So, a relative of mine messed up her knee a few weeks ago, possibly a ligament tear. She goes to see one of the "feed lot" orthopedists here in town. I think she's in the office for 2 minutes before he starts handing her brochures about recovering from her surgery. She of course, rebels and demands to discuss other options (physical therapy, cortisone, etc) because the injury doesn't appear to be that bad.

Knee improvement has been slow, and now her shoulder has been acting up, so she decides she'll go ahead and have a follow-up appointment to discuss the knee and the shoulder together, and maybe even have the MRI for both.

"Oh no," the doctor says. "We only see one joint at a time. You have to make two appointments." HUH?

After all, why give up all that additional insurance money?

I used to think that a 'hybrid' government-private approach would be a good solution. Now I think that single payer is the only way to eliminate this kind of greedy double-dipping.

No, seriously. I'm not making that up:

To pay for the tax credit, McCain would eliminate the tax exemption for people whose employers pay a portion of their coverage, raising an estimated $3.6 trillion in revenues, Holtz-Eakin said. Companies that provide coverage to workers still would get tax breaks. McCain would also cut costs by limiting health care lawsuits.

Clinton responds:

"The McCain plan eliminates the policies that hold the employer-based health insurance system together, so while people might have a 'choice' of getting such coverage, employers would have no incentive to provide it. This means 158 million Americans with job-based coverage today could be at risk of losing the insurance they have come to depend upon."

Uh, Hillary, divorcing health insurance from employment is the only sane part of McCain's plan.

Obama says:

McCain is "recycling the same failed policies that didn't work when George Bush first proposed them and won't work now. Instead of taking on the big health insurance companies and requiring them to cover Americans with preexisting conditions, Senator McCain wants to make it easier for them to reject your coverage, drop it, or jack up the price you pay."

I didn't get that part, but maybe it's in the details McCain hasn't provided. And Obama is standing up to the insurance companies how? By not making you buy their product?

According to this report, McCain said that he would "encourage state governments to create guaranteed-access plans" as a safety net for high-risk workers. Sounds like another unfunded mandate. And state Medicaid and SCHIP programs are already stretched to the breaking point.

At any rate, one thing all the candidates agree on is that insurance policies should be portable and available across state lines. We will have to wait for more details of McCain's plan, but it doesn't sound like there's a dimes worth of difference between any of the three proposals. OK, maybe fifteen cents. And the bottom line is that the President can't unilaterally enact any of this anyway.

In a Knoxville News Sentinel op-ed yesterday, Sen. Bob Corker says the government should pay for people's health care.

According to Sen. Corker, he only recently learned from speaking to a gentleman in East Tennessee that a lot of people don't have health insurance and end up going to emergency rooms for treatment.

Sen. Corker's solution is to provide every American "cash in hand," $2,160 for individuals or $5,400 for families, to purchase health insurance either through their employer or in the private market. He says it will be revenue neutral, but he doesn't explain how.

He also says that the alternative is "government-sponsored health care," which would "lower the quality of care, limit access to physicians and put a government bureaucrat between a patient and his or her doctor."

A couple of things.

If "government-sponsored health care" is such a bad thing, why he is proposing exactly that?

Second, Sen. Corker seems out of touch with regard to the cost of premiums. The average annual total premium cost in 2007 was $4,479 for single coverage and $12,106 for family coverage (source).

Third, Sen. Corker is apparently unaware that insurance companies in Tennessee aren't required to write anyone an individual policy. So if you're not employed by, say, the Federal Government (like Sen. Corker), good luck. Not only that, but employers aren't required by federal law to offer insurance either. So a big check from the government isn't going to help you if you are unemployed, self-employed, underemployed, or your employer doesn't provide health insurance, especially in Tennessee.

Fourth, Sen. Corker, like many Republicans, believes we can fix anything in the tax code ("we make the tax code treat all Americans equally when it comes to buying health insurance"). Meanwhile, his colleague, senior Tennessee Senator Lamar Alexander, just recently called for eliminating the tax code and going to a flat tax. So how can we solve all our problems through the tax code if we don't have a tax code? Maybe Sen. Corker's people ought to get with Sen. Alexander's people and schedule lunch?

