PCM

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4 days, 12 hours ago
  • Hey everyone! Look over here! Cuba! Talking with Raúl Castro! Witty repartee on the phone! Cuban rum! Cuban cigars! Classic American cars! Over here, everyone! Looking forward! Not backward at torture or white police departments and court systems running harassment, shakedown, and for-profit-prison rackets on black citizens and killing the ones who get uppity! (Wait, did I say that last part out loud?) Look over here! Cuba!

  • These comments would seem to indicate the end of an assault on freedom of the press that the government had been waging against Risen for the past six years. * * * “If the result is that the Attorney General does not want to issue the subpoena that his own Department of Justice fought for all the way to the Supreme Court, then three years of Mr. Sterling’s life have been wasted in litigation.”

    To paraphrase a former criminal procedure instructor of mine, “In many (and maybe even most) cases, the punishment is the PROCESS, whether the target is innocent or guilty.”

  • PCM commented on the blog post There is No Preparing for Health Care Calvinball

    2014-12-13 23:38:38View | Delete

    [G]overnment has a bad track record in VA health care.

    I’m going to have to call you out on that. The VA suffered a very well publicized scandal after being saddled with a big bolus of new patients without being given commensurate additional funding. Immediately prior to the scandal, the VA had been rated by a couple of serious studies as offering not only the best quality/cost ratio but also the best absolute quality of care of any major healthcare system in the country — including outfits like Johns Hopkins and the Mayo Clinic. Besides, the VHA is a non-universal Beveridge system with a restricted provider network, not a universal single-payer system with a universal provider network, and its excessive-wait-list problem is more likely to be reproduced under the ACA, with its narrowing provider networks, than under single-payer. The VHA scandal is not evidence that “government can’t handle healthcare,” and to say so is to mindlessly or maliciously repeat a Big-Health political talking point. So stop doing it already.

  • PCM commented on the blog post The Study Health Care Reform Desperately Needs

    2014-12-10 14:57:18View | Delete

    At some point, Jon, you’re going to have to muster the integrity and courage to go beyond critiquing how artfully the turd was polished, even if it makes the people who forced us to buy the turd unhappy.

  • Yes, mulp. In universal healthcare systems that provide care to everyone on an egalitarian basis at a cost of 40% to 50% less than ours, they do it by making “everyone in health care slaves so they are not paid.” Take Canada, for example:

    [An internal document of PNHP-Western Washington, dated 3 September 2014:]

    CANADIAN vs. US PHYSICIANS – ANNUAL INCOME

    Specialty / Canada (2010-2011) / US (2013)

    Total Physicians / $295,606 / NA

    Anesthesiology / $323,975 / $338,000
    Cardiology / NA / $351,000
    Critical Care / NA / $281,000
    Emergency Medicine / NA / $282,000
    Diabetes & Endocrinology / NA / $184,000
    Family Medicine / $241,077 / $176,000
    Gastroenterology / NA / $348,000
    General Surgery / $386,723 / $295,000
    HIV/ID / NA / $174,000
    Internal Medicine / $371,795 / $188,000
    Nephrology / NA / $242,000
    Neurology / $277,928 / $219,000
    Ob/Gyn / $401,465 / $243,000
    Oncology / NA / $290,000
    Ophthalmology / $675,551 / $291,000
    Orthopedic Surgery / $372,742 / $413,000
    Pathology / NA / $239,000
    Pediatrics / $268,172 / $181,000
    Physical Medicine / $255,972 / NA
    Plastic Surgery / $337,874 / $321,000
    Psychiatry / $215,434 / $197,000
    Pulmonary Medicine / NA / $258,000
    Radiology / NA / $340,000
    Rheumatology / NA / $214,000
    Thoracic/Cardiovascular Surgery / $467,794 / NA
    Urology / $430,358 / $348,000

    Canadian Data: http://www.theglobeandmail.com/news/national/average-gross-fee-for-service-payment-per-physician/article7824173/?from=7750697

    US Data: http://www.medscape.com/features/slideshow/compensation/2014/public/overview#2

  • I find it shocking that 57% of the people are eir satisfied with their healthcare costs.

    Don’t be shocked. I myself did a poll of a bunch of frogs in pots of water heating on the stove. I asked them if they were satisfied with the temperature of their water. Blithely unaware that other frogs were enjoying the cool waters of a nearby pond, 57% of them answered, “Riggit.”

