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#Post#: 777--------------------------------------------------
UNIVERSAL Primary Care small price tag — less than 6% of total
spending — is offset by lower premiums
DIR By: AGelbert
Date: January 14, 2023, 12:02 pm
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January 13, 2023 This commentary is by Dr. Deborah Richter,
M.D., a practicing family physician in Cambridge, Vt. She lives
in Montpelier.
[center]
Dr. Deborah Richter:
HTML https://soberthinking.createaforum.com/gallery/soberthinking/1-110422180553-643238.gif<br
/>Yes, we can do something about Vermont’s health care
crisis[/center]
Legislative leaders have already laid out their agenda for this
session. Despite the dire state of health care for the almost
half of Vermonters under age 65 who are “underinsured,” it is
clear that they have no intention of doing anything meaningful
to address the state’s health care crisis.
Underinsured is an abstract idea that is easy to dismiss, but it
has serious, potentially deadly real-life consequences. The
underinsured 😞 have two alternatives when they are sick:
► Delay care and risk their health.
► Pay for care and risk falling into debt, getting
evicted, etc.
Delaying care can cost them 🥵 dearly. Two examples:
► A diabetic with a huge deductible fails to get routine
checkups and ends up needing a foot amputation.
► A person with a high fever and shortness of breath waits
days to seek care and dies of bacterial pneumonia.
The other alternative, paying for care you can’t afford, also
costs them dearly. That’s how “around 30,000 Vermonters” ended
up with medical debt turned over to collection agencies, while
“tens of thousands more … are paying down medical bills” that
have yet to be turned over to collections.
If you want to see what medical debt does to your life, read
over some of the stories
HTML https://soberthinking.createaforum.com/gallery/soberthinking/1-050422182057.gif<br
/>collected by the state’s health care advocate
HTML https://www.vtmedicaldebt.org/.
Medical debt has dramatic
effects on these people’s lives, from ruined credit to skimping
on food to postponing retirement. It goes without saying that
these people avoid getting future medical treatment for fear of
running up even more debt.
This kind of deciding between a rock and a hard place goes on
every day in Vermont. It amounts to the worst, most unfair kind
of health care rationing. 🥺
[b]Why do we allow it?[/b] Here are the
HTML https://soberthinking.createaforum.com/gallery/soberthinking/1-090822164512.png<br
/>excuses we hear from some of our
HTML https://soberthinking.createaforum.com/gallery/soberthinking/1-080822134118-17091258.gif💵🎩<br
/>legislators:
Excuse 1: Because Medicare and Medicaid are federally directed,
we can’t change the rules they have in place.
This is simply not true. Waivers of federal rules are very
common in Vermont and other states. In Vermont, VHAP, Dr.
Dynasaur, and the all-payer model and the accountable care
organization running it all operate under waivers of federal
rules. And anyone watching the recent circus in Washington knows
that we cannot expect a national universal health care system
anytime soon.
Excuse 2: We don’t have enough primary care clinicians and
expanding coverage would just make this worse.
Again, not true. Implementing universal primary care would be a
magnet drawing primary care clinicians to this state. Including
all patients in one program, with one set of rules and
regulations rather than hundreds they now face, would vastly
reduce the amount of time and effort they are forced to spend on
administrative tasks.
Few people outside the medical profession appreciate how heavy
that burden is now: 15.9 hours a week for family medicine
doctors, according to a 2020 survey
HTML https://www.medscape.com/slideshow/2020-compensation-overview-6012684?src=WNL_physrep_200514_comp2020&uac=317871PZ&impID=2380343&faf=1#19.<br
/>
Excuse 3: It is too expensive to expand coverage to everyone.
In fact, we already spend more than enough to provide
comprehensive care to all Vermonters. That has been shown in
study after study.
HTML https://soberthinking.createaforum.com/gallery/soberthinking/1-050422133908.gif
mplementing a universal system would save massive amounts — as
much as $1 billion, according to some studies
HTML https://ljfo.vermont.gov/assets/docs/healthcare/1a3342b9a2/FINAL-REPORT-Hsiao-Final-Report-17-February-2011_3.pdf.<br
/>
Excuse 4: We need to address cost of care before expanding
access.
The truth is that we will never be able to make health care
affordable until we implement a universal access system. First,
keeping people out of the current system is administratively
very costly, as discussed above. Second, our current system
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/>encourages delayed care, which ends up costing more because
people get 🤧🤒🤮🤢🤕 sicker
during the delay.
​Note that these arguments against needed reforms are
generalities while avoiding real reform inflicts very specific
and extensive damage on a large portion of Vermonters.
