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Boomer Bob

Boomer Bob
The Big Cheesey Carnival, Nevada, USA
April 08
Yep, I love it. Come on by anytime
An honest to goodness, card-carrying member of the Occupy Movement. MAKE A DIFFERENCE - DON'T JUST WRITE ABOUT IT, PARTICIPATE!!! Active member of Occupy Las Vegas

Editor’s Pick
JANUARY 7, 2011 2:45AM

RW005s Trojan Horses

Rate: 35 Flag



Trojan Horses are not only inserted into bills as they’re developed, the “horses” are very often developed later as a result of those bills too.

To fully understand the health care system in the U.S. today, one must understand, or at least see the history of health care in the U.S.

Now my very encapsulated history lesson for you today :-(  

Major advancements were made in medicine in the world in 19th and 20th centuries, most of which we all know about, but prior to these advancements, doctors, in particular, surgeons  were  typically barbers (hence the red and white striped barber poles – representing bloody bandages.  The Catholic Church saw surgery as a sin against the sanctity of God’s creation), herbalists and alchemists.  Cocaine and opium were not only legal, they were common household remedies.

As the practice of medicine changed and improved, doctors were no longer expected to provide their skills as a public service and began charging patients.  The change was not a particularly welcome change among the less fortunate; we had begun our trek towards health care for those who could buy it.

Most don’t know it, but health care reform was born as early as 1910 as the labor unions and progressives became keenly aware of the pending social imbalance, but even then, special interest groups especially the blossoming of a very prestigious group - doctors with their newly formed AMA were of course deeply opposed to any reforms.  Those special interests and WWI derailed all reformation attempts. 

The Great Depression resulted in the passage of the Social Security Act and yet, health care insurance was but a ramrod idea taken on by Blue Cross in a few states, for those who could afford it.

WWII began and in order to entice those left at home to join the workforce in the massive U.S. war industry, employers began offering employees health care benefits.  After the war President Truman proposed a national health program. Guess who came to the party with a bad attitude – the AMA.  Some in the House of Representatives even called the concept a Communist plot.

15 short years later, in the early 1960s, there were in excess of 700 insurance companies selling health insurance policies, doctors had long become the new class of wealthy, hospital costs doubled and doctors were becoming high-cost specialists.  The health care industry was becoming an out-of-control concept as the industry sold itself to those who could afford the coverage/care. 

Suddenly, we became a nation of very sick people and using the new, massive and very powerful industry to make ourselves well was, well a must.

As with any resource, the growing consumption created a need for better products and higher production rates.  Rapid advances were made in pharmaceuticals, technology (pharmaceutical and high-tech companies even began advertising campaigns directly to consumers) and education and the smell of vast profits was sweet-smelling chum in the water.  The demand drove the industry into a feeding frenzy throughout the 1970s and 80s.

In an effort to control rising costs, payments to hospitals were changed by Medicare to "Diagnostic Regulatory Groups” (DRGs) wherein hospitals are paid by diagnoses rather than an all-out free-for-all treatment and private insurance industries followed suit.  Capitation of payments were created to control the high expenses of doctor visit.

To combat these infringements upon their fair share of profits, hospitals began to incorporate into huge health care conglomerates and in a conflict of interest that would seem obvious to most over the age of 3 years old, insurance companies, doctors and hospitals began partnering, creating a hybrid industry of doctor and insurance-owned hospitals.  Health care became a frightening dragon on the horizon, but the feds all but ignored them, until that is, they began committing Medicare fraud faster than Leisure Suit Larry could pick up chicks at the discos.

Hospital corporations grew wildy, creating such tremendously lop-sided competition that community hospitals soon became, much like the corner grocery store, a fond memory of the past.   

Enter the feds “to our aid.” 

Regulatory Agencies:

Regulatory agencies have a major propensity to increase costs, precisely due to what RW005s post illuminates – Trojan Horses, or regualtory capture. The Wiki article very effectively provides a bit of insight into the impacts of these “regulatory agencies” and suddenly, health care is now, arguably, the most regulated industry in the nation.  The only industry that can boast similar regulatory efforts is the financial industry and we’ve recently witnessed the effectiveness (or truly the lack thereof) and the impact those  “regulations” have had on our lives. 

Just as with international policy and affairs, domestic policies often create blowback and we’re witnessing major domestic blowback in the form of health care and now government is trying to appease the goliath insurance and health care industries while presenting the consumers with smoke and mirrors.  Again!

