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Universal Health Care
Sep 6, 2009

Granted, "Universal Health Care" sounds great up front. I invite you to research the mythological "Semele" before you look too closely. The primary purpose of government has ALWAYS been to keep the base of the power pyramid (worker bee) functional but controlled. "Power," the basis of Government, has been defined by control of weapons, wheat, medicine, and (thanks to automation) oil/energy; and they all boil down to control of the working class. In regards to HIV, Putting health care in government hands will reduce incentive to find "the cure" but will strengthen the status quo of lifelong treatment. If this happens, "we the people" have just been yolked and saddled yet again. What will you do if/when private practice medicine is just another history lesson, both as a patient and as a Doctor?

Response from Dr. Frascino

Hello,

Please note Semele was indeed mythological and your conspiracy theories about government are myths as well.

"The primary purpose of government has ALWAYS been to keep the base of the power pyramid functional but controlled."???? WHAT??? I must have missed that part in my reading of the Constitution and during my government courses in college. Are you sure you're not talking about the Catholic Church or the Republican Party perhaps? This philosophy you describe could apply to either of those organizations.

"Putting health care in government's hands will reduce incentive to find 'the cure' (for HIV)"???? WOW, exactly how much of that crazy Kool-Aid have you been drinking lately? Not only are your fears and theories completely without substance; they are completely irrational.

As for your fears about private practice becoming extinct, chances are as a practicing physician for over 30 years I know a bit more about that topic that you. The problem that universal health care is trying to fix is that for 47,000,000 Americans private practice (or any other type of health care) doesn't exist! Please note every other industrialized nation on this planet offers its citizens some form of health coverage. It's time to separate myths like the one you harbor from facts. Both as patient and doctor, I strongly support health care reform. See below.

Dr. Bob

HOW CAN YOU SUPPORT SOCIALIZED MEDICINE?????? Sep 5, 2009

Dr. Bob,

How can you of all people support socialized medicine. It scares the hell out of me.

Penny

Response from Dr. Frascino

Hello,

"Socialized medicine" is a propaganda term dreamed-up by insurance companies and right-wing lunatics to try and scare folks into rejecting any kind of healthcare reform. If your house was on fire would you be worried about "socialized firefighters" coming to put out the blaze? Or if you are the victim of a violent crime, will you shun "socialized policemen" who come to your rescue? These programs are government run! The government also runs part of our current healthcare system: Medicare and the Veterans Affairs Medical Program. See the columns by Nicholas Kristof from the New York Times below. Hopefully, you'll find them enlightening!

Dr. Bob

September 3, 2009, OP-ED COLUMNIST

Health Care That Works

By NICHOLAS D. KRISTOF, New York Times

Here's a paradox.

Health care reform may be defeated this year in part because so many Americans believe the government can't do anything right and fear that a doctor will come to resemble an I.R.S. agent with a scalpel. Yet the part of America's health care system that consumers like best is the government-run part. Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high. Multiple surveys back that up. For example, 68 percent of those in Medicare feel that their own interests are the priority, compared with only 48 percent of those enrolled in private insurance. In truth, despite the deeply ingrained American conviction that government is bumbling when it is not evil, government intervention has been a step up in some areas from the private sector. Until the mid-19th century, firefighting was left mostly to a mishmash of volunteer crews and private fire insurance companies. In New York City, according to accounts in The New York Times in the 1850s and 1860s, firefighting often descended into chaos, with drunkenness and looting. So almost every country moved to what today's health insurance lobbyists might label "socialized firefighting." In effect, we have a single-payer system of public fire departments. We have the same for policing. If the security guard business were as powerful as the health insurance industry, then it would be denouncing "government takeovers" and "socialized police work." Throughout the industrialized world, there are a handful of these areas where governments fill needs better than free markets: fire protection, police work, education, postal service, libraries, health care. The United States goes along with this international trend in every area but one: health care. The truth is that government, for all its flaws, manages to do some things right, so that today few people doubt the wisdom of public police or firefighters. And the government has a particularly good record in medical care. Take the hospital system run by the Department of Veterans Affairs, the largest integrated health system in the United States. It is fully government run, much more "socialized medicine" than is Canadian health care with its private doctors and hospitals. And the system for veterans is by all accounts one of the best-performing and most cost-effective elements in the American medical establishment. A study by the Rand Corporation concluded that compared with a national sample, Americans treated in veterans hospitals "received consistently better care across the board, including screening, diagnosis, treatment and follow-up." The difference was particularly large in preventive medicine: veterans were nearly 50 percent more likely to receive recommended care than Americans as a whole. "If other health care providers followed the V.A.'s lead, it would be a major step toward improving the quality of care across the U.S. health care system," Rand reported. As for the other big government-run health care system in the United States, Medicare spends perhaps one-sixth as much on administration as private health insurers, although the comparison is imperfect and controversial. But the biggest weakness of private industry is not inefficiency but unfairness. The business model of private insurance has become, in part, to collect premiums from healthy people and reject those likely to get sick or, if they start out healthy and then get sick, to find a way to cancel their coverage. A reader wrote in this week to tell me about a colleague of hers who had health insurance through her company. The woman received a cancer diagnosis a few weeks ago, and she now faces chemotherapy co-payments that she cannot afford. Worse, because she is now unable to work and has to focus on treatment, she has been shifted to short-term disability for 90 days and after that, she will lose her employer health insurance. She can keep her insurance if she makes Cobra payments on her own, but she can't afford this. In her case, her company will voluntarily help her but I just don't understand why we may be about to reject health reform and stick with a dysfunctional system that takes away the health coverage of hard-working Americans when they become too sick with cancer to work. On my blog, foreigners regularly express bewilderment that America may reject reform and stick with a system that drives families into bankruptcy when they get sick. That's what they expect from the Central African Republic, not the United States. Let's hope we won't miss this chance. A public role in health care shouldn't be any scarier or more repugnant than a public fire department.

