HCR -- GOP Quixotic Attack Day

By John Ballard

As Presidents Obama and Hu Jintao engage in discussions that could impact a global population, the GOP majority running the US House of Representatives is staging the equivalent of an off-campus frat party.  The contrast is startling. And the media, sadly, is treating both events with about the same amount of air time and seriousness. Republicans are following through on a campaign promise to "repeal Obamacare", even though even they agree that anything leaving the House is a symbolic which no informed person believes possible to fulfill.

Fortunately, if #hcr Top Tweets are any indication, most Americans see through the charade.

 It's hard to know which is the more Quixotic, Republican efforts to repeal PPACA or Dennis Kucinich arguing once again for a single-payer system.

Meantime, here are a few healthcare reform related items for your attention...

?Steve Jobs Bought Human Liver Like Foie Gras by Lindsay Beyerestein points to one of the many ways the "best healthcare in the world" is reserved for those who are either rich or fortunate, preferably both. Not to mislead anyone, this is not an issue that will be addressed by PPACA that I know of, but it underscores the inequity of leaving life and death decision-making up to the states.

[Apple founder Steve} Jobs lives in Northern California, but he got his liver in Tennessee. Why? Different parts of the country have different waiting lists, and the wait in Northern California was three times longer than the wait in Tennessee. In fact, the median wait in the Tennessee area where Jobs snagged his liver was around 15 percent of the national average. Jobs confirmed last year that this is why he went to Tennessee: "My doctors here advised me to enroll in a transplant program in Memphis, Tennessee, where the supply/demand ratio of livers is more favorable than it is in California here."* Legally, you're allowed to get on multiple waiting lists around the country. That's how you game the system.

You can't list-shop unless you can afford to show up in person to register and then transport yourself on a few hours' notice when an organ becomes available. Also, you have to be able to pay the full cost of your surgery out of pocket.

If you can afford to list-shop, you increase your odds relative to other patients who would might have had a better chance of long-term survival. Saletan suggests that Jobs wouldn't ordinarily have been considered a top candidate for a new liver because he already had cancer.

?National Guard Suicides Double in 2010

Today, Iraq and Afghanistan Veterans of America (IAVA), the country's first and largest nonprofit, nonpartisan organization for veterans of the wars in Iraq and Afghanistan, released the following statement in response to the Department of Defense (DoD) announcement that suicides in the National Guard doubled in 2010:

�The National Guard and active duty suicide rates should be a wake-up call for every American. A service member commits suicide on average every 36 hours in this country, and the rate of suicide among National Guardsmen and Reservists nearly doubled in the last year alone,� said IAVA Founder and Executive Director Paul Rieckhoff. �As a nation, we aren�t doing nearly enough to ensure suicide prevention methods reach every service member. Even as casualties climb in Afghanistan, we are losing service members to this suicide crisis at home at shocking and unprecedented rates.�

Rieckhoff continued, �The DoD�s recent task force report and mandatory post-deployment mental health screenings for troops are a step in the right direction. But without a national prevention campaign targeting every service member and veteran from Kabul to Kansas City, too many men and women of this generation will continue to fall through the cracks. We need real leadership from the President on this issue and we need the Administration to issue a national call for more military mental health professionals. Our country must use every tool readily available to stem this crisis for our troops, veterans and their families who have already sacrificed enough during 10 years of war.�

Again, this is not directly related to PPACA but underscores another challenge to the baseline of American health. There may not be a mathematical correlation between military suicides and civilian attitudes and social opinions, but most thinking people would agree that the numbers indicate a large and growing problem crying for attention. There is no way that this or any other country can adopt a policy of continuous war and not expect to inflict psychological scar tissue on its soldiers, as well as their families and non-combatants of the conflicts. This is not a new problem but it's getting worse.

?Insurance companies are making millions on "playing the float" with Medicare payments.  This article describes the slick accounting by which Medicare sweetens the pie for private insurance plans which have been offering the mis-named Medicare Advantage plans. I say mis-named because they are exactly the opposite: NOT Medicare and of NO ADVANTAGE for those covered if they incur too many expenses.

Private health insurance plans catering to Medicare recipients are making millions by taking money the government sends in advance - but isn't immediately needed - and using it to make investments, federal investigators say in a report obtained by The Associated Press.

In financial parlance, it's called "playing the float."

In contrast with another government program that also deals regularly with health insurers, Medicare lets its plans keep the cash.

An audit by the Health and Human Services inspector general's office estimates that private Medicare Advantage plans collected $376 million from investment income on advance payments from the government in 2007, the latest year available.

I'm happy to report that this big leaking hole in Medicare is being phased out by PPACA. As I have pointed out repeatedly, Medicare Advantage plans are NOT Medicare and should not be called by that name. These plans are one of several schemes the insurance industry was able to extract from Medicare in the name of private enterprise. The scheme is to poach beneficiaries from Medicare (hopefully those in better health, which is why our insurance representative advised my wife and I to look at MA if we didn't expect a lot of medical expenses but to stick with traditional Medicare + a "medigap" supplement if expensive medical attention was expected.) I can't write rationally about this exploitation of Medicare. The reader is urged to read the link for part of the details.

?I want once again to link Deinstitutionalization, Civil Commitment and Other National Nightmares, my post about mental illness, while the Tucson tragedy is still fresh in everyone's memory. I don't know how many "isolated incidents" of crazy people blowing up and staging mass killings it will take to wake up enough people to address the problem. But I feel confident in predicting that before 2011 is over the headlines will once again be screaming aboout another tragedy like the one in Tucson. The targets may or may not be elected representatives, or children, or random strangers, or co-workers...there is no way to know in advance where, when and how a crazy person will explode.

But several realities about crazy people have been apparent for years.

• Crazy people can legally buy and use firearms. That crap about "When guns are outlawed only outlaws will have guns" is plainly wrong, as this most recent example illustrates.


• Community mental health resources and aftercare are not preventing crazy people from killing others.


• Deinstitutionalization, which started about forty years ago, is as much a failure as the so-called War on Drugs.  It is time for a reality check for both.


• Everyone I know has personal knowledge of somebody who is crazy. Not eccentric or strange or a loner or with special needs, but out and out card-carrying crazy. Most crazy people are harmless but a relatively small minority are dangerous and are candidates for civil commitment. There are not enough professionals to prevent these crazy people from killing others so it is the responsibility of everyone to take seriously the responsibility to protect themselves and those they care about against the harm that will result if crazy people are not managed properly.


• In the same way that society has learned to confront overt racism, smoking and drunk driving, it is time for a movement to raise the awareness and responsibility of everyone to be more alert to potentially crazy people who need professional attention. Yes, we still have racists, smokers and drunks among us, but those qualities are no longer as acceptable as they were just a few years ago. It's time for ordinary folks to wake up to the dangers of crazy people. As in the case of child abductions and the dangers of fire, there are not enough professionals to fight the problem without help from the public. 

And anyone who thinks this is not about healthcare reform needs to go back and read the memo again.