By Lee Camp, the creator, host, and head writer of the comedy news show “Redacted Tonight with Lee Camp” that airs every Friday on RT America and at YouTube.com/RedactedTonight. He’s a former comedy writer for the Onion and the Huffington Post and has been a touring stand-up comedian for 18 years
I find it hard to get involved with the healthcare debate in this country because I believe there is no healthcare debate in this country. I don’t believe it exists.
Sure, there are red-faced politicians screaming about one make-believe side or the other, but that doesn’t mean there’s a legitimate debate. In order for there to be a debate, there needs to exist two sides that – if argued well – could seem to hold merit. But that’s nowhere to be found in the current healthcare debate. Instead there are two sides, both of which are disingenuous, both of which are corrupted by big money, both of which are hardly even SIDES; instead they’re two separate spots in the center of whatever proverbial thing we’re picturing having sides. (I’m picturing a duck. Not sure why.)
The debate SHOULD be “Is our country wealthy enough to cover the healthcare of every man, woman, and child without causing extraordinary harm to other citizens?” If the answer is yes, then the answer is do it. (And the answer is yes.) The other side of the debate should be, “Let ‘em die.” …I admit the second side of the argument is a bit terse, but not without merit –especially if the dying patient happens to be the man who gave a young Michael Bay his first camcorder, thereby putting us all on an inescapable, calamitous path to a future involving at least 7 and as many as 36 “Transformers” movies. (I mean, a small car turns into a 5-story-tall robot with heavy artillery, and hundreds of millions of viewers are just FINE with that?? It doesn’t even adhere to the law of conservation of mass! …And THAT gaping plot hole is then followed by two hours of meaningless metal pieces flying at your face in a vomit-inducing tornado of suck. God help you if that suck is in 3D!) So if that camcorder-distributing man were to get a rare lung infection generally only found in lemurs in the deep corners of the Amazon, I could quite easily be talked into joining the “let ‘em die” camp.
Point being, in the “healthcare-vs-let-em-die” debate, there would be two legitimate sides. But in our current healthcare debate, we first have Obamacare: a pro-corporate system designed to enrich an industry made of slimy parasites who spend their days trying to figure out how to make sure people either owe them lots of money or die quickly. Then we have Trumpcare: a pro-corporate system designed to enrich an industry made of slimy parasites who spend their days trying to figure out how to make sure people either owe them lots of money or die quickly. …BUT with one of those options there are no pre-existing conditions. (Except for the pre-existing condition of national psychosis which acts like this is a genuine debate.)
Don’t get me wrong. Trumpcare is undoubtedly worse. The estimates are that by 2026 as many as 51 MILLION Americans would be uninsured. As of 2016 there were still 27 million Americans without health insurance. But saying Trumpcare is worse and Obamacare is better is like saying, “It’s better to catch crabs from sleeping with a hot young lady, than to get it from a used gym towel.” Sure. I guess. But shouldn’t we just be focusing on the fact you have crabs? Who gives a shit about the towel? And shouldn’t you also switch gyms?
Our healthcare system – both Obamacare or the possible Trumpcare – is a travesty on par with your beloved dog getting hit by a truck carrying your favorite flavor of ice cream. Not only do you lose your best friend, but now your favorite ice cream tastes like profound depression and loss.
Remember, under Obamacare 27 million people still don’t have healthcare, and millions of people have filed for bankruptcy over the past decade because of healthcare costs, and rich people live on average 15 years longer than poor – partially due to the cost of good healthcare. This unmitigated failure of a healthcare system in “the wealthiest country in the world” will get even worse under any conceivable version of Trumpcare. It will kick millions of people off their insurance and will set up what remains of Obamacare to crumble to the ground so that Trump can go, “I told you it would collapse!” (Most of Trump’s presidency seems to be premised on the idea that he can just set up everything to collapse even further and then sell ugly hats that say, “I fucking told you so!” as he rides off into the sunset in a double-wide helicopter.)
But all of these healthcare plans are simply tinkering around the edges of a unique torture device designed to suck money out of desperate Americans – or Americans when they’re at their most desperate – and place it gently into the pockets of morbidly obese insurance companies. THAT is the system. By design, that IS the system. Or rather, it’s the versions of the system that get heavy rotation on our mainstream media. Sure, ideas such as universal healthcare exist, but they’re only allowed a quick 3-minute shout-out by Bernie Sanders before MSNBC plays him off like he’s an Oscar speech that has gone on too long. “I’m sorry! That’s all the time we have for the only rational, moral course for our country to take on healthcare. Coming up next, 4 hours of Obamacare vs. Trumpcare! The battle of the titans!”
Universal healthcare is the electric fence that our politicians don’t want to touch, nor even piss on. Just last week Democrats in California killed the single-payer plan even though they could’ve passed it if they had wanted to.
We are debating between two horrific, criminal versions of healthcare designed to make people rich off of the pain and suffering of every American. Yes, Obamacare is better. Yes, Trumpcare is worse. Yes, I don’t care. By acting like this is a legitimate debate, we are subconsciously solidifying cultural hegemony for the idea that healthcare should be something exploited for profit. It should not. Stop dignifying that thought process.
This is why I have a tough time running around yelling endlessly about how bad the GOP healthcare plan is. Make no mistake, it’s on par with Caligula’s healthcare plan (which was shoddy at best). But, let’s put it this way, imagine there were a Ferris Wheel that was poorly constructed and therefore was decapitating everybody on it (and for some reason each decapitation made a lot of money for the CEO of Blue Cross Blue Shield). And I noticed two people standing next to the Ferris Wheel arguing over which was sadder – the fact that a 10 year-old angel of a child had just died on the Ferris wheel or that a 12 year-old asshole of a child had just died on the Ferris wheel. I would not weigh in on the debate. I would think both people are psychopaths for standing there arguing, and I would yell, “How do we turn off the fucking Ferris wheel?!” …Well, when it comes to our national dialogue on healthcare, I think it’s time we all asked how we turn off the fucking Ferris wheel.
A small Volkswagen bug can’t magically morph into a massive building-sized robot monster. Making money off of the fact that someone is sick or injured or dying or failed to fill out some paperwork on time can’t magically morph into a morally defensible way of doing things. …And that’s why we’re the only developed country that does it this way.
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Bravo
Now DAT’S ammonia!!!
((NH4)2CO3): ammonium carbonate.
Smelling salt for the non-chemists out there.
