A 12-Year-Old’s Massive Stroke And How We'll Pay for It All September 14, 2009March 16, 2017 REAL ESTATE INDICATOR A friend just bought a home on Miami Beach. It sold for $1.2 million in 2007. He and his partner paid $280,000. I would guess the bottom for that particular home has been reached. MEDICARE FOR ALL Writing in yesterday’s Washington Post, George McGovern asks: “We know that Medicare has worked well for half a century for those of us over 65. Why does it become ‘socialized medicine’ when we extend it to younger Americans?” DOCS FOR REFORM Last summer, pediatrician Alex Blum wrote eloquently of his work to help elect Obama. Now, in this LA Times op-ed, he writes of a 12-year-old who arrived in his emergency room having suffered a massive – preventable – life-ruining stroke, and urges passage of the President’s health plan. HEALTH CARE IN WISE, VIRGINIA Every summer, Governor (and DNC Chair) Tim Kaine goes with his wife to visit the Wise health fair in the Southwest corner of Virginia. It gets bigger every year as the word spreads. This year, he says, he counted license plates from 16 states. People sleep in their cars, waiting all week to begin signing up Friday for free medical, dental, and optical care. The care is all volunteer (as described here) – a program like the ones they do in Africa. Governor Kaine tells of seeing all this and wondering what country we are living in. He really wants to see Congress pass the President’s plan. Bob Dole wants to see us take action as well. Remember former Senate Minority leader and 1996 Presidential candidate Bob Dole? Who helped kill the Clinton health care bill? As New York Times reported Saturday: When former Senator Bob Dole was the Republican minority leader, he helped deep-six President Bill Clinton’s health care plan. This year, Mr. Dole, 86, who left the Senate in 1996 to run for president, is working behind the scenes to help resurrect one. His motivation comes partly from experience. After his body was shattered during World War II, he underwent seven operations in veterans hospitals and three years of rehabilitation. “I had good treatment and it’s probably why I’m still around,” he said in an interview. He has been working on the issue since the 1970s, and admits now that “we probably should have passed the Clinton bill, but it got so politicized.” It seems he got a memo from Bill Kristol advising that allowing the reform to pass would kill his chances. It was just more important to defeat Clinton than to provide coverage to the millions of uninsured. Now, for so many, the key thing is to defeat Obama. So they come up with all kinds of truly crazy things (communism! Nazism!) . . . and other things not crazy, just untrue, designed to confuse and concern. (I heard Texas Senator John Cornyn on TV Saturday morning talking about the “trillions” the Obama plan would add to the deficit and hours later found myself on the same flight, from Austin to Dallas, only a few feet away. If we had been sitting together, it would have been a lively conversation. The Obama plan will not add to the deficit, let alone “trillions” – see below.) THE PRESIDENT’S PLAN Here it is (with a little copy-editing on my part): If You Have Health Insurance, the President’s Plan: Prevents insurance companies from dropping you when you get sick. Caps out-of-pocket expenses so you don’t go broke when you do get sick. Eliminates charges for preventive care like mammograms, flu shots and diabetes tests. Eliminates the “donut-hole” gap in coverage for prescription drugs. If You Don’t Have Insurance, the President’s Plan: Makes it available even if you have a pre-existing condition. Creates a new insurance marketplace – the Exchange – so you can compare plans and buy insurance at “group rates.” Helps low-income citizens pay for it. Offers new, low-cost coverage through a national “high risk” pool to protect people with preexisting conditions from financial ruin until the new Exchange is created. For All Americans, the President’s Plan: Won’t add a dime to the deficit and is paid for upfront. Requires additional cuts if savings are not realized. Implements a number of delivery system reforms that begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality.<?b> Creates an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system. Orders immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine. Requires large employers to cover their employees and individuals who can afford it to buy insurance so everyone shares in the responsibility of reform. HOW DO WE PAY FOR IT? There are two big costs: insuring the uninsured; improving benefits. Some of that cost we already bear – emergency room treatment that we already provide the uninsured. That cost is not added, just shifted (and perhaps reduced by handling it more sensibly). How do we pay for the rest? First, by wringing inefficiencies out of the system – see the three bold-faced items above. We devote more than 16% of our GDP to health care. None of our industrialized competitors comes even close – yet the health of their people is generally as good as or better than ours. Second, through a new emphasis on preventive care. Consider the 12-year-old boy who arrived at Alex Blum’s emergency room with a massive stroke, as recounted above. He will be a “burden on society” for what could be the next 50 years. If his mother had been able to afford to follow doctor’s orders after his first (mild) stroke, those next 50 years might well have been productive, self-sufficient, and tax-paying. Third, if needed, through taxes. There is nothing sacred about the 15% top marginal tax rate levied on $100 million-a-year hedge fund managers – when their plumbers face marginal rates well over 40% (Federal income tax plus FICA). I know Joe the plumber is desperate to see his hedge fund manager’s tax rate stay low; but does he really speak for all the other plumbers out there? And while this is an extreme example to make the point, the truth is that a very modest increase on taxes at the top – on folks who can really, truly, afford to chip in a little more, as they always used to – would be enough to make up any shortfall that efficiencies could not. But if we’re smart, efficiencies alone will do the trick.