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The Voice of the Poor on Proposed "Health Care" Plans

chicago dyke's picture

Unfortunately, none of the leadership of either party seems to have any regular contact with dirty, smelly poor people. There are times when it really frustrates me, to listen to what candidates or pundits say about health care and the reality of it for most people. It's as if they are speaking another language, they often feel so distanced from where I am and millions like me are. This post isn't about HRC or BHO per se, so much as it's meant to contrast with some much wonkery I read both in the blogosphere and the SCLM on the topic of health care. This feels so much more in touch with reality to me. The comments are good too:

Now, I didn’t hear the whole debate, and I’ve been trying to find the plans laid out point by point so that I can examine them more closely–but from what I can find, apparently the plan to make sure everybody is covered is basically the following for both candidates:
1. offer cheap health insurance.
2. give tax breaks so “families” can afford it.

The tricky part comes when it comes to how to actually get people on the programs–and this is the part where my head is exploding because I can’t find any definite information about each candidate. Apparently both candidates would impose some type of ‘fine’ or ‘penalty’ on people who do not buy health insurance once the option is made available–thus universal coverage. At the debate, I couldn’t figure out what Hillary was saying at all, and all I took from Obama is that he will be all about fining parents/penalizing parents if they don’t cover their children.

I found this article, which is from early Feb. and only says what I am saying here–how confusing it all is.

Thus, I will give you my reaction to these proposed ‘fines’ and penalties of parents for not covering their children from a purely uneducated point of view: YOU GOT TO BE OUT YOUR DAMN MIND.

...

Apparently in Massachusetts, where there is mandated health insurance, less than half of the uninsured have enrolled–in spite of the heavy fines imposed on those who don’t.

I can tell you why–even if health care is only 40 or 50 dollars for the entire family to be enrolled–you know what? I can buy groceries for a week and a half with 40-50$’s. I can pay for about two weeks worth of gas for my car, or stop a shut off for my water/gas, or god forbid, get a few clothes that actually fit for the kids.

Any poor person that is facing the emergency of eating or having electricity or water NOW versus the possibility of maybe an injury occurring at a later point (but maybe not if we’re all careful), is going to pick the week of groceries any day of the week. It’s not even a choice, really.

The thing is, people who are not struggling week to week literally are unable to fathom that 40$’s is NOT “just” 40$’s to a poor person. 40$’s is a lot of fucking money to a poor person–some times as much as a third or half of a weekly pay check.

To a poor person, 40$’s is the mark of what emergency can be staved off for another few days–hunger? Cold? 40$’s is survival.

And guess what? From our end of the spectrum, the parent that deserves to be penalized is the one who would spend 40$’s on something other than food or heating. The one that would let their kid go hungry so that s/he could pay for service that may or may not be used some time eventually up the road.

And meanwhile, the people who could afford to pay for health insurance to begin with have chosen some other health insurance (rather than state provide health insurance), and are living just fine just like they always have done.

If this is universal health care–just another way to criminalize and burden the poor–please take it back, with my blessings. I don’t want it.

Too many discussions "we" progressives have fail to include voices like these. There is no doubt in my mind that the majority of the national leadership would be utterly befuddled by this. Which is why they fail to perceive what a time bomb this issue really is for them and all like them, trapped in the idea that insurance companies have a right to be at the table. Politically, failing to deal with health care is the lion that is going to come back and bite some on the ass, hard. Sooner than they think, too.

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vastleft's picture
Submitted by vastleft on

It's the people of marginal means who get burned by the mandates.

As Hillary noted last night, it's not really accurate to say that Obama's plan doesn't have mandates. It has mandates for parents to buy insurance for their kids, but it does not have mandates for adults to buy it for themselves.

HRC vs. Obama is a moot point as of last night, thanks to the good folks at General Electric. The question moves on to whether Obama's plan's mandates are too much or too little.

And the devil is in the details -- what the threshold is for free coverage, and how the costs ramp up for people who may or may not be able to pay $40 or whatever.

wasabi's picture
Submitted by wasabi on

There will be a huge fight over healthcare for whoever wins the presidency. The idea that a tax rebate to reduce the cost of care just won't fly with the people who need it the most. For those of moderate means who have been shut out due to "pre-existing conditions" it may be satisfying. One hell of a fight to come.

Submitted by lambert on

... is fighting about how to implement the mandate. Maybe Hillary doesn't have the best approach. Instead, Obama demagogued the issue with Harry & Louise ads and the distorted fliers in Ohio. Way to go, Unity candidate, on a life and death issue for millions of Americans. Fortunately, NBC's debate last night really allowed the American people to focus... Oh, wait. Sorry.

