Condition; “Critical”


copyright © 2008 Betsy L. Angert.

Twas the night before Election Day and my mind, heart, body, and soul were filled with fright.  I fear I did not do enough; nor could I have, to truly bring about change.  I more needed time with those that trust me or were still open to reflection.  When last I made calls for candidate Barack Obama, I was slammed, damned, and spoken to with much disdain.  Similar occurred when I stood on a street corner and waved my signs.  Granted, I saw and heard there was much support.  Still, I had friends who would not vote for Senator Obama.  Several were sure that they preferred John McCain and Sarah Palin.  Then, there was John Michael Rubens.  John is eligible, older; he is registered.  This fine fellow has cast many a ballot in his lifetime.  Doctor Rubens is prominent pillar of the community.  The well-trained physician is a scholar.  He cares.  Yet, he would not cast a ballot for either candidate.

John’s positions affected my faith.  Everywhere I went, other people told me to believe, to be hopeful.  However, I knew that no matter who entered the Oval Office, blood would be spilled.  On battlefields abroad and on the streets of America, brutality born of terror would continue to flow.  For some people weapons wield strength.  Innumerable individuals use words to kill.  Some take advantage of signatures on insurance forms, benefits no longer offered with salaries, or just the Health Care system.

Hours before Americans went to the polls, my very close friend, a man familiar with the field of Health Care and the coverage necessary to treat illness and injury, spoke of what time, or a national election tally would not easily erase.  Doctor Rubens avowed, the tangible that he thinks is in need of serious attention, is  the way in which medicine is taught, practiced, and paid for.

John believes the Health Care system is a mess.  He fears it is too far-gone.  No Doctor, Democrat, or Republican, can revive a lifeless body that is virtually dead.  Doctor Rubens offers his diagnosis; the institution known as medicine is virtually dead.

Doctor Rubens has long felt antipathy for elections.  For years, I have endeavored to persuade him to vote.  I did not have, nor did I express, disdain for his decision not to cast a ballot.  I only hoped life’s daily doings would encourage him to go to the polls.  As he shared his personal narrative, I inquired.  “Will you vote in hopes that coverage, costs, and the circumstances for practitioners and patients are improved?”  “No,” was the immediate response.

He laughed.  John Rubens was not joyous or jovial.  The physician was pensive.  He pondered aloud.  No amount of money, and neither of the Presidential candidate’s plans will do anything to improve what John just experienced.  John Michael Rubens recently returned from an extended hospital visit.  He was the patient, not the physician.  

While in the hospital, it became increasingly obvious to the man I love, hospital staffs are underpaid.  Personnel are scant.  Each day more and more positions are cut.  The economic downturn has had a direct effect on employee benefits, on whether ill or injured persons seek care, and on the ratio of attendants to individuals admitted to the hospital.

J.M. Rubens, M.D. observed nurses, physical therapists, and specialists in surgical procedures are asked to stretch them selves beyond what any person could physically, or emotionally endure.  He recounts his own medical history, as a Doctor, and in treatment.  John marvels.  Surgeons, who may stand for as long as seven hours in the course of a single operation such as his, make less per hour than he earned decades earlier.  The number of people medical practitioners in every field serve has increased.

Among specialists, invasive cardiologists’ compensation declined (0.18 percent loss) even before inflation.  Conversely, noninvasive cardiologists’ compensation increased 11.72 percent.  Compensation for emergency medicine physicians and hematology/oncology also failed to keep up with inflation.  Specialists who fared better included anesthesiologists (6.43 percent increase above inflation) and urologists, posting a gain of 5.5 percent above inflation – compounding a similar gain in 2006.

“Although primary care physicians posted modest gains in compensation as a result of increased productivity and re-weighting of evaluation and management codes, overall practice costs continue to rise at staggering rates,” said William F. Jessee, MD, FACMPE, president and CEO, MGMA.  “The continued uncertainty of the reimbursement environment creates an untenable situation for physician groups.”

