I Will Never Understand This

There are a lot of things I don’t understand. Bitcoin. How wireless internet works. Why anyone gives a rat’s patootie about Kardashian-type celebrities.  Lots more.

But on Thanksgiving–when I reflect on my good health and comfortable life and give thanks for my family– I am reminded that what I really, really don’t understand is why so many people oppose allowing government to insure other people’s health.

Don’t get me wrong: I certainly understand debating the how of healthcare, arguing for policy A rather than policy B or C. But I’m appalled by those who evidently consider health care an optional consumer good–and believe that people who can’t afford it shouldn’t have it.

What triggered this rant was a post from Dispatches from the Culture Wars. I’ve met Ed Brayton, who writes Dispatches. He is a delightful person, a steadfast proponent of reason, the rule of law, civil liberties and science.

He also has a pre-existing condition.

While Trump and virtually every Republican lies about not wanting to do away with the ACA’s protections for those who have preexisting medical conditions, the AARP has a new report out that says the result would be a massive increase in premiums for people like me, as high as $26,000 a year.

Brayton quotes from the AARP report:

The revised American Health Care Act (AHCA) threatens to do away with the Affordable Care Act’s (ACA) protections for people with preexisting health conditions. These protections prevent insurance companies from denying these individuals coverage or charging them higher rates based on their health.

Eliminating these protections could force millions of Americans to — once again — rely on state high-risk pools. State high-risk pools are supposed to provide access to health insurance for people who cannot get coverage in the individual health insurance market because of preexisting health conditions.

State high-risk pools may sound like a good idea but, in reality, they are fraught with problems. One of the biggest lessons learned from experience with state high-risk pools: They bring steep premiums that put coverage out of reach for millions. In the past, monthly premiums in state high-risk pools could be up to 200 percent higher than in the individual (nongroup) market. Consequently, only a small fraction of those with preexisting conditions could afford to buy a plan. Yet, these premiums — high as they were — only covered about half the amount needed to pay enrollee claims. Most states tried to close the financial gap through taxes on providers and government subsidies, but even those efforts proved insufficient. We project that if states return to pre-ACA high-risk pools in 2019, as proposed, high-risk pool premiums for people with preexisting conditions could be as high as $25,700 annually.

Brayton’s reaction paints the picture in very personal terms:

High-risk pools are a disaster. They make insurance completely unaffordable for the overwhelming majority of people. As I’ve said many times, if the Republicans succeed in repealing Obamacare, I’m dead. Probably within a year. There’s no way I could afford the premiums in a high-risk pool and my medication costs run into thousands of dollars a month, and that doesn’t count all the specialists and tests and stays in the hospitals.

The United States health industry (as a student once explained to me, we don’t have a ‘system’) costs twice as much per person as in the next most expensive country, and our outcomes are far worse. (We not only aren’t “number one,” the last time I looked, we were number 37.) Private health insurance companies have average overhead costs of 23-25% (costs that include bloated management salaries and corporate jets, along with marketing costs and personnel hired solely to decide that you don’t really need that medicine).

Medicare’s overhead is 3%.

Americans pay much more for much less, all because we don’t want to subsidize medical care for the Ed Braytons of the world–or for the children of poor families, or people who don’t look like us.

The day America joins the rest of the civilized world by guaranteeing universal access to basic medical care will really be Thanksgiving.


    “Is the health insurance business a racket? Yes, literally. And this is why the shameless pandering to robber baron corporations posing as “health providers” is such an egregious … and obvious … tactic to do nothing more than plump up insurance company profits.”

    “And do you know who’s to blame? Believe it or not, the downfall of the American health insurance system falls squarely on the shoulders of former President Richard M. Nixon.”

    “In 1973, Nixon did a personal favor for his friend and campaign financier, Edgar Kaiser, then president and chairman of Kaiser-Permanente. Nixon signed into law, the Health Maintenance Organization Act of 1973, in which medical insurance agencies, hospitals, clinics and even doctors, could begin functioning as for-profit business entities instead of the service organizations they were intended to be. And which insurance company got the first taste of federal subsidies to implement HMOA73 … *gasp* … why, it was Kaiser-Permanente! What are the odds? It’s all right here to read for yourself.”

