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Friday, July 31, 2009

Health Care Realities - NYTimes.com

At a recent town hall meeting, a man stood up and told Representative Bob Inglis to “keep your government hands off my Medicare.” The congressman, a Republican from South Carolina, tried to explain that Medicare is already a government program — but the voter, Mr. Inglis said she, “wasn’t having any of it.”  (why are republicans so stupid?)

It’s a funny story — but it illustrates the extent to which health reform must climb a wall of misinformation. It’s not just that many Americans don’t understand what President Obama is proposing; many people don’t understand the way American health care works right now. They don’t understand, in particular, that getting the government involved in health care wouldn’t be a radical step: the government is already deeply involved, even in private insurance.

And that government involvement is the only reason our system works at all.

The key thing you need to know about health care is that it depends crucially on insurance. You don’t know when or whether you’ll need treatment — but if you do, treatment can be extremely expensive, well beyond what most people can pay out of pocket. Triple coronary bypasses, not routine doctor’s visits, are where the real money is, so insurance is essential.

Yet private markets for health insurance, left to their own devices, work very badly: insurers deny as many claims as possible, and they also try to avoid covering people who are likely to need care. Horror stories are legion: the insurance company that refused to pay for urgently needed cancer surgery because of questions about the patient’s acne treatment; the healthy young woman denied coverage because she briefly saw a psychologist after breaking up with her boyfriend.

And in their efforts to avoid “medical losses,” the industry term for paying medical bills, insurers spend much of the money taken in through premiums not on medical treatment, but on “underwriting” — screening out people likely to make insurance claims. In the individual insurance market, where people buy insurance directly rather than getting it through their employers, so much money goes into underwriting and other expenses that only around 70 cents of each premium dollar actually goes to care.

Still, most Americans do have health insurance, and are reasonably satisfied with it. How is that possible, when insurance markets work so badly? The answer is government intervention.

Most obviously, the government directly provides insurance via Medicare and other programs. Before Medicare was established, more than 40 percent of elderly Americans lacked any kind of health insurance. Today, Medicare — which is, by the way, one of those “single payer” systems conservatives love to demonize — covers everyone 65 and older. And surveys show that Medicare recipients are much more satisfied with their coverage than Americans with private insurance.

Still, most Americans under 65 do have some form of private insurance. The vast majority, however, don’t buy it directly: they get it through their employers. There’s a big tax advantage to doing it that way, since employer contributions to health care aren’t considered taxable income. But to get that tax advantage employers have to follow a number of rules; roughly speaking, they can’t discriminate based on pre-existing medical conditions or restrict benefits to highly paid employees.

And it’s thanks to these rules that employment-based insurance more or less works, at least in the sense that horror stories are a lot less common than they are in the individual insurance market.

So here’s the bottom line: if you currently have decent health insurance, thank the government. It’s true that if you’re young and healthy, with nothing in your medical history that could possibly have raised red flags with corporate accountants, you might have been able to get insurance without government intervention. But time and chance happen to us all, and the only reason you have a reasonable prospect of still having insurance coverage when you need it is the large role the government already plays.

Which brings us to the current debate over reform.

Right-wing opponents of reform would have you believe that President Obama is a wild-eyed socialist, attacking the free market. But unregulated markets don’t work for health care — never have, never will. To the extent we have a working health care system at all right now it’s only because the government covers the elderly, while a combination of regulation and tax subsidies makes it possible for many, but not all, nonelderly Americans to get decent private coverage.

Now Mr. Obama basically proposes using additional regulation and subsidies to make decent insurance available to all of us. That’s not radical; it’s as American as, well, Medicare.

Op-Ed Columnist - Health Care Realities - NYTimes.com

Sunday, July 26, 2009

Republicans are Such Stinking Hypocrites.