Compensation, when it comes, is inadequate.  In truth, the doubtful delivery of reparation is, in part, why John retired early.  If the patient is “covered” by Medicare, reimbursement is less.  The time needed to evaluate is not considered in the repayment.    Little is.

Doctors have complained for years that Medicare rates haven’t kept pace with costs, such as new technology and the added paperwork required by insurance companies.  The formula for determining reimbursement rates has basically been unchanged since Medicare was created in the 1960s, said Gondo.

Medicare reimburses doctors for about 46 percent of their fees while private insurance pays from 60 to 65 percent, said Dr. Timothy Melhorn, medical director at Cornerstone Medical Clinic, which is owned by Yakima Valley Memorial Hospital.

Medical practices incurred a 7 percent increase in operating costs in 2005, but Medicare reimbursed doctors less than half that amount, according to the Medical Group Management Association, which advocates for medical practice managers.

Doctor Rubens reminds me of what he received when I was a Medicare patient.  The payment was very low by today’s standards.  Even then, before he saw me, he told me he would not take on another patient who did not have private insurance.  His office maintained a waiting list. Quality referrals were my entrance into his office for one visit.  All those decades ago, John agreed to see me for a single appointment.  Fortunately, for me, during our first encounter, he realized we had so much in common.  John Michael Rubens, thankfully, decided to add me to his workload. Rarely, do the millions on Medicare list have this opportunity.

Today, in territories such as Texas, more than forty percent [40%] of physicians will not accept new Medicare patients.  Before 1990, ninety percent [90%] of medical professionals were willing to take on the persons now turned away.

At the time, Doctor Rubens saw me, he felt he could afford one more “charity” case.  Today, he observes medical professionals do not have the time to be so benevolent.  They work more hours than is healthy.  Money does not motivate them.  Indeed, the profession is no longer a fruitful pursuit.

The physical condition of the health care system is not what it was a score ago when John saw me as a patient.  On many occasions, Doctor Rubens has said, “Physicians’ income fell 7 percent between 1995 and 2003 after adjustments for inflation.”  I have heard the many stories.  I recall what he shared of his last years in practice.

When John Michael Rubens was eight years out of Medical School, he was able to purchase a house in an exclusive enclave.  That property is now worth millions.  The lot looks over the Pacific Ocean.  From what was once his window years ago, he had a panoramic, breathtaking view of the surf and shore.  Today’s Doctors, John declared with a deep sense of distress, even after many years in practice, cannot begin to pay for what he had after less than a  decade.

In 2006, in what feels like an eternity ago when we consider today’s economic crisis, the greater number of jobs lost, and a reduction in employer provided benefits, it was reported that Doctors’ income falls over eight years.   Primary care physicians are impacted more than specialists; although at the time of this survey, surgical specialists’ revenue dropped 8.2%.  Young persons who, in the past, thought a future in medicine would be wondrous, are affected by reduced returns on an ample investment.  Fewer wish to enter the medical profession.  

Earnings are but one consideration.  Malpractice premiums, technology for an office and personnel are large expenses.  Then, there is the paperwork, and telephone calls not paid for.

“Every day, I spend at least an hour after my workday to call patients back, to discuss lab results, to discuss test results,” Ryan Mire said.  “That’s not compensated.” . . .

“Just in the last three weeks, I have actually noticed three medication errors from specialists who prescribed medications for my patients because they did not have the full history,” Mire said. “I received those consultation notes, saw what the specialist prescribed, and said, ‘Absolutely not, do not take that medicine.'”

Yul Ejnes, a Rhode Island internist also on the panel [part of an internal medicine conference in DC] added a couple other typical primary care tasks that aren’t reimbursable: “talking with family members,” and “just sitting down and thinking” about a case.

“Sometimes I wonder whether I want to keep doing this,” Ejnes said.

These doctors are not alone.  John Michael Rubens wrestled with the question for quite some time before he decided emotionally, physically, economically, the career he once loved was not worth the toll it took on his personal and professional life.

