Medicare for All: Force the Vote

53 thoughts on “Medicare for All: Force the Vote”

1. I’m all for principled conduct. My own earned me time in several military prisons. Speaker Pelosi is a pragmatist; that’s what keeps politicians in office. That’s why Bernie endorsed Biden after his own defeat by the Dem. Establishment. Could Biden be persuaded to change his mind on Medicare for All? I just read an email from an environmental cause group gushing with praise for Joe’s pick to head the EPA. Seems the nominee might NOT be a tool of polluting industries! I can’t vouch for that. But even if Biden “wanted to” approve this concept, there’s a bigger hurdle than the GOP looming: the National Debt is gonna be so out of control–not to imply it isn’t already!–in the wake of this pandemic that it will be infinitely easier to argue that the nation “just can’t afford it.” We know this is a false claim, because we know billionaires were once taxed on their income at up to 90%. With fewer loopholes avail. in the Tax Code. I’d suggest seizing all of Trump’s assets to put toward healthcare for the masses but…no one knows how much the SOB is actually “worth”!! Except maybe one or two accountants, sworn to secrecy under threat of death if they squeal!

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   1. When I think of Pelosi, several words come to mind: Compromised. Privileged. Out of touch. Establishment. Phony. Corporate tool.

      “Pragmatist” isn’t one of them.

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   2. Certainly we can afford it, as revealed in the last “article” of this July 2019 Newsletter, “A Workable Moral Strategy for Achieving and Preserving World Peace,” by Raymond G. Wilson. The money would be there.

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   3. There was a study, funded by Republicans (!), that concluded M4A would cost less money over time than the current system of private health insurers.

      That study was quickly downplayed — not exactly what the donor class wanted to hear.

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      1. IMO the healthcare “system” we are currently “blessed” with is one enormous SCANDAL. That of Cuba yields superior results in many areas re: health of the overall population.

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      2. One of the reasons for my self-imposed exile to The Netherlands was there was no way I could afford anything remotely resembling decent health care in the USA unless I continued working until I kicked my clogs, and even that would be a stretch.
         Now, I pay approximately $170.00 per month with a yearly deductible of (approximately) $400.00 and no one pushes me into the world of generics, says anything about pre-existing conditions or equates socialized medicine with Communism.

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         1. My wife and I pay $45/month for quality healthcare here in Taiwan. I’ve had two severe lacerations sewn up, one skin cancer removed (ear) and three stent implantations in partially blocked coronary arteries after experiencing two heart attacks. I get regular examinations and medicine prescriptions filled for very little additional cost. I literally would not live today or have any life savings to supplement my meager Social Security income had I not left the United States seventeen years ago and moved here to Southern Taiwan. Discussion of medical matters here do not involve ideological or religious crusades in any manner that I can ascertain nor would the people here tolerate for an instant any posturing politician who started babbling about such irrelevant matters.

            For an excellent treatment of this subject, see “America’s Sick Priorities”, by Finian Cunningham, Information Clearing House (December 12, 2020). Americans should have no other priority than establishing a single payer national health care system. If unsure of how to do this sort of thing, the Taiwanese would gladly provide Americans with the necessary instruction.

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2. Spending more for meager results seem to pervade our perceived “greatnesses “. In the US we spend $11,100 dollars per capita on healthcare. That the “largest” in this developed world. What’s that get ya…? Some poor health metrics… we are worse in these common areas
   Life expectancy
   Infant mortality
   Unmanaged diabetes
   Even though we spend more money our health outcomes are not any better than any other developed nations.
   Factor in the highest administration costs $940.00 dollars, which is 4 times the average of other developed countries and it looks like we should be demanding a course correction. Currently we spend about $516.00 on prevention or long term health care.
   For profit health care doesn’t deliver consistent reliable solutions to disease. If they did they would put themselves out of business; but shouldn’t that be more in line with the altruistic response of healing the wounded. It seems to be a common theme of the Greatly Made American Lifestyle, increase your wealth at someone else’s expense.
   Our society will never match up to it’s utopian aspirations until it learns to share each other’s burdens equally and without any obscene profiteering. Especially when there are many of us who believe there exists statistical evidence that the very practices of modern living has been decreasing human vitality and the vitality of Mother Earth. She was created to nurture us all; and we have been inflicting toxicity into the very nurturing qualities She possesses to provide us all with good health freely. Right now we are a backwards people and to not be demanding universal health care/ Medicare for all is one of our most backward practices.