A major contributor to health care costs are the COLASSAL bureaucracies created within and for the government.  Our political officers have learned all too well how to generate fiefdoms from our needs related to health care.

Just try to comprehend of the “depth” of this name alone “United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, National Center for Health Workforce Analysis.” 

There are literally scores if not hundreds of agencies, most of which either compete with one another, or carry out their frequently overlapping agendas, at a very hefty price to you and me. 

AND these agencies don’t begin to scratch the surface in comparison to the cost of; “support” industries generated to “aid” the host industry (in this case, health care) with compliance.  Plus, the vast requirements of manpower within the industry simply to manage the mandates of regulatory agencies is incomprehensible to many. 

Some examples:

Although not directly employed by the feds, The Joint Commission (TJC) (formerly “Joint Commission on Accreditation of Health Care Organizations, or JCAHO) supplements the fed’s ability to regulate the industry and, in theory, is a voluntary membership for hospitals designed to monitor and improve care within hospitals (however, I can attest to the fact that patient care has NOT improved since the creation of TJC).  There are multiple “voluntary” organizations related to health care organizations including NCQA, ACHC, etc.…. and it can vary from state to state.  Membership is voluntary, however, any hospital that does not pay the required membership fees will not receive payments from Medicare or Medicaid, a vital source of revenue for all hospitals.  The average cost to a hospital for a TJC “survey” is $43,000.00, fees are based upon the size of the hospital.  Surveys are now conducted in cycles ranging from 18 to 39 months, 18 being the least amount of time between surveys, 39 the most.

In 2008 the Joint Commission collected $165 million in revenue, mainly from the fees it charges U.S. health care organizations for evaluating their compliance with federal regulations. Its expenses during this period were $162 million. TJC lost $27 million.  And who pays for those losses?

The list of regulatory agencies and acts in health care is very long and tedious (FDA, TJC, AHRQ, CMS, CDC, HIPAA, OSHA, EPA, HRSA,…….) and impacts literally every function of a hospital’s activity, form purchasing supplies to mopping the floors, yet; has our health care truly improved in the decades following the healthcare upheaval begun in the 1980s?   I can assure you, regardless of what the industry leaders and our corporate-biased government tells us, it has not.  Just take a look at some comparative health care information.

Due to CMS and Medicare HCPCS, I’ve seen staffing in hospital billing offices swell to biblical proportions just to capture all charges possible from Medicare and even private insurance companies. 

Due to HIPAA, I’ve seen medical records departments increase staffing dramatically or consulting firms contracted simply to ensure that HIPAA requirements are met.  Very large software corporations have developed in response to HIPAA requirements. 

IT departments in hospitals are growing at twice the rate of health care providers such as nurses, med techs, etc. just to keep up with the IT requirements of government.

Administrative departments have grown in the number of executives and their support personnel.

The ONLY areas of health care I haven’t seen grow are the front line caregivers – nurses, medical techs, etc.   In fact, those areas are under incredible strain as a result of very high stress levels of caring for patients under new regulations that place bureaucratic functions on the shoulders of those caregivers, taking their attention and time away from caring for patients. 

Medical errors, especially medication administration errors, as a result of nursing staff’s inability to manage patients and the absurd mountains of paperwork required by all this ‘government coming to the aid of Joe the Public” are reaching epidemic proportions.  Front line caregivers are no longer there to care. 

And now you know why your care is substandard and even deadly in hospitals. It is not the fault of the caregivers, they are simply too overwhelmed with the real functions of hospitals, conducting business, to care for their patients. This alone is a huge embarrassment to me. I truly believe that most nurses and other medical professionals did not envision bureaucracy when they began their journey years before joining the workforce and it’s utterly shameful to the industry to place them in such a catch 22 situation (manage the bureaucratic shuffle and care for patients too?  I say that's an impossible task and error rates will suppor my claim) that it’s now becoming extremely difficult to find enough people willing to be nurses and medical professionals.

As of 2007, the U.S. spent 16% of its GDP on health care, yet we stand alone in the world in being the only developed nation not providing UNIVERSAL HEALTH CARE (this is vastly different than, to coin the phrase “Obamacare,” wherein the political machine merely constructed the usual smoke and mirrors to keep the public placated). 

In 2007, 15.3% of the nation had no health care benefits at all, that was 45.7 million people.  These are GOVERNMENT statistics!  Believe them if you wish, but like unemployment figures, there’s more than what they like us to see and I suspect the numbers were much worse than those published. 