Everyone agrees that health care needs to be fixed. Admittedly
it is a gargantuan task to try to fix the whole system at once.
After all, health care is nearly 20% of the Vermont economy with
big, entrenched
💵🎩
HTML https://soberthinking.createaforum.com/gallery/soberthinking/1-010922192452.gif<br
/>“stakeholders” who exercise considerable influence over what
legislation gets “moved” in the Legislature.
So why not start with a smaller piece: Universal primary care.
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That makes primary care — including mental health and substance
use disorder services — a public good, like police protection
and firefighting. Commercial insurers would no longer have to
pay the cost of primary care, and premiums would be reduced
accordingly.
Universal primary care is a small but important piece of the
answer. It comes with a small price tag for taxpayers — less
than 6% of total spending — and that is offset by lower
premiums. But it would make a big difference. Everyone needs
primary care, even healthy people.
Make no mistake: This legislation is within the power of the
Vermont Legislature. Ask your legislators to support universal
primary care.
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HTML https://vtdigger.org/2023/01/13/dr-deborah-richter-yes-we-can-do-something-about-vermonts-health-care-crisis/
#Post#: 1220--------------------------------------------------
Healthcare is Still Sparse 😞
DIR By: AGelbert
Date: August 4, 2023, 4:33 pm
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AUG 4, 2023 by EDWIN LEAP 👍
[center]Healthcare is Still Sparse[/center]
[move]Remember to plan, and train, ahead.[/move]
SNIPPETS:
I was working in what I call ‘rural Emergistan’ recently when I
saw an elderly gentleman who had fallen. His fall was not
severe. It was not from a ladder or porch, but merely from
standing. But that simple fall conspired with his advanced years
and resulted in severe internal injuries requiring intervention
by a specialist.
His injuries were too complex for our small hospital and he
needed to be transferred to a trauma center. (In point of fact,
trauma centers now have special trauma alert designations for
older patients with falls. It’s an enormous, growing problem.
HTML https://www.cdc.gov/falls/index.html)
The hitch was that we had no way to send him to the other
facility, which was two hours away by ground ambulance.
Helicopters were not flying due to typical Appalachian weather
and we didn’t have any ambulances to spare.
Ultimately, several hours into the situation, an ambulance
became available and off he went, fortunately very stable at the
time he left.
This scenario would seem shocking to many urban dwellers, but it
is played out day after day, night after night in rural areas
across the country. It is made worse by the steady, unrelenting
closure of rural hospitals.
HTML https://medcitynews.com/2023/07/rural-hospital-insurance-finance/
Of course, this isn’t a problem of the US alone. Our Canadian
cousins face similar problems with hospital closures, or face
hospital ERs with reduced hours.
HTML https://london.ctvnews.ca/stabbing-victims-arrive-at-southwestern-ont-emergency-department-overnight-only-to-find-it-s-closed-1.6504091?taid=64caa436889a42000155c5c2
In addition to hospital closures we frequently face limitations
on available specialists, like cardiologists or assorted species
of surgeon. In these situations transfer is warranted but often
difficult.
I’m not offering a solution to systems problems. But I am asking
everyone to be careful and plan ahead. If I seem repetitive due
to prior posts, I apologize. But here are a few important tips
for these strange times: ... ...
6) I know I’ve said this before, but make sure to learn basic
first aid, bleeding control (
HTML https://www.stopthebleed.org/)
and
CPR. Check with your local EMS service or Red Cross chapter for
classes. If you are concerned about yourself or a friend or
loved-one, try to get some Narcan to use for overdose. It’s a
simple, life-saving fix.
7) Keep a good first aid kit with you whether traveling locally
or across the country. There are so many out there! I don’t have
any financial interest in this company but I have kits from My
Medic. (
HTML https://mymedic.com/)
They’re quite good. I keep one at
home and one in my vehicle. In fact, I’ve started traveling,
even when I fly, with a large gauze dressing and tourniquet in
my carry-on. I’ve never had a single problem or question asked
by security (Unlike the time I forgot that I had ammunition in
my bag…don’t do that, FYI.)
Full article:
HTML https://edwinleap.substack.com/p/healthcare-is-still-sparse
AGelbert COMMENT:
All good advice, Doctor Leap. I would only add that what we
need, even more than getting more caring people into medicine,
is to convince, with righteous confrontational vigor, all those
friends and family who work for "Health" Insurance corporations
to STOP BEING GREEDY! It is precisely because of the embrace of
the corporate Social Darwinist (SEE: "Nice guys finish last.")
based ideology that we have the severe problems in healthcare
that you have faithfully documented in this Blog.
