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A System From Hell > Letters

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Requiring citizens to spend good money to purchase questionable insurance to participate in a failed healthcare system is harsh and counterproductive.

Kate Michilman is not alone saying: "If there is an upside to the country's healthcare crisis, it is that the problem is hurtling toward a point at which it absolutely cannot be ignored without immediate and disastrous consequences. If there is an upside for me, it is this: returning to those difficult days of poverty and fear in 1969 also means returning to a place where anger inspires activism...."

The Wyden-Bennett Healthy Americans Act is a bad plan being crafted to appease entrenched insurance interests at the expense of citizens who would be forced to purchase insurance and to pay higher costs for care.

In the Wall Street Journal (April 10), Gerald F. Seib presents "A Health-Care Plan That Could Bridge the Divide."

Obstacles abound, of course. Here's a big one: Many Democrats would want to include a so-called "public option" -- that is, a health-insurance plan provided by the government itself -- alongside private insurance plans. Mr. Bennett and other conservatives are dead-set against that, arguing that the government's ability to impose cost controls doubtless would make its plan the cheapest one, sucking consumers away from private insurers and opening the way to universal government health care.

This concern for big contributor's profits over our citizens and our nations fair treatment and well being has reached a volatile point.

Everyone needs health care regardless of their circumstances.

A low cost federally operated VA style National Health Care option needs to be made available that anyone could choose to use.

People happy with their existing systems do not need to change, they can continue paying for and keeping the private system that they like.

For perhaps as many as 100 million people no practical system for health care exists, nor is a usable one being proposed.

Current health plan reform proposals will only add to the bloat that has destroyed the practicability of our current health care system.

Businesses would also benefit if they were allowed to choose between staying with their private system and switching to a new national health care system that would not force them to be involved in any way for the health services their employees receive.

A National Health Care system is needed that will care for everyone who chooses to use it, made available for free, no restrictions, no more insurance needed period.

This can only be accomplished if costs of delivery are lowered.

The Veterans Administration model could deliver healthcare to users, at a fraction of the cost per patient, of existing systems.

The service could be funded by a national sales tax. That way everybody pays for service.

Our financial disaster has demonstrated that expenses recur day after day, for everyone.

People like Kate and her family provide an example that screams that everything we are doing is inadequate, even when like Kate, you think you have a good plan and good insurance coverage.

Expenses continue for the unemployed, or for those who have lost their money through their own misfortunes.

Missteps or frauds caused by financial institutions that citizens trusted to protect their, savings, investments, and retirement accounts have also made it impossible for many people to pay for needed health care.

People among us who are just plain down on their luck or those incapable of caring for themselves also need health care and any proposed solution requiring payment from them is totally unrealistic.

Even people with good incomes are not immune from the pressures of meeting voracious continuing expenses.

It is in everyone's best interests to have a healthy population that enjoys the most comfortable, productive, and happy life possible.

A large population of infectious unhealthy citizens interacting within society is a health threat to all citizens.

Health care is too important to remain in the hands of those protecting special interests profits.

The Veteran’s Administration model, has been providing care for qualified Veterans for years, totally free, including all prescribed treatments and medications, with total transferability between regions, and it has no restrictions for any preconditions.

The VA's proven system could relieve patients of the unsolvable problems that block many from receiving care caused by preconditions, or their inability to afford the financial outlays required.

A VA style system, controlling the problems with access, cost, quality, and malpractice is THE solution for America’s healthcare problems.

The system could be jump started by using bailout money to purchase existing private systems choosing to sell to the National Healthcare System.

Building and staffing this system will provide immediate and perpetual economic stimulus's by employing millions of health care workers.

If funding is raised through a national sales tax on non essential purchases, rather than insurance premiums and co pays, demanded from patients, a giant immediate and perpetual stimulus will be provided to everyone choosing to use National Healthcare.

This would transform family money from budget busting medical funding burdens, into family discretionary income.

“What most Americans fail to realize is that recessions are much easier to weather when citizens are provided guaranteed and affordable health care. Now is the time to push for a single payer system.” Commented marc from Maryland in the NYTimes April 7, 2009 .

National Health System users will never have to pay another insurance premium, medical service co pay fee, or prescription cost.

No more medical bankruptcies, no more uninsured people denied care, no more forced dilemmas between going without food or other necessities in order to pay for needed medications or care.

This is a real stimulus for getting people back into the stores and car dealer ships and improving everyone's health and outlook.

Happy days will be here again.

