by Donna Smith

Since the health insurance reform bill passed this past spring, you’d think we suddenly stopped having American patients die and suffer unimaginable horror at the hands of the corporate owned and operated healthcare business system in the United States.  No one tells the stories. The reality is that patients were props, and they just aren’t needed as props any more.

An estimated 45,000 preventable deaths occurring in these United States annually due to the lack of access to appropriate healthcare marches on.  That does not account for those dead from other preventable causes like medical error.  45,000 every year.  That’s 123 dead every day.  Today’s dead: 123.  Have you seen that reported anywhere?  Yesterday’s dead?  123.  Any reports?  Tomorrow’s dead?  123.  Is anyone trying to save those pending dead?

Though more Americans die preventable deaths every day without access to healthcare right here at home than die in weeks on any foreign battlefield, no one is searching for them in the wilderness of greed and profit-driven medicine.  No one needs their painful realities right now.

123  Dead today.

Patient stories were used as props by elected officials, mainstream and alternative media members and groups, advocacy groups and think tanks.  Relatives of dead patients made especially good fodder for the debates.  Moms and dads of dead kids were prime targets to stand up on stages, sit at witness tables and have their names and details of the loved-one’s death shared with the world.   Cancer patients who could not access care were pretty valuable too.  If they could still stand, think and talk, cancer patients made for great photo-ops for all and better fundraising tools for others.

123 dead tomorrow.

Some may say this is to be understood as the nation has moved on to other issues following the passage of the health insurance bail-out bill –  we are now worried about jobs, the oil spill,  the Arizona immigration bigotry, the leak of documents on the Afghan war.  All critical issues to be sure. Some may add that we’ll just have to wait and see if those numbers drop in 2014 or 2016 or 2018 as parts of the health insurance reform bill unfold

123 dead yesterday. Those insistent dead just don’t stop dying.  They aren’t waiting for a third political party to emerge.  They are the dead and the dying.

Patients are dying and suffering every single day in larger numbers even as the weeks of recession roll on and medical providers become even more tightly controlled about uncompensated and undercompensated care – meaning they are protecting their bottom lines too and uncompensated care is the term used for patients who come without any means of payment or with inadequate means of payment.  Patients are suffering more, not less.  Payments are demanded up front.  Patients cannot pay the thousands or even the hundreds required for treatment.  More death, not less.

123 people today will not die pretty, gentle, fade away in their sleep deaths with tearful loved ones at their sides.  They may have spent weeks or even months begging for someone to treat them.  They may have been working even weeks ago or days ago but unable to get past the co-pay and deductibles of their insurance to get early treatment and unable to slack off for even one moment on their jobs lest an opportunistic employer decide to lay people off based on unspoken measures of value, like use of sick time for doctor visits.  They will die after arguments and struggles with those they leave behind as the financial pressures mounted and their illnesses deepened.

I searched every news outlet page I could find to see if anyone was reporting on yesterday’s dead.  No one did.  123 people died, and few people even noticed their passing.  I searched to see if anyone was reporting the impending slaughter of 123 innocents in the United States today, and no one is reporting on it.

Along with the 45,000 dead, we allowed 700,000 patients and their families to go belly-up financially in 2009. In the U.S., medical crisis leads to more than 50 percent of the personal bankruptcies (and of those patients, 75 percent had health insurance).  So, as we saw personal bankruptcy filings rise 31.9 percent overall in 2009, we also added more patients and their families into our deadbeat files.  Even if those folks get well physically, we’ll punish them forever for having gone broke.  Bankruptcy bruised credit takes years to repair.

123 dead today. 1,917 going broke today in the midst of medical crisis.  In this nation. Yet no one reports.  No one.

The one thing I know for sure is that the patient horror stories were certainly an integral part of the fuel that moved any debate on health reform to take place at all.  The dead and dying made for a better frame for press pieces than simply selling health reform as a way to bail out the private, for-profit health insurance industry and bolster the medical-industrial complex overall.  Patients are necessary in this system and in the debate only to the extent that without them you cannot run the engines of medical profit.

123 dead.  1,917 in financial collapse.  Homes lost.  Futures torn apart.  And no one reports.

