Biden and Warren Can’t Avoid Their Weaknesses Forever

While both remain in the lead in various polls on the Democrat presidential nomination contest, both Joe Biden and Elizabeth Warren leave me with a sense of unease and a continued fear that neither can defeat Trump in a general election.  On Biden's part - if one overlooks his constant gaffes and age - the albatross of his son Hunter hangs over him and he refuses to fully and properly address the issue - something that plays directly into the hands of Trump and Fox News, the GOP state news channel.  On Warren's part, her refusal to admit that her health care plan would raise taxes in a very visible way is an Achilles heel that will not go away.  This, combined with her liberalism in general could likewise play to Trump's advantage. As a piece in New York Magazine notes, neither one of these candidates appears willing to address these liabilities and prepare for an onslaught by Trump should they win the nomination.  Here are article highlights:

If you paid close attention to the Democratic presidential debate this week, you noticed something that Democrats might find disturbing. The two leading candidates — Elizabeth Warren and Joe Biden, probably in that order — both faced tough questions that could damage them in the general election. And neither appears prepared to defend themselves against what is coming.

Begin with Biden, who has a simple problem with no clear solution. His son, Hunter, traded on his father’s name. In Ukraine, Hunter Biden accepted a lucrative position on the board of Burisma, a Ukrainian energy company. Burisma surely believed hiring the vice-president’s son would give it political juice with the United States government. It did not. . . . Yet this does not fully absolve either Joe or Hunter. . . . At minimum, the arrangement marginally spent down the moral capital of the American government and economy by promoting the perception that official favor can be purchased through family members of powerful officials.

Trump, of course, has degraded that moral capital a million times over with his open nepotism and self-dealing. The problem Biden faces is that it is difficult to communicate the nuance of his position. . . . . Biden’s response to this dilemma was to elide it completely. At the debate, Biden simply insisted he and Hunter did nothing wrong while deflecting the inquiry.

For human and understandable reasons, Biden is obviously reluctant to scold his troubled son in public. Yet the fact is that his son’s behavior is an albatross for the father, and all indications suggest that, if Biden wins the nomination, the damage from this relationship will only grow.

Warren, for her part, faced yet another round of criticism over her refusal to acknowledge the financing mechanism of the health-care plan she has endorsed. The political weak point of the Sanders plan is that it would move 157 million Americans off of employer-sponsored insurance and onto Medicare. In theory, this should work out great. (I would be happy to trade my employer insurance for Medicare.) In practice, this requires convincing half the country to swap their current insurance for a government plan, and to convert their health-care premiums (which are nontransparent and remitted directly by their employer, reducing their wages only indirectly) into taxes (which are paid directly). Poll after poll shows both these changes turn the abstractly popular notion of broader coverage upside down.

Warren’s strategy is to dodge both objections. She has, in the past, avoided the question of people losing their employer insurance by saying nobody likes their insurance company. . . . On taxes, she changes the question to total cost and refuses to acknowledge that taxes will go up in the swap.

Warren’s admirers consider this dodge to be clever, but the last debate shows just how politically corrosive it could become. The problem is that Sanders, who wrote the damn bill, openly admits taxes would go up.  . . . The contrast between one Medicare for All supporter honestly admitting how the plan would work, and the other one refusing to admit it, did not make her look good. It gave her opponents an opening to cast her as shady, which they seized.

Pete Buttigieg pointed out that Warren’s response was “a yes or no question that didn’t get a yes or no answer.” Biden said, “it’s important to be straightforward with them,” and Amy Klobuchar added, “at least Bernie’s being honest here.” This is not merely a problem of Warren being associated with an unpopular policy. It is a question that is corroding her reputation for honesty, which is a foundation of her outsider, truth-telling brand.

As with Biden, Warren will find the reality that Trump is orders of magnitude worse to be of little value. Republicans have a party-controlled mass-media apparatus that has trained its rank and file to support liars, but the Democrats do not.

If Biden wants to beat Trump, he needs to put more distance between himself and his son. If Warren wants to beat Trump, she needs to ditch Bernie’s health-care plan and come up with one that doesn’t have political poison pills. The question with both candidates is, what steps are they willing to take to win?

The Health-Care Crisis Has Spread to Employer Plans

America continues to have the most expensive, least efficient healthcare system - if one can even call it a system, given its fragmented nature - where people pay vastly more for the same procedures than people in Canada or Europe.  Add to that the ungodly high prescription drug costs that allow pharmaceutical companies in the USA to price gouge consumers, and it is a recipe for financial hardship for many who find themselves deferring care because they cannot pay policy deductibles.  While the focus of the Affordable Health Care Act was to bring insurance to the uninsured, a growing crisis is developing under employer based plans that are using ever increasing deductibles and prescription limitations as a means to cope with soaring costs.  It's little wonder that life expectancy is falling in the USA.  A piece in New York Magazine looks at the growing crisis.  Here are article excerpts:  

For most of this century, the big U.S. health-care policy issue has been providing insurance to the uninsured, including the uninsurable people with expensive health conditions. Yes, the majority of non-elderly Americans covered by employer-based insurance were affected by this debate insofar as sharing the costs of more universal coverage would increase their premiums and/or taxes. But for the most part, Americans were relatively happy with the insurance they got at work.

That’s changing, as is graphically illustrated by a major new survey conducted by the Los Angeles Times and the Kaiser Family Foundation that shows insurance deductibles, co-pays, and other “cost sharing” requirements by insurers are putting the squeeze on affected policyholders in a big way.

As the Times’ Noam Levy explains, the rise of deductibles has been dramatic:

In the last 12 years, annual deductibles in job-based health plans have nearly quadrupled and now average more than $1,300 [family coverage deductibles are far higher].

