Healthcare

P.R. and a Guest Essay

Reading time – 3:25  .  .  .

A guest essay follows a few comments on our federal “Who cares about it anyway?” crisis.


How is it possible to explain the inadequate and, reasonably labeled as cruel behavior of the President of the United States toward the people of Puerto Rico and the mayor of San Juan?

We questioned the foot dragging of federal help for victims of Hurricane Katrina, wondering if the response would have been as slow and miserly had the miserable victims holed up in the Superdome been white and had not been poor. Consider the same question in our current circumstances, substituting “had they not been Puerto Rican’s.”

Relief arrived a lot faster in both Houston and Florida last month. How come it has been so slow in Puerto Rico?

Where are the Army MASH units? Why has it taken a week and a half to dispatch a Navy hospital ship?

Why are there locked shipping containers of critically needed food, water and medical supplies sitting on a dock in San Juan instead of being opened and the supplies distributed to the hungry, thirsty people?

The mayors of cities and towns on that island are operating from vehicles instead of from their offices because many of their office buildings no longer exist. So, why are FEMA bureaucrats demanding memos from them in order to dispatch relief to the people?

This weekend citizens of Puerto Rico are dying, as there is no power for dialysis machines, no more insulin and they are drinking unclean ground water because there is nothing else available. All that horror and more is happening, while the leader of the free world tweets his venom and plays golf this weekend at his posh resort in New Jersey. Let’s call him President Reprehensible.


Guest Essay

College pal Al Shuman is something of a thinker and a stringer of words who often has something to say offline about these Disambiguations. His recent comments, though, prompted me to ask his permission to post his pennings here, suspecting that others may find them useful. See what you think and offer your notions in the Comments section below.

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I’ve almost written responses to the last couple of Disambiguation pieces and still may. I learned a new word from the last piece – I had not heard “limbic” as an adjective (or actually known its meaning) and it’s good to get new words.

What I had begun to write was that what I was reading felt like it was a transmission from my thoughts to your keyboard – all except one thing. I am sad that I no longer get a lump in my throat when I see the country celebrated (in the “usual” ways). Such events usually stir thoughts of jingoism, and I often feel uncomfortable. I get the lump now in the presence of true acts of courage, involving commitment to principle rather than an automatic performance of a ritual, which suddenly, in this moment, strikes me as akin to idol worship.

So, I am sitting in anticipation of your next piece, which I expect to be a commentary on Trump’s handling of the Puerto Rico fiasco and his shameful tweeting about the mayor of San Juan. It was not surprising, but I think that this is the lowest he’s gone and I want to put my hands over my ears and shout, “SOMEONE PLEASE MAKE IT STOP!!!” Mr. Mueller, you must have enough stuff by now; please hurry up and help bring this nightmare to an end.

And in defiance of what WE think is ALL common sense, his “base” is forever unmoved. The fact that they* feel empowered as never before provides the filter through which all events are viewed, all evidence is judged, interpreted, or dismissed. These people have too much at stake to abandon their commitment and “see the light.”

Although I think I understand what motivates these people and wish not to disrespect them, I confess that I continue to think of a wonderful line in Blazing Saddles where the Waco Kid says to Sheriff Bart, “You’ve got to remember that these are just simple farmers. These are people of the land. The common clay of the New West. You know . . . morons.”

Guilty as charged.

*Acknowledging that many Trump supporters are expressing party loyalty and/or political expediency, the “they” in this case are not those; they’re the ones whose support many of us judge makes no sense.

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Last Chance!

If you’ll be in the Chicago area on October 4, come join us for a presentation by Mike Papantonio, host of Ring of Fire Radio. Here’s a link to get tickets. Space is limited, so, “Don’t you wait and be too late.” This promises to be a terrific evening for those who continue to believe we can be better.