The Best Care Anywhere

Ten years ago, veterans hospitals were dangerous, dirty, and scandal-ridden. Today, they're producing the highest quality care in the country. Their turnaround points the way toward solving America’s health-care crisis.By Phillip Longman

By 1998, Kizer's shake-up of the VHA's operating system was already earning him management guru status in an era in which management gurus were practically demigods. His story appeared that year in a book titled Straight from the CEO: The World's Top Business Leaders Reveal Ideas That Every Manager Can Use published by Price Waterhouse and Simon & Schuster. Yet the most dramatic transformation of the VHA didn't just involve such trendy, 1990s ideas as downsizing and reengineering.

It also involved an obsession with systematically improving quality and safety that to this day is still largely lacking throughout the rest of the private health-care system.


Bill Watson

Menlo Park, CA

Apr 13 2009 - 11:19pm

Web Letter

Kate, you have written brilliantly and passionately about a topic which affects us all, whether we have yet realized it or not. Brava! As a registered nurse for thirty-two years, and as a woman I have seen the "system" from all sides, my heart goes out to you and your family, and I sincerely hope that someone will pay you large amounts of money so you may use your very articulate voice and sharp wits to help fix our broken system.

Laura Allender

St. Louis, MO

Apr 13 2009 - 4:54pm

Web Letter

Kate Michelman's plight is so familiar to me, in several ways. Bad luck for her and her family, you say? Her family should have foreseen this possibility and adequately insured themselves? I defy any human to devise an insurance scheme that will cover every possible combination of health situation that can come up for a family.

There are always cracks to fall through. I should know--I was a spousal caregiver for my first wife for twenty-nine of our thirty-one years of marriage, which ended in her death. We lived in Canada, the home of the single-payer health system so touted by many Americans. Well, we still had to have insurance for drugs and treatments not covered by Canada's universal healthcare system. One year our out-of-pocket expenses reached $17,000, and over those twenty-nine years I, as the single-income source in our family, must have paid out-of-pocket at least $150,000 for healthcare. In Canada!

The moral of my tale is that yes, the US desperately needs some kind of blended system, or even single-payer--but don't expect it to cover everything. On the other hand, as a "refugee" from Canada living in the US, I see a system so chaotic that the people it "serves" and their family caregivers end up getting sick from the frustration, aggravation and worry of dealing with it. As President of the Well Spouse Association, I and our 3,000 sustaining and associate members can attest to that.

In the US, individual wealth creates health inequalities. In Canada, waiting lists create inequalities--unless you have enough money to go south and buy your own treatment!

Richard Anderson

Alexandria, VA

Apr 13 2009 - 2:30pm

Web Letter

I have read both Kate Michelman's story of family tragedy, and a number of the letters sent in response. The writers of those letters question why tools such as health insurance, LTC insurance, and disability insurance, or even Medicaid, was not available.

I write from first hand experiences similar to Mrs. Michelman's. It is a story, and a system, I know all too well. My family experienced a similar series of illnesses and tragedies--my mother sufffered from multiple sclerosis for thirty years, until her death a few years ago. My sister has suffered with MS for three decades as well. My brother suffered a traumatic brain injury in a motorcycle accident and has permanent brain damage. My father had Parkinson's, and declined over a period of about four years.

And all of this was happening at once. My sister's spouse and my brother's spouse "quit" and let the family of origin deal with it.

It was overwhelming, for about six years. That's how long it took to sort out living arrangements for everyone, get them onto Medicaid and try to get everyone the care they needed. The out-of-pocket costs were approximately $250,000 for all four of them, paid for out of assets of all four and other family members.

And that was with good health insurance, medical retirement, Social Security Disability, and every other source of income we could come up with. (There was no insurance settlement/lawsuit in the case of my brother's accident, as he was racing and took on those risks himself, just like the young woman riding horses.)

We are a middle-class family. It is a miracle that we got everyone through it with good care in the end. And here's what we learned:

a) Health insurance helps a great deal, but out-of-pocket costs could still be as much as the $8,000 experienced by the family in the story. But that is only the beginning.

b) the real costs are in assisted living, as the Michelmans found out. Medicaid does not normally cover assisted living. Nor does insurance, though long-term insurance can help contribute to the costs. Most long-term insurance policies that I had examined would not have covered many of the costs of my stay-at-home care or assisted-living care--would have helped, but not have solved the problem for as many years and with the requirement of 24/7 care. My mother could not feed herself, could not change her clothes or dress herself. She was a complete quardraplegic for about ten years, and before that required a great deal of care, which my father provided before he declined. He retired early to take care of her, which decreased their retirement income and savings.