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   1. Good observations. But I just wanna point out that “the Founding Fathers” believed they were establishing a genuinely New Order in how to govern. But Utopia? Since they were “the elites” of their time, if there was to be anything like a Utopia it would be one that would ensure their own continued privileges and dominance of the economic life of the young republic.

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      1. Absolutely…. they were self concerned from the start. Utopia never happens in this dimension; but each and every action we perform should be done with a utopian attempt in mind. You only get one chance to complete any moment but that effort should honor the creator that provided the opportunity to enjoy the experience. Honoring creation with your best effort and intentions is as pure as it gets here. Sometimes I succeed; sometimes ( more than not, I know this from experience ), the end product is still wanting. But giving the best you’ve got in thought mind and deed will generally produce a result most of society can benefit from. I know… I’m a dreamer, but I’m not the only one. Anybody on this sight is attempting to live through the heart and not the dense archaic mind that dominates this war thirsty land. To want to step back from war is the beginning of wisdom dawning. Right now it’s a rare perspective in this country, but it won’t always be that way. The pendulum says so. We sure did pick a strange stretch of time to exist. But we can teach the children around us well, they’ve been born for this moment and with proper direction and understanding they can make this nation live up to it’s ideals.

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         1. a preternaturally arresting, heartening, and soul-seizing comment, utejack. you have been inspired by your innate goodness… the only ‘god’ that is worthy and makes sense, i.e. god w/ a doubled ‘o’. thank you. if only astore’s site attracted more sentient beings than the quondamly-converted acolytes.

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            1. Darned acolytes!! [insert smiley here]

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               1. by “more sentient beings” i meant it in terms of quantity not quality, i.e. “more of us” numerically visiting astore’s site, not a higher quality of sentient beings than those already attracted to his remarkable site. my syntax perpetually lacks clarity… shame-faced apologies to astore’s devoted acolytes!

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3. Two Things:

   1. The President-elect’s Cabinet selections sound like nothing so much as ticking off the boxes on a Diversity Checklist, not all that different from the numbers game Affirmative Action spawned.

   2. I think one of the first orders of business for the Biden/Pelosi/Shumer triumvirate will be beating down and marginalizing “the progressives” like a red-headed step-child. They can bark and snarl all they like, but without their own party it will be “play ball or be gone.” No recognition or support from The Party and watch for DNC-approved challengers to their seats in the mid-terms.

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   1. Agree. Debra Haaland, however, seems to be the exception that so far proves the rule. She’s true diversity and what’s more, a lady with class. Finally some hope for Indigenous populations?
      And yes, they should start their own new, progressive party, with Bernie and other progressive senators and get it up and running in time for the 2024 primaries.

      As for Pelosi, seems to me she’s too self-centred to care for anyone beyond her own interests and her inner circle. How much time, attention, concentration & energy does this 80 years old woman waste every single day in order to desperately try to look some 35 years younger ?!
      Incapable of aging with grace.

      PS : I signed, I think you guys should have proper medical care 🙂 and added that they should start their own party, for your own and the rest of the world’s sake.

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4. Caitlin Johnstone has an answer here as to why M4A is not happening:

   https://caitlinjohnstone.com/2020/12/20/why-theyre-denying-you-healthcare-and-financial-support-during-a-pandemic/

   I think she’s spot on.

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5. As I physician I am aware of things about Medicare that others may not know. While I would like health care for all, I think that Medicare for all is a mistake. Medicare is a corrupt system and is responsible for much of the dysfunction in American healthcare. Medicare reimbursement rewards specialists for doing procedures far more than it pays for public health or primary care. The “widget” that physicians are paid for under Medicare is the “relative value unit” or RVU. Every procedure code is assigned a certain number of RVU’s. A group of physicians that was secret until recently set the number of RVU’s by decree. The vast number of physicians in that cabal were specialists so it is no surprise that specialist procedures have far higher RVU numbers than actually caring for a patient. Under Medicare a gastroenterologist can make oodles more money scoping patients than actually taking care of them. Private insurance companies tend to follow the Medicare RVU assignment. That’s why the average orthopedic surgeon makes many times more than the average pediatrician.