  • The aggregate costs will be lower and 95% of us will end up spending less for dramatically better coverage. See marym’s links, supra.

  • In healthcare as in many other domains, free-rider-and-moocher-mongering is the hallmark of industry shills and the terminally disinformed. Some people are beyond clues.

  • PCM commented on the blog post Validation on Health Care Reform

    2014-12-04 21:42:51View | Delete

    You know what would be hilarious? If the Republicans pulled their heads out of their asses, gave the finger to the for-profit health sector, peddled their asses exclusively to the non-health sector instead,* and passed HR 676. Now that would be poetic justice.

    *With single-payer, the non-health sector would save a boatload of money and also see increased demand.

  • PCM commented on the blog post Validation on Health Care Reform

    2014-12-04 12:49:19View | Delete

    But … but … but … Sarah! In exchange for voting to maintain and expand the trillion-dollar-a-year skim, Bernie got a billion dollars a year for ten years for community health clinics (some of which are now faced with closing due to Obamacare patients being unable to make their copays). Now that’s what I call being pragmatic!

  • PCM commented on the blog post Validation on Health Care Reform

    2014-12-04 12:27:30View | Delete

    [I]n America, how do you price in access if everybody can get any treatment they want[?]

    This does not appear to be explicitly addressed in HR 676, probably to avert alarmist political opposition based on exaggerated fears of excessive rationing. However, the bill does mandate coverage of “medically necessary” services [§ 102(a)] and establish a National Board of Universal Quality and Access tasked with advising the Secretary of Health and Human Services on “access to care” [§ 305(b)(2)(A)] and with establishing a universal, best-quality standard of care with respect to, among other things, “best practices” [§ 305(b)(3)(d)]. Taken together with the reality of inherently limited financial resources, these provisions almost certainly mean that what specific treatments are covered will be determined primarily on a cost-effectiveness basis, rather than rationed by the patient’s ability to pay as they currently are. I expect we may end up with something like England and Wales’ National Institute for Health and Care Excellence (“NICE“), which ranks treatments by cost-effectiveness (based on their contribution to quality-adjusted years of life) and determines whether or not they will be covered by the National Health Service — but with a considerably higher cut-off point. (The NHS is very stingy … but still gets better overall health outcomes than we do.) We’ll probably end up providing more bone marrow transplants for kids and young adults (which is already the case in most of our peer countries) and fewer knee and hip replacements for senior citizens with imminently terminal Alzheimer’s. Heroic, futile end-of-life measures will probably be out as well. It probably won’t be perfect, and groups with political or media clout may get coverage for their particular condition even if it isn’t actuarially justified. But it will be much better than the current system.

    Another issue is “keep your doctor.” … How much does this “keep your doctor” need cost Americans?

    HR 676 establishes a universal provider network; every licensed healthcare professional is covered [§ 102(b)]. From an insurance standpoint, everyone can “keep his or her doctor,” which was not the case prior to the ACA and is still less the case under the ACA. This is a non-issue. How much will a universal provider network cost Americans? Around $600 billion a year less.

    [I]f you don’t have a cost component, how does the best specialist in the country pick their patients for a disease[?]

    Ideally, by suitability of the particular case, but I expect personal connections, political clout, and class will come into play as well. In France, the health insurance authority has to police high-end specialists in Paris’s hoighty-toighty 16th arrondissement for keeping lower-class patients out of their waiting rooms, and we’ll probably have to do something like that as well. Again, it won’t be perfect, but it will be much better than what we have now. I don’t think you’ll run into a lot of Medicaid patients in the waiting rooms of our top specialists now.

  • PCM commented on the blog post Validation on Health Care Reform

    2014-12-04 10:51:18View | Delete

    Just a general observation: Jon seems to be laboring under the delusion that Democratic members of Congress represent and are working for working- and middle-class Americans and want to actually provide them with affordable, cost-effective healthcare, as opposed to just saying they do. Sorry, Jon: destitution, morbidity, and death amongst the little people don’t count for much with either Republican or Democratic politicians when Big Health weighs in.