Finally (I guess that was more than a couple of things), I am not clear on how "government-sponsored health care" (which is ironically what he proposes) would "limit access to physicians" or how it would put a "government bureaucrat between a patient and his or her doctor."

The last time I checked, just about every physician and hospital accepts Medicare. And unlike most private insurance, which requires pre-approval by minimum-wage cubical clerks in call centers (in India?), standard Medicare requires no pre-approval. And study after study shows Medicare is more cost effective and has lower administrative overhead than private insurance. In fact, some studies say we could reduce our overall health care costs (another one of Sen. Corker's goals) by $200 billion to $300 billion per year by opening up Medicare insurance to everyone. In other words, we are already paying for "universal coverage," we're just not getting it.

Sen. Corker should study up on plans such as HR676, which accomplishes everything he says he wants and a lot more for a lot less, before floating more half-baked, recycled GOP talking point "solutions." The problem from Sen. Corker's point of view, though, is that a comprehensive single-payer solution doesn't benefit the corporate insurance company middle men and gatekeepers, who are the real beneficiaries of his plan.

Frank at Left of the Dial has a report with commentary.

RELATED: 60 Minutes coverage of Remote Area Medical's Knoxville clinic.

Knoxville News Sentinel:

In Tennessee between 2000-2006, the report said, more than 3,600 people 25-64 years of age died as the result of a lack of health insurance. Uninsured people are 25 percent more likely to die prematurely than adults with private insurance.

This is a disgrace.

A few months ago, Knoxville was the site of a shocking event: hundreds of East Tennesseans and others from nearby areas flooded into downtown to seek medical care that had become unaffordable to them. A few months later, we learned that Baptist Hospital, one of the biggest and best of our fine local hospitals, was to be absorbed by the St. Mary's system.

Is it possible that these two events are related? Could it be that, if we had universal, single-payer health care, those hard-working Tennesseans who were reduced to begging for what in most civilized countries is a basic human right would have filled those unused beds at Baptist, thereby averting the closure of one of the best hospitals in the area?

Why have we chosen to enrich the private insurance companies, close our hospitals, and subject more and more of our citizens to ill health and bankruptcy? You always hear that "rationing" of health care is a result of socialized health care, but it's increasingly obvious that unrestrained capitalism is the real culprit.

WBIR reports (by way of KT) that the new citizen's grant review panel declined grant funding for Dr. Kim's Free Clinic. According to the report, the clinic has received funding for the past three years, and was hoping to get funding for a new nurse position this year.

Personally, this seems like a bad start for the citizen's grant review panel. But I suppose there are a lot of tough decisions that have to be made. Maybe some of them are better left to pros. (I also wonder if this has anything to do with the St. Mary's/Baptist merger? Does that affect future plans for the clinic?)

Anyway, if you'd like to help Dr. Kim's Free Clinic fund a new nurse position, you can make a donation:

Make checks payable to Free Medical Clinic and mail to:

Baptist Health System Foundation
Free Medical Clinic Fund
101 Blount Avenue, Suite 530
Knoxville, TN 37920

A $22 price difference for a prescription. But I'm ahead of myself.

As I have stated here previously, I am a patient of Interfaith Clinic. Early in the week I was feeling fatigued and sick to my stomach, Wednesday I woke up well past the sort of, maybe state of being sick. I was afraid I might have the flu, so I called and got an appointment for that afternoon.

Long and short, no flu but there's also a nasty virus going around that has some of the same symptoms. We're going through the vitals check, and the doc listens to my lungs. She stops, and has the pre-med student who is making rounds listen. It was to demonstrate what asthma sounds like. I've never had asthma, but the doc says it's probably viral, since I've never had "attacks" and no one has ever expressed the possibility to me. The air comes in fine, but I'm wheezing when it goes out.

