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The vast great economy of George W. Bush finally tapped yours truly on the shoulder on Thursday March 6th. I was laid off by my employer and for the first time in my entire working life I am without a job. Depressing as that may sound, my families health insurance for my five girls, my wife and I, was canceled effective with my the deliverance of my vacation pay and box of personal effects.For some odd reason my interest in the election for President has a new foundation on why health insurance for all is very important. Not having health insurance that I’ve had my entire working life is somewhat perplexing that for every day I no longer have coverage our former Governor Mitt Romney found it in his heart to penalize this out of work citizen for. What a swell guy… NOT!

If you have followed this little blog then you might be aware that one of our children has been very sick for a very long time. She is the star in her Daddy’s eye and her life has such huge potential that sometimes it scares me. Even with what most would call full medical coverage by my now former employer, we lost everything when she spent ten months in the hospital. Our home, our A1 credit rating, and our self respect. One thing we did not loose was faith and hope in our oldest baby. Time is a wonderful thing and today she still has personal health issues but her future is brighter than ever. Is it really health insurance when all the things your companies medical plan does not cover drags you financially under?

One of the reasons that I am backing Barack Obama is the simple fact that his Universal Health Care plan has the best chance of passing in the Congress once he is elected President. The important part of that last statement was “best chance”. We still live in a democracy and legislation like this is not a given once you sit behind the desk at 1600 Pennsylvania Avenue. Unlike President Bush who has had a slam dunk, in his pocket, looking the other way at all times Congress. Our nations next President will have a very new and independent Congress to face. Just because you promise Universal Health Coverage does not mean the Congress will pass it.

When it comes to health coverage for all we need a President that can and will work across party lines for the good of the country. Not that Senator Clinton has not shown that ability in the past but on this issue you need to convince the opposing side with a little kindness and political charm and Obama brings that and more to the table.

I’m off to figure out what to do with my lack of a good job with good pay and health insurance. I’ve already begun the networking of friends in the wire and cable industry. If you hear of anyone looking for a great sales guy in the wire and cable business please point them my way. Otherwise I’ll be knocking on doors come Monday morning till one of them says come on in and have a seat.

Papamoka

Originally posted at Papamoka Straight Talk

Feel free to link to this post…

There is an ongoing battle over health care in the United States. Those opposed to universal health care argue that the implementation of such a plan will result in a decline in the quality of care. Time and again, they cite the reported delays in accessing needed procedures in those countries that provide such care as evidence. They also make anecdotal assertions about the growing number of foreigners who seek medical care in the United States…while ignoring the same indications that more Americans are seeking medical care in other countries.

While there may be legitimate concerns about the implementation of a universal health care system, I’ve previously written about the fallacies contained in many of these arguments. I’ve also directed readers to studies that offer a less than stellar assessment of the health care we’re currently receiving.

The recent report from Nevada on the mishandling of syringes and vials, which may have resulted in potentially exposing 40,000 patients to Hepatitis C, is further evidence that our system has its share of deficiencies.

WASHINGTON (AP) — An outbreak of hepatitis C at a Nevada clinic may represent “the tip of an iceberg” of safety problems at clinics around the country, according to the head of the Centers for Disease Control and Prevention.

The city of Las Vegas shut down the Endoscopy Center of Southern Nevada last Friday after state health officials determined that six patients had contracted hepatitis C because of unsafe practices including clinic staff reusing syringes and vials. Nevada health officials are trying to contact about 40,000 patients who received anesthesia by injection at the clinic between March 2004 and Jan. 11 to urge them to get tested for hepatitis C, hepatitis B and HIV.

Senate Majority Leader Harry Reid, D-Nev., met Monday with CDC head Dr. Julie Gerberding, and on a media conference call after their meeting both strongly condemned practices at the clinic.

Health care accreditors “would consider this a patient safety error that falls into the category of a ‘never event,’ meaning this should never happen in contemporary health care organizations,” said Gerberding.

“Our concern is that this could represent the tip of an iceberg and we need to be much more aggressive about alerting clinicians about how improper this practice is,” she said, “but also continuing to invest in our ability to detect these needles in a haystack at the state level so we recognize when there has been a bad practice and patients can be alerted and tested.”

Let me attempt to explain exactly what appears to have happened at these clinics. In performing procedures on patients with Hepatitis C, clinicians may have been reusing the syringes used in sedating these infected individuals on other patients…or they were reusing the same syringe a second time on an individual infected with the disease when drawing a sedating medication from a multi-dose vial…which was then used to draw medication to sedate other patients. The bottom line is that the disease could have contaminated either the syringe or the vial containing the sedating medication.

