What Part of Single Payer Don't You Understand?

Republicans and Medicare: The Final Solution

Now, MeanMesa realizes that there is no shortage of content criticizing the overall make up and performance of Medicare.  Every voice from disgruntled senior to "ideologically paralyzed" neo-con has taken a turn at the wheel when it comes to lambasting the plan.

Although not the case that it couldn't be, this posting isn't simply another one of those rolling "bitch sessions."

Instead, this little article is more of an NPR-style, "flannel shirt," Sunday morning commentary.  MeanMesa had been "putting it off" for long enough.  The more or less complete stack of information required to re-enlist for next year's Medicare plan had been building up in a pile of unopened mail for a couple of weeks, and now it was, grumble, grumble, time to figure out just what was to be done.

However, rather than simply "jumping into the fray, whole hog plus the postage," MeanMesa was suddenly -- and unexpectedly -- cast into an unanticipated reflective moment.  That pile of stuff was, well, one hell of a pile of stuff, indeed!

(image source: MeanMesa )

So, rather than simply demand that MeanMesa visitors just mindlessly subject themselves to yet another gaseous, detail-starved tirade, the idea arose that a  more meticulous account of just what was "on the table" might be in order.  Let's take a look.

137 pages - Medicare and You 2011:  This publication from the US Health and Human Services Department presents a basic outline of the law.  The content has been carefully "dumbed down," making it not only somewhat narcotizing, but, theoretically, intellectually available to geriatrics with early on-set dementia and other Americans who are -- or have become -- educationally challenged as a result of age.

1 page - "Personal" Cover Letter from Presbyterian Senior Care (PSC):  The "letters" must be counted with the total pages because, although form letters, they contain vital information about the rest of the stuff, including a description of exactly what actions will be required from those "served."

40 pages - PSC Summary of Benefits:  This booklet presents the specific parts of Medicare which are provided through the HMO.  Most of this content duplicates what is presented in the US Health and Human Services catalogue, but there are important exceptions.  The implied message is that the additional monthly premium cost of the HMO provides additional services, but "on the ground" experience suggests otherwise. 

The "persuasion" campaign details why the HMO is justified in charging an additional 15% or so above what raw Medicare would charge.  The actual facts suggest that HMO doctors are willing to provide services for the HMO compensation, but that they wouldn't be so agreeable if they received only the Medicare payments.  The argument is a bit "too light on facts" for MeanMesa to totally buy into the idea.

105 pages - PSC Formulary:  This is a reference document which lists which medicine will be covered by the HMO's repackaged version of Medicare Part D.  MeanMesa's experience suggests that most of the HMO doctors have not ever looked at this document.  They seem to have no problem continually prescribing medicine which is not covered in the formulary list.  These prescriptions become impossibly expensive when they are not covered by the insurance.

169 pages - PSC Evidence of Coverage:  This contains primarily a more carefully constructed explanation of exactly why the HMO's policies are legal in the sense that they comply with Medicare laws and regulations.  Although a little more "legalese" than most folks have any appetite for, this booklet more or less represents the actual contract which describes what is insured and what isn't.

The Evidence of Coverage manual is most likely the one which MeanMesa will store away in a safe place for future reference.

8 pages - The PSC Summary of Ratings of Health Plan Quality:  This is a "representative summary" of client opinion polls dealing with satisfaction levels of people using this health plan.  Of course, the questions tend to be a little "leading," and the "results" have a suspicious "cherry picked" quality to them.

9 pages - PSC Annual Notice of Changes:  Digesting this little jewel might produce some fleeting coherency if the reader were intimately informed about  the details in last year's form of the policies which were now being changed.  However, absent that awareness, the document amounts to little more than new policies for coverage which are being instituted for this plan period.

The main reason for such "changes?" 

Limiting payments for previously covered costs and adding to the "non-profit" PSC's revenue stream by cutting liabilities, in other words, "Because we can."

1 page - Cover Letter Invitation to (Annual Notice of Changes) ANOC Explanation Seminars:  At the last ANOC "convention" MeanMesa attended, there were around 1,200 PSC subscribers.  Everyone attending got a Presbyterian Senior Care umbrella, a small bowl of "breakfast fruit," and half a dozen marginally relevant lectures by PSC executives.