There are those who still clamor for real transformation of the U.S. healthcare system from the for-profit model to a social insurance model like extending and improving Medicare for all.  But even many of those people have somehow decided that it’s only the money arguments that need to be made – only the profit-takers who need convincing with the language of more profit and fortunes still to be made.

I disagree.  I think someone must have the courage to keep reporting the healthcare war dead.  In fact, I believe their faces and their names ought to be more prominent as we go forward as measures of what we are allowing to be done to our fellow human beings in this nation.

123 dead yesterday.  123 dead today.  123 yet to die tomorrow.  Since the passage of the health insurance reform bill in March 2010, 14,670 American patients are dead.  And no one spoke their names.   The day we become a nation that turns its back on that much death and suffering is the day we have lost much more than a political battle — we’ve lost our collective soul.

By Donna Smith

Oh, the things we did not fix in the healthcare bill are shocking.  Just as seniors falling into the Medicare drug benefit donut hole begin to get the $250 checks meant to calm their fears about our new healthcare legislation, the rest of us would do well to remember the abuses of the for-profit healthcare system that will continue and even accelerate in the coming years.

Health insurance is not health care.  Health insurance is a financial product marketed and sold to protect health and wealth which may do neither thing very well. I view it as a defective product.   Yet, very soon we will be buying more of it and helping more of our fellow Americans buy more of it with the subsidies that support the great health insurance bailout that is being called “patient protection.”

Yesterday, I went to the doctor for an appointment I waited weeks to secure.  I am insured.  I have what some would say is fairly good insurance from one of the for-profit insurance giants.  I waited patiently in the waiting room, and then was escorted to the exam room.  There was a flurry of activity around me.  A thorough history was taken.  X-rays were taken.  The nurse said, “Oh, honey, are you in pain?  Those X-rays show some pretty awful deformity.”  I said I have been hurting for years but that I have waited until I could stand no more to seek treatment.  Most of the time I take large amounts of OTC anti-inflammatory medication and muddle through.  It’s the American way.  It’s the insured American’s way.  It’s the working, insured American’s way.

The doctor buzzed in rather quickly and began discussing a treatment plan with me.  Some immediate care to relieve some of the pain, and some longer term non-invasive care to see if we could avoid surgery.  I was hopeful and thrilled though a bit worried about how it would feel to get shots in the joints of my feet to help the heel spurs and the bone pain.  I’ve had shots in my knees, and it isn’t fun.

Suddenly, as quickly as I had felt the anticipation of some relief, the flurry of activity ground to a halt.  The doctor left the room.  Another office person came in.  She said, “I’m sorry Ms. Smith.  Your insurance will not cover what the doctor wants to try.”  Matter of fact.  She’s said these words before – many times.  I ask how much it would cost to pay for it myself.  She answers.  I cannot pay that much.  The visit is ending.  The hope is shriveling.

I could feel the muscles in my face tense as the humiliation spread through my body.  This body, just moments ago worthy of plans to relieve pain and head for some better health, now was deemed unworthy of care.  Shame.  All that old shame I used to feel before our medical bankruptcy was rising in my gut.  It hurt so badly.  But I was determined not to show my anger or my sadness.

The doctor wandered by the room and saw me.  He stepped in and gave me some soft inserts for my shoes.  He said they won’t help much or for long, but that maybe it would be a little relief.  He must have seen the look on my face and felt at least a little compassion.  A little.  I thanked him. But I could say little else, and I could not look him in the eye.  I felt so ashamed, and I don’t even really understand why I’ve been so conditioned as a patient to feel it is my failure when these things happen.

On the way home, I alternated between sadness and anger.  Clearly someone wasn’t being honest with me.  Either the treatments this doctor was suggesting really aren’t a good idea (as the insurance company’s denial to pay would lead one to believe) and therefore are not approved for coverage or the insurance company just wants to push those costs onto patients who cannot usually afford them.  Either way, I didn’t get the care I needed.  Either way, I left hurting.  Either way, I lose.  The doctor made some money on the office visit and my co-pay at least.  The insurance company avoided paying for anything beyond that.

My husband sat beside me in the car, sad and angry for me.  As a person covered under one of our nation’s single-payer programs and a supplemental private policy, he has never heard the words I heard – he has never been denied care.  He felt helpless for me.  As I cried tears of rage, he sat silently.

