Germs on the Hand. Courtesy Talk is Cheap

5% of hospital patients develop an infection. And the majority of those infections are acquired from the hands of Health Care Providers.

Medicare pays 40% of the nation’s hospital bills. (This, in and of itself, is an argument for a single payer system – one single payer already pays 40% of hospital bills. And it’s the Government.) However, Medicare does not reimburse hospitals for their mistakes. It shouldn’t. If I borrow your car, and run out of gas, it’s my fault, not yours. Note that this is an example of the government doing something right.

Because of this policy decision, medical accidents went from being a source of hospital revenue to a massive financial drain. Medical institutions were forced into the business of disease prevention, at least once people were in their care.

According to the Committee to Reduce Infection Deaths statistics, (PDF) hospital acquired infections kill more people in America than AIDS, Breast Cancer and Auto Accidents combined. What is worse is that 5% of the patients in hospitals acquire infections in the hospital, and the vast majority of the patients that acquire such infections in hospitals get them from the hands of health care providers.

More details after the click.

in Moving Through Hospitals: Designing Handwashing and Designing Handwashing Part 2: Diverse Nudges in a Hospital, by Rachel Lehrer, a designer, dancer, and student at the MFA in Transdisciplinary Design at Parsons, and excerpted below.

In October, 2008, Medicare—the United States’ government program that pays 40% of the nation’s hospital bills—decided to stop covering hospital failures. This meant that a litany of preventable mistakes, including treatments resulting from surgical errors, patient accidents and infections, were now the financial responsibility of the hospital. As a result, medical accidents went from being a source of hospital revenue to a massive financial drain. The good news is that medical institutions were finally forced into the business of disease prevention, at least once people were in their care.

What can be done to prevent costly medical mistakes? The hospital reform with the greatest potential is also the easiest to implement, at least in theory. According to the Committee to Reduce Infection Deaths statistics, hospital acquired infections kill more people in America than AIDS, breast cancer and auto accidents combined. Furthermore, the vast majority of the patients that acquire such infections in hospitals—and more than 5 percent of patients do—get them from the hands of health care providers. Thankfully, hospitals have become increasingly concerned with hand hygiene. The dirty hands of doctors and nurses aren’t just gross—they are an extremely expensive and potentially fatal act of carelessness. Hospital staffers, in order to follow protocol, need to wash their hands hundreds of times a day. Their failure to follow protocol perfectly is their personal responsibility but non-compliance on such a broad scale is also a failure of the medical system that creates the rules and environment that lead non-compliance.

The medical industry’s acknowledgment of hand hygiene as a systemic problem has led to the establishment and growing influence of Infection Control and Prevention Units. For Infection Control and Prevention, solving handwashing takes the form of cheeky posters of doctors reminding everyone to wash their hands, developing inane training videos demonstrating how to properly wash your hands and implementing incentive programs where health care workers reward each other with certificates when they observe a co-workers consistent compliance. In the hospital where I have focused my research, these certificates were returned unused.

One increasingly popular but misguided program has to been to implement paternalistic monitoring of nurses and other providers, who are forced to undergo increasing levels of surveillance. Whether it is video monitoring systems borrowed from meat manufacturing plants or sensor systems that read the alcohol content on hands, staff are cajoled into changing their behavior by receiving real time feedback combined with their fear that their personal compliance level is now public knowledge. There is no carrot—there is only a stick.

via Moving Through Hospitals: Designing Handwashing – Core77.

Rachel Lehrer is a designer, dancer and student of the MFA Transdisciplinary Design program at Parsons. Her work centers around the question: how can we optimize our body’s intelligence to improve performance? Through years of movement, choreographic and improvisational practice she’s gained expertise in physical learning, tacit knowledge, movement analysis, movement scripting and conducting deeply felt research that vacillates between being highly structured and improvisatory. Rachel also likes writing, rehearsing and making videos about people, ideas and designs that matter to her. Follow her on twitter @rachielehrer.  Core77.

The Committee to Reduce Infection Deaths was founded by Betsy McCaughey, Ph.D. in 2004. McCaughey was Lt. Governor of New York from 1995 thru 1998, during Gov. Pataki’s first term. Lt. Gov. McCaughey was not contacted for this post.