   The EHR’s that were forced on physicians by Medicare were designed by companies to maximize the RVU per patient visit. Their purpose is to maximize billing and revenue generation, and they are abysmal for patient care. This was rolled out as supposedly good for patients under the term “Meaningful Use.” That was a complete lie and I referred to it privately as “Meaningless use” and refused to participate. Because of my refusal to focus on clicking boxes and uploading my patients’ information to a server that is almost certainly going to be hacked I receive a lower fee from Medicare.

   The Medicare manual is insanely long. Only major medical organizations can figure out its arcane regulations and if you make a mistake in billing then you are guilty of fraud, even if the mistake comes about because the regulations are too convoluted to make sense of unless your staff get specially trained to do so.

   Being a psychiatrist, I despise Medicare. I have to fill out computer forms to get even generic medications approved. My chronic pain patients can’t get physical therapy because Medicare either refuses to cover the visits or reimburses so low that no one will take it. I had a chronic pain patient lose her private insurance and go onto Medicare because she was on Social Security Disability. Her pain was severe and physical therapy was required as the standard of care. Medicare refused to cover it. Unbeknownst to me she obtained heroin to help her cope with the pain and died of an overdose. Psychotherapy for pain, addiction and other mental health conditions is not reimbursed enough by Medicare for me to find therapists who will take it. They can make more from patients who will pay cash.

   Medicare is a corrupt cash cow for the medical-industrial complex. Here is one example. A group of cardiologists has an outpatient practice where they do procedures such as stress-tests etc. A hospital purchases the practice for a large sum and pays the doctors the same amount. How can the hospital afford this? Well, under Medicare if the same procedure is provided by a “hospital” instead of an outpatient facility then a “facility fee” can be added to the cost. So because the building is now owned by a hospital the hospital can charge more for the exact same procedure done by the exact same people in the exact same place. The hospital pays the docs the same and pockets the difference. Corruption.

   Here’s another example: Device manufacturer pays doctors to invent a condition that is common and that their device will test for. Device manufacturer lobbies Congressional representatives to make the test covered by Medicare. Once Medicare will pay for the test then private insurance companies are pushed to follow suit. Device manufacturing company can then market the device to medical clinics because doctors can get paid for running the test. This does nothing to improve patient outcomes. But its great for the device manufacturer and the medical clinics. This is done by pharmaceutical companies as well. The term is “disease mongering.”

   I could go on for pages. I am not taking any new Medicare patients because Medicare is too difficult to work with. I am seeing Medicaid patients as the private insurance companies in my area who are contracted under the Oregon Health Plan are great to work with. Thank God for the ACA. If I need to get something authorized I usually can get on the phone with a case manager who is intelligent and experienced and work out something that will help my patient.

   As Medicare requirements have become increasingly oppressive, complex and impossible to meet without staff dedicated to doing so, solo and small group practices have become increasingly unable to work with Medicare. They have either gone out of business or been bought by large health-care corporations. Those large corporations employ the doctors as serfs and push them to maximize RVU’s, which means seeing patients as fast as possible, clicking boxes in an EHR to maximize revenue per visit, and essentially paying little to no attention to the patient. Sometimes the results are funny. I had a patient who is quite deaf but adept at reading lips come in for her appointment and ask me if she had dementia. She was about 60 and had just gotten a new job and was doing very well in her training for it. So, no, she did not have dementia, and I informed her of that. I asked her why she thought she might have dementia and she said she had gone to see her primary care doctor, who worked for a large “health-care” company. Her doctor had administered a cognitive test and she had done so poorly that her doctor had told her she had dementia. I was puzzled as to how the doctor could have gotten such an impression with a patient who was clearly above average in cognitive ability. Then it hit me. My patient is deaf. She reads lips. The doctor was probably asking her the questions while reading them off the computer and staring at the screen to make sure she clicked the right boxes. I asked her “Was the doctor looking at you when she gave you the test?” My patient responded “No!!! She was staring at her computer the whole time. I kept leaning over trying to see her face so I could read her lips and understand what she was asking me, but I couldn’t. So I just guessed at what she was asking.” I explained the cause of her non-existent “dementia” and we both had a good laugh. Other mistakes I have caught have not been funny.

