs to a trough, trying always to figure out a way to game the system.
August 30, 2009 12:36 PM | Reply | Permalink
To get at the trough, they will agree to regulations they have never faced before.
I have yet to advocate against a public option. I simply think it is better handled via Medicare/Medicaid reform instead of creating a whole new government agency. Contrary to your assertion otherwise, there are many black-holes in government where money is dumped and accountability is nil, including the current government health insurance programs.
Ignoring the fraud, waste and abuse that is pervasive at all levels of government is no more truthful than saying insurance companies will change out of the goodness of their own heart.
August 30, 2009 3:00 PM | Reply | Permalink
Debbie, I suffer the same. I have found myself spending less and less time reading up on the "progress" of health care negotiations, wondering why ......why don't people get it? It is hard for me to watch Obama not press as hard for this as I think he might. My reps all support the birther movement.....Am I hopeful they'll be responsive to my vote?!
For me, these are days of trying to be grateful for small moments.
August 28, 2009 6:28 PM | Reply | Permalink
governments have always failed the people.
what makes most people I speak with angry is that they all feel as if they were fooled by Obama or fooled themselves about what to expect from him.
yet, the small few I know are only part of what is going on in the country.
people will never support a president they view as weak on the issues that they hold firm.
your angry and depressed and so are tons of others.
sad that Obama has brought this all on himself by not drawing a line and defining the debate.
pretending otherwise would make me angry and depressed.
I do not give anyone that control over me.
August 28, 2009 8:52 PM | Reply | Permalink
We The People failed the republic, not the other way around. With a pathetic 16% average turnout for primary elections, the only possible form of government we would end up with was a partisan hell designed to keep incumbents in power.
Until Americans as a whole take their civic responsibility more seriously, nothing will change because the same idiots end up back in Washington sent their by the same die-hard fans who are willing to be a part of that 16% turnout that determines the winner in most districts.
August 29, 2009 9:31 AM | Reply | Permalink
Well, it is just so wrong. I have tried so hard not to care about this issue in a major way, meaning studying it. We do not go to doctors except in the most extreme emergencies. Decades ago we became disillusioned with mainstream medicine; it had failed our family time and again. We use alternative approaches; it seems there are many who have chosen a different road. About half of the health care dollars in the country are spent on alternative health treatments, but as it turns out i do care about people's lack of access to AMA doctors, etc., if that's what they want. Personally, I have told my kids to let me be a Cash-for-clunker-oldie-grandmas; take the $5000, send me into the lake on a burning boat, and skedaddle. Not kidding.
It is so depessing to me that A-hats like george stephanopolous are going on about "Teddy would have dropped the public option; he was all about incrementalism." It is bogus; even his good buddies would not negotiate over his public, universal health bill. We are spiraling down, but maybe soon as his funeral is over, someone will come forward with What Ted Really Wanted. And maybe, maybe? it will be a game-changer.
(Sorry, no editing, i am tyoing while i'm on the phone with my daughter.)
August 28, 2009 8:56 PM | Reply | Permalink
DDN,
Deep breaths and keep telling your story. There is no excuse for not having a public option and we need to force the issue with tales such as yours.
I truly know how you feel, and even worse, I know how easy it would be to fix.
Stiff upper lip Deb, Stiff upper lip.
August 29, 2009 5:26 AM | Reply | Permalink
I know what you mean, about being depressed. My mom learned to take her blood pressure, because she lives with a serious heart condition. She is very careful, because she is "waiting for Medicare". She has been waiting to be old enough to get it without dying.
I was in a doctor's office yesterday and he wanted me to see a hand specialist (I have cellulitis from an infected cat bite.) Alas, there was no way my insurance would pay, so while he hunts down another hand specialist that does take my insurance, I am taking stronger antibiotics and hope that I don't lose function in my hand.
My life, my mother's life, your family's, everyones, are just pawns in a game of corporate greed. How people do not see that is beyond me. I am tired of emails and phone calls. I want a march of the sick on washington - on every goddamn insurance company, and every media outlet, media entity that perpetuaes misinformation and lies.
August 29, 2009 8:27 AM | Reply | Permalink
People don't see it until they themselves or a close family member has a health crisis. Those who are healthy go trotting along through life, thinking their insurance will cover any problems that come up. Then they get sick and get a rude awakening.
Even my brothers - Mom's been having problems for years but she didn't talk to them about it. It's only been since this spring, when she had multiple hospitalizations that they caught on. She kept getting sent home because her insurance would only cover so many days. Then she'd get sicker at home and end up back in the ER and get re-admitted.