Look, I’m not a doctor or a scientist…but it isn’t that difficult to understand that if you put something (a needle connected to a syringe containing a fluid) into a contaminated substance (blood in the tissue of an infected individual in this case), there is a risk that the infected substance can travel into any connected portion of that device (think backwash from a straw or the basic concept of osmotic transfer) or into any container that device may subsequently come into contact with.

So what does this tell us about our health care? Well, according to the representative from the CDC, these clinicians were conducting practices that are NEVER EVER acceptable. In doing so, they were violating a very basic guideline; not some complex concept beyond those capable of rudimentary rational thought. Frankly, if one can’t be sedated for a colonoscopy without the risk of contracting Hepatitis C, what hope should we have that a life saving surgical procedure will follow proper protocol?

To be fair, that isn’t an argument that affirms the quality of services one might expect under a universal health care system. However, it is a valid criticism of our existing system as well as a rebuttal to those who sing its praises. Truth be told, health care is only as good as the commitment of those who provide it. The argument that universal health care will make the practice of medicine less lucrative may…and I repeat may…have some merit. At the same time, are we to believe that the hippocratic oath is subject to suspension should the bottom line be diminished?

Given the incidence of malpractice and the other previously referenced negative reports on our health care system, it appears that ever increasing profits are no more a predictor of high quality health care than decreased profits would be of lesser quality care. Further, if those in the field of medicine predicate their performance upon profitability, we’re all one bad bottom line away from a botched procedure.

Unless and until we restore the word “care” to our health system, it won’t actually matter whether it is administered as a result of an open market construct (think 47 million uninsured) or as a function of some degree of universally mandated insurance. The provision of care ought to be a given; not an endless negotiation. It’s time we choose to do the right thing. It’s a matter of life and death.

Cross-posted at Thought Theater

A report on the rising number of incarcerated Americans provides a disturbing look at the unspoken impact of economic inequality and the high cost we pay for perpetuating it. At the same time, during each election cycle, politicians from both parties accuse each other of practicing suspect fiscal discipline.

For this discussion, I want to look at the costs of incarceration in relation to providing universal health care as well as the Bush tax cuts. Time and again, the GOP points out the exorbitant costs that might be associated with providing universal health care. From what I’ve read, the plans being pushed by Senators Clinton and Obama are reported to cost 10 to 15 billion dollars annually. That’s a big expense…but before one concludes we can’t afford it, one must consider the burgeoning costs of incarceration and the distribution and impact of the Bush tax cuts.

From The Seattle Post-Intelligencer:

NEW YORK — For the first time in U.S. history, more than one of every 100 adults is in jail or prison, according to a new report documenting America’s rank as the world’s No. 1 incarcerator. It urges states to curtail corrections spending by placing fewer low-risk offenders behind bars.

Using state-by-state data, the report says 2,319,258 Americans were in jail or prison at the start of 2008 - one out of every 99.1 adults. Whether per capita or in raw numbers, it’s more than any other nation.

The report, released Thursday by the Pew Center on the States, said the 50 states spent more than $49 billion on corrections last year, up from less than $11 billion 20 years earlier. The rate of increase for prison costs was six times greater than for higher education spending, the report said.

So in the course of 20 years, we have increased our annual corrections spending by a whopping $38 billion dollars. That is roughly three times the projected annual cost to provide universal health care…health care that would help elevate the very people who are disproportionately represented in the prison population. Factor in the following data on the Bush tax cuts and one will begin to see the larger picture.

From MSNBC.com:

WASHINGTON - Since 2001, President Bush’s tax cuts have shifted federal tax payments from the richest Americans to a wide swath of middle-class families, the Congressional Budget Office has found, a conclusion likely to roil the presidential election campaign.

The conclusions are stark. The effective federal tax rate of the top 1 percent of taxpayers has fallen from 33.4 percent to 26.7 percent, a 20 percent drop. In contrast, the middle 20 percent of taxpayers — whose incomes averaged $51,500 in 2001 — saw their tax rates drop 9.3 percent. The poorest taxpayers saw their taxes fall 16 percent.

Unfortunately, these percentages are deceptive. Let’s look at a practical explanation of what these tax cuts meant to the working poor.

From BusinessWeek.com:

Imagine you are a waitress, married, with two children and a family income of $26,000 per year. Should you be enthusiastic about the tax cuts proposed by President Bush? He certainly wants you to think so. He uses an example of a family like yours to illustrate the benefits of his plan for working Americans. He boasts that struggling low-income families will enjoy the largest percentage reduction in their taxes. The income taxes paid by a family like yours will fall by 100% or more in some cases. This is true–but highly misleading.

