Americans are mad as hell (The Leftist view from Canada)

My niece saved a woman's life last month. She was in a pool outside Denver when she noticed that a woman who had been doing laps had vanished. She enlisted the aid of a panicked, 17-yearold lifeguard to get the drowning woman out of the pool, then administered CPR until the woman brought forth a geyser of pool water just as the ambulance technicians arrived.

Despite the near-death experience, the woman was sufficiently aware to protest. "I didn't drown," she told the technicians. "You don't need to take me in the ambulance. I can't afford it."

That is America in the 21st century: still wealthy, still powerful - but unable or unwilling to provide basic services at an affordable cost that citizens in most industrial democracies take for granted, to the point where a woman who has almost drowned tries to refuse an ambulance ride.

Nor is the country likely to find enlightenment any time soon, because America is adrift on a wave of anger, in denial of the most obvious political truths:

Medicare works. Gun control works. Ruinously expensive wars in farflung corners of the world always end badly.

It all seems so painfully clear. So why doesn't the U.S. get it, you ask? Part of the answer today lies in the anger industry: billions of dollars poured into a nationwide propaganda effort, enlisting the frustrated and the uncomprehending in a massive effort on behalf of billionaires like Rupert Murdoch, who are behind the scenes pulling the levers.

Monday, the United States of America will celebrate its 235th anniversary. Impossibly old for any human not named Methuselah, still a relative babe in the annals of nations. In a little more than two centuries, the U.S. has been both the beacon of freedom and the dark force undermining the legitimate nationalist aspirations of people from Vietnam to Cuba and the Dominican Republic.

In its 235-year history, the U.S. has fought one of the most brutal and destructive civil wars in human history - a war fought, in the land of the free, to decide whether one human being has the right to own another.

America supplied the wealth and military power that proved pivotal in two world wars, then betrayed the values for which it fought so gloriously by getting involved (despite the prescient warning of former general and president Dwight D. Eisenhower) in a never-ending series of nasty little wars in faraway places, often on the wrong side, from Korea to Panama, Vietnam and Cambodia to Iraq and Afghanistan.

The United States has been held up as a model of democracy, a capitalist prototype in which the dynamism of free enterprise provides best for the most - while the rich have shamelessly manipulated the levers of power to provide most for the fewest.

Now the U.S. is on the brink of another season of madness: the quadrennial election spasm, which is already underway and will last until the first Tuesday in November 2012 - longer than some minority governments here in Canada.

If the past four years are any indication, anger will be the first item on the agenda, because the Tea Party is dictating the tone. As the Republican Party throws up (the phrase is apt) one joke candidate after another (Newt Gingrich, Donald Trump, Michelle Bachmann, Sarah Palin), you shake your head and wonder how any sane person could vote for any of these wild cards.

But they become candidates because, in 21st century America, anger has gone industrial. For Fox News and anger jocks like Glenn Beck and Rush Limbaugh, anger is a big-bucks business. It's the force behind the Tea Party and it has propelled the political careers of those improbable right-wing blunder babes, Sarah Palin and Michelle Bachmann, who appear indestructible no matter how many mistakes they make. Even Palin's gunsight map, with Arizona representative Gabrielle Giffords specifically targeted before she was shot, wasn't enough to end her White House ambitions.

Beck, whose stock in trade is spewing hatred, complained this week that on a visit to New York City, his family encountered the same hatred in reverse. Palin believes it's all right to put gunsight targets on her opponents, but complains that some celebrities hate her. That's America.

The right hates the left. The left (yes) hates the right. The Red States hate the Blue States. Everyone hates the federal government. The election of President Barack Obama in 2008, far from bringing about a new era of peace and harmony between the races, instead triggered a run on gun shops and paranoia. Despite Obama's best efforts to cross the aisle during the first two years of his administration, his Republican opponents set out from the beginning to make it impossible for him to govern.