Yet Americans’ savings are not keeping pace, data show. And more than four in 10 workers enrolled in a high-deductible plan report they don’t have enough savings to cover the deductible.

One in six Americans who get insurance through their jobs say they’ve had to make “difficult sacrifices” to pay for healthcare in the last year, including cutting back on food, moving in with friends or family, or taking extra jobs. And one in five say healthcare costs have eaten up all or most of their savings.

And that’s not even counting those who skip care they need because they cannot afford to pay their “share” of steadily rising medical bills.  When people don’t get essential care, of course, insurance has failed everyone other than the insurer itself. And while everyone was aware cost-sharing requirements were steadily increasing, it did sneak up on policy-makers whose attention was elsewhere:

The 2010 healthcare law — often called Obamacare — provided landmark protections to Americans once shut out of health coverage. But as Democrats and Republicans fought over the law, Altman said, neither focused on the rapid run-up in costs for people covered through work.

But this was by no means accidental. High-deductible insurance plans were promoted both by the industry and by conservative politicians: . . . . Backers of the high-deductible strategy nevertheless argued that patients, given “skin in the game,” would become active consumers who would force drugmakers, hospitals and other medical providers to rein in prices.

If that sounds familiar to consumers of political rhetoric, it’s because Republicans have long promoted patient-driven competition as a health-care cost panacea, usually through a combination of high-deductible insurance plans and tax-preferred health savings accounts designed to help consumers save for out-of-pocket costs.

Guess who got left holding the bag? That’s right, the employees, who were essentially victims of a bait and switch.  Now, suddenly, people with employer-sponsored health insurance have more to worry about than fighting managed care and/or maintaining the right to choose doctors

This shift in sentiment also helps explain why Medicare for All is so popular an idea. Yes, seamless universal coverage is attractive, but getting rid of deductible, co-pays, and even (in the more generous proposals) premiums could be an even bigger deal. It’s enough to make proponents of “skin in the game” nervous:

Even former Utah Gov. Mike Leavitt, a Republican who supported the move to higher deductibles as Health and Human Services secretary in the George W. Bush administration, acknowledged that adjustments may be needed, even if returning to the days of no-deductible coverage is not the solution.

“There needs to be a way to relieve the pressure,” Leavitt said. “Otherwise, people will feel like they have no insurance at all.”

Exactly.

Democratic House Majority’s First Order of Business: Restore Democracy

In the 2018 midterm elections Democrats won 8.8 million more votes than their Republican opponents and won as of this writing 39 seats in and control of the U.S. House of Representatives.  Yet due to gerrymandering, the structural failure of the U.S. Senate, Republicans continue to hold an outsize measure of control in Washington - a  control that benefits the wealthy, large corporations and corrupt politicians to the detriment of average Americans.  In a column in the Washington Post, Democrats lay out their plan to re-balance democracy in favor of the majority, not the select few and racist minorities. Among the reforms the House Democrats seek to enact - getting them through the Senate may be an obstacle - are: (i) ending dark money form politics and forcing donors to be identified. As of now, we still do not know who paid Acting Attorney General Whitaker $1.2 million through a shell "charity," (ii) closing down the revolving door between Congress and large corporations, and (iii) ending gerrymandering and Republican voter suppression efforts.  Unless one is part of the greed driven 1%, a racist, or a vulture capitalist, these goals should be attractive to decent moral citizens.  Here are column excerpts:

Americans went to the polls and sent a powerful message: The election not only was a resounding verdict against Republicans’ assault on Americans’ health care and wages, but also it was a vote to rescue our broken democracy.

In the face of a torrent of special-interest dark money, partisan gerrymandering and devious vote-suppression schemes, voters elected a House Democratic majority determined to bring real change to restore our democracy.

The new Democratic House is ready to deliver with H.R. 1: a bold reform package:

First, let’s end the dominance of money in politics. For far too long, big-money and corporate special interests have undermined the will of the people and subverted policymaking in Washington — enabling soaring health-care costs and prescription drug prices, undermining clean air and clean water for our children, and blocking long-overdue wage increases for hard-working Americans.

So let’s rein in the unaccountable “dark money” unleashed by the Supreme Court’s Citizens United v. Federal Election Commission decision by requiring all political organizations to disclose their donors, and by shutting down the shell game of big-money donations to super PACs.

Next, let’s make sure that when public servants get to Washington, they serve the public. Restoring the public’s trust means closing the revolving door between government and private industries, and imposing strong new ethics laws to stop officials from using their public office for personal gain. To do so, we will expand conflict-of-interest laws, ban members of Congress from serving on for-profit boards, revamp the oversight authority of the Office of Government Ethics, and prohibit public servants from receiving bonus payments from their former employers to enter government.

Finally, let’s make it easier, not harder, to vote. Since the Supreme Court took the teeth out of the Voting Rights Act, Republican political operatives have increasingly turned to blatant schemes to make it more difficult for the Americans left behind to participate in elections — a narrow agenda all too often targeted at communities of color.
We must renew the Voting Rights Act to protect every citizen’s access to the ballot box and restore the vital safeguard of pre-clearance requirements for areas with a history of voter suppression. We will promote national automatic voter registration, bolster our critical election infrastructure against foreign attackers, and put an end to partisan gerrymandering once and for all by establishing federal guidelines to outlaw the practice.

These are the reforms that will ultimately change the balance of power in Washington. When we get dark money out of politics, clean up corruption and ensure fair elections, we will dismantle the ability of special interests to stack the deck of our democracy and our economy against hard-working Americans.

