This Week in Elder News: 12 January 2008
A Kafka-esque Nightmare in Elder Abuse

All Americans Deserve CheneyCare


[ This is not a repeat. Some of you may have seen the image below as part of another story posted last week. I removed it when I realized it was confusing apples and oranges, and is expanded here today.]

Universal healthcare, also called single-payer system, has emerged along with the economy in general as a top domestic issue of the presidential campaign. You wouldn’t know that from the Republican candidates who support the status quo of market-based, private healthcare. But the Democratic candidates have heard the call of the populace for universal coverage and have remarkably similar proposals.

Dennis Kucinich is the only one supporting a true, single-payer system based on the Medicare. Other than him, the Democrats all offer play-or-pay to employers. That is, provide health coverage to employees or pay into a fund to support the cost of coverage from pools to be created to offer coverage to those who don’t get it from their employers. All the proposals subsidize low-income families.

Recently, the leading Democratic candidates have been squabbling over “mandates”:

  • Barack Obama’s plan would mandate purchasing coverage for children, but not adults – at least in the beginning.

  • John Edwards wants to automatically enroll people on tax returns, but not mandate coverage until costs come down.

  • Hillary Clinton supports mandates, but can’t decide if there should be penalties for non-compliance

One problem with all the mandate plans is that even with subsidies, some people cannot afford coverage. In fact, Mitt Romney’s universal coverage plan in Massachusetts, in effect now for a couple of years, has so far needed to exempt 20 percent of people from the mandate.

Another difficulty is that all the proposals maintain private insurers in the mix, an unlikely method of lowering costs. All elders need do to realize that is check the percentage increases in their Part B and Part D premiums this year.

An important financial aspect of a successful universal healthcare plan is including everyone in the pool. The 80/20 rule of business applies to healthcare; about 20 percent of the population uses 80 percent of healthcare. By spreading the cost – through taxes, premiums, subsidies where necessary, etc. – everyone contributes and everyone, rich and poor alike, has equal access to healthcare.

If the 80 percent of healthier people object to financing the 20 percent, they would do well to keep in mind that each of us is only one disease or accident away from joining the 20 percent. And if the wealthy want to purchase additional coverage for luxury hospital rooms and monkey-gland treatments at spas in Switzerland, fine. But healthcare is a human right and the time has come for the United States to join the rest of the industrialized nations in granting that right.

Contrary to conventional wisdom, the U.S. does not have the best healthcare in the world. It lags far behind every other industrialized nation in the standard benchmarks of national health including life expectancy and infant mortality, and those other nations achieve their superiority at a much lower cost per person than the United States.

During the caucus campaign in Iowa, the California Nurses Association and the National Nurses Organizing Committee ran this clever (and true) image in local newspapers campaign and are now taking the ad campaign national.

SIGN OUR ONLINE PETITION FOR CHENEYCARE, says the headline above this image:


"CheneyCare!" Don't you love it. The ads support HR 676 intended to extend Medicare to all citizens. There's a website, Guaranteed Healthcare, supporting CheneyCare which they describe thusly:

“Unlike the average American, the president, vice president and members of Congress all enjoy government-financed health care with few restrictions or prohibitive fees. They are never turned away for pre-existing conditions or denied care for what an insurance company labels ‘experimental treatments.’ Such are the benefits of what we call ‘CheneyCare.’”

Although it makes a good deal of sense, HR 676 is an unlikely contender for adoption for the entire country if for no other reason than it eliminates private health insurers who contribute so much money to presidential and congressional campaigns to preserve the status quo. But the CheneyCare initiative raises awareness of the disparity between what kind of healthcare our officials grant themselves and what they are willing to do for the rest of us. For that alone, it’s a terrific idea.

Only Dennis Kucinich, who has little chance of gaining the Democratic nomination, would support CheneyCare for all. So if the best we can expect from the rest of the candidates is a hybrid of public and private healthcare, any of the other candidates will be fine on that issue and I’ll take it for now. Let’s just get something that covers everyone in any form and tweak it later.

[At The Elder Storytelling Place today, Ronni Prior tells the tale of a special pair of Little Brown Boots.]


I remember hearing an interview about Carol Mosley Braun's single payer plan on NPR when she was trying to get nominated. Her explanation was so perfectly clear and detailed, it was obvious that this was the way to go. I immediately signed up as a supporter of hers, alas to no avail.