Thank you, Yves and Lee Camp.
Right on the money — and so not-funny.
Just like Trump can’t have massive tax cuts without Trumpcare, we can’t have single payer until we reduce military spending and that will never happen. The only path forward is a public option to buy into medicaid on a state by state basis. Republicans recognize this threat and and are trying to their best to curtail medicaid spending. That’s the new fallback, defensive front line in this debate, not single payer. It now comes down to who has a “meaner” plan. I’m looking at the Badass Option. I will spit in the eye of any health professional who gets near me. Cost is zero stinking dollars.
This one-or-the-other argument, that we can’t afford single payer until we reduce the military budget, or can’t afford it because of Trump tax cuts for the wealthy is simply not true. The fact is that federal government spending is not funded by taxes. The federal government is the sole issuer of its own nonconvertible fiat currency. You *cannot* run out of that which you create at will.
The *only* real constraint on how much money the federal government can create/spend is, are there the resources available to buy with it. There are a finite amount of goods and services available at any given time. If government spending is buying up those resources in competition with the private sector, then that may put upward pressure on the price of those resources – you might get inflation. Supply and demand.
The debate over how much the federal government should spend is simply not a financial debate – it is strictly a political debate. Do we want healthcare for everyone? We absolutely can afford it, so the arguments for or against it boil down to ideology (and the moral world-view that each ideology encompasses).
Politicians keep pushing the “we’re broke” and “how will you pay for it” mantra because it’s easy to say that instead of : “Look, you f-ing peasants, you’re like a bunch of cry babies who think you own the place. Well, you don’t. If you are too poor to afford medical care it’s your own fault. Nobody twisted your arm to smoke, or become obese, or engage in all those other unhealthy habits that got you into your decrepit state. It’s not everybody else’s fault your parents gave you a set of faulty genes. That’s survival of the fittest, it’s the natural order. So just accept your fate as gawd’s will and just go off into the woods and die. Or whatever.”
Disclaimer: I don’t agree with any of the above screed, but I’ve read statements like those in many comment sections on the web so often , I am forced to accept that this is the opinion of many of my fellow citizens :^(
Thank you, Higgs.
I’m sorry to inform you that there is not one politician in either party who was elected on the platform of budgets don’t matter and we can print all the money we want…and there never will be.
Therefore your proposal is confined to the art of the impossible. It’s not how the game is played. We only “borrow” money to refinance the debt and expand the military.
The Fed can and does create money out of thin air, but that’s a different story.
They might not get elected on that platform, but it’s exactly what they do once they’re in office.
Once statement we’ve never heard from any politician: “We’d really like to start that war but we simply don’t have the funds. Maybe next year.”
So the politicians know this can be funded, they simply choose not to. And the actual people of this country are waking up to the possibilities, and are not listening to the politicians anymore.
I would argue that’s why we have the president we currently do. And I predict we, the people will continue to elect buffoons until we’re allowed to vote for candidates who will actually help us out. Pretty sure there are still actors from Predator who have not held elected office yet and would be happy to serve.
Side note: I had a fundraiser call me yesterday asking me to stop the ACHA and protect Obamacare right after I’d had a very large cup of coffee. They got an earful much along the lines of this post, although a lot angrier and not nearly as humorous ;)
What platforms? Our politicians run on platitudes and mud-slinging. If you can identify a platform of some sort do you also see any tendency to follow through on that platform?
[Groaning with head in hands…] Isn’t that the sad truth? Every year it seems like our political candidates spend less and less time describing the details of what they’d actually like to accomplish. While the media becomes more and more focused on personality conflicts and the “horse race” instead of actual policy details.
Is it any wonder that our esteemed leaders in DC seem to be flailing around more than ever before?
I partly disagree Higgs Boson. Not with the MMT stuff, I’m fine with that. My argument is one of societal fairness. While certainly we can afford for everyone to have medical care, it is not fair that the medical community gets vastly outsized remuneration for their efforts.
The government must also find a mechanism that ensure the medical community is compensated fairly for its contributions. Today, the prices charged are wildly outside any reasonable number. The two must go hand in hand for either to succeed.
Yep. That’s one of the problems with MMT-based calls for massive new federal spending. When the federal government showers a particular industry with newly-printed MMT dollars, there is considerable opportunity to reap outsize profits, and very little incentive to engage in any sort of cost-control efforts whatsoever.
We’ve seen it with the military-industrial complex, the educational-industrial complex, and the medical-industrial complex. In ALL of these industries, costs seem to relentlessly rise year after year after year.
But for people working in industries that don’t regularly receive infusions of newly-printed MMT dollars? Life’s a lot tougher there. Your concern about societal fairness is very relevant.
What does MMT or balancing the budget have to do with the lack of efforts to control costs in each of the N-Industrial Complexes you identified? MMT or balancing the budget deal with how to pay for what “we” decide “we” want.
The costs for Medical Care are too much in the hands of the Physicians and Hospitals. The Insurance Industry helps support the “affordability” of the increasing prices for Medical Care — much as low interest rates drive house prices — and the rising costs for Medical Care enable the rising costs for Insurance.
I see similarity in the way the costs of Medical Care ratchet up and the way the costs for body work and paint jobs for cars ratchet up. There is a difference in that the Physicians seem to get a larger cut of the take — unlike the guys in the shops pounding the metal and spraying the paint. However I wonder whether that difference is short-term as the costs for Medical School, Malpractice Insurance, office management and rents, and costs for dealing with Insurance providers take ever larger bites from the Physicians cut. I believe the support for medical licensing constraints on H1-B foreign doctors is controlled State-by-State. Given the Republican animosity toward unions and the Republican control of most State governments … are Physicians really such a valuable voting and contributions block that they can rest comfortable once they’ve driven the costs for Medical Care to a “satisfactory” level?
Jon S
June 26, 2017 at 11:51 am
I agree – too much of “reform” is just paying WHATEVER amount the medical community demands. And at the prices charged, you get right quick to “lifetime caps” – which if there was any cleverness on the parts of dems, would be called deathtime caps….
https://www.aol.com/article/news/2017/06/26/mom-of-boy-with-rare-disorder-shares-photo-of-astronomical-hospital-bill/23002769/
Chandra calculated that she would have had to pay 231,115$ OUT OF POCKET for her son’s surgery without help from insurance, a bill impossible to foot by the average American.
And that was just for one procedure. As Chandra points out, patients like her son often need countless operations and prescriptions to keep them alive.
