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We Need a Centralized Medical System Too

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Ted Rall

Is there a central database for medical records in the U.S.? - Quora

The coronavirus pandemic has laid bare two fundamental flaws in the American healthcare system.

Number one: There’s a reason that other rich countries treat healthcare as a taxpayer-financed social program. Employer-based health insurance was stupid pre-COVID-19 because our economy was already steadily transitioning from traditional full-time W-2 jobs to self-employment, freelance and gig work. The virus has exposed the insanity of this arrangement. Millions of people have been fired over the last two months; now they find themselves uninsured during a global health emergency. The unemployed theoretically face fines for the crime of no longer being able to afford to buy private healthcare.

The second inherent flaw in the U.S. approach is that it’s for profit. Greed creates an inherent incentive against paying for preventative and emergency care. Even people who are desperately ill with chronic conditions see 24% of legitimate claims denied.

When your insurance company issues a denial, they don’t merely pocket that payment. They also add to future profits. Even if you’re insured, the hassle of knowing that you might get hit by a surprise bill for uncovered/out-of-network charges makes you more likely to stay home rather than to risk seeing a doctor or filling a prescription and going broke. “Visits to primary care providers made by adults under the age of 65…dropped by nearly 25% from 2008 to 2016” due to routine denials by insurers, reports NPR.

Denials also create a societal effect: news stories about patients with insurance receiving bills for thousands of dollars after being treated for COVID-19, even just to be tested, prompt people to stay away from hospitals and try to ride out the disease at home. Some of those people die.

There’s another, third structural problem exposed by the pandemic—but it’s not receiving attention from public policy experts or the media. I’m talking about America’s lack of a centralized healthcare system.

A centralized healthcare system has nothing to do with who pays the doctor. A centralized system can be fully socialized, government-subsidized or fully for-profit. In such a scheme all patient records are stored in a central online database accessible to physicians, pharmacists and other caregivers regardless of where you are when you need care. If you fall ill while you’re on a trip away from home, the admitting nurse at a walk-in clinic or hospital has instantaneous access to your complete medical history.

The current system is primitive. Data is not transferable between doctors or medical systems without a patient’s directive, which inexplicably is often required by the obsolete technology of sending a fax. That assumes the sick person is sharp enough to remember which of his previous doctors did what when. And that’s it’s not a weekend or national holiday or a Wednesday, when some doctors like to golf.

Unless a patient happens to be wearing a medical alert bracelet, there is currently no way to determine whether an unconscious victim is allergic to a drug, has a chronic illness or that there’s a treatment regimen proven to be more effective for them. Even if the patient is alert and conscious, a new doctor may ignore her request for a specific medication in favor of cookie-cutter one-size-fits-all treatment.

A few months ago I developed the classic symptoms of what we now know to be COVID-19. I live in New York. I succumbed while on business in LA. Trying in vain to fight off a relentless dry cough, difficulty breathing and day after day of brutal aches and fever, I visited a CVS walk-in clinic. I have a long history of respiratory illnesses: asthma, bronchitis, pneumonia, swine flu. I requested a third- or fourth-generation antibiotic since I knew from experience that I would inevitably decline with anything less. “We do not treat viral infections with antibiotics,” the nurse, a charmless Pete Buttigieg type, pompously declaimed. I pointed out that viral lung infections usually have a bacterial component that should be treated with antibiotics.

This would not have been a issue back home in New York, where both my general practitioner and my pulmonologist know my medical history. Either doctor would have prescribed a strong antibiotic and a codeine-based cough syrup.

Because I happened to be in LA, I left CVS empty-handed.

I declined.

It got to the point that I couldn’t walk 100 feet without pausing to catch my breath.  I felt like I was going to die.

I called my doctor back in New York. She called in a prescription to the same CVS. It helped arrest my decline. But I wasn’t getting better.

I visited a different walk-in clinic, in West Hollywood. It was a better experience. They tested me for flu (negative), X-rayed me (diagnosis was early stage- pneumonia) and put me on a nebulizer. I began a slow recovery.