And these figures are from 2007, PRIOR TO THE ECONOMIC MELTDOWN! 

Is the U.S. truly looking for healthcare for all?  Or is it TROJAN HORSE BUSINESS AS USUAL?

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You don't really need an answer to your last question, do you....!
That darn rate thingie isn't working .....again!
The most complete and easy to read and understand piece on health care I have seen in a while, especially here. Even if they were to provide universal HC in the US they would still find a way to profit from it. I'm not talking doctors and caregivers either, corporations and politicians and hosts. It has always been pathetic and corrupt.I myself am a 100% Disabled Veteran and have always received great care at the VA. But the cost per year for my 2 daughters and wife for HC is about half the total cost p/y of my 1st house in 1978. Did you know the VA if you are on Medicare at 62 or disabled on Medicare will charge a portion of your treatment back to MC to recover costs. Peter paying Paul? Get free drugs though yippee........they ought to let Americans have free access to marijuana they might actually feel better. Great post Bob time for morning coffee and a joint........o/e R++++++
No Sky, I really don't. And I fear it's just going to continue perpetuating until it implodes.

Thanks O/E. The entire system seems to be robbing Peter to pay Paul (or screwing Jane to give Sally herpes, I haven't quite figured out which).
Having been a physician in the fray from 1968 until 2005 I have a slightly different perspective on your short history, but can't take issue with your time line or the impact of bureaucracy on the cost and implementation of patient care. The term health care was invented by a bureaucrat. I agree about the AMA. I was not a member for years due to their intransigence on changing the way things worked. Anyone could see that the system was broken and getting worse by the day.
You didn't give hospitals their due in the creation of the Healthcare Industry. I interned in a Catholic hospital run by the Sisters of Mercy. The administrator was a nun. By the time I finished the hospital was being run by a man with a business degree. Within a few years hospitals were not run by administrators, but, instead, by presidents and then CEOs with large numbers of Vice Presidents with titles like COO and CFO. Nurses worked themselves into this vast hierarchy and away from the bedside.
I was a pathologist and was responsible for the blood bank and transfusion service. Problems with hepatitis were reduced by going to an all volunteer donor system and better testing for the virus. The FDA got involved and our first inspector was a meat inspector who had no earthly idea what she was doing. She photographed everything and left. This was before anyone had heard of HIV.
During my career my job became progressively harder due to the layers of regulation and paper work created by the government and by hospital groups and physician groups trying to satisfy the government regulation. My caseload increased, my hours greatly increased, and my income was flat and then began dropping as a result of decreasing reimbursement from Medicare, Medicaid, insurance companies - for profit and not for profit - and HMOs.

Retirement came none too soon. I get my own care through Medicare. The monstrosity that was created by Congress paraded as Healthcare Reform is the result of pandering to all of the vested interests in the process. It is designed to protect Big Pharma, the manufacturers of medical equipment, hospital systems, physicians, malpractice attorneys, the health insurance companies, and, yes, the government agencies that have created the incredibly top heavy system that exists.
Rodney - only those of us who have experienced health care as an insider know the relief of no longer being associated with a shameless monster it has become. I too am so danmed glad to be away form the industry. Hell, I forgot how to be a human for 30 years.
Professional level health care and maintenance really shouldn't be free market commodities in any civilized society, much less the most 'prosperous' one on the planet.

It took me a very long time to come around to that point of view, so I don't have much hope anything revolutionary or evolutionary will occur anytime soon on the issues of access or affordability, much less quality.

Good post.

I do think the strangleholds on policy commercial enterprises that have grown up around health care, have, are a far bigger problem than the bureaucracy though.