The federal government is limited only by the real resources that are available for sale in dollars. While it is obvious that we have problems with regard to healthcare resources (hence, healthcare inflation), all of these problems are solvable by a motivated society. Not enough doctors? Subsidize the training of more. Not enough medical schools? Build them. Not enough well-care beds for indigent seniors? Again, build them. The only concern is to limit price gouging between now and when these solutions can be realized. Stop granting patents disproportionate to the contributions made by the drug companies. Narrow the gap between GPs and specialists.
Yes, it’s a long list and a lot of work. But we’ve let this system fester for many decades. It’s going to take time and effort to correct the mess. But it’s not a shortage of money that’s stopping us. It’s a shortage of willpower in our selected leaders.
Agree with your points. I’d go one step further. Step by step start nationalizing the components of the healthcare system. First get rid of the insurance leaches. Second, nationalize the pharma and medical device companies. Third, rein in the hospitals and doctors. Work on it one step at a time.
Nothing’s impossible if there’s widespread outrage.
There is a concerted effort by the medical profession to limit enrollment in medical school to limit the supply of doctors. The American Medical Association is a criminal racket that needs to be broken up by the RICO laws, likewise the American Bar Association. How about free tuition to Medical School, likewise Law School as a societal good. Just listen to the professional classes caterwauling!
As with the great works done in the past…electrification, transport systems etc. The projects lowered the cost of living and doing business…it made our country great. The object of government spending…the fourth factor of production was to lower the cost of living and working. The object was not to make a profit as is all the hubbub. The way things are set tax wise – giving relief thru nationalized health care would free up lots of loot to be plucked by other sectors of the FIRE sector.
So nationalize health care and tax the crap out of speculative “investments” and other rentier bull that put us in the doldrums to begin with.
Last thing anyone should be listening to is a bunch of spineless politicians that abdicated their sworn affirmations years ago.
Look what happened with all the bluster a bunch of politicians were making about how much better their plan would be if given a chance to put one forward…… as I see it..it was what it always was.. a bunch of empty posturing and hot air that normally exudes from an orifice other than the mouth.
Apparently these people on both sides of the isle are so up the asses of their benefactors that they literally took an oath of orifice.
Jack Ma made the simple point that the US screwed up bigtime and spent $4 trillion bombing Stone Age people in faraway deserts back to the Stone Age instead of on US infrastructure, rail, electric, highway, telecom, airport, port.
Utter genius observation!–which means the truth of it will be resisted stupidly by our ruling class until the end of time. (Heavy sigh).
Well, it’s a Catch-22 – the only reason we can print money at will and not have the value of the currency collapse is because of the massive military budget, which is used to control global shipping lanes and oil-rich zones; it’s not an entirely complete argument, the petrodollar one, and its future is very iffy, but that’s a big part of the picture.
So, yes, the only realistic solution is to redirect at least 50% of the military budget to domestic health care, education and infrastructure – which could very well lead to a bit of a hit on the value of the dollar, internationally speaking.
World Health Organization’s Ranking of the World’s Health Systems 2017
France #1
Approximately 1/2 the cost of the US
Colombia: #25
Private health care system in a (formerly) 3rd world country.
USA #37
Insurance-based medical extortion system. Most expensive in the world. Millions receive no health care.
Of course maintaining the world’s most extensive military industrial complex to support the Empire is grotesquely expensive, but it has nothing to do with the country’s ability to pay for health care for its citizens.
In the U.S. the health care system and the military do have something in common – they are both orders of magnitude more expensive than any others around the world and remarkably ineffective despite the lavish spending.
And they both kill people — by omission AND commission.
That same WHO list had United Kingdom, Australia, and New Zealand (all “single-payer”) at #18, #32, and #41.
At risk of repeating myself, single-payer is not the promised land merely a different starting point for happy crapification via cynical underfunding by neoliberal ruling elites. One starts to wonder whether speaking English is the problem.
Do you have a link to this ranking?
Here’s a link to a Commonwealth Fund ranking for the OECD countries (2013 data). The US ranks last in life expectancy at birth, infant mortality, obesity rate, and percent of population 65+ with 2 or more health conditions (Exhibit 9).
Wikipedia
has the 2000 rankings. WHO stopped publishing rankings on grounds they were too complex/costly to produce. Rankings are also a matter of opinion. My opinion: US system is not great but single-payer systems can also be not-great if funded to fail.
Who is proposing that any system can work if funded to fail?
As a supporter of HR 676 I propose that a system built on for-profit insurance can’t succeed, and point to all the countries which eliminated for-profit insurance and have lower costs and better outcomes on an array of metrics, though not every metric.
I agree that it’s to some degree a matter of opinion, goals, and values as to which particular metrics are more important.
The only countries that spend more public money on healthcare than the US are Norway and the Netherlands. The US spends more private money than every other developed country privately spends. Despite that, we still cannot “afford” to provide universal coverage. The US simply has a bloated, inefficient, and unequal healthcare system that is a massive suck on national resources and is hurting our competitive position in the world. Other than that, it is pretty good. http://www.visualcapitalist.com/u-s-spends-public-money-healthcare-sweden-canada/
Some of the other countries use a single-payer universal coverage system. Others have various public-private options. The only major common theme is that all spend at least 20% less than the US (Switzerland), and most are 1/3 to 2/3 the US per capita total cost. So single payer is an option, but not the only one. People will whinge about the “failures” of the other systems to provide good care, have extensive delays etc. Keep in mind that the population could elect to have their system pay 10% – 20% more to eliminate many of those issues and they would still be nowhere close to per capita US healthcare costs.
We need to have real congressional hearings with testimony from experts actually executing functioning economical systems around the world so that we can reconstruct ours. That won’t happen because there are too many corporations and executives getting fat off of our grossly wasteful system.
DH: The US simply has a bloated, inefficient, and unequal healthcare system that is a massive suck on national resources and is hurting our competitive position in the world. Other than that, it is pretty good.
I’m sorry. Health care that leaves out millions of people can never be “pretty good.” I really don’t give a shit how good it is for you or me. HELLO???
Right on.
Absolutely fantastic prose!
When I read that one (1) California Politician took the single payer health care plan off the legislation calendar, it was because the bill was in danger of passing. The proposed bill had six page list of supporters and one page list of opponents. The opponents….. surprise, surprise was the insurance companies, their lobbyist groups and chambers of commerce from around the state. You can figure out the rest from here! Can’t have a disease like this spreading out of California to the rest of America.