   The purpose of American medicine is not to provide health care. It is to suck as much money as possible out of the pockets of the people and funnel it into the pockets of a small number of people. Some of those people are physicians, most are not, and none of them are caring for patients. Medicare and its focus on procedural and hospital based medicine is the cause of this and so Medicare for all will just continue the travesty.

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   1. Yes. I’m not an expert on this.

      The point, of course, is government-provided health care for all. If M4A is already too corrupted, start over with something new and sensible.

      Remember when we used to say, “If America can send men to the moon, we can do x, y, z”?

      Surely we can figure out what other countries have done and are doing. Maybe the Taiwanese can help!

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      1. Agreed. I am absolutely in favor of everyone having health care. And looking at what other countries have done makes perfect sense. The American media constantly trots out worst case scenarios from other countries to scare Americans away from any other model. The general public imbibes this Kool-Aid and supports the current system in which taking care of people is a much lower priority than making money.

         I know health-care professionals who have creative ideas that would improve efficiency. But unless their ideas will generate profit over and above costs they get shut down.

         I want to make it clear that the large majority of the people who are actually providing the health care have caring for people as their top priority. However, they are not the ones making the rules and a good number of them are burnt out, depressed or commit suicide because of the moral injury caused from working in such a corrupt system.

         A few years ago I did a grand rounds (a talk for which attendees get medical education hours) at a local hospital. It was on mindfulness and resilience. I pointed out how the current use of mindfulness is a perversion that is used to reinforce passive acceptance of a corrupt status quo, and the main reason health care providers were suffering from burnout was the systemic corruption in medicine in which the values of the system were at odds with the value of caring for people, and those who did not accept that were punished. Real mindfulness involved being able to identify the corruption and take effective action against it.

         One of the physicians in the audience came up to me afterward and told me he almost didn’t attend because he thought I was going to be the typical corporate stooge telling them they needed more “radical acceptance”. He couldn’t believe that I actually spoke out about the corruption and moral injury and put that front and center.

         An efficient health-care system is like a pyramid. The lowest level is public health. The next lowest is primary care which includes mental health. These all generate revenue, but not profit as the interventions require skilled workers to put in time and energy, but not a lot of drugs, devices, or procedures. Our system funds those the least and most of the money goes to the top tiers which are proceduralists, drug and device manufacturers, then high level managers and finally executives.

         There are strong parallels between the medical-industrial complex and the miltary-industrial complex. Just as the military-industrial complex does not exist to win wars but to fund corporations, the medical-industrial complex does not exist to heal people but to fund corporations. Both are a disaster and arise from the cancerous form of capitalism that flourishes here. My solution is a very steep progressive tax system with no loopholes for “not-for-profit” or “non-profit” organizations. Then greed is at least put to the common good.

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         1. “Moral injury” — a very important concept.

            Health care — doctors, nurses, etc. experience moral injury as they’re driven to prioritize profit over patients.

            The military — troops experience moral injury as they’re driven to implement orders that end up killing innocents in the false name of protecting freedom.

            We have to get profit out of health care and profit out of military action. If we don’t, it’s just wealth care and warfare as welfare for various corporate entities.

            It’s sad that our society sees war as the health of the state and sees health as something to make a buck off of. To paraphrase MLK Jr., we’re experiencing a form of spiritual death in the USA.

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         2. I had commented earlier about the need to “tax the rich” (convenient shorthand)–like REALLY tax ’em!–to fund a better system. Unfortunately, we can place no hope at all in Joe Biden stepping up to “rock the boat” on this issue. “Do I look like a Socialist?!” he asked rhetorically in one of the “debates” with Trump. Uh, no, Uncle Joe, you sure as hell don’t! If ol’ Joe doesn’t last long in office due to his own health issues, will a President Kamala Harris show more intestinal fortitude? Only time will tell. But I advise against holding high hopes. The higher them things are, the more painful their being dashed to the ground.

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         3. My previous comment seems to have vanished into cyberspace, so I’ll repeat a more condensed version: Joe Biden gives us zero confidence that he’s willing to try to rock the boat in the realm of taxing the uber-rich at more appropriate levels.