Here are a few links for you and all the other caring people
here to read, copy and vociferously quote to all those you know
who support the pervasive socially destructive Corporate
"Health" Insurance Modus operandi:
VTDigger July 30, 2023 This commentary is by Lee Russ of
Bennington, a retired legal editor who was the lead
editor/author of both the third edition of “Couch on Insurance”
and the Attorneys Medical Advisor.
Lee Russ: In health care, it’s 10 to 1 against us
SNIPPET:
... that’s the reality in American health care. There are now 10
health care administrators for every doctor: “The ratio of
doctors to other healthcare workers is now 1:16, up from 1:14
two decades ago. Of those 16 workers for every doctor, only six
are involved in caring for patients — nurses and home health
aides, for example. The other 10 are in purely administrative
roles.”
How does this insanity come to pass?
Full article:
HTML https://soberthinking.createaforum.com/who-can-you-trust/profits-over-patients-in-the-'health'-care-field/msg1208/#msg1208
VTDigger January 13, 2023 This commentary is by Dr. Deborah
Richter, M.D., a practicing family physician in Cambridge, Vt.
She lives in Montpelier.
Dr. Deborah Richter: Yes, we can do something about Vermont’s
health care crisis
SNIPPET:
Universal primary care is a small but important piece of the
answer. It comes with a small price tag for taxpayers — less
than 6% of total spending — and that is offset by lower
premiums. But it would make a big difference. Everyone needs
primary care, even healthy people.
Full article:
HTML https://soberthinking.createaforum.com/advances-in-health-care/universal-primary-care-small-price-tag-less-than-6-of-total-spending-is-offset-b/msg777/#msg777
Oct 12, 2022 Health Insurance Whistleblower: Medicare Advantage
Is "Heist" by Private Firms to Defraud the Public
SNIPPET:
The beginning of the end for Medicare Advantage programs was in
2006, with the passage of the "Medicare Modernization Act,"
which opened the field to for-profit insurers like Cigna,
Humana, Aetna and United Healthcare. The Part D drug program was
a massive giveaway to for-profit Insurance companies and the
Pharmaceutical and Pharmacy industries. These companies have
become fully integrated, owning not only the insurance plans but
also pharmacy benefits management, pharmacies and even hospital
ownership. It's pure collusion and it does nothing but harm to
Medicare-eligible enrollees who are restricted by burdensome
rules such as the referral system to see acspecialist, denial of
expensive diagnostic imaging services, denial of care
necessitated by one's own doctor's orders. In some cases, the
benefit is worse even than what one would have if one had
Medicare only.
Full article with video:
HTML https://soberthinking.createaforum.com/advances-in-health-care/medicare-advantage-is-capitalist-corruption-of-medicare-for-greedball-'health'-i/msg590/#msg590
October 13, 2022 BY Cory Doctorow
US health insurers get more and more federal funding, deliver
less and less care
SNIPPET:
People are angry at their insurers, and justifiably so. Cigna
isn’t just raising prices and co-pays, it’s committing
mass-scale fraud: “exaggerat[ing] the illnesses of its Medicare
members to obtain higher payments from the federal government.”
Also credibly accused of Medicare fraud: Unitedhealth and
Elevance.
Full article:
HTML https://soberthinking.createaforum.com/advances-in-health-care/medicare-advantage-is-capitalist-corruption-of-medicare-for-greedball-'health'-i/msg653/#msg653
Another AGelbert COMMENT:
Back in 1978, I took a course in CPR at a local hospital. We
worked on a dummy and they showed us how to work a baby's heart
with only two fingers on the sternum instead of the double hand
thing on an adult.
In December of 1980 my brother in law, a dentist, an excellent
swimmer and scuba diver, decided late in the day at a beach
outing, to go for a swim. I advised him against it as the tide
was going out and I could see ripples in the shallow water
indicating a possible rip current further out in the surf. I
said, "It looks kinda rough out there, John." He said, "It's
okay.". John had not been feeling well. For that reason he had
not gone in and out of the water like my brother and John's two
sons. My sister made the tragic mistake of nagging him ("Why
don't you play with your children like my brothers do?"). I was
sitting next to him watching my 6 and 8 year old children
playing in shallow waters when she said that. I then voiced my
concern to him, as I stated above. John was over six feet tall
and quite strong. He was in is early forties, the picture of
health. Well, I told my wife to get my young son and daughter
our of the shallow water they were in and keep them out. It was
about 3:45 P.M. and we had been at this lonely beach since
around noon. I hoped we could leave soon. I began to pick up our
stuff and take them to our car.