It’s always fun to see how Ds spin abandonment of progressive issues–especially in Democratically controlled states like California and Oregon, where I live. While Obamacare is still alive, they can argue, “Don’t let perfect be the enemy of good.”
The Democratic Party pretense of single payer support and other progressive issues that would re-distribute wealth works well to keep their diehard base fooled that they are the better of two evils.
Follow through is important in sports. Borrowing a Quora response to the reasons why that is so, we can apply them to politics. A novice doesn’t follow through because they can’t concentrate on all of the things at once. That means that they’re missing a lot of opportunities to impart momentum and energy to what it is they’re trying to achieve: the lack of follow-through indicates a failure at every step.
When pros don’t follow through, they rig the game. This is true when Democratic Party leaders ignore state platforms that include single payer financing. They purposefully lose, concentrating on their wealthy donors, who bet on them to maintain the status quo. The vulture capitalists’ “Entrepreneur’s Guide to Disruption” only feathers the nests of the 1%ers.
Democratic leadership has only themselves to blame when voters abandon the party and don’t turn out to vote.
I’d be very cautious about implementing single payer on a state-by-state level. (States are not the same as Canadian provinces.) Any state implementing single payer would immediately become a magnet for the critically ill from neighboring states without single payer, and placing residency requirements would likely not work. (What do you do when the person arrives at the ER in desperate need?)
Far better to implement it at the federal level. (1) Both Mexico and Canada have single-payer already, so there’d be no one crossing the borders to get into ours. (2) Unlike the states, the ability of the federal government to fund the program is unlimited. (3) A failure at the state level would provide strong (but incorrect) ammo against national implementation.
I know we all really want single-payer, but we have to be very careful to avoid a failure the first time we try it, because it’ll be a long time before we get a second chance if we do.
I understand there are large and complicated challenges to implementing single payer state by state. California isn’t just another state though. It’s got a population larger than Canada’s and an economy the size of France’s.
Having spent considerable time in both states, I can tell you that health care currently already works much better for most people in California than it does for most people in Ohio. I’m not a great fan of California in many respects, but in this one, my somewhat educated impression is they’re doing better than most of the country.
(And I see I contradict myself just below. Well, I don’t know if California govt actually functions well enough to implement single-payer or not, but would guess they may have the best shot at it out of all the state govts. in the country.)
On the other hand, if Proposition 98 is the hurdle in CA, one would need Federal pre-emption.
There’s also the issue that the states aren’t currency issues, unlike the Federal government, so at the first downturn, what gets cut?
The City and County of San Francisco ran its own health care plan open to anyone without employer provided coverage, paid for by a 3% tax on businesses, which ran for several years before the ACA started up. I believe it provided care for enrollees at local clinics associated with a locally organized provider network and at county general, though I don’t know the details of the coverage or the eligibility criteria. When it started, some businesses put up signs telling customers they should know the businesses were forced to charge them more because of this 3% tax. Gradually the signs came down, because people didn’t care. The plan had been voted in by the people, and it was a special boon to employees in high-turnover work, where employers generally have long eligibility periods (3-6 months) before enrollment in employer-sponsored plans. I never heard anyone complain about a free-rider problem.
Prop. 98 is not a hurdle for Federal single payer. What it is a hurdle for is expansion of the California state budget to finance Single Payer(by requiring so much of the budget by spent on education). So for example you could expand “Federal” Medicare to “Medicare” for all with 100% Federal funds and have no problem with prop 98.
One issue is that the NNU doesn’t actually consider “Federal” Medicare as it exists today to be “true” Single Payer because of Medicare co-pays, premiums, and Medicare Part’s C and D. Interestingly enough the California Senate single payer proposal while using “fee for service” as the “default” payment mechanism(which got a lot of criticism from health care wonks who hate fee for service) also left the door open for a Medicare Part C/Advantage style program(What I call single buyer healthcare).
To be fair fee for service is actually pretty rare in Universal Health Care systems and is mainly found in US “Federal” Medicare and the Canadian system(where due to the influence of the US hospital and providers are “independent” of the government unlike the UK NHS). Most healthcare wonks even those who support single payer tend to prefer the UK NHS over the US influenced Canadian system.
The NNU (National Nurses Union) is absolutely right. Medicare is not true single-payer at all. It was crapified by the insurance industry from its inception, and has crapified much more since the advent of Medicare Advantage, and then Obamacare. When Obamacare advocates said it wouldn’t hurt Medicare, they were lying.
People should only talk about Expanded, Improved Medicare for All.
One criticism of a Canadian style single payer fee for service model is you still have a profit motive in medicine. Doctors are incentivized to perform lots of procedures unneeded or otherwise to increase their billings unlike the UK NHS doctors who paid on straight salary.
Yes all of the logistical issues are true (although I really wonder if the quality of Mexico’s healthcare system is really so great that they wouldn’t far prefer American single payer if such existed).
But the warning people not to take a chance on the state level because they might not get a second chance anytime soon isn’t going to persuade anyone when we’re not even getting a FIRST chance on the federal level and who knows if or when we ever will. Even having a proposal in California is more traction than anyone has gotten from the Fed gov.
Who’s this DimRat Congressman. Let’s shame him publicly.
Definitely a keeper.
I wonder whether citizens’ initiatives could be used to implement single-payer in those States with such an electoral option.
It could be used to PASS single-payer. Implementation, unfortunately, requires government — something we just don’t have any of, anymore.
I propose that we immediately stop referring to ourselves as a “developed” country (clearly a misnomer). Then we can compare U.S. health care only to that in other “under-developed” countries, and our health care outcomes will be better than those in some of them. USA! USA!
Of course on a dollar spent per-capita basis, we’ll look even worse. Oh, we can just stop reporting that one-sixth of the economy…
Before we can even contemplate single payer, we need competition in the marketplace; there is absolutely none now. We need price lists of what procedures cost; when you go to an ER or hospital and the doctor says you need such and such procedure or operation, you have no clue as to what it will cost. They won’t tell you. They have you by the balls; after all your are sick otherwise why are you there. They also make up or grossly inflate costs—ever read a hospital statement? Cotton swabs at $10 each; bedpan charges at $50 per when you were mostly ambulatory and could hit the bathroom by yourself; rubber gloves @ $10/pair when a whole box of 100 costs $6.49. And because you don’t know the cost up front, the provider and the insurance companies try to out game each other, but not to your benefit; always to theirs.
