Tag Archives: Medicaid

A Question of Value(s)

There’s a lot being said these days about health care, from Medicare to Obama Care. Get past the lies and rhetoric, and most of it boils down to questions of financing and access. Think of them as “who makes the rules over who gets to play”.

Republicans believe that we should ‘get government out-of-the-way” and let the free market provide financing of health care, and people can choose and buy whatever they can afford; Democrats believe that the most cost-effective way is partnership between government and the private sector, with basic health care available to all Americans whether they can afford it or not.

Beliefs that are as different as can be.

“Getting government out-of-the-way” is a catchy phrase that sounds good on paper, until we stop to consider that it’s our government that makes possible Social Security and Medicare and Medicaid and WIC (a Federal program for Women, Infants and Children). Only those who will never need those programs are against them being available for those of us who do.

My parents and grandparents (and one great-grandmother too!) benefited greatly from social security and Medicare; my nieces and nephews and their kids have benefited from Medicaid and WIC.  Not because they  refused to take personal responsibility for their lives, but because they were either very young and victims of un-employment and divorce, or retired after a career of working and paying in their fair share, or very old and widowed to men who did the same.

I think about what life would have been like if Social Security hadn’t been there to keep them independent, in their own house with their own stuff; if Medicare hadn’t been there to get them the lowest prices on their health care, and to cover their hospital bills which ran into the mid six figures for each of my parents.

It’s a picture that more people need to consider.

Once upon a time, when I started working in health care, Medicare operated as a fee-for-service operation. What that meant was, we provided a service, any service for any reason, and we’d get paid what we billed.

When I worked directly for the hospital, we had guidelines for care. When I worked for the private, free market company that the same hospital contracted with to provide services, instead of “care” guidelines, we had “charge” guidelines.  That’s our first clue as to the differences in purpose between a public and a private health organization in how they approach treating patients.

The one that still rings in my mind’s eye is PRN (as needed) oxygen. We put oxygen equipment in every room, and charged every patient every day, whether they used the oxygen or not. I filled out enough charge forms to still remember the totals after all of these years: $37.50 per day, for just in case.  Another example was post-op breathing treatments ordered to ‘prevent’ pneumonia. Every surgical patient received not one or two, but three different breathing treatments, each four to six times a day until discharge.

The first big round of Medicare reform in the 1980’s stopped those practices, as the Medicare powers that be, among other things, declined to pay for that which wasn’t used, and only covered those things that were proven to be of benefit.  What a concept!

Think of the car dealer that charges for undercoating we don’t want or need, but no undercoat was ever applied. Think of the restaurant that charged you for an appetizer that you neither ordered nor received. None if us would stand for that, nor would we likely continue doing business with those businesses.

My free market industry screamed foul, and said government had no place in health care, and said government was stifling business, and said that government was killing jobs, and they still lost. Millions were saved that very first year by not paying the free market what they said they deserved, just because they said they deserved it. No longer would everyone pay for oxygen they didn’t use; no longer would treatments be covered to prevent pneumonia when pneumonia wasn’t even a risk to be had.

That’s millions in Medicare (taxpayer) dollars, saved by the recommendations of Medicare panels, the first ones to get the moniker ‘death panels’ for daring to come between “the physician and his patient”. My field, respiratory care, was still a relatively new field when I entered, helped lead the way to data driven health care, using good science to get data that showed us what worked, and what had the same or worse impact as not doing it all.

Facts are powerful, but only when people listen to them.

Those Medicare rules didn’t apply to other insurers, although the insurance industry was quick to adopt any reason that limited their payments on claims, because fewer claims paid means higher profits. That’s why they have pre-existing condition clauses.

It didn’t change for the un-insured, however, who to this day pay higher (retail) prices for everything in health care than does Medicare (big volume discount) or private insurance (big stick discount).

And that’s the key, folks… you see, it’s the un-insured, those who are charged retail, that eat up the space in our emergency rooms. They’re the ones who increase everybody’s costs, and by the retail price, not the much lower volume price.  Most un-insured still get emergency care, in the most expensive way possible, but also in a punishing way, one that demands that their basic health needs be neglected until they become emergencies. One shouldn’t have to suffer a life threatening pneumonia just because of lack of money to treat a chest cold. One shouldn’t be forced to buy an ICU stay or lose a leg because of lack of money to treat diabetes or a scraped shin that becomes infected.