Recently, for two long weeks, Doctor Rubens laid in a hospital bed, listened to the tales of sickroom staff, and observed what occurred before and after his operation.  John took time to reflect on his earlier evaluations, his money, his health, and his life.  When circumstances were not as bad as they were today, John chose the retirement that has provided him greater perspective.  Frequently, he has mused, ‘There is so much I missed, or just did not understand in the way I do now.’

Time with family, friends was perhaps less than he had hoped it might have been, although he was sincerely committed to his relationships at home, and in the office.  John, the Medical Doctor, in private practice, was more often than not, on call.  Doctor Rubens loved his work.  He chose his profession for the love of people.  Physician Rubens entered a consultation room with a desire to heal.  He yearned to lend a hand to the patient who wished to help him or her self return to good health.  

John took the time to talk and more importantly to listen to his patients.  John Michael Rubens was invested in the Doctor Patient Relationship.  As he speaks with younger Practitioners, who drop in and then quickly out of his hospital room, John grasps, for them, the Hippocratic oath is a luxury they cannot afford.  The current Health Care culture dictates, money matters are the vital sign to be considered.  Empathy for a patient has been eliminated from the profession.  In the latter years of his practice, Doctor Rubens prescribed as practitioners have, “The changes in medicine are at odds with many of the values that defined the profession I joined”

The physician realized there was a transformation when  health insurance companies identified him as a “provider.  He was assigned a number.  His name was as meaningless as his diagnosis.  He spent hours on the telephone in an attempt to advocate for patients.  The ill and injured were denied treatment.  Payment for prescriptions could not be secured.   John recalls when he worked with a particular hospital, months passed and he received no pay.  His children, now attorneys argued he should sue.  Doctor Rubens preferred to just walk away.  Today, he expresses with trepidation, litigation is more prevalent than quality licensed health care.

As the Doctor reminisces, he reflects on the education young interns receive.  He hears tales of woe from his daughter-in-law, who is enrolled in a teaching hospital.  He reads of how these premier institutions are in crisis.  Some experts are anxious.  While no one believes the refuge for research, development, and the place in which a patient can receive better medical care will disappear permanently, the money needed to maintain such stellar institutions is no longer a priority in a managed care culture,

As a physician in practice, John knew times were tough.  However, he did not fully imagine what it must be like for those who are captive to coverage plans that do not consider the wellness of a patient.  Life as one who is in dire need of medical treatment has also opened his eyes.  Only days ago, John was in critical condition.  He had been rushed to the hospital.  Repairs made in a crucial operation years earlier ruptured. Toxins spread throughout his body. The medical professional needed to place his faith, his life in the hands of those who he trusted had stresses of their own.  The surgical procedure was deemed a success.  Physical pain nearly paralyzed John.  His ability to toss or turn was trivial.

Every movement required great effort.  When he rang for a nurse, often, no one came, or they arrived long after he alerted them.  Ultimately, Doctor Rubens realized if he was to receive adequate care and attention, he would need to hire his own personal nurse to perform tasks that hospital employees could not get to.  John Michael Rubens, who is an avid reader, knows the research.

[H]igher patient-to-nurse staffing ratios are associated with higher mortality rates and greater incidence of medical complications and errors, lower job satisfaction, and more burnout among nurses.  The findings that follow in this report provide additional insight into the effects of nurse staffing levels from the perspective of the nurses directly providing patient care in hospitals today.

The survey data demonstrate that nurses view understaffing as a serious problem when it comes both to the quality of care that patients receive and to nurse burnout.  For example, three in five (59%) hospital nurses say that the staffing level at their hospital is having a negative impact on the quality of care patients receive . . .

The study’s data on patient-to-nurse ratios explain why nurses are so concerned about staffing levels today. Med-Surg nurses report that on average they are caring for 8.0 patients per shift

There are so many people to care for.  Yet, circumstances, realities in the Health Care system make this career choice less desirable.  The once sought after benefits, and a superior sense of service have virtually been eliminated from the medical profession.  

As Doctor Rubens may have heard amongst paid health care specialists, the occupation has been reduced to rituals.  Physicians push papers and pills.  Nurses administer shots and sponge up urine. Blood is spilled and no one has the time or resources to repair a medical system in distress.  The condition is critical.  