Best news headline of the week:

Hugh Heffner’s bedoom

Officials Investigating Hugh Hefner’s Death Suspect Foreplay

From The Onion, September 28, 2017

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Ed. note: There is much in America that needs fixing and we are on a path to continually fail to make things better. It is my goal to make a difference – perhaps to be a catalyst for things to get better. That is the reason for these posts. To accomplish the goal requires reaching many thousands of people and a robust dialogue.

YOUR ACTION STEPS: Offer your comments below and pass this along to three people, encouraging them to subscribe and engage.  Thanks!  JA

Copyright 2017 by Jack Altschuler
Reproduction and sharing are encouraged, providing proper attribution is given.

Healthcare Reality

Reading time – 3:44; Viewing time – 5:17  .  .  .

The most recent policy issue – in contrast to the daily dump of Trumpian crazy – was healthcare. That issue deserves one last piece of clarity.

Conservatives believe that small government is best. They like minimum taxes, which obviously means that in their view the government cannot take on the 17% of our economy that is healthcare, because taxes would have to increase to pay for that. That’s a key reason they rail against Medicare and Medicaid, claiming that the government has no business being in that business. Some say that the issue should be handled by the states, while others think the citizenry, we rugged individualists, should be responsible for ourselves and that government should just butt out. These notions are offered in earnest, but let’s get serious about the actual facts, not magical thinking (see How America Lost Its Mind). Let’s take a look at Medicaid.

Medicine has changed dramatically over the past 100 years. We have amazing pharmaceuticals and they come with astronomical prices. We can replace joints and modify genes, all at very high cost. Medicine is finely specialized and the medical people in those highly specialized fields spend ungodly amounts of money for the schooling required and, in consequence, it’s expensive to use their services. Medical tools like MRIs and robots that do surgery are crazy expensive, but if you need what they do in order to save your life or restore you to health, there has to be a way to pay for that.

The point is that when Doc Smith came to the house with his black bag, it was possible to pay his bill with a couple of chickens. But Doc Smith doesn’t work that way today and the price of everything is orders of magnitude higher now. So if all you have are a couple of chickens, unless you get help from somewhere, you’ll have to go without healthcare.

In the absence of Medicaid, that means that poor people never visit the doctor until things are dire. Then they go to the emergency room, where they can’t be turned away even though they can’t pay for their care. By the time they get there, symptoms are far worse than had they earlier been under the care of a primary physician. They require even more extensive and more expensive medical care, all delivered in the very costliest manner, in the ER; worse, the patient may be too ravaged by disease to be saved.

What that means is that leaving people nothing but the ER for their medical care produces less than the best outcomes and has the highest cost. Because hospitals have to admit ER patients who can’t pay for their care, the cost of their care is passed along to the rest of us through inflated charges when we use the system, like the $40 Band-Aid. And what that means is that one way or another you and I have, are and will pay for the healthcare for poor people.

Medicaid was created so that poor people could get better, earlier medical care at lower cost and not have to rely solely on the ER. Limiting or removing that support will make the cost to taxpayers that much higher and cause unnecessary suffering and even early death for poor people.

So, forget the idea that getting government out of healthcare is fiscally sensible. The libertarians, conservatives and neo-cons are simply wrong – factually wrong about who covers the costs.

Click for the commercial

Yes, we have higher taxes on you and me to do that. The alternative is a dramatically higher cost you and I will pay when we go to the hospital. It’s a little like that old Fram oil filter commercial. You can pay your mechanic a little bit now to install a new oil filter, or you can pay him big time later when  your engine breaks down. Translated to healthcare, you can pay for healthcare for our poor through taxes or by grossly inflated hospital and doctor charges when you need care. Pick one.

And another thing  .  .  .

On his way out the door of the White House in January, 2001, President Clinton issued a pardon to Marc Rich, the financier and hedge fund manager who had fled to Switzerland to avoid prosecution for tax fraud. Using his wife’s name, Rich donated $1 million, distributed among Hillary’s campaign for the Senate, the Democratic Party and the Clinton Library. Righties and lefties alike cried foul, as this had the profound and unmistakeable stink of Rich having bought a pardon.