And, so, how will any of this change under the new healthcare bill?  It won’t.  In fact, the pressure for insurance companies to deny more care will grow as they are compelled by law to take more people who have pre-existing conditions like having feet.  Cherry picking the healthiest folks will require a bit more skillful contortions for the for-profit insurance companies, and doctors will leave more patients sitting on the edge of exam tables like naughty little children who do not deserve to be treated.

Healthcare is a basic human right in most of the rest of the modern world.  Only in this nation do we believe that only the richest people deserve the best of care.  It’s a wild twist on the old Bible lesson about it being tougher for a rich man to get to heaven than for a camel to get through the eye of a needle.  We’ve made it harder for a working person or a poor person to get healthcare in America than for a rich man to get to heaven.  We are a sick society indeed.  No Golden Rule values herein.

Only when we finally decide that we believe in a compassionate and just healthcare system for all will we ever have the courage to change it.  Right now we just don’t believe in that sort of system at all.  As a patient, I am fodder.  At least this morning I was able to turn my outrage back on the system that left me in that exam room alone and sucking back tears of anger.  No one should go to a doctor to seek care and leave less well.  That’s cruel and unusual.

I was raised to have more compassion than this for my fellow human beings, and I think most Americans were raised with similar values.  How in the world did we get to a place where we participate in doing this to one another?  Is this the system we want to leave to our children?  Do you want to leave your child lacking care when he or she needs it?  Your grandchild?  Then, for heaven’s sake — for heaven’s sake — stand up and let’s get back to work to fix this mess.  There is much to be done.

Three women who were featured in Michael Moore’s 2007 documentary, SiCKO, will be marching, meeting and speaking in support of healthcare as a basic human right in the United States this week in Detroit at the U.S Social Forum. Each woman will convey the message that even the recently passed health insurance reform will not prevent their stories from happening to other Americans in the future. The three women serve together on the board of American Patients United and advocate for transformation of the US healthcare system into one of healthcare for all, not just some.

“I wish I could say that the new health care bill meant we’d won the fight for decent medical care for all Americans. It doesn’t, it means the fight has just started. Everyone should listen to what Donna,

Reggie and Adrian have to say,” added Moore as three of his documentary subjects continue to raise concern about healthcare in America.

SiCKO followed the stories of several US patients with health insurance who had been unable to get adequate healthcare or who were devastated financially due to insurance inadequacy or denials.  The film also featured a segment showing several patients traveling to Cuba to seek the medical they were unable to get in the United States.

Donna Smith of the Washington, DC, area, now works for the California Nurses Association/National Nurses Organizing Committee and is also the co-chair of Progressive Democrats of America’s national Healthcare Not Warfare campaign, but when SiCKO was released three years ago, she and her husband Larry had filed for bankruptcy due to medical crisis and also lost their home, even though they were fully insured.  “I wish it were not so, but Congress did little to change the stresses in the US healthcare system that led to my family’s financial collapse – in fact, as more Americans are forced to purchase insurance that often is only affordable with high deductibles, co-pays and out-of-pocket expenses, many more will face financial ruin when they get sick.  I expect medical bankruptcy to continue to rise unless we stem the tide with a truly universal, improved Medicare for all.”

Reggie Cervantes of Oak Hills, CA, was featured in SiCKO as one of the 9/11 first responders who have been struggling to get healthcare ever since she helped on the scene at the World Trade Center in the 2001 terrorist attacks.  “I remain committed to seeing that everyone has access to healthcare so no rescue worker, no person working to serve the public ever again is left injured and ill.  Just as thousands of 9/11 workers still fight to get care for respiratory illnesses, cancers and PTSD, thousands more people now working on the Gulf oil spill will face the same health and financial damage as this current tragedy unfolds.  President Obama was right to compare this environmental catastrophe to 9/11, but I certainly hope that two or three or five years from now, the workers won’t face what 9/11 rescue workers still face today in terms of the lack of access to appropriate care and relief.”