"You are literally encouraging their murder." Hotlist

Thu Jun 25, 2009 at 10:11:12 AM PDT

Rep. Duncan Hunter Jr. (R-CA-52) had an interesting comment on the debate over an amendment to the National Defense Authorization Act that would rescind a Bush-era policy classifying the names of attendees at the Western Hemisphere Institute for Security Cooperation (formerly known as the School of the Americas). The amendment, offered by Rep. Jim McGovern (D-MA-03), Joe Sestak (D-PA-07), Sanford Bishop (D-GA-02) and John Lewis (D-GA-05), would require public disclosure of the names of the Institute's attendees.

In opposing the amendment, Rep. Hunter said that by releasing the names of attendees publicly -- as was routinely the case prior to 2006 -- "you are literally encouraging their murder."

What an interesting thing to say, in light of continuing right-wing insistence that no such thing is true with regard to the public posting of much more specific identifying and actual targeting information about certain women's health providers, don't you think?

And as it happens, Rep. Hunter's pronouncement also comes at a time when right-wing superkook Michael Savage has announced his intention to post similar information regarding the staff of Media Matters.

But keep in mind that because there are no right-wing terrorists (and angels, I'm assured, are tearing up just at the mention of the words in close proximity to one another), Rep. Hunter's worry about attacks which have never taken place or even been threatened against foreign military operatives is very real and deserving of serious concern, while the attacks which are openly threatened and in fact carried out time and again against doctors or anyone otherwise deemed "too liberal" (not to mention the new hobby of stalking and ambush of people writes things wingnuts don't like) are not only frivolous and silly concerns, but are downright anti-American to discuss.

Congress Matters :: "You are literally encouraging their murder."

Christian Immoralists

Sharlet is the author of The Family: The Secret Fundamentalism at the Heart of American Power. Scary, scary stuff for any of us that don't like the idea of our government being run by creepy, extremist, right wing Christain fundamentalists.

Sharlet also wrote a piece for Rolling Stone on Sam Brownback which is well worth the read back in 2006 titled God's Senator: Who would Jesus vote for? Meet Sam Brownback.

Maddow: As part of the research for the book, Jeff lived among the family and saw many of its actions first hand. [...] What is C-Street? I know it's a house on C Street in Washington. How is it part of the family?

Sharlet: Well, the C-Street house is actually a former convent and now it's registered as a church and it's run by The Family and used by them to provide housing for six to eight congressmen at any given time, and to provide spiritual counseling for these congressmen.

Which all sounds fine so far, but what makes it a little bit different than other Christian conservative organizations, two things, you said that it's secretive. Indeed the leader of the group describes, he says, the more invisible you can make your organization, the more influence it will have. And the other things is the nature of the influence they want to have.

I got to sit in on one of these spiritual counseling sessions between the leader of the family and Congressman Todd Tiahrt when I visited the C-Street House, I actually met Sen. Ensign there. As the leader of The Family was counseling Congressman Tiahrt, he had this very standard issue, bill of issues related to the Christian right. He said you've got to have a bigger vision of what we're talking about here. He called it Jesus plus nothing.

He said it's sort of a totalitarian idea of Christianity and he gave as examples men who he believed understood the way power should be wielded. He actually gave as examples, Hitler, Pol Pot, Osama bin Laden and Lenin.

Maddow: Wow. When I read your book, The Family, when it first came out in hardback, my notes on um, I write notes in the flyleaf about what I was thinking about. And my notes about it, I went back and looked, were that it was essentially to promote, it saw its role as promoting American power, world wide, unfettered capitalism with no unions, no programs to help poor people, all with this idea that godly powerful rich men should get as many resources as possible personally, and they should just privately help everyone else. That is the impression that I was left with. Was I close?

Sharlet: That's dead on the money. The family began, it's the oldest Christian conservative organization in Washington and it goes back seventy years. And the founder believed that god gave him a new revelation saying that Christianity had gotten it wrong for two thousand years and that what most people think of as Christianity, as being about, you know, helping the weak and the poor and the meek and the down and out, he believes god came to him one night in April in 1935 and said what Christianity should really be about is building more power for the already powerful. And that these powerful men who were chosen by god can then if they want to dispense blessings to the rest of us, through a kind of trickle-down fundamentalism.