President Obama

President Obama thinks that every American should have access to health care. Judge Henry E. Hudson in Virginia, however, ruled that compelling people to buy health insurance is unconstitutional. (NY Times, New York Magazine, CNN)

President Obama is obviously correct. President Bush and Senator McCain might actually agree. Pres. ush, who appointed Judge Hudson to the Federal District Court, said in Cleveland, Ohio, July, 10, 2007, (1, 2), “People have access to health care in America. After all, you just go to an emergency room.” Sen. McCain repeated this during his 2008 campaign for the Presidency (click here). While this implies a form of universal health care, Pres. Bush and Sen. McCain, miss the nuance that emergency rooms are not primary care facilities (click here). Emergency rooms are designed for EMERGENCIES. They are not equipped to handle primary care (click here).  (This is a ‘nuance’ big enough for an aircraft carrier to sail thru.)

Judge Hudson, however, may have a point. While it’s one thing to mandate that everyone have access to health care, it’s another to mandate that everyone patronize a set of investor owned or privately held enterprises.  It’s like saying that every child must go to school, and must also go to a private school.

But if both Pres. Obama and Judge Hudson are right, is there a common ground?

Let’s look first at the uninsured.

They’re not the wealthy, because wealthy people can afford the $8,400 per year for individual insurance, and $2,500 per year for family coverage that an insurance company charges for their “low cost” in-network only plan, or the $10,416 to $27,996 the insurance company charges for their higher coverage individual and family plans.

President Clinton

They are not the children, covered thanks to President Clinton, or young people out of college, without a job covered thanks to President Obama.

They are not the elderly, who are covered by Medicare, thanks to Presidents Roosevelt and Johnson.

Nor are they the poor, who are covered by Medicaid, thanks to President Johnson.

They are not people with good jobs or union contracts.

They are not men and women who wear or wore the uniforms of the Army, Navy, Air Force, Marine Corps, or National Guard and other armed forces who defend our country, and who are covered by the Pentagon, the Armed Forces, or the Veterans Administration.

They are not Senators, Representatives of Congress or Representatives to state and local governments or Judges. Nor are they former representatives who have been voted out of office. Our noble and honorable civil servants have voted themselves a privilege they deny the people who pay their salary, and pay for that privilege.

Even prisoners incarcerated because of crimes they have committed have access to health care.

President Johnson

That leaves working people between 18 and 65 who are not in college and who have neither a good job nor a union contract.

So how can we provide medical care to people who work, who’s taxes contribute to health care for politicians, soldiers, children, the elderly, criminals in jail, and others? If and when they get sick, in addition to lost productivity on their jobs, they present a clear and present danger to the health of the public.

Pres. Franklin Roosevelt

The answer seems to be to expand Medicare, Medicaid, and the health care system that covers elected Representatives, Judges, soldiers, union teachers and other civil servants to include citizens. And what about medical practitioners who don’t want to take new  Medicare and Medicaid patients? Expand the Veterans Administration – call it the Veterans and other Citizens Health Care Administration.

What about undocumented workers? They clean our houses, clean tables in restaurants, mow our lawns, work on factory farms, and in slaughterhouses. If and when they get sick, in addition to lost productivity, they present a clear and present danger to the public health.

Thus the system should be expanded, on national security and public grounds, to include undocumented workers. Call it the National Public Health System. Or Health Care for All Americans.

The other thing is, access to health care for people who don’t pay for it – the poor, the elderly, the incarcerated, and the politicians, is paid for by people who also pay double for their own health care. How is it logical and right that I should pay for someone else’s health care via taxes, yet pay for my own via an insurance premium?

Tiger Woods may be a great golfer. But I wouldn’t buy a mortgage from him. Here’s why.

(click to stream audio)

Economics II: Macroeconomics and Political Economy

The way for the government to stimulate the economy and to avoid or climb out of a Depression, as John Maynard Keynes wrote, and as President Franklin Delano Roosevelt proved with the New Deal, is to invest money and resources in infrastructure, not to lower taxes or put money in the hands of private businesses. This latter tactic, which New Jersey’s new Governor, Chris Christie¹ is trying, was not proven to work by President Herbert Hoover and proven not to work by President George W. Bush.