Until we have a transparent, market based cost system, no single payer will work without totally bankrupting the country (although, in truth, we already are bankrupt).
And even worse, you typically have to sign a form where you agree to cover all charges that the insurance company doesn’t cover, even though you have no idea what the charges will actually be. If you don’t sign, they won’t treat.
Could you imagine buying a car this way? Agreeing to pay for the car (plus whatever add-ons the dealer feel are appropriate) without seeing a price tag first? It’d be ludicrous. And unfortunately, it’s a fairly good analogy of how hospitals do their billing.
No, single payer will not bankrupt the country. And no, the country is not bankrupt.
And no, markets have NO place in the provision of health care.
I’m OK with what you say until I get to the phrase “transparent, market based cost system”. “Market based” grates especially. Medical Care is not something the Market should or can address. It have none of the characteristics which might support even an imperfect “Market”.
[I hope you mean costs in line with “actual” costs. For example rubber gloves at $10/pair versus a box price of $6.49 per 100 — is that $6.49 per 100 really an “actual” cost in a world of giant conglomerates of the production and sale of those gloves?]
Great piece, thanks.
I would be interested to hear from commenters more familiar with California politics than myself re: what exactly happened in the California Assembly / is going on with its Speaker that caused him to table SB 562.
dbk, ger answered your question above, at 8:10 a.m.
I was hoping for a finer-grained response – which interests specifically strong-armed whom, etc. – and wasn’t this anticipated by the bill’s supporters and sponsors? The general outline of what probably happened is pretty clear, I was asking what specifically is going on…
Personally, I don’t need graphic descriptions of homicides. The victim is dead. I want to know who did it, what the weapon was, maybe what the motive was and most importantly, WHAT THE PUNISHMENT WILL BE. I don’t need to know precisely how the knife was twisted, and how many times, and if or how the murderer enjoyed it. And I question what examining this kind of corruption gets us: are we trying to learn how to do it ourselves? I, for one, am not going there.
I found this remark, It makes sense to me…but what do I know.
“What I have said is that the current polling doesn’t show enough support to get this done. Polls are at 65% support for single payer amongst Californians, which is a good number. But when voters are told there’d be a tax increase support drops below 50%.
The reason that is pertinent is because the voters need to approve a single payer taxes with a 2/3rd majority. If we can’t get there, single payer is DOA.
So what advocates need to be doing is building support amongst independents and hesitant democrats. It’ll take all hands on deck to get this done, and attacking the people working to do so, like Speaker Rendon, is foolish and counterproductive.”
http://www.rawstory.com
I’d like to hear about that too.
Via The Intercept, the perp in this case is Gov. Jerry Brown.
See paragraph two.
https://theintercept.com/2017/06/23/california-gov-jerry-brown-thinks-single-payer-cant-work-watch-presidential-candidate-jerry-brown-disagree/
GP
So it’s all about the insurance companies skipping out of payment….not about Big Pharma, for profit hospital corporations, doctors like the ones in today’s Links who are opioid drug pushers, the whole notion of mixing medicine and capitalism to begin with?
Uh, no.
Insurance companies are the key players in raising prices for customers. In single payer systems it is far easier for the ‘buyer’ of health to insist on fixed fees by providers, whether those providers are doctors, drug manufacturers, or others. In single payers systems, be they insurance based (such as Germany or Canada) or based on direct provision (UK, Sweden), doctors tend to be salaried with no incentive to over prescribe, drug use and drug choice is far more tightly regulated, and for profit hospitals (if they exist) are put under real and direct competitive pressures.
The insurance companies as they exist are the cause of the problem – price gouging doctors, hospitals or drug/medical equipment are byproducts of the core cause.
In America the AMA has always played a prominent role in blocking healthcare reform. This was true under Truman and under LBJ they opposed Medicare. Insurers came to be an increasingly necessary middleman because of the inflation in medical costs. It’s the medicine as business mentality that is the problem.
However it is true that insurers have a strong incentive to oppose government run healthcare because it would cut them out of the picture completely. But they are only one among many groups opposing a more rational system because profits. It’s way too easy to blame the whole thing on insurance parasites because saying mean things about doctors isn’t popular.
My fantasy of single payer would be to see employees of health insurance corporations destitute and living in boxes under overpasses for the abuse that they have visited upon the American people. It boggles the mind that people have not come to their senses about health insurers being the actual death panels.
During the day they’d be holding up signs “help me….” and stand along the freeway entrance ramps and divided highway medians. I hope your fantasy is a vision that will come true.
“My fantasy of single payer would be to see employees of health insurance corporations destitute and living in boxes under overpasses for the abuse that they have visited upon the American people.”
No, please. Only the top managements and boards of directors, along with the lobbyists and the politicians whose skids they greased.
Insurance employees, like bank employees and enlisted personnel in the military, are just trying to make a living and support their families.
Don’t punish the troops; hang the generals.
They were just following orders when they denied life-saving treatment, same way SS soldiers were following orders when they shoved people into cattle cars.
Thank you for looking at it more broadly. The passage you quoted also stood out to med immediately when I read the article.
Everyone involved with health care – the insurance companies, hospitals, doctors, pharmaceuticals, etc – should be included in any cost containment reform.
Maybe robot doctors (all owned by the government) will make health care more universally affordable (they will gladly take life long assignments to remote areas).
If you don’t support universal healthcare, you do support leaving somebody out.
It’s just that simple.
All that’s left is the definition of the undeserving.
Bingo! And the issue is that a significant percentage of US citizens have been duly propagandized/brainwashed by the usual suspects in the media, plus their willing lapdog “churches,” to view another percentage of the populace as undeserving and unworthy of health care.
Preaching to the choir here, but we all know the drill: if you don’t have a job, it’s your own fault because you’re lazy. If you’re poor it’s because you’re not a good enough “Christian” and so you deserve your fate, etc. If you have money, you shouldn’t have to pay for someone else’s health care. Blah blah blah…
So having Universal health care simply doesn’t fit into the ethos of many US citizens. They think it’s not fair. Some even think it’s “evil.” (not kidding).
We need a NYT full pager of this.
Hear, hear! Shared and circulated widely this morning!
Debate should be on how to mitigate corruption in a single payer system. And how the lemurs got into the deep recesses of the Amazon. No wonder they got lung infections after that ridiculously long flight from Madagascar.