Maddow: Well do you see a connection between that large sort of power theology and the fact that neither John Ensign or Mark Sanford for that matter, who's also affiliated with the group, aren't quitting despite these scandals. Is there something about this type of theology that tells these guys, hey don't worry about the affair, you know, big picture, you're good, stay where you are, it's important for you to stay in power?

Sharlet: Yeah, no, I think actually Gov. Sanford made it very clear when he cited King David as an example of the reason why he wasn't going to be resigning office and that struck a bell with me because I, the King David story, the core teaching of The Family, when I first heard it, I was living with The Family.

One of the leaders of The Family was explaining why King David was important and it's not because he was a good man. It's because he was a bad man. You know, he seduced another man's wife, he actually had the husband murdered and he once explained why this was a model and he said it to one of the men in the group. He said, suppose I heard you raped three little girls. What would I think of you? And this guy, being a human being says, you would think I was a monster. Well, the leader of The Family says no, not at all because you're chosen. You're chosen by god for leadership, and so the normal rules don't apply.

Maddow: When Sen. Jim DeMint of South Carolina talked about his relationship to this group, he's also lived at the C-Street House, he described the group to the AP years ago, six years ago by saying "We do have a bible study...somebody'll share a verse or a thought, but mostly it's more of an accountability group to talk about things that are going on in our lives, and how we're dealing with them". And you've written that members of The Family give each other veto power over their lives, which, with these two scandals, I mean looking at the John Ensign scandal, how does a group like that not veto putting the mistress' kids on the Republican party payroll? How does that not get outed by this group?

Sharlet: Well, because the responsibility of the other men in your accountability group, and I would say by the way, you don't have accountability behind closed doors, that's the opposite of accountability, what these other men are doing is they're saying, alright, we're going to look out for you. Sort of self interest by proxy and what they're calling accountability is a man might bring to the group for instance that he is having an affair with another woman, or the fact that he is perhaps corrupt in some way and so on, and these guys are going to deal with it internally.

Maddow: Wow.

Sharlet: Very much behind closed doors, and we as a group actually once said, what we do is, to use this pretentious Latin phrase, beyond the din of the vox populi. What it means is beyond the voice of the people.

Maddow: Jeff Sharlet is an editor at Harper's Magazine. He's also the author of the book The Family, and if you think this has incredible implications for domestic politics and hypocrisy and affairs, wait till you read about third world dictators and how these guys empower them.

The Rachel Maddow Show: Christian Conservatism's Shadowy Secret Society | Video Cafe

Republican Stupidity

Dear Mr. President: I am writing you today because I am outraged at the notion of involving government in healthcare decisions like they do in other countries. I believe healthcare decisions should be between myself and my doctor.

Well, that is not strictly true. I believe healthcare decisions should be between myself, my doctor, and my insurance company, which provides me a list of which doctors I can see, which specialists I can see, and has a strict policy outlining when I can and can't see those specialists, for what symptoms, and what tests my doctors can or cannot perform for a given set of symptoms. That seems fair, because the insurance company needs to make a profit; they're not in the business of just keeping people alive for free.

Oh, and also my employer. My employer decides what health insurance company and plans will be available to me in the first place. If I quit that job and find another, my heath insurance will be different, and I may or may not be able to see the same doctor as I had been seeing before, or receive the same treatments, or obtain the same medicines. So I believe my healthcare decisions should be between myself, the company I work for, my insurance company, and my doctor. Assuming I'm employed, which is a tough go in the current economy.

Hmm, but that's still a little simplistic. I suppose we should clarify.

I also believe my healthcare should depend on the form I fill out when I apply for that health insurance, which stipulates that any medical problems I ever had previously in my life won't be covered by that insurance, and so I am not allowed to seek further care for them, at least not at my insurance company's expense. That seems fair; otherwise my insurance company might be cheated by me knowing I needed healthcare for something in advance.

