Tuesday, January 27, 2009

Universal Health Revisited

Universal Health Revisited

My mother-in-law loves insurance agents, and they love her. They offer relief from the hassle of deductibles and coinsurance that is most appealing to an 88-year-old. But the hassle-free life is brief. Soon she hears, “We don’t cover that,” or “your doctor did not provide one of our diagnostic codes,” aggravation and an unhealthy rise in her blood pressure follow. Can we eliminate this conundrum that constantly repeats itself?

We’ve tried. In 1947, President Truman presented a plan. The AMA railed against it as “socialized medicine.” In 1971, President Nixon put forth a program to provide a public plan that is better than most of what is now considered "progressive." The insurance industry and Congressional Democrats led by Ted Kennedy, defeated it. Hillary Clinton oversaw development of a broad coverage plan in 1993. Because of a proposed increase in employer funding, business lobbied against it. The insurance industry that had the most to loose led a lobbying attack that was championed by Congressional Republicans and some disaffected Democrats.

Every year financing health care has become increasingly more difficult. More and more Americans are no longer insured (47 million according to the Census before the latest downturn in the economy). About the same number are considered to have inadequate coverage.

Increasingly the electorate is asking our representatives to do something. But they seem to be stymied between the veritable rock and hard place. The rock is “how do we fund a program that will cost over $1 trillion,” and the hard place is “how do we counter the insurance lobby’s power.”

The largest insurer, Aetna, gathers more than 20 cents of each premium dollar for "administration." The proportion of an individual premium that goes to administration increases as the number of beneficiaries in an insurance pool decreases. Thus, small employers find that their premium per worker is much higher than larger competitors. Younger workers often opt out of employer plans because they view their share of the premium as “not worth it.” They’d rather risk the possibility of a heavy medical expenditure against paying the monthly premium. The loss of this healthy group increases the premium that must be paid to cover older workers. And we pay for these uninsured when they get sick, $43 billion in 2005.

In these troubled times, universal health care makes even more sense because more services can be purchased for less! According to The New England Journal of Medicine, Canada’s single payer plan spends 17 cents of each health care dollar on administration. The comparable U.S figure is 31 cents. The potential saving is 14 cents of each health dollar or $280 billion. The bargaining strength of a universal plan would reduce the price charged for all types of services similar to what Medicare has done, an estimated saving of $200 billion.

Employer and employee premium payments reduce income before tax. This tax advantage, amounting to $200 billion, would end and lead to increased income tax collection. The end of the Medicaid program would produce a saving of more than $200 billion. Without an income tax increase, general revenues would increase $400 billion.

The current method of financing health care is inefficient. How would the program be funded? We are already paying for it, in fact, as shown above, we are overpaying. Allocating for the program would continue to need contributions from employers, employees and government.


France’s health care system provides an example of what can be done. In 2000, the World Health Organization rated the French system the best in the industrialized world. (The U.S. ranked 37th of 191, just ahead of Cuba).

The French system is only partially publicly funded. Individual responsibility for paying for care increases with income. Individuals use private insurance, similar to Blue Cross and Blue Shield, to supplement public contributions. If a person falls below an income ceiling, stays more than 30 days in a hospital or has a chronic or debilitating illness, financial exposure is minimal. The equivalent situation for an American is often bankruptcy.

Almost all French providers accept the fee schedule set by government. Patients are responsible to pay providers directly, receiving reimbursement in about 10 days.

Based on studies between 1997 and 2000, the French have more resources per person than the U.S. Per 1,000 people, France has 3.3 physicians and 4.0 acute hospital beds; in the U.S., those numbers are 2.8 and 3.0, respectively. The only place the U.S. far exceeds the French is in nonphysician personnel: 1.9 in France, 5.7 in the U.S. Personnel who handle administration and billing account for the difference.

The French have twice as many office visits per capita, longer hospital stays, use more pharmaceuticals, but only half as many expensive MRIs as Americans.

Tax revenues fund 75 percent of the French health care program. Over half comes from a tax on employers and about 35 percent is from general revenues. Additional amounts come from taxes on automobiles, liquor, cigarettes and pharmaceutical companies and a 5 percent tax on earnings.

Why are we troubled about our health care system? After all, 83 percent of Americans have some form of third party coverage, yet only 40 percent are “fairly satisfied.” Are we more critical than the French, two-thirds of whom give high ratings to their system?

I submit that the U.S. system is balkanized and more bureaucratic than the French, the country that created bureaucracy. Our private insurers (there are about 1,300 of them) determine whom they will pay, for whom and how much based on contracts that change annually.