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            1. And now my comment from 3:14 PM has mysteriously appeared! Fun with the interwebs!

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      2. I agree. It is not Rocket Science like the late 1950’s or 1960’s where new ground was being broken. Western Europe, Japan, Australia among other have universal health care. A team could evaluate each system and take the best workable parts and create a new health care system for the USA. The Corporate Politicians in the GOP or Democratic Party will not permit this.

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      3. Yes, but landing humans on the moon was a propaganda coup. “Merely” providing high-quality, affordable healthcare to all our citizens? Where’s the propaganda value, since all the rest of the “developed world” beat us to it eons ago?? [insert frowny face]

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   2. JPA (replying to your initial comments)–This is precisely why I prefer to speak of Universal Healthcare rather than “Medicare for All,” but the latter won out in public consciousness. The very phrase “health care corporation” is a self-contradiction that irritates me. “Somehow” (!!) every “advanced” nation on Earth has found a way to have a better system than the US’s. So it couldn’t be clearer that our problem here is lack of political will to change things. See: lobbyists in D.C., etc. In fact, not much need to look any farther than that phenomenon.

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6. I’m in complete agreement with you and JPA, Professor. It’s discouraging and demoralizing to us little people who have no chance to change outcomes, no matter how much we support Progressive values with donations, letters, petitions, and our votes. No wonder so many people have their heads firmly in the sand….

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7. This may get complicated – It is a system design flaw.

   My daughter has Medical Care through her employer. It is a fairly large financial institution.

   Her costs as are follows for a family:
   Medical including Prescription drugs per year: $5,460
   Vision $301 per year
   Dental $780. per year.
   Total $ $6,541 per year.

   Deductibles $1,500 per person
   Deductible $ 3,000 Family

   Out of pocket maximum:
   Per Person $3,000
   Family $6,000

   As an example between the Family Deductible of $3,000 and the Out of Pocket Maximum of $6,000
   You must pay a 20% Coinsurance charge, or $600.

   So the first $3,000 is out of Your Pocket. Than $600 out of your pocket for the amount between $3,000 and $6,000. After the $6,000 there is 100% Coverage.

   So you could pay $3,600 out of pocket for expenses in a year, plus the Premium of $5,460 or $9,060 total.
   Prescription drugs also have a coinsurance charge 20% for generic and 40% for Preferred Brand.

   I presume the Vision and Dental have a deductible since when I was employed by corporate America they had separate deductibles.

   The employees are encouraged to set up a HSA (Health Savings Account). For a family you can contribute up to $7,100 in 2020. This $7,100 is deducted from your gross income. You do receive a tax deduction for the HSA.

   The kicker is her coverage is contingent on her continued employment. If the company downsizes and she is terminated -No More Health Insurance.

   I worked in Corporate America from 1975 to 2013. During that time I witnessed plenty of people caught in the various downsizing’s. Suddenly you have no job and no health insurance.

   This type human tragedy does not worry the GOP and the Corporate Democrats like Nancy Pelosi are indifferent.

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   1. There’s been reporting in MSM of late that “many” folks are doing fine and dandy financially during the pandemic. I imagine they’re quite okay with their “Cadillac-level” healthcare plans. I would just caution these folks that to the extent that their feeling “flush” is based on the fantastic (literally, as in no connection with reality) performance of their stock portfolios…well, that ain’t gonna last forever. If any change for the better is to be realized, it will have to come from agitation from the bottom of the heap, where yours truly has resided all his life.

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   2. I had the same story with healthcare through my former employer, except deductibles for my husband and myself came to something like $10K per year, and THEN the coinsurance and out-of-pocket maximum. When I was downsized, that was the end of even that monstrously expensive arrangement. Yep, it’s a racket.

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8. Several years ago I went to my V.A. Primary Care Physician. I had a heart attack back in 2001. Every year after that my Cardiologist would schedule a tread mill test where you are hooked up to a monitoring device.

   I asked my V.A. Doctor if he was going to schedule a tread mill test?? He asked me if I was having any chest pains or symptoms? I replied, No.

   He said there was no need to schedule a tread mill test. The V.A. Doctor said in so many words Corporate Medical Care is driven not by need for the patient but for profit. Once those expensive machines are paid for they are now a profit center. The Cardiologist I had was a part of the Hospital where she scheduled the tests. Since I had good insurance I was a gravy train.