    “And to perfectly cement HMOA73 as the profiteering boondoggle that it actually was, the law Nixon mandated also included clauses that encouraged medical providers to not CURE afflictions, but to PROLONG them by only treating the symptoms. There’s no money to be made in CURING sickness. But the sky’s the limit when it comes to forcing people to endure repetitive doctor visits, endless (and often useless and redundant) tests, and … of course … let’s not forget the ever-increasing demand for American-made prescription drugs!”

    The term “pre-existing condition” had not been used prior to Nixon’s aid to his friend Edgar Kaiser. Today, technically, those of us with permanent health issues which were not previously covered due to being pre-existing and any health issue which was diagnosed after signing onto specific ACA health care insurance coverage would be considered a pre-existing condition if the American Health Care Act becomes policy. Any child born with a serious health issue would never be covered under Trump’s AHCA; remember Jimmy Kimmel’s praise for the ACA when his son was born with a heart defect and the newly enacted ACA provided for his care. We read of those “Golden Parachute” retirement packages of millions of dollars given to retirees from the health care corporations at the same time we read of employee lay-offs due to no money to pay them. Primary Care Physicians (required in most health care systems) no longer practice medicine but are information and referral specialists; referrals to costly specialists located inconveniently; often seniors, disabled and low-income patients have no transportation to get to needed specialist health care or cannot afford the co-pay rate included in the annual deductions.

    “Americans pay much more for much less, all because we don’t want to subsidize medical care for the Ed Braytons of the world–or for the children of poor families, or people who don’t look like us.”

    My disabilities, including those that naturally come to all elderly people, would not be provided for. There is also that middle-income group which comprises many Americans; not enough income to pay the rates ourselves but considered by “the system” to have incomes too high to qualify for public assistance. Consider all of this as we watch the current overweight, mentally incompetent, billionaire president throw away our hard earned tax dollars protecting us from non-existent enemies such as Democrats and placing our military at the Mexican border and his regular golf outings and his unending 2020 presidential rallies which began the day he was inaugurated.

    Maybe we can put it all aside for today; those of us who will have a Thanksgiving meal to enjoy. Maybe the Republican evangelicals will include them in their “thoughts and prayers” along with those who lost everything in the California wildfires because they didn’t rake their forests.

    “The day America joins the rest of the civilized world by guaranteeing universal access to basic medical care will really be Thanksgiving.”

  2. I believe the fear of those opposed is based on the lies they are told about the “freeloaders” who are sponging off of them, the lack of personal experience that proves how truly deadly lack of access can be, the lie that “death panels” will make decisions about care as if insurance companies don’t do that now.
    Case in point, T1 diabetics who age off coverage from the state or their parents under the ACA are faced with insulin costs that are thousands of dollars per month without insurance. They must deal with the disease, very often hereditary, by insulin dependence or they die. Even if their employer offers a plan, the deductibles are in the $10K range before they kick in, way out of reach for most in the middle or working class. So they ration, borrow insulin from other family members, get sicker faster, and, as is happening all over the country, dying.
    The costs are much greater than mere dollars. The real costs are felt in the loss of human lives and their potential, not only on a personal level, but to the moral and financial health of the country.

  3. I paid for health insurance through the IN High Risk Plan for two decades. It was poor insurance and the cost was high — 14,400 for ONE person the last year. It was a real treat when I was able to get Medicare. (and the AARP plan F to fill it out). I sure hope everyone can get this. SO much better.

  4. If we do away with for profit health insurance companies where would members of congress obtain their millions of dollars in campaign donations that they depend on? Where would they get their millions of dollars of other dark money that is hidden from public view?

    We can’t do what is right for the citizens of this country if it means taking away power and money from members of insurance company C-Suite and Congress. Finally, what would the losses be in the stock market? Oh my! We can’t have that. How can we possibly value people’s lives over the value of stocks?