[W]ith a system that works for the people, we will deliver policy outcomes that make life better for all Americans: We will lower health-care costs and out-of-control prices for prescription drugs. We will rebuild the United States’ infrastructure, raise the minimum wage and put leverage back in the hands of workers and consumers. We will finally advance common-sense, bipartisan solutions to prevent gun violence. We will confront discrimination with the Equality Act , pass the Dream Act to protect the patriotic young undocumented immigrants who came here as children, and take the first step toward comprehensive immigration reform.

We have a responsibility to honor the vision of our founders, the sacrifices made to expand the right to vote and our duty to the American people.

Here in Virginia, we can aid in the effort by electing Democrat majorities to both the Virginia Senate and the House of Delegates in November, 2017, and end Republican obstruction.  

Politicians Continue to Allow Big Pharma to Screw Americans

Americans pay more for healthcare than residents of any other developed country.  The same goes for drugs.  It is common for American consumers to pay three times (often many times more) the prices paid in Europe, Canada and even Mexico.  The reasons for this rip off of American consumers?  First, the lack of a decent, national health insurance system where managing care, not maximizing prices for private interests, is the goal  Nowhere is the greed and rapaciousness in American healthcare worse than in the area of prescription drugs.  Big Pharma is allowed to hold monopoly power and charge whatever outrageous price it wants and the government refuses to force price negotiations of prices for programs such as Medicare.  The result stems from politicians being bought by pharmaceutical companies.  Indeed, Congress has played a huge role in allowing the opioid epidemic to grow by tying the hands of would be government regulators.  A piece in the New York Times looks at America's broken system.  Here are excerpts: 

So Donald Trump broke another promise: he did not, after all, empower Medicare to negotiate lower drug prices. Instead he (and Michael Cohen, who definitely isn’t his bagman) took money from drug lobbyists, appointed them to key positions, and announced a plan that sent drug stocks soaring. I’m sure you’re shocked.

But promise-breaking aside, would introducing a policy of bargaining drug prices down have been good for America? Actually, yes.

Oddly, I never got around to doing my homework on the economics of drug-price bargaining – partly because I was realistic enough about the political economy to realize that it wasn’t going to happen in America any time soon. Still, the fact that Trump promised to do something makes it somewhat relevant, even if he did predictably break that promise. And it turns out that the economic case for doing what Trump just didn’t do, for putting caps on drug prices, is remarkably strong.

Let’s start with where things are right now. After a drug company gets a patent, it has a temporary monopoly on sales of its drug. So its situation looks like that of a standard monopolist . . . It charges a price that is above the marginal cost of producing the drug – usually well above marginal cost.

[O]verall, society gains from the drug’s existence. However, . . . . society would gain more if someone – regulators, purchasing managers at government agencies, whatever – forced the drug company to charge less than the monopoly price.

[T]he United States would almost certainly be better off with a moderate level of bargaining/price control than it is under the current hands-off regime. Why? I count at least four distinct reasons.

First, a point made by Lackdawalla and Sood is that the profit effects of constraining a monopolist’s price are second-order. . . . . What’s going on here is that the profits lost on existing sales are almost fully offset by the profits on additional sales.

What this means in turn is that the negative effect on innovation is small if prices aren’t pushed down a lot, while the consumer gains are first-order. Some price bargaining is always welfare-improving.

Second . . . . . it’s often argued that pharma companies basically develop too many drugs, wasting resources on what amounts to unnecessary duplication. To the extent that this is true, discouraging some innovation isn’t a bad thing.

Third, the consumer surplus calculation assumes that consumers actually pay for the drug. In fact, many drugs are paid for by insurers – which is necessary, because like much of modern medicine the cost if you need it is far beyond most people’s ability to pay out of pocket. But this means that the price someone is willing to pay may greatly exceed the value to the patient. In general, the interaction of drug insurance with monopoly pricing creates potentially huge distortions in both drug development and drug use, reinforcing the case for bargaining.

Finally, it’s a global market – which means that much of the consumer surplus from drug development accrues to foreigners, not U.S. citizens. Maybe there should be more drug development from the point of view of global welfare. But given the unique unwillingness of the U.S. to bargain over prices, we end up paying a much larger share of the costs of that development than we receive of the benefits. Funny how Trump is America first on everything, except when a nationalist position might be bad for Big Pharma.

Yes, Trump says he wants to force other countries to raise drug prices. Good luck on that.

What this comes down to is that there is a very strong case for doing what Trump promised to do but didn’t. I’m aware that simply saying “let’s bargain over drug prices” isn’t effective unless coupled with a willingness to say no – to tell a drug company that an overpriced drug will be excluded from the formulary. So it wouldn’t be politically easy. But it would be good economics.

The Growing Support for a Single Payer Healthcare System

Last evening the husband and I were reviewing plan options for his salon staff (and us since I am about to roll off of coverage through my former employer that was far cheaper due to the size of the company).  The best description is to say that there are NO attractive options with the costs for us as a couple totaling to well over $1,500 per month ($18,000 per year).  That exceeds the individual annual payments on any of the mortgages on our properties and exceeds what we spend per year even when my hand surgery last year is factored in.  The winners in this game, of course, are the health insurance companies which laugh all the way to the bank.  It's little wonder that (i) health insurance companies are nearly universally hated and (ii) that more and more Americans - other than the wealthy, of course - support a single payer system.  A column in the Washington Post looks at this trend which collides head on with the GOP's effort to throw Americans off of insurance coverage to pad the wallets of the wealthy and insurance companies.  Here are excerpts:

Despite the rise of the tea party and unified Republican control of government, one decidedly anti-free-market idea appears ascendant: single-payer health care.

And it’s no wonder, given that a record-high share of the population receives government-provided health insurance. As a country, we’ve long since acquiesced to the idea that Uncle Sam should give insurance to the elderly, veterans, people with disabilities, poor adults, poor kids, pregnant women and the lower middle class.