President Bush fails to mention that your family pays only about $20 a year in income taxes, so even a 100% reduction does not amount to much. Like three-quarters of working Americans, you pay much more in payroll taxes–about $3,000 a year–than in income taxes. Yet not a penny of the $1.6 trillion package of Bush tax cuts (in reality, closer to $2 trillion over 10 years) is used to reduce payroll taxes. Moreover, should your income from waitressing fall below $26,000 as the economy slows, your family could be among the 75% of families in the lowest 20% of the income distribution that stand to get absolutely zero from the Bush plan.

The President claims that the “typical American family of four” will be able to keep $1,600 more of their money each year under his plan. Since you won’t be getting anything like that, you might be tempted to conclude that your family must be an exception. Not really. The reality is that the President’s claim is disingenuous. Eighty-nine percent of all tax filers, including 95% of those in the bottom 80% of the income distribution, will receive far less than $1,600.

In other words, when a 100% tax cut is the equivalent of $20.00, a family of four might be able to translate that twenty dollars into a meal at McDonalds…one time in 365 days. On the other hand, if one is lucky enough to be in the top one percent (those with $915,000 in pretax income…and first class health care) of earners and receive a 20% tax reduction, I suspect the savings would buy more than one fast food dinner over the course of a year. The skewed advantages…and disadvantages…suddenly become obvious.

If that isn’t bad enough, let’s return to the costs of incarceration and look at future cost projections.

From The New York Times:

By 2011, the report said, states are on track to spend an additional $25 billion.

The cost of medical care is growing by 10 percent annually, the report said, and will accelerate as the prison population ages.

In less than four years, we will spend another $25 billion annually (more than enough to pay for universal health care) to incarcerate more and more Americans…the bulk of which come from the economically underprivileged.

More From The New York Times:

Incarceration rates are even higher for some groups. One in 36 Hispanic adults is behind bars, based on Justice Department figures for 2006. One in 15 black adults is, too, as is one in nine black men between the ages of 20 and 34.

The report, from the Pew Center on the States, also found that only one in 355 white women between the ages of 35 and 39 are behind bars but that one in 100 black women are.

Let me be clear…crime is wrong…and it should be punished. However, we cannot ignore the factors that facilitate crime. Failing to provide opportunities to those most lacking in resources is also wrong…and it often leads to a lack of education and therefore a susceptibility to participating in crimes that are driven by poverty.

We have likely exceeded the point at which it will cost us more to punish and incarcerate those who commit these crimes of poverty than it would have cost us to insure their education, to raise the minimum wage above the poverty level, and to grant them the dignity and peace of mind that comes with knowing one’s family members can receive health care when it is warranted; not just when it is necessary to prevent death.

Instead, under the guidance of the GOP, we have elected to ignore the fact that 47 million Americans lack health care and to focus upon further enriching the wealthiest…all the while being forced to endure asinine arguments that doing so will create jobs and thus facilitate a rising tide to float the boats of all Americans. It simply isn’t true.

At a savings of $20 a year, millions of Americans can’t even buy a seat in the boat…let alone stay afloat by treading water in the midst of the steady deluge of ever more ominous waves. If the number and availability of life preservers continues to dwindle, we are fast approaching the point at which our society will collapse under the weight of the inequity we chose to ignore.

If that happens, it will be as my grandfather argued many years ago, “They can eat you, but they can’t shit you”. The cannibalism has begun. What follows will not be pleasant.

Cross-posted at Thought Theater

According to this Business Week article, 2007 might be remembered as the year angry customers started fighting back. We all heard about the 76-year-old woman who came storming into her local ComCast office with a hammer and started swinging. After damaging a keyboard and a phone, she yelled out “have I got your attention now?”

And last Spring a pissed-off Apple customer made a YouTube video of himself smashing his Macbook with a sledgehammer after Apple refused to honor a service warranty. So far over 340,000 people have seen the video. (And Apple has agreed to replace his defective computer.)

The author, Jena McGregor, says: “Consumers already pushed to the brink by evaporating home equity, job insecurity, and rising prices are more apt to snap when hit with long hold times and impenetrable phone trees.”

She uses the term Consumer Vigilante. Even if you don’t settle your grudge with a sledgehammer, more and more people are discovering that there are other options besides sitting there waiting on hold all afternoon because both operators are busy.

The e-mail carpet bomb is becoming more popular.

Last October a National Public Radio host created a website called ComCastMustDie.com. The article has a few other examples of pissed off customers who settled things their own way.

And occasionally the courts come through. A few days ago, one of those slippery HMOs got hit with a crushing left hook to the bank account. In 2004, Health Net canceled a woman’s medical insurance while she was undergoing treatment for breast cancer. She was left with $129,000 in unpaid medical bills. A judge has ordered Health Net to repay the $129,000 plus $750,000 for emotional distress and $8.4 million in punitive damages.