As with many things, the interests of the vast majority will not be looked after until the vast majority rules again.
TY for this Bob. I ain't got coffee here yet, it is still dripping. So I ain't awake enough to have any intelligent responce here.
But looks like you have summed this up well.
This is one reason folks with chronic, long term health problems should think long and hard about treatment for their problems.
This should be mandatory reading. For EVERYONE. Excellent and informative. Thank you for writing this.
But once again, aren't we preaching to the choir?
The people who should be aware of this are not going to read about it.
Great information.
Great post.
Since the American people are demonstrably complacent about how the financial, the military, the medical, the corporate, and the pharmaceutical sectors, (and of course the political sector) among others are screwing them silly why should anybody care? The sooner the dumb beast expires and the whole system collapses the sooner there will be more peace and sense in the world. Unless they suddenly wake up and raise bloody hell. That would be nice.
Eye-rolling Canadian here, baffled by American barberism. (Haha - barber...)
The more I learn about healthcare, the more confused I get. Maybe Alan Grayson is right, if you get sick, die quickly. Do you think the public option would help or not? And what about the CBO claiming this will save billions? Maybe I will go back to bed. I suddenly don't feel so good.
Don't even get me started. It was a hospital that killed my husband, the one adversary he couldn't overcome.
Obama Care turns medicine into a public utility which I would argue are the most regulated entities in the US. It is evident you have worked hard on this piece and the effort has paid off. Our new health reform looks much like Massachusettes which can be examined to see its effect. The system is overused for one thing. Six out of seven people who see a physician in his office would get better on their own. Thirty years ago nobody had heard of carpal tunnel syndrome, restless legs syndrome, ADHC or a long list of ailments now costing billions of dollars. Great post. Rated. //=o)
Congrats on the EP, I knew it had a pretty good shot as soon as I read it not too long after you posted. They get one right once in awhile. You were smart to post in the middle of the night, otherwise what Cartouche had for breakfast probably would have gotten the nod. Don't get me wrong, she's quite talented on occasion as are several other perennial favorites of the OS editors. Lets be real though, the political and gender bias really has gotten out of hand on here. I suppose they must know OS' days are numbered, and apparently just don't care. We've lost some good posters of recent, and others have decreased their prolificacy, so this has become a pet peeve. Please forgive the digression.

Kathy I'm so sorry about you losing your husband. I've had my own harrowing experiences that resulted from family members not getting the quality of care every hard working American should be entitled to.

As near as I can tell, it was only by the grace of God things worked out okay.
Yes, you are preaching to the choir however the choir is really demoralized nowadays, and need it.
And you do it so well, hence the EP!
Glad you postponed the ADHD/Ritalin argument...usually it ends up with ignorant yet opinionated people shouting over each other and people who actually have to struggle with these issues being left in the middle, bitter and confused. I did want to speak about ritalin itself- it's a generic medication, and is available for $4/month at Wal-Mart and other pharmacies who do the $4 program. It's the same medication as many other ADHD meds, but short-acting rather than long. But considering other branded ADHD meds cost upwards of $200/month, a 98% discount by using generic is often a useful cost-cutting measure.
No doctor knows my name and that is why I feel good. However, my newlywed husband is paraplegic with other problems and the shoddy condition of health care and requisite insurances in this country are becoming all too apparent to me as I learn to navigate through it for him. It is, frankly, shameful.
I was so lost in its complexity, I appreciate your analysis and understanding.
rated with love
Thank you for this. I appreciate reading a post from someone who's been in the system and knows how it really works.
antisocialgrace - oh how strongly I agree. Whenever I get involved in this discussion, I always find myself thinking of all the private fire brigades of San Francisco. Some became quite unscrupulous, refusing to douse fires if the building's owner didn't pay their fees. There are basic human requirements that should not be private - police and fire protection, utilities, food and health care. But as you said, money rules and the majority drools in this country.
Mission - you are very welcome. Unfortunately, we've become so conditioned in thinking we all need the attention of a doctor that those who truly do have a difficult time in getting care. The U.S. population grossly over-uses health care, it goes along with our seemingly conflicting standards towards living wildly and longevity; most times they cannot both be accomplished.
Ms C. As always, so very good to see you. And thank you for your comment. Most Americans see complex functions a bit like a donut shop. Behind the door, someone is rolling up dough and frying it, then sugar-coating it for us to eat. Simple, right? In health care, you go in the door with an ailment and hope like hell you come out AT ALL, yet very little is known about the inner workings
These are some very surprising statistics. Now try to fix the superbugs that are infecting our hospitals with people on no budgets and you have a real winner.
RW – you’ll be super pissed when you hear this: Pharmaceutical companies use brand-placement to extreme in hospitals. Hospitals receive FREE baby formula so the moms and babies are “started” on a brand of formula and almost always remain with that brand of formula. Same goes with pharmaceuticals. ALL pharmaceuticals are named with three separate names; chemical name, generic name and brand name. Let’s take a look at a pharmaceutical that became a household name in the very early 1960s, VALIUM. Valium was patented by Hoffman-La Roche, or “Roche Pharmaceuticals” in the U.S. and approved for use in the U.S. in 1960. The chemical name is 7-chloro-1,3-dihydro-1-methyl-5-phenyl-2H-1,4-benzodiazepin-2-one, the generic name is diazepam. The drug became known as “momma’s little helper” because of its tranquilizing effects. It was the Xanax of the 60s, 70s 80s and even into the 90s and was hugely successful here.