HEALTH CARE REFORM, WON'T IT BE BAD FOR HIV POSITIVE PEOPLE? Sep 2, 2009

Dr. Bob, Why are you pushing Obama's health care reform? They are going to take over medical care, cut care to elderly folks like grandmothers and have panels to decide who lives and dies. I'm sure they will cut care to those of us with HIV cause it is expensive to treat us. Shouldn't we try to block such rationing of health care? Zelda

Response from Dr. Frascino

Hello Zelda,

Health care reform will not throw your granny off a cliff, nor will it cut off care to HIVers! In many ways we already have health care rationing that is not only unfair; it's morally reprehensible. (See Nicholas Kristof's article from the New York Times below.) It's time you turned off Fox News and stopped listening to the scare tactics of the insurance companies and rightwing wingnuts. Democrats, like Obama, have had to fight for every dollar in the AIDS Drug Assistance Plan (ADAP) and Ryan White Fund. Don't be fooled by the myths, lies and hype. Health care reform is desperately needed.

Dr. Bob

Until Medical Bills Do Us Part

By NICHOLAS D. KRISTOF, Op-Ed Columnist New York Times, August 30, 2009

Critics fret that health care reform would undermine American family values, not least by convening somber death panels to wheel away Grandma as if she were Old Yeller.

But peel away the emotions and fearmongering, and in fact it is the existing system that unnecessarily takes lives and breaks apart families.

My friend M. you'll understand in a moment why she's terrified of my using her name had to make a searing decision a year ago. She was married to a sweet, gentle man whom she loved, but who had become increasingly absent-minded. Finally, he was diagnosed with early-onset dementia.

The disease is degenerative, and he will become steadily less able to care for himself. At some point, as his medical needs multiply, he will probably need to be institutionalized.

The hospital arranged a conference call with a social worker, who outlined how the dementia and its financial toll on the family would progress, and then added, out of the blue: "Maybe you should divorce."

"I was blown away," M. told me. But, she said, the hospital staff members explained that they had seen it all before, many times. If M.'s husband required long-term care, the costs would be catastrophic even for a middle-class family with savings.

Eventually, after the expenses whittled away their combined assets, her husband could go on Medicaid but by then their children's nest egg would be gone, along with her 401(k) plan. She would face a bleak retirement with neither her husband nor her savings.

A complicating factor was that this was a second marriage. M.'s first husband had died, leaving an inheritance that he had intended for their children. She and her second husband had a prenuptial agreement, but that would not protect her assets from his medical expenses.

The hospital told M. not to waste time in dissolving the marriage. For five years after any divorce, her assets could be seized precisely because the government knows that people sometimes divorce husbands or wives to escape their medical bills.

"How could I divorce him? I loved him," she told me.

"I explored a lot of options with an attorney here in town," she added. "The attorney said, 'I don't see any other options for you.' It took about a year for me to do the divorce, it was so hard."

So M. divorced the man she loves. I asked him what he thought of this. He can still speak, albeit not always coherently, and he paused a long, long time. All he could manage was: "It's hard to say."

Long-term care constitutes a difficult and expensive challenge in any health system. But the American patchwork, full of cracks through which people fall, has a special problem with medical expenses of all kinds bankrupting couples.

A study reported in The American Journal of Medicine this month found that 62 percent of American bankruptcies are linked to medical bills. These medical bankruptcies had increased nearly 50 percent in just six years. Astonishingly, 78 percent of these people actually had health insurance, but the gaps and inadequacies left them unprotected when they were hit by devastating bills.

M. still helps her husband and, quietly, continues to live with him and care for him. But she worries that the authorities will come after her if they realize that they divorced not because of irreconcilable differences but because of irreconcilable medical bills. There were awkward questions from friends who saw the divorce announcement in the newspaper.

"It's just crazy," she said. "It twists people like pretzels."

The existing system doesn't just break up families, it also costs lives. A 2004 study by the Institute of Medicine, a branch of the National Academy of Sciences, found that lack of health insurance causes 18,000 unnecessary deaths a year. That's one person slipping through the cracks and dying every half an hour.

In short, it's a good bet that our existing dysfunctional health system knocks off far more people than an army of "death panels" could even if they existed, worked 24/7 and got around in a fleet of black helicopters.

So, for those of you inclined to believe the worst about President Obama, think it through. Suppose he is indeed a secret, foreign-born Muslim agent who is scheming to undermine American family values while killing off as many grandmothers as possible.

If all that were true, why on earth would he be trying so hard to reform our health care system? We already know how to prod families into divorce and take a life unnecessarily every 30 minutes all we need to do is reject reform and stick with exactly what we have.



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