As conservatives are always saying, severe punishments are the only way to deter criminals.

Health Net is also being sued by the City of Los Angeles for illegally canceling the health insurance policies of 1,600 other patients. The company had an incentive program: administrators had to meet a certain cancellation quota, and if they exceeded their quota they’d get a bonus. (See, this isn’t just something Michael Moore dreamed up.)

Maybe these are just isolated incidents, or maybe there’s a positive trend. No matter who or what gets elected next November, maybe this 21st Century Gilded Age is starting to wane.

Just how many revised economic forecasts does it take to finally conclude that the U.S. is in a recession? Former Fed Chairman Alan Greenspan likes to up his odds we’re heading into a recession by approximately 20 percentage points every quarter. Current Fed Chairman Ben Bernanke seems to prefer a different approach. His modus operandi is to lower GDP a few tenths of a percent with each revised outlook.

As an outside observer, this measured slide towards using the “R” word feels like being in my car at a red stoplight with my favorite backseat driver seated beside me. As we wait for the lights to change (because we know they will), my trusted traffic manager sits there predicting the seconds until the opposing green light will turn yellow…never getting it quite right…but jubilant each time he announces…after the fact…that “The light just turned yellow”. This process continues until our red light turns green and we can proceed to the next intersection…to start all over again.

While I realize my analogy isn’t an actual equivalent, the frustrations are much the same. Yes, predicting the twists and turns of the economy isn’t an exact science…but I do find our willingness to grant these prognosticators a free pass each time they err to be a rather absurd practice. The fact that the nation holds its breath each time a new report is scheduled for release merely supports my contention.

WASHINGTON (AP) — The Federal Reserve on Wednesday lowered its projection for economic growth this year, citing damage from the double blows of a housing slump and credit crunch. It said it also expects higher unemployment and inflation.

Under its new economic forecast, the Fed said that it now believes the gross domestic product will grow between 1.3 percent and 2 percent this year. That’s lower than a previous Fed forecast for growth, which at that time was estimated to be between 1.8 percent and 2.5 percent.

With economic growth slowing, the Fed projected that the national jobless rate will rise to between 5.2 percent to 5.3 percent this year. That is higher than the central bank’s old forecast for the rate to climb to as high as 4.9 percent. Last year, the unemployment rate averaged 4.6 percent.

And, with energy prices marching upward, the Fed also raised its projection for inflation. The Fed now expects inflation to be between 2.1 percent and 2.4 percent this year. That’s higher than its old forecast for inflation, which was estimated to come in at around 1.8 percent to 2.1 percent.

The Fed said its revised forecasts reflected a number of factors including “a further intensification of the housing market correction, tighter credit conditions …. ongoing turmoil in financial markets and higher oil prices.”

In truth, I suspect that the average American has just as good a sense of where the economy is headed as those who get paid to inform us. If the last number in our checkbook is negative, we conclude we have a problem. Why wouldn’t the same math hold true for our national economy?

No, we allow our political leaders to sell us on the notion that a tax rebate of $300.00 to $1,200.00 is all that matters and all that is needed to jump start the economy…even as they continue to predict further economic contraction. Excuse me, but isn’t that on par with each of us taking a cash advance on an already debt heavy credit card and thinking we’re suddenly in the black?

Look, I understand the notion of spending an economy out of a downturn. However, the rest of that equation posits that the increased spending will result in new jobs, greater investment and productivity, and increasing revenues for the individual, the corporation, and the government.

Unfortunately, this equation may no longer be valid…especially since the jobs are often created in other nations, the investments are frequently targeted for countries with cheap labor such that productivity is less relevant, and the only increased revenues find their way into the pockets of formerly impoverished third world individuals and the corporations and their CEO’s that benefit from the enhanced bottom line that ensues.

So what does the average American get? A stimulus package that provides a single check that won’t overcome the unfavorable wage-inflation ratios, the higher costs of fuel, the expanding credit card debt, the skyrocketing health care costs, and the ever shrinking job opportunities.

At the same time, some of our political leaders clamor for making the tax cuts for the wealthiest Americans permanent and lowering the corporate tax rate from 35 to 25 percent. I don’t know about anyone else, but these refund checks remind me of the dynamics underlying “the world’s oldest profession”…the one where one party gets poked for a few bucks by the fat cat who realizes that money can buy him anything he wants.

In the end, getting the powers that be to speak the “R” word is an exercise in relabeling. After all, once the deed has been done and the hush money has been paid, does it really matter what we call an old fashioned screwing? I think not.