The drug was widely used in hospitals too. The cost to the hospital, if I recall correctly was roughly $15.00 for a box of 100 “unit dose tablets” of various strengths (individually packed tablets for dispensing into patient medication trays). CHEAP!! The cost of a prescription outside the hospital was hundreds of dollars.

Here’s the kicker: Typically, pharmaceutical patents expire somewhere between 15 and 20 years, after which ANY pharmaceutical manufacturer can receive approvals through the FDA and begin producing the product under their own brand name, or more typically, under the generic name, in this case “diazepam.”

Unlike most pharmaceutical companies, when Roche’s patent expired, they actually raised their prices rather than lowering them to meet competitive pricing. Roche knew how strongly they had marketed the product and it worked like a dream. When pharmacists received the prescriptions, as they always do, they asked the patients if they wanted the generic form, costing less. In the case of valium, there is NO difference at all in efficacy between the brand name and the generically produced product, yet almost all people were very adamant about using only the branded product. Still today, Valium as a brand is expensive as hell and 50 years after its introduction people will still request the brand name, even when the generic is easily 10 times less expensive.

Ritalin is precisely the same way. It was created in 1944 and used widely as a stimulant as early as the 1950s. In the 1960s, it became the drug of choice for ADHD (the stimulant effect is theorized to speed the body functions up to the high paced brain activity of ADHD people, thereby having an appearance of calming them). It became a huge medical success too. The patent expired in 1967, but very few would accept the generic methylphenidate, again with identical efficacy in most cases, but would insist upon Ritalin brand at close to ten times the expense.

Tylenol, Micro-K (potassium chloride replacement) and many, many others were sold to hospitals for $.01 – yes 1 cent, for a box of 100 unit dose (yet when hospitals charged for drugs as a separate charge, they often charged absurd prices for one table/capsule such as $20.00 for one Tylenol, etc). The product placement in hospitals for little and even NO cost is a concept beyond what most would believe and it doesn’t end with pharmaceuticals. Colostomy and Urostomy products, breast cream, breast pumps disposable diapers, baby formula, and the list goes on. Even high-tech people are getting into the game now. You’ve likely seen advertisements lately from some orthopedic device (hip, knee, shoulder joints, etc) manufacturer. A consumer is not going to have access to DePuy, Biomet, Smith & Nephew or any other implant manufacturer, but it worked well for pharmaceuticals; so why not?

Soon, the likes of pacemakers, heart valves, skin grafts, ocular implants, even orthopedic reconstruction supplies such as screws, plates and pins will begin to advertise.

The size of health care business is beyond comprehension for most.
Steve - I'm not sure there is a choir in this case. VERY few people know the inner workings of health care. To most, doctors, hospitals, clinics, etc are a very mysterious process

Jan - I often wonder which will come first too, death or enlightenment

Bonnie - error rates are like government statistics, they're partial truths, but the death rate in hospitals, especially due to medication errors is staggering - the last I saw, there were around 180,000 deaths per year in hospitals due to medication errors, a total of 225,000 combined medication and other errors. But we cannot blame the caregivers. As I noted, they are massively overwhelmed by the bureaucracy of corporate health care.

Myriad - I can just imagine. My friend in Australia has the same wonderment :-)

Michael Rodgers - personally, I think the "public option" as it developed, is a complete scam shoved on us by our politicians, bought and paid for by lobbyists and special interests - insurance and health care manufacturers. Absolutely not! As it is, it's the “public option is an additional industry Trojan Horse created by the feds. Nothing short of true SINGLE-PAYER, UNIVERSAL HEALTH CARE will work. Industries such as the insurance companies will profit even more wildly than they do now from this joke of a plan.