Adrian Campbell Montgomery of Wolverine Lake, MI, slipped across the border to Canada with her little girl to seek care she could not afford in the United States, and those scenes are featured in SiCKO.  Today, like many thousands of Michiganders, Adrian faces mounds of medical debt and low prospects for employment.  “Having huge medical bills this early in my life is forcing me to make life choices that might have been different if we had a truly just healthcare system in this country.  Instead, I work terrible jobs when I can find them and get few or no benefits, so that when I get sick, I cannot get care without worrying about the bills and the collection agencies and all the trouble later.  We need a single-payer system that covers all of us no matter what.”

All three women have stayed in touch since the movie’s release in 2007, and refer to one another as “SiCKO sisters.”  They share a bond born of pain and shared suffering and the belief that they do not wish to leave this system to their children and grandchildren.

The SiCKO sisters will march in the USSF opening march on Tuesday afternoon, June 22, participate in a single-payer healthcare workshop on Thursday, June 24, 10 am – noon at the UAW Building, and will help facilitate a healthcare discussion along with several other groups on Friday, June 25, from 1 to 4 pm in Cobo Hall. All three women are also members of Healthcare-Now, one of the sponsoring organizations for the healthcare events at the USSF.

For press availability for interviews in advance or on the ground in Detroit, June 22-26, call Donna Smith at 773-617-4493, Reggie Cervantes at 760-515-0297, or Adrian Campbell at 517-304-3018.

By Donna Smith

It’s 10:45 p.m. when the patient’s legs begin to shake.  First like a chill setting in and then more like a tremor.  The only thing that helps is standing.  As the shaking continues, the patient breaks out in a cold sweat and has a mild chest discomfort, something he has learned to listen to after 20 years of cardiac difficulty.  Both the patient and his wife dress quickly, get in the car and make the 10 mile drive to a local well-respected hospital emergency room.

And the saga began that no insurance reform bill will fix.  It is only through a systemic transformation that this barbaric system of non-delivery of healthcare in the United States will be fixed.

Inside the ER waiting room, children are crying, a woman holds a plastic bowl on her lap as she vomits, a young man sits with gauze wrapped around a hand obviously cut, and there are no open seats not littered with fast food bags, soda bottles or other discarded pieces of trash.  It is now 11:30 p.m.

After filling out an intake form, the patient sits at a child’s table in a chair close to the floor that was made for a 5 year old but is called in to a triage area for a quick EKG and a blood draw just to rule out a heart attack.  Though his main worry is the tremors and a headache that has gone undiagnosed for almost 10 months, with his complicated cardiac history (including three open heart surgeries), the heart takes precedence for this medical staff.  But no one even asks about the tremor or the headache.  No one asks him to explain so that he can mention the fleeting numbness down his right side.  He had a brain MRI to try to find out what is going on the day before at an outpatient clinic for which results are not yet available, but the triage staff is uninterested in that and has done its immediate duty, and the patient is put back out into the general waiting area.  It is 12:15 a.m.

Before he left home, the patient took his normal medications – he had no way to know that he’d be seeking emergent medical care in the hours ahead.  So the medication he takes at night before bed has left him groggy and even a bit disoriented.  His wife picks up trash from a few chairs, takes it to the overflowing women’s bathroom trash can and then wipes down a chair so she can sit next to him.  She already mentioned the messy waiting room to the staff, but no one came to clean up.  The vomiting woman is still there; the young man with the cut hand is slumped over a table-top sleeping and another young woman has brought a urine specimen cup out to the bathroom with the overflowing trash to give up a sample.  She looks like she feels terrible.

The television drones on with late night talk shows and the closed captioning running slightly behind the sound.  Another patient in a wheelchair leans over to sleep and her family covers her with jackets to keep her warm.  It’s now 1:30 a.m.  No one has returned to ask the patient how he feels or to check on any of his other symptoms or to tell him if the cardiac enzymes drawn were normal or not – he and his wife must guess that no communication means no heart attack.  But no one says that.  No one says anything.

The patient tries to dose sitting up but jerks himself awake as he worries what is happening inside his body.  No one calls his primary care doctor – that just isn’t done anymore.  Doctors do not generally race over in the dead of night; doctors do not generally call patients when the office has closed for the day.  Patients must fend for themselves with the internet as a symptom guide and a guess about whether an emergency room trip is needed or not.