Keynes’ basic analysis rests on two evident economic phenomena. One is the different effects on the Keynsian Multiplier of government revenues collected as taxes and government revenues not collected as tax-cuts. The other is the basic response of people to a “Deep Recession” or a Depression.²

If a Recession is a series of calendar quarters in which there is a decline in GDP, a “Deep Recession³” or a Depression is characterized by a recession in which there is a general reluctance to invest in new staff or new projects on the part of businesses and individuals. A portion of any income, tax refund, or tax cut is saved. Money is hoarded. Money spent by the government is obviously, spent. The Keynsian Multiplier of money spent directly by the government is greater than money provided to businesses by tax credits because the government spends money directly, while individuals and businesses spend what they must and hoard what they can. For example, for every $1 Million the government spends purchasing goods and services, $1 Million is added to the GDP. However, for every $1 Million of taxes the government cuts, there is $1 Million the government doesn’t spend, a chunk of that $1 Million is spent, and a chunk that $1 Million is hoarded.⁴ When the government spends directly, particularly on domestic infrastructure, the Multiplier is, in a word, multiplied.

Obama’s tax incentive to hire people, is partially neo-classical, supply-side economics of the type favored and proven ineffective by Hoover and Bush. However, to the extent that it generates jobs, it will help the people whos jobs are created, their families, and the economy.

Robert Reich, a Keynesian economist, said^5,:

“The best and fastest way for government to prime the pump is to help states and locales, which are now doing the opposite. They’re laying off teachers, police officers, social workers, health care workers, and many more who provide vital public services. And they’re increasing taxes and fees. … We need a second stimulus directed at states and locales. “

Paul Krugman⁶ seems to agree. The only way to avoid a Depression is for the government to spend money. Lowering taxes doesn’t work when people are reluctant to spend. However, the government must create jobs that will reduce the deficit in the future.

Wars don’t do this. As President Bush demonstrated, wars create jobs that increase the deficit and deplete the economy by destroying capital, both human and physical. Investing in local clean, sustainable energy and rearchitecting the health care system in the United States, however, are ways to use government spending today to reduce future deficits.

Local Clean Sustainable Energy

Suppose we were to install a 50 kw photovoltaic solar array and a 2,500 liter (660.4 gallon) solar hot water heater system on every school in the United States. That’s approximately 100,000 of each.⁷ Suppose each solar electric system costs $7.50 per watt, or $375,000, and each solar hot water heater would cost $50,000. That’s $425,000 per school, at 100,000 schools that’s $42.5 Billion. .

Because these are powered by a natural process — sunlight — rather than non-renewable fuels, and because of relatively low maintenance costs and operating costs, these systems will pay for themselves quickly and last a very long time, they will pay for themselves over and over. The return on investment is between 10% and 16% for PV Solar and 20% to 33% for Solar Hot Water. This is outlined in Table 1, below.

Solar Electric and Solar Hot Water Heaters
	Solar Electric	Solar Hot Water
Cost of each	$375,000	$50,000
Total Cost	$37.5 Billion	$5.0 Billion
Years to pay for itself	6 to 10 years	3 to 5 years
Useful Life	40 years	25 years
Annual ROI	10% to 16%	20% to 33.3%
Table 1.

The ROI is higher when you factor in the external benefits of clean, renewable energy — there is no pollution, and therefore are no health effects from pollution.

One way to use the deficit to stimulate the economy in a manner that is consistent with reduced long term deficits is thru the development of clean energy resources, such as solar electric and hot water systems on the nation’s public schools.

Health Care

In July, 2007, President George W. Bush said “People have access to health care in America. After all, you just go to an emergency room.⁸” While Emergency Rooms are well suited for acute conditions — emergencies — such as the traumas of car accidents, gunshot wounds, and broken arms, they are ill-equipped for chronic conditions such as hypertension, diabetes, cancer. If a person with diabetes was to go to the emergency room, the emergency room staff would say “We can’t help you. Come back when you’re in a coma, or you need your leg amputated.” Similarly, while the Emergency Room can’t manage hypertension, it can treat the heart attack or stroke suffered by a person with hypertension.