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9. Pingback: Force the Vote: Medicare for All - LA Progressive

10. We can afford war, can’t we? Priorities are not well in America.

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11. Caitlin Johnstone nails it:

    “Americans will not be given Medicare for All despite overwhelming public support because an immense amount of power depends on keeping them in a state of financial struggle so they don’t interfere in the affairs of a nation which serves as the hub of a global empire. The US political system does not exist to serve the interests of Americans, it exists to serve the interests of the empire. No part of that system is there to protect the people from the powerful; it’s there to protect the powerful from the people.”

    https://caitlinjohnstone.com/2020/12/21/why-its-good-to-push-politicians-to-do-the-right-thing-even-when-they-probably-wont/

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    1. Why are we so sick in America? Why are so many disabled? So exhausted? So divided? “The system isn’t broken. It was built this way.” Caitlin is right.

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12. The odd thing that many people do not realize is that tens of millions of Americans already get some form of government healthcare. Medicare, medicaid, VA, ACA subsidies, active and retired military and families, and all the federal, state, and local government employees who get healthcare through the employer agency. I’ve had low cost healthcare from military then state government most of my adult life, now on medicare. Yes, it is economically possible but won’t happen in my lifetime.

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    1. Unfortunately, Medicare provides zero assistance for dental and vision issues. So far I’ve managed to avoid having to throw myself on the mercy of the VA in those areas.

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13. In this powerful video, beginning at the 12 minute mark, Jimmy Dore explains how a serious illness drove him into bankruptcy and had him contemplating suicide.

    For his honesty and courage, I salute him.

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14. As I mentioned previously, the purpose of American medicine is not to provide health care but rather to suck money out of the pockets of the populace and funnel it into the pockets of the owners of corporations. The insurance industry and the hospital industry are often in cahoots on this.

    Case example:
    https://www.npr.org/sections/health-shots/2020/12/23/949287668/retiree-living-the-rv-dream-fights-a-nightmare-12-387-lab-fee

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    1. Legalized theft against sick people.

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       1. Yes. Its “interesting” how if a person robs $100 from a single store they get a criminal record, but if a hospital corporation robs $1000’s from multiple people the executives get bonuses. Dooh Nobir strikes again.

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          1. Or, as Woody Guthrie wrote and sang: “Some rob you with a six-gun/And some with a fountain pen”!!

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          2. ‘vide infra’ woeful narratives from family members, one of whom suffered the aleatoric misfortune of being trapped in a miami hospital when attending an american friend’s wedding after a boil appeared following a minor cut on son firth’s arm:

             On Dec 20, 2020, at 16:16, Maine McEachern wrote:

             The US “healthcare” system is, sadly, the laughingstock of the developed world. It’s the worst in patient access and outcomes (indicating higher mortality rates of amenable mortality), while being far-and-away the most expensive and thus least efficient (the US spent an average of 17% of its GDP annually on healthcare in the 2010s, while the OECD average was exactly half that – a statistic made even more mind-blowing given the huge size of the US economy). There is plenty of evidence on the dysfunctionality of the corporate-profiteering US healthcare system relative to its peers reported by various independent think tanks, watchdog agencies and NGOs, e.g. the Peterson-KFF Health System Tracker: https://www.healthsystemtracker.org/about-us/ (never mind all the personal accounts of people who’ve been patients in the US and other developed nations; many of their harrowing tales of the US system contrasted to the excellent, efficient and gracious treatment they consistently report from countries such as Canada, the UK, Australia, etc, can be found on Quora and Reddit and make for great and sometimes heart-stopping reading.)

             The problem of corporate cartels cornering the market on some critical public service – aided and abetted by the amoral politicians whose campaigns they fund and to whom they direct their lobbyists – where, once they’ve formed a firewall around the service they monopolize, they have free rein to gouge the public for maximal profit, is universal. Healthcare is just a glaringly ruthless example.