“how the lemurs got into the deep recesses of the Amazon”?
Prime-ates get free shipping?
MEDICARE for ALL is the only antidote to the insurance industry /pharma profit machine masquerading as a healthcare system. GREAT READ–as sad as it is funny.
Well, that and rewriting Part D.
HR 676 Expanded and Improved Medicare for All includes prescription drug coverage and price negotiation. It replaces private insurance.
“The debate SHOULD be “Is our country wealthy enough to cover the healthcare of every man, woman, and child without causing extraordinary harm to other citizens?” If the answer is yes, then the answer is do it. And the other side…”
Completely misses the point of the position of the other side.
How does it miss the point of the position of the other side? Please explain.
The positions of the several other sides include ‘not a legitimate function of government’, ‘forcing me to buy something I don’t want from a private supplier is immoral’, ‘increases the size of the Federal government’, and, of course, ‘will actually cost even more than it does now’. That’s a start. Don’t forget ‘a creation of Barack obama and Mitt Romney must be truly evil.’
An alternative to compulsory purchase has been found. I have not seen examinations of how teh solution can be gamed. The problem is people who would only buy insurance when the get sick. The solution, which I am not endorsing, is ‘you may opt out of compulsory purchase, but if you did not purchase, you must wait six months after applying to buy the insurance before you actually get it.’
The position of the other side is that poor people are bad and deserve to suffer. Or am I missing the point?
Well one could argue that it’s the position of both/all “sides,” as ACA also premits something like 57million citizens to die horribly v. BHCA which permits something like 320million to die horrible deaths.
I mean, like, we’re just all angels dancing on the head of a pin arguing whether ACA is “better” than BHCA.
Unless or until we’re really discussing Universal Health Care, there is no true “other side” to the argument, imo.
Ayup. Completely.
. . . waiting, GP.
I do not spend all day looking for responses to my comments, because I rarely get any responses. Ayup complete was in response to knifecatcher.-
When it comes to macroeconomics, I’m just a layman who likes to read. BUT, it appears to me, George Phillies, that the point of the position of the other side is derived from the notion that money comes from God (or at least the Christian Dollar) and should be treated with great reverence and solemnity and care. Money used to come from the King who was God’s representative on Earth but we had that little thing called the Enlightenment and 1776 and so on.
I am sure that someplace there is someone who thinks that money comes from God, but I have never encountered such a person or their writings. Who is this person? Surely you can name one?
A significant cause of 1776 was in fact just teh opposite, namely that money was *not* coming from the King, leading to the manufacture of pine tree dollars, because the currency was being sucked out of the economy by taxes shipped to England.
The purpose of the American Medical Extortion System is twofold:
1-Guarantee that everyone in the lower 99% of the population has every penny of their life savings extracted and transferred into the hands of the System by the time of their death.
2- Speed up the demise of the Worthless Eaters who are no longer necessary for the Financial Poizi since production has been moved overseas to places where wage slaves are cheaper and Ponzi Chips are created out of thin air and distributed to the Important People with no need for them to first be recycled through consumption..
I’ve never seen the American Medical Extortion System described with more accuracy and passion than Lee Camp just did.
One really weird thing about the health care debate in Congress is the idea that cutting back on federal health care spending will save money. Sure, it will save money for the federal government, but in that case, someone else will pay, with dollars and/or health. A real solution to the problem must address overall cost, not just costs for the federal government.
Conservatives also oppose big government. Big government can sometimes be a problem, but in this case, all that we need is something better than private health insurance, which is a pretty low bar. If you have a quasi-religious belief that government can’t do anything right, then you will never support single payer, but if you are open to facts, the evidence is pretty clear that government runs Medicare and Medicaid more efficiently and cheaply than private insurance companies. If you are serious about saving money and not just saving capitalism at all costs, then single-payer is the way to go.
Yeah, well far too many citizens wouldn’t know a real, truthful, verifiable Fact if it smacked them upside the head.
Many US citizens live in an alternate reality created by the media and their “churches.” Facts need not apply.
They believe the propaganda from CNN, Fox, MSNBC, NBC, CBS, ABC and PBS which create the alternate reality.
I can understand how the insurance industry can intimidate a state into backing off single payer – because the state cannot print dollars and so the constraints of a state budget facilitate insurance company control. The state could actually print its own currency, not circulated beyond California borders, and it could be used for all things medical. That would be like creating a state within a state. But how on earth does the insurance industry extort money from the federal government – the federal government can pay for medicare for all easily and cannot go bankrupt over any of it. So that’s my question – why doesn’t the federal government insist on the efficiency and savings of medicare for all? What power does the insurance industry wield? Besides bribery. We voters should demand the medical insurance industry be shut down as an extortion racket immediately.
Bribery is more than enough.
With the GMOs, pesticides, and other environmental toxins which are blithely foisted upon us by the Few,
I am thinking the Few’s plan is “make them die”, rather than “let”, while extracting the rents to which they
so obviously feel entitled. Just a thought.
Pretty much that seems to be what’s happening, from my point of view.
The rapine and plunder presently pursued by the Trump Admin is Evidence Number One of this.
While I think this is a great perspective, it misses the true underlying debate we’re having in this country. It’s not about “Are we rich enough to give health coverage to each and every American?”, but “Which Americans are worthy enough to have health coverage?”. Being born in this country is not itself sufficient, because identity politics has lead to an “us” vs. “them” distinction… there is no “we” anymore.
But all of these healthcare plans are simply tinkering around the edges of a unique torture device designed to suck money out of desperate Americans – or Americans when they’re at their most desperate – and place it gently into the pockets of morbidly obese insurance companies. THAT is the system. By design, that IS the system.
BOOM!
Could the fact that some many are >64 and now covered by Medicare be part of the problem? Hard to convince anyone >64 to get excited about health care change since theirs is pretty good now?
Great read. thanks.
Jim at Stonekettle has something about this issue also….
reply below @ 11:37
Right— Medicare is so good that for a major operation the co-pay 20% billed to the “insured” is about the same expense as flying to Thailand and paying for the entire operation out of pocket. (And at a hospital at least as well equipped and staffed as its US counterpart.)
I fall into that >64 category. I can tell you that Medicare is better than private health insurance, but not by much. Some doctors refuse to see Medicare patients (insufficient remuneration, they believe).