Assuming Pres. Bush’s statement is accurate, then the approximately 47 million, or one out of six, or 15.46% of Americans who don’t have health insurance only have access to health care in an emergency. This means that the Health Care System can handle non-emergency health care for five out of six Americans, but is not capable of meeting the non-emergency needs of one out of six, or 15.46% of Americans. This means we need about 15.46% more doctors, nurses, medical office staff, hospital staff, medical offices, and hospitals. For every 100 medical doctors practicing today, we need 115.46. For every 100 nurses, we need 115.46.

According to the Bureau of Labor Statistics, there were about 661,000 physicians and surgeons in the US in 2008 and are about 2.6 million Registered Nurses, RN’s, today.⁹ If this is sufficient for the 357 Million Americans who have health insurance, then we need an addtional 102,191 physicians and surgeons, and an additonal 401,960 nurses, and they need offices, examining rooms and other infrastructure. However, we can’t just push a button and create 102,191 physicians and surgeons and 401,960 nurses out of thin air. It takes nine years to train a physician and three years to train a nurse.¹⁰

Selected Demographic Information
Americans	With Insurance	Without Insurance	Total
Americans	257 M	47 M	304 M
Medical Professionals	Have	Need	Total
Physicians & Surgeons	661,000	102,191	763,191
Nurses	2.6M	401,460	3.0 M
Table 2

Another way to use deficit spending today to stimulate the economy and invest for the future is to build the medical infrastructure for the 47 million Americans who can’t afford or are without health insurance.

Paul Krugman on Banking, Securitization, and The Canadian Model

In his recent columns in the New York Times, Paul Krugman¹¹ has discussed the banking industry, the banking debacle, banking reform, and the Canadian model for banking regulation and banking risk management. He quotes testimony by Jamie Dimon of JP Morgan Chase and Lloyd Blankfein of Goldman Sachs. In hearings of the Financial Crisis Inquiry Commission, Dimon basically said “this was business as usual.” Blankfein, however, said “it was an act of God.” While they disagreed about the cause of what happened, they agree with the solution: “Let bankers be bankers. If the government regulates banking, the economy will crumble.” It appears that we tried this deregulatory approach, and the economy crumbled.

“Securitization” of loans, in which bad loans are bundled with good loans and sold, doesn’t limit risk, it rewards risk. In terms Tiger Woods or a Wall Street banker should be able to understand, Securitization is like sexual activity and HIV AIDS. Suppose one person has 100 relations with 10 partners, 10 with each, one of whom is infected with the HIV AIDS virus. Suppose another person has one relation with each of 100 partners, one of whom is infected with the virus that causes HIV AIDS. Clearly the first person has a higher risk of infection. However, the second person is also at risk. In the case of securitization of “toxic assets” the bankers were rewarded to have relations with as many people as possible. They didn’t minimize risk. They spread it around.

The Canadian banking model limits risky loans, limits bank leverage, and limits securitization. This is what Obama must do. He must demand and enforce regulations that require transparency in banking, regulate derivatives, eliminate incentives for bankers to make bad loans, create incentives for bankers to make good loans; to practice what might be called safe banking

. Regulations, for example, like those mandated by Glass Steagal.

Patrick Henry once said. “Give me liberty or give me death,”

Today he might add, “Entrust my money with cautious bankers.”

———— Notes ————-

1Faced with high unemployment and a lack of unemployment compensation funds, NJ Gov. Christie is proposing to cut unemployment benefits, and cut the unemployment tax used to fund unemployment benefits. Beth DeFalco, “Christie proposes to cut jobless benefits,” NJ Herald, 2/25/10, http://www.njherald.com/story/news/nj-jobless-benefits, and Athena D. Merritt, “Christie proposes fix for N.J.’s insolvent unemployment fund,” Philadelphia Business Journal, 2/25/10, http://www.bizjournals.com

2Discussed at length by Riddell, Shackelford, Stamos, and Schneider, Economics, Pearson — Addison Wesley, 2008, pg 365-368.