In the U.S., if you have the ability to pay, you can receive first class health care. But, a significant portion of our population (between 16 and 30 percent) is locked out and must resort to inferior, often more costly services, or none at all.

In 2006, more than 16 percent of our GNP went for health care; the French laid out less than 10 percent. While the French government funds 75 percent of services, the U.S. funds 50 percent. Yet, on a per-capita basis, we are spending more public funds than the French.

Looking at systems like France, I can see the possibility of providing access to first class care to everyone with the financial resources we now use, maybe even less.

On Monday, August 31, 2009, Paul Krugman wrote an article on the Nixon Proposal. I have been touting this proposal that is more progressive than anything that has been put forth, so far. I urge followers of this blog to view it: http://www.nytimes.com/2009/08/31/opinion/31krugman.html?hp

Doctor Appointment: Wait 3 Months


Incentives in our public and private health insurance are skewed away from prevention. The incentives for a medical graduate are to go into specialization. This incentive system has led to an excess of specialists and a paucity of preventive care primary care physicians. A recent survey of 1200 graduating medical school students indicated that only two percent were oriented to primary care. (TIME, 9/10/09). Because we have an excess of specialists, we don’t have the lines for elective surgery that exist in other countries. That is why a Canadian with means comes to the States for elective surgery. That is also why specialists, trained in Canada, come to the States to practice. To a great extent, that is why we spend over 16% of our GNP on medical care and most other countries spend (on average) 9%. That is also why our health statistics lump us with third world countries on such indicators as infant mortality. In addition, Dartmouth researcher, Elliott Fisher, M.D. suggests that too much health care may actually be killing us. His research indicates that as many as 30,000 Medicare recipients die annually from too much doctoring.

Primary care physicians report that up to sixty-five percent of what they are paid goes to administering their office. (Read Shannon Brownlee, July & August 2008 AARP Magazine, Why Does Health Care Cost So Much? Also read September 2008 AARP Bulletin.

Monday, January 26, 2009

Birding in Bosque del Apache New Mexico

In central New Mexico south of Albuquerque lies a premier spot for one of the most spectacular birding sites of North America. The Bosque del Apache is a National Wildlife Refuge in which you will have no trouble during the winter seeing bald and spotted eagles and hundreds if not thousands of Sand Cranes and white Geese.

I am not a great birder, but I enjoy the outdoors, and this year has been special in New Mexico. While the rest of the U.S. has suffered winter, temperatures have climbed to 60F with clear dark blue sky and no crowds.

The pictures on this page were taken by me and demonstrate the abundance just waiting to pose.

The Bosque is about 100 miles south of Albequerque just off of I-25. If you get a chance, don't forget your camera.

Wednesday, January 21, 2009

Super Bowl XLIII

This year's matchup between the Steelers and Cardinals should have been a repeat of one 61 years ago. As discussed in my father's biography, two coincidences are hard to ignore. In 1947 the Cardinals,led by Pitt All-Star Marshall "Biggie" Goldberg,knew the Steelers' offense and trounced them in the regular season. Then, Steelers' field goal expert, Joe Glamp, hit the cross-bar on a thirty yard attempt against the Redskins. Winning either of these games would have placed the Steelers in the championship game against the Cards, then from Chicago. VISIT

Oh well, that was then, this is now. Again the Steelers are up against a Pitt great,Larry Fitzgerald. The only way to stop him is to get to the quarterback. Let's hope that a great officiating team is sent to this game. I'm tired of throwing my yellow flag at the TV when Harrison is blatantly held.

[Joe Tucker would be 100 this year. Here he relates his disappointment on the missed field goal. Myron Cope, longtime friend, introduces Joe].

Tuesday, January 20, 2009


Volunteering in Pittsburgh


Future President and Future Press Secretary Deplane

David Axelrod juggles papers and cell phone

Barack's message of hope and change challenged us to work on this campaign and why we are so proud, today, to be Americans.

Monday, January 19, 2009

Placitas, New Mexico and More!

As the snow kept coming in Steamboat we were very glad that we had planned to spend five weeks in January beginning Sunday, January 11th in Placitas,NM. Luckily we had a sunny day between snow flakes the Thursday we left. An easy leisurely drive was highlighted by a short side trip to a castle made of beer cans in San Antonio, CO and a tour through the Earthship Visitor Center It was fascinating to see how discarded tires stuffed with mud were a key part of the construction materials used. The Center itself is "a fully functioning Earthship that combines passive solar architecture with thermal mass construction, uses renewable energy, integrated water systems and is made out of natural and recycled materials." Check out their website www.earthship.org.