When the bills started coming in, I made her show them to my youngest brother. He was against health care reform until he saw the stack and I explained the reason she screens her calls is because she has collection agencies calling her day and night.
And she has "good" insurance.
August 29, 2009 1:02 PM | Reply | Permalink
Someone should tell your brothers that the Health Insurance Portability and Accountability Act of 1996 (sponsored by Ted Kennedy) made it very difficult for employers to deny coverage because of pre-existing conditions. Pre-existing conditions shouldn't keep your brothers from looking for a new job.
From the Department of Labor website: http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html
One of the most important protections under HIPAA is that it helps those with preexisting conditions get health coverage. In the past, some employers' group health plans limited, or even denied, coverage if a new employee had such a condition before enrolling in the plan. Under HIPAA, that is not allowed. If the plan generally provides coverage but denies benefits to you because you had a condition before your coverage began, then HIPAA applies.
August 29, 2009 9:34 AM | Reply | Permalink
Sorry, but this is why HIPPA didn't actually fix anything with regards to preexisting conditions:Under HIPAA, a plan is allowed to look back only 6 months for a condition that was present before the start of coverage in a group health plan. Specifically, the law says that a preexisting condition exclusion can be imposed on a condition only if medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to your enrollment date in the plan. The only six months part is the key because most people who are getting screwed are people currently being treated for something like diabetes or high blood pressure. Something they would have been treated for six months previously.
Whatever comes out of conference committee is sure to fix that loophole because it will also have mandates that makes such policies impossible. Insurance companies should play ball because it is the only game in town and the rules are about to change.
August 29, 2009 10:23 AM | Reply | Permalink
Well, it's a bit more complex than that. There's also a "creditable coverage" provision that basically says that if you've had coverage within 63 days of getting your new coverage, pre-existing conditions must be covered regardless of the 6 month provision. The purpose of the 6-month rule was to prevent people with no coverage from buying coverage after they found out they were sick. People who had coverage and are just changing it (because they are changing jobs) are generally not subject to any pre-existing condition limitations. Most employers don't even bother putting pre-existing condition limitations in their policies anymore because they would rarely come into play and trying to administer the rule for the few cases where they might apply is a pain.
August 29, 2009 11:04 AM | Reply | Permalink
I should qualify one statement I made: most large employers don't bother with pre-existing condition limitations anymore. Smaller employers are more likely to try to enforce pre-existing condition limitations, but anyone who had coverage from a prior employer should be able to get a certificate of credible coverage proving that they had past coverage (it's a requirement that the insurer provide this certificate if asked for) and the new employer is obligated to honor that prior coverage.
August 29, 2009 11:27 AM | Reply | Permalink
I don't know what the law is but I know the reality. I personally know people who had insurance, changed jobs because of layoffs, and were denied coverage for pre-existing conditions with their new insurance. They work for companies with fewer than 50 employees.
August 29, 2009 1:11 PM | Reply | Permalink
Yes, people who are laid off and can't afford to continue coverage may become subject to pre-existing condition limitations if they were uncovered for more than two months. This definitely needs to be reformed--and is, in my mind, another reason for supporting a public option. But if, as you imply, your brothers are currently insured (and have been so for a full year), they should not fear changing jobs as long as their new employer offers health insurance coverage and they do not have a gap of more than two months without coverage between jobs. HIPAA prevents companies that offer health insurance from excluding pre-existing conditions for new employees who had coverage for the year before they took their new job.
August 30, 2009 8:40 AM | Reply | Permalink
Yes, but if you LOSE your job and have to get insurance as a person, rather than through an employer (or if you work part-time and don't get employee benefits, or you employer just doesn't offer them) pre-existing conditions raise your premiums significantly. It doesn't matter if you are keeping your coverage without a lapse. Your previous problems: high blood pressure, back pain, diabetes, any cancer, depression, neck pain, knee pain, stomach problems, cysts of any kind -- all add up to increased premiums or ridiculous co-pays.
Oh, and if you have a job and become too sick to work, then COBRA (for a limited time, and is VERY expensive) is prohibitive for many people as well.
Who do you think made these rules? Why, the insurance industry, of course.
August 30, 2009 7:42 PM | Reply | Permalink
All true and all good reasons for a public plan. Tying health care coverage to employment really makes no sense because the seriously ill often can't work and therefore lose their coverage just when they need it the most! It's a screwed up system. Still, I think it's worth pointing out that changing jobs (from one job where you have coverage to another job where you can get coverage) shouldn't expose you to pre-existing condition limitations (assuming you've had your coverage for at least a year and haven't had a break in coverage longer than 63 days). This is one reform Ted Kennedy was able to get passed and, while it doesn't solve the systemic problems, it certainly has helped many people.
