An old friend of mine gave one of his kidneys to his girlfriend and now he doesn't like her very much anymore.

I wonder if it's considered community property in California? Maybe he can get half of it back.

That's harsh. The Corporation has no heart - no soul - an empty vessel.

Dear Lord,

Please let Senator's Baucus, Conrad, Lincoln and Nelson lose their health insurance, and then come down with a horrible chronic disease.

Thank You Lord.

Sincerely,
Karma

And who makes these decisions? Death Panels? Who comes between the patient and their doctor?

The paid shills for the insurance companies are whining about the right things. They're just on the wrong side of the argument.

More on conservatives gloating in America's Olympic defeat from George Hairhat Will, Shit Fumes and Cokie Cane Roberts.

http://jed-lewison.dailykos.com/

I just found out that it is going up 33% in 2010. How can insurance companies continue to---so arrangantly---not just deny coverage, but raise the fucking premium in the light of the ongoing crap in DC? I know the answer: Obama, et.al. are playing a closed-door game called 'Let's Continue To Fuck Americans And Make 'Em Think We Are On Their Side'.

Not without a big revolt from us. Everyday theres new stories like these - it just blows my mind!
We need SINGLE PAYER, not public option, right NOW Mr. President. (whathappenedtoTHATObama?!!??)

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I want to thank you everyone but particularly Rabbi Levin for inviting me to speak this morning, I’m new to Kansas City and it is nice to feel welcome in the Jewish community. The more I learn about Beth Torah, however, the more I realize that being invited to address this Congregation about the topic of health reform is not really a very friendly or hospitable gesture.

We are going to discuss some of these ideas later this afternoon – but if I say something that you really disagree with, I’d encourage you to just shout out, “You lie!” and that would keep our dialogue at about the same level as the dialogue in Washington.

Let me start not with health reform but with another remarkable event in our national life, Sonia Sotomayor’s appointment to the Supreme Court. To me, the most remarkable thing about her nomination and subsequent confirmation as a Justice of the United States Supreme Court was not that she is Hispanic and certainly not that she is a woman. Instead, it is that she has been diabetic since she was eight years old. Women and Hispanics have always had what it takes to get to the Supreme Court. Until this generation, however, most people who were diagnosed with diabetes in childhood would have developed so many complication by the time they were fifty that elevation to the High Court would not be an option. The successful, long-term treatment of a chronic disease like diabetes is just the sort of medical miracle that often goes unheralded as we focus on the new, the glitzy, the high tech, and the controversial.

Until the 1920s, diabetes was a rapidly fatal illness. After the discovery of insulin in 1921, the disease was transformed. Insulin was not then – and is not now - a cure for diabetes. Instead, it transforms the disease from an acute and rapidly one into a chronic degenerative one. Prevention of the long-term complications of diabetes -- blindness, renal failure, coronary artery disease or peripheral vascular disease -- requires good technology and good pharmacology. Diabetes treatment has also improved because of new and better forms of insulin and because of new and better ways of monitoring blood sugar – particularly the development of microcomputer chips powering tiny insulin pumps that allow better control of blood sugar – the key to preventing long term complications.

Technology and pharmacology are not enough, though. Good outcomes also require excellent primary care. In one recent study, the best predictor of long term outcome, and thus the best measure of quality care, was how often a doctor or a nurse took off the patient’s socks and examined the feet for ulcers. This is a disease for humble practitioners.

It is remarkable the Ms. Sotomayor could get such care, growing up as she did in the public housing projects of New York City. It could only have happened because New York City has one of the best health care safety net systems – a network of public hospitals and city clinics – which care for everyone regardless of their ability to pay. Thanks to that system, even poor children with type I diabetes can grow up to become Supreme Court justices. That is an amazing thing.

I was thinking of Ms. Sotomayor and her health story this summer while I was having some health problems of my own. My prostate story is everyman’s prostate story. I had my PSA checked at a routine physical. It was slightly elevated. A biopsy revealed a low-grade tumor. I was faced with a choice about which experts in the field disagree - I was given all the options – surgery, radiation, or watchful waiting – and had to decide.

At the time of my diagnosis, I was about to leave one job and start another. I would have a month without health insurance. Luckily, I was diagnosed in time to schedule the surgery before leaving my job. Otherwise, I’d have had to delay the surgery or buy a COBRA policy. If I hadn’t found another job – if I’d just been laid off, I’d have joined the growing ranks of the uninsured and, with my new diagnosis, the uninsurable.

As it was, I got excellent care through my HMO. To this day have absolutely no idea what my treatment actually cost. I paid one $10 co-pay and that was it.