More on the jump.

In case you missed it, here's the 60 Minutes report on Knoxville based Remote Area Medical and the recent free clinic they conducted in Knoxville.

See also this column in yesterday's Knoxville News Sentinel by Dr. Tom Kim who operates the Free Medical Clinic in Knoxville. And this article from last week that reports there are up to 80,000 uninsured in Knox County alone.

This is a national disgrace. Dr. Kim describes the scene at the RAM event as a "Third World emergency room." In Knoxville, Tennessee. In the United States of America.

Watch the 60 Minutes report. Read the articles. If you have an ounce of human compassion it will break your heart. If you care at all about social justice you will be outraged that we are allowing this to happen in America.

In the 60 Minutes report, Joanne Ford was hoping to get in to the clinic. When asked what she would do if she couldn't, she said "I don't know. I have a lot of friends and I have a lot of church support. I was very active in my church and I have a lot of friends in church. I just hate to ask. I've worked all my life. I hate to ask."

I hate to ask.

Well, I hate to ask, but if you think this is a disgrace please do a couple of things.

First, go over to Remote Area Medical's website and make a donation. Then write a check to Dr. Kim's Free Medical Clinic or the Interfaith Clinic or one of the other local organizations helping the needy and the working poor who are uninsured and can't afford basic health care.

Second, when politicians ask for your vote, ask if they are committed to fixing America's broken health care system so that every man, woman, and child in America has health insurance they can afford or that is provided for them if they can't.

Read up on HR676 and ask your Senators and Representative why this hasn't been brought up for a vote or at least debated. Ask them if they think it's a good idea, and if not why not. Ask them what their better idea is, and don't accept more empty rhetoric about "market based" solutions and tax credits for employer-provided insurance as the answer. Tell them to watch the 60 Minutes report and get back to you on how that's working out for the poor and the working class people of America.

The Knoxville News Sentinel had a bold headline on the front page of today's local section proclaiming "Electronic exchange of patient info close" with the sub heading "AT&T and Tenn. create system for accessing, sharing medical records." The opening paragraphs state:

AT&T Inc. is partnering with Tennessee to provide the country's first statewide system to electronically exchange patient medical information, the telecommunications company will announce today.

The system is designed to securely transmit detailed patient information between medical professionals.

It will allow doctors to access medical histories, prescribe medicines over the Internet and transfer images like X-rays, MRIs and CT scans.

The problem is that the system is not a medical records system and it does not manage patient histories or medical imaging as one might conclude from reading the article.

Instead, if you read closely it says that the system allows "exchange" and "access" and is designed to "securely transmit" information. That's all it does, as far as I can tell. But what do you expect from a cut and paste wire report rewrite of an AT&T press release?

It's like the cable guy coming in to your home or office and setting up a broadband modem and a VPN ("virtual private network") for you and then giving you an 800 number to call if you have a problem. That's what they're selling.

The Mrs. was at the drug store picking up a prescription for me yesterday (thanks!) and there was a woman in front of her with six prescriptions to fill. The clerk was going over the cost of each prescription with her, so she could decide which ones she would have filled. She couldn't afford to pay for having them all filled.

It is immoral and just plain wrong that anyone in America has to make decisions like this. Yet millions do every day.

I just wanted to note that anecdote, but it also reminded me of the KnoxRX and BlountRX programs.

Think again. From WATE:

Plans to add a new hospital in Roane County hinge on the votes of just five people.

That's because the proposed site where Covenant Health wants to build is located outside Harriman's city limits. The city needs to annex some county property in order for the deal to work.

WATE is not clear on why the properties need to be annexed for the "deal to work," but a hospital is a great asset for any community.

I guess the question is why it has to be inside city limits (we're guessing it has to do with infrastructure and/or tax incentives). Maybe WhitesCreek Steve can help us out here?

At any rate, here's a case where two or three votes matter. So the moral of the story is, vote!