Many Americans are asking: Why not the rest of us, too?

A recent survey from the Economist/YouGov found that a majority of Americans support “expanding Medicare to provide health insurance to every American.” Similarly, a poll from Morning Consult/Politico showed that a plurality of voters support “a single payer health care system, where all Americans would get their health insurance from one government plan.”

Divining the longer-term trend in attitudes toward this idea is difficult, as the way survey questions on the topic are asked has changed over time. Views of a health-care system in which all Americans get their insurance from the government single payer vary a lot depending on how you frame the question. Calling it “Medicare for all,” for example, generally elicitsmuch stronger approval, while emphasizing the word “government” tends to depress support.

But at the very least, some survey questions that have remained consistent in recent years show support has been rising back up over the past few years for the broader idea that the federal government bears responsibility for making sure all Americans have health-care coverage.

The increase in the share of Americans on government insurance is partly due to demographics (baby boomers aging into Medicare) and partly due to deliberate policy changes growing the pool of Americans eligible for government insurance (such as the creation of the Children’s Health Insurance Program and Obamacare’s Medicaid expansion).

In both the recent YouGov and Morning Consult polls, for example, the age group most opposed to single payer was the only one that basically already has it: those 65 and up. In other words, single payer for me but not for thee.

That’s not because older Americans hate their experience with Medicare and wouldn’t wish something similar upon their worst enemy. To the contrary, those on Medicare are more satisfied with how the health-care system works for them than people on private insurance are, according to Gallup survey data.

Rather, seniors are probably worried that expanding government coverage to more Americans could put their own generous benefits at risk. 

Trump supporters with deep hostility toward Obamacare, among other government programs. Some of these Trump supporters are, perhaps puzzlingly, themselves Obamacare beneficiaries, receiving government subsidies for private insurance on the individual exchanges. But often what these Trump voters say they want is not a return to pre-Obamacare days; rather, they want in on the great insurance deal that they think their lazy, less-deserving neighbors are getting.

House Speaker Paul D. Ryan (R-Wis.) and his congressional compatriots seem to further believe — despite all evidence to the contrary — that the private sector is on the verge of some innovation that will magically reduce health-care costs and give all Americans the coverage and care they yearn for. 

Americans as a whole pay through the nose for the least efficient and most costly health care system in the world.  Why can't this country learn from the experience of other advanced nations and opt for universal coverage and a single payer system?  Two reasons, I suspect: (i) many of the wealthy don't give a damn about their fellow citizens, and (ii) the evangelical Christians hate most of their fellow citizens and want to keep their monies for themselves.  

The Moral Bankruptcy of the GOP's Obamacare Repeal

The moral bankruptcy of today's Republican Party - and the 81% of evangelical Christians who voted for Der Trumpenführer - cannot be stressed often or strongly enough.  Nowhere is this moral bankruptcy more evident than in the GOP drive to repeal Obamacare.  Despite the lies and smoke screens being floated by Republicans, the underlying agenda of Obamacare repeal is to provide huge tax cuts to the wealthy (one estimate of Obamacare repeals is a $270 billion gift to high income households) while depriving millions of coverage,   Left without coverage, the uninsured will be left to secure treatment at non-profit hospitals that must treat - at least for now - the uninsured through their emergency room operations, the most expensive and least efficient method of healthcare delivery.  This, of course, leaves hospitals forced to recoup these costs by drastically raising prices for those with insurance and/or the ability to pay for care.  The result?  Americans pay two to three times more for healthcare than any other advanced country, all of which have some form of universal coverage.  An op-ed in the New York Times written by a hospice nurse aptly describes the GOP's moral bankruptcy on this issue.  Here are excerpts:

Imagine a car crash. There’s twisted metal, broken glass and the low moaning of an injured human being. An ambulance arrives, and two emergency medical technicians get out.

Now imagine this: One E.M.T. moves to the wreck, sees the wounded driver — a man, the one who’s moaning — and before doing anything else, flips down the driver’s seat visor, looking for an insurance card that isn’t there. Then he stands back up, frowns and shakes his head.

“No insurance?” his partner calls out. The E.M.T. shakes his head again.

Maybe nothing this extreme would ever happen. But contrary to what some congressional Republicans say, a world in which it could is the logical conclusion of their efforts to repeal the Affordable Care Act and set per capita caps on Medicaid — and the all-but-explicit desire among dozens of hard-liners.

The House leadership is making gestures toward covering the uninsured by retaining popular portions of the A.C.A. and offering a suite of “market-based” programs like health savings accounts and tax credits. In some ways, that’s their problem; if the Republican bill designed to replace the A.C.A. fails, it could well be because of pressure from the far right, which is insisting on repeal, full stop. For a large number of Congressional Republicans, any effort to cover the costs of care for the poor and uninsured smacks of socialism and unwelcome government interference in the market.

It’s easy, politically, to make that case against the A.C.A., since the Republicans have spent the better part of a decade demonizing it. And it’s easy to forget how bad things were for tens of millions of Americans before Obamacare.

To begin with, consider the numbers. A percentage of the 20 million Americans who gained insurance under the A.C.A. will very likely lose it if the law is repealed. Even with the provisions in the proposed American Health Care Act, the “replace” part of the Republican approach, an estimated 10 million people would fall off the rolls. . . . . a vast majority, will be terrified by the idea of living without health insurance. As was the case before the passage of the A.C.A., many of the uninsured — the terrified and relieved alike — will end up using hospital emergency departments for their health care needs, even if they cannot afford it.