As T’s Hammer pointed out, Medicare covers only a percentage of medical costs. There are “curated” private insurance policies available to cover the gap (mine is currently $111/month). Some Seniors forego that “gap insurance” because they can’t afford it. (They won’t be able to afford the unpaid costs for any major medical bill, either.)
The point of the article was that medical care in the USA is a broken, untenable, scam that needs major surgery, if not chemotherapy.
PS. Most working adults have paid into the funding of Medicare at some point in there lives. It is not “free”.
Unless you apply for “gap” insurance at the time your social security coverage begins it will only cover future health problems. The insurance extortionists will deny coverage for anything deemed to be pre-existing that a doctor has uncovered. And when you are 65+, everything is pre- existing.
Better off just to immigrate to somewhere like Ecuador where your social security budget comes closer to providing social security.
I am >64 and happier with Medicare and my supplement insurance than I was with the policy I used to available through my employer.
I also have young adult children who will be caught in the middle of our Medical Industrial Meat Grinder if they become injured or ill. I went to a lot of trouble to get my children and endured many long years of marriage to a fisherman’s wife [as in the tale of the magic fish] to remain as close a possible to my children. Instead of worry and concern for me I must continue dealing with growing worry and concern for them. I don’t believe I could just stand by and watch one of my children die or sink into financial ruin thanks to our Medical Industrial Complex — so I fear that I might be dragged down trying to help them. I suppose other parents feel similar grief and anguish about the Education Industrial Complex and the ever growing costs for college.
Lee Camp claims that the rich live 15 years longer than the rest of us. Even if that’s exaggerated, a few years are too many.
Four years is 5% of an 80 year life span. 0.05(326,381,938/80) = 203,988.7 Americans that the lack of quality universal health care is killing each year.
Terrorists can’t compete with the insurance, big pharma and corporate med monsters, who operate their deadly fraud without real opposition by the Repucrats. They are wholly owned properties of the elite masters, like everyone and everything else.
but that’s not accurate, that’s only one reason why poor people die younger, and likely very far from the most important one (not that it’s not important for those for whom it is the reason).
A lifetime of financial worries and financial stress and sometimes frank despair over the situation, work stress at bad jobs, lack of any power on the job or in the political system, lack of safety protections on the job, dangerous and polluted neighborhoods, etc. That’s why the poor die younger. It’s the whole economic system, not just the medical system.
Ah, but Obamacare (primarily) did two things:
A convoluted scheme which did just about everything imaginable to get for-profit private health insurance to function such that it would give acceptable results. This is the exchanges + subsidies. This kinda just barely worked, and could continue to just barely work with maintenance and a bit more funding.
Expanded one of our single-payer systems. This is the medicaid expansion. This worked very well. Even better thanks various red states deciding to sacrifice their poor people and even better the later decisions of several of these to stop sacrificing their poor people we have right in front of us ridiculously good evidence of how well it worked, far more than we usually get on policy changes.
We have done a grand experiment pitting the two sides of the great american healthcare debate against each other. The conservative corporate democrats plan vs the more liberal progressive democrats single payer ideas.
Now, off to the side we have the republican party. They don’t really care about healthcare. They care about tax cuts for the rich.
So we have a real healthcare debate, but republicans are in power so that isn’t relevant. The relevant debate is ‘do the rich have enough money?’.
There are 9 million (2013 report) low-income people on Medicare who also receive Medicaid for services not covered by Medicare, including long-term care.
http://www.kff.org/tag/dual-eligible/
http://www.kff.org/infographic/medicaids-role-for-seniors/
Nine million seniors on Medicare + Medicaid compares to 6.4 million Americans with Obamacare policies in 2017. In both cases, these are single-digit percentages of the adult population.
One can surmise that the demographics of the nine million skew toward less influential, less politically active individuals. The roughly 47 million seniors managing their own Medicare copays (including a substantial slug who are retired from the managerial and professional class) will easily drown them out politically, as doug suggested.
Does that assume the 47 million think they can pay for long-term care when the time comes? I think the 9 million number, is low relative to all Medicare eligibles, at least in part, because the need for long-term care for the elderly increases with age (see second chart in second link).
I think I’ve read the average time on-long-term care is 2-3 years. Generally that would be the oldest and sickest segment of Medicare recipients, so a small portion of Medicare recipients for a small portion of their time on Medicare.
Can’t say if their own potential needs, or their own human concern for the needs of elderly or any other Medicaid recipients would be enough to influence their opinions, if they had adequate information about it.
was intended as reply to doug @ June 26, 2017 at 11:12 am
I wonder how many people will see this and immediately dismiss it because it’s from RT. Guy must be another Putin Stooge, no?
The opposition to Trumpcare is neglecting its best arguments.
1) The US will continue losing out in economic competition unless everyone is healthy and works as long as they can?
2) Several European countries (Switzerland, Germany, Netherlands, perhaps others) provide good, universal health insurance without a single payer system. The health insurance companies, if properly regulated, would support such a system in the US.
3) Getting American health care costs down to the OECD average is a way of getting the so-called “right wing” to support up-to-date universal health insurance which emphasizes prevention.
4) Trump is too ignorant to notice but the US could pressure other rich countries to share the burden of pharm research,
Countries that provide universal healthcare using private health insurance (Bismarck model) require that the companies provide the government-defined set of benefits on a non-profit basis. Any link to any evidence that US insurance companies would support this?
Why would the companies (mega corps) that compete internationally give a hoot? They practice being the middleman making a huge profit by using cheap labor from China, India and other unfortunate countries. Besides, if they didn’t have to pay for health insurance for their few employees, they’d pocket the money.
Western Civ is too expensive … China and India are the future, with Russia as a resource base. So much for Francis Fukuyama. You can’t have goodies handed out to voters, or corporations, without empire. It is all based on injustice abroad and corruption at home.
It is possible to shift from guns to butter … but guns are too profitable. Butter can’t compete.
The proposed single payer system in California violated Prop. 13 and Prop 98(David Dayen discussed this extensively on his Twitter feed) thus it was killed by the California Assembly Speaker. Basically in Dayen’s opinion the California Single Payer proponents are playing the same games as Greece played against the EU a few years back. Make promises you can’t deliver on.
**Yves should do an interview with David Dayen on this subject as he seems to have a lot more knowledge on the issues with this CA Single Payer proposal.
I was worried that the drafting would be careless. One would think that NNU, being the drivers, would strive to get that right.