Within minutes, tragedy struck. I heard some shouting and ran
towards the beach. The surf was getting quite large and John was
floundering in it about 30 yards from shore. My brother was
grabbing a big dead tree branch (I guess he was planning to use
it as flotation device - bad idea in rough waters) and his wife
ran up to me with some swim fins from her daughter for me to
wear. She said, "Put these on. You aren't a good swimmer.". I
told her I would be all right. The fins were small and I didn't
want something so tight on my feet. I ran to my brother at the
edge of the water and told him that tree branch would hit us in
rough surf. He dropped it and we both looked to see if John's
predicament had improved. He looked exhausted and was making no
headway against the rip current from the tide going out. The
breakers were about 8 feet above him, smashing down on him.
He would disappear and bob up some seconds later. I knew in my
heart there was no way I would survive trying to rescue him, but
I figured I could not live with myself if I just sat on the
beach and watched him drown. My mom had grabbed John's children
so they would not attempt to save their father and drown along
with him. All this happened in less than a minute. My brother
Larry and I hyperventilated for about 30 seconds to get some
extra oxygen to improve our chances somewhere above 0% of saving
John, never mind ourselves, from drowning (we had no life savers
or flotation devices of any sort.). We dove in and were next to
John in deep water within less than a minute due to the current.
I said, "We've got you, John", and grabbed one of his arms while
my brother grabbed the other one. He looked at us with relief
and bowed his head under water, closing his eyes. I saw this
under water next to him. With great fear I saw bubbles start to
come out of his mouth just after he bowed his head. I knew we
had very little time. We struggled to kick and swim towards the
shore as massive breakers smashed over us. I have often been at
a beach with surf and have never felt such powerful pummeling by
waves. After one massive breaker I actually felt the water try
to bend the femurs on my legs! The life or death struggle got
worse as it took longer for us to reach the surface after wave
after wave broke over us. My throat began to burn as I
inadvertently breathed salt water. Larry and I were running out
of air and strength. After surfacing subsequent to wave
pummeling, I said, "We are going to DIE out here!". Larry said,
"A man has to think of himself!". Without another word we sadly
released John to his drowning doom and began trying to reach the
shore.
I began to pray out loud, praising God and thanking Him for
saving me, though rationally speaking, to those who lack Faith,
that was an irrational statement. I got separated from Larry. I
tried diving just before a wave would hit to avoid the
pummeling, which seemed to help, but my strength was almost gone
and I was having a lot of trouble making my arms and legs move.
You can call it massive lactic acid buidup or whatever, but they
were simply slowing down, not cramping. I no longer had the
strength to voice any prayers. The next time a wave hit, I
struggled to the white foam covered surface.
The shore still looked at least 20 yards away. It was then that
my arms and legs would not move. I went under. I asked God right
there to take care of my family when I was gone. The water was
clear and light around me as I sank. I resolved to not breathe.
I didn't want that searing pain from salt water going down my
windpipe. A doctor told me later on that the decision to not
breathe saved my life (I don't think that natural causes can
explain it.). Not having the use of my arms or legs, I couldn't
hold my nose so I did the best I could, as it got darker and
deeper around me, to breathe in and out from my lungs to my
mouth and back. I began to be sleepy, but kept up my resolve to
not intake salt water. At that point I felt something scraping
my right foot. I thought of a shark, but then realized it was my
foot sliding across the bottom. I concentrated all my thoughts
on my toe and was able to move it to get a toehold on the rough
bottom, which cut and hurt, but woke me up from my increased
torpor from lack of oxygen. I would let go of the bottom when
the current moved me forward towards the beach, and get a
toehold when I felt I was being moved backwards. I did this for
about 4 or 5 minutes, while doing the breathing thing from lungs
to mouth and back. Yeah, I know I should be dead, but I'm not,
thanks, I firmly believe 100% to God. Try holding your breath
for 4 minutes after swimming so hard your legs and arms refuse
to move. I could never do that before and would certainly not
try to do that again.
Near the end of my ordeal, the water became lighter and the
bottom became sandy, instead of rocky. My toe had a small cut
and stung, but I was so intent on grabbing the bottom with it
that when it slipped on the sand and the water above me fell
away from my head, I ducked under water to get a better hold
instead of breathing! Of course I immedietely corrected that
foolishness and tried, and succeeded to wobble up out of the
water. The first thing I saw was my sister, looking at me with a
stricken look on her face. I guess I looked equally stricken
because she said, "You tried.". I looked down and took the few
faltering steps to the edge of the beach and fell on my knees
throwing up, and then began to cry.
