White Coat Underground

I’m really trying to understand this. Really. Why is the outcry against health care reform so much louder than the call for reform? I have a very hard time believing that a majority of people are against some sort of improvement in our system. Around here, people are losing their insurance right and left. But they sometimes seem more scared of reform than of remaining uninsured.

Those of us in favor of a single payer system are shut out of this one. “Medicare for all” is uttered only quietly among well-known co-conspirators. When people who oppose this plan, or even just oppose the president, continue violent rhetoric, bring loaded firearms to rallies, is it any wonder we are silent? How is bringing a loaded gun to a rally not intimidating? And don’t give me the “it’s only one dude” argument—that’s disingenuous and unconvincing. There has been more than once incident, but more important, there has been overt support and quiet assent for nuts like this from the right. When prominent journalists and prominent right-wing politicians fail to condemn this sort of behavior, the intimidation is magnified.

I’m not saying there isn’t real opposition to health care reform, but there is an almost complete absence of real debate, and this implied violence is playing a role. We already entrust our elderly to the government’s care, and we’re pretty damned happy about it, so why not expand it? Do people seriously believe they will have decreased access to services? Do they have any precedent showing that extreme forms of rationing are taking place in any other democracy? Do they have data showing dissatisfaction or worse health outcomes?

Of course not. It’s a purely ideological debate, leaving real, suffering people behind. Let’s start interviewing people recently released from the hospital and staring at a $60,000 bill. Let’s interview former auto workers who are both unemployed and uninsured. Let’s talk to doctors on the front line, trying to find ways to treat diabetic patients who can’t afford medications or testing supplies. Let’s visit rehab wards and dialysis centers where these folks end up after our first failure to care for them.

This isn’t a game. This is a real, dirty, nasty, mortal debate. Our current system is unsustainable, financially, morally, and scientifically.

As medicine has become scientific over the last thirty years, we have let our system continue to accrete chaotically from a country-doc model into a hodge-podge of coverage that ignores the science, the data, the humanity. We cannot build a “scientific system” of health care coverage—-but we can build a system that recognizes our hard-won knowledge. We can implement a just, financially more sound, better system—and it wouldn’t even be that hard to do. We already have all the tools in place to cover everyone. Let’s get loud. Let’s shout down the shouters. University students are about to come back to campus. Let’s get them out there making some noise, agitating for real change.

Let’s be loud but compassionate and brave, and let the violent fringe of society see that we stand together against them, but that if they fall, we will pick them up. Let them try to turn down good care out of spite for us. Let them call for seniors to turn in their Medicare cards to protest “big government”. The right is all about exclusion. We will have a system that cares for all, that excludes none. Let them see that the left cares about them and about their parents and children. And let them see us carry on, care for all, and leave none behind.


  1. #1 Bob O'H
    August 23, 2009

    lack of insurance is being reported. In the UK.

  2. #2 Denice Walter
    August 23, 2009

    *Anyone* can call his/her representative and senators locally or call Congress directly (1-202-225-3121)M-F; although Congress is in recess, the operator assures me that staffers will take your comments.(I called locally,the staffer was articulate,courteous,and better still,she agreed with me!)

  3. #3 Donna B.
    August 23, 2009

    This is not all about health care reform. The public anger started with TARP and the protests started with the stimulus package and bailing out GM and Chrysler. The shallow economic thinking of this Congress was further demonstrated by cash for clunkers.

    People are losing their insurance right and left because they are losing their jobs.

  4. #4 DJ
    August 23, 2009

    Care for all! That is a great rally chant… imma gonna steal it.

    Back to campus tomorrow for me, hopefully I can find some like-minded folks.

    In light of all the recent right wing crazy going on, I’d like to thank you for an energizing post.

  5. #5 Nattering Nabob of Negativism
    August 23, 2009

    The ‘public outcry’ is scripted, directed, and staged. They have websites and schedules. And none of them are from where they are ‘protesting’. They are racist haters, true outside agitators.

  6. #6 dave
    August 23, 2009

    Donna, you make a strong argument for decoupling insurance from employment.

  7. #7 History Punk
    August 23, 2009

    The gubmint better keep its paws off Medicaid, Medicare, VA, and TRICARE.

  8. #8 Donna B.
    August 24, 2009

    dave — decoupling health insurance from employment would be a good thing, I think. As far as I know that’s not actually proposed in any of the bills being currently considered.

    The problem is that the country can’t afford the creative destruction it would take to do that right now. That’s partly because of TARP and the stimulus. We’re not anywhere close to getting out of this recession and spending more money on anything is just going to make it longer.