c) Nursing homes are not an option if a person is still healthy enough and independent enough--the grey area between nursing homes and assisted living is precisely the problem for long-term care. Medicaid beds exist in nursing homes, but not in assisted-living care (although many nursing homes continue to cut back on the number of Medicaid beds because they are costly to the institutions struggling to meet their budgets).

d) $8,000-$9,000 a month is a bit high for 24/7 care, but not out of the question either. For brain injury, the private-pay institutions are $10,000 a month. When I quit my last job to spend full time looking for a place for my brother to live, I was told by my boss to take a few weeks' family leave and go find a living situation, just as one of the board members of the company had for a relative. The board member is a muti-millionaire. We are not, I explained. His family can pay $10,000 a month for many years. We cannot, and there are no affordable alternatives for a 30-something-year-old man with brain injury.

e) Most nursing homes won't take a patient under the age of 55.

It is living, for years, with disability, that is so costly. The article explains the $8,000 out-of-pocket costs but never talks about the real long-terms costs of care over years. I imagine that the writer was just too overwhelmed to think about it, as we were at times.

With the help of excellent lawyers, we were able to set up special-needs trusts with what little assets were left, allowing a little bit of money to pay for extras like cable TV and a telephone for the family members once they were on Medicaid and had a nursing home room. It took six years, tons of lost income, many hours by family members providing care directly, a few guardian angels and much luck to get there. And I feel for Kate Michelman, because I know exactly what she is going to. There is no answer.

Assisted living must be covered over the long-term somehow, through Medicaid, more affordable insurance with better coverages, or something. Long-term care insurance should be offered and perhaps even paid for in part by corporations--because chances are very good that without it, the employer is going to lose employes to caring for their aging parents, or an injured sibling or child. It is unavoidable.

The alternative for these patients is death, homelessness or ... well, those are the alternatives.

Something has to give. Medical care now can prolong the life of an MS patient or a Parkinson's Patient or a brain-damaged person--but with all the advances in medicine, there has been no corresponding advancement in sufficient means to pay for those patients when they are kept in our lives for decades longer than they ever would have fifty years ago.

Barbara Buchanan

Vienna, VA

Apr 13 2009 - 1:09pm

Web Letter

Kate Michelman's "A System From Hell" should be required reading for all legislators in the United States. Here is reality in a nutshell: the reality of health insurance is it's a game of Russian roulette. Even doing all the right things, many people face the risk of financial devastation simply because the system in the USA is broke.

For all the cries of "socialism" and the turgid braying of Republicans, the truth is that only publicly funded, single-payer healthcare works to avoid the sort of unfair hardship Michelman and her family now face.

I have lectured on public healthcare to audiences large and small, and I can say with absolute certainty that the only people who benefit from the current American model of health insurance are the insurance companies themselves.

Kate Michelman says in her piece she wants to fight for healthcare. I applaud her sentiment and encourage The Nation's readers to rally in support.

Believe me, it is more imperative than ever that healthcare be accessible to all and not become a mine field of avoidable financial casualties!

Lynnette Dubois

Toronto, Ontario, Canada

Apr 13 2009 - 10:49am

Web Letter

Mr. Zimmerman, the actuary (and self-described troll), provides a fantasy-filled letter about Ms Michelman's joining the healthcare fight. Especially noteworthy is the closing paragraph that manages to compare the notion of universal health insurance to Marxism, when even conservatives like Hayek can be found suggesting that the state should help organize a universal system of social insurance (go run to your copy of The Road To Serfdom, all you conservatives out there, and check page 125).

Furthermore, a little Google search will verify that when it comes to for-profit health insurance in the United States, Mr. Zimmerman's notion of being charged $10,000 overhead for every $200,000 paid out in benefits (5 percent) is a fantasy on par with the Tooth Fairy and the Easter Bunny. Careful studies put the overhead of our for-profit health insurance north of 25 percent (this study by Public Citizen, for example, found 31 percent).

To rephrase that in terms that are almost comprehensible, when we speak of for-profit health insurance in the United States, we're not talking about a little bit of overhead to "file financial reports with the state insurance department" and keep "electronic records, etc." We're talking about the biggest privately created bureaucracy in the world--rivaling the Pentagon! We're talking about the waste of hundreds of billions of dollars every single year, even more money than has been blown on bailing out AIG (so far).

Speaking of bailing out AIG, where are the howls of protests from conservatives when executives from AIG and Citibank arrive hat in hand? So "to each according to his needs" has never, ever, worked? Funny how the "old-fashioned" "responsible" talk disappears when billionaires start having big needs.

All the for-profit health insurance industry is good for, if you don't own stock, is vacuuming up our money and causing the sick to suffer needless heartache, bankruptcy and premature death. Call me old-fashioned, but I think the true definition of "irresponsible" is standing idly by while human beings needlessly suffer.