Kathy – I’ve read your posts. I’m very sorry for your loss. It’s especially tough when the loss could have been avoided. My mother-in-law died as a result of hospital issues too. She spent the last week of her life on a respirator trying to overcome multiple nosocomial infections (hospital acquired), C-diff, MRSA, VRE, and Pseudomonas. She died; her blood and body so septic due to the inability of even the latest antibiotic regimen to treat her that we had to gown up (gowns, gloves, masks) just to walk into the room. These tough germs are the very beginning of a hellish nightmare with a very bleak outcome and the frustrating part is that the industry was forewarned many years ago about the rise of these horrific bugs, yet the industry continued its practice of over-prescribing antibiotics and anti-infective agents for disease states that did not call for them. Pop a pill and get rid of the cold! The problem is, viruses (the most common form of infection resulting in doctor office visits) are NOT susceptible to this treatment, however bacteria are very smart and mutate to resist their effects when abused. And that’s where we are now.

RW – are you kidding me? He honor is all mine my friend.

David – you are so right on this issue and therein lies much of the problem - ABUSE. Americans use health care like water and that abuse created the out-of-control industry we’re strapped with now. We don’t give our bodies credit (and we abuse our health). We can overcome much of what we go to the doctors and emergency rooms for on our own. We did it well before this industry went rogue on us and made us think we should see the doctor for scrapes and scratches, sore throats and headaches.

Antisocial – thanks. I hadn’t even realized the EP until I read you remark. I hope it provides a few some education into the workings of health care.

Fred – thanks man. I appreciate your comment and your company, as always.

Rob – you have the right idea – generics, in most cases, are perfectly suitable for what they’re intended.

Maryway – it is indeed shameful and I can tell you that after thirty years of the industry, I am very happy to be “disconnected.”

RP- it is complex by design. Keeping us baffled and confused is what industry and government does best. PR campaigns are even designed to do exactly that.

Fusun – thank YOU for your comment and visit.

Algis – those superbugs are damned scary things. I once saw a patient admitted through the ER with a cyst on his knee. They drained huge amounts of fluid from his knee in the ER. He died three days later, septic as hell – MRSA in his blood.
Business as usual, I'm afraid, is the answer to your question. Rated.
The government in America seems to be robbing you, like Batista robbed the Cuban Peasantry. Like Porfirio Diaz robbed the Mexican Campesinos. Where is our modern day Zapata? Where is Villa?

In Latin America, we are not as sheep like as you Americans. You once proclaimed you were the land of the free. But I see you are just the land of the lazy and the home of the lame. How many times will you bend over and take it in the ass, before you wake up and say "no!"

Oftentimes, the best thing to stop a rape from happening is to say, boldly, NO. STOP!

But even here, as your nation is raped, you do nothing.

The oppressed peoples of the world have nothing more to learn from you. Your own people have forgotten what freedom and liberty are. How can you deliver it to others?
You have a spot on column. I have a few comments to add. First, given the over 700 insurance companies with different exclusions, eligibilities, and payment systems, this guarantees an enormous overhead as well as an enormous regulatory structure both from the government and private groups. If we were to adopt a true single payer system, we could eliminate much of this overhead and regulatory overburden.

Second, due to the fact that many patients in hospitals are still uninsured, this leads to cost shifting. Just as auditing the defense conract eventually reveals the $300 screwdriver, so does cost shifting for things like drugs and procedures lead to ridiculous overbilling, just to make up the deficits imposed by treating the uninsured.

The demand for health care is virtually unlimited. As a health planner, the analogy would be like asking people what kind of car they'd like to drive, and then providing them with it. People would opt for Rolls Royces or Ferraris if they had a car for free, and this is what's promised on some high-end insurance policies. Society as a whole suffers as a consequence, as rationing of health care is going to take place one way or the other. Again, single payer would solve many of these problems with waits for some procedures to be anticipated the same way they're divvied out in Canada or England.

Lastly, hospital operations and caregivers have to be partly responsible for parts of the problems of "complications." Hygiene is always an issue, and the superbugs are the result of the prescription of too damn many antibiotics for no good reason.
Tink - yep, the business of screwing us a

Ernesto - what we need is some of your Latino fire in our blood. You're absolutely right, much of the world is in fact leaving us behind, just as it has happened to dominate, dogmatic republics throughout history.