  5. Thanksgiving is every morning I arise.., out of 7.5+ people on the face of this planet I have access to a really good medical facility in Bigfork MN, I arise to a window of trees, and critters and a large pond out the way. This and the fact that at least I know I can count on lively replies and opinions from people like me, who care what is going on in this country, this society and this world. People who still have the capacity to see through that which is really FAKE. Thank you, thank all who contribute to your blog – and let’s all hope that somewhere in this morass of confusion and hate and mess we call our political situation in this country – we can all just sit down and start dialoguing again and not just yelling. Let’s all be thankful it hasn’t gone to hell YET!!! – Thank you Ms. Kennedy for your blog.

  6. Guess what! Those people who are opposed to universal health care believe that people always get the treatment they need and that when they do, someone else (not them) covers the cost. They see it as taking on an additional financial burden. Economics is not their strong suit.

  7. Greed, plain and simple greed. Squeeze people for every dime that can possibly be extracted.

  8. Exactly, Nancy!

    Capitalism is still in a predatory phase which is why we need such a large military with bases in nearly 200 countries. If our brand of democracy and capitalism is so great, why would anyone want to attack us or defend themselves from us?

    It’s pure logic.

    Because of Trump, it’s really easy to see. We don’t all need Ph.D.’s when we can infer with our own eyes. Why can’t all people be equally covered by Medicare universally?

    Because we aren’t equal and profits are more important than people. In spite of the thousands of brands of Christianity out there which teaches about the love of money and making good moral choices, we worship at the money altar.

    Don’t think it’s a Democrat vs. Republican thing either because the corporate wing of the DNC, which includes Nancy Pelosi, refuses to endorse universal healthcare. She’s great as raising money because she can take insurance lobby money and then trick uninformed voters to cast a ballot for Dems because they’re NOT Trump. It’s a game and it’s rigged.

    More evidence, look at Saudi Arabia swimming in oil money. They spend billions buying weapons from us so they can commit mass genocide in Yemen and use “rebels” to disrupt the Middle East (the rebels consist of Mossad and CIA paid mercenaries who create chaos requiring our military action).

    They also tortured a dismembered a WaPo journalist in a Turkey embassy. Do you think they’ll be sanctioned? No, they will not.

    Two words that make Oligarchs in this country panic are “democracy” and “socialism”.

    They obstruct any efforts by the people to bring about change from predatory capitalism where money can buy elections. You want to vote, go ahead and try. We’ll obstruct you at every corner. Look at Texas, Florida, Georgia, Arizona, and New York elections.

    Horrendous displays.

    What keeps people from revolting in the streets and walking off their jobs? Propaganda media and economic insecurity (fear).

    What would happen if the unions organized a strike for retail workers across the country on Black Friday?

    Think about the systemic dysfunction which would occur all over the country…

  9. It’s this simple for those that say they are conservatives:
    “I’m not paying taxes so that others can get healthcare by making bad choices with their lives. I’ve got mine, you get yours.”
    I’ve read that sentence so many times, I’m convinced it’s true.

  10. All things considered, leave a seat open for a new friend at the table, Happy Thanksgiving.

  11. Have you notice those happy to say health care (and they will say the same about education) isn’t a right are also the loudest to state any gun control is against the constitution and are either silent or willing to repeat the lies used to justify voter suppression. Consistency is lacking on both sides but the rights inconsistency is killing people.

  12. Medicare low administrative costs are a myth and has been debunked in many studies. See Forbes June 30, 2011 for example. We need a single provider system, not single payer in order to get better care at significantly lower costs.

  13. I appreciate this message today. Healthcare can become an all consuming issue for those that have even the simplist of illness and it needn’t be. It seems we are not even allowed to ask the easiest of questions like ‘how do we make it better?’ At the highest level of our government we seem to have Monty Python characters telling us, ‘YOU have perfect healthcare!’ in a comical voice. And we say,’OK then.’ Ridiculous indeed. On a more positive note, I wish you all a warm and happy Thanksgiving…

  14. The “fear” of universal health care has roots in McCarthyism’s fear of socialism and communism. Like racism, this fear was passed along for generations. As with Nixon’s opening of the doors of for-profit health insurance, so too did Citizens United open the other door for capitalism’s grab for every dime for the few.