The "breakfast fruit" was to encourage better eating habits among those of us still able to digest fresh fruit.   Only about the first 800 got a chance at the free pancakes and sausage.

The "cover letter" includes an RSVP for this year's event.  MeanMesa says, "No thanks."

2 pages - Invitation to join Silver Sneakers:  This is an exercise program offered through a deal with several local fitness centers.  Old people are supposed to attend low impact "arm moving" and "waist turning" groups.  The big attraction?  It's FREE!

1 page - Getting Help with Your Premiums:  This letter details ways for seniors to get discounts or subsidies for their PSC premiums.  The US Health and Human Services booklet describes a Federal program which covers this for straight Medicare recipients, but the Federal program also includes ways to get help paying for services and pharmaceutical co-payments.  This is another case where the extra 15% you pay for the HMO actually provides less benefit than what you would get from straight Medicare.

142 pages - PSC Provider Directory:  This reference book provides lists of the doctors who work with the Presbyterian (PSC) plan.  During the time that MeanMesa has been covered by the plan, approximately one third of the doctors seen have not been listed in this Provider Directory.  This is caused primarily by by high rate of turn-over the plan experiences.  MeanMesa has to assume that this is the result of low payments to plan doctors.

2 pages - Invitation to Join Free Dental Source Plan:  This is the equivalent to a CostCo discount group.  MeanMesa tried this plan a few years ago, but found that most local dentists won't even touch it.  Medicare does not, generally, include dental coverage.  This phony discount scheme is one of the "additional benefits" the HMO uses to justify it's 15% high rates.

This posting is not about whether or not MeanMesa is grateful for Medicare health coverage.  MeanMesa is incredibly grateful!

( image source: MeanMesa )

However, when the sheer volume of the required details is considered, most of which have arisen from irritating little caveats injected into the process by Republicans serving their corporate insurance company sponsors, the single payer idea gains some real traction.  The coverage dollars unavoidably consumed by each claim trying to swim through such an immense bureaucratic swamp tells us that we made the wrong choice when we obliterated the single payer idea.

The “Co-Op” Will Save the Day!

“It's like a condom with a hole. It looks like protection.” Stephannie Miller (Albuquerque, KABQ 1350AM, 18 August 2009) 110

The Republicans and the Democratic Senators of the “wholly owned” variety dismissed the possibility of a single payer approach to the health care reform matter at the first light of the first day of debate. The total resistance was presented in a chilling certainty: “We will never vote for a health reform package which includes the single payer option.” Period.

The obvious implication of such a well ordered affront to what the American people had indicated as their first choice was, well, negotiate.

Once those negotiations were in progress, the dramatics were introduced on all fronts. Senator Grassley's (R-Ohio) “unplug Grandma” was perhaps the first of many carefully tuned “word salads” to gain traction under media enhancement. “Federal take-over of health care” placing a bureaucrat “between you and your doctor” quickly followed.

The hill billies and bigots, that is, the base of the Rush Limbaugh Party, found “secret” diamonds in their salads. No thought was required for these reactionaries to literally explode with “free market” outrage, whatever that meant. Dick Armey, a very soiled Senator for the racist past, had been languishing in the rest fields of forgotten bigots for too long. In no time he found himself at the helm of an incredibly well funded “organizing committee” with the stated task of keeping the hill billies and bigots in a frenzy of manageable outrage. There would be the harsh doggerel of the hand made signs, the “Obama is Hitler” and the unchallenged appearance of gun toting “freedom thinkers” on the fringes of Presidential town hall meetings almost at once.

You see, the hill billies and bigots among us had taken quite an affront at the ease of the Obama camp during the Presidential campaign in 2008. It was a predictable response to being excluded from a sophisticated, sincere populous of Obama supporters. The “Yes We Can” crowd was having discussions about ideas which might map a possible emergence from the destruction of the Bush autocracy. The hill billies and bigots were left by themselves, stranded with their vacuous insistence that “there were two sides to the argument.”