What I absolutely love to read about is the transformation of Latino countries in the past few years. The exciting Bolivarian Alliance of Latin America and the Caribbean - countries such as Brazil, Venezuela, Ecuador, Nicaragua, Bolivia, Cuba, etc. are finally making some really cool worldwide impact in spite of the American government's efforts to keep them "fenced-in in the back yard."
Lefty - you're exactly right on all accounts. Overhead seems to be the calling card of most governments; sanctimonious jackasses ruling their fiefdoms. It's supremely infuriating how the feds refuse to listen to us. WE WANT UNIVERSAL, SINGLE PAYER HEALTH CARE, not the gimmick they’ve devised to enrich the industry even more.
I really think a nursing error in the early morning in the ICU hastened my second husband's death. Read with sorrow.
Excellent piece, Bob. It is obviously the industry that won with Reform last March. I keep telling myself that it's better to have some sort of reform/regulation than none at all, but then, I'm not so sure. Where there is money to be made, there are people to be put last and given barely enough so that they will think the system actually works...half way anyway. Just as you said, I've been placated.
You put time into writing this long piece about how "Regulatory agencies have a major propensity to increase costs". You are correct. Famous last words "we are from the government and we are here to help".

So why is it that most everybody here likes Obamacare? Thousands of pages and when you add those incorporated by reference tens of thousands of pages, and you figure this will bring down costs and improve care?

Since you have a problem with regulation being over restrictive and adding costs how about we go the other way, free markets? Nope, people here want single payer. That's read "more government regulations" but that is what you cry against.

While the world needs some regulation, you can't have your cake and eat it to, and under Obamacare, eating the cake may be illegal.
Bob: Many thanks for this illuminating post. I saw plenty of evidence of what you describe duirng several recent incarcerations in HospitalWorld. And while a hospital almost killed me (hospital mistakes, as you know, kill 200,000 a year) I'm very glad you discriminated between the bureaucrats / suits / boards of directors and the front-line folks who simultaneously care for patients while battling constant efforts to kill their unions. It's a monstrous mess and your post is a sobering reminder what we're all up against.
You are so passionate and deeply informed on this subject, I just read it with deep interest, digesting the implications and realities we are living with today. Yikes.
Lea - it's a bit worrisome, isn't it, when people begin to compare their lives in a relatively small community - OS and arrive at what most people would consider "coincidence." Pffft! I firmly believe that statistics are rarely coincidental liars (although people can bend them to their benefit) and that the Devil is in the details.

Raz - you're right on the MONEY there. Just tattoo that $ symbol on your soul and the health care industry will know that your intentions were honorable when they pull the plug on you for occupying an otherwise profitable hospital bed :-)

Catnlion - Definition of REGULATION: "Regulations are issued by various federal government departments and agencies to carry out the intent of legislation enacted by Congress. Administrative agencies, often called "the bureaucracy," perform a number of different government functions, including rule making and compliance."

Definition of PROVIDING: "To furnish; supply, to make available; afford, to supply a means of subsistence.

True UNIVERSAL HEALTH CARE is NOT an act of regulating an existing entity built solely for the purpose of generating profits, it's an act of providing, be it service or tangible products, regardless of profit or loss and is based solely on the needs of the recipients. The two aren't even related, not even politically.

I’m not sure I understand your correlation.

I’m not saying universal health care is free, NOTHING is free. We either pay for it individually or via taxation of some sort. What I am saying is that certain services are basic human rights, i.e. medical care and as such, should NOT be a number on some corporate spreadsheet or report reflecting profits and losses, therefore subject to the subjective decisions of those corporations to maximize profits.

But you are right in one thing; too many people fall for the concept pounded in our heads for two years now, that of a “public option.” “Public Option” is nothing more than a worthless, silly-ass, catch phrase devised by the government PR people to sell us on a line of bullshit so utterly convoluted it defies all logic.

Regulating industry is NOT the answer. Ridding society of an industry that is a leach on our human rights IS the answer. Force corporations to return to manufacturing and true business if you wish rather than shipping those jobs overseas, I’ll even join in the effort, but get the corporations out of the business of profiting from our personal lives/health. Corporations ARE NOT individuals! In the business world they are simply a system established solely to generate wealth through governance of business activities and investment.

Do you truly want some CEO/CFO to determine yours or your family’s physical well-being based upon profit margins and investor relations??? If you do, then at what segment of the income/profit/return on investment line do you place the value of yours or your family’s lives? At the top? At the bottom? Somewhere in between?

Jeremiah – thank you. It is indeed a dim prospect for the future when we place value of investment over the lives of human beings. I’ve been on both sides of the fence and it is truly very painful to see well-intended individuals doing what they deem a very worthy effort to improve life, simply to see it snuffed by blind greed.
Thank you Cathy. The passion comes from 30 years of disappointment in a profession that I thought would be a gratifying contribution to society, even at my limited contribution, only to discover my chosen profession is not just covered in slime, it IS slime.
Thanks, Bob
It's easy to see the insurance problem, which will be "cured" by piling gov. bureaucracy on top of private. It's enlightening to see how many alphabet soup agencies clog the pipes and raise costs, and only those with inside knowledge can explain it.
What a mess...
catnliar: "you can't have your cake and eat it to, . . "

I'll never understand why people continue to try explain concepts and facts to a guy who is still stuck on to = two = too.