By 2:30 a.m., the patient and his wife are wondering how long others have waited.  Five hours.  Six hours.  Some seem grateful just to have anyone ask or notice them at all.  Little children are restless and crying if not sleeping.  And the patient’s headache continues along with the tremor and occasional numbness.  No one even peeks out from triage to see if he is still there or doing OK.  No one calls his name.  There are gurneys in the hallway with no one on them where the patient could lie down, but no one offers.

At 3:30 a.m., the patient and his wife realize that they might be safer at home and just a phone call away from 911assistance than they are in this emergency room waiting area.  The patient and his wife have not even seen a doctor much less spoken to one.  They realize that perhaps the soonest they will see a doctor is the next day when normal business hours arrive again and not in this hospital setting.

Finally, the patient and his wife ask that the IV needle be removed and that he just go home.  No one says they are sorry.  No one asks much of anything as it seems this is a fairly normal course of events for the staff.  More than three-an-a-half hours after arrival, the patient has no more information than when he arrived, he is now very weary and still suffering most of the symptoms that brought him to seek care.  No one cares.  One staff member tells the patient he could have waited for a bed, but she says it out of annoyance not out of concern.  Perhaps she’ll be reprimanded for losing a billable hour or bed in the ER. No matter.  The patient did not come first.

The patient walks to his car as his wife supports his unsteady gait, and they drive home.  Headache.  30-pound, unintentional weight loss in three months.  Now leg tremor and occasional numbness.  Months and months of worry and suffering, yet treatment is in very short supply.  The patient has insurance – Medicare and a private supplemental.  It is not a money issue.  No one really cares, and that is the issue for today’s patients.

Patients are part of an assembly line of profit-making and profit-taking.  Some may be lucky enough to find medical professionals who remember what caring about people means in terms of offering medical care, but few do anymore.  They’ll write it off to overcrowding and overuse of services and they’ll blame it – always – on the patients they mistreat.

The health insurance reform passed this year will not relieve these problems for patients.  In fact, as more people have insurance they may be fooled into thinking that means they’ll have care, and nothing could be less true.  Having insurance is not having healthcare.  Ask any one of those vomiting, bleeding,  trembling emergency room patients waiting in the night for some relief or even the slightest communication about when relief might be expected.

I believe in a progressively financed, single standard of high quality care for all because I think the funding mechanism we have now – the for-profit, private insurance model – drives this assembly line mentality ever forward.  But the problems in our healthcare system go way deeper than just the financing methods.  We have a human dignity and human rights problem.

That patient is my husband.  But he could be anyone.  It’s a mess out there.  After months and months of appointments with specialists who treat one body part or system and rarely look beyond their own billing silos, there is the nearly inevitable crisis and the dreaded trip to the ER in the middle of the night.  But there surely is no diagnosis and no treatment.  There are headaches and tremors and fear and pain.

And until we create a humane healthcare system in which treating people’s suffering and people’s illness is our priority, we can pay for it any which way we want to and it just won’t matter at 3:30 a.m. in a dirty, crowded emergency waiting area.  What have we come to?

Friends:

After much discussion, we are experimenting with using ads on our site to generate revenue for the organization.  If you have thoughts, or suggestions please let us know.

APU

Here is an informational commercial on Single Payer that the good folks in Washington have distributed for your viewing pleasure. Single Payer

By Donna Smith

Just blocks from President Obama’s Hyde Park home south of the Loop in Chicago, more than 70 activists gathered on Saturday, March 27, 2010, to plan strategy for advancing an improved and expanded Medicare for all system as the law of the land.  Activists across the nation are undaunted by the passage of the current health reform bill as they know that mandating the purchase of private insurance is not the same as providing access to healthcare.

Joining the activists from throughout Illinois was Illinois State Representative Mary Flowers, chief sponsor of Illinois’ single-payer health reform bill HB311, seen in the photo on the left.

By sharing their successes in advancing the Medicare for all, single-payer position, the activists spent eight hours together, broke into issue panels and came away with the formation of four task forces to explore the most effective and strategic ways to move the movement in Illinois both in terms of state legislative energy and as part of a larger national movement.

Among the engaged activists were nurses from various practice settings and locations throughout the state.  Many have seen drastic cuts to programs and services in their communities, and as patient advocates remain firmly committed to restoring not only those programs and services cut but also improving and enhancing patient access and care until a single standard of high quality care is the law of the Land of Lincoln and the Land of Obama.  HB311, The Health Illinois Act, would assure RNs in Illinois that no patient would be turned away because they lacked insurance, lacked adequate cash to self-pay or had been denied treatment by an insurance company.