  9. #9 dave
    August 24, 2009

    Donna, given the exponentially rising cost of healthcare, I don’t see how we can afford NOT to make signifigant changes. Failure to address healthcare reform is fiscally irresponsible. The changes must include a public option/Medicare for all, in order to compell the insurance co’s to lower costs. The only thing at risk is corporate profits, and you can see the fight that the moneyed interests are putting forth. We certainly couldn’t do much worse than we currently are, spending twice as much as any other country, yet having poorer measured outcomes. We owe it to ourselves to try to do better. What do we value more? Human welfare? The ability of purely extractive businesses to profit by treating healthcare as a free-market commodity?

  10. #10 Chet
    August 24, 2009

    I wonder if all the chaos over healthcare is not about healthcare at all. Maybe at the root of this “conflict” is that fact that there are too many folks in this country that cannot accept the fact that we have an African American democrat as a President. All the fighting that’s going on in the town hall meetings, with analogies being made to Hitler and people barring weapons, is, in my opinion, largely triggered by racism and “democraticphobia”. To make matters worse, the right-wing media continues to fuel these fires.

  11. #11 dav
    August 24, 2009

    Chet: bingo!

    This still is not as crazy as it was during the civil rights era, but there does seem to be a primed powderkeg of anti-tax, anti-gov militia types itching to reignite the civil war. Perhaps the upcoming football season will provide a socially acceptable outlet for this southern-flavored angst.

  12. #12 Denice Walter
    August 24, 2009

    @ dav: But I thought that’s was what NASCAR was for.

  13. #13 catgirl
    August 24, 2009

    I’m actually planning to go to a local town hall meeting tomorrow, and I plan to get there as early as possible, sit in the front, and be loud about my support for health care reform and especially a public option. However, I’ve been doubting myself all weekend for several reasons. I’m a little worried about being seen on the news, because my coworkers and boss disagree with me. I will also admit that I am a little afraid of the anti-health protesters. I know it’s unlikely that it will actually escalate to violence, but in a way I’m just sick of hearing their nonsense and lies. In the end, I decided to go because someone needs to speak for the majority.

    In reality, the vast majority (77%) of Americans want health care reform. Sorry I can’t link to a source because I’ve only seen it on TV. It bothers me that we are caving to the small but loud minority.

  14. #14 Denice Walter
    August 24, 2009

    Aaaaaargh! See? Even thinking about those who *cavil* on so about “Obamacare” is enough to ruin my grammar!(correction: “I thought that’s what NASCAR was for”.)

  15. #15 Patient
    August 24, 2009

    Medicare for all?
    I have medicare. I hate it. None of my doctors take it. It doesn’t cover many drugs. It doesn’t cover mental health care of ANY type, even if one could FIND a psychiatrist to take it. You can’t get a clear idea of what is covered from the website, nor can you ever get anyone on the phone to ask anything. You end up with a big bill at the end of the day, and you can never be sure if the amount you owe is correct because no one knows what will be paid for and what won’t be. And it doesn’t pay for everything either–you are still on the hook for at least 20%, and sometimes more depending on what the procedure is. No better than any private plan.

    My doctors all hate medicare too. It doesn’t pay enough, it pays too slow, and it often pays the wrong amount. Most of them have opted out because they can’t deal with it anymore. In my area, there is a long wait for a primary care doctor if he takes medicare, and most of these doctors are not the ones in the “best doctors” book, if you get my drift.

    The medicare system is rampant with fraud because there are no checks and balances. There is little enforcement of fraud, and NO type of customer service when dealing with them….it is like dealing with the department of motor vehicles only 10 times worse.

    I have had both medicare and private insurance, and I would take private insurance over medicare any day of the week. The nice thing about private insurance companies is that because they are concerned about the bottom line, they will do everything they can to combat fraud and waste. The government? Not so much.

  16. #16 PalMD
    August 24, 2009

    Wow. Your doctors don’t take medicare? I’ve only heard of two docs in my career who don’t. The vast majority of docs take medicare. For primary care services, it doesn’t pay enough, but it does pay consistently.

    Medicare is not about Rx coverage, at least it wasn’t until Bush II. Part D is optional. If it weren’t, coverage would be quite different.

    If you think dealing with private insurers on the phone is better than medicare, i salute you. The biggest thing though is most patients never have to call medicare since there is rarely a problem.

  17. #17 Patient
    August 25, 2009

    With all due respect PAL, this problem has been written about:


    My experiences are what they are, and I don’t think medicare is the answer for the health care problem, and I feel like a second class citizen when I whip out the medicare card. Suddenly the tone of the billing department is different—like the doctor is doing you a favor by seeing you.