[x] Any (D) in the general. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.

chicago dyke's picture
Submitted by chicago dyke on

that's the real question. and one of incentive, i hope the Big Thinkers on our side understand this.

if you are destitute and unemployed, you can get some coverage. now, and more under the coming dem plan. anyone who has experienced "health care" as a member of this class knows that you get something very close to what you pay for. and don't get really sick, because they will find ways to kick you out of the system before you're fully healed.

but what is the "poverty line," really? arbitrary, and not reflective of reality in certain parts of the country. the working poor are the ones who will get really screwed, and those who live paycheck to paycheck, and a small paycheck at that.

i guess the point of this post is to remind people that there really are people in this country for whom "40$ is a big deal." even if they aren't technically poor- i know SUV 'owners' who live in hovels, and land rich, cash poor people living hand to mouth. we shouldn't even be having this discussion, in the sense that the answer is right there staring us all in the face. too bad our pols can't see, hear or say "universal single payer not for profit."

Submitted by lambert on

I remember when I was in no heat, no electrical power mode back in Philly, and living on canned beans and vegetables I got at the Reading Terminal (heated with a hot-plate from power I took from the apartment building's hallway), and I thought I'd see if there were any meals programs.

So I did some research and made some calls (the telephone was the last to go) and the red tape was incredible. Bring financial records, bank books... It reminded me of Prussia, where what today we call welfare was run out of the police department.

And so I never went and gutted it out. The whole experience was in great contrast to a meals program I participated in (as a server) back when "the homeless" first became, er, a problem... Where all you had to do was walk in, and you would be fed.

Gatekeepers and rentiers everywhere, and the irony is if they were gotten rid of, giving people the food, or the medical care, they need would be better and cheaper.

[x] Any (D) in the general. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.

Submitted by [Please enter a... (not verified) on

I realize why nobody is talking about the fact that healthcare has got to be taken away from insurance companies altogether (oh, I suppose there will always be a market for frills and excess; let them fight over that.) Insurance companies are not in business to provide healthcare, they are in business to make a profit.

They do this by taking in money which goes to run up the totals in scare stories like the current one that "Healthcare is going to take 1 in 5 of every dollar in the US economy by 2012!!ZOMG!!" or whatever year it was.

Not a single news show/story I saw/read that quoted this line even mentioned, much less tried to break out, how much of this ZOMG figure went to people who actually provide healthcare (doctors, nurses, hospitals, EMTs, even Big Pharma) and how much goes to pay employees and executives and stockholders in "healthcare" insurance companies.

I bet it's a lot. For nothing.

Insurance companies go to greath lengths to screen out the poor, the already sick (hey Mr. Unity Guy with mandated "coverage" for poor children...you know what it costs to take care of a premature baby? One born with a congenital or prenatal condition? Answ: lots.), those with irregular or unstable employment, et tedious cetera. Once we "mandate" everybody to have "insurance", how do we force these companies to take these people? Who they don't want?

janittdott's picture
Submitted by janittdott on

And, I'm sure, he assumes I'm just...slovenly.
(and SELF INDULGENT cause I...employ...gonzo punctuation)
Ever READ any...Hunter S. Thompson... Joe?

I suppose I could tell...Joe Bourgeois...(well named bytheby)
that I can't type and spell very well because I was born with
a massive "katestrofic!" skull deformity, craniostinysosis,
(I can spell that!)
that crushed the tiny ram chip in my cranial computer
that let's Joe's...superior brain...small and unspecial as it is,
type and spell...and fault find in others.

Hot shit surgeons repaired my skull but couldn't fix my brain
Still the part that does work works wonders. I'm fairly...bright.
So I compensate well and no one notices I have...brain damage.

Hence I'm always getting "edited" by bullies like...Joe Bourgeois.

Anyway...

The end result of the way my life started is that I've never been
AS employable as someone with seven years of liberal arts college
should be.

Plus I was a...playwright. (best way I could think of to get...rich)
When you take your curtain calls the audience is not muttering
"Psst! She can't type & spell, you know...brain damage!"

(BTW, Joe, Harold Pinter uses ellipses artfully in his exquisite scripts.
His contracts require that actors...pause...where noted in his plays).
that's what ... are for, to make people...pause...and hopefully...think
before they say something...stupid...or...insensitive...or...unkind.)

Do you realize how MANY impaired writers. with dyslexia for instance,
won't come on line because shits like you say shit like that!

Anyway...

When I came down with Chronic Fatigue Syndrome ten years ago
I ended up on that panacea for the poor and unproductive
Social Security Disability with Supplemental Security insurance (SSI)
Being based on your past income, I wasn't "awarded" much to live on.
800 bucks a month. For ten years now. With CFS. In rural Wisconsin.

And that tells you what I CAN do. I can...survive.