The only real answer is to cut out the insurance corporations from the mix except for extra perks; but it employs a lot of people, donates to all the candidates, is a stock market factor, and you can bet they won't do it. We are just digging ourselves deeper and deeper into a system that doesn't work. As long as the insurance companies have to maintain high profits, there is no way to bring the costs down.

Ronni, you have summarized the situation perfectly. Alas, Rain is right. The Insurance companies are the Elephant in the room.


My husband has been a member of a Union for more than 57 years. For all of those years (Including retirement years)we have paid in to our Health and Welfare Plan and,as a result, have a wonderful health insurance program.

I'm wondering what will become of this program if the entire system is revised. I am absolutely going to vote for whomever is the Democratic nominee, because I want EVERYONE to have the type of insurance I have because it is worryfree and we can seek medical care whenever we need it and never worry about how we are going to pay for it. But, will my program go away because of the new system I hope is established?

Do you think any of the candidates are considering people who are currently satisfied with their care, and do not want it changed, but DO want excellent health care for everyone?

Just wanted to pass along a link to an article from today's entitled: Heartbreak Shouldn’t Blind Us to Intrinsic Human Dignity.

I think Nancy's concern is incredibly important. The biggest argument against single payer universal coverage seems to have to do with a lowest common denominator. Who wants long waits in the emergency room, limited choice in facilities, or disrupted relationships with doctors and nurses we already know and trust? Nancy has a stable, cost controlled, high quality plan in place, and it is imperative that public policy address bringing others up to her standard of care, not lowering her expectations to fit everyone into a one size fits all plan.

All that said, it can certainly be done if the health care professions and the people are willing to wrest control of the system away from the private health care finance industry and their partners such as the corporations with huge interests in medical supplies and equipment (GE, for example, or pharmaceutical companies).

Here's a no-brainer...let's all vote for Kucinich!


Too bad he has already been totally wiped off the slate by the all-powerful two-party system.

The health care proposals of the candidates don't even try to come to grips with long-term care. Virtually all private health insurance is no good whatsoever for what is dismissed as custodial care, which is care for people who are not going to get better, because they are old and are eventually going to die of their chronic diseases, even if they live 15 years with it. They don't need skilled nursing, so Medicare is no help. Instead they need help with dressing, bathing, toileting, medication, transportation, shopping, eating, laundry, transferring from the bed to the wheelchair to the toilet to the tub, etc.

If they have dementia, they need constant supervision so they don't wander off and get hit by a car, fall down the stairs, leave the stove on and start a fire, leave the water running and flood the house. Medicare covers only very short-term care for people recently discharged from hospitals and capable of recovery and progress. For example, Medicare only pays for physical therapy if your therapist can document that you are making steady progress. They don't care about help that would keep you out of a nursing home.

Many people could stay out of nursing homes if there were government programs that paid for the necessary home modifications necessary to them in age in place. Financing ramps, guardrails , and stair lifts is lots cheaper than paying for broken hips and nursing homes.

Nursing homes in New York City and Long Island cost more than $100,000 a year. Home health agencies charge $18 to $20 per hour for home health aides. Medicaid is more likely to cover nursing home care than home care. Desperate, people spend down all their resources and are then eligible for Medicaid. Well spouses don't fare that well, but at least they are now able to keep their houses. Affluent families hire lawyers to hide or transfer their assets, so they can go on Medicaid, make the government pay what they could afford themselves, and save their children's inheritance.

Don't think long-term health insurance is the magic solution. The amount that many long-term health insurance pays is laughable; my mom had a supposedly good policy that only paid for 6 hours a day. Lots of policies seem like a scam; they have so many disqualifying conditions that your only chance of collecting anything is hiring an expensive case manager to be your advocate. Home health aides are shamelessly exploited by home health agencies supposedly under government supervision. The aide gets less than half of the 18-20 an hour charged by the agency; they rarely have any benefits. Many long-term health care policies require you to go through a home health agency, instead of hiring the aide privately and paying her a living wage.

To accomplish Single-Payer, I think it needs to be framed in the following ways :

1. It is the "Christian" thing to do.
2. It will be "Good for Business"
a ) For BIG Business (Automakers, Steel, airlines Wal-Mart etc)
b ) for SMALL Business.

Those are not MY reasons for supporting single-payer, but they are the ones that will WORK.

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