They were not entirely successful. Obama pressed through a watereddown medicare bill and a successful bailout bill for the auto industry and he became the president who hunted down Osama bin-Laden, despite all that George W. Bush "Wanted Dead or Alive" nonsense. But the right has been able to completely weaken or block much important legislation, including all climate control initiatives, preventing the U.S. from making any significant headway on the most important issue of our time.

How is the right so successful in manipulating voters? It begins with anger. Americans are mad as hell and they aren't going to take it anymore. If you ask what they're mad about, the first two things they will mention are big government and taxes.

Yet the reason a woman who almost drowned would refuse an ambulance ride has nothing to do with any of the above. If anything, most of the problems come from the fact that the government is not doing enough to take care of its people and that Americans don't pay enough taxes to make it possible for their governments at the state and local levels to function properly.

Watch the footage of the rage-contorted faces at a Tea Party rally and you come away scratching your head. What are these people so mad about? They are overwhelmingly white, well-fed (often too much so) well-scrubbed and clearly well off, at least by the standards of most of the planet. They aren't likely to get shot by teenage militia tomorrow, or to be dragged off to jail for years without benefit of trial, or to face a 10-mile morning hike for fresh drinking water.

They know that the U.S. (and much of the world) went through a financial crisis in September of 2008. They have been persuaded, however, to ignore the obvious, which is that the crisis was created by the hedge-fund pirates and derivatives manipulators on Wall Street, aided and abetted by the absolute lack of control coming from the Bush White House.

Instead, the anger is focused on taxes. Why? Because the rich and the well-off don't want to pay taxes. Thus the Tea Party moniker, derived from the original Tea Party in Boston Harbour, marking the beginning of the American Revolution.

But taxes, collected fairly and wisely spent, are one of the pillars of any rational, humanist society. They pay for our schools and roads and hospitals. They make possible, in the context of the U.S., the American dream that any poor child with enough will and moxie can get a university education and become whatever she wants to become: doctor, lawyer or hedge-fund manipulator.

Yet the assault on taxes, made doctrine by the Reagan administration and a key component of Republican Party policy since, is responsible for the near bankruptcy of a dozen states (including right-wing Texas) and the trillion-dollar deficit faced by the federal government. The big lie perpetrated by the last Bush administration, that you can fight simultaneous wars in Afghanistan and Iraq without raising taxes, lies behind that deficit. The two wars have cost at least $1.3 trillion to date with fears that the final total may be significantly higher - but the anger is directed at Obama, who inherited both the wars and the deficit from Bush.

I was at a dinner party a few weeks ago when a Canadian who has lived for years in the U.S. was holding forth with opinions that might have come straight from Fox News. I bit my tongue while he extolled the virtues of George W. Bush and attacked Bill Clinton, but I drew the line when he blamed Clinton for the deficit.

The truth, I pointed out, was that Clinton left the U.S. treasury with a budget surplus. Foiled on the deficit issue, he veered onto a new tack. "Well," he said, "it was Clinton who let all them damned ragheads demonstrate outside the White House until you ended up with them attacking the World Trade Centre."

There is little that can be said in the face of such astounding ignorance. The last time I was in Nebraska, a good, apparently rational friend of mine said she was reluctant to vote for the very Christian Obama because he is a Muslim. She hadn't quite fallen under the spell of the birthers but she had fallen for another of the Big Lies.

Ordinary folks don't pluck these Mad Hatter opinions out of the air: The same and worse can be heard on the airwaves 24 hours a day, from Limbaugh and Beck to Bill O'Reilly, Ann Coulter and all the others who have realized that there is big money to be made by retailing mindless anger as a commodity.

If you listen to the anger jocks, they have little to offer beyond rage - sometimes articulate, more often not. Their tools are bluster, bombast and sarcasm. There is no call to a higher plane of discourse and no room for tolerance - just a hodgepodge of sly winks, "you betchas" and the mostly unspoken promise that all those African-Americans, Hispanics, gays, lefties and unreliable university professors will be put in their place once the Tea Party controls the White House.

