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Obamacare? I know nothing about it, but it seems those who hate it are the same ones who hate Obama for the usual reason. I've never had commercial medical insurance of any kind. This is where a chronic lack of money pays off, how the US differs from places with real socialized medicine. Anyone can be seen regardless of income and social status, but here you must be seriously broke and able to prove it. Reagan's mythical welfare queen is a fairy tale concocted for reasons of racism and resentment of anyone "getting something for nothing." Going through the hoops to get medicaid coverage is not "nothing." It requires time, social skills and willingness to suspend all traces of vanity.

In the early 70s I found out about Medi-Cal, as Medicaid is called in California. This came in handy although I didn't use it much. Coming down with double pneumonia in 1976 I was admitted to Marin General, told I was at death's door and prescribed heavy-duty antibiotics. Once you're into the Medicaid program it's easy to stay in. My health was relatively good until I went to stay in Wisconsin in 2004, where I needed prostate surgery and entered the university hospital system. Not long after the prostate issue was resolved, it was cancer, something I wouldn't have afforded treatment for if not for Medicaid.

Middle class - that's who's getting the shaft and it's getting worse If you want decent medical care, you're better off being rich or poor - in between is where it's dicey. If being middle class is the American Dream, you can have it. A lot of people who qualify will not sign up for reasons somewhere between fear and pride. Wait till they find out what an MRI costs, or even a basic doctor appointment.

The university hospital system, to be sure, is not your friendly home town doctor with the black bag. I first heard the term "HMO" in the 90s, the Clinton years. Health Management Organization. The university system appears to be a giant HMO, or a chain of HMOs. The experience is a bit Orwellian but the hospitals are highly rated, and once you get in, the doctors generally behave like human beings. The staff does not know or care if you're on Medicaid (or Medicare these days, since I achieved age 65). Since then I've had follow-ups and any peripheral medical business at three more university facilities - UW in Seattle, UC in San Francisco, and University of Colorado. One's medical records move easily through the cyber world. These places are usually crowded, parking is a nightmare.

Do I have a choice? No, it's the only option there is. Your doctor is called a "primary care provider." He or she mostly manages information and writes prescriptions, gives minimal exams and shuffles you off to a specialist (a department) if anything specific needs attention. I've gotten used to it and am glad to have it. Fortunately I don't need to be coddled. It's business, not personal.


  1. LouisBedrock May 4, 2016

    “Obamacare? I know nothing about it, but it seems those who hate it are the same ones who hate Obama for the usual reason.”

    Obamacare is an abomination, Jeff. Perhaps you need to read about it.
    I hope this is a start:

    “…Obamacare has strengthened the for-profit insurance industry by transferring public, tax-generated revenues to the private sector. It has done and will do little to improve the problem of uninsurance in the United States; in fact, it has already begun to worsen the problem of underinsurance. Obamacare is also financially unsustainable because it has no effective way to control costs.

    Abundant data substantiate that the failure of Obamacare has become nearly inevitable. Even after the ACA is fully implemented, more than one-half of the previously uninsured population will remain uninsured—at least 27 million people, according to the non-partisan Congressional Budget Office—and at least twice that number will remain underinsured. Due to high deductibles (about $10,000 for a family bronze plan and $6,000 for silver) and co-payments, coverage under Obamacare has become unusable for many individuals and families, and employer-sponsored coverage is headed in the same direction.

    Private insurance generally produces administrative expenses about eight times higher than public administration; administrative waste has increased even more under Obamacare, and remains much higher than in other capitalist countries with national health programs. These administrative expenditures pay for activities like marketing, billing, denials of claims, processing copayments and deductibles, exorbitant salaries and deferred income for executives (sometimes more than $30 million per year), profits, and dividends for corporate shareholders. The overall costs of the health system under Obamacare are projected to rise from 17.4 percent of GDP in 2013 to 19.6 percent in 2022.

    A conservative projection shows that premiums and out-of-pocket expenditures for the average family will equal half of the average family income by 2019 and the full average family income itself by 2029.”


    • LouisBedrock May 4, 2016

      I’m a cancer survivor too.

      God doesn’t exist and prayers don’t work, but regular exercise and a vegan diet are cheap and can work wonders.

      I wish you the best.

  2. Jeff Costello Post author | May 4, 2016

    Louis, I do recognize as a commercial insurance business and I could no more afford it than any other such thing. I went from Medicaid to Medicare and as a certified indigent citizen, there’s no need to study up on it.

    • LouisBedrock May 4, 2016

      I’m on myself.
      Without it, surgery and radiation treatment would have exhausted my resources.

      I wish everyone had Medicare.

      Stay strong, Jeff.

  3. Jim Updegraff May 9, 2016

    The U. S. spends about 15% of its GNP on health care while countries like Germany and England which provides excellent health care to ALL its citizens at a cost of about 8% of its GNP. The successful programs have built thier universal care on the then existing health care structure. In the U. S. for a single payment plan we should have used Social Security as its base. Of course, since the U. S. is a very selfish country we ended up with an expensive poor performing plan.

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