A centralized system would have been more efficient. The CVS nurse would have seen my history of non-response to treatment devoid of strong antibiotics. He also might have taken note of my pulmonologist’s effective use of a nebulizer to treat previous bouts of bronchitis and pneumonia. I might have been prescribed the proper medication and treatment as much as a week sooner.

COVID-19 almost certainly would have been detected in the United States sooner if we had a centralized medical system. “One example of a persistent challenge in the early detection of health security threats is the lack of national, web-based databases that link suspected cases of illness with laboratory confirmation. This leaves countries vulnerable, as they cannot accurately and quickly identify the presence of pathogens to minimize the spread of disease,” according to the U.S. Centers for Disease Control. Algorithms can automatically scan massive volumes of information for signs of novel infectious diseases, help identify potential problems and focus responses where they are needed most.

How many people’s lives could have been saved if lockdown procedures had begun earlier? If public health officials had seen the coronavirus coming back in December—or November—they might have been able to protect vulnerable populations and avoid a devastating economic shutdown.

There are substantial privacy considerations. No one wants a hacker to find out that they had an STD or an employer to learn about documented evidence of substance abuse. Keeping a centralized healthcare system secure would have to be a top priority. On the other hand, there is no inherent shame in any kind of illness. In a nightmare scenario in which medical records were to somehow become public, no one would have anything to hide or any reason to look down on anyone else.

We can’t pretend to be a first world country until we join the rest of the world by abolishing corporate for-profit healthcare and decouple insurance benefits from employment. But reform without centralization would be incomplete.

(Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, is the author of the biography “Bernie,” updated and expanded for 2020. You can support Ted’s hard-hitting political cartoons and columns and see his work first by sponsoring his work on Patreon.)

Would You like Some Coronavirus with Your Wealth?

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Ted Rall

The coronavirus crisis is laying bare massive inequities in society. What’s interesting though is that because we are dealing with a contagious virus, even the rich and powerful can no longer hide from the effects of their perfidy and greed.

Masochistic Kinks Exposed

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Ted Rall

55% of Americans want to keep their current private insurance plan. They should discuss that with a psychologist but you know it wouldn’t be covered under their health plan.

Damn Bernie Sanders Has Had It, Goddammit

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Ted Rall

In the second presidential debate of the 2020 cycle, democratic socialist Bernie Sanders made headlines by noting that he had written the “damn bill” on switching Obamacare to Medicare for all.

SYNDICATED COLUMN: Here’s the Constitutional Amendment We Need But Never Thought About

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Ted Rall

Image result for public urination

Amendment XXVIII: No law governing a basic human need shall be passed in a jurisdiction whose government fails to provide citizens with the means to fulfill that need.

Start gathering petition signatures.

If you’ve ever had to work for someone else, you’ve probably been presented with a no-win situation of someone else’s making. “Be promptly at your desk at 9 am,” my boss ordered me. “We can’t have customers calling at the start of business with no answer.” Reasonable. But it was a two-man office — him and me — he had the only key and he was often late. When customers complained, he’d yell at me. “What would you have me do,” I’d ask, “break in?” Unreasonable.

A lot of bosses are stupid little tyrants. But government should know better than to pass a law its citizens can’t obey.

Like most cities, New York prohibits public urination. It’s no longer a criminal offense but public pee-ers still risk a ticket and a fine. The NYPD issues 20,000 to 30,000 such summons a year. Yet, as The New York Times noted in 2016, “New York City…is one of the most public-bathroom-resistant places in the world.”

People pee. People poo. A city that chooses not to provide people to pee and poo knows that some folks won’t find their way to Starbucks or other de facto public restrooms before it’s too late.

The city wants people to pee and poo in public.

Experts estimate that properly equipping Gotham’s streets with the thousands of toilets necessary to serve the city’s inhabitants and visitors would cost tens of millions of dollars. “I gave you a pot to piss in” isn’t the legacy most mayors want to be remembered for (though perhaps they should reconsider). Getting NYC to do the right thing by everyone with a bladder would require ratification of my proposed 28th Amendment.