Nurses will serve on each of the four task forces created:  legislative, media, labor and direct action.  The legislative task force will assess the work necessary on Illinois’ elected officials — both state and federal — to help advise other single-payer reform supporting groups how best to motivate those in office to support and defend HB311 and national improved and expanded Medicare for all and how to select and target campaigns of those wishing to be elected in Illinois to make sure those candidates are single-payer solid.  The media task force plans to do outreach to local and regional media to develop better lines of communication and enhance chances for coverage of single-payer issues and also make good use of the members within the Illinois Single Payer Coalition who create media on the web and beyond.  The labor task force will work with local labor bodies to enhance advancement of the AFL-CIO’s Resolution 34 supporting single-payer reform and will research becoming a part of the national Labor Campaign for Single-Payer.  And the direct action task force will continue seeking effective settings in which to challenge the power of the profit engine — private insurance, big Pharma, corporate healthcare providers, etc — with those actions which will advance the cause of single-payer reform.

Also on hand for the day was Dr. Quentin Young of Physicians for a National Health Program.  Dr. Young is a long time resident of Hyde Park, and PNHP has its national office in Chicago.  Katie Robbins of Healthcare-Now was also in from Philadelphia and New York and facilitated the meeting.  Several members of Progressive Democrats of America’s Chicago chapter helped plan the meeting, as did members of the local and state Green Party along with members of CHI-SPAN, the Chicago Single Payer Action Network, a wonderful group of people from Access Living in Chicago, Health Care for All Illinois (HCAI) members, the Champaign County Health Care Consumers, and a strong contingent of activists from Springfield and from East St. Louis, IL.  Every group worked cooperatively and with purpose to celebrate the path forward for all who believe that healthcare as a basic human right applies to every person — not just those with money or influence or both.

The event was hosted by the Illinois Single Payer Coalition with tremendous support offered by Dr. Anne Sheetz, who always lends her intelligence and humanity to the effort to transform healthcare for all in her state.

My participation was complete joy in seeing a movement that has been insistently advancing for the past several months firmly plan next steps and remain undaunted by whatever the political turmoil and tumult in DC.

My home state — and my beloved Chicago — can do so much to entrench common Midwestern values about right and wrong and human decency into a healthcare discussion that all too often is focused on revenues and denials and everything but good health for all.

Onward, Illinois.  Onward.

Nurse Volunteer Group to Coordinate Emergency Nursing Mission
The nation’s largest organization of registered nurses tonight activated its nationwide disaster relief program to recruit nurse volunteers to provide assistance to residents of earthquake devastated Haiti, the National Nurses United announced Tuesday night.

Registered Nurse Response Network sent more than hundreds of  nurse volunteers to the Gulf region following Hurricane Katrina. RNRN has also sent volunteers to Sri Lanka after the South Asia tsunami and to help following huge Southern California wildfires.  RNRN is affiliated with National Nurses United, AFL-CIO, the national union and professional association for Registered Nurses.

Details are still being worked out, but nurses can sign up at the NNU website, www.nationalnursesunited.org.
NNU will also provide follow up information at www.twitter.com/nationalnurses for details and plans.
The 150,000-member NNU was formed last month through the unification of California Nurses Association/National Nurses Organizing Committee, United American Nurses, and Massachusetts Nurses Association.

Through RNRN, the organization hopes to send nurses to provide emergency short term and long term medical support, as it has in previous major disasters. Following Katrina, for example, RNRN volunteers worked with local healthcare and emergency agencies and officials in mobile clinics, area hospitals, and other healthcare settings in Louisiana, Mississippi, and Texas.

“We are calling on nurses throughout the U.S. to join us in this critical effort,” said NNU Executive Director Rose Ann DeMoro.

“Nurses will be fundamental to the disaster relief process, to provide immediate healing and therapeutic support to the patients and families facing the devastation from this tragic earthquake,” DeMoro said.

From our friends at the NYT …..

A Less Than Honest Policy

By BOB HERBERT

There is a middle-class tax time bomb ticking in the Senate’s version of President Obama’s effort to reform health care.