The first primaries are a week away. Where do the Democratic candidates stand on health care? Find out at TennViews...

The House is scheduled to vote on overriding Bush's veto of the State Children's Health Insurance Program today.

Contrary to GOP talking points, it's not "socialized medicine" for "people who can afford their own insurance." It's insurance (not health care) for people who make too much to qualify for Medicaid but not enough to fork over $12,000 per year for family health insurance. SCHIP premiums range from about $10 per month per child up to $450 per month per family depending on income and which state program.

Nonetheless, the Bush 30% dead-enders will likely block the veto override. Our Congressman, Rep. Jimmy Duncan, will be one of them.

Nearly 10 million children do not have health insurance. The bill would add $35 billion over five years to help cover some of them. That works out to $7 billion per year. The occupation of Iraq is costing us nearly $10 billion per month.

You can contact Rep. Duncan here.

Heard Bill Scher on Sam Seder's Air America show correcting right wing spin and lies about the SCHIP program. Here's a summary.

Probably the best point he made on the show was that Republicans want SCHIP to fail because it proves that government health insurance programs work and are effective.

It looks like all three of the front-running Democratic presidential candidates have now done what today's Democratic politicians do best: surrender. Barbara Ehrenreich says it as well as it can be said:

Link...

Democratic presidents won two world wars, but now they're too timid to even fight a bunch of insurance companies. You'd think that, as a trial lawyer, Edwards would at least have the cojones to step up to the fight, but his healthcare plan is no different from Obama's or Clinton's. They all want to preserve the failing employer-based private system, and they want the federal government to force you and me to dig further into our pockets to further enrich the insurance rackets. They promise government assistance to help out the poor, but experience tells me that's the part of the plan that will disappear after the election.

Maybe the Republicans are right. Maybe Democrats are too timid to fight a real national threat: insurance companies whose denial of claims kill five times the number of Americans who were killed on 9/11, and they do it every year. The Dems' response: we'll get the taxpayers to give them more money.

Once again, Kucinich is the only candidate willing to fight the real enemy, but he's disqualified because he has a lot of bad hair days.

What was once a pretty good consumer-oriented organization for folks fifty and older is now a corporate shill that has excluded the only presidential candidate advocating single-payer health care from a national debate. Read the ugly details below.

Link...

Hillary Clinton will unveil her plan for universal health coverage in Iowa today. According to the Associated Press, the plan will cost about $110 billion per year and includes the following:

• Requires all individuals to purchase health insurance

• Businesses must offer health insurance to all employees or contribute to a government-run pool

• A small business tax subsidy to offset the cost of providing coverage

• Medicare and the federal employee health insurance plan would be opened up to those who can't get insurance through an employer

The plan would be funded by ending Bush tax cuts for those making more than $250K.

UPDATE: This plan isn't very good, but for exactly the opposite reasons expressed here.

Another fine example of people who don't even bother to read past "Hillary" before offering up idiotic kneejerk reactions, and who have decided to be part of the problem instead of the solution. The irony is that they are too stupid to realize that the Clinton plan perpetuates what they already have which they seem to think is such a great deal, until they might actually need it. I guess they have a problem with eliminating tax cuts for those making over $250K, as if it might apply to them. Hope springs eternal, I guess.

It looks like lingering questions about Baptist Hospital are answered.

Hmmm, Baptists and Catholics hooking up. Speaking from personal experience with the nominally Catholic Mrs., Baptists usually get the better end of that deal.

UPDATE: More details (PDF format):

• Official announcement

• Questions and Answers

Well, our favorite know-nothing know-it-all is back on the front page of today's KNS editorial section with another incredibly stupid and misleading column.

I can't find a link to it from the KNS opinion page, nor did their online search turn it up. Maybe they were embarrassed by it. Which is almost just as well, because I am loathe to link to it. But you really have to read it to fully appreciate the profound ignorance. So, Google to the rescue.

In this week's installment of dangerously misinformed radical right-wing propaganda, this Pete Stevens character tells us that "The best way to fix the American health-care system is to make it just like the American grocery system. There isn’t an American grocery system. Free-market economics works — every single time."