3I’m using the term “Deep Recession” in conjunction with “Depression” because there appears to be a general reluctance on the part of bankers, journalists, pundits, and others to use the term “Depression” in discussions of the state of the economy today.

4Acharya, Viral and Ouarda Merrouche, “Precautionary Hoarding of Liquidity and Inter-Bank Markets: Evidence from the Sub-prime Crisis,” July 3, 2009, at Stern.NYU.edu, http://pages.stern.nyu.edu/~sternfin/vacharya/public_html/acharya_merrouche.pdf.

5Reich, Robert, “Obama Needs to Teach The Public How To Get Out Of The Mess We’re In, But He’s Not”, 1/29/10, http://www.huffingtonpost.com

6Paul Krugman, the Princeton University Economist, and Nobel Laureate, writes a column for the New York Times.

7According to Statemaster.com there are about 94,260 elementary and secondary schools in the US. I rounded this up to 100,000 to simplify the math. http://www.statemaster.com/graph/edu_ele_sec_tot_num_of_sch-elementary-secondary-total-number-schools.

8On July 10, 2007, “Pennsylvania Progressive” reported then President Bush said: “People have access to health care in America. After all, you just go to an emergency room.” http://pennsylvaniaprogressive.typepad.com/my_weblog/2007/07/bush-on-healthc.html

Also reported on July 11, 2007 by Dan Froomkin in the “Washington Post,” in his column “Mock The Press”. http://www.washingtonpost.com/wp-dyn/content/blog/2007/07/11/BL2007071101146_5.html

9Bureau of Labor Statistics, Occupational Outlook Handbook, 2010-11 Edition,

Physicians and Surgeons. http://www.bls.gov/oco/ocos074.htm#outlook,

Registered Nurses, http://www.bls.gov/oco/ocos083.htm

10I’m assuming a 6-year Biomedical program and a 3 year Medical Residency for physicians and surgeons and a 2 year practical nursing program with a 1 year Residency for nurses.

11Krugman’s Recent columns in the NY Times include, “Bubbles and the Banks”, 1/8/10, “Bankers Without A Clue”, 1/15/10, “March of the Peacocks”, 1/29/10, and “Good and Boring,” 2/1/10. These can be found on the Internet at http://www.nytimes.com.

President Barack Obama.

In his State of the Union Address <video, transcript Englsh, en español>, President Obama said “The best anti-poverty program is a world classeducation

The President also asked for a better health care plan. I can answer that in five words: “Single Payer; Medicare For All” <link>  just approved by the California Senate. Medicare works for my octogenarian father. Health Insurance Care doesn’t work for a 20-something friend of mine. He just graduated from college. He has no job and therefore no medical insurance. If he was a full-time student he’d be covered on his parents’ insurance. A simple reform would cover recent graduates until they find a job that pays a living wage and provides health insurance benefits. Another would be by expanding Medicare to cover all citizens. This is much easier said than done. Our medical care system cannot adequately care for approximately 50 million people – one out of six. This can’t be changed overnight – we need to train more doctors and nurses, and build more hospitals, but it must be changed.

Mountain strip mined for coal. Chris Dorst, Charleston, WV Gazette.

Energy is another set of systems problems. No one who has seen a once pristine valley after strip mining or “mountain-top removal”  uses the term “Clean Coal.” Countries like Denmark, Ireland, Israel, Japan, and Sweden built their economies with education not extraction of natural resources. As the President alluded to, conservation and clean, renewable energy technologies – solar, wind, geothermal, hydro – can be implemented faster, at a lower cost, and with fewer negative economic externalities than traditional fuel intensive resource based technologies like fossil fuel and nuclear power. This suggests another of the differences between New Jersey and West Virginia – the “Blessings of Education” versus the “Resource Curse” <link> from which economies built on extraction of natural resources suffer.

Arklow Bank Wind Park, off Arklow Bay, Ireland. Image courtesy Oneworld.net, UK.

The President needs economic advisors who start think in terms of ecological economics <link1 / link2>, of metrics like the Genuine Progress Indicator, GPI <link>, rather than Gross Domestic Product, GDP <link>. Simply put, ecological economics is neoclassical economics with a better understanding of the long term and of costs. Spending one dollar – or one trillion dollars – to clean up a mess is not as good as allocating those resources to build factories, houses, libraries, museums – the infrastructure, culture, and community of a nation.