[T]he opposite of the A.C.A. is not a free market. The Emergency Medical Treatment and Labor Act, a 1985 law, requires that hospital emergency departments treat all comers. So, while some uninsured patients will forgo care after repeal of the A.C.A., others, especially the seriously injured and mortally ill, will secure the care they need even if they can’t pay for it, even if they know they will never be able to pay for it. And in the end, all of us pay for that care through higher insurance premiums, increased hospital costs and overtreatment of the (paying) insured.

[F]rom decades of debate leading up to the A.C.A., the only way to rein in health care costs in a system without some form of universal public health insurance is to place limits on care for those without insurance or the ability to pay for it outright.

I remember a recent case, here in Pittsburgh. A woman, young and fit, moved to the city to be with her boyfriend. She didn’t have health insurance because she was new in town and hadn’t yet found a job. But she wasn’t worried; her youth, she thought, guaranteed her health.

But it turned out she had A.M.L. — acute myelogenous leukemia — a killer disease, the medical version of a high-speed collision. The first round of curative treatment required a six-week hospital stay, multiple infusions of chemotherapy and intensive round-the-clock nursing. And that was just the start. . . . . Treating A.M.L. can cost upward of $100,000. Neither she nor her boyfriend had that kind of money.

If the A.C.A. is scrapped and Medicaid is converted to per capita caps, partly to ensure that everyone who gets care pays her fair share, I worry about what will happen to patients like this young woman. Abandoning this patient to her terrible disease simply because she couldn’t pay for the cure feels sad and wrong. Just as sad and wrong as abandoning an injured patient at a crash site.

House Speaker Paul Ryan and others would take mock offense at the idea that they’re willing to let people go without care, but it’s the unavoidable logic of their drive to undo Obamacare — the part that Republicans would rather not talk about, even as it drives them to ram through the legislation without debate.

People without insurance and little money are still going to need care, some of it very expensive. To deny these people care by restricting their access at the source — ambulances, emergency departments, hospitals — would reflect equity in a you-get-what-you-pay-for model. But the human cost of limiting health care to those who can pay would be higher than any of us should be willing to bear.

 Congressman Joe Kennedy, III, correctly condemned the GOP in his statements - which the GOP chair cut short because they were all too true.

Personal Medical Lessons Learned

My hand after the initial surgery

Throughout the life of this blog, I have shared my thoughts and experiences in the hope of educating others or offering a chance for others to avoid my own negative experiences.  Other than a brief post on Facebook, to date, I have said little on what has been going on for the better part of the last month in terms of what became a frightening personal medical issue.  I have learned a great deal, not all of it good.  Now, I want to share some of what I've learned.

First, the background.  For a number of years I had what appeared to be a wart on one of my fingers. It seemingly responded to at home treatments and finally, last year my dermatologist did an in-office freezing treatment.   At first, the treatment appeared to work, but then the spot began to significantly increase in size.  The dermatologist sent me to a hand surgeon to remove it and all thought it was a simple procedure.  The surgery seemingly went fine, but then the pathology report suggested a benign growth with possible "malignant transformation" and recommended full removal with "appropriate margins."   That's when things became very scary.  What I had was very rare - an incidence of 0.005%.  The local physicians recommended removal of the entire finger - something unacceptable from both a vanity perspective - I am a gay male, after all and from the perspective of on dealing with clients almost daily where my hands are in view as papers are executed was truly appalling.

Thankfully, after a round of bitchiness, the local oncologist referred me to specialists at the Medical College of Virginia ("MCV") hospital complex in Richmond - a surgical oncologist and a hand surgery specialist who does reconstruction work.  After a number of nights with restless sleep at best, the husband and I went to MCV today. Not only was the pathology report considered an overstatement, but removal of my finger was not considered necessary.  Yes, as a precaution, I will need an additional surgery and a likely skin graft in three weeks to address the additional tissue removal, but the entire situation is far less frightening and life threatening.  I will sleep far better tonight than over the last week or so!

As for the lessons learned, here's a run down.

1. Always have anything out side the norm checked out early and get a second opinion if you have any questions whatsoever.

2. Even with "really good" healthcare insurance, many families can quickly face financial Armageddon.  Between deductibles and maximum out of pocket provisions, even with fairly top of the line coverage, you can be looking at a $10,000 financial outlay for a single year (the same limits would hit again in the following policy year).  While it will be a strain, the husband and I will survive the cost.  Many families raising children could not.  Hence my renewed conclusion that we need a single payer health care system akin to what they have in France.  Needed healthcare treatment should not drive families into bankruptcy.

3. Always seek out specialist, preferably at a top teaching hospital.  The local physicians meant well and one was very kind and caring, but based on today's visit and assessment, they were simply wrong.  By insisting on a second opinion, I have in all likelihood avoided an unnecessary extreme "solution."

4. Rely on your own intuition and seek out others who will be supportive and encourage you to seek more answers and look for specialists outside of the local area.  I thank the husband and certain of his clients who went out of their way to be supportive and to encourage me not give up.

5. Treasure those who are supportive of you.  This entire ordeal has reminded me of how lucky I am to have a wonderful man as my husband and best friend.

Democrat Debate Winner and Loser

I watched the Democrat presidential debate last night and was once again struck by the difference between it and the largely substance free Republican debates that focus mostly on sound bites and pandering to the racism, religious extremism and general misogyny of the GOP base.  Last night - as in the prior Democrat debate - real substance was discussed and when there were vague generalities, most often they came from Bernie Sanders.  As a piece in the Washington Post notes, the night overall went to Hillary Clinton.  Here are some excerpts:

Winners:

* Hillary Clinton: Beginning to end, this was Clinton's best debate of the election.  In the first half hour, Clinton poked a series of holes in Sanders's health-care proposal and broadly cast the Vermont senator as someone who talks a big game but simply can't hope to achieve his goals.  She was calm and cool throughout -- even when fighting on Sanders's home turf on wage inequality. Clinton also effectively cast Sanders as insufficiently loyal to President Obama, a point that will resound with black voters among whom Obama remains extremely popular.