Myles Sussman

San Francisco, CA

Apr 13 2009 - 12:14am

Web Letter

The most comprehensive analysis of the American health system has been given by Michael Moore in his documentary Sicko. Every American citizen should see this documentary with a open mind. Even more instructive are the interviews in the DVD's special features section; watch them and think about them.

After all, it is about a more humane society.

Fortunately, President Obama seems to have a clear view about what is wrong, but the road to efficient and affordable health insurance will be long. One of the main issues will be to recognize the difference between acute ilness and chronic disease; nobody can cope with the financial consequences of chronic disease in the long run, which makes it a responsibility for the government to provide care for the chronically ill out of taxpayers money. It leaves only acute and curable disease to play with for the shareholders' controlled healthcare industry.

Victor Wiedijk

Willemstad Curacao, Netherlands Antilles

Apr 12 2009 - 1:05pm

Web Letter

Ms. Michelman's article is yet another example of how screwed up this country is. Then I read some of the letters in response. One in particular was ao cold and so indifferent to the human condition that I found myself thinking this person has a problem. He does not offer any good ideas, just mean-spirited conservative rhetoric that does nothing except reinforce a bankrupt ideology. This kind of mentality is self-serving at best and is the reason why we will most likely never solve this issue.

Are we as a collective entity of consumers purchasing health insurance with the idea that it is supposed to defer the cost enough that we don't end up on the street in a cardboard box? If we are putting millions of dollars into these companies, what is the point of it if we can't use it when we need it most? Take Ms. Michelman's husband, who is retired and spent his entire working life paying into this system and yet it still failed him and his family.

Our system is broken, period. We don't have a healthcare system, if you get right down to it--we have a market.

Opponents are quick to use Canada as a model of why universal system does not work. Well, there is a reason that these people use Canada as a bad example, they have the worse system of the countries that have universal healthcare. If you look at the Netherlands, Switzerland, Germany and France, you can find healthcare systems that work well. The Netherlands and Switzerland are particularly good to look to; they have a system that could be used as a model for us, as it is a combination of government and private insurance companies.

jeff freedner

Voston, MA

Apr 12 2009 - 12:34pm

Web Letter

The first three letter-writers show why we may not survive as a society. Gut reaction: Too bad we didn't let a lot of insurance firms like AIG go under.

(The actuary's shows how having a material interest in insurance can determine your world view.)

William G. Bagnuolo

Social Circle, GA

Apr 12 2009 - 11:44am

Web Letter

My heart goes out to you, Ms. Michelman. You have had to endure far more tragedy than most Americans do in their lifetime. I would be terribly jaded and probably despondent, rather than determined, if these things had happened to me.

However, as a medical student who has seen the academic/public healthcare system in action, it is not a system that should be used to replace private insurance on a massive scale. It really would be akin to abolishing all private schools and enrolling everyone in public schools because many children get bad educations outside of private education. It simply wouldn't work.

While you think the government has all the money in the world necessary to compensate you and those like you for extended costs/co-pays, it really does not. This does cause rationing, which leads to the lack of purchasing of needed, expensive equipment, such as MRIs, which are lifesaving.

As someone pointed out, you had $8,000 in bills for a months-long hospital stay, but this probably was a fraction of the cost of labor, test, equipment, food, etc. that happened in all that time.

I wish we had a limited system that could pay for extended care. Perhaps the government could have a fund that guaranteed medical treatment for people with catastrophic or perpetual medical conditions.

The only way to truly reduce costs is preventive medicine, which requires steps that we may not be willing to take. One major one that could reduce costs by 30 percent or more in the long run would be to ban cigarette smoking. Although most argue that banning a substance increases its use, this wouldn't be true for tobacco, which is only semi-intoxicating. It also requires extreme, chronic use to cause pathology. Banning it would prevent the latter from happening.

Another way to do it is tort reform. Many doctors in certain fields (such as neurology, which you are certainly familiar with) have huge malpractice premiums because they treat incurable conditions. People love to sue over incurable conditions, because they are attempting to seek justice for metaphysically unjust outcomes. Higher premiums means high doctor overhead just for practicing, which leads to high labor costs. We are all paying indirectly for people to sue their brains out. It has to stop.

I would love for the government to pay for health care for all if it had the money. But it doesn't, it can't, and it never will. That's the way it is. Abolishing private healthcare, I'm sorry to say, will just extend the horror stories from a subset of the population to the entire population.

Jeffrey Planchard

New Orleans, LA

Apr 11 2009 - 5:31am

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