I guess the answer from David Dayen is along the lines of the only way to get around Prop 98 is a ballot initiative and NNU doesn’t even want to consider that for obvious reasons(i.e. the left doesn’t have a great track record in ballot initiatives and insurers/pharma will throw everything they have at it). Plus we are actually kind of late in the game to get organizing on a ballot initiative for 2018.
As of today I am more convinced than ever that while might see a single payer system in one of the “blue” states it won’t be California. The obstacles of a ballot initiative are simply too high. New York which doesn’t have ballot initiatives either way is probably a more likely candidate.
Perhaps the greater lesson is even those like the NNU who support single payer don’t want to touch prop. 13(which is the basis/justification for prop. 98)
“Morally indefensible R Us,” is the appropriate tagline here. Most excellent post. Thank you so much. Must send this post to CONgresscritters.
Funny thing – that is exactly the debate that’s going on right now, except that one side isn’t being honest about where they stand.
The author is trying to have it both ways here. The thought process we should all stop dignifying is the “both sides are equally as bad” since the author is completely ignoring what the system was like pre-Obamacare. Remember when insurance companies could deny you coverage due to pre-existing conditions? Remember when insurance companies could take away your insurance coverage in the middle of cancer treatment (rescission) because you cost too much? Or how crappy the plans were on the individual market? Obamacare is imperfect, but to say that it’s horrible is disingenuous and misleading because it implies that things were better pre-Obamacare.
Is Trumpcare designed to make things better? What problems does it fix? How does it achieve those goals?
With all due respect to my fellow commenters, the real issue with the healthcare system isn’t who is doing the paying. The issue is who is receiving the payments, and why are the payments so much larger here than for equivalent products and services elsewhere in the world?
It doesn’t matter who is doing the paying when the vendors are legally-protected monopolies.
In fact, having the “government” do the paying is likely to be worse, because the monopolies already own the government.
Single-payer only makes sense in a world where the machinery of government is thoroughly democratic and responsive to the public will. At best, we elect a few, carefully pre selected, palatable-to-the-monopolists “candidates” to a few positions … but the bureaucracy carries on regardless of who got elected.
A truly progressive health insurance reform would enforce anti-trust and anti-racketeering laws, and eliminate the prohibition on import/export of medical goods so global pricing is commoditized. There is no legitimate reason why medicine in the U.S. should be priced 10x or more what it costs overseas. Americans once revolted over a tea monopoly… Why not fight for free trade in Tagamet, Tetracycline and Theraflu?
Similarly, hospitals and other care providers should only be allowed to charge one pre-advertised price for a given service. EVERYONE should pay that price regardless of insurance arrangements. Without transparency in the pricing it won’t matter who is the payer, we’ll all be robbed blind.
I’m always pleased to see the non-debate called out, and while the two sides identified are presented with clear bias, the point remains worthy of consideration.
How is this matter different from the other ones so often complained about?
If one follows the money, looks for the lack of transparency and identifies who benefits from it, and how – the similarities start becoming apparent. Identify the anti-competitive or biased laws or regulations that advantage particular parties and disadvantage others, then one gets closer to the truth.
These are all simple mechanisms and pretty easy to follow as the work has been done. And they touch all areas of human need and endeavor.
So is the reasonwe don’t quickly identify and target the system itself is that we likely all benefit from it in our own area so want to protect that?
Couldn’t this healthcare issue, like many others, be addressed quite quickly through the use of technology and data science to create true transparency?
I wonder – if we forget about changing anything except for a massive campaign to organize and normalize the key data at an individual provider level for each service rendered that could be verified by an individual before, during, and after service and made it such that it was all easily understandable, wouldn’t the gaming become evident?
Then if that data was used to make decisions with the real impact being quantifiable, wouldn’t that put us leaps and bounds ahead of where we are now?
There are privacy issues that would need to be dealt with, i suspect, but could be like a TOS agreement – any government money goes into your pocket – then here are the rules of engagement. Same as i have with my phone and cable if i want to use the service – it’s not a choice, really.
Data science. anonymized public databases with api’s and authentification.
Look at amazon, uber, airbnb, facebook, etc.. and tell me it couldn’t be done if there was a will. the reason we can’t or won’t is not capability, but the clear view of where the skimming lies creates a powerful incentive to safeguard those profiting from the current system.
And these new “founding fathers” would be those that help provide the data structures and fields that would allow for creative use of all this data. So it really works and isn’t missing anything to allow for clear and robust reporting.
now THAT sounds like a formula for disruption.
If the doctors don’t understand that healthcare is a public service and willing to stand up for patients in a legal and financial debate that destroys real people.
.
Don’t expect politicians to face the fact healthcare is consumed as a public utility in high percentage.
.
Lawyers, big pharma, insurance companies, and credit is more powerful than the US government at the very least.
Who cares about millions of Americans in prison, terrorism, 4 trillion dollar 10 year multinational contracts, espionage, and a military police state big enough to do my job.
.
security is important
Speaking on behalf of the rest of the world, we are not unhappy if Americans die or are too sick to pick up guns and invade us.
Snark aside, those of us who do live in civilized countries are appalled at the American debate over health care. America purports to be a Christian nation (yeah, yeah, the Constitution says no religion, blah, blah, blah…but try electing an atheist in America!) but I don’t recall Jesus saying, “Suffer the children to come unto to me so I can watch them die horrible deaths while I ponder eternal verities and deny them my healing touch because Lord God my Father has decided that they should die and who the fuck am I to interfere and they are probably stupid and lazy anyway or they could pay for a healer.”
America is immensely embarrassing to expats like me.
The reason there is no ‘legitimate Health Care Debate in this Country’ is because the people who own the Political Wh#re Class (PWC) in Washington D.C. love the status quo. Profits, Profits Profits for one thing, but there is another reason just as important. The current Health Care System is a “Lose your job, Lose your Health Care System”. This helps the Corporate lobbies immensely. They can justify not paying their employees more, citing rising Health Care costs. Also in the current System, employers can use the potential loss of Health Care as leverage over their serfs, er, employees. Employees will work extended hours and shortened or NO vacations because the consequences of losing one’s job is HUGE–and all of them are negative. Conversely, IF employees have Health Care free and clear od their employers, they will more freely move from job to job. Employers may have to actually pay their employees more!! Have NO doubts about it. If the Business Roundtable or the US Chamber of Commerce wanted single payer Health Care its puppets in the PWC would have the Bill ready for passage in record time. This doesn’t happen because TPTB do not want ANY meaningful Health Care Reform.