Happy Birthday Medicare

By Robert Reich, Robert Reich's Blog

27 July 15

edicare turns fifty next week. It was signed into law July 30, 1965 – the crowning achievement of Lyndon Johnson’s Great Society. It’s more popular than ever. 

Yet Medicare continues to be blamed for America’s present and future budget problems. That’s baloney. 

A few days ago Jeb Bush even suggested phasing it out. Seniors already receiving benefits should continue to receive them, he said, but “we need to figure out a way to phase out this program for others and move to a new system that allows them to have something, because they’re not going to have anything.”

Bush praised Rep. Paul Ryan’s plan to give seniors vouchers instead. What Bush didn’t say was that Ryan’s vouchers wouldn’t keep up with increases in medical costs – leaving seniors with less coverage.

The fact is, Medicare isn’t the problem. It’s the solution.

Its costs are being pushed upward by the rising costs of health care overall – which have slowed somewhat since the Affordable Care Act was introduced but are still rising faster than inflation. 

Medicare costs are also rising because of the growing ranks of boomers becoming eligible for Medicare.

Medicare offers a way to reduce these underlying costs – if Washington would let it.

Let me explain.

Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is almost two and a half times the average of other advanced nations.

Yet the typical American lives 78.1 years – less than the average 80.1 years in other advanced nations. And we have the highest rate of infant mortality of all advanced nations.

Medical costs continue to rise because doctors and hospitals still spend too much money on unnecessary tests, drugs, and procedures.

Consider lower back pain, one of the most common ailments of our sedentary society. Almost 95% of it can be relieved through physical therapy.

But doctors and hospitals often do expensive MRI’s, and then refer patients to orthopedic surgeons for costly surgery. Why? Physical therapy doesn’t generate much revenue.

Or say your diabetes, asthma, or heart condition is acting up. If you seek treatment in a hospital, 20 percent of the time you’re back within a month.

It would be far less costly if a nurse visited you at home to make sure you were taking your medications, a common practice in other advanced nations. But nurses don’t do home visits to Americans with acute conditions because hospitals aren’t paid for them.

America spends about over $19 billion a year fixing medical errors, the worst rate among advanced countries. Such errors are the third major cause of hospital deaths. 

One big reason is we keep patient records on computers that can’t share the data. Patient records are continuously re-written and then re-entered into different computers. That leads to lots of mistakes.

Meanwhile, administrative costs account for 15 to 30 percent of all health care spending in the United States, twice the rate of most other advanced nations. 

Most of this is to collect money: Doctors collecting from hospitals and insurers, hospitals collecting from insurers, insurers collecting from companies or policy holders. A third of nursing hours are devoted to documenting what’s done so that insurers have proof.

Cutting back Medicare won’t affect any of this. It will just funnel more money into the hands of for-profit insurers while limiting the amount of care seniors receive.

The answer isn’t to shrink Medicare. It’s to grow it – allowing anyone at any age to join.

Medicare’s administrative costs are in the range of 3 percent.

That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums).

And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

Meanwhile, as for-profit insurance companies merge into giant behemoths that reduce consumer choice still further, it’s doubly important to make Medicare available to all.  

Medicare should also be allowed to use its huge bargaining leverage to negotiate lower rates with pharmaceutical companies – which Obamacare barred in order to get Big Insurance to go along with the legislation.

These moves would give more Americans quality health care, slow rising healthcare costs, help reduce federal budget deficit, and keep Medicare going.

Let me say it again: Medicare isn’t the problem. It’s the solution.

Why I'm Not Ready to Rule Out Suicide in the Case of Sandra Bland

By Ray(nise) Cange, Black Girl Dangerous

27 July 15

promised myself I wouldn’t watch the Sandra Bland video. I didn’t think my soul could handle it. I should have been more honest with myself when making that promise. I should have known that I would have to avoid Facebook because autoplay does not care about my mental health. I saw it playing and I clicked on it. And I heard a dialogue that made me weep.

Sandra Bland was arrested because she didn’t put out her cigarette. Listen to the moment of escalation. It is her refusal to put out a cigarette that is in her car that sends an officer on a power trip. He drags her out of the car, out of view of the camera and we only hear her voice crying out in different ways. I counted 13 times, other sources reported 14, where she asked what she was being charged with only to receive no answer.

This video was clearly edited. I can only imagine what is shown on those missing seconds. But I want to focus on the fact that this video was released as a way to justify her arrest. I am sure the goal was to show an “uncooperative” Black woman. For me, it showed a Black woman who knew her rights and demanded they be respected. It showed me a man using the power of a system to break a woman. And the intentional, deliberate actions of this man is why I believe it is plausible for Sandra Bland to have committed suicide.

When the hashtag #IfIDieInPoliceCustody first started, I was apprehensive. I shared a few things on Facebook and retweeted a few thoughts, but things didn’t sit right with me. And finally it clicked: I couldn’t say that I wouldn’t kill myself if I were in police custody.

The surfacing of this video confirms that Sandra Bland was subject to a violent, racist, and trauma-producing encounter with the police. And after seeing what I saw, from a video that was edited to remove what I believe are the worst parts, I refuse to dismiss the idea that she may have committed suicide.

Not only do I believe that the impacts of violence against Black bodies could push someone to mentally breaking, I also refuse to say Sandra Bland didn’t commit suicide because she is “not that type of person”. It is dangerous to push that narrative because it implies that there is a type, and does not leave room for nuanced discussions of mental health in the face of violence.

There is not a type of person who commits suicide. There are red flags for some people, ranging from a history of depression to past attempts, but I believe anyone can reach a breaking point. The only “evidence” that says she was not “that type of person” is the archetype of the “strong Black woman,” which does not allow for Sandra Bland to be a full human being who was impacted by trauma. This narrative also paints suicide as weakness. And for me, as someone who lives with depression and suicidal thoughts, suicide has always lingered in the back of my head as the option to say I am strong enough to walk away from this life of fighting systems that seek to destroy me.

The shifting of suicide from a position of weakness is why I want us to not take suicide off the table and to recognize the power within that action, if she did commit suicide. Sandra, from the beginning, refused to give up her power. And in that jail cell suicide may have been a form of resistance and an astounding statement of self-love. A statement saying I will not give you the power to kill me and I love myself enough to not endure you killing me slowly.

I want us to hold multiple truths. Whether Sandra Bland committed suicide or not, we can indict a system. We must hold nuanced discussions that address the implications of state violence while removing the stigma around mental health and suicide, recognizing that state-sanctioned violence can produce suicide as a response. Black people, especially Black women, do not all possess the strength and resiliency to continue to move through a world made brutal by white supremacy. And we can fight against state-sanctioned violence while recognizing the ways in which suicide can be a manifestation and a resistance to that same violence.

So #IfIDieInPoliceCustody, I ask you to do what I am doing for Sandra Bland. Do not deny me full humanity, including the possibility of suicide, and do not stop pushing and interrogating the circumstances surrounding my arrest and my death. Do not wait for a cause of death report to indict the system. Know that no matter how I died, by my hands or the hands of someone else, the system is guilty. Be it a bullet or a self-tied noose, this system kills Black people.