Within the next 15 minutes, I was forced back in the water, now
in an irrational state of sheer terror of water, to help fish
out my brother, who was fairly near but floundering and cussing
up a storm with his last breaths. My sister-in-law and I got him
to the beach and laid him down. He was exhausted but breathing
okay. Then we saw the teenage son of John go in the water. My
mom and sister were yelling at him to not go but he would not
listen. The body of John, because it had floated and not sunk,
was fairly close (about 10-15 yards) when Bruce went after his
father. I, still in a state of irrational terror of water, went
in. There was nobody else to help. We managed to get John's body
in water that wasn't over my head (I doubt if I would have had
the courage to go any deeper) and took him to shore and laid him
on the sand near my brother Larry, who was basically okay, but
out of it at that time.
My sister was studying to be a nurse at the time, so she
immediately began mouth to mouth on John her husband. John was
blue all over. I got into the CPR position and worked on him for
about 20 minutes. A young lady saying she was a medical student
joined us and said John had a pulse. My arms were on fire but I
kept trying. Somebody yelled that an ambulance had pulled up
nearby. The attendants came and I smacked John on the chest with
the bottom of my fist in the pure agony of frustration from
failure. My sister left in the ambulance with John's body. He
was declared dead at a clinic where they took him. The many
pictures taken earlier in the day of a happy beach outing,
including smiling dentist John, were painful to see.
All that said, I am glad I took the CPR training and recommend
everyone out there to do so as well. And another thing: ALWAYS
take a nice long rope and life vests when you go to the beach, a
river or a lake to swim. You will never know when you need them
and a loved one drowns because you did not have them.
#Post#: 1222--------------------------------------------------
Stunned incredulity that Affordable Care Act system could
produce such relentlessly bad outcomes.
DIR By: AGelbert
Date: August 4, 2023, 8:56 pm
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[center]
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[center]
HTML https://www.counterpunch.org/wp-content/uploads/2023/08/a-graph-showing-the-growth-of-the-country-descrip.png[/center]
Graph: following from the Commonwealth chart above, child and
maternal mortality, gun violence, suicide, and the health impact
of the industrial food system, have now accumulated to have
Americans live 6.2 years less than the citizens of functioning
nations. This approximates the drop in life expectancy that took
place during the dissolution of the Soviet Union. At the time,
it was considered amongst the greatest tragedies in human
history. American liberals elected Joe Biden to toss another
trillion dollars into it. This is ☠️
[glow=red,2,300]genocide[/glow]. Source: OECD; World Bank.
[center]
HTML https://www.counterpunch.org/wp-content/uploads/2023/08/a-close-up-of-a-text-description-automatically-ge.png[/center]
Chart: having followed the healthcare impact of the ACA
(Affordable Care Act), Obamacare, since the program was first
introduced, the reporting has shifted from speculative— based on
the imagined healthcare benefits of insurance expansion, to
stunned incredulity that any healthcare system could produce
such relentlessly bad outcomes. The Commonwealth Fund (above) is
interesting because it employed Liz Fowler, the health insurance
lobbyist who wrote the ACA. The evolution of its coverage has
shifted from quiet despair to absolute horror at how little the
program has actually accomplished. As a
HTML https://soberthinking.createaforum.com/gallery/soberthinking/1-040622202719-1406786.gif<br
/>bonus, its [glow=red,2,300]neoliberal logic[/glow] is now
being
used to gut Medicare.
HTML https://soberthinking.createaforum.com/gallery/soberthinking/1-050422145533-5671050.gif<br
/>Source: Commonwealth Fund.
The US spends far more per person on healthcare than other
‘rich’ nations, and yet has the worst healthcare outcomes
amongst them (graph, chart, above). Excluding bonuses and stock
options, the healthcare ‘industry’ has the highest paid workers
in the US who are producing the worst outcomes in the developed
world. Like the defense industry, capitalists flipped the public
purpose of the healthcare system on its head. The
HTML https://soberthinking.createaforum.com/gallery/soberthinking/1-040622210450-1415528.gif<br
/>[glow=red,2,300]goal is now[/glow] to extract maximum public
payments
HTML https://soberthinking.createaforum.com/gallery/soberthinking/1-010922192452.gifwhile<br
/>providing
HTML https://soberthinking.createaforum.com/gallery/soberthinking/1-050422182057.gif<br
/>minimum goods and services in return.
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Read more:
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/>
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HTML https://www.counterpunch.org/2023/08/04/fascism-is-the-western-answer-to-class-struggle/
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