             On Sun, 20 Dec 2020 at 00:58, Jeanie McEachern wrote:

             tnx, maine; a supernal coverage of the for-profit ‘non-coverge’ of the failed state’s [the US] failed medical system. recall that your brother firth was charged nearly 23,000$US for an infected cut on his arm when he made the brobdingnagian error of entering a miami hospital that subsequently refused to release him until the esurient bastards had bombarded him w/ every conceivable test regnant in the entire medical-tech cabal… despite firth’s making herculean attempts to escape from their greedy enshacklements! what an outré scam that hospital was running.

             On Sun, Dec 20, 2020 at 1:47 PM Maine McEachern wrote:

             Yeah, Firth’s phantasmagorical tale of his $23000 abscess in Florida – the same problem he suffered in the Philippines, for which a nurse in a walk-in clinic fixed in 10 minutes for $10 – is a classic illustration of how the corpus of the US healthcare system has grown so infected and bloated by the many corporatized cartels that parasitize it (the insurance companies, Big Pharma, device manufacturers, politicians and lobby groups paid by them, doctors, hospitals, etc). There’s gouging every step of the way; and with every gouge, more money flows to the rich, efficiency plummets, healthcare declines and society suffers.

             [reply from Firth McEachern, now teaching in Bogota, Colombia]:

             While the US care was way more expensive, it was WAY worse. I had to wait three days in a Miami hospital bed before they lanced the boil, whereas in the Philippines I waited 20 minutes. The one defense that the US model might have is that healthcare employs many people. I wonder what the number is of people in the US who are employed in healthcare, and whether the per capita figure is significantly higher than countries like Canada, UK, Australia, New Zealand. Even so, doctors, pharma execs, medical equipment providers, and health insurance reps are paid way too much in the US.

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             1. “doctors, pharma execs, medical equipment providers, and health insurance reps are paid way too much in the US”

                This is why health care reform loses the support of the front line workers. When reformers claim “doctors are paid way too much” it shows they are not interested in understanding why medical costs are so high, and how to intervene effectively.

                A few facts about doctors in the US. First, there is a huge variation in pay among doctors. Some specialists make 10 times more what a primary care physician makes. Specialist pay is far higher priced in the US than in other countries, but primary care much less so. For example, a pediatrician starting salary is about $100,000 per year. An orthopedic surgeon starting out will make double that.

                Physicians in the US usually start out with over $200,000 in debt. Other countries pay their physicians less, but also provide more free education. Again, this hurts the primary care physicians much harder, so it tends to drive US graduates into higher paying specialties. The pediatrician starting out at $100,000 per year sound like she is making a lot of money, but not when paying $3000+ per month in student loan payments, which are post-tax. An ultra-sound technician or massage therapist takes home more per hour. The orthopedist has double the salary of the pediatrician, but will have 3 times as much left over after the loan payments. That exacerbates the pay discrepancy between primary care and specialist pay.

                Lumping doctors’ pay with the pay of “pharma execs, medical equipment providers and health insurance reps” is a huge insult. That is the usual arrogance of telling front line workers they are paid too much because managers and executives make high salaries. “We have to cut costs, so all you workers need to work harder for less money.” Of course those who are not working continue to get bonuses and pay raises.

                In the last 20 years the proportion of the healthcare budget paid to doctors (and other health-care workers) has decreased substantially. The money paid to administrators, executives, and middle-men has increased steadily.

                In the US we are facing an increasing shortage of primary care physicians. The working conditions are becoming increasingly aversive and physicians are leaving the profession early and are not encouraging others to become physicians. Most of the “progressives” and “liberals” i hear from have no interest in understanding what the life of a frontline health care worker is like. They have a distorted view that comes from anecdotes out a sensationalized news media and this view justifies their contemptuous view of people who work in healthcare. They then spout “solutions” which are just going to make things worse.

                Its very similar to what I hear about from “liberals” who spout nonsense about police reform. They get their impressions from sensationalized news stories. They know nothing of what an officer actually goes through and have no interest in learning, preferring to hold to their holier-than-thou, contemptuous attitude. Then they blame others for not supporting their “solutions.”

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                1. too too troo, jpa. tnx for your stats-quantified, hi-quality inputs. maine was commenting from the perspective of a canadian, the purview of a human rights lawyer/legal consultant for indigenous first nations, and the outrage of US charges over his younger brother’s usurious bills, which are still being submitted, for a simple boil on his arm. when firth meandered into that miami hospital, he was hopelessly naive about the fraudulent dynamics of said-hospital. he was inside a fugue, forgetting that he was the prisoner of a malfeasing, bloated, inept US medical system, not back home in the philippines. apologies for the belaboured ratiocinations.