    As Marx predicted, capitalism is its own worst enemy. Our easily corrupted politicians, mostly Republicans, make this prophecy a front-page issue. We are dooming ourselves to the return of Lords v. Serfs, but so-called conservatives still keep feeding their drooling sheep the lies that keeps them rich and in power.

  15. I lost my job last June because In State Nurses Assoc lost its contract with the state to monitor nurse with addiction. The quality of mental health and addictions treatment and the # of treatment centers has markedly decreased due to the “free market economy” in health care. Well, it is NOT free. Insurance companies have forgotten that their customer should be those paying the premiums, NOT the shareholders. So have pharmaceutical companies. I now have better coverage through Medicare and am glad I no longer have a $6000 out of pocket for Outpatient that is in network. My employer paid Anthem over 1000/mo to insure me. The greed of corporate America has markedly damaged the quality of our health care.

  16. Relegalizing Cannabis would go a long way in fixing the healthcare mess. We don’t need their high priced “Medicines” many of which are more poisons than anything else. You can’t spell “Healthcare” without THC.

  17. There is only one way forward and that is Single Payer – Universal Health Care as outlined in HR-676 Expanded & Improved Medicare For All Act. HR 676 currently has 123 Co-Sponsors all Democrats. The two top Democratic Leaders in the House Nancy Pelosi and Steny Hoyer are NOT co-sponsors of HR 676.

    The vast majority of Americans, 70 percent, now support Medicare-for-all, otherwise known as single-payer health care, according to a new Reuters survey (Aug 2018). That includes 85 percent of Democrats and 52 percent of Republicans. Only 20 percent of Americans say they outright oppose the idea. (Side Bar the two top Democrats Pelosi and Hoyer must be in this 20%.)

    The For Profit Health Care System and their puppets are counter attacking – That is the Empire Strikes back.
    With ‘Unlimited Funds to Lie,’ Insurance Industry Readies Propaganda Blitz as Medicare for All Surges. Medicare for All is rapidly surging in popularity among the American public and gaining momentum in Congress, but private insurance interests and Big Pharma have no intention of giving up their immensely profitable stranglehold on the U.S. healthcare system without a fight.

    According to strategy documents obtained by The Intercept and the watchdog group Documented, the private healthcare industry is working aggressively alongside corporate Democrats to spread anti-single payer propaganda and “minimize the potential” for Medicare for All as an alternative to the current for-profit status quo.

    Over the summer, leading pharmaceutical, insurance, and hospital lobbyists formed the Partnership for America’s Health Care Future, an ad hoc alliance of private health interests, to curb support for expanding Medicare.

    The campaign, according to one planning document, is designed to “change the conversation around Medicare for All,” then “minimize the potential for this option in health care from becoming part of a national political party’s platform in 2020.”

    Adam Gaffney, president-elect of Physicians for a National Health Program (PNHP),”There is no brand loyalty to insurance companies, which are rightly seen as parasitic,” Gaffney said. “Once single-payer is widely understood as a program that covers everyone, that doesn’t impose copays and deductibles, that has more comprehensive benefits than existing plans, and that doesn’t employ restrictive insurance ‘networks,’ support will only grow.”

    ACA was a step forward however, it was like NASA’a Gemini Program, two astronauts in a space capsule circling the earth. HR-676 Expanded & Improved Medicare For All Act is the Apollo Program – Three Astronauts that go to the moon and back safely.

  18. I’ve often heard and read that before 1973, or thereabouts, it was illegal to profit off of health care, but I didn’t really think about what that statement meant. Now that I am thinking about it, I recall our family doctor in the 1950s living fairly well on the profit he made from caring for the sick. And a few pharmaceutical companies made fortunes in profit before 1973. Surely, that statement does not mean what it says.