John feels the pain in the profession he loves.  I too worry and wonder.  Since we spoke of the dire crisis on the day before this decisive election, I inquired as I had so many time in the past, “Will you vote tomorrow?”  Doctor Rubens quickly replied “No.”  John sad with apparent sorrow; he assessed John McCain’s Health Care agenda.  John saw the Republican leader did not put his country or the citizenry first.  Barack Obama, the Physician proclaimed, offers no change that he, personally, could believe in.  John Michael Rubens laments today as he did before there was a President-elect, ‘Yes we can; yet, we do not provide adequate care for Americans.’

Sources for a dire situation; Health Care and Medical Coverage in America . . .

Hillary Clinton, Geraldine Ferraro, the Campaign, and Medical Coverage Issues

Keith Olbermann Special Comment on Hillary Clinton

copyright © 2008 Betsy L. Angert

Talk abounds.  Hillary Clinton, her campaign, and the comments made by Geraldine Ferraro are being discussed on every avenue.  The former First Lady states we need to return to what is more real and relevant.  I concur.  Hence, I invite us to again consider Universal Health Care Plans or the prospect of what is not and will not be if we adopt the “Choice” proposal Hillary Clinton presents.

Rarely do I pen a missive with little research or one that relates more to the personal than the profound.  However, today I wish to take a moment to muse of what is for me, a reality.  Dear reader you may have read the intimate details of my life, or more accurately my history with medical insurance, or the lack thereof.  In Health Care in America; Uninsured, Underinsured, Universal Woes I disclosed what has been true for me, as an adult for all but a year.  Although I was, am, and intend to be a well-educated, professional person, employed, and by all appearances extremely healthy, I have lived life on the edge.

I am among millions of persons in the United States of America that is forced to think, “What if . . .?”  When the unexpected occurs, I must face more than my fears of injury and illness.  I need to gather the strength to heal a financial folly caused by the circumstances prevalent in a country that claims to care for its citizens, and yet, does not.  I could go on and provide details offered in my earlier essay; however, there is no time today.

I need to scurry.  As corporations make many necessary cuts, I again find myself among the millions affected.  Most of my life, I was with those uninsured and I may return to that group.  Threatened by the loss of health care coverage, I must quickly travel to the doctor’s office, if only to ensure my peace of mind.  The diagnosis I seek is validation.  I hope to verify that for now, I am healthy.  Thus, I apologize for being away most of today.

I offer what I think an interesting discussion stimulated by Keith Olbermann’s tirade.  Bombarded with a barrage of barbs in reference to Geraldine Ferraro and her racial, sexist, silly references, Presidential aspirant Hillary Clinton declared . . .

“It is regrettable that any of our supporters on both sides, because we’ve both had that experience, say things that kind of veer off into the personal.

“We ought to keep this on the issues,” Mrs. Clinton said.  “There are differences between us.  There are differences between our approaches on health care, on energy, on our experience, on our results that we’ve produced for people.  That’s what this campaign should be about.”

Please Senator Clinton, let us have the conversation you think most important.  May we chat about your approach to health care.  Later, perhaps, after my doctor’s appointment we can focus on the folly of energy and “experience.”

Hillary Clinton, while what I am about to say may not seem to pertain to health care, it does.  You continue to harp on claims that you are more qualified than Barack Obama.  You state that he has yet to cross over the threshold of Commander-In-Chief.  Silly and absurd as this assessment may be, it brings to mind your plan for “Universal” Health Care.  Separate from the speeches you or Barack Obama offer, I find ample reason to question your supposed “correct” solution for Americans such as I that are uninsured, underinsured, or are about to lose the insurance they have.  

Senator Clinton, you have yet to authentically address the concerns that affect the common citizen.  To force me to purchase what I have never been paid enough to afford, and will once again forfeit, matters, at least to me.  Be I a Black person, insulted by the remarks your close friend and a former member of your vast financial committee made or a white woman who is supposed to understand gender bias, either way, I cannot support your stance on Health Care.