Now that President Trump has issued a pardon to the justice flaunting, law breaking, immigrant hating Joe Arpaio, one of the first public officials to endorse Trump for President, I’m looking for that same blend of howlers from the law and order types. Where are those tough-on-crime voices now that a severe rightie is the perp and the President is a Republican? I want to hear the Congressional tough guys and the Fox News propeller heads and the radio talkers crying, “Foul!” As of this writing, it’s been eerily quiet.

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Ed. note: There is much in America that needs fixing and we are on a path to continually fail to make things better. It is my goal to make a difference – perhaps to be a catalyst for things to get better. That is the reason for these posts. To accomplish the goal requires reaching many thousands of people and a robust dialogue.

YOUR ACTION STEPS: Offer your comments below and pass this along to three people, encouraging them to subscribe and engage.  Thanks!  JA

Copyright 2017 by Jack Altschuler
Reproduction and sharing are encouraged, providing proper attribution is given.

Figure It Out

Reading time – 3:57; Viewing time – 6:38  .  .  .

We have yet another edition of the interpretation game, “I think what the President meant was  .  .  .” His “fire and fury” ad lib has spawned no end of pols, politicians and pundits pretending they can get into the President’s very unusual brain and interpret his most recent inane statement, trying to make rational sense of Trump’s irrationality. Listen for the interpretation game words following his next tweet designed to take the focus off the investigation into his possible collusion with the election hacking Russians. Those who take the bait and respond to his 140-character stupid stuff will use the exact words, “I think what the President meant was  .  .  .” That’s the moment you’ll know that listening further is a waste of your life.

It’s so sad that the President of the United States requires so much interpretation and guesswork in order to have any hope of understanding his meaning. Actually, it’s far worse than that. Be sure to read through to the last section of this post for the existential implications.

Thom Hartmann recently asked a question on his radio show, inquiring of callers whom they would prefer as President, Donald Trump or Mike Pence. In this era of expected impeachment, that was a thought provoking question and some interesting views emerged. Here’s my short list:

Donald Trump:

He is a non-stop chaos creator and his actions are dangerous for us and for the world.

Trump’s dalliances with non-reality are an impediment to solving our national problems.

Under the spell of Stephen Bannon, Trump is working to “bring the establishment crashing down,” which means he wants to eliminate much of what we think of as good things, like education, the environment, healthcare, our fundamental functions of government, the press and more.

There is a danger that we’ll become weary of Trump’s crazy and destructive behavior and stop paying attention. That’s when the really bad stuff will happen.

Trump is incompetent enough to start a nuclear war.

Mike Pence:

He’s a serial liar.

Pence wants to make the United States of America a Christian theocracy. Forget about whether you like the idea; it’s unconstitutional. And you better hope he isn’t an Armageddon crazy.

When Pence was Governor of Indiana he was proud to discriminate against the LGBTQ community as though doing so were somehow constitutional. He is holy unhinged.

I have no basis for saying this, but I think it’s possible that Pence has enough competence to avoid nuclear war. But that’s just a guess.

What all of that and more means is that neither Trump nor Pence is a good choice. Still, impeachment will happen before January 20, 2019 (my best guess) – or Trump will resign so that he can declare he’s a victim, proceed to demonize his detractors with scathing tweets and otherwise lie constantly and have his signature temper tantrums.

On the other hand, should Trump somehow escape the Mueller noose, he may run again in 2020 and will obliterate Pence the same way he did “Little Marco”, “Low energy Jeb” and “Lyin’ Ted”. Try these for Trumpian slime-names:

“Plastic Pence”

“Boring Mike”

“Do nothing Mike”

“Back-stabbin’ Mike”

“Drop the Mike”

It’s unlikely you’ll actually have to choose between Trump and Pence. Nevertheless, weigh in with your view of these very flawed characters in the Comments section below. Which one would you prefer in the West Wing? Note that “Choice E, None of the above” is not an option for this exercise.

In Other News  .  .  .