Fat harold, a true one and only.
Paul, Mark - The government has done an exceptional job of selling us away from universal health care, using this bullshit "public option" as a means to continue supporting the insurance and health care industry. We all know our trusted friends in DC ALWAYS think of our needs while piecing together legislation and I hate to hurt their feelings, but they are CLASS I MORONS who are bent on getting what they can while the can. They remind me of the less than scrpulous gold panners who would rob other claims while their neighbors rode into town for supplies.

I for one am danmed tired of carryng the fat-ass, lazy claim jumpers on my back AND paying them for allowing me to carry them. Set their lard asses in the river and watch them float away as thye stutter and babble that "we're making a huge mistake."
I'd have to be really drunk to try and put a Trojan on a horse.
Congrats on the EP!

There's a saying: the good is the enemy of the best. When it comes to legislation, I think the best is the enemy of the good. I don't like Obamacare, for lack of a better name. But I'm deeply cynical about the possibility that we'll get anything better.

I'd vote for universal Medicare, but that wasn't a choice.

I have good health insurance and have always been covered, but I've been long aware that I and my family are just 2 bits of bad luck away from medical bankruptcy. If my husband loses his job and his health insurance and one of us acquires a long-term, high-cost medical problem once the COBRA runs out, we're hosed.

I could rant at length about the deficiencies of Obamacare, but given the choice of keeping it and repealing it (as opposed to replacing it with the health care solution of my choice) I'm vehemently for keeping it.
Willie - Not to mention very resourceful to find a service station restroom that carries the right size :-)

Malusinka - unfortunately we have no choice in the matter, but as you said, we can accept the morsel thrown at our feet while continuing the fight for what is truly our rights as human beings.
Older/exasperated - I forgot to respond to part of your response. Medicare is a sleezeball organization through and through.

My father-in-law developed a terminal form of cancer caused by asbestos - mesothelioma. He spent WWII in the Navy sleeping on asbestos-coated ship decks because he was claustrophobic and couldn’t sleep below. He was also an aircraft mechanic. Later, after the war, he became a diesel truck mechanic. He was exposed to asbestos and asbestos dust literally every day from age 17 through 65 when he retired and he paid the ultimate price for that exposure. He was a decorated veteran, losing an eye to the war during an air raid.

His medical bills were horrendous and he knew he was dying, so at my suggestion, they began litigation against asbestos manufacturers simply to provide his wife a means of living after his death. Medicare covered portions of his huge bills and his secondary covered the rest, but here's the rub; after he died, his wife received a modest settlement from their litigation efforts. It was pretty much a piss in the wind as Medicare sent her a demand for total refund for all medical expenses they’d covered, in excess of $150,00.00 when they discovered that he'd received the settlement. I couldn’t believe what I was reading, so I contacted the attorneys they used for the litigation and they confirmed that she was required by law to repay Medicare, or they’d simply freeze all her assets and sell them for the value owed.

My mother-in-law was right back where she started before her husband died, holding on to what little she had by spending every penny she just to keep herself housed and fed. She died some 8 years later, living in her mobile home with no resources to enjoy the final years of her life.

What a wonderful system we have.
Oh, and BTW, rated.

The latest study shows we could reduce medical costs by 25% by eliminating (instead of regulating) insurances companies and getting rid of this massive administrative overhead. We need to follow the example of other industrialized countries and cover everyone (while saving money) by adopting a single, national, publicly funded, universal health care program.
You're right Doc.

Far too many 'industries" have become leaches, attaching themselves to the government oversight coattails and insurance is the largest leach of them all.
In light of what Anti Social Grace said it seems all my friends have been getting EP’s lately. Lets keep it that way even after Holleman returns. Has Emily seen the Great Wall of China yet?

After Rw’s carefully researched and erudite presentation of “Trojan Horses” I Pmed him musing about Boomerbobs take on the matter since he had spent over 20 years in the Health Care industry. This post certainly does not disappoint. There is enough information in it to write a book on, a book that should be required reading for all Americans.
Thanks Jack. I’m truly honored to have such a vote of confidence from you and RW.