Mercifully, that appears unlikely. The more plausible Republican candidates for the White House run in 2012 - Mitt Romney, Jon Huntsman Jr. and Tim Pawlenty - aren't quite as unhinged as Trump, Gingrich, Palin and Bachmann. (Palin, it should be said, has not yet announced that she will run, Trump has dropped out and Gingrich has committed political suicide by taking off for the Greek islands with his paramour at a critical moment in his own campaign - leaving Bachmann as the current standard-bearer for the lunatic fringe.)

Even if Obama wins a second term bolstered by a Democratic majority in Congress, the anger phenomenon is not going to go away. It will only get worse.

There is a warning here for any Canadian worried about the Conservative Party attack ads that helped to destroy Michael Ignatieff's campaign, or the potentially insidious influence of Pierre Karl Péladeau's Sun TV, an attempt to create a Canadian parallel for the destructive bombast of Fox News.

But it's hard to think of any one thing that makes Canadians really mad (in Quebec, some might say it's language) - we're relatively civil.

As the U.S. prepares to celebrate the Fourth of July, the real fireworks display isn't the kind that lights the night sky. It's anger unfettered, the sort of orchestrated rage that undermines humanist values, puts genuine liberties at peril and makes it almost impossible for a rational leader to govern. It is ugly, it is underhanded - and for now, at least, it is almost the first thing that comes to mind when you think of America.

this post is just to inform, not debate with anybody. I am 63 and self-employed and have only had health insurance the past 40 years (480 months), about 10% of the time or about 40 months. None of that was continuous, just here and there. During one period of having health insurance, I had a heart ablation. Cost: $75,000. Got lucky! Insurance paid all but about $7,500. I negotiated that $7,500 to half and paid them off to clean up credit report issues.

Now, basically, I just can’t get insurance so last week I negotiated an MRI down from $2,000.00 to $495.00. Then, a few days later, I had a spine lumbar disc procedure. Cost to insurance was $750.00. I paid cash for $366.50.

I estimate that in 40 years I have saved at an average of 5k a year in premiums or about $200,000.00.

Now, there are all sorts of conclusions that all sorts of people can draw about the foregoing experiences. But, one is not debatable. When a patient pays CASH..........the price goes down...........but you gotta shop around and you gotta ASK!

Anybody paying the INSURANCE PRICE is just a damn fool.

THIS ALSO PROVES THAT THE ONLY WAY TO BRING HEALTH CARE COSTS DOWN NATIONALLY IS TO BRING THE PATIENT INTO EACH TRANSACTION WHERE HE/SHE HAS SOME SKIN IN THE GAME! SINCE IT WAS MY MONEY, AND NOT SOME INSURANCE COMPANY’S, I CHECKED AROUND AND DID SOME OLE FASHIONED NEGOTIATING!!

The foundation of medical care is predicated on what is known as fee for service.

The Usual and Customary or Reasonable (UCR) fee is defined as the charge for health care that is consistent with the average rate or charge for identical or similar services in a certain geographical area. To determine the UCR fee for a specific medical procedure or service in a given geographic area, insurers often analyze statistics from a national study of fees charged by medical providers, such as the data base profile set up by the Health Insurance Association of America (HIAA). Some insurers compile their own data using their own claim information; UCR can therefor vary by carrier. Carriers use these statistics to chart a range of fees for each geographical area in which services are provided. Then, when you submit your claim for a specific treatment or procedure, the insurer pays all or part of the claim, depending on whether the amount of the claim is within the Usual and Customary allowance. The amount that the insurance carrier pays is called the allowed amount, the remainder is the write-off amount.

ALL carriers consider their fee schedules to be "proprietary" (confidential information belonging to the insurer, not shared with the public). If there is time you can request a predetermination of benefits from the insurance company. Most carriers will request a written statement from the doctor with the industry CPT codes for the proposed procedures before providing a predetermination of benefits.

Many carriers utilize medical bill review companies. These entities review procedures by CPT code and evaluate the reasonableness for the procedure in accordance to protocols established for each ICDM-9 diagnosis code. Procedures may be denied as not necessary for any arbitrary ICDM-9 dx. The charge for that CPT code would then be forwarded by the provider to the patient in accordance to established UCR billing. The difference between billed and UCR is writen-off.