Clinton was helped by the dearth of questions about uncomfortable topics for her (paid speeches, State Department investigations); when pressed on her super PAC being financed heavily by a few individuals, Clinton was uncomfortable and gave one of her worst answers of the night. But, those moments were few and far between. If she -- and her campaign -- were knocked back after her massive loss in New Hampshire, it didn't show.  She was in total control all night.

Losers:

* Bernie Sanders: If the challenge for Sanders was to show that he could be a candidate for people other than those who already love him, he didn't make much progress toward that goal Thursday night. Sanders did come across as more well-versed on foreign policy than in debates past -- a low bar -- but he struggled to score clean hits on Clinton during the first hour of the debate, which focused exclusively on domestic policy, which should have been his strong suit. Sanders, at times during that first hour, sounded like a broken record -- citing millionaires and billionaires and Wall Street to explain almost anything he was asked.

Then there was Sanders's insistence that he would be better on race relations than Obama, a slip that you can be sure that the Clinton campaign will make sure African American voters hear about (and then hear about some more) in the coming days and weeks.

Perhaps Sanders' biggest problem, as noted by the husband who is usually good at picking up on average voter reactions is that Sanders comes across as always angry - something that in general election could prove damaging. 

GOP Schizophrenia On Health Care Reform

At times I wonder if some of the GOP leadership suffers from schizophrenia.  On the one hand we have Marco Rubio ranting that a continuing resolution to fund the federal government for the rest of the fiscal year must include provisions to defund Obamacare in its entirety.  Meanwhile, a group of top House Republicans have written a letter to President Obama asking him to preserve a temporary program included in the law that provides health care coverage to people with pre-existing conditions.  Obviously, one cannot have it both ways.  Here's what Rubio was saying during an interview via Think Progress:

Rubio parroted the usual litany of wild — and widely debunked — conservative hysteria about the dire consequences that Obamcare will have on American businesses and the U.S. health care industry, asserting that he would only vote to avert a government shutdown if Obamcare implementation is halted completely:

HEWITT: Senator Rubio, the continuing resolution is headed your way. How is this stacking up as Act III of the spending drama?

RUBIO: Well first of all, I don’t think anyone is in favor of shutting down the government, but I think that’s where we’re headed ultimately here, unfortunately, if we don’t fix our debt problem… But here’s what I’ve said about this continuing resolution. Senator Cruz from Texas is offering this amendment to defund Obamacare. If that gets onto the bill, in essence, if they get a continuing resolution and we can get a vote on that and pass that onto the bill, I’ll vote for a continuing resolution, even if it’s temporary, because it does something permanent, and that’s defund this health care bill, this Obamacare bill, that is going to be an absolute disaster for the American economy.

One can only assume that Rubio has not bothered to have a chat with his GOP compatriots in the House of Representatives where something quite different is underway.  Think Progress reports this:

In another sign of the growing political support for health reform — or the sense that opposing its most popular elements has become politically perilous — a group of top House Republicans have written a letter to President Obama asking him to preserve a temporary program included in the law that provides health care coverage to people with pre-existing conditions.

The so-called Pre-Existing Condition Insurance Plan (PCIP) was designed as a bridge to the exchanges for families and individuals who don’t have an offer of coverage from an employer and cannot find insurance in the individual market. The $5 billion program, which covers only sick people is incredibly costly, and will soon stop processing new applicants. 

Republicans however, are incensed, and are demanding that the White House shift funds from prevention or comparative effectiveness research to keep the PCIP running. 

“Your administration’s action will leave thousands of Americans with pre-existing conditions without access to health care,” the group of House Republicans write in a letter first obtained by the Talking Points Memo’s Sahil Kapur. The letter reiterates the GOP’s opposition to the Affordable Care Act as a whole but notes, “to allow PCIP to continue to accept new enrollees, we urge you to support efforts to transfer the funds necessary from other PPACA programs, such as the Prevention and Public Health Fund, the Secretary’s transfer authority to assist with state based exchanges, comparative effectiveness, planning, or another similar program to PCIP.”

 The letter to Obama was signed by House Speaker John Boehner (R-OH), House Majority Leader Eric Cantor (R-VA), House Majority Whip Kevin McCarthy (R-CA), Republican Conference Chair Cathy McMorris Rodgers (R-WA), Energy & Commerce Chair Fred Upton (R-MI), Energy & Commerce Health Subcommittee Chair Joe Pitts (R-PA) and Rep. Michael Burgess (R-TX).

The truth is that this country desperately needs health care reform and the reality is that the Affordable Health Care Act went nowhere near far enough in fixing the problem.   I for one support a single payer program because nothing else is going to rein in exploding hearth care costs - my firm heath plan premiums are going up over 11% even though we have had no major claims filed - and end the monopoly games being played by hospital systems.

The other irony is that the House GOP leaders are suddenly worried about those with pre-existing conditions while seeking to kill Obamacare and leave millions totally uninsured.  For a political party that claims to so supportive of Christian values, kicking millions to the curb as disposable garbage is the height of hypocrisy.