For Ms. Sotomayor and me, the health care system worked. We got excellent care from the U.S. health care system. I don’t think we were any more deserving of such care than the many others who have been dealt a different hand. I had felt the terror of the newly diagnosed and the nearly uninsured. I felt lucky. I also felt the dread that comes from the recognition of how lucky I was and how, without luck, my outcome, like Ms. Sotomayor’s, might have been very different. We are all one biopsy result and one pink slip away from both life-threatening illness and bankruptcy.

In most industrialized countries, such arbitrariness, such bizarre lotteries for medical care, such fear of being excluded from the system, have all become things of the past. For citizens in those countries, health care is just there, the way clean water, police protection, and electricity are just there. People don’t think about it, don’t worry about, don’t shape their lives around it.

After the surgery, I took a few weeks off and went to Monhegan Island, a beautiful dot of land ten miles out in the ocean and an hour ferry ride from Port Clyde, Maine. Monhegan is a place of stunning natural beauty – sheer granite cliffs rise from the sea. Waves crash against the stark and craggy cliffs. It seems like the waves are powerless, the rocks immovable and permanent. But we know that, over time, those persistent waves have worn away the hardest granite. With persistence, even things that seem unchangeable can be shaped and altered Monhegan was a good place to heal and to ponder the intractable problems of our health care system.

I thought about my two brothers, who also have had prostate problems. My older brother Jeff, like me, had an elevated PSA. His biopsy, too, was positive. He had surgery and was cured. He is a schoolteacher in the LA public schools with health insurance through his job. He paid his $2500 deductible and the rest of his care was covered by insurance. He took his sick leave and lost no income during his illness..

My brother Tom had an elevated PSA. His biopsy was negative but 24 hours after the biopsy, he developed a high fever. He was admitted to the ICU with septicemia, probably caused by the biopsy, and nearly died. He was in the ICU for seven days. He is a psychiatrist in a private practice who buys his own health insurance. His policy had a $10,000 deductible, which he had to pay out of pocket. And, since he was out of work, he lost all his work income during the time he was sick.

So we three brothers all got the same diagnosis at about the same age. We all had different insurance. I have the highest income of the three of us and paid the least. Tom, who wasn’t even sick until the biopsy made him sick, paid the most. I’m sure every family has stories like this – curious little parables about the curious ways that our health care system treats people differently.

It doesn’t have to be this way. In most other countries, countries not so different from ours, countries that spend far less per capitta than we do on health care, if you get sick, you get treatment. You don’t worry what plan to buy, how much it will cost, or whether, because you get sick, your costs will skyrocket or you will be denied insurance in the future. The purpose of insurance in those countries is to enhance access for the sick, not to exclude them.

It was the summer of the Great Obama Health Reform Debate, one of our periodic national conversations about our health care system. Such conversations have become almost a ritual of American life. We elect a Democrat to the White House and they begin anew, each as ritualistic and predictable as a Kubuki play..

Each time, it seems like this will be the time. Each time, the urgency is there, as if we cannot wait any longer. Each time, we are treated to the dire statistics of utter unsustainability. Harry Truman, in his efforts, famously predicted that if health expenditures ever went above 4% of GDP, the economy would crash. They are now at 17% of a much larger GDP – this year, we will spend $2.4 trillion on health care – and Harry was wrong. They seem to be one of the few things that is sustaining the economy.

Each time, our highest hopes and our darkest fears are both engaged.

And each time, so far, we chicken out of comprehensive reform, we convince ourselves that the system is not so bad after all - and opt for some partial fix – another patch, another crutch, to keep the old nag of a health care system hobbling along. Roosevelt settled for Social Security. Truman passed the Hill-Burton Act that funded the construction of hundreds of hospitals throughout the United States. Johnson got Medicare and Medicaid. And it is not just the Democrats. Nixon proposed a national health care insurance program. Reagan, without much fanfare, implemented a whole new way of paying hospitals for inpatient care – the diagnosis-related group. W passed the Medicare prescription drug benefit and expanded funding for community health centers.

Every new piecemeal program adds to the astounding complexity, the enormous bureaucratic inefficiency, and the bizarre irrationality of our health care system.

These stories illustrate what I see as the biggest problem with our system. It is NOT that it is unjust in the sorts of ways that usually bother liberals. That is, it is not a system in which only those with money and power get good health care or in which the poor, the minorities and the disempowered suffer systemic deprivations. When you look at those without insurance, they are not, for the most part, the poorest people in the country. The poorest people qualify for Medicaid, a $400 billion government insurance program. The elderly get Medicare, a $500 billion program. The sickest people, the chronically ill or disabled, qualify for Medicaid, Social Security, or something called SSI.