Read more...

Americans are living longer than ever, but not as long as people in 41 other countries.

Life expectancy ranks 42nd of 222 countries.

Possible factors:
* 45 million Americans lack health insurance
* Nearly a third of U.S. adults 20 years and older are obese
* The U.S. has the resources that allow people to get fat and lazy
* Racial disparities
* Relatively high infant mortality rate

I used to get some letters published in the Metro Pulse, but with their new owners, I suspect I'll be blackballed there just as I have been at the News Slantinel.

So, here's the original letter in the current Metro Pulse--to be found under the mysterious title "Gu-wrong": Link...

And here's my reply, which will meet its fate as my first blog entry:

Mac McAdams wrote an interesting letter about the movie “Sicko” and health insurance in the current (8/2/07) issue of the Metro Pulse. And while I disagree with Mr. McAdams on two of his points, I strongly concur on two others.

Health care is in fact free in Canada, Britain, France, and all other democratic countries—just like public libraries, fire and police departments, and most highways in the US. When you need a cop, a firemen, a library book, or a doctor you should never be asked for money. All of these public services are of course funded by taxes, but it might interest Mr. McAdams to know that the taxes used to fund universal health care in these countries add up to far less than the private insurance premiums, co-pays, and deductibles that most Americans pay—if they’re lucky enough even to have health insurance, as about 45 million Americans do not.

The answer to why wealthy celebrities and world leaders come to the US for medical treatment is simple: We have very good specialized doctors and hospitals, if you can afford them. Unlike a growing number of Americans, these rich foreigners can easily afford high-level American care. (Still, keep in mind the experience of Canadian comedian Dana Carvey, who had a heart operation in San Francisco during which the surgeon replaced the wrong artery.)

Mr. McAdams is correct, though, in observing that the US does not have to worry about “running an almost three billion dollar debt this year like France”; instead, we can look forward to paying over a trillion dollars, that’s trillion with a “t,” to pay for George W. Bush’s insane war in Iraq. The government of France wisely refused to get involved with that disaster, leaving them with funds to provide health care for their citizens instead of the death and destruction that our tax dollars are reaping.

I would also agree with Mr. McAdams that we do not “want the government that is running months behind issuing passports to provide our healthcare, . . . the government that took a week to get water to the Superdome.” In order to provide quality, universal health care and other necessary programs, we Americans will have to start electing competent governments, ones who don’t put “Heckuva Job Brownies” in charge of essential services. You know, like the French have figured out how to do.

C.E. Petro names names of the Democrats who voted against it.

Gov. Phil Bredesen: "It comes back to personal responsibility - we don't have it in our power to promise everyone free health insurance without limits. But we do have it in our power to offer them access to affordable and portable health insurance, and then the choice is theirs."

Sound familiar? If so, maybe it's because we've heard it before:

Rudy Giuliani: "Americans believe in free-market solutions to the challenges we face, and I believe we can reduce costs, expand access to, and improve the quality of health care by increasing competition. [..] To reform, we must empower all Americans by increasing health care choices and affordability, while bringing accountability to the system."

Mitt Romney: "We get people that were uninsured with private health insurance. We have to stand up and say the market works. Personal responsibility works."

Go read Egalia on why Bredesen is the last Democrat who should be talking about health care (along with some other thoughts on the DLC).

Giuliani makes a big, dramatic announcement re. his health care "plan". It's a $15,000 tax deduction (or credit, hard to say which - the AP writer calls it both, and they are, of course, entirely different) to buy "private insurance".

He hasn't worked out all the details and he doesn't know how much it would cost or how many people it would cover (he hopes to have those numbers in the next few months).

Here's a clue. A tax deduction won't help any of the 50 million people without health insurance. Most of them don't pay taxes. Oh, if it's a credit I guess it would help everybody. It would also cost about $1.5 trillion.