August 31, 2009 7:07 AM | Reply | Permalink
Whatever the actual statute says is immaterial because we have long failed to enforce most regulations that big companies operate under. I guess my main point is that whether we have a purely public system or a purely private system or a hybrid of the two, regulations and the enforcement of those regulations will be key to the success of any reform effort.
Simply replacing what we already have with a publicly-run plan won't actually fix what ails our country. It certainly won't fix health care over the long run because no one is talking about our horrible diets and how that is the real driver of the rising trend in health care costs associated with chronic disease management.
August 29, 2009 1:17 PM | Reply | Permalink
Do you have an example of a large company that violates the HIPAA pre-existing coverage laws? I'd be very surprised if you do. Maybe some smaller employers violate the rules, but I have some firsthand experience with companies' policies in this area and I can tell you that many (maybe most) large employers have dropped pre-existing condition limitations from their plans altogether and those that haven't dropped them follow the law and do not exclude pre-existing conditions when a new employee has prior creditable coverage.
In this case, the regulations work fine. The problem, however, is that when health care coverage is tied to employment, the unemployed are out of luck. Worse, the very ill who need coverage most, often are too ill to work and therefore are likely to lose their coverage when they need it most. Private systems on their own can't solve the problem. At a minimum we'd need the government to step in and buy coverage for the very ill and unemployed. I am open to some kind of private or private-public system, but so far none of these seem to solve the problems we face better than a pure public option. I'm not going to get into the entire argument for a public option here, but I do think it is the simplest, least administratively complex way of ensuring that all citizens have coverage and placing controls on cost. Everything else requires much more complex arrangements with far more complex regulation and oversight.
Diets are a problem . . . but there are bad diets and obesity elsewhere (Britain, for instance) where health care costs aren't as high as they are here. So diets aren't the primary driver of the cost problem in the US, though they certainly contribute to the problem.
August 30, 2009 8:57 AM | Reply | Permalink
It isn't a company policy it is a health insurance company policy. That six months clause allows the insurance companies to deny coverage or to raise rates to the point that a company drops their coverage. I am not sure where you get the idea that preexisting limitations have something to do with the large companies buying insurance.
Medicare setting costs is a large part of why the system is screwed up today. They pay much lower fees than other insurers and then only pick up 80% of those reduced costs. That delta is passed along to the rest of the system as higher charges for private insurance companies and individuals paying cash. Government intervention is clearly a part of the solution, but until they can design a sustainable government plan, I am not all that happy extending it to the rest of the country. All that would do is greatly increase our costs and the instability of the system. Absent massive Medicare reform, I suspect the most Americans will support are the nonprofit coops and some sort of independent board to help set required benefits. Costs will be lowered as they are in Switzerland or Holland, by private companies competing on price via cutting internal costs, such as obnoxious salaries and bonuses minus stellar performance.
As to diet, the UK is not two-third overweight, with a third of those people considered obese. The UK also doesn't have the wide-spread use of corn-fed animals and products made with corn by-products. It isn't just our diet, it is what composes our diet and is by far the number one drive of rising health cost because of the multiple chronic diseases associated with being obese or overweight. Our relationship with food is pathological in a way that no other country on the planet can match. We're the only country in the world with fat poor people.
Again, no one is talking about it because no one wants to believe it, not even liberals.
August 30, 2009 9:49 AM | Reply | Permalink
Jason, most large companies self-insure and (with help from the insurance company that administers the plan and consultants) determine what's in the policy.
By the way, I worked for Mercer too in the late 1990s (funny coincidence) and wrote a bunch of SPDs myself when HIPAA first was implemented. Early on, a lot of companies tried to administer pre-existing condition limits. But most gave up after a few years, finding it was a waste of time. I've changed jobs a few times since the late 1990s with some serious pre-existing conditions and never once have had a problem with denial of coverage. I've never even been asked to show proof of creditable coverage. Most large companies just abandoned pre-existing condition limitations a few years after HIPAA became law. Sure, some may still try to enforce the rules, but people coming from a job with creditable coverage still wouldn't be subject to pre-existing condition limitations, since HIPAA forces the new company to honor the old coverage.
Since you and I both worked in the industry: one question for you. Why do you think companies haven't gotten more strongly behind public health care? I guess if I were a CEO I'd be just dying to hand all my health care liabilities over to the government. Is it just (as some health care consultants have told me) that the finance people like the flexible tax credit they get when the make contributions to their health care trust that much? It seems to me that the benefits of the tax credit must be beginning to appear small relative to the cost and liability.