    I am not convinced that medicare (in its present form) was ever a good idea. It has cost far more than it was ever intended to and price controls are NEVER a good idea from an economic standpoint. I certainly appreciate wanting to provide health care for everyone at a reasonable cost, but entitlement programs have a bad track record and Medicare and Medicaid are no different in that regard. You state that there is “rarely a problem with medicare”, but I beg to differ with you. It may not be a problem for many people who don’t have to pay the bill, but it IS a problem for doctors and hospitals that have to balance their budgets on slim medicare payments in contrast to what insurers offer. There have been many reports of hospital administrators noting that a switch away from regular insurance to medicare may put pressure on hospitals.

    Again, “rarely a problem” also has to do with the fact that people who are not paying for something have little incentive to report fraud. My elderly father got a bill recently where medicare paid for his blood tests and also his transvaginal ultrasound. He called the doctor’s office about it, but since he didn’t have to pay the $496.00, it isn’t like he followed up on it, and I expect the taxpayers wouldn’t be too happy if they knew that obvious errors like this one are rarely corrected.

    Some estimates have put medicare fraud in the 80 billion range. That says to me that medicare is not working. When something doesn’t work, you fix it first– BEFORE you expand it.

  18. #18 PalMD
    August 25, 2009

    Wow, pt, you’re conflating a whole lot of different problems, which I’m sure you can see.

    Your experiences are what they are, but they are not the norm. You also need to recognize the different problems you are raising—patient-centered, physician-centered, institution-centered, and society-centered (cost, fraud, taxes, etc).

    It’s true that under the current system, medicare often pays less than private insurers. It’s also true that to most patient this is a transparent issue, and one that is important, but separable. I do know a few physicians who have opted out of medicare, but they are rare and the rest of us think it’s kind of nuts.

  19. #19 D. C. Sessions
    August 25, 2009

    Some estimates have put medicare fraud in the 80 billion range. That says to me that medicare is not working.

    Let’s go with that: 80 billion out of a budget of 800 billion, more or less. That’s a 10% loss. Add the administrative overhead (rounded up) of 5% and you have 85 cents of each budget dollar going to provide patient care.

    Can we agree that that’s unacceptable?

    OK, then what do you say to the private insurance industry which pays an average of less than 80 cents per dollar on patient care, plus putting much higher paperwork loads on caregivers [1], plus denial of services?

    I’ll go along with your assertion that Medicare is bad. It’s also, by your own yardstick, much better than what we’ve got.

    [1] PalMD: could you lay a few words on us about the amount of time and labor that a private practice has to spend on getting reimbursed by private insurance? That’s not usually included in the costs of the present system, but I get the impression that it’s not small.

  20. #20 Jennifer B. Phillips
    August 25, 2009

    I’m sure you’ve seen this, Pal, but I’d be interested in your opinion:

  21. #21 Zuska
    August 26, 2009

    My full time job these days is managing my mother’s health care/health insurance interactions. She has both Medicare and private insurance. Essentially all my problems stem from the private insurance, not from Medicare. Even when her wallet was stolen and I had to get replacement Medicare and private insurance cards – it was much easier to get the replacement Medicare card, and there was no interruption in her Medicare coverage. I am STILL fighting with the insurance coverage to have my mother’s existence restored to their system – their way of dealing with her stolen card was to somehow remove her from the system, at least in the sense that when any provider tries to call to verify her coverage, it can’t be done – they keep being told she doesn’t exist.

    The one Medicare related problem I can think of right now actually wasn’t even Medicare’s fault – it was a provider trying to bill for a service my mother hadn’t received, and that was even more or less a clerical error due to some bulk billing issues (because she is in assisted living). And it was resolved with one phone call. I can’t think of ANY billing issue relating to the private insurance that I have been able to resolve with just one phone call.

  22. #22 "GrrlScientist"
    August 26, 2009

    patient — if you feel like a second-class citizen when you whip out that medicare card, try feeling completely invisible when the hospital ER discovers that you are unemployed and uninsured, and have been so for five years, and have no money whatsoever to pay for anything (including food!) after rent has been paid? or try feeling constant pain from permanent damages to your body that are SOLELY due to your lack medical care? or try feeling like a worthless human who, despite having an excellent education, cannot find a job because no one will hire you due to a medical condition for which you must have treatment but cannot get because you have no job/insurance/money, and this lack of treatment prevents you from getting a job? (insurance/money)

  23. #23 RoxieInTheSouth
    August 26, 2009

    My dad is 81 and on Medicare plus a private supplement. He had bypass surgery a couple of years ago. His out of pocket cost was over $9,000. Luckily he has a good retirement income and was able to pay it. His primary care physician has now stopped taking any medicare patients so he pays full price to see him. My dad also has diabetes. I support a truly universal health care system paid for by everyone’s taxes proportionate to income. It is the only moral course to take on this issue. No one should have to fret over the financial consequences of getting ill or injured. I’ve emailed both my Senators and my Representative. Best I can do. People are suffering and dying and all they do in the media is talk economics.