    Also, I’m barely familiar with Harkin other than by name. Who has he carried water for in the Senate, and who will he be getting his revolving-door payoffs from? Or is he just another feckless pseudo-progressive Democrat who went along with the New-Democrat/Blue-Dog leadership on big-money issues like healthcare reform? (I apologize if I’m being presumptively harsh. My own US representative was publicly — tactically? — a vocal champion of single-payer, albeit only state-by-state single-payer. He ended up voting for the ACA, single-payer’s diametrical opposite, and has been spending his time shilling for it ever since, like most of the rest of the Congressional Progressive Caucus. I no longer have any tolerance whatsoever for “progressives” who sell their electorates out on the big-money issues.)

  • PCM commented on the blog post Validation on Health Care Reform

    2014-12-04 10:19:25View | Delete

    Of course. My apologies for not having provided links to source documents for most of the percentages, figures, and claims. They’re accurate and substantiated, but I’m tired of being a Cassandra and no longer take the time and effort (which is considerable). marym is pretty diligent in this respect, and always dead-on accurate, and concise to boot. When the Patient Protection-Racket and Unaffordable Care Act crashes and burns and the iron is once again hot, perhaps I will be motivated to resume peppering my online posts with citations.

  • PCM commented on the blog post Validation on Health Care Reform

    2014-12-04 10:00:23View | Delete

    Great analogy. Apples are picked by exploited migrant workers, kind of like the ones who provide home healthcare and nursing-home care. And armadillos harbor leprosy, kind of like many American hospitals harbor nosocomial infections. (Okay, that’s a stretch. Your policy almost certainly doesn’t cover any home healthcare or nursing-home care. But I still liked the analogy.)

  • PCM commented on the blog post Validation on Health Care Reform

    2014-12-04 09:47:35View | Delete

    Alan, I’ve seen your handle frequently enough in comments to FDL healthcare posts to know that, if you’ve ever bothered to read any of marym’s comments, you should know better. If Congress enacted HR 676, “Expanded and Improved Medicare for All,” progressive taxes would take the place of most of our existing healthcare-related taxes, and go up somewhat, but no one would have to pay health insurance premiums or out-of-pockets (deductibles, coinsurance, copays, out-of-network exclusions) anymore. The net effect would be that 95% of us would end up paying less money for dramatically better, irrevocable womb-to-grave coverage and the country as a whole would save around $600 billion a year from the start.

    How can this be?

    First, having a single insurer and a single policy would save hundreds of billions a year in administrative costs on both the insurer side and the provider side. It costs American providers a small fortune to deal with the complexity and uncertainty of hundreds of different insurers, with hundreds of different plans with hundreds of different rules and exclusions. (Not only do they have to hire small armies of insurance and billing clerks to handle routine insurance matters, but they frequently have to take time away from seeing patients to participate in the haggling.) The most famous anecdotal example is Uwe Reinhardt’s, comparing Duke University Medical Center, which has around a thousand billing clerks for around a thousand beds, with the Royal Vic in Montreal, which has a total accounting staff of twelve for around five hundred beds. And the administrative staffing payroll of small physician practices in Canada is a fourth of that in America; Canadian providers only have thirteen different provincial/territorial plans to cope with, plus the odd foreign plan. In France, which has a single national policy, provider-side administrative costs are even lower than Canada’s; for a lot of French GPs they consist of a computer and a card-swiper.

    Second, having a single bargaining agent to negotiate provider prices on our behalf would counter providers’ currently overwhelming market power and bring medical prices down, in many cases considerably. Every other developed country uses monopsonistic bargaining or price-setting to determine uniform fees and prices for medical services and products. We don’t, and our medical prices are by far the highest in the world, pretty much across the board.