Cross-posted at Thought Theater

Protected from those nasty lawsuits and actions brought about by the physicians refusal to provide medical procedures or medications that they deem against their religious beliefs. From the RawStory writeup:

Pennsylvania Senate Bill 1255, also called the Conscientious Objection Act, would absolve medical care providers of liability in cases where reproductive care was denied based on a practitioner’s religious or moral beliefs.

Services a provider would be free to withhold, with immunity, include performing an abortion, artificial insemination, and prescribing birth control or emergency contraception (also known as the “morning-after pill”).

Notice it’s all about reproductive procedures and medications. Nothing else. Surely there are other types of procedures and medications that some physicians would find against their religious beliefs.

Leave it to the Republican’s to narrow it down to reproductive issues. Must be an election year..

I have written before that in general conservatives operate on fear while liberals operate out of necessity.

Let me briefly review this idea. In general conservatives are the successful wealthy business people who fear losing what they have - money. Or, conservatives are the morally upright religious zealots who fear that society could go down the toilet at any moment. These two groups represent the majority of conservatives. Progressives however, feel that the world has already caved in all around them. Progress is anything that can help them dig out of this mess. Progressives are willing to try almost anything to fix the problems in society, while conservatives fear that anything new will lead to the downfall of everything they have come to love.

Since the people who are happy with the way things currently are is usually a smaller number than those who believe that they are up to their necks in shit conservatives needed to craft a way to convince those in need to vote to change things to the way they have been. The idea that change back to the “old ways” was a progressive change was championed by the Reagan revolution. Fear and progressive change have been the guiding principles of American politics for a long time.

Well, it actually turns out that the majority of people actually reside somewhere in the middle. These moderates fear change that is too rapid, but they want some change to help them out of the doldrums. For these people “fear” and “change” are words that can move them to support a candidate. Reagan used “change” to move these people to his side. George W Bush used “fear” to keep them there in 2004.

The truth of the matter is that we should worry a bit about change. But, we should also recognize that change can happen for the better.

It is easy for people to become fearful of terrorism. Obviously seeing 3000 people killed in one day in an orchestrated terrorist effort is scary. I don’t need to say this, but we all know that death is a bad thing. But, death does not only come from terrorist attacks. Death comes in many preventable ways. And, progress happens when we can reduce unnecessary death no matter where it comes from.

But, how can we know which efforts to defeat unnecessary death should be taken on, and which efforts should not? We have limited resources and we can only do so much. This is known as risk. We can calculate risk by what we observe. For example, we can count the number of people killed by terrorist attacks and divide by the number of years that we examine. We can quickly see that even before the security measures taken on by the government we have had relatively few people die in terrorist attacks per year. We can compare this to automobile accidents and we quickly realize that driving our cars is much riskier than going back to our old level of security before 9/11/2001.

But, fear rules and conservatives are controlled by their fear. Our conservative government has told us to be afraid and to do whatever we can no matter what the cost in order to protect ourselves from terrorism. We have spent billions of dollars in Iraq fighting a war out of the fear that terrorist will attack us again. We have spent billions of dollars trying to prevent terrorist attacks that rarely happen. We could calculate how many lives have been saved by counting the number of deaths due to terrorism occurring in the seven years leading up to 9/11 and compare that to the number of lives lost in the prevention of terrorism since 9/11. We can include the amount of money spent and we will quickly come to the realization that we have lost more lives and spent more money based on irrational fear than before 9/11. The risk of terrorism was small and it is still small. We have lost more lives. It is almost as if we are paying terrorists to kill our soldiers. If we used a balance sheet that would be the conclusion.

But, the sad and frustrating part of this wasted effort is that the money could have gone to save lives instead. One example is our health care system. It turns out that roughly 18,000 people die each year because of lack of health care. That is equivalent to six 9/11s per year. Many of these people could have been saved if they had the health care that a civilized country like the United States has available to every citizen. With preventative care and regular checkups many lives could be saved or enhanced. The billions of dollars that we are wasting in Iraq to bring that country up to the twenty-first century could have been used to bring our poor and needy up to this century instead.

The foes of open borders continue to complain that immigrants too easily have access to services provided by our country. However, we freely give this same aid to Iraqis in an effort to appease them so that they will not join the insurgents. This may be working, but if we weren’t their in the first place it wouldn’t have even been an issue. And, if we had assessed to risks in a proper way we would never have gone into Iraq anyway.

Fear can be tempered by considering the risk involved. Fear of driving to and from work is almost zero for most commuters. The risk of this drive is far greater than to probability of being attacked by a terrorist. Roads could be made safer, but fear has persuaded the hand of government to spend more money on the terrorist “threat” and less on our roads.