So who are the uninsured? About 40% of the uninsured, 20 million people, live in families with annual income over $50,000. They are small business owners or employees, entrepreneurs, young people. About 10 million are not U.S. citizens – though most are legal immigrants and pay taxes. Many of the rest qualify for one of the existing programs, but either don’t know they are eligible or don’t know how to enroll. Almost all live in major metropolitan areas which is also where most of the safety net providers are. Twenty million Americans get care at one of 1000 federally qualified primary health care centers – places like Swope or Rogers in Kansas City. Their care will be either free or billed on sliding scale according to the patients’ income. Safety net hospitals, like Truman or Children’s Mercy, get money from the federal government based the amount of care they provide to the poor.

Taken together, these disparate elements of our public health care system, that is, our very own socialized medicine system, costs as much per capita as Britain’s TOTAL expenditures on health care – that is about 9% of GDP.

Thus, we have a decent public system alongside our private system. Because we have both systems, our administrative costs and inefficiencies multiply. It becomes harder and harder for people in either system – the public or the private- to figure out what they need to do to get good medical care.

Are there people who fall through this tattered safety net? Sure. But – and this is crucial – they are not, for the most part, the neediest people in our society. Lack of insurance – or underinsurance – is more random than that.

So the problem is not the cartoony sort of injustice that liberals endlessly decry and conservatives haughtily deny. It is not a lack of Justice. It is a lack of Fairness.

Justice would require attention to deservingness and to power differentials. Fairness only requires agreement on a universal set of rules. Making rules is what our crazy government does best – we create agencies that make and enforce rules to level various playing fields and make market competition possible. The SEC sets rules for stock trading. The FAA sets rules for airlines. OSHA and EPA make rules. The health care system needs some equivalent – a referee and a rulebook.

As it is, we are playing the same game, but with hundreds of sets of rules. Each state has its own regulations. Each insurance company has its own policy rules. Each employer makes deals with both insurers and employees. True costs are hidden. It is nearly impossible to find out what we are actually paying or what things actually cost, much less talk about what we are entitled to or who should decide. Everyone tries to game the system, tries to get their hands on some of the $2.4 trillion that will flow through the health care system this year. Insurance companies have strong incentives to deny expensive care. Each doctor and hospital has an incentive to preferentially treat patients who have the best insurance and shun patients with the worst. Each medical student assesses this fiscal landscape and chooses a career specialty based upon the existing rules. No wonder we have more specialists and fewer primary care docs that any other country. No wonder those specialists provide care that is expensive, high tech, and lucrative, even though it leads to outcomes that are no better than the outcomes in countries with different incentives.

Primary care for diabetes is not one of the money makers. All the more reason why Ms. Sotomayor’s life is so remarkable.

We could change all this by starting with one simple rule: people cannot be denied health insurance because they are sick.

To implement this rule, there would have to be rules about what, exactly, is a fair premium to charge – since one way to effectively deny coverage is to price people out of the market. Once the government starts setting rates, then they will also need to subsidize some people in order to make sure they have access to the insurance market. This would have an impact on Medicare and Medicaid, which might have to adjust. Changes might be needed in the rules that currently allow states to regulate their insurance industries. Interstate commerce rules come into play. And so, even a simple rule, if it is to have the desired effect, will require complex elaborations. The system is like a spider’s web, in which a disturbance at any point disturbs the whole, or a Rubik’s cube: you fix one side and find the another side is messed up.

The fact that it is complex, however, doesn’t mean it is impossible. But complexity causes fear, and fear causes paralysis, and paralysis preserves the status quo. Which is also complex. And unfair. So…

In this mess, it is silly for liberals to insist that only government solutions can work and for conservatives to insist that only markets can work, especially because liberals in America are not really bleeding heart socialists – they like markets as much as anyone – and because conservatives in this country aren’t really heartless capitalists – they also believe in charity and safety nets. We have much more in common than it seems. We really should be able to talk about these issues, these problems, and possible solutions without shouting or carrying weapons or invoking Nazis or demonizing capitalists or insurance companies. None of us is pure, none of us is perfect, and we are all in this together.

Yom Kippur is a time to think not just about matters of life and death – and health reform is a matter of life and death – but also to think about our sins and transgressions, both personal and political. We recite long lists of sins, not because we, individually, necessarily committed each and every one of those sins – though some might have – but, instead, to remind ourselves of the ones we have forgotten and to take responsibility for the ones that may have been committed by other Jews, by other members of our sacred community, in our name and thus in the name of God.

So for the sins we have committed by tolerating the unfairness of our health care system, the sins we have committed by our complacency in the face of other people’s suffering, and for the sins we have committed by selfish partisanship and destructive divisiveness at a time we need to come together as a community to solve one of our most important communal problems -- for all these, God, forgive us, pardon us, grant us atonement.

Shana tova…