  19. greetings from nodak,, were cold,gloomy,(the blues are) and its thanksgiving. today, lasagna.i spent my paycheck at the various food banks, and next week im buying all the bicycles at the thrift stores for giveaways. i request the manager to seek those single parents out,who need a lift..anyway, bestbwishes
    if the ACA was to become a enity of health,imagine what we could afford if, we had decent wages and a pharma that cares about where thier located…if by all means, we should become a nation of the people again, we could actully live a healthy life, but we allowed the moneied intrests to propagadize our lives. social media has taken control of our attention,pacifiying its viewers. last week, and i guess its been awhile,i looked at mass media,msnbc,fox,etc. talking heads all agreeing on something,that if you were not current on the issue,your tendancy to jump to conclusion would make you fit for the olympics..(is that the trumps type?).anyway,seems some of the running new progressives will give in to pelosi, i wonder if shes going to change,and find a way to cheat wall streets greed,, ill hold my breath..after i eat…as i see it, if your doing buisness in the u.s. and expect our goverment to represent you when the problems arrise, and your taking our taxes and free labor,(o.k. ot isnt free,but were always riding a line of poverty,and looking at how flush wall street is) then if you still feel we own you something, then get out… try china,russia,or some of those tax havens that so much want your money too. rememeber, you then pay to keep us healthy,so we can work for YOU…

  20. Some things to give thanks for:

    1. MBS has killed only one journalist (that we know of) and starved only 85,000 Yemeni children to death with the help of Donald the Admirer. Whether he succeeds with the other 8.5 million he is trying to starve and bomb (using U.S. weapons) remains to be seen.

    2. Chief Justice Roberts has concluded that he must defend the American judiciary from a president who defines a “good judge” as one who is a Republican and who rules in his favor.

    3. As we hoped, women came through and saved us from another 2 years of presidential abuse of power, or are at least in a position to investigate it.

    4. Matt (The Pretender) Whitaker has yet to gather the courage to fire Mueller as his boss hired him to do.

    5. No U.S. troops at the border have seen fit to use lethal force against immigrants as the president authorized them to do.

    6. Ivanka and Melania have removed all doubt about whether they meet the intellectual requirements to earn the name “Trump.”

    7. Putin has agreed not to accept Trump’s handover of the U.S. Government until Trump agrees he has met his personal financial goals.

    8. Mueller and his staff are enjoying a rollicking laugh over the written answers Trump so proudly claimed (who knew he could write?) to have personally authored.

    9 . Trump’s claim of Saudi expenditures ($450 billion) in the U.S. is only 30 times higher than the real number ($14.5 billion). After all, he could have said “$1 trillion” and convinced his entire base.

    10. The sweet, dulcet tones of the chief choristers like Cohen and Manafort and Gates who are singing their tonsils out to the Special Prosecutor.

    11. The overdue departure of Jeff Sessions, one of America’s leading racists and sycophants, and Paul Ryan, who presented himself as an Eagle Scout but turned out to be totally devoid of values, Republican or otherwise.

    12. That America’s most disgusting human being, Mitch McConnell, who has no competition for his title except for our president, will be stymied by Nancy Pelosi and a host of female and/or non-Aryan opponents in his efforts to help Putin and Trump establish a joint dictatorship in America.

    13. That Trump’s future seems much more in doubt than it did a month ago.

  21. JoAnn you comments are not only on point but poignant. I am also retired and in poor health along with a fixed income that has begun to shrink in this “inflated” economy. Thank you for your piece.

    Todd: Two words that make Oligarchs in this country panic are “democracy” and “socialism”. All I can say to that is amen! And I suppose I should add that we are rapidly losing both.

    Jeff: “Have you notice those happy to say health care (and they will say the same about education) isn’t a right are also the loudest to state any gun control is against the constitution and are either silent or willing to repeat the lies used to justify voter suppression. Consistency is lacking on both sides but the rights inconsistency is killing people.” Your observations are valid and too often ignored. We must continue to fight.

    I have nothing to add today. Those preceding me have covered the topic very nicely. Thank you.

  22. There are other big problems with the Republican “solution” of state high risk pools that aren’t cost related. For one, they limit your care to in-state. So much for having a special disease that may require seeing a specialist out of state. So much for taking the risk of traveling out of state for Thanksgiving or south for the winter. Out of country- never. And then there were the previous requirement to even apply for a high risk pool – you had to prove that you had NO insurance for six months or so. Hopefully you hadn’t bankrupted your family during that time. How pathetic. The Republicans are simply put – monsters who lie.