The bill that passed the Senate with such fanfare on Christmas Eve would impose a confiscatory 40 percent excise tax on so-called Cadillac health plans, which are popularly viewed as over-the-top plans held only by the very wealthy. In fact, it’s a tax that in a few years will hammer millions of middle-class policyholders, forcing them to scale back their access to medical care.

Which is exactly what the tax is designed to do.

The tax would kick in on plans exceeding $23,000 annually for family coverage and $8,500 for individuals, starting in 2013. In the first year it would affect relatively few people in the middle class. But because of the steadily rising costs of health care in the U.S., more and more plans would reach the taxation threshold each year.

Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress’s Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy.

Proponents say the tax will raise nearly $150 billion over 10 years, but there’s a catch. It’s not expected to raise this money directly. The dirty little secret behind this onerous tax is that no one expects very many people to pay it. The idea is that rather than fork over 40 percent in taxes on the amount by which policies exceed the threshold, employers (and individuals who purchase health insurance on their own) will have little choice but to ratchet down the quality of their health plans.

These lower-value plans would have higher out-of-pocket costs, thus increasing the very things that are so maddening to so many policyholders right now: higher and higher co-payments, soaring deductibles and so forth. Some of the benefits of higher-end policies can be expected in many cases to go by the boards: dental and vision care, for example, and expensive mental health coverage.

Proponents say this is a terrific way to hold down health care costs. If policyholders have to pay more out of their own pockets, they will be more careful — that is to say, more reluctant — to access health services. On the other hand, people with very serious illnesses will be saddled with much higher out-of-pocket costs. And a reluctance to seek treatment for something that might seem relatively minor at first could well have terrible (and terribly expensive) consequences in the long run.

If even the plan’s proponents do not expect policyholders to pay the tax, how will it raise $150 billion in a decade? Great question.

We all remember learning in school about the suspension of disbelief. This part of the Senate’s health benefits taxation scheme requires a monumental suspension of disbelief. According to the Joint Committee on Taxation, less than 18 percent of the revenue will come from the tax itself. The rest of the $150 billion, more than 82 percent of it, will come from the income taxes paid by workers who have been given pay raises by employers who will have voluntarily handed over the money they saved by offering their employees less valuable health insurance plans.

Can you believe it?

I asked Richard Trumka, president of the A.F.L.-C.I.O., about this. (Labor unions are outraged at the very thought of a health benefits tax.) I had to wait for him to stop laughing to get his answer. “If you believe that,” he said, “I have some oceanfront property in southwestern Pennsylvania that I will sell you at a great price.”

A survey of business executives by Mercer, a human resources consulting firm, found that only 16 percent of respondents said they would convert the savings from a reduction in health benefits into higher wages for employees. Yet proponents of the tax are holding steadfast to the belief that nearly all would do so.

“In the real world, companies cut costs and they pocket the money,” said Larry Cohen, president of the Communications Workers of America and a leader of the opposition to the tax. “Executives tell the shareholders: ‘Hey, higher profits without any revenue growth. Great!’ ”

The tax on health benefits is being sold to the public dishonestly as something that will affect only the rich, and it makes a mockery of President Obama’s repeated pledge that if you like the health coverage you have now, you can keep it.

Those who believe this is a good idea should at least have the courage to be straight about it with the American people.

So, all the great fanfare and all the king’s horses. The great and almighty U.S. Senate has spoken. I will have to buy private health insurance – forever, amen. The defective product that has left me wanting for real healthcare for all of my adult life is now a step closer to being the law of the land.

A lump of Christmas coal all polished up with sparkling rhetoric.

Here’s what the Chicago Tribune said this week, and I agree:

On Sunday, the Chicago Tribune published an exhaustive front-page analysis by Northwestern University’s Medill News Service and the Center for Responsive Politics of how it was done. The main culprit: “a revolving door between Capitol Hill staffers and lobbying jobs for companies with a stake in health care legislation.”

The study found that 13 former congressmen and 166 congressional staffers were actively engaged in lobbying their former colleagues on the bill. The companies they were working for — some 338 of them — spent $635 million on lobbying. It was money extremely well spent — delivering a bill that, by forcing people to buy a shoddy product in a market with no real competition, enshrines into law the public subsidy of private profit.

