<p>“All we get to do is vote and opine”</p>
<p>and whine and sulk</p>
<p>Actually, “whine” and “sulk” are not things we do, just how we do them. We vote and opine as definite actions. We may opine in a whine and vote in a sulk, however.</p>
<p>lorelei2702: post#180: I agree. You have great insight into the process by which we all make our choices. We can be rational but we cannot be truly objective. Our choices are subjective and we are all influenced by our own past experiences and our instincts. Amazing how the same behavior elicits such diametrically opposite reactions. I see the debate and I think what a decent and respectful man, while someone else sees the exact same debate and sees an arrogant man.</p>
<p>teriwtt: Totally agree. The fact that he has a strong wife like Michelle reassures me that he is not a sexist jerk. In many ways Michelle reminds me of Hillary- strong, opinionated, and the intellectual equal of her husband.</p>
<p>At my age I have learned that my truth is not the same as your truth. I know good and decent people who do things I think are not what should be done, and yet I know when they hash out their plans and attitudes with their spouses, they are in agreement, on the same page. At the same time I know that if my husband and I were experiencing the same thing we would have a totally different reaction. (That is until this election!) Frequently I wish that I could be a fly on the wall so I could hear what the thinking is. </p>
<p>It is similar to seeing someone dressed in a way which looks outrageous and inappropriate. Guaranteed, when they are looking in the mirror, they are seeing something entirely different that what I see, and they think they look good, when I think “oh, dear”. </p>
<p>I do try very hard to allow for that difference in taste and “truth”. But it is hard not to judge and mind.</p>
<p>Soon it will be time to focus on the general election. Only two personalities to analyze, but I do hope the conversation turns to ideas. When Obama says that we can be the change we want, it sounds overly idealistic, but perhaps we should take that thought and run a little way with it. </p>
<p>Let’s talk more about what our country needs than which personality we “like” best. Maybe that will enable us to convince others. </p>
<p>Did anyone watch "60 Minutes " tonight, the segment about all the people in Tennessee who showed up for a weekend of free health care, provided by an organization that usually works with impoverished South Americans? Absolutely shocking that we have that kind of vast, unmet need right here. I think “we” have the power to convince others that everyone needs access to health care, and that daring to try something new is vastly better than claiming that nothing is going to work.</p>
<p>SuNa, I did not see 60 Minutes, but a few months ago I saw a photo essay about that organization operating at a state fairgrounds in the south somewhere in the NY Times Sunday Magazine. It reminded me of Depression-era photographs - they were absolutely haunting.</p>
<p>If you simply provide more “access to health care” without actually providing MORE health care, all you end up doing is increasing the rationing of health care and increasing the wait-times for care, already longer than in Canada, that we have now.</p>
<p>Providing insurance for entry into a broken system is neither a short- nor a long-term solution.</p>
<p>“Very few people realize what a crisis the healthcare situation in the US is.”
Since it ranks so high on voters’ priority lists, I think people know very much about the healthcare situation.</p>
<p>I’d stil like to see really good information about who is uninsured, for how long they are uninsured and why they are uninsured.</p>
<p>Here are the two best sources I know:</p>
<p>[The</a> Uninsured: A Primer - Kaiser Family Foundation](<a href=“http://www.kff.org/uninsured/7451.cfm]The”>http://www.kff.org/uninsured/7451.cfm)</p>
<p>Whoops - the Kaiser Family Foundation site is currently down - I’ll update with the Health Affairs October 2007 article when I can.</p>
<p>Overall, 46.5 million uninsured, 80% from working families. 80% citizens. Overrepresentation of minorities, and younger workers. Mainly growing due to lack of insurance offered by employers. </p>
<p>But that only tells part of the tale:</p>
<p>[USATODAY.com</a> - Report: 82M went uninsured](<a href=“http://www.usatoday.com/news/washington/2004-06-15-uninsured-report_x.htm]USATODAY.com”>http://www.usatoday.com/news/washington/2004-06-15-uninsured-report_x.htm)</p>
<p>You see, who is in the uninsured pool is constantly changing. This estimate is that number is around 82 million or so; over five years, it is probably 100 million give or take. What that means for the system is that, besides the catastrophic things that happen intermittently, those who find themselves in the system rush out to get pressing needs taken care of, while the system fights back, trying to “manage to care less”, hoping that “eventually” (actually, soon) they will go away. And many of them do. Some will then fall into the state Medicaid system (that’s where I am), where the high costs of pent-up demand fall on the taxpayers (rather than the employers and employees). Here the incentive is to keep costs down by squeezing docs, etc., and, especially, denying them access to mental health or substance abuse treatment, which, again, left untreated, will result in catastrophic costs.</p>
<p>Getting everyone insured is important, but getting them CARE is more important. The system of private insurance is set up in such away that the incentives are to delay or deny care as long as possible. The problem is not simply one of coverage.</p>
<p>[Characteristics</a> of the Uninsured: Who Is Eligible for Public Coverage and Who Needs Help Affording Coverage? - Kaiser Family Foundation](<a href=“http://www.kff.org/uninsured/7613.cfm]Characteristics”>Characteristics of the Uninsured: Who Is Eligible for Public Coverage and Who Needs Help Affording Coverage? | KFF)</p>
<p>The problem remains because patients and providers are denied access to decisionmaking about their care, which rests with employers and insurers, who have distinctly different interests. Making sure that patients can’t be dropped, regardless of their employment status or change, would go a long way to moving incentives toward longer term health rather than health care emergency. But it clearly wouldn’t be enough.</p>