And if I didn't know about an existing condition I had, but I could have known about it, had someone discovered it, I suppose it doesn't make much sense for my insurance to cover that either.

But let us assume that all hurdles have been cleared and I am allowed to see my doctor, chosen from a list of available doctors, about a health problem, except health problems I have previously been treated for. After that, I believe my healthcare decisions should be between myself, my insurance company, my insurance plan, my employer, and my doctor.

Oh -- and the doctors at the insurance company, of course.

They will never actually meet me, or even speak to me on the phone, and in fact I couldn't tell you the name of a single one of them, or what state they were in, or whether or not they've just all been outsourced to a computer program somewhere in Asia at this point -- but they're in charge of determining which treatments might be "effective" for me, and which will be a waste of money, er, time. They do this by looking not at my case, which is individualistic and piffling and minor, but at the statistical panoply of treatments on the insurance company spreadsheet and their statistical cost vs. effectiveness. My doctor may think one treatment or another might be effective for me in a particular instance -- but he may be a little too closely involved with my personal case, and unable to make these decisions nearly as well as my less involved, more dispassionate insurance company can.

And then there's the claims office. When my doctor sends a bill to my insurance company, it must travel through a phalanx of people and departments and procedures in order to determine whether or not it is, in fact, a valid medical complaint to be treated for, done the right way, at the right time, by a doctor on the right list. If the paperwork is not done on time, or not done completely, or not done to the satisfaction of the right people, or if I did not receive the proper prior approval for the medical treatment administered, or if that approval expired, or if the insurance company rescinded the approval months after the fact, my medical care will not be covered. While my doctor has had to sometimes forgo payments because the 30-day window for receiving "all requested documentation" somehow slipped by, I myself have received notes from the insurance company denying coverage for treatments from twelve full months beforehand. It can't be helped: sometimes it takes twelve months for their computers to process the paperwork and determine that I owe them more money. They like to be thorough.

So that's getting a bit more complete. I believe my healthcare decisions should be between me, my insurance company plan, my statement of preexisting conditions, the claims adjusters at my insurance company, my insurance company's doctors, my employer, and myself.

And the separate claims review team that will be looking over my treatment.

My health insurer might have flagged me as someone who needs a lot of healthcare, and who is therefore costing the company money. Needing to use the insurance you paid for is naturally a suspicious activity: that means that a special review team will look over my paperwork, seeing if there is any vaguely plausible reason for the company to be rid of me. They will look for loopholes in my application, irregularities in the paperwork my doctor filled out or any other situations which, like magic, mean that all the money I have paid for health insurance premiums was in fact irrelevant, null and void, and they don't have to pay a single cent of claims because I defrauded them by neglecting to remember that I had chicken pox in sixth grade, not fifth, or that what I presumed was a bad cold in 1997 was in fact maybe-possibly-bronchitis, and I can't possibly expect to be covered for any lung-related complaints since then. I suppose I cannot complain too much; after all, this is a crack squadron of employees whose pay is determined by how much they can reduce the healthcare costs incurred by the company. It would be irresponsible for them to not look for such loopholes.

And then there is the board of directors at the insurance company, of course. My personal healthcare is irrelevant, when considered in the abstract; a health insurance company exists to make a profit, and the pay of every executive in the company and every board member is dependent on squeezing out the maximal amount of profits from every dollar.

This is where "experimental" and/or "preventative" treatments come in. New-fangled treatments, things that have only been around for a decade or two, are usually the most expensive. For example, when I complained of chest pains I could have had an CT scan to determine the state of the arteries around my heart, and it would have shown exactly where the problems, if any, lie. This is what the specialist recommended -- but using a CT scan in this way is considered "preventative" treatment, not "diagnostic" treatment, so it is not covered, and I am not allowed to have one. Instead, less accurate tests were used to get a "feel" for what the arteries might look like; these tests are covered. Problem solved; as it turned out, my chest pains were probably a preexisting condition, most likely caused by me having bones. And if it's not, I suppose we'll find out in another ten years or so, when no doubt I am covered by another insurance company and not this one.