I know of a man who spent over 3 months in ICU, on and off life support, because he lacked the money to buy insurance to see a doctor to get a tetanus shot.

He got tetanus. Really.

We all paid his bill, through our higher prices, a bill easily hundreds of thousands of times more than the cost of a tetanus shot.  Now think about that for a second…

That’s just one reason universal health care is a more cost efficient model than what we have today.

Every business in America, and especially insurance companies, are in business not just to make a profit, but rather to make the most profits. That’s how so many were able to literally (and legally) soak Medicare all of those years, and why Medicare went along with it. We should thank them, because it’s because of that soaking that Medicare became data driven and has the control it has today.

I’m not against capitalism, but because I believe that health care should be a basic right, and not just a privilege of the wealthy, I believe that government has to not only be involved, but has to be in the driver’s seat of the financing.

The government has shown, through the VA Health system and Medicare, that they can be both smart with our money and make sure that all qualifying Americans are included. That’s not saying that they each do not have their issues, but it’s a much better system than it was when I started. Much better.

The free market has proven to be into profits, and profits alone, the rest of us be damned. Deaths from the tainted compounded drug, now up to eleven, that fungus filled injectable drug from the unregulated compounding pharmacy which chose profits over our safety… that’s as good an example as any against letting the free market run health care.

Fee for service and the free market works with cars and trucks, and restaurants maybe, but not for health care.

Without a Net

There’s an interesting notion that ‘our children’ cannot afford our present ‘safety net’ promises to take care of our seniors and impoverished, of providing adequate education and nutrition in our schools, and of ensuring that the foods we eat and the products we use are not tainted with poison.  We’re told that in order to progress, a little rape of the earth and ourselves with toxic by-products is a necessary thing.

My Dad used to like to point out that physicians used to come by the house, and hospitals were “where you went for surgery, not to die”. “Nowadays”, he’d say, “more people die in hospitals than die anywhere else”, with the implication that hospitals were killing people. When he was growing up in the 1930’s, most people couldn’t afford to go to hospitals, and many of the doctors who made house calls were paid not in legal tender but in goods or services, whatever the family had or grew that could be used as a payment. Ask any old country Doc, many times payment was made in chickens, or greens, not greenbacks.

Parents who lived too long moved in with their children once they were unable to care for themselves. In a single wage earner world that was hard enough. In a two wage earner household it became impossible. Nursing homes boomed. Medicaid boomed as a result. Most Americans do not realize that the majority of Medicaid recipients are our parents and grandparents in nursing homes. End Medicaid, and they’ll have nowhere to go but back to their children. The dominoes of real costs to our children start accumulating from there.

Before the ‘safety net’, what we consider today to be relatively simple maladies resulted in yesteryear’s deaths.

Expectant mothers received no prenatal care, deaths during childbirth, of mother or child, or both, were not uncommon.

Children died of measles and whooping cough.

Grandparents succumbed to colds that resulted in simple pneumonias that, left untreated, ended their lives prematurely.

Working fathers were subject to job conditions that directly impacted their health and lifespan… black lung, cotton lung, asbestosis…  all easily preventable, yet they took thousands of lives in the 20th century.  Items like hard hats and steel-toed may shoes seem like a no-brainer on a construction site, yet thousands of workers have lost fingers, toes, eyes, arms, legs, and lives to worksite hazards.

Since the safety net, the data is clear: maternal and infant mortality and job related disability and deaths were all much higher in my father’s day. Average life expectancy was much lower as a result.

Gross Domestic Product (GDP, think of it as the wage of the USA), median family income, personal education level, and pretty much all of economic indicators are much higher today than in my father’s time. And so is life expectancy.

What has made the difference?

It’s been Government.

It’s been government-sponsored education for all.

It’s been government programs, demanded by the public, that protect us from toxic substances in our food and water.

It’s been government programs, demanded by the public, that protect us from the diseases that ended our grandparents lives prematurely.

It’s been a social conscience that realized that health and welfare trump profit at any cost, and that productivity and innovation are greater when the workforce is educated and healthy.