He also doesn't explain where people are supposed to buy this mythical "private insurance."

Great plan, Rudy. What an incredible nincompoop.

But it's so typical -- solve everything with a tax break sprinkled with fairy dust. These guys sound like a broken record, and are so incredibly clueless I don't even know why anyone takes them seriously about anything.

My brother just wrote:

"Marelle and I are in Paris. She arrived for the end of
the TOUR DE FRANCE and noticed she had red bumps.
Before long she had virus symptoms and was really
going down hill. I called the American Hospital in
Paris and they wanted 200.00 dollars to see her. So we
went the French route and for 30 Euro she saw a great
French doc just around the corner from our apartment."

By way of Elaine Davis, an update on the effort to get nurses in all Knox County schools.

The East Tennessee Branch of the Juvenile Diabetes Research Foundation is lending their support, and will speak to the School Board about it at the School Board's Aug. 6th meeting.

In addition, School Board Chair Karen Carson has called an informal public meeting on the topic. The meeting will be this Thursday, Aug. 2nd at 10AM at the Atlanta Bread Co. at Turkey Creek. Anyone interested in talking about funding for school nurses at all Knox County schools is invited to attend.

Ed. note: I'm surprised this is even an issue. I guess I assumed every school had a school nurse. Even tiny little South Knoxville Elementary had a nurse when I was growing up, and she was a primary source of health care for lots of kids.

Although school nurses should be trained not to leave kids alone in the exam room. I remember one occasion when I was sent to see the nurse due to complaining about, uh, non-specific symptoms. The nurse left me alone, and I ran the thermometer under hot water from the sink and managed to get sent home with a "fever."

In a health care workshop at the DLC in Nashville this weekend (more on that in another post), Gov. Bredesen touted Cover Tennessee as a model for addressing the problems of the uninsured.

I guess it's better than a sharp stick in the eye, or no insurance at all, especially if you've suffered a sharp stick in the eye.

Or maybe not:

I didn't expect it to be fabulous insurance. 5 visits per year, 5 prescriptions per month, just enough to cover yearly things and the occasional sickness, but better than nothing. Well, it might as well be nothing, because I can't find anyone that actually takes it. I've been seeing the same OBGYN for 15 years and her office doesn't (and is not going to ever) take Cover Tennessee. As I'm sure the women on here know, being comfortable with that particular kind of doctor is a big deal. In my quest to find a new OBGYN, I discovered that of the 9 participating Knoxville providers listed in the handbook, only one is a woman. Upon calling to make an appointment, I was told that she does NOT take the plan, things have changed since the book came out.

We need to quit sticking band-aids on our broken health care system and perform some major surgery.

Sen. Bob Corker responds regarding HR676:

Dear Mr. Neal,

Thank you for taking the time to contact my office about H.R. 676, the United States National Health Insurance Act. Your input is important to me, and I appreciate the time you took to share your thoughts.

Healthcare is one of the most important issues facing our nation today, and I agree with you that something needs to be done to address rising healthcare and prescription drug costs as well as the rising number of uninsured Americans. Since arriving in Washington, I have been working closely with my Senate colleagues to create comprehensive healthcare reform aimed at providing affordable, portable health insurance for all Americans, even the most costly and difficult to insure. H.R. 676 has not yet been introduced in the Senate, but I will certainly keep your thoughts in mind should I be given the opportunity to vote on this legislation.

Thank you again for your letter. I hope you will continue to share your thoughts with me over the next six years.

Sincerely,

Bob Corker
United States Senator

To Sen. Corker's credit, "comprehensive healthcare reform aimed at providing affordable, portable health insurance for all Americans, even the most costly and difficult to insure" is a worthy goal. HR676 does this, so I hope it will get a fair hearing in the House and then the Senate.

There's no mention of the pledge to refuse campaign contributions from insurance and pharmaceutical interests, though.

OK, so we've seen the movie and we're sufficiently outraged and we're starting to talk about our broken health care system.

What now? What can we actually do about it?

Read more...