August 30, 2009 10:32 AM | Reply | Permalink
I don't think most CEOs believe the government is capable of running that system, despite the obvious issues that are occurring in the current private-public system.
Medicare is still heading toward insolvency in ten years, no matter that it is being positioned as the basis for a single payer plan. I think a smarter strategy would have been positioning Medicare as the public option and kept it separate from health insurance reform, which was also needed but is a totally different kind of conversation.
As to the HIPAA points, you sound like much more of an expert than me at those provisions. That is a funny coincidence on Mercer. I was there about six years ago. I have worked for a couple big companies since then, as well as a number of smaller ones, and none of them self-insured. We always insured via a large private insurer and there were preexisting conditions clauses that came into affect.
We have never been bit by them, but it appears to be a huge issue for other people.
August 30, 2009 10:43 AM | Reply | Permalink
Knee jerk ideological opposition from our Republican CEOs . . . even when it's bad for them! Of course, many probably fear the government will tax them and their companies to cover the cost of the government program.
August 30, 2009 10:55 AM | Reply | Permalink
There is some of that, but being skeptical of the government's ability to do things in a cost-effective manner is not exactly ideological or a knee-jerk response.
There are some things Uncle Sam does really well. The jury is still out on whether or not health care insurance is one of those things based on their performance to date.
August 30, 2009 11:04 AM | Reply | Permalink
One other comment--I agree that merely expanding Medicare is at best only a short-term solution. Medicare uses a chain saw approach to cost control and you're right that providers put up with it only because they can shift some of their real costs to the private insurers. Successful health care reform will have to address the way care is provided. Ultimately, I think that means a greater role for primary care physicians who are skilled at allocating care based on both likely outcomes and cost and who have no financial interest in the choices they make about care for their patients. I'm not sure how that system would be structured, but I can imagine an approach that would have primary care doctors working for the public and being responsible for choosing appropriate private-sector providers for their patients, taking into account cost, quality, and likely outcomes.
August 30, 2009 10:47 AM | Reply | Permalink
I would love to see the nonprofit community health clinics, which have been enormously successful and supported by both parties, expand into a nationwide resource for primary care disease prevention instead of health insurance disease management.
I forget where I heard about them, but I might have to do a blog about it because they are getting fabulous results on shoestring budgets, as most nonprofits do. They are government supported by privately run and are the only primary care providers within hundreds of miles for most of their clients.
Right now it is a pay as you can structure, but I don't see why it couldn't be something that could be modified to fit our needs, both in the rural areas they currently are as well as our urban centers with lots of emergency rooms but no family doctors.
Good discussion. I am pretty optimistic that this problem will be fixed over the next few years and by way of multiple efforts. If one of those bills doesn't kill the commodity corn industry, though, it won't matter what we do for health care reform now as the country continues to become fatter and sicker over the coming decades.
It really is an epidemic more severe than any in our history and it's barely discussed. Strange.
August 30, 2009 11:02 AM | Reply | Permalink
I think you're on to something with non-profit primary care clinics. As you say, we need to get insurance companies out of the business of choosing what care people get and put doctors in that position. But for that system to work, doctors have to step up and look not only at health-effectiveness of care, but also at the cost-effectiveness. So far, the health care debate has focused way too much on paying for care--but ultimately reforms in the provision of care (combined, as you say, with better prevention and more healthy lifestyles) will be the heart of a successful reform program.
August 30, 2009 11:16 AM | Reply | Permalink
PS: I was speaking of big companies in general not following the regulations they are supposed to operate under, including health insurance companies.
As far as I can tell, HIPPA didn't solve the problem because it didn't really change much about how the insurance companies operated and instead was aimed at employers who provide coverage.
I worked at Mercer HR Consulting in their group benefits in the early days of HIPPA implementation and all those former insurance actuaries and executives who worked there explained to me that it wouldn't change much about how we reviewed the insurance companies summary plan descriptions being offered to our clients.
The incumbent would still scour the "experience" from the previous year as well as the new plan participants and price the plans accordingly. If a company hired a couple diabetics with high blood pressure, they could be excluded from coverage if they had received treatment in the last six months. Now, if the person was in remission on a preexisting condition that hadn't needed treatment for six months prior to joining and then made it another year after joining the group plan without needing care, then they would get coverage under HIPPA.
The legislation was yet another example of Congress doing something that meant well and did nothing.
August 30, 2009 9:54 AM | Reply | Permalink