  23. The French, who have the best single payer healthcare in the world at somewhat more than half the cost we pay for our pretense in patchwork exclusions (aka Kaiser and its progeny), not only cover their own but I read an American’s story of how she got sick there, had the care of a doctor and pills, went to pay her bill and was told there was none, upon which she told them she was an American and not French and they told her they knew that and that there was no cost. Here I have heard of how a galloping cancer can wipe out an American citizen’s retirement savings in one fell swoop, so that if the victim survives the cancer he or she and theirs will live in penury. I will agree to Medicare for all but would prefer a single payer arrangement paid for by a surtax on the rich or by some other financing arrangement impacting the coddled few (like a Tobin tax) who have been making out like bandits at the cost and health of the rest of us. In this country 41% of bankruptcies come about because of inability to pay medical bills; in France 0%, and it’s not just a disaster for those taking bankruptcy but also a disaster for their creditors, vendors et al., where bankruptcies in the aggregate account for billions of dollars lost per annum to such innocent people and businesses. Virtually every Western country has a single payer healthcare system, and as one contributor wrote recently, he didn’t see a one of them who had bills up to get rid of their systems. Figures. Happy T-Day, everybody!

  24. “8. Mueller and his staff are enjoying a rollicking laugh over the written answers Trump so proudly claimed (who knew he could write?) to have personally authored.”

    Terry; about this number 8, he said at least twice that he wrote his own answers, then must have realized that caught in any lies he couldn’t deny simply them in this instance…he then said he dictated his answers to someone else to write. I believe this is known as a “disclaimer”; a specialty used by liars and scam artists. No idea why he would be worried about lying at this point in time; it is the foundation of his administration.

    Number 2 is my favorite on your list; the Chief Justice of the Supreme Court appears to show no fear of Trump, he is a Republican, appointed by a Republican President and Head Honcho of Article III of the Constitution, not one to be ignored.

    Wray; thank you. So many stand to lose so much unless Congress can be held in abeyance till after January 3, 2019.

  25. A failing of those who support universal health care is the failure to educate us that all who pay for for individual and for employer-provided health insurance are paying more than their own freight much of the time. Hospitals and doctors and pharmacies all charge paying customers more to help cover the costs of those who cannot pay PLUS the profits of each of these entities plus the profits of the insurer. Nevertheless, so many are denied services and medications.

    There are also many in the GOP who oppose medical care for those who can’t pay their own way even though many of them enjoy employer-provided health care rather than paying for their own insurance. They do NOT believe health care is a right even though denying it is deadly. They are pro-life only until birth.

  26. “Hospitals and doctors and pharmacies all charge paying customers more to help cover the costs of those who cannot pay PLUS the profits of each of these entities plus the profits of the insurer.”

    Nancy Papas; this has been going on for many years, in a different format, prior to the ACA requiring working people obtain health care insurance. Sadly; I had family members guilty of being among those having big screen TVs, every electrical entertainment appliance available, when cell phones came out, even children had their own phone, etc., etc., etc. But most didn’t have health care insurance or a family doctor; they would take a sick child late at night, or go for medical treatment themselves to Hospital Emergency Rooms and many ignored the bills when they came due. When asked why they didn’t have health care or a family physician; it was because “we can’t afford it.” We have been paying for them all along through the decades of increasing health care and medication costs.

    The fact that primary physicians do not practice medicine adds to our cost due to the many referrals to specialists for everything, plus co-pays for expensive tests and lab fees…IF we have a way to travel to their inconvenient locations out near county lines in huge expensive medical facilities. I am letting some of my health care go untreated for these reasons; transportation for seniors, disabled and low-income is not available or cost prohibitive if you can find it. It must be doubly difficult for those in rural areas to get to health care locations.

    Health care corporations will not give up their profit margins to provide health care even in a Medicare for all system because they are all “for profit” corporations, not health care providers. Being able to travel to a health care provider isn’t included in any health care coverage even if we can afford to pay for it. The entire system is geared to treat those who can afford it. I have Medicare and Medicare supplemental and can’t get to the medical facilities I need. How many others are in this same situation? This is our world today; progress does not always mean improvement.

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