President Obama

Washington, DC, Nov. 7, 2009, 11:00 PM. The U. S. House of Representatives passed a health care bill that appears to profoundly change the system.

According to President Obama, (click here or  here)

Comprehensive health care reform can no longer wait. Rapidly escalating health care costs are crushing family, business, and government budgets. Employer-sponsored health insurance premiums have doubled in the last 9 years, …. This forces families to sit around the kitchen table to make impossible choices between paying rent or paying health premiums. … The United States spent approximately $2.2 trillion on health care in 2007, or $7,421 per person – nearly twice the average of other developed nations. Americans spend more on health care than on housing or food. If rapid health cost growth persists, the Congressional Budget Office estimates that by 2025, one out of every four dollars in our national economy will be tied up in the health system. This growing burden will limit other investments and priorities that are needed to grow our economy. Rising health care costs also affect our economic competitiveness in the global economy, as American companies compete against companies in other countries that have dramatically lower health care costs.

According to Rush Holt, D, NJ-12, (click here or here)

Rep. Rush Holt, D, NJ-12

This bill would provide secure and stable health coverage regardless of whether you change jobs or are between jobs, ensure Americans will never be denied care if they get sick, and extend coverage to those not well served by the current system.

This is a historic vote and the furthest we have come toward providing affordable and quality health coverage to all Americans.

watching tron: legacy online

Once this bill becomes law, it immediately would eliminate cases where insurance benefits run out because of an expensive illness, would allow young adults to remain on their parents’ insurance through age 26, and would shrink the Medicare prescription doughnut hole.

The bill would strengthen and extend existing programs.  For example, those who have health insurance through their employers would benefit from caps on yearly out of pocket costs.  Under the legislation, Medicare would be intact, only better – recipients would benefit from free preventive care and better primary care.  Clickhere to read more about what the bill would do for you.

Reform would preserve the relationship between families and their doctors and shift to a focus on healthy outcomes and rewarding physicians for treating the whole patient.

In an e-mail to supporters, Rush Holt, D, NJ-12 said,

Rep. Rush Holt, Ph.D.

I just now voted for the Affordable Health Care for America Act. I want you to know about this development and what the bill means for you. This bill would provide secure and stable health coverage regardless of whether you change jobs or are between jobs, ensure Americans will never be denied care if they get sick, and extend coverage to those not well served by the current system.

This is a historic vote and the furthest we have come toward providing affordable and quality health coverage to all Americans.

Once this bill becomes law, it immediately would eliminate cases where insurance benefits run out because of an expensive illness, would allow young adults to remain on their parents’ insurance through age 26, and would shrink the Medicare prescription doughnut hole.

The bill would strengthen and extend existing programs.  For example, those who have health insurance through their employers would benefit from caps on yearly out of pocket costs.  Under the legislation, Medicare would be intact, only better – recipients would benefit from free preventive care and better primary care.  Clickhere to read more about what the bill would do for you.

Reform would preserve the relationship between families and their doctors and shift to a focus on healthy outcomes and rewarding physicians for treating the whole patient.

It would do all these things without adding to the deficit, while it would hold down costs for families in the future.

This bill is the culmination of one of the most open and deliberative processes in recent memory.  During the past few years, Congressional committees held more than 53 committee hearings, debated and voted on almost 240 amendments, and considered health reform for 167 hours.  We have held thousands of town meetings, read hundreds of thousands of letters, and met with health care experts and patients.  Many of the amendments addressed concerns raised by constituents, such as an amendment I championed to help small businesses pool together to purchase insurance at group rates, an idea brought to me by a Monmouth County small businessman.

When I considered health reform, I talked with patients, seniors, doctors, nurses, small business owners, and others to learn their perspectives.  I received and responded to thousands of letters from Central New Jersey residents.  The stories I have heard highlight the fact that health care reform is about real people who are disserved by the broken insurance system.

For more information and resources about the Affordable Health Care for America Act, including the text of the full bill and a bill summary, please visit my website.  There you can also see my remarks during the debate on the House floor.