The biggest problem that we face is not terrorism, or roads, or even health care. The biggest problem that we face is the education of our children. It turns out that we could make very good decisions based on the calculation of risk. However, our education system has cheated so many people in our society from having a useful education that politicians, if they actually can think, are able to persuade the public to fear risks that are as tiny as the threat of another terrorist attack. If we don’t educate our society to think, we will surely become a society where the wealthy and well-to-do minority will be able to control the rest of us through our ignorance. The erosion of our education system will ensure that any progress that we have made over the last 50-some years will erode as well.

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Don’t forget what Stephen Colbert said, “Reality has a well-known liberal bias.”

Cross Posted @ Bring It On, tblog, Blogger and BlogSpirit

Reflection

Yes of course it’s in California. And just to push even more conservative buttons — the owner (of the vending machines and the property) is a swarthy Middle Easterner. Dear God!

Just think of the millions of rightwing hands being wrung and teeth being gnashed when this story hit the news sites. While he’s at it, the owner might as well install an abortion clinic and a gay bar on the premises. With millions of wingnut voters undergoing a simultaneous seizure, and an election next November…

Vincent Mehdizadeh, inventor and owner of the machine, described his service as: “Convenient access, lower prices, safety, anonymity.”

If you have a card authorizing the use of medical marijuana (and you’re registered in Mehdizadeh’s computer database), you have 24-hour access to these pot-dispensing machines. There are three of these dispensaries; two of them are on property owned by Mehdizadeh.

These dispensaries are completely unobtrusive and they’re surrounded by strip malls, car dealers, furniture shops, etc. The premises are nearly empty except for a security guard, some shelves stocked with herbs and vitamins and a contraption that looks like a large refrigerator (that’s the pot machine). The device is officially known as a Prescription Vending Machine (PVM). You provide your fingerprints and your pre-paid card, and the machine dispenses a bright green envelope. Guess what’s inside!

Since the War on Drugs is one of America’s top priorities (your tax dollars at work), the Spanish Inquisition DEA is already zeroing in on this screaming emergency. A few months ago they developed a new improved, more jugular-based tactic: going after the owners of the property where medical marijuana is dispensed, and confiscating the property. If our government went after real problems with one tenth this much ferocity, this would be a much nicer country to live in.

A DEA spokesman said: “Somebody owns it, it’s on a property and somebody fills it. Once we find out where it’s at, we’ll look into it…”

Well, that takes care of that urgent problem.

Those opposed to an overhaul of the U.S. health care system frequently tout it as the best health care in the world. However, while there are many positive aspects to our health care system, more and more deficiencies have begun to emerge and receive the attention they warrant. Following last weeks report that the U.S. ranks last in the number of preventable deaths, the time one has to wait before receiving emergency care continues to increase…leaving those in need of prompt attention at risk.

TUESDAY, Jan. 15 (HealthDay News) — The last thing you want to hear in the emergency room when you’ve got crushing chest pain or can’t breathe is that you have to wait before you can get treatment.

Unfortunately, in too many instances, that’s exactly what’s happening. In fact, new research found that waiting times in emergency rooms have increased by 36 percent for all patients, to an average of 30 minutes per patient. And the sickest sometimes have to wait the longest: As many as one-quarter of all heart attack patients had to wait 50 minutes or longer before seeing a doctor.

Study author Dr. Andrew Wilper, a fellow in general internal medicine at Harvard Medical School and an internist with the Cambridge Health Alliance, reports in the Jan. 15 online issue of Health Affairs that the increasing wait times are the result of a “perfect storm” that has occurred as emergency room visits are on the rise while many ERs are closing their doors.

These expanding wait time compounds the plight of those who lack health insurance and rely upon indigent emergency room care for their health care. Not only are preventable and treatable illnesses being ignored until they become medical emergencies; those arriving in the emergency room with them are at greater risk since they are having to wait longer periods of time to see a physician and receive the attention they need. Is it any wonder that the number of preventable deaths in the United States is on the rise?

“The real problem is that patients are backing up in the ER. If a patient is still in the ER six or even 12 hours later, it means that room, that nurse and that equipment just aren’t available for the next patient that comes in the door,” explained Dr. Art Kellermann, a spokesman for the American College of Emergency Physicians.

Kellermann said a good analogy to this situation would be if controllers at a busy airport started parking planes on the runways. “We’d think they’d lost their minds, but that’s what hospital administrations are doing with ERs,” said Kellermann. “We’ve taken the most time-critical portal of care and allowed it to become gridlocked.”

For the current study, Wilper and his colleagues reviewed data from 1997 through 2004 and included 92,173 adult ER visits. Of those visits, almost 18,000 were thought to need immediate attention at the time of initial evaluation, and 987 had a diagnosed heart attack.