Keith Olbermann may question whether you, Hillary Clinton, are affected by your advisors, and hence, have recently been led astray.  I do not.  My experience is that from the first Hillary Clinton, as a Senator, and as a First Lady, you have never provided the answers to what is a  paradox for the American public.

Throughout this campaign, you have obfuscated, just as you did more than a decade ago in the White House.  In meetings, closed to the community, you created a culture of conflict.  It appears that is your history, your experience.

I invite you Senator Clinton to contemplate the words of Jamie Court voice long before the recent brush up.  Mister Court spoke of your signature Health Care Plan, the price, and the coverage.  He attended to issue, as I wish you had or would.

Mandatory health care won’t curb costs,

What do Mitt Romney, Arnold Schwarzenegger, and Hillary Clinton all have in common?  They all support the government forcing the middle class to buy a private health insurance policy — but none want to limit how much insurers can charge or spend.

And that’s the problem. Mandatory private health insurance proposals are all stick and no carrot.

The average health insurance premium for a family of four is just over 12 grand per year. What middle-class family making, say, 60,000 bucks per year can afford that bill?

What we need is the carrot of affordable health care. That means government standardizing charges by insurers, doctors, hospitals, and drug companies. No more $6 Tylenol in the hospital.

The reason health insurance is so unaffordable today is that no one is watching the costs. With standardization, insurance would be cheaper and people would want to buy it — not have to because the government is threatening them with a tax penalty.

Oh wait, I can hear the plaintive cry of the free market. You can’t tell a doctor, insurer, hospital, or drug company what’s reasonable to charge. That’s socialism. Well, how reasonable then is it to tell every American you have to buy a product whose cost is obscene if you want to be a U.S. citizen? Isn’t that corporate socialism?

Mandatory health insurance is a government bailout of a free market that’s failed its customers. Fewer people and employers are buying private health insurance because it costs so much more and delivers so little.

So rather than let customers demand a new and better product, politicians are forcing us to buy it. Whatever happened to creative destruction?

There’s a business plan of course. Mitt, Arnold and Hillary each received six or seven-figure campaign contributions from the insurance industry. The plan is insurers send the bill and we have to pay it.

Jamie Court is president of the Foundation for Taxpayer and Consumer Rights.

Yikes, I am late, just as the conversation you Senator Clinton promised us is ,  Please let all of America speak of the issue that is most real to millions such as me.  Health Care proposals presented by the Presidential hopefuls do nothing to alleviate the pain of the uninsured, underinsured, or soon to be without coverage.

Senator Clinton, at least with Barack Obama’s Health Care Plan there are no false assertions or assurances that all will be covered.  I prefer the truth.  When a person is honest, the consequences are great.  I experience Barack Obama has integrity, although admittedly his Health Insurance plan does not provide for the people.  Veracity alone is a quality that gives me reason to hope.  If a change is proposed, I can have some faith the submission will be sincere.

First Lady Clinton, if you have found your voice, please use it to speak to real people about issues that are relevant to their daily lives.  Do not tell us you are ready to command [the troops] when persons such as I need Health Care.  We, the people crave a plan that is genuinely Universal, not one that maintains profits for the Pharmaceuticals and Insurers who contribute to your campaign.  

Senator Clinton, when you are ready to devote your “energy” and “experience” to the “issues” that effect average people such as me, each and every day, then, maybe we can have that conversation you proposed when you first declared your candidacy.  For now, you repeatedly state you are “in,” and all I see is that you, or perchance, your plan to insure Americans is  outrageous, out of touch with those who have no health care options, and out of the luck Geraldine Ferraro believes Barack Obama has.  

I believe we create our own destiny. It is not the color of Barack Obama’s skin that is his good fortune, Senator Clinton.  It is his ability to reflect, relate, and be real rather than simply say “get real,” as though that were the cure for what ails America.  Senator Obama’s Health care Plan is seriously flawed; however, Presidential hopeful Obama does not give us the false impression that if he is elected, we all will be covered.  