<p>Both HillaryCare and ObamaCare would deal with the “portability” problems (at least in theory), but would do so at a cost of several TRILLION dollars over the next two decades to health insurers and their lobbyists. If the latter like SCHIP, they’ll LOVE HillaryCare and ObamaCare. Now I happen to believe that, over the long term, patients and providers can make better decisions about health care than employers and insurers - to my mind, the performance of my own single payor insurance proves it. And both Hillary’s plan and Obama’s plan embed the “Congressional” option - once individuals find out about it, I doubt they’ll purchase anything else, but it will take two decades to get there, which I think is just a bunch of silliness.</p>
<p>mini:</p>
<p>the USA Today article also infers that a lot of the “uninsured” are not uninsured for long, i.e., it can be a temporary thing. And, of course, it just ignores those that qualify for government medical insurance assistance, but, for whatever reason, do not apply; and, it ignores those working folks who purposely chose not to purchase even a bare-bones policy, even tho their income qualifies as “middle.”</p>
<p>bluebayou - let me answer part of that question. Regarding Medicaid, depending on the state, it seems as if (my perception) they’ve been given a standard order to deny every application the first time around. I can tell you from my experience that it’s just mind-boggling what people have to go through to get Medicaid. If someone does not qualify for Medicare, and does for Medicaid, our agency will go to bat for them, over and over again, as otherwise, their care expenses come from our Foundation. We never turn away anyone from our agency who due to inability to pay, but if they can get Medicaid, you bet our social workers are all over it - thankfully if it eventually comes through, the hospice benefits are retroactive, but you should hear about the hoops they have to jump through. Our social workers do a tremendous job navigating the system, but it takes up a huge amount of their time that could be spent with patients with other issues.</p>
<p>mini, I’ve also wondered whether the “Congressional option” would turn out to be a stealth path to a single-payer plan. I don’t think it will take decades for people to figure out the situation and switch.</p>
<p>I can confirm that, at least for state employees, the “Congressional option” is indeed the “stealth plan”. Over time, in our state it has grown to be by far the most popular choice. This happens without advertising or marketing of any kind, but by simple virtue of the fact that, for exactly the same coverage, it is far cheaper and provides far more choices, coupled with the fact that the private insurers leave the market on a regular basis once they have built up the level of delayed and denied care. Single-payor is simply cheaper and more efficient, among other reasons because it forces providers to compete on the basis of quality. Competition is anathema to the corporate socialists. But under Hillary or ObamaCare, it will take TRILLIONS of extra dollars to get there.</p>
<p>"the USA Today article also infers that a lot of the “uninsured” are not uninsured for long, i.e., it can be a temporary thing. And, of course, it just ignores those that qualify for government medical insurance assistance, but, for whatever reason, do not apply; and, it ignores those working folks who purposely chose not to purchase even a bare-bones policy, even tho their income qualifies as “middle.”</p>
<p>Yes, the 82 million folks include the 46.5 million who are uninsured for a full year, plus the almost-40 million who drop in and out of coverage. Among the problems with that is that over say five years, there are probably more than 100 million people who fall in and out. There are indeed some who “purposely” choose not to be covered, but studies cited by the Kaiser Foundation indicate that the main reason most do not have insurance is that their employer no longer provides it. </p>
<p>There are Medicaid social workers at virtually every hospital - if you hit the emergency room without insurance, they will be all over you if they think they can get you qualified - the last thing the hospital wants is more charity care.</p>
<p>Mini, thanks for responding to my request. Haven’t had a chance to read yet, but I wanted you to know that I noticed and appreciated your courtesy.</p>
<p>The 60 Minutes report is available on video on the CBS website:</p>
<p>[U.S</a>. Health Care Gets Boost From Charity, “60 Minutes”: Remote Area Medical Finds It’s Needed In America To Plug Health Insurance Gap - CBS News](<a href=“http://www.cbsnews.com/stories/2008/02/28/60minutes/main3889496.shtml]U.S”>http://www.cbsnews.com/stories/2008/02/28/60minutes/main3889496.shtml)</p>
<p>It is moving and horrifying. And it was striking that some of the people who showed up at this weekend clinic had health insurance, but still could not afford medical or dental care. So the statistics on how many are uninsured do not capture the scope of the problem.</p>
<p>and that is run by a guy who sleeps in abadoned school building and used to take baths with a hose and is a Brit.</p>
<p>^^ He’s doing an awful lot of good in the world. I don’t particularly care that he’s eccentric.</p>
<p>“And it was striking that some of the people who showed up at this weekend clinic had health insurance, but still could not afford medical or dental care. So the statistics on how many are uninsured do not capture the scope of the problem.”</p>
<p>Another way of looking at that is how many people choose not to spend money on healthcare. The truck driver that you are talking about said that he couldn’t afford the $500 deductible that his insurance required. If he doesn’t want to spend $500 for a deductible, how would he buy the insurance that Obama and Clinton call for? Certainly $500 can be a significant expense for certain incomes but I wonder if this person couldn’t afford it or chose not to.</p>
<p>One problem I do see in America is that a lot of people assume that their baseline of “what I can afford” is based on their very, very comfortable lifestyle. So, for example, if a person cannot afford health care while also continuing to live a life that includes luxuries like vacations, new cars, new houses, whatever, then they “cannot afford health care”. In reality, they are simply choosing to spend their money on other things than health care… but if you point out to someone that if they cut down on spending they could easily afford many things they think they can’t, you will get a very snappy response - people tend to assume a certain standard of living as their baseline, when, really, that isn’t the case at all.</p>