Not surprisingly, the wait to see an ER physician also increased during that time. In 1997, the average wait was 22 minutes. By 2004, the average wait was up to 30 minutes — a 4.1 percent increase in wait time each year.

For heart attack patients, even a few minutes of delay in treatment can literally mean the difference between life and death. Yet, the average wait time for a heart attack patient increased from eight minutes to 20 minutes over the study period — a 150 percent increase.

The study also found that blacks, Hispanics and women had to wait longer for care. Whites waited an average of 24 minutes, while blacks had to wait an average of 31 minutes and Hispanics had to wait 33 minutes on average. Wilper said it’s possible that blacks and Hispanics might be more likely to visit hospitals that have longer wait times in general.

He said there needs to be an expansion of insurance coverage, modified management of inpatient and elective surgeries because so many ER beds have been lost, and an expansion of primary care that might help ease the overflow at the emergency room.

“This is an issue that cuts across insurance status,” said Kellermann, who pointed out that even people with insurance are left waiting in ERs, because there just isn’t enough space or enough resources.

The report also notes that several hundred emergency rooms have closed their doors. I suspect that the decline in hospitals offering emergency care adds to the problem and likely reflects the disincentive for hospitals to provide such care since it often involves patients who lack insurance or any real means to pay for the services rendered.

As the number of uninsured Americans increases, the problem will only exacerbate…a fact that ought to be recognized by all Americans since it also has and will impact the care provided to those who are insured. Reciting the president’s meme that everyone in America has access to health care may be an accurate statement; but it is also an inarticulate assessment. As the number of uninsured expands, a tipping point is inevitable and those inclined to ignore as much are simply burying their heads in the sand.

Those who emphasize the waiting times for health care in other countries as a reason to oppose some form of universal health care seek to portray those delays as a justification for the U.S. market driven system. Unfortunately, that rationale only succeeds so long as 47 million uninsured Americans fail to receive preventative care and treatment for chronic illnesses and diseases. If those countries providing health care to all were able to ignore the routine health care needs of nearly 20% of their citizens, I suspect their wait times would decrease.

If America wants to assert its prowess in providing timely and top-notch health care, it must soon address the needs of the 47 million Americans who are being ignored. Our challenge shouldn’t be to match the health care provided by other nations; it ought to be to actually provide the best health care in the world…to all Americans…when they need it.

To do otherwise is an exercise in self-deception that will continue to be evidenced in additional negative reports. Wouldn’t the verifiable pride that comes with a can-do attitude be preferable to false pride that results from a “don’t look, don’t see” mentality? Even worse, how can the deaths that result from foolish pride be anything but inexcusable?

Cross-posted at Thought Theater

During this election cycle we’ve often heard politicians argue that the United States has the best health care system in the world. Unfortunately, there are problems with how this assertion should be measured and a new report suggests that U.S. politicians have ignored one very important factor. Specifically, for the 47 million people who lack health insurance, the results can be deadly despite the following inane comment from George Bush at a recent speech in Cleveland:

I mean, people have access to health care in America. After all, you just go to an emergency room.

In the report released by “Researchers Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine”, the evidence suggests that the United States ranks dead last in terms of preventable deaths…a statistic that fully refutes the wisdom of the president’s observation. Basic logic should tells us that treating conditions in an emergency setting is inferior to routine care and monitoring…which rarely happens for those individuals who lack health insurance.

France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations, researchers said on Tuesday.

If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs.

Nolte said the large number of Americans who lack any type of health insurance — about 47 million people in a country of about 300 million, according to U.S. government estimates — probably was a key factor in the poor showing of the United States compared to other industrialized nations in the study.

“I wouldn’t say it (the last-place ranking) is a condemnation, because I think health care in the U.S. is pretty good if you have access. But if you don’t, I think that’s the main problem, isn’t it?” Nolte said in a telephone interview.

All the countries made progress in reducing preventable deaths from these earlier rankings, the researchers said. These types of deaths dropped by an average of 16 percent for the nations in the study, but the U.S. decline was only 4 percent.

“It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance,” Commonwealth Fund Senior Vice President Cathy Schoen said.

“The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals and efforts to improve health systems make a difference,” Schoen added in a statement.

As one can see, this report clearly points out just how absurd it is for the President to make the above statement. Yes, everyone knows that the uninsured can go to the emergency room…if they’re having an urgent medical event such as a heart attack, kidney failure, diabetic coma, and so on…but they’re not going to be provided with long term care in the form of heart medication, blood pressure medication, or insulin The care that is needed to treat long term medical conditions and chronic diseases and to avert or reduce these emergency room events as well as the increased risk of death is not available to many of the uninsured.