First Lady Clinton, a time ago you stated for you, this is personal.  Please know, for me, it is as well.  I need to know honestly that the President of my country is concerned for the commonweal and will represent me.  My health, and whether I am able to receive medical care, is a very personal issue.   Rather than rant or rage against a person’s race, let us speak of Single Payer, Not For Profit Universal Health Care.

Sources; A Choice Health Care Plan that does not heal . . .

Clinton and Obama Offer Universal Health Care Plans; No Insurance

Clinton Obama Cleveland Ohio Debate – Health Care Battle

copyright © 2008 Betsy L. Angert

Senators Clinton and Obama, bicker as you might, neither of you have proposed Universal Health Care plans.  Those who support you [plural] state a semantic argument attests to your authenticity.  Many espouse “universal” means “to affect, relate to, or include the whole.”  Granted, all Americans will be changed by your plans.  However, not everyone will be insured if either proposal is implemented.  

Indeed, every United States citizen can connect to the need for coverage.  Universally, we recognize we are in quite a predicament.  Whatever options are offered, the entire electorate will be forced to consider a personal response.  Universality, or an appeal to the aggregate, perhaps better defines what each of you have designed or delivered.

Have you Hillary Clinton or you Barack Obama introduced an actual Universal Health Care plan?  No.  Constituents concerns will be integrated into the agenda.  However, the proposals you have presented to the public, do Not guarantee that life for those who currently are without health insurance will be any better than it is now.  The only certainty Americans have is that some of what is will be altered, just slightly.  

Insurers will still control costs.  Pharmaceuticals can continue to profit, and the poor persons in Middle America will remain insecure, underinsured, and yes, even uninsured.  As one who for most of my adult life has not had insurance, I can assure you, that if a person lives paycheck-to-paycheck, they cannot afford insurance at any price!

I could recount the times that I lay writhing in pain, slipping in and out of consciousness; yet, unwilling to call for help for I feared the cost.  I might share the stories of how or when I went without treatment for the financial expense seemed far greater than the physical toll on my body.  I might mention my fear of an accident, or an age related concern that I need to attend to.  Preventative medicine, pooh-pooh.  I am among many who hope that my mind will control the matter.

I am among millions who still feel the repercussions of decisions made in the 1990’s.  You may remember then, the headlines screamed of the impending crisis.  Employers Winning Wide Leeway to Cut Medical Insurance Benefits.  People cringed.  The then President stepped in.  I am certain Senator Clinton you recall the day.  Bill Clinton appointed his wife to head a panel, which promised to better circumstances.  

Yet, fight as you say you did Hillary Clinton your combative energies did not cure what ails society.  What was, is.  Circumstances convened more than a decade ago continue unchecked.  So long ago, Americans read of a reality they lived.  Today, this phenomenon is normal.

A rapidly growing number of victims of cancer, AIDS and other serious illnesses are discovering that under recent court interpretations of a law that was originally intended to protect employees’ benefits, their insurance coverage can evaporate when they need it most.

The recent [1992] Federal court rulings have given employers that now act as their own insurers wide leeway to cut back on existing coverage — or to skimp on coverage in the first place.  These “self-insured” employers, a large majority of companies from giant corporations to an increasing number of smaller businesses, have been exempted from state insurance laws governing what ailments insurance companies must cover. . .

At the same time, a Supreme Court decision has made it much harder for patients under all kinds of health insurance plans to sue to get benefits they say have been unfairly denied . . .

In effect, the court rulings and the health plans that take advantage of them are another manifestation of a system of private health insurance in which the sick are increasingly separated from the well.

Americans have no assurance that this situation will improve.  Actually, there is ample evidence to indicate it will not.  The prospects for business are grim.  The economy suffers, as do the people.

The economic situation has become distinctly less favorable since the time of our July [2007] report.  Strains in financial markets, which first became evident late last summer, have persisted; and pressures on bank capital and the continued poor functioning of markets for securitized credit have led to tighter credit conditions for many households and businesses.

Slowing job creation is yet another potential drag on household spending. . .