As we approach the end of Obama’s first year in office, this public subsidizing of private profit is becoming something of a habit. It is, after all, exactly what the White House did with the banks. Just as he did with insurance companies, Obama talked tough to the bankers in public, but, when push came to shove, he ended up shoving public money onto their privately held balance sheets.
This is not just bad policy, it’s bad politics.

Now, back to my own thoughts as a patient:

I went broke while carrying health insurance, a disability insurance policy and a small healthcare savings account. And if I get sick under this mess of a plan, it will happen to me again. Little has changed except that millions more of my fellow citizens will join my ranks.

How does it happen to insured people under this plan? Easy. Step-by-torturous-step. Slowly. Like water-torture.

1. Buy health insurance at work or on the new exchange;

2. Avoid using insurance due to co-pays, deductibles and out-of-pocket maximum exposures – not to mention lost work time and the worry about losing one’s job in a tough economy;

3. If symptoms are noticed, treat by internet medical site suggestions and over-the-counter drugs until no other option but going to a doctor are available;

4. Attempt to make appointment with doctor but first find one who accepts both new patients and your insurance;

5. Go to doctor and pay co-pay up front before ever speaking to anyone about medical problem;

6. Sit in outer waiting room for as long as required, missing work and worrying;

7. Sit in exam room waiting for doctor for as long as required;

8. See doctor for five or six minutes, if lucky, during which time you will either be prescribed some expensive drug to fix a problem the doctor isn’t sure you have, referred to another doctor who may have a month or two wait for appointments, be directed to get some tests done you aren’t sure your insurance will allow or pay for, and do it all sitting in your underwear or less;

9. Leave medical office owing more than what you thought your insurance and co-pay advertised (and never get an explanation for how that is possible) and never sure if this experience was much different than being to a used car lot where the sales folks have assessed your financing mechanism before showing you anything at all and then only show you what fits the financing not what you need or want;

10. In the alternative, if you collapse or wait until symptoms get so severe that going for an office appointment is impossible, go to an emergency room – repeat steps five through eight – and either be admitted to the hospital if your insurance is adequate and you have any available sick-time from work (if not, beg for drugs and to be released) or go to number nine.

11. Need a dentist? Too bad. Have dental insurance? Still too bad. You might get a cleaning and some x-rays, but getting the care you may or may not need will be again totally related to your ability to pay whatever portion of the dental work is not covered (and amazingly, every penny of what dental insurance will cover will be eaten up by whatever problem you may or may not have) – in the alternative, avoid dentists or just pull teeth as they go bad;

12. When the bills roll in, try to pay some after trying to find out how you can possible owe hundreds if not thousands more than the insurance policy you have indicates is possible;

13. When the collectors call to collect all of the balances due, try to negotiate payments but endure threats of lawsuit, garnishment and worse as the collectors report back to the doctors you saw for a few moments in number eight;

14. Try to get your meds – if too costly, go without;

15. Try to get well – if you cannot, go back to work;

16. Try to act like this is all wonderful and you are grateful to have any insurance at all;

17. Get sued by a collection agency for a doctor bill or hospital bill you cannot cover;

18. Sell your house and use whatever proceeds you have to try to pay some of the debts;

19. Collectors for the doctors and hospitals are not happy if you don’t pay it all in full and up-front most of the time;

20. Feel stress, fear, anguish – but don’t gripe and don’t show it at work – buck it up, chump;

21. Sell keepsakes and anything valuable to try to stay afloat;

22. Stress, more stress. Fear to answer the phone. Friends and family fall away as they don’t want you to ask to borrow money;

23. Keep working – sick or not, keep working or you’ll lose that damn insurance if you cannot pay the premium – or you’ll be back out on the exchange trying to buy another policy that is cheaper and even worse;

24. Watch your elected officials claim victory and history as they work to make sure your kids and grandkids must suffer the same fate if they need healthcare in America;

25. Have a Merry Christmas, so says your U.S. Senate.

Don’t think this can happen to you because it hasn’t yet? Count your blessings this Christmas.

I’d really like the gift of healthcare. Medicare for all, single-payer healthcare would remove so much of this awful process. That would be a gift.