These may seem like arbitrary determinations, but they are not. They are based on a rigorous study of how well the treatment works, how much it costs, and how likely it is that the company will have its corporate ass sued off if they do not provide it. This is weighed against the desired profit announcements for the insurance company during that quarter in order to determine how much care must be denied to customers, in aggregate, in order to meet the appropriate financial goals.

Let us not forget the obligations to the stockholders, after all.  Of every dollar paid in premiums, currently eighty cents it paid back out for actual medical claims; the rest is administration and profit-taking. Fifteen years ago the number was 95 cents: in other words, the insurance companies themselves have gone from taking five cents of every healthcare dollar to taking twenty cents of every dollar, all since the Clinton presidency.

The stockholders require healthy profits. The executives require personal profits for providing those profits. And since people for some reason aren't getting any healthier, those profits can only come from one place -- reducing what the company pays out when people do become sick.

I recently heard a radio interview with a health insurance company whistleblower; he was describing his trips on the company jet. Gourmet meals were served on china, and the forks were gold plated.

I was pondering this, while looking over the letter from my insurance company informing me that they were switching the coverage of my most expensive monthly medication -- those expensive allergy/asthma shots now count as a "procedure", not as "medicine", and so therefore those vials are not covered by my pharmaceutical plan anymore. It must be very difficult to balance all the tasks of an insurance company CEO. If the corporate jet has inferior place settings, imagine the corporate shame. If a new medication or treatment is no longer considered "experimental", or a treatment classified as actually useful, as opposed to "preventative" nonsense, consider how many millions of dollars the company would have to pay out to give people that treatment. It seems reasonable indeed for the president of my insurance company to have personally pocketed a few hundreds of millions here or there -- I cannot imagine the stress of keeping up with proper utensil etiquette during a time when those you insure are doing you the constant insult of actually getting sick.

So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company's list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company's claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company's crack cost-review and retroactive cancellation and denial squads, my insurance company's executives and board of directors, my insurance company's profit requirements, the shareholders, my employer, and my doctor.

Anything else would be insulting.

 Dear Mr. President

Soldiers in Colorado slayings tell of Iraq horrors - Yahoo! News

Another reason to hate wars.. They create monsters of our children.

COLORADO SPRINGS, Colo. – Soldiers from an Army unit that had 10 infantrymen accused of murder, attempted murder or manslaughter after returning to civilian life described a breakdown in discipline during their Iraq deployment in which troops murdered civilians, a newspaper reported Sunday.

Some Fort Carson, Colo.-based soldiers have had trouble adjusting to life back in the United States, saying they refused to seek help, or were belittled or punished for seeking help. Others say they were ignored by their commanders, or coped through drug and alcohol abuse before they allegedly committed crimes, The Gazette of Colorado Springs said.

The Gazette based its report on months of interviews with soldiers and their families, medical and military records, court documents and photographs.

Several soldiers said unit discipline deteriorated while in Iraq.

"Toward the end, we were so mad and tired and frustrated," said Daniel Freeman. "You came too close, we lit you up. You didn't stop, we ran your car over with the Bradley," an armored fighting vehicle.

With each roadside bombing, soldiers would fire in all directions "and just light the whole area up," said Anthony Marquez, a friend of Freeman in the 1st Battalion, 9th Infantry Regiment. "If anyone was around, that was their fault. We smoked 'em."

Taxi drivers got shot for no reason, and others were dropped off bridges after interrogations, said Marcus Mifflin, who was eventually discharged with post traumatic stress syndrome.