The risks to this outlook remain to the downside.  The risks include the possibilities that the housing market or labor market may deteriorate more than is currently anticipated and that credit conditions may tighten substantially further.

Lest we forget, illness is the cause for one half of all personal bankruptcies.  Most of those who are infirm realized they cannot cover the debt.  These persons have health insurance.  A Harvard University study, conducted in 2005 revealed the inadequacy of many private insurance plans.  Doctors and lawyers examined the current crisis and offered, many policies offer worst-case catastrophic coverage, but little financial security for less severe illnesses.

“Unless you’re Bill Gates, you’re just one serious illness away from bankruptcy,” said Dr. David Himmelstein, the study’s lead author and an associate professor of medicine.  “Most of the medically bankrupt were average Americans who happened to get sick.”

Steffie Woolhandler, Associate Professor of Medicine at Harvard Medical School, in an interview with the Chicago Tribune, described what many of us know but do not wish to discuss.  

“Our study is fairly shocking.  We found that, too often, private health insurance is an umbrella that melts in the rain.”

Certainly, Senators Clinton and Obama you have not touched on this tender taboo in your “debate” rhetoric.  Businesses bleed.  Benefits hemorrhage; and Americans lose Health Care coverage, financial stability, or their lives.  The “Universal” not health care for all plans you each offer exacerbate or ignore what is.  Employment is provisional.  Company provided Health Insurance is more and more a luxury.  When institutions do offer the option, an individual is expected to pay a large part of the expense.  As Americans assess the plans put forth, if they bother to, your [plural] proposed policies do not offer much relief.  Sadly, for countless of the under or uninsured voters, such as I, we have been down so long, now a discussion looks like up.  In truth, talk is cheap.

Mandates that require a citizen with an uncertain salary to provide for their personal insurance needs will leave many in a legal predicament.  For the millions who struggle to survive lower rates bring them no hope.

As prices for fuel, food, and shelter rise, those who could not afford to go to the movie theatre, buy clothing, dine away from home, or vacation certainly will not find the funds to purchase medical insurance,  Gainfully, employed citizens who cannot afford to purchase beyond the basics will not be able to pay for coverage.  The tens of millions who fear a minor fall, for they know, even one Emergency Room visit can break the bank will not be moved to purchase what remains out of reach.  Please Senators, before you begin your ascent to the Oval Office reflect on what is real for most Americans.

[O]f the 47 million uninsured people in the United States, 7.3 million come from families with incomes of $75,000 or more, and an additional 6.9 million earn between $50,000 and $75,000, according to 2006 census estimates.

Some of those with moderate or high incomes may have been shut out of the insurance market because of age or pre-existing health conditions.  Researchers believe a majority are self-employed or among the growing number of Americans whose employers do not offer affordable insurance.  Their only insurance options may be high-priced individual policies.

Those comfortably covered love to discuss the individuals who waste their dollars or do not pay for what they believe they do not, or will not need.  In a recent New York Times report readers were introduced to a twenty-three year old lovely who believed she paid her way through taxes.  She smiled and spoke of the free medical clinics available to her.  Ms. Coons mused,

“I’m young and in pretty good shape,” Ms. Coons said one recent afternoon, on her way to the treadmill at the Fitness Factory in Midtown Atlanta.  “I looked at Blue Cross Blue Shield.  But the only thing I could see myself really needing it for are prescriptions and dental  . . .

She continued, “The insurance premium was more than what I would pay for my prescriptions, so I just decided not to deal with it.”

Times journalists asked Americans to consider the circumstances of those who use the system and do not pay premiums.  Fraud was implied, or a “free ride” was defined and accounted for.

Many free riders are assumed to be young and at little risk of major illness, but they do consume health care.  A recent analysis by the New America Foundation, a Washington policy group, found that 16 percent of the patients who received uncompensated medical care in 2004 had family incomes of at least four times the federal poverty level (which would currently be $41,600 for an individual and $84,800 for a family of four).

They accounted for $5.8 billion of the estimated $41.4 billion in uncompensated care that year.