If nothing else, those who answer nature’s call in the streets and avenues could do so without fear.

Some people charged with a crime have successfully used the “necessity defense” that the harm they committed was necessary in order to avoid a greater wrong or harm. If you’re trying to escape from someone trying to kill you, a judge should dismiss the charge that you trespassed on private property to get away.

Yet, even though it defies common sense, American law still permits government to pass laws that are impossible to follow. In June the California Supreme Court ruled on a law requiring gunmakers to microstamp bullets fired from semi-automatic weapons with unique identifying information.

The court’s ruling was complicated but it included this gem: “impossibility can occasionally excuse noncompliance with a statute, but in such circumstances, the excusal constitutes an interpretation of the statute in accordance with the Legislature’s intent, not an invalidation of the law.” In other words, an impossible-to-follow law can be passed and no court can invalidate it. Each individual who wants to be exempted on the basis of impossibility must hire a lawyer and file a lawsuit.

The Impossible Law Amendment (ILA) would ensure that any law deemed impossible for any citizen to follow would be overturned on constitutional grounds.

Impossible-to-follow laws are more common than you might think.

The Affordable Care Act requires people to purchase health insurance from private for-profit corporations or get slapped with a fine when they file their annual tax returns.

The cheapest healthcare plans in the Obamacare marketplaces run around $1600 to $1800 in many counties. One out of four Americans say they can’t afford healthcare. If the United States insists on spending tax dollars on blowing up brown people in Muslim countries rather than caring for its own sick people, that’s a political priority this nation is free to select. But it’s insane to charge people a fee for not buying something they can’t afford. Punishment is immoral if there was no intent or desire to disobey the law.

The ILA would effectively eliminate an entire class of government fines for things people are mandated to buy but must have in order to live: motor vehicle registration fees, smog inspection fees, parking.

On July 27 The New York Times reported that parents, usually mothers, are routinely arrested and have their children taken away from them by child-welfare authorities, because they can’t afford daycare and so are found guilty of such “abusive” behavior as leaving their kid in the car for a few minutes while running into a store.

Children have died of heatstroke in locked cars, so it reasonable for the police to be concerned when they come across a possible case of neglect. But society should not criminalize the behavior of people who have no other choice. Daycare runs about $200 per week per child. Individual average income runs about $500 a week before taxes, or $350 after taxes. Unless the average American goes without food or shelter — which child-welfare authorities will look down upon at least much as leaving a kid in a car — he or she can’t afford daycare. In many other (civilized) countries, of course, daycare is provided gratis by the government.

If and when the U.S. provides daycare for all, it may prosecute parents for refusing to use it.

A government that passes laws that anyone — much less a significant portion of the population — cannot obey, yet imposes fines and jail terms, deserves nothing but contempt. Ratify the ILA!

(Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, is the author of “Francis: The People’s Pope.” You can support Ted’s hard-hitting political cartoons and columns and see his work first by sponsoring his work on Patreon.)

 

How the Press Leads “The Resistance”

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Ted Rall

The Trump Administration is guilty of countless wrongdoing, including monstrous acts that no one cares about, at least not in the press. In the meantime, the media is obsessing over a meeting between a 2016 Kremlin-connected Russian lawyer, Donald Trump, Jr. and a number of other attendees.

Doomcare

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Ted Rall

House Republicans voted to overturn the Affordable Care Act (Obamacare). Now it’s off to the Senate. Because the House vote was considered political suicide, triumphant Democrats began taunting Republicans on the floor of the Congress, on national TV. You’d hardly know lives were at stake.

The Hopelessness of Unaudacity

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Ted Rall

Confronted with an optimistic opponent who promises substantial changes in American foreign and domestic policy in the form of Bernie Sanders, establishment candidate Hillary Clinton has been reduced to promising incremental improvements, and defending past gains. She argues her approach is more pragmatic. But will voters be satisfied with more of the same?

SYNDICATED COLUMN: Healthcare Insurance Pigs Soaking Americans With Secret 20%-40% Rate Increases on Obamacare

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Ted Rall

http://pilothealthadvocates.com/wordpress/wp-content/uploads/money-greedy-234x300.png

This is what happens when you trust free markets.