"You didn't get blamed unless someone could be absolutely sure you did something wrong," he said

Soldiers interviewed by The Gazette cited lengthy deployments, being sent back into battle after surviving war injuries that would have been fatal in previous conflicts, and engaging in some of the bloodiest combat in Iraq. The soldiers describing those experiences were part of the 3,500-soldier unit now called the 4th Infantry Division's 4th Brigade Combat Team.

Since 2005, some brigade soldiers also have been involved in brawls, beatings, rapes, DUIs, drug deals, domestic violence, shootings, stabbings, kidnapping and suicides.

The unit was deployed for a year to Iraq's Sunni Triangle in September 2004. Sixty-four unit soldiers were killed and more than 400 wounded — about double the average for Army brigades in Iraq, according to Fort Carson. In 2007, the unit served a bloody 15-month mission in Baghdad. It's currently deployed to the Khyber Pass region in Afghanistan.

Marquez was the first in his brigade to kill someone after an Iraq tour. In 2006, he used a stun gun to shock a drug dealer in Widefield, Colo., in a dispute over a marijuana sale, then shot and killed him.

Marquez's mother, Teresa Hernandez, warned Marquez's sergeant at Fort Carson her son was showing signs of violent behavior, abusing alcohol and pain pills and carrying a gun. "I told them he was a walking time bomb," she said.

Hernandez said the sergeant later taunted Marquez about her phone call.

"If I was just a guy off the street, I might have hesitated to shoot," Marquez told The Gazette in the Bent County Correctional Facility, where he is serving a 30-year prison term. "But after Iraq, it was just natural."

The Army trains soldiers to be that way, said Kenneth Eastridge, an infantry specialist serving 10 years for accessory to murder.

"The Army pounds it into your head until it is instinct: Kill everybody, kill everybody," he said. "And you do. Then they just think you can just come home and turn it off."

Both soldiers were wounded, sent back into action and saw friends and officers killed in their first deployment. On numerous occasions, explosions shredded the bodies of civilians, others were slain in sectarian violence — and the unit had to bag the bodies.

"Guys with drill bits in their eyes," Eastridge said. "Guys with nails in their heads."

Last week, the Army released a study of soldiers at Fort Carson that found that the trauma of fierce combat and soldier refusals or obstacles to seeking mental health care may have helped drive some to violence at home. It said more study is needed.

While most unit soldiers coped post-deployment, a handful went on to kill back home in Colorado.

Many returning soldiers did seek counseling.

"We're used to seeing people who are depressed and want to hurt themselves. We're trained to deal with that," said Davida Hoffman, director of the privately operated First Choice Counseling Center in Colorado Springs. "But these soldiers were depressed and saying, 'I've got this anger, I want to hurt somebody.' We weren't accustomed to that."

At Fort Carson, Eastridge and other soldiers said they lied during an army screening about their deployment that was designed to detect potential behavioral problems.

Sergeants sometimes refused to let soldiers get PTSD help or taunted them, said Andrew Pogany, a former Fort Carson special forces sergeant who investigates complaints for the advocacy group Veterans for America.

Soldier John Needham described a number of alleged crimes in a December 2007 letter to the Inspector General's Office of Fort Carson. In the letter, obtained by The Gazette, Needham said that a sergeant shot a boy riding a bicycle down the street for no reason.

Another sergeant shot a man in the head while questioning him, lashed the man's body to his Humvee and drove around the neighborhood. Needham also claimed sergeants removed victims' brains.

The Army's criminal investigation division interviewed unit soldiers and said it couldn't substantiate the allegations.

The Army has declared soldiers' mental health a top priority.

"When we see a problem, we try to identify it and really learn what we can do about it. That is what we are trying to do here," said Maj. Gen. Mark Graham, Fort Carson's commander. "There is a culture and a stigma that needs to change."

Fort Carson officers are trained to help troops showing stress signs, and the base has doubled its number of behavioral-health counselors. Soldiers seeing an Army doctor for any reason undergo a mental health evaluation.

Soldiers in Colorado slayings tell of Iraq horrors - Yahoo! News