After carefully analyzing and reviewing this bill, I believe it will improve the quality of life and the economy of nearly all families and of the nation as a whole. I would not support it if I did not think so. I look forward to working toward completion of meaningful health care reform legislation and sending it to the President for his signature.

If it is right for the government to distribute flu vaccine, and try to stop smallpox, malaria, other epidemics, then it is right for the government to institute a national health care plan – “Single Payer” or “Medicare for All,” or “The Public Option

.”

Everybody knows this. President Obama knows it, President Bush and Senator McCain knew it. Bush and McCain said “We have a ‘National Health Care Plan’ – Anyone can go to the emergency room.” The problem with this approach is that it’s inefficient, illogical and expensive. The emergency room is the best place to reset a broken arm, however, it’s simply not the place for treatment if you have diabetes, cancer, or a heart condition. It’s the Emergency Room, not the Chronic Illness Clinic . That’s why we need “Single Payer,” “Medicare for all,” or “The Public Option.”

Patrick Henry once said “Give me liberty or give me death.” Without health care we face bankruptcy or death. Patrick Henry, Thomas Jefferson,  John Adams, George Washington, Abe Lincoln, all would support Medicare for All.

The Giant Pool of Money is an outstanding radio documentary which explains, in

Click here for other economic coverage by This American Life.

Why is this subject relevant at Popular Logistics? Because widespread poverty – or its effects, fear, limits on health care, housing, and food – constitute disasters, whether caused by a hurricane, indusstrial accident or by  failure.

Here’s the choice, as I see it:  The “Public Option”

versus The Status Quo.

Medicare for All versus Health Insurance for Most – affordable to the healthy and employed, but rationed to five (5) out of six (6) Americans. As Will Rodgers might have said, “Five out of six ain’t bad; Unless you’re number 6, and excepting that the five get exposed to whatever it is that number 6 has got.“

Health Care for all, versus Rationed Private Insurance Care that doesn’t cover 47 Million Americans that are over 18 and under 65, who’s taxes pay for Medicare for their parents and grandparents, their children covered by SCHIP, and for procedures given to charity care patients in hospitals.

In other words, “Health care By the People, Of the People and For the People,”

versus “Health care run By the Bean Counters Of the Insurance Companies For the Stockholders!”

I have a good full-time job. I buy the health insurance my Human Resources Dept tells me to buy. (This is not, by the way, a “free market” as described by Adam Smith, David Ricardo, John Maynard Keynes, Milton Friedman, and other neo-classical economists.) I pay enough that I could be driving a Hummer  about 2,400 miles per month (at current gas prices).

But my coverage is rationed by insurance company beancounters. When I need a doctor, I see one of their docs.  A complete physical is free once a year. It takes about two hours and 30 seconds – two hours waiting and 30 seconds in which the doctor says “You’re breathing. That’s good. You’re blood pressure is high, if it gets higher we’ll put you on meds.”

That’s ok, or what passes for ok. As long as I don’t get sick I’m ok. That’s why my blood pressure is high. I’m worried about getting sick. Or losing my job. Or losing my job and getting sick. In that case I’ll lose my house.

One thing I don’t worry about is that my father. He’s well over 80, and he has good health, and good health care. He’s on Medicare. It’s great. Efficient.  Government run. Not sexy like the Apollo Mission to the moon, but very important. And for the health care that my kids teachers get. They go to public school. The teachers are in the unions. And the health care is good. The kids too get good health care. My kids, my kids friends, even if their parents work but don’t get health care, then, thanks to Presidents Clinton and Obama, and despite the efforts and vetos of President Bush, they get health care.

But one of the things that really gets me, the thing that makes my blood boil – which is why I’ll need blood pressure meds – is that close to 50 Million Americans – one out of six – have no health insurance. And it’s people between the age of 18 and 65. People who work, or would work, if they could find jobs.  This is wrong on many levels. It’s not just that I have friends in that position, and that I was in that situation – working hard, falling backwards, no health insurance – barely able to afford food. According to Paul Krugman, in the New York Times, “many of the protesters who don’t want “Government Run Health Care” are on Medicare.” While that’s almost funny, it’s also very sad.