We have been settled in our 100 year old abode house for a week. The house we are renting was built by the grandfather of the owner who welcomed us and showed us around. Friends who live in Placitas had found the property and checked it out. As you can see from the pictures, the house is nothing to speak of from the outside, however it is furnished in a lovely and comfortable way. About the only challenge is that the bathroom is through the kitchen and up stairs, rather than conveniently off the bedroom.

The village of Placitas has a long and interesting history going back to Spain. I have taken several interesting walks around our neighborhood, passed horses and a winery, strolled on dirt roads, and up hills to vistas.

Placitas, itself is a community 15 miles north of Albuquerque and six miles east of I 25 at the foot of the Sandia Mountains. Lovely housing exists on each side of the main route back and continues past the village for several miles. We have wandered into a few open houses and home prices range from $300,000 up to several million. Most sit on an acre or more and are nestled into the hills.

There isn't much commercial businesses in Placitas, just one small shopping area about three miles in and then a mini mart, gas station and post office in the village. However, all that one could wish for is a short drive to Albuquerque. We have discovered both Trader Joe's, Whole Foods, a good place to work out and a movie theatre with 24 screens and lots of diverse restaurants.

We look forward to discovering more about this area over the coming weeks.

Tuesday, January 6, 2009

Steelers Bars USA+

While in Steamboat Springs we have enjoyed Sunday Brunch or Late Lunch at the Tap House that has about 15 flat screen TVs. Other than when the Broncos played, Steelers fans dominated.

But, as usual, we traveled. For each Sunday we sought out a place to watch the Steelers. In Fruita, CO, I sold three books and yawned through the drubbing of the Bungles. On return from a family reunion in Lost Wages (thanks Aunt Bess Tucker-you really had that place pegged right) we stopped east of Grand Junction, CO. The bar there had seven screens-six covering the Broncos, one on the Steelers. Another easy day.

Then a near death experience in Atlanta (picture). This was truly Steelers country-Large screen and several 32 inch plasma screens provided more than adequate coverage. The old 14 inch screens provided coverage of the other games. It was close, but we prevailed.

CBS in Denver prefers airing infomercials to Steelers games, so back to the Tap Room for the second near death experience- the Ravens II, seemed to have creamed Ben.

The last bar was in Sarasota. Almost all the patrons were Steelers fans, but we had to argue to get a screen on the game.

Nothing really compared to watching the AFC championship and Super Bowl XL in Ushuaia-the most Southern city in the world.

Yes, JoAnne and I are part of the Steeler Nation and proud of it.


Over the holidays we spent a week in Atlanta visiting with grandkids, daughters and son-in-law.  Accompanying our daughter, Julie, from NYC was her 8 month old Yorkie, Izzy, the first dog in our immediate family. According to Julie, no tranquilizer was needed for the 2 hour flight, but they did fly first class.

Well... need I say that Izzy was clearly the center of attention. Everyone wanted a turn to play with her and what I found most interesting was how Izzy adapted to each one of us. The 8 year old "loved" her .... hugging her tightly and she tolerated it from him and would play the roughest with him. She was also smart enough to welcome time in her crate knowing that it was a time out from Brandon.

I had grown up with dogs as a kid but once married, Murray and I preferred cats. Walks were fun except the one time she decided she didn't want to walk with me and just went belly down on the sidewalk. She made her point and back to the house we went. The rest of the time she was a delight to walk sniffing from side to side and playful, especially to other people and their dogs regardless of size.

At first she was reluctant to go the stairs at the house but that lasted only a day or two and she was soon bounding up and down making the whole house her own.  

A slice of carrot was her treat and she got lots of practice on commands of "sit", "down" and "paw" as all of us wanted a chance to interact with her in this way.

I came away from the week with a deeper understanding of why the relationship between dogs and their owners becomes so important.

At our condo in Steamboat over the years we have had countless "dog" issues. Originally there was a no dog policy, but two owners found a way around that and managed to have their dogs grandfathered in. One of those dogs is still here and royally patrols the property. Now we have a policy that an owner can have a dog on the premises for up to 60 days which works fine for non-resident/second home owners. Renters cannot have a dog and it is amazing how many people attempt to sneak a dog on site for a few days rather than selecting a dog friendly advertised place.  

Now the 60 day policy will work for us. Izzy can be our "registered" dog and visit us any time.