The worst and most shocking part of the whole misadventure
is that I have been KEPT, almost the penny, AT the poverty line.
Correct me if I'm wrong but isn't the poverty line...
that the point where you really CAN'T live in America?

I got a seventy dollar "raise" in benefits once. I thought I was better off.
Till my foodstamps were cut from 35 to...ten dollars...a month
And I DID get a cost of living increase on my SSI check this year.
it went up from 112 bucks a month to 114.

It's the mindless calculated cruelty of it as much as the deprivation.
That previous comment someone made is true.
What you RECEIVE on disability has nothing to do with what it COSTS
to actually...live...so maybe they hope you will...die.

And, as Scrooge would advise, decrease the surplus population

At first i threw all my "working the system" savvy at the problem.
I called social security and articulately explained that a disabled person
could not LIVE on so little. A healthy person could not live on so little!
I was sure it was a mistake, It wasn't.

I called my senator Feingold, congressman Kind, govenor Doyle
They were all very sympathetic, very compassionate people.

But I still have no water supply since the old windmill quit turning.
( I collect rain and melt snow now)
And I have so little heat in my house that on mid winter days
I can see my breath.

I wrote an adaptation of a Christmas Carol once
huddled at my keyboard In a hat & scarf, wrapped in polar fleece,
blowing on my fingers in gloves with the fingertips cut off.

As i tried to type i thought, look! i AM the surplus population!

If you go to Hillary's site you will find that she not only has
an EXCELLENT section of rural opportunities and concerns,
she ALSO specifically mentions SSI, the stupid wrongheadness of it!
Not that many Americans are trapped by this slow death,
But she THOUGHT to mention us.

For me this election is not ABOUT crowning a wealthy ambitious guy
to be Oprah's First Black President to make some sort of...statement.
Not about President Feelgood to ease the guilt of the educated elite,
It's about people like ME who have barely held on through Bush
And what will happen to US if Hillary is NOT elected.

Cause i KNOW with his studied studious forward looking stare
That Upward and Onward Obama doesn't even SEE me down here.

I was wistful watching 10 Things I Hate About You, yesterday
Missing Heath Ledger who didn't make it. Lots of artists don't.
(yet another group of people who don't matter in America)
And that paint ball scene came on and I realized where it was...
The Seattle park where a friend of mine...hung himself.

THREE of my best friends have committed suicide on SSI.
And they were ultimate survivors. Gladiators of Getting By.
Life had done terrible things to them and yet they persisted.
But they could not...live...on Supplement Security Insurance.

They fucking...KILLED...themselves on SSI.

The punctuation of that sentence stands.
And i WAS going to run this through spelchunk just for you, joe
but, you know what?

Skrew you.

...

bringiton's picture
Submitted by bringiton on

Like the rest of the entire world. We spend twice per capita what other first-world nations do for health care, and leave half our people without basic preventive and early intervention care. What this does is drive up future cost while increasing suffering, not exactly responsible for what is supposed to be a Christian nation and just plain bad business for the country as a whole.

Here’s what the insurance industry proposes to do about it by cutting expenditures but not premiums, and the source document for scary stories about ZOMG fear-mongering:

health care costs compare other countries

Nice, eh? All they can think of are ways to keep the trend rising at very nearly the same rate, a “Well we tried” approach that makes certain insurer’s profits are maintained while the people continue to pay more and more for less and less.

But here’s what could be done if we did just the same as every other civilized country and went to a government-run not-for-profit single-payer system (exactly like Medicare) for everyone:

healthcare costs industry projections

Fact is, if we cut out the insurers we could easily cover the cost of health care for everyone in the country and have money left over:

The U.S. wastes more on health care bureaucracy than it would cost to provide health care to all of the uninsured. Administrative expenses will consume at least $399.4 billion out of total health expenditures of $1,660.5 billion in 2003. Streamlining administrative overhead to Canadian levels would save approximately $286.0 billion in 2003, $6,940 for each of the 41.2 million Americans who were uninsured as of 2001. This is substantially more than would be needed to provide full insurance coverage.

What is it the Constitution says about the purpose of our government? Oh, yeah: “Provide For The General Welfare..” Picture if you will a class action lawsuit to force universal health care, with 45 million plaintiffs. Somewhere there must be a skilled trial lawyer with some time on his hands…

vastleft's picture
Submitted by vastleft on

Info from a friend who knows about such things:

People below 150% of the federal poverty level get free health insurance according to Ch. 58. That's about $15,000 per year income. Between $15,000 and $31,000 you get subsidized insurance. Over $31,000 and you pay full freight.

Sima's picture
Submitted by Sima on

Certainly these are my concerns about health care.