Republicans: Their Own Worse Enemy on Healthcare

While much political focus has been on the so-called "fiscal cliff" which the GOP seems bound and determined to take the country over, within the nation's fiscal problems lies an issue that is driving much of the increased spending on what the GOP derisively calls entitlements: exploding healthcare costs.  Exploding healthcare costs that are driving up Medicare and Medicaid costs sharply.  But rather than address the real issue behind the growing budget deficit, the GOP as a party prefers to coddle big medicine and big pharmaceutical companies while treating millions of Americans as disposable trash.  And this from the political party that claims to embrace Christian values which ought to by any interpretation include caring for the poor and the sick.  A piece in the Washington Post looks at the GOP's ass backwards behavior which defies common sense.  Or at least common sense among rational people.  Here are column excerpts:

Conservatives once genuinely interested in finding market-based ways for the government to expand health insurance coverage have, since the rise of Obamacare, made choices that are dysfunctional, even from their own perspective.

Start with the decision of the vast majority of Republican governors to refuse to set up the state insurance exchanges required under the law. The mechanisms would allow more than 20 million Americans to buy coverage. They were originally a conservative idea for large, trustworthy marketplaces where individuals and families could buy plans of their choice.

So, irony of ironies, in declining to set up state exchanges, conservative governors are undermining states’ rights and giving liberals something far closer to the national system they hoped for. As Robert Laszewski, an industry critic of Obamacare, told The Post’s N.C. Aizenman, conservative governors are engaging in “cut-off-your-nose-to-spite-your-face” behavior.

This is one of many forms of conservative health-care unreason. The “fiscal cliff” debate has been distorted because the problems confronting federal finances are consistently misdescribed. We do not have “an entitlement problem.” We have a giant health-care cost problem. 

Our major non-military fiscal challenges lie in Medicare and Medicaid. In principle, conservatives should seek to find ways of holding down health-care inflation in both the private and public sectors.

The result is that conservatives would either let government get bigger, or they’d save money by throwing ever more risk onto individuals by undercutting core government guarantees.

Their most outrageous move was the big lie that the original health-care bill included “death panels.” This would have been laughable if it had not been so pernicious. The provision in question would simply have paid for consultations by terminally ill patients — if they wanted them — with their physicians on their best options for their care.

Is it any wonder that our fiscal politics are so dysfunctional? Yes, we liberals are very reluctant to cut access to various government health-insurance programs. With so many Americans still uninsured, we are wary of depriving more people of coverage. But we fully accept the need to contain government health spending.

Yet given the conservatives’ habit of walking away even from their own ideas (the exchanges, for example) and of rejecting progressive efforts to save money, is it any wonder that liberals suspect them of greater interest in dismantling programs than in making them more efficient? We won’t find genuine common ground on deficits until we resolve this dilemma.

The GOP has become a pack of rabid dogs that reject their own former ideas and seem Hell bent on destroying the nation's economy and throwing millions of Americans overboard.  All so that they can appease a shrinking group of insane Christofascists and Tea Party Neanderthals who comprise the party base.

Romney Praises Israel's Government-Run, Universal, "Socialized" Health Care System

In addition to outraging Palestinians by stating that their cultural inferiority was at the root of their inability to prosper, on the second stage of his overseas trip to attempt to demonstrate that he has the wherewith all to handle foreign policy matters, Mitt Romney took time in Israel to lavishly praise Israel's health care system.  The only problem is that the Israeli system is - oh, the horror - a government controlled, universal health care system.  A "socialized" system if you believe the bleating and whining against "Obamacare."  And what has this heinous system (at least from a GOP perspective) achieved?  High quality health care at a far cheaper cost than in America where the government of Israel strictly regulates costs and delivery.   Blue Virginia looks at Romney's idiotic hypocrisy of condemning Obamacare yet praising the Israeli system.  Here are highlights: 

[H]ow can one explain the following facts: 1) he signed "Romneycare" into law; 2) "Obamacare" is basically identical to "Romneycare;" 3) Romney claims he hates "Obamacare" and would work to repeal it; and 4) Romney now has heaped praise on Israel's government-run, universal, "socialized" health care system?

Romney, who championed the Massachusetts health care mandate, but is an opponent of the federal mandate passed by President Barack Obama, marveled at how little Israel spends on health care relative to the United States.  

"Do you realize what health care spending is as a percentage of the GDP in Israel? eight percent," Romney told donors at a fundraiser at the King David Hotel in Jerusalem, speaking of a health care system that is compulsory for Israelis and funded by the government. "You spend eight percent of GDP on health care. You're a pretty healthy nation. We spend 18% of our GDP on health care. Ten percentage points more. That gap, that 10 percent cost, compare that with the size of our military - our military which is four percent - four percent. Our gap with Israel is 10 points of GDP. We have to find ways - not just to provide health care to more people, but to find ways to find and manage our health care costs."

Of course, this is EXACTLY the point many of us who pushed for Medicare for all, or robust public option, have been attempting to explain for a loooong time -- namely, that the U.S. health care system costs a lot more than other industrial democracies' health care systems, yet delivers far worse results. In other words, we get among the least "bang for the buck" of any advanced nation in the world in terms of health care, in a system that is mostly based on for-profit health insurance companies. The fact that Romney is busy praising Israel's system of "socialized medicine" is fascinating on many levels, not the least of which is the utter disconnect between everything he's been saying in this year's presidential campaign. It's also a case study on the lengths to which Romney will go to pander to whatever audience he happens to be in, and to say ANYTHING to kiss their butts. 

A piece in the Washington Post looks more closely at how Israel has achieved its successful health care system:

How it has gotten there, however, may not be to the Republican candidate’s liking: Israel regulates its health care system aggressively, requiring all residents to carry insurance and capping revenue for various parts of the country’s health care system.  

Israel created a national health care system in 1995, largely funded through payroll and general tax revenue. The government provides all citizens with health insurance: They get to pick from one of four competing, nonprofit plans. Those insurance plans have to accept all customers—including people with pre-existing conditions—and provide residents with a broad set of government-mandated benefits.  