  24. #24 katydid13
    August 26, 2009

    My father’s primary care physician died (which BTW resulted in his supplemental coverage sending him a letter saying his doctor was now out of network, which I guess technically he was). He had real trouble finding a primary care physician who would take on another Medicare patient. My mother is a librarian at a large state university medical school so she hangs out with a fair number of doctors and someone took him on as a favor to her.

  25. #25 Theo
    August 27, 2009

    The reason there is not more call for reform of heathcare is that John Mccain is not President. The election Barak Obama has had the unfortunate effect of unintentionally silencing progressives from protesting for Universal Health. Their “voice” supposedly is now in the White House.
    Look at the relative lack of opposition to the expanding war in Afghanistan, the continuing war in Iraq.Can you imagine if John McCain were president and announced that an additional 17,000 American troops would be deployed to Afghanistan.
    Obama never was a strong supporter of Universal Health Coverage. Edward Kennedy forced Obama’s hand by repeatedly stating that the Obama campaign was for universal care.
    Obama had fantasies of being the next FDR. Instead, he is only a slightly hipper version of Jimmy Carter. By the way, I do not mean this as a compliment.

  26. #26 Nomen Nescio
    August 27, 2009

    since y’all seem to be trading anecdotes…

    i’m covered by a health insurance plan through my employer, a complex quilt of blue cross/blue shield, a “flexible” (hah!) spending account (an insulting and demeaning waste of my money i shan’t make use of again), and a mail-order pharmacy. this plan also covers my spouse, who in addition has medicare.

    medicare has, in our experience, a legion of frustrating faults, giving us trouble and headaches with some regularity. but not nearly as often or as badly as that private insurance plan. plus, when medicare has a problem, it’s usually easier and quicker to resolve (in such a way that it stays resolved) than the private “competition”.

  27. #27 upnorthgirl
    August 27, 2009

    Thanks, PalMD, for the article and to all concerned. There are many options to be heard and I highly recommend that you look for local marches in Sept. to join in support of reform. Also check out Mad As Hell Doctors who are traveling cross-country to DC. They have a web site up with the stops they plan to make.

  28. #28 Patient
    September 3, 2009

    DC Sessions, I posted an answer to you a few days but evidently I was the victim of the cyber-censors; to repeat then:

    What do I say to the private insurance industry which pays an average of less than 80 cents per dollar on patient care, plus putting much higher paperwork loads on caregivers, plus denial of services?

    I say that the higher administrative costs are due to the costs of fighting fraud, marketing, higher salaries for workers, AND fiduciary requirements that insurance companies are bound by law to have– mainly to keep a “reserve fund” for payouts on claims (which add additional administrative costs). Since Medicare is government funded, they are exempt from these regulatory constraints and fiduciary costs. Does that make medicare a “better” system because it has “the appearance” of lower administrative costs? Appearances can be deceiving, and if one wants to throw 80 billion a year down a hole under the guise of giving health care to all, that may be short sighted seeing as how an expanded medicare program will certainly exceed that fraud figure once more individuals start lining up for their payouts. Unchecked, this “expanded system” will surely exceed all expectations into waste and mismanagement.
    With regard to cutting services, Medicare already doesn’t cover many things, including mental health services, certain drugs, etc. Expansion of the Medicare system will no doubt bring more cuts, as the current Medicare system is already in deep water financially and in need of cost cutting measures. That means rationing of services. The real question here is whether you want your government to do the rationing, or would you prefer the marketplace to make those decisions. While private insurance is in need of regulation with regard to coverage of pre-existing conditions, dropping coverage, and other marketplace ills, I feel that one has a better chance of “tweaking” the marketplace system to make it workable, than expanding a system that is already unworkable due to its current problems. I maintain that the government needs to fix one problem before embarking on another one, and perhaps re-inventing the wheelchair is NOT the right prescription at this time.

    I would add an especially insightful article about rationing written by an oncologist that I just came across today:


New comments have been disabled.