I'm land rich, I suppose, and money poor. I guess I could sell my home and very small farm, and then be money rich for a bit, and then poor poor.

The thing I fear the most is having health care bills that make it so I have to destroy my home, my family, and my living in order to pay them. So I don't bother. I don't go to the doctor. I can't afford yearly visits anyway, and I simply DONT WANT TO KNOW. I don't want to die of some stupid preventable thing either, but I can't get around it, I can't afford insurance and I can't afford doctor's visits.

When I was younger, and more of childbearing age (although I'm still not past that, I'm in my 40's), I got all my health care through Planned Parenthood. Yea, all of it. I suppose I should try and find a low cost clinic and go there. But who can afford the tests?

Having said all this, I'm way better off than someone who needs that 40$. I think the country absolutely needs UHC. Not Universal Insurance coverage, but Single Payer, Government run, Health Care. Period. That's the only thing that'll work and be at least partly fair.

Submitted by [Please enter a... (not verified) on

Because if it's just the expense of paying all the insurance company people, from the ones whose job is to sell you the policy in the first place to the ones who screen every claim to find a way to deny it, to the ones who decide whether the claim is so big your policy has to be (retroactively) cancelled, to the lobbyists who are paid to keep all this legal, to executives and their golden parachutes....

...then they're missing a WHOLE lot of administrative costs on the other side of the street. In the doctors' offices that is. All those employees who spend all day on the phone getting needed treatments paid for, and the ones spending all day hunched over computers coding patient files with all the different company's different numbers, and yes, the ones bumping these numbers up a notch to a "worse" diagnosis because that's one the Ins. will pay a decent amount for unlike the code for what the patient most likely really has.

The unneccessary testing is often complained about. Doctors defend that the testing is needed to fend off misdiagnoses and resultant malpractice claims. The Republican solution is to stop people from being able to sue for malpractice.

How about we make such lawsuits less neccesary because you don't need the proceeds to pay for more treatment to fix what the first doc screwed up? Or to live on for the rest of your life because the botched procedure crippled you and made you unemployable?

God damn but a sane and humane system would save so much money, time, health, life and happiness. No wonder the Wreckin' Republican types hate it so much. Why, why, it's almost like that "life, liberty and the pursuit of happiness" shit, and we know that's quaint obsolete stuff not condusive to making the obscenely rich obscenely richer.

bringiton's picture
Submitted by bringiton on

I provided above; go here:

http://www.medicalnewstoday.com/articles...

I do try to be a responsible postperson. :-)

The actual article requires subscription but there are many discussion links available by a google of the author names.

What they did was the opposite of what you assume. They called as administrative cost the salaries and overhead required to actually administer health care; all the people in doctors offices, hospitals, nursing homes, clinics, etc who deal with the nuts and bolts of operating the system. They excluded the salaries and overhead of the people who work for insurance companies, and also for places like pharmacies where the admin costs are realtively small.

The estimate they provide is deliberately low, they wanted it to be defensible, but your point is well taken: the vast bulk of administrative cost is on the treatment end, dealing with the snarl of paperwork and preposterous rules designed for denial of care rather than facilitation of treatment. Denial of reasonable health care should be a crime; under any system of ethics, it is a sin.

Submitted by [Please enter a... (not verified) on

At me.

My apologies; I can't even blame your link being subscription as I did not click it.

That "other administrative" rant was delivered somewhat by reflex as it's...well, it's a little lengthy and complex to qualify as a meme but at least call it a topic I've been plugging on for some years in one format or another. Including barstools, back when I had access to same.

Glad to see the data has finally been at least somewhat quantified. I wouldn't have known where to begin looking to put together such numbers. YOu are a good postperson indeed. :)

bringiton's picture
Submitted by bringiton on

Anyone with common sense could deduce that one asshat behind an insurance company desk in Omaha can create meaningless busywork for tens of thousands of clerks at doctors offices and hospitals and nursing homes all over the country. The "studies" done by insurance company front groups always limited the administrative cost estimate to the insurance company employees and agents, excluding the cost of implementation at the end of the chain and, in false projections like the one I showed in the uppermost figure, also excluding insurance company profit - of all the damn gall, but that's what was done.

The NEJM article referred to showing the true cost of health care administration exclusive of the insurers themselves was the first one to do so, and it ends the argument that switching from insurance to universal not-for-profit government programs would not be cost-effective. Not only would it save an enormous amount of money immediately AND provide universal coverage, it would lower future costs enormously by providing easy access to preventive care and early intervention as oppoosed to what we have today with little to no preventive care and generally later-stage intervention.

The good news, Xan, is you have been right all along and now everyone knows it. Next step is to - how to phrase this? - ah, yes: shrink the health insurance industry down to the size where we can drown it in the bathtub.