While this may seem to many to be progress, Businesses and the GOP fought, and continue to fight, advances that bring benefit to the common worker and their families.  Their argument? The regulations are unnecessary. The costs are too high. Regulations kill jobs. Accidents happen. It’s nobody’s fault.


As I said, the data is clear: Since implementing these social policies, these entitlements, these (pick your term), the U.S. has experienced the greatest period of growth and prosperity, both nationally and individually, than in any other period in our history. Think about that for a second…

The safety net could hardly have been bad for business,  bad for the economy, or bad for profits (well, except to those math deniers out there). And while living longer, healthier lives with less disease may not be necessary, I think we can all agree that it goes an awful long way to contributing to the Pursuit of Happiness.

And that’s one of our inalienable Rights.

But there’s a group that wants us to think that the safety net is a bad thing. They want us to think that the regulations preventing our food from containing poison are bad for the food industry and the reason we have high unemployment. They want to do away with the Environmental Protection Agency (EPA) that prevents profit driven business practices from poisoning us and our unborn children.

They want us to think that regulations ensuring that workplaces are safe for workers are the reason unemployment is so high. They want to turn back the clock to ‘the good ol’ days’ when Business made the rules, and the One Rule was profit above everything.

They want to do away with the Food and Drug Administration (FDA), which makes sure that our cough syrup isn’t snake oil and our tomatoes aren’t covered in e.coli or flesh eating bacteria.

They want to do away with the Occupational Safety and Health Administration (OSHA) that requires safe workplaces for us. They want to do away with the rules and inspectors that ensure safe and accepted procedures and protocols are followed when working in the Gulf of Mexico, or the gas fields of Pennsylvania, or the mines of West Virginia.

Despite their record otherwise, they want us to believe that Companies will conduct themselves safely, on their own recognizance, without any oversight.  Because it’s the ‘right’ thing to do.

Who here can think of a mining disaster that didn’t involve a company with a long history of documented safety abuses? I didn’t think so.

Who here remembers that BP took shortcuts to meet profit deadlines, resulting in an ‘accidental’ dumping of millions of barrels of oil on our shrimp and grouper and sport fishing fields.  Is it any wonder that the gas and oil industry has pumped millions of dollars into ads to defeat President Obama, who insisted that BP pay for their damage done.  The other Party apologized to BP for the treatment they were getting after so many of us lost our jobs and livelihood during the cleanup, calling the fines and mandated cleanup fund the ‘real tragedy’. (1)

They want us to think that Medicare and Social Security are ‘nanny state’ entitlements, and that real Americans take care of themselves, by themselves. Any infirmity should be dealt with by picking oneself up by the bootstraps, not looking for a government handout. Craig T. Nelson, of Coach fame, says it all when he complained about people looking for help from the government. “I’ve been on food stamps and welfare, did anybody help me out? No.” (2)

They want us to think that health care is a privilege reserved only for those wealthy enough to pay. The simple fact that public health ended the polio epidemic, the scourges of pertussis, diphtheria and tetanus, childhood deaths from measles, and a range of maladies from rickets to scurvy do not deter efforts to disband public health in the name of abstinence education and protection of the unborn.

They attack public health, telling us that vaccinations cause cancer and autism, when in fact it’s industrial toxins that are linked most closely to cancer (a list too long to, well, list) and increasingly implicated in Autism. (3)

Despite all evidence to the contrary, they want us to go back to the days when health care was a privilege of the wealthy.

Why? Because healthy people are more capable of learning. Because educated people make informed decisions. Because informed decisions lead to voting one’s own interests. Because there are way more of us (99%) than there are the wealthy (1%). Because wealthy interests rarely cross over to the rest of us. Trickle down has been tried and repeatedly shown to be a marketing gimmick.

They have vowed to disband public health and public education and public protections from industry, including (especially) Wall Street. Not to make the Country better, or to save our children’s future, but because they believe that by virtue of their wealth and station in life that they are better than the rest of us.

You can’t get more un-American than that.


(1) http://www.cbsnews.com/8301-503544_162-20008020-503544.html

(2) http://www.youtube.com/watch?v=yTwpBLzxe4U&noredirect=1

(3) http://www.environmentalhealthnews.org/ehs/newscience/phthalates-bpa-linked-to-atypical-child-behavior