Israel’s lower health care spending does not look to sacrifice the quality of care. It has made more improvements than the United States on numerous quality metrics, and the country continues to have a higher life expectancy.  

How’d they do it? Jack Zwanziger and Shuli Brammli-Greenberg took a crack at that question in a 2011 Health Affairs paper. The answer, they say, has a lot to do with “strong government influence: The national government exerts direct operational control over a large proportion of total health care expenditures, through a range of mechanisms, including caps on hospital revenue and national contracts with salaried physicians.  

The Ministry of Finance has been able to persuade the national government to agree to relatively small increases in the health care budget because the system has performed well, with a very high level of public satisfaction.

Israel is another example of how the GOP sacrifices the needs of citizens for medical industry and pharmacuetical company profits.  The fact that Americans are needlessly dying and paying needless exorbidate amounts for healthcare means nothing to Mitt Romney and today's GOP.

Why Are Republicans - And Conservative Christians in Particular - Against Health Care Reform?

The New York Times has a main editorial today that looks at the consequences of millions of Americans not having health insurance coverage. Among them ar 18,000 needlessdeaths each year, inefficient and costly use of emergency rooms in lieu primary care givers, and late diagnosis of problems that could have been addressed earlier thereby saving huge costs later. As I have said before, the irony is that the principal opponents of a public option are conservative Republians - who constantly proclaim that they are pro-life and Christian - and their evangelical Christian base. 18,000 needless deaths and the sick going untreated certainly do not strike me as something that Christ would have approved of based on the Gospels which so many of these opponents of health care reform claim are inerrant. The hypocrisy of it all is most telling and further demonstrates that fundamentalism is turing the Christian message into something truly evil. As for the GOP elected officials, they obviously honor the money they receive from drug companies and the insurance industry more than the Gospel message. I wish the MSM would challenge these hypocrites on this issue. Here are some highlights from the editorial:

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No matter how you slice the numbers, there are tens of millions of people without insurance, often for extended periods, and there is good evidence that lack of insurance is harmful to their health. Scores of well-designed studies have shown that uninsured people are more likely than insured people to die prematurely, to have their cancers diagnosed too late, or to die from heart failure, a heart attack, a stroke or a severe injury. The Institute of Medicine estimated in 2004 that perhaps 18,000 deaths a year among adults could be attributed to lack of insurance.

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The oft-voiced suggestion that the uninsured can always go to an emergency room also badly misunderstands what is happening. By the time they do go, many of these people are much sicker than they would have been had insurance given them access to routine and preventive care. Emergency rooms are costly, and if uninsured patients cannot pay for their care, the hospital or the government ends up footing the bill.

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The Agency for Healthcare Research and Quality in the Department of Health and Human Services estimates that 28 million people were uninsured for all of 2005 and 2006 and that 18.5 million of them were uninsured for at least four straight years. That does not sound like a “temporary” problem, and the picture today is almost certainly bleaker.

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THE WORKING POOR The Kaiser Family Foundation estimates that about two-thirds of the uninsured — 30 million people — earn less than twice the poverty level, or about $44,000 for a family of four. It also estimates that more than 80 percent of the uninsured come from families with full-time or part-time workers. They often cannot get coverage at work or find it too expensive to buy. They surely deserve a helping hand.
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THE UNDERINSURED The Commonwealth Fund estimates that 25 million Americans who had health insurance in 2007 had woefully inadequate policies with high deductibles and restrictions that stuck them with large amounts of uncovered expenses. Many postponed needed treatments or went into debt to pay medical bills.

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If nothing is done to slow current trends, the number of people in this country without insurance or with inadequate coverage will continue to spiral upward. That would be a personal tragedy for many and a moral disgrace for the nation. It is also by no means cost-free. Any nation as rich as ours ought to guarantee health coverage for all of its residents.

Median Family Income Has Dropped 2.6 Percent While Bush in Office

One has to wonder how much more of the GOP economic plan the American public can take. The economy is seriously tanking, gasoline prices are at an all time high as are foreclosures, and now a report shows that working class Americans are making less today than in 2000. It would seem that rather than trying to continually knee cap Barack Obama, Hillary Clinton ought to be talking about what really matters to Americans. Oops, I forgot - it's all about Hillary and her sense of entitlement to the presidency. From my involvement representing hospital systems at various times over the years, if non-profit health care/hospital systems spent less time playing monopoly like games to lock up the provision of services and more time focusing on the delivery of cost efficient health care services, the price escalation would be less and the nation's citizens would be better served. In any event, here are highlights from the Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2008/03/23/AR2008032301770.html?hpid=topnews):

Recent history has not been kind to working-class Americans, who were down on the economy long before the word recession was uttered. The main reason: spiraling health-care costs have been whacking away at their wages. Even though workers are producing more, inflation-adjusted median family income has dipped 2.6 percent -- or nearly $1,000 annually since 2000.
Employees and employers are getting squeezed by the price of health care. The struggle to control health costs is viewed as crucial to improving wages and living standards for working Americans. Employers are paying more for health care and other benefits, leaving less money for pay increases.

Since 2001, premiums for family health coverage have increased 78 percent, according to a 2007 report by the Kaiser Family Foundation. Premiums averaged $12,106, of which workers paid $3,281, according to the report. The runaway cost of health care has long been a concern, largely because of the huge number of Americans -- estimated at 47 million -- who are uninsured. But health-care costs are re-emerging as an economic and political issue in part because of the role they play in the stubborn problem of stagnating wages.

Researchers Ezekiel J. Emanuel and Victor R. Fuchs say that employer-sponsored health-care plans create the "myth" that workers are getting their health benefits for little or nothing. But, in fact, "workers and households pay for health insurance through lower wages and higher prices," they wrote in the March 5 issue of the Journal of the American Medical Association.