The healthcare craziness in Congress has quieted, but the issue is not settled. To understand where We The People see this, have a look at the Kaiser Family Foundation tracking poll of August 11, 2017. Here’s one of the charts from this most interesting report.There is much to learn from the poll and this chart highlights one of the key points. Note the resistance among Trump supporters to making the ACA work. It’s that consistent 30-something percent of Americans who back Trump no matter how wacky, insulting or dishonest his behavior. Meanwhile, a significant majority of Americans now like the ACA and want its weak points fixed.

Congress: Do you hear us?

And finally  .  .  .

President Trump has flexed his ego muscles by threatening Kim Jung-un and North Korea. He’s done that using inflammatory, belligerent language much like a schoolyard bully. Trump never backs down, regardless of how obvious it is that what he has done is counterproductive or dishonest, so instead of finding a way for diplomacy to work, he has instead suggested that his threats may have been, of all things, too mild. All of his chest thumping has been done in the total absence of any direct diplomacy. There are no talks underway with North Korean officials. We have no means of dialogue with them. We don’t even have an ambassador to South Korea because Trump has refused to appoint one.

The President’s in-your-face behavior is happening in this context of no possibility for diplomacy, which leaves few choices to Kim Jung-un. Trump has backed him into a corner where if he caves in to Trump’s threats, he will lose face on the international stage. He just may feel that there is more honor and ego protecting in striking out militarily and causing millions to die, rather than to cave in to the American tough talker. All those deaths will occur because of Trump’s self-imposed limitation that our only international negotiating tool is military force.

And Secretary of State Rex Tillerson, who refuses to recruit a full and capable diplomatic team, tells us to sleep well. Good luck with that.

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Ed. note: There is much in America that needs fixing and we are on a path to continually fail to make things better. It is my goal to make a difference – perhaps to be a catalyst for things to get better. That is the reason for these posts. To accomplish the goal requires reaching many thousands of people and a robust dialogue.

YOUR ACTION STEPS: Offer your comments below and pass this along to three people, encouraging them to subscribe and engage.  Thanks!  JA

Copyright 2017 by Jack Altschuler
Reproduction and sharing are encouraged, providing proper attribution is given.

Plumbing

Reading time – 1:34; Viewing time – 2:23  .  .  .

During a recent visit to my dentist I stopped in the men’s room and found a – let’s call it “interesting” – wall sign. Honestly, I have never heard of sensitive plumbing. I mean, isn’t it just a bunch of sturdy pipes? Does the plumbing in a commercial building have feelings? Does it become upset if something that doesn’t belong there gets introduced to its innards? Is anxiety triggered just beyond the next pipe fitting by a careless user? What are we to make of this new age accommodation to the emotions of plumbing?

Well, nothing, of course. But it brought to mind the crude and cruel behavior of those in the White House and Congress and how they seem to view the American people. Perhaps they haven’t seen this sign and don’t realize that the American people, for all our strength and rugged individualism, for all our can-do spirit, have certain sensitivities. There are some things that just don’t go down well.

For example, we’re sensitive to the healthcare needs of one another and we don’t want people thrown under the plumbing just because they aren’t wealthy. We’re sensitive to the thousands who are killed by gun violence every year, so we really want sensible gun laws to protect our dear ones. We’re sensitive to the outrageous tsunami of money heaped into our politics by extremely wealthy people in a pay-to-play scheme – it’s corroding our democracy. We’re sensitive to the inability of those we send to Washington to accomplish much more than naming a post office. We’re sensitive to our rapidly heating planet and fear for the future of our kids and grand kids. And we’re sensitive to the declining standard of living for about 90% of us.

Click me – then sign up to learn more about the Summit for righties, lefties and indies

Tell you what let’s do. Copy the picture above and paste it into an email to your senators, congressperson and to President Trump. Tell them you’re a sensitive American and you want them to solve the vexing problems we face and for them to stop the stupid stuff. Let them know that if they don’t, they’ll be the ones introduced to the plumbing in 2018.

Apologies to all for my tasteless metaphor.