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             2. The $23,000 boil, a chilling tale to read on Xmas Day! But fear not, Mr. Trump is working furiously to fix things…wait, check that. I understand he’s out pretending he can golf again today. Speaking of efficiency, a huge chunk of those employed in healthcare rationing (which is what this system amounts to) in US are doubtless those processing the paperwork for the administrative bureaucracy. When my dad was terminally ill 28 years ago, the amount of paper that came in the mail from Medicare was astonishing.

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15. jeanie – Thanks for your putting Maine’s comments in context. His younger brother was subjected to a mugging when he went for medical care and outrage is appropriate. When people lump “doctors” into a homogeneous group that is a mistake because “doctors” are no more homogeneous than “cops” or “blacks” or “gays”. Most doctors want to deliver good patient care. Most of these hate the system. However, a significant minority of doctors is quite happy with the current system and oppresses doctors who speak out against it. I work with a lot of healthcare professionals who are driven to depression or suicidal despair because they are trapped in a system which abuses them and their patients.

    It is very likely that the tests ordered by the doctors who treated Maine’s brother were mandated to do so by the hospital’s electronic health record (EHR). EHR’s are mandated by law in large healthcare organizations ostensibly to improve patient care. In reality these make patient care more difficult and their real purpose is to run algorithms to determine the way to maximize the billed charges.

    Doctors who work in hospitals are employees who are pressured to admit patients, do procedures, and run tests. If they don’t they can be fired, and their contracts usually contain non-compete clauses that prohibit them from working in the area. When someone has a family, and large student loan payments, then one is at the mercy of the employer. Very few people have the courage to stand up to that kind of pressure. Those who do often risk bankruptcy or divorce when the spouse realizes that they are not going to have the lifestyle they planned upon.

    Or the hospital labels the physician as “disruptive” and other physicians who act as stooges for the hospital fabricate complaints that get the “disruptive” physician in trouble with their state medical board.

    Here are the main things I hear from healthcare providers
    -It is not possible to practice good medicine in the current environment
    -The pressure to meed corporate demands for revenue generation is contrary to good medical practice
    -Clinical guidelines are set by people/organizations with conflicts of interest
    -Upcoding, excessive testing, unnecessary procedures/screening/testing are expected and demanded
    – For profit medicine does not work

    Individual corruption occurs when a person behaves unethically. That is not the problem in American medicine. The problem in American medicine is institutional corruption.

    1) Institutional corruption occurs when the laws, policies, and guidelines of a system are structured to enforce a set of values that is antithetical to the values the system is ethically obligated to express and uphold.

    2) Health care professionals are obligated to place a higher values on patient care than on making profit.

    3) The laws, policies, and guidelines of the American healthcare system are set up to prioritize making profit over providing patient care.

    4) From 1, 2, and 3 above, the American medical system is institutionally corrupt.

    This system is supported and maintained by a corrupt system of government. For further reading on this I recommend On Corruption in America by Sarah Cheyes.

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    1. Thanks, JPA. This really should be a “Bracing View,” not buried in the comments. Is it OK with you if I add it as an addendum to the main article?

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       1. Thank you for offering that. Please place it wherever you think it would be most helpful.

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          1. Thanks, JPA. I added your comment to my original post. Your arguments and experience are vitally important here.

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16. gracious and accommodating of you, jpa, to broaden my horizons on the diversity and levels of gravitas among US medico-hierarchies and primary-care physicians’ commitments to their patients’ well-being. as you elucidate, the range of care-taking in the medical profession is expansive and cannot be assessed w/ sweeping generalizations which are, unfailingly and fundamentally, falsifications of reality. i will share your illuminating comments w/ firth and maine, neither of whom is a blog participant on astore’s site. in fact, i failed to solicit permission to include their personal comments to our family members on wja’s bracing views site. ooops.

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17. Pingback: Trump Failures and Revealing Moments - LA Progressive

18. I like the idea of Medicare For All. The only issue as I see it is in the contradictory stories I have heard and read related to people who are on Medicare.

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