You betch'a. Precisely as there are two sides to a plan to bail out a life boat after a ship wreck.

In fact, once the “bail out” plan was executed at a significant cost of Obama's political capital, the hill billies and bigots continued to fervently criticize it. Unable to comprehend the gravity of the situation of the “life boat” or the “bail out,” the hill billies and bigots insisted on pretending that the calamity was no more than politics, you know, a simple matter of which side will prevail. The matter of the sunken ship and the life boat tossing about on the stormy ocean of a very perturbed world meant nothing more than an opportunity to them. The “lesser people” could be inducted to the pedestrian tasks of laboring to save the country while the hill billies and bigots remained unburdened with any of such menial chores, free to savage new opportunities.

The outcome? More negotiating, only, this time, the “public option” was to be removed from the table as a condition of talks. Anything less would be tantamount to an imposition of appeasement. The billionaire insurance masters were emboldened. They issued this “combat order” to their servants in the Senate, and those toadies obeyed, promising to employ every Senatorial “trick” that they had learned after spending all those years in Washington.

Time for more moments with Grassley. His orders included proposing the “health care Co-Op” idea. He very dutifully trotted out his long, warm hearth tale of Co-Operative development in his heartland agricultural state. The trustworthiness of Co-Ops arising from the fact that they were non-profit entities managed by members – innocent consumers of the Co-Op's wares honest, hard working, dedicated to the good of the membership and elected rather than appointed in the thrall of glory oozing out of a Board of Directors who would sell Mother Mary's after birth if given a chance.

Grassley's exposition might have material, factual merit when applied to agricultural co-operatives. Those groups were forced to rise up in their own defense from market manipulators with very starkly “free market” ambitions of controlling agricultural markets to the detriment of farmers. When those farmers saw these economic parasites routinely bankrupting them, purchasing their farm lands for pennies on a dollar and then amalgamating their advances into gigantic agricultural conglomerates such as ADM and Monsanto, they formed co-operatives as a form of self-defense. The continuing threat continually posed by the Juggernauts of those “farm gobbling” monsters has sustained the enthusiasm for such co-operatives even today.

A perfect, prepackaged ruse for the Grassley. What could be more attractive to a population of wounded, health care greed victims than such a story of “good old American know-how” and “stick-to-it-ism.” The plan would include very little government intervention and, yet, would still be a “free range” of health care insurance providers beyond the death grip of the insurance corporations.

The media was ordered to portray the plan as a literal, modern, economic “wet dream.”

It did. In no time, the “co-operative health care” solution was ascending with no less glory than the bright warm, dawn sun of a beautiful new day.

However, as usual with media portrayals, some rather pertinent details were carefully omitted from that gushing media presentation. Those details would be any mention of an example of the recently ennobled phenomena of “co-operative health care.” After all, weren't there contemporary examples of such a fabulous solution to the dilemma?

Uh, not exactly. You see, there is actually a contemporary example of the perpetual blessings of a “co-operative health care wet dream,” and it is close at hand. Blue Cross and Blue Shield began their corporate lives as a co-operative health plan. Along the way, this co-operative of health care consuming members “drank the Kool Aid,” turning into one of the current mega-corporations practicing every one of the profit extracting outrages typical to the industry giants. It now splays itself in a myriad forms, tax exempt, “non-profit,” legally monopolistic (thanks to the good work of its carefully purchased Senators and Congressmen), all deceptive, grotesque (and profitable) denizens of the “big take,” quite able to defend themselves by embarking on “lie campaigns” and freely furnished, misleading television propaganda.

An exaggeration? Media Matters produced an insightful “Fact Check” on a typical Blue Cross Blue Shield operation in North Carolina. ( http://mediamattersaction.org/factcheck/200905190001 ) There, in that hill billy paradise of illiteracy and corruption well populated with Republican Neo-Con miscreants and other bigots with ambitions of destroying the President because he is black, every nasty aspect of the stinking game emerges into daylight.

It turns out not to matter so much. The Republicans and their Blue Dog (lap dog) Democrats have already said they will never vote for a Co-Op health care plan either.