The bottom line is that the prevailing problem being ignored by the President and the 2008 GOP presidential candidates is the cost of health insurance and the inability of many, if not most of the 47 million uninsured, to afford it.

The topic was discussed in the recent ABC New Hampshire Republican debate. The following are a few relevant excerpts that clearly demonstrate the insufficiency of the GOP’s proposals to correct this urgent and expanding problem.

MR. ROMNEY: Charlie, it — that doesn’t mean it shouldn’t be improved. And I think — I think that the notion of people buying their own private health insurance is a very good one, so long as a lot of them do it. Only 17 million Americans right now buy their own health insurance. If 50 million Americans were buying their own health insurance — because it would be just as tax-advantageous to do it that way — and we had a health savings account, people — economists believe there’d be a 30 (percent) to 50 percent reduction in the cost of health insurance, and quality would come up.

MR. GIBSON: You all have proposed free market, consumer- purchased insurance, and you all talk about giving tax deductions for buying insurance. Let me do a little math. The average family employer-provided insurance, when the companies buy it, its $13,000 a family.

Now, you’ve talked about a 15 (thousand) to 20,000-dollar deduction, right, for people buying their own insurance? If you take a median-income family of $62,000 in this country, you’ve just saved them $3,000 on their taxes. That doesn’t come close to buying an insurance policy.

MR. GIULIANI: Charlie, a health savings account actually helps to accomplish what the governor is talking about. If somebody can put aside — and the plans that we’ve been talking about include a health savings account — you’d have a — you’d have an exemption up to 15,000 (dollars). If you could find a policy for 11,000 (dollars), you could have a $4,000 health savings account. You would be able to buy some of your health care and your prevention yourself. It gives you an incentive over a lifetime to deal with wellness.

None of these comments address the fundamental problem. The fact is that the vast majority of the uninsured don’t have the income to buy health insurance even if they wanted to do so.

Let’s look at some of the GOP candidate’s specific statements. Mitt Romney seems to suggest that the problem will resolve if we can simply get more individuals to buy private health insurance. Excuse me, but there are millions of Americans who can’t even afford to pay their portion of an employer sponsored insurance plan. Just how are those individuals going to be able to afford even more expensive individual policies?

Rudy Giuliani’s plan isn’t any better. Note Charlie Gibson’s explanation whereby the government offers a tax incentive for individuals or families to purchase private insurance. However, to do so, a family needs to be able to afford at a minimum of $13,000.00 (the amount they currently pay for employer sponsored insurance) in order to receive a $,3000.00 tax break. If you haven’t the ability to pay for the insurance, the tax break is meaningless. Therefore the Giuliani plan only works for those who can already afford health insurance. It sounds nice to talk about a 15 to 20 thousand dollar exemption, but it isn’t going to help those with low incomes who already pay minimal taxes.

When Giuliani goes on to laud the benefits of an HSA, he is once again insulting our intelligence. If most of the people who lack health care had the ability to set aside $4,000.00 in an HSA…or under their mattress…wouldn’t they already be doing so? Further, the assumption that people aren’t mindful of their own wellness is laughable. If you can’t put food on the table for your family, you sure as hell don’t put $4,000.00 in an HSA account for wellness care.

Frankly, the bulk of the GOP rhetoric on health care is little more than smoke and mirrors intended to feign concern without ever having to fund care. I would relate it to one of my favorite expressions told to me by an old friend, “I’d have a ham and cheese sandwich…if I had any ham or cheese.” By and large, the same logic holds for the plight of the uninsured.

In fairness, both John McCain and Mike Huckabee argued that the lack of wellness and preventative care are largely responsible for the skyrocketing costs of health care. Their statements are a sensible equivalent to the oft heard expression, “you can pay me now or pay me later”…except for one critical omission. The “pay me now” portion of the equation is the lion’s share of unfunded health care costs…costs which are only currently covered by health insurance…the health insurance that millions can’t afford…and that the GOP has little desire to fund.

Since the health care industry isn’t absorbing these costs (and doesn’t want to), they have absolutely no motivation to offer to subsidize this type of care. At the same time, it’s abundantly evident that the GOP opposes the government stepping in to cover these costs. The truth of the matter is that the health care industry and the GOP both accept that it’s cheaper (and more profitable) to continue only requiring the health care industry to provide indigent emergency care. In the end, that essentially leaves few people advocating for the needs of the uninsured…and more people in the morgue.

It’s been more than seven year since George Bush sold the American public on the notion of “compassionate conservatism”. Let’s hope that the election of a Democrat in 2008 will be the first step towards seeing it demonstrated.

Cross-posted at Thought Theater