However, what was not discussed was the ounce of prevention and the pounds paid for a hopeful cure.  Ms. Coons might have been me years ago.  She may not have stated or contemplated an illness, or unexpected injury.  I too appeared fit.  An interviewer might have seen me on the way to the pool.  He may inquire of my Health Insurance plan, or lack there of.  I, possibly would not have explained that I severely injured my back long ago, and then, due to the damage lost my job.  At the time, my employer feared medical charges I might incur, and now I must swim daily to remain physically stable.

In embarrassment, in my youth, I could have, would have, given a glib response.  For decades, I did not wish to speak with strangers of the bulimia I battled.  The preexisting condition that I paid for dearly, helped to affirm medical coverage was not available to me.

I know not of Ms. Coons.  I can only speak for myself.  Bulimia or other “disorders” do not burden my life today.  I do not imbibe any alcoholic beverages.  I never did.  Drugs do not deliver me from depression or dismay.  Prescription and street fare were not my medications of choice.  I have no addictions to strain my budget.  I am but one of millions who scrimps, wishes to save, finds it futile, and fears the veracity.

[T]here is also a shift to the privately insured.  Hospitals and doctors raise their fees to compensate for the losses they incur by treating uninsured and underinsured patients, and insurers pass those increases along to consumers.  A 2005 study found that the shift added 8.5 percent to the average premium.

Presidential aspirants, please ponder what the pundits have not.  Numbers on paper may look lovely.  Economists can scribble statistics on scratch paper.  Power Point presentations can graph the details in glorious color.  Experts can pen impressive essays, and America trusts that you, the candidates can eloquently deliver the text.  Yet, as you may know . . .

Neither campaign has provided enough detail about its plan to enable more than guesswork about how it might influence consumers . . . They have not detailed what kind of subsidies would be needed or who would be entitled to them.  Mrs. Clinton has not fully explained how she would make everyone comply with her plan or exactly how she would cap the amount a family would have to spend on premiums.

Each candidate would raise the money needed to subsidize premiums by rolling back President Bush’s tax cuts for high earners, taxing businesses that do not insure their workers and reducing costs through electronic record keeping, preventive medicine and chronic disease management.

But there is little certainty about how much those initiatives might save, or when. . . .  There are also questions about whether the new savings and tax increases would be enough to subsidize insurance for all who need help.

Both candidates are backed by teams of prominent economists from top universities and policy groups.  But with little real-world precedent to guide them, their assessments are necessarily an amalgam of statistical modeling and back-of-the-envelope calculation.

“In a campaign, people put out proposals that aren’t highly specified, that don’t have enough detail to model them effectively,” said E. Richard Brown, director of the Center for Health Policy Research at the University of California, Los Angeles, and an Obama adviser.  “These numbers are based on a lot of assumptions.”

In speeches, debates and dueling advertisements, Mrs. Clinton and Mr. Obama have brandished projections that even their originators acknowledge are tenuous.

Senators Clinton and Obama, when your own authoritative advisors admit the claims are unsubstantiated, formulas are fragile, and the numbers are shaky, there is reason for concern. Stalwart as you each may be, this character trait may not be a strength in times such as these.  Lives are at stake.  Illness and injuries occur in every moment.  Accidents are not preventable.  People bleed as the two of you argue over the specifics of inadequate agendas.  

If you truly wish to insure every American, be honest with yourselves and us [the citizens of the United States].  The only genuine Universal Health Care Plan is a Single Payer, Not For Profit program.

Your passionate pleas, your tears, and talk do not comfort a citizenry or a system sick and in dire need of help.  Please, feel our pain and protect us.  We, the people need a President that cares.  Provide the preventive, practical, and profound programs.  Do not continue to play with language.  We the people languish, as either of you smile and say, “My plan provides Universal Health Insurance.”  I could just cry, but I worry.  What if I were to weep endlessly?  Dehydration might send me to the hospital.  I cannot afford to see a physician, let alone the premiums you [plural] wish to charge me.

Universal Woes; Wounds, Worry, and the Source of Scars . . .