You probably heard that the Supreme Court rejected the latest legal challenge to the Affordable Care Act, a.k.a. Obamacare, a.k.a. The Great Transfer of Taxpayer Dollars to Scumbag Health Insurance Companies. That news broke during a major news day.

What you likely missed, because it came out on July 3rd when everyone was driving to the beach or flying somewhere fun for their Independence Day weekend getaways instead of paying attention to the news, was that the ACA is tanking. That’s why you have me: to read depressing tidbits about America’s decline, and to annoy Obamabots with another I-told-you-so.

When Obama resurrected 1993’s benighted Hillarycare scheme, I warned that there were two major problems with this convoluted hybrid of government-managed healthcare and for-profit healthcare.

First, the Affordable Care Act kept the insurance companies in business. Aetna, United Healthcare and the other big insurers are a huge drain on the system, sucking out billions in profits and driving up costs. Profitmaking has no place in healthcare, which is a basic human right, like air and water. Air and water are free; healthcare should be free too. But that’s the opposite of what drives health insurers: they want to give you as little care as possible while charging you as much as possible.

Second, the ACA diminished Americans’ zeal for socialized medicine, the standard in the developed world. “In legislation no bread is often better than half a loaf,” Robert La Follette, the Wisconsin Progressive of the late 19th and early 20th centuries, pointed out. “Half a loaf, as a rule, dulls the appetite, and destroys the keenness of interest in attaining the full loaf.” I wrote last year: “In 2007, before Obama and his ACA came along, 54% of Americans favored single-payer. Now, thanks to a system that’s better than nothing but not nearly good enough, it’s down to 37%. Hillary Clinton is endorsing Obamacare, and has officially come out against single-payer.”

Now that the public has had a chance to use and pay for Obamacare, support for single-payer is back up to 50%.

Back to that story that broke on the deadest news day of the year. From The New York Times: “Health insurance companies around the country are seeking rate increases of 20% to 40% or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected…Blue Cross and Blue Shield plans — market leaders in many states — are seeking rate increases that average 23 percent in Illinois, 25 percent in North Carolina, 31 percent in Oklahoma, 36 percent in Tennessee and 54 percent in Minnesota, according to documents posted online by the federal government and state insurance commissioners and interviews with insurance executives.”

Did your paycheck go up 20%, much less 40%, in the last year? I didn’t think so.

The proper reaction to this disgusting move — remember, we’re talking about a for-profit corporate sector that rakes in billions of dollars a month and pays its CEOs millions of dollars a year — is to line up the executives responsible against a wall and shoot them full of holes, then deny the healthcare claims of any who survive just because, as the rest of us routinely experience.

Since that would be illegal, however, the second-best approach should be to shame the bastards relentlessly on social media, until they’re forced to go join ISIS because people would subject them to Two Minute Hates wherever they go. (Not to say that ISIS, which provides free healthcare, would want these human turds either.)

This is where one naturally turns to political leadership. Surely the President of the United States, a.k.a. He For Whom Obamacare Is Named, will crack down on these insurance pirates?

Not so much. Obama “said that consumers should put pressure on state insurance regulators to scrutinize the proposed rate increases. If commissioners do their job and actively review rates, he said, ‘my expectation is that they’ll come in significantly lower than what’s being requested.'”

No doubt the healthcare industry itself, which rakes in billions each year from their new involuntary customers, hears our anger.

Not so much. Marinan Williams, CEO of the Scott & White Health Plan in Texas, which applied for a 32% rate hike, says: “Over the next three years, I hope, rates will start to stabilize.” How about we “stabilize” her salary at 32% less than she gets now?

How’s your interest in the “full loaf” — single-payer socialized medicine — now?

(Ted Rall, syndicated writer and the cartoonist for The Los Angeles Times, is the author of the book “Snowden,” the first biography of NSA whistleblower Edward J. Snowden. It is in graphic novel form, and will publish August 18th. You can subscribe to Ted Rall at Beacon.)

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