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Ed. note: There is much in America that needs fixing and we are on a path to continually fail to make things better. It is my goal to make a difference – perhaps to be a catalyst for things to get better. That is the reason for these posts. To accomplish the goal requires reaching many thousands of people and a robust dialogue.

YOUR ACTION STEPS: Offer your comments below and pass this along to three people, encouraging them to subscribe and engage.  Thanks!  JA

Copyright 2017 by Jack Altschuler
Reproduction and sharing are encouraged, providing proper attribution is given.

Plans for What?

Reading time – 2:45; Viewing time  – 3:58  .  .  .

Healthcare is our current favorite distraction from the Russian cyber invasion of America and the possible involvement of Trump groupies, so let’s have a look at what the geniuses in Congress have proposed for the health and well being of all Americans.

It’s well established that the House and Senate attempts at delivering on the brainless “repeal and replace” mantra have little to do with healthcare delivery to Americans. Healthcare is simply the cover for an $800 billion dollar gift to already rich people. In the unlikely circumstance that you aren’t fully enraged by that, consider that part of the windfall for the wealthy is a reimbursement of taxes paid on financial transactions, money that was used to fund Medicare expansion for our poor under Obamacare.

That’s right: these plans dig a deeper hole of debt for America because the 1% need more money. I guess I missed that turn when Republicans stopped obsessing over debt. Nice to know that it doesn’t matter any more, so it’s okay to slather more cash on the rich.

Enough about the struggling wealthy. We’ll let them pull themselves up by their Gucci bootstraps and instead have a look at how the House and Senate plans will affect you.

Click me to see the 5 things to know about Mitch McConnell

If you’re poor, you’re screwed. The Congressional Budget Office”s analysis is that under the House plan 23 million more Americans will be cut out of healthcare insurance entirely, which will effectively leave them without primary healthcare; under the Senate version that number drops to an only slightly less cruel 22 million more Americans whose medical needs we’ll ignore. Either way, tens of millions of Americans will have nothing but a last ditch, begging for mercy trip to the emergency room as their primary healthcare. Those trips are always made well after medical attention is needed, so the conditions presented to emergency room staff are far worse and often irreversible. That means people who might have been cured will die.

Plus a visit to the emergency room costs more than any other way to deliver healthcare, driving our overall cost much higher. Be clear that every hospital is required to deliver healthcare to whoever shows up at their door, regardless of a patient’s ability to pay. That means that the cost to care for a poor person who drags into the emergency room and receives that expensive care is passed along to all the patients who can pay, like you. That’s how slashing Medicaid will drive up your cost of healthcare.

Click me to link to the article

The Kaiser Family Foundation has crafted a nifty way to learn how the various cruel congressional plans stack up against the ACA (Obamacare). Access the comparison with the Senate plan (“BCRA”) here; link to the comparison with the House plan (“AHCA”) here. Just enter your age, income and the state in which you live. Then click on your county, review the results and decide which plan you like best. Be sure to look ahead to what these plans will cost you 10 or 20 years from now. Good chance you’ll be surprised – and not pleasantly so.

But that’s just you. Before deciding which plan to support be sure to consider the poor people who will have no place to go but the emergency room for medical care under either congressional plan. Also, don’t forget the rich people who need your financial support.

Click me to link to the article

The net of this is that both the Republicans in Congress and the president are so desperate to “get a win” that they are sucking up to the wealthy and abandoning our poor. That is to say, the win means more to them than life or death of our most vulnerable.

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Ed. note: There is much in America that needs fixing and we are on a path to continually fail to make things better. It is my goal to make a difference – perhaps to be a catalyst for things to get better. That is the reason for these posts. To accomplish the goal requires reaching many thousands of people and a robust dialogue.

YOUR ACTION STEPS: Offer your comments below and pass this along to three people, encouraging them to subscribe and engage.  Thanks!  JA

 

 

Copyright 2017 by Jack Altschuler
Reproduction and sharing are encouraged, providing proper attribution is given.

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