Suppose an insurer determines that it will pay UCR fees falling below the 80th percentile of the fee range. If you have a tonsillectomy and your medical provider charges a fee for a tonsillectomy that is higher than what 80% of the providers charge in that region (according to the insurer’s UCR fee schedule), the plan will exclude coverage for the amount over the 80th percentile and that amount will be the patient's responsibility. If your provider charges a fee that is below what 80% of the providers in the region charge for a tonsillectomy (according to the company’s usual and customary fee schedule), your claim will not be reduced. The patient coinsurance amount is calculated after the UCR fee is determined. Therefore, if your policy pays 80% for the tonsillectomy, the benefit paid will be 80% of the UCR fee (which is calculated at the 80th percentile).

If the provider is "non-participating" (doesn't have a contract) with the carrier, they are NOT under any obligation to accept the reasonable and customary payment whatsoever either in part or in full; the patient may be balance billed. If the provider is participating (has a contract) with the carrier, the patient may not be balance billed, except for co-payments and/or co-insurance (if applicable). That constitutes insurance fraud; contact the carrier and ask that it step in. Depending on the circumstances that could result in denial of ALL claims made by that provider. It is really no different than disputes made by a customer against a vendor.

If the patient is covered by a preferred provider option policy (PPO), then they must use participating providers to obtain the best benefit available under the policy. The PPO policy allows the patient flexibility to use non-preferred or non-participating providers (as opposed to Health Maintenance Organizations (HMOs), which explicitely limit the patient to the closed network of providers). However, this flexibility may come at a great out of pocket cost which may not be realized when reviewing benefits. Many PPOs now pay non-participating providers based upon the negotiated rate that would have been paid to a participating provider had one been used one. For example, let’s say that a PPO policy pays 70% for non-participating surgeon charges and a bill for $5,000 is incurred from a non-participating surgeon. Now let’s say that a participating provider would have been paid $2,000 for the same surgery. Using the contracted or negotiated rate as a basis for payment, the carrier will pay 70% of $2,000 for the surgery. The patient's out-of-pocket will be $600.00 for the 30% copayment and another $3,000 for the amount over the negotiated fee. NOTE: the $3,000 does not accrue to the out-of-pocket maximum on the policy.

Another fee methodology being used by some carriers is payment for non-participating provider claims based on a percentage (for example 200%) of the Medicare published rate for the same or similar service. This methodology can result in very low reimbursement of the non-participating provider claim because Medicare rates are relatively low rates established by the federal government for payment of Medicare claims.

Cost accounting for medical providers is one of the most complicated subjects known to man. What has to be kept in mind is that for any provider there are fixed and variable costs. As soon as the patient walks into the door they're paying for the rent, utilities, salaries and maintenance costs. Moreover, there are several schools of thought with regards to equipment. Suppose that a facility acquires a major piece of diagnostic equpment costing $15 million.

According to Generally Accepted Accounting Principles (GAAP), the equpment must be depreciated w/in a set period of time. Typically after 5 years the equipment has residual value that of scrap. So $15 million over 5 years is straight line depreciation of $3 million per year. You either use that equipment on everybody, or you only use it once per year. If you do one test per day, each test would cost $8200. OR you charge $5000 per test, and spread the remaining $1.6 million equitably across ALL other procedures performed. Otherwise each test costs $3 million. Suppose the insurance company pays $5000 per test. That means that $2.995 million would be distributed across ALL other procedures. On the other hand, if the equipment is used on EVERYBODY, although per test costs are much less the equipment wears out faster and significant repair expenses are incurred. Furthermore, the equipmnt may not be available in an emergency.

One of the major costs incurred by medical facilities are that of emergency care and trauma facilities. Now throw in the GAAP allowance for doubtfull accounts and cost accounting for medical facilities can quickly become an intractible mess.

One solution that has been proposed is establishment of fixed pricing. Each and every item has a fixed price and each and every occupation has a specific wage. These things are established by edict.

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