The Warren Gap fallacy—or how she promotes envy and sows discord

For Example:

There are three married couples; all named The Bruces. White, 8th generation, college educated Americans.   Bruces A are 20+ years old; Bruces B are 50+ years old and Bruces C are 65+ years old. From top to bottom, Bruces A, B, and C.

Bruces C are much wealthier than Bruces A and Bruces B. They have pensions, 403-b, 401-K, Social Security,  investments  and 2 homes. Bruces B have some savings, no investments, and 2 homes.  Bruces A have one house, no savings or investments.  There’s a wealth gap.

Bruces B have a much higher income than Bruces A and Bruces C.  There is an income gap.

Bruces A are much healthier than Bruces B and Bruces C.  There is a health gap.

Bruces A have minimal health insurance, some hospitalization coverage never used; Bruces B have great health insurance from large self insured employer—OSU; Bruces C have Medicare A & B, plus supplemental. Good, but not as great as Bruces B.  There is an insurance gap.

Bruces A take no medications at all.  Bruces B have minor conditions requiring little medication.  Bruces C have had heart, blood pressure, cancer, asthma, cholesterol problems, all treatable.  There is a health consumption gap.

Bruces A are usually employed or under employed—they are students or lower level employees; Bruces B are fully employed, or self-employed and are DINKS; Bruces C are not employed even irregularly.  There is an employment gap.

Bruces A rarely ever have a vacation or travel; Bruces B occasionally travel to visit relatives or vacation close to home; Bruces C travel to many countries and enjoy cruises, they eat out frequently, attend art events, pursue hobbies.  There is a leisure gap.

Which of the Bruces, A, B, or C, does Elizabeth Warren want to tax to "help" the other two?

Are Americans the worst patients in the world?

“Recriminations tend to focus on how Americans pay for health care, and on our hospitals and physicians. Surely if we could just import Singapore’s or Switzerland’s health-care system to our nation, the logic goes, we’d get those countries’ lower costs and better results. Surely, some might add, a program like Medicare for All would help by discouraging high-cost, ineffective treatments.

But lost in these discussions is, well, us. We ought to consider the possibility that if we exported Americans to those other countries, their systems might end up with our costs and outcomes. That although Americans (rightly, in my opinion) love the idea of Medicare for All, they would rebel at its reality. In other words, we need to ask: Could the problem with the American health-care system lie not only with the American system but with American patients?”

Atlantic July 2019. https://www.theatlantic.com/magazine/archive/2019/07/american-health-care-spending/590623/

Anna Loska Meenan, who lives in the Rockford area and used to be on staff at the Mt. Morris clinic, says:

This excellent article explains why Medicare for All in the US would quickly lead to one of two scenarios: Either the health care system would be immediately bankrupted, or the resulting rationing would lead to riots in the streets. Having been involved in health care, I can confirm that this author speaks the truth, and from conversations with docs who are still seeing patients, I can see that things have only gotten worse since I left medicine 10 years ago.

Politics and healthcare

At the coffee shop today I was reading the Oct. 9, JAMA and noticed an editorial on "Politics and Healthcare." JAMA's left of center, but I thought I'd take a look. Praise for Lyndon Johnson and Medicare in 1965, praise for Barack Obama and PPACA (Obamacare) in 2010 and then 3-4 paragraphs lambasting President Trump who, but for McCain, would have been able to undo Obama's disastrous grab of the private sector and 1/5 of the economy. It's one of the reasons Trump was elected--the people hated it, especially those who lost good coverage or lost their doctor or were forced to buy coverage for contraception and abortion. Obamacare was the only significant piece of social legislation that got zero support from Republicans, who had supported FDR and social security, and LBJ and Medicare. In fact, it's doubtful those programs would have passed without Republican support. It is the Obama administration that created the extreme partisanship we see today, not President Trump.

Yes indeed. Politics and healthcare in black and white in JAMA. So I looked up the author, Donald M Berwick--he's retired, but has been on just about every government board and committee to give us socialized medicine, was part of the Clinton administration, and even worked with the British National Health Service and was knighted by the Queen! I would not have expected anything else from him.