    Look: we spend around 18% of GDP on “healthcare,” use it to provide spotty care to around 88% of the population, and get medical outcomes that are generally less than mediocre by First World standards. The second most medically expensive tier of countries in the world (e.g. Switzerland, France) spend around 12% of GDP on healthcare, use it to provide comprehensive care to 100% of their populations, and get pretty much the best medical outcomes in the world. (Exception that reinforces the point: Japan, which has some of the lowest “negotiated” (mandated) medical prices and spends only 9% of GDP on healthcare, gets outcomes that rival Switzerland’s.) If you apply the percentage difference between our healthcare spending and the second tier’s to our GDP, that’s a trillion dollars a year more we’re paying for worse coverage and worse outcomes. That money is going into the pockets of administrative featherbedders and skimmers (e.g., health insurance companies, benefits management companies) and price-gouging profiteers (e.g., pharmaceutical companies, hospitals, ambulance companies, diagnostic labs, medical device manufacturers, and, yes, many interventional-specialist MDs). To the Big Health profiteers, that trillion-dollar parasitic skim made it well worth their while to spend upwards of $10 billion on PR (including astroturfing and sockpuppetry), advertising-leveraged media control, political advertising, campaign contributions, lobbying, and revolving-door/family payoffs to make sure that foreign systems and single-payer were barely mentioned in mainstream media and that single-payer never made it out of committee in Congress or got scored by the CBO. It was the cheapest investment with the biggest payoff that the American for-profit health sector ever made. And it worked: the skim is still intact (and growing), and people like you are still asking, “Where will the money come from?”

    But I digress. The short answer is, with Expanded and Improved Medicare for All, our taxes would go up somewhat, our out-of-pockets would go down even more, all of us would get the best health insurance coverage in the world, for life, and the great majority of us would end up with more money in our pockets at the end of each year. (And “medical bankruptcy” — medical bills are still the number-one cause of personal bankuptcy — would be a thing of the past. And you’d never have to worry about your kids’ and grandkids’ medical coverage. Sorry. I couldn’t help throwing those last bits in.)

  • PCM commented on the blog post It takes a hypocrite to know one

    2014-12-01 08:11:18View | Delete

    I was aghast at the recently released poll results revealing the ugly fact that only 27% of working white folks support President Obama.

    I’m aghast, too. It’s just not mathematically possible that 27% of working white folks can be in the top 1% in terms of wealth and income, let alone the top 0.1%. Oh, wait; that’s not what you were going for. Okay then: African-Americans lost 80% of their household net worth under Obama’s watch. How ungrateful can white Americans possibly be? Oh wait; that’s not what you were going for either. Okay then: Almost every white American who saw Django Unchained despised Stephen, the, uh, “majordomo of color” so brilliantly portrayed by Samuel Jackson. It was probably because he was black, right? Kind of, in a way? Oh wait: I get it: if white people don’t support President Obama, or Attorney General Eric Holder, or Associate Justice Clarence Thomas, or Herman Cain or Papa Doc or Mobutu Sese Seko, it’s because they’re racist. Gotcha.

  • PCM commented on the diary post Imagine; A Satire by Ohio Barbarian.

    2014-11-30 11:04:24View | Delete

    You don’t want to know how long it took me to figure out that “LOD” probably stood for Lawrence O’Donnell. In the end, I had to do a Google search for LOD site:firedoglake.com . I don’t have my copy of the Bluebook, Chicago Manual of Style, Elements of Style, or even Words Into Type handy, but in their absence, [...]

  • PCM commented on the blog post Increasing Number of Americans Are Putting Off Seeking Health Care

    2014-11-28 09:48:52View | Delete

    Not to worry, eric. The more people are forced by cost and lack of access to go off their antipsychotic meds, the more people will share your brilliant, penetrating take on Obama and the ACA. When the psychotically deluded add their voices — including the ones in their head — to those of the self-deluded, the extreme far teabag right will be no match for the sheer genius of Obama’s Democratic-Party progressivism. Forward!

  • I’ve had arguments with people who, seemingly in earnest, insist that they would rather pay a lot more for crappier insurance and foot significantly higher provider bills than help subsidize lazy, good-for-nothing moochers (by which I assume they mean hippies and people of color, but mostly people of color). In some people, the preference for actuarial fairness (solipsism) over distributive justice (solidarity) is apparently so strong that it’s actually self-harming. Of course, there’s a chance the people I was arguing with were actually Big Health sockpuppets…

  • Wow, that’s a lot of typos for such a short post. With age, the portion of my brain that controls my fingers is becoming dissociated from the portion that formulates speech and my fingers are going on autopilot, plus, my eyesight is getting worse and worse. Too bad I don’t have one of them nifty Obamacare Marketplace plans… Oh!, that’s right: no vision coverage.

    Anyway:

    * before, before >>> before, but
    * that that >>> that the
    * >$29 >>> <$29

    I'm sure you all got the substance of what I wrote, but I apologize nonetheless.

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