Physician reimbursement—or why you’ll wait, by Dr. Anna Meenan (retired at 54)

If you're wondering why your doctor is discouraged and depressed (and many are, though they don't show it) these days, this might help explain it:
http://www.physiciansmoneydigest.com/practice-management/Physician-Reimbursement-Dropped-Sharply
As best I can tell, these are the rates paid by COMMERCIAL insurers. Medicare and Medicaid pay even less than this, and have also been lowering many of their rates. If you think that this is what goes into the doctor's pocket, you are wrong. Out of these sums, the doctor must pay all the overhead of running an office: skilled labor, equipment, supplies, utility bills, and thousands of dollars in malpractice insurance. Think for a moment about what you were charged the last time you called a plumber, or the last time you took your car in for repairs, and put the value of those services up against the value of your life and health. I'm just saying.

$86 for code 99215. Just to clarify, 99215 is the highest code for an office encounter. This is what your doctor would code if you came to his/her office with, oh, let's say, out-of control diabetes with a life-threatening electrolyte imbalance, or if a senior citizen was brought in who was suddenly very confused and not eating. 

Dr. Meenan graduated from the University of Illinois at Chicago, practiced in Rockford and formerly was with the medical clinic in Mt. Morris, Illinois

Fat Cat Obama supporter is cutting workforce in medical devices

"Stryker Corporation has announced that it will close its facility in Orchard Park, New York, eliminating 96 jobs next month. It will also counter the medical device tax in Obamacare by eliminating 5% of their global workforce, an estimated 1,170 positions. Jon Stryker was one of the top 5 donors to Obama's campaign. . .   Stryker contributed millions to help Democrat candidates in his home state of Michigan. He also gave nearly $250 million to groups supporting gay rights, transgenderism, and funds social justice projects." 

Is anyone organizing protests?

Daring and Eloquent

That's what Georgie Anne Geyer called Obama's speech to Congress on a "crucial and complicated theme."

She's really angry with big insurance. I read through her article, and everything insurance, either private or government, is supposed to do, it has done for her. But she's still very, very angry. Her cancer sounded just awful, and one has to sympathize with her on that.

She battled cancer, but with her excellent insurance and terrific medical care and probably the latest in drugs and technology, she survived (this with lack of innovation and investment will all shrink under Obamacare). So what's she mad about? Her insurance was then cancelled. Legally. No tricks. She says they claimed she was an independent contractor and therefore not eligible for her employer's benefits. It's just like your car insurance if you haven't reported a DUI and later make a claim. I don't really know how they could do that unless she's filed that way with the IRS--but she doesn't go into much detail, and didn't deny it, just that she'd paid her premiums. A quick check with her syndicate's HR could settle that one. But they did pay for her cancer treatment. How many private contractors (free lance writers) should your syndicate have to pay for? Just you? What do the other writers do?

Have you checked with Timothy Geithner? He seemed baffled by the independent contractor rules too, and he's head of the IRS, formerly big poo-bah with the fed--maybe he could offer some sympathy.

Then she lauds Medicare and COBRA, both government plans, and AARP, a lobbyist for private insurance companies, which is apparently her supplemental coverage for what the government plans don't cover.

Well, lady, what do you think the rest of us old people are complaining about? The elders in the USA, many of whom aren't quite clear that Medicare IS socialized medicine, don't want to lose what they have, they like it. And you, by supporting Obama's "daring and eloquent speech" on a "complicated theme" (which seems to evolve each time he speaks on it) are trying to trash it.

The Council for Affordable Health Insurance

"At a time when both Congress and state legislatures are considering health care reform, it's very important to recognize that government usually makes health insurance more expensive, not less expensive," said Dr. Merrill Matthews, CAHI's executive director.

CAHI has regularly tracked all state mandates since 1992, and its actuarial team estimates the impact those mandates have on the cost of a health insurance policy. For the year ending in 2008, CAHI has identified 2,133 state and federal mandates, an increase of 172 over last year's figure of 1,961 state mandates. This year CAHI is also including federal mandates because they affect state coverage.

"Mandates come with a cost," continued Matthews. "While mandate advocates like to claim that mandates lower the cost of coverage, that's not the actuarial experience. They raise costs because utilization goes up. Those costs are then passed on to consumers in the form of higher health insurance premiums -- increases that make coverage unaffordable for millions of Americans."

Check the web site HT Dave

Here's Obama's health care mandates that raised insurance costs in Illinois.

The health care gap and the poor

My years in a medical library have left me with a bias and love for medical literature. I'm pretty much down to reading JAMA regularly (love the poetry, essays, editorials and book reviews), but I also visit a lot of web pages and have bcome dependent on googling the terms that confuse me (many). I have a growing concern alarm about the amount of money circulating to support research on research (i.e. the value and distribution of information) and/or research on social/political issues or conditions. When you look at the huge dollar amounts from NIH, corporations, pharmaceuticals or foundations or even various philanthropic runs or walks for the disease of the week, you see that so much of it never finds its way into the lab or the clinic. It never touches the virus, bug or neoplasm. It gets sifted and sorted and distributed to various versions of the medical community organizer--ACORN in a lab coat--for lack of a better term.

For example, let's just look at this simple phrase in a review of Metabolic syndrome and psychiatic illness by Scott D. Mendelson (2008) which appeared in JAMA, Oct. 15, p. 1824.

Patients with chronic mental illnesses may not have access to regular medical care and may lead unhealthy lifestyles, and their physical conditions are often not diagnosed or treated in a timely fashion.

I can guarantee you there will be millions and millions of grant dollars heading out the door to chase "access" and "timely fashion," and not enough toward diagnosis and treatment. Further, there will be more millions wasted on "unhealthy lifestyles," primarily in the form of education, information, and hand wringing with endless lectures by the nearest relative--especially the mother! At the risk of sounding like a cold hearted wingnut as some of my readers call me (not realizing I'm a reformed humanist), I call that "peace and justice medicine." Science isn't advanced, people aren't healed, but liberals get a warm glow, a sense of doing something and a good salary.

Before you buy into peace and justice medicine, just look around at your own family or friends. Especially someone with very serious health concerns. You probably won't find lack of access or timely treatment (unless you're on a government plan, but that's another topic). You'll see that person's genes and jeans. What they inherited from the generations who came before them, and what they are doing with it now: eating too much, exercising too little, driving too fast, chasing too many rainbows, drinking too much, smoking or chewing tobacco, sleeping around, shooting up or sniffing, and hanging out with bad people. That about covers it.

There may be an insurance gap, gender gap or access gap for the mentally ill, but that isn't what made them ill. There may be some people who need cholesterol or high blood pressure medicine and don't get it because they bought groceries instead, but that's not what caused their high cholesterol. There may be men going to bath houses who don't know there is a drug out there for the disease they are about to plant inside the anus or mouth of another man, but it isn't ignorance or poverty that is causing their behavior.

More later. Time for the coffee shop and reading more book reviews in this excellent issue. I'm going to write P. Murali Doraiswamy, MD and tell him/her that was really an excellent review.

A poem for today's dilemma

From a story I heard at the coffee shop today.

Health Insurance Woes

Look at me strut
and show off my stuff.
Can you see my thong?
It's not so tough.

I can barely move--
my jeans are so tight,
And guys look at me so,
now, that just ain't right!

At the top of my grade
and the job is secure,
three kids and a guy,
my home life is sure.

Except for my shape--
He wants implants for me!
Would S-CHIP cover it?
I think I'll go see.

3912

Why big business opposes market-based medical care

Craig J. Cantoni used to earn his living making corporations more competitive and productive. He was the go-to guy who would figure out how to reduce costs in health care--higher co-pays and deductibles, second opinions, etc.--although he says the one problem he never could solve was how to stop employees from thinking they were spending other people's money. He admits he was slow to ask himself some painful questions about how he earned his living.

Corporate executives in high tax brackets benefit the most from getting employer-provided medical insurance with pre-tax dollars. But millions of lower-paid rent seekers also benefit from employer-provided medical insurance, including employee benefits managers and administrators, benefit consultants, tax consultants, actuaries, ERISA attorneys, producers of record-keeping software, and publishers of benefit forms and booklets. . . Many are Republicans who in the privacy of the voting booth would never vote to give up their regulatory rice bowl. . . Many others are Democrats who bemoan the plight of the uninsured and deplore the growing wage gap. But in the voting booth, they would never vote to give up their regulatory rice bowl, which drives up the cost of medical insurance and lowers wages by subsituting medical insurance for wages."

Read his article , published in the Journal of American Physicians and Surgeons, based on his address to the AAPS in 2006.