American Health Care.

Dear Friends: American health care is an unholy mess and this letter from a guy on Quora.com sums it up better than most answers I've read:

Why is healthcare such a divisive issue in the US?

Robert Pfaff, 

You have asked a question of great importance.

The answer breaks my heart. This issue carries so much ideological baggage, lopsided with misconceptions, outright lies, bad stereotypes and political myths.

It has become so warped by heated rhetoric I find it impossible to provide an answer that does not compound the divisiveness.

When common sense and basic fair play have no common currency?

When the facts do not matter?

There is no rhyme or reason.

I don’t pretend to have all the answers, and I am open to compromise, but we have crossed the point of no return when healthcare has evolved into another weapon in a cultural war that ensures our mutual destruction.

1. I can attempt to explain 1,000 times how we pay for the public health one way or the other, so the practical question is how do we manage the inevitable costs? I listen to the silence, and it tells me this question is too reasonable.

2. I hear a lot of talk about costs, but I hear no talk about the transcendent public costs - or ‘opportunity costs’ - of NO compromise on reform.

It does not matter because it is no longer about efficiencies or taxation.

Its about winners versus losers.

3. The logic behind the cost argument seems to be if we eliminate the programs, then we eliminate the costs. That is not a logical position. It does not make sense, and it will trip us up in the end.

I cannot accept the opposition wants live in a world where people to die in the streets. I cannot accept it as their conscious agenda.

4. Without compromise, our default system will exacerbate the costs in terms of unpaid emergency room bills, which already exceed $41 billion a year in 2014. In 2013, The Kaiser Foundation placed the aggregate cost of serving the uninsured at $121 billion.

5. For these reasons, my response to those concerned about about costs has been as follows: “Do you understand we already pay for it, and in the most inefficient way, leaving room for too much graft?”

If “no compromise” is your honest position, I find it hard to believe you want to live in that world, but I hear too much objection to cost without the inverse question: What about the costs of either continuing down the same path or simply allowing the system to collapse?

3. I can explain how top 10 drug companies use $25 billion of our tax dollars to market products to Americans at a premium not allowed in any other developed nation.

4. I can explain how this markup cost us an extra $40 billion while they enjoy an average 20% net profit margin, and spend 71% more on often illegal sales and marketing, not research and development, but no one responds because…why?

I cannot pretend to know, but I must wonder….

Do they think it does not - and could never - affect them or anyone they care about? It only applies to the outliers, so who gives a shit?

4. What blows my mind?

I can make the obvious point that 19 Governors rejected a guaranteed nine-times return on their investment in Medicaid expansion, throwing their most vulnerable citizens under the health care bus to make a political point about states’ rights and perhaps taxation.

AT THE SAME TIME, these states accept the most in federal subsidies for less essential amenities at the expense of other states.

In my home state, we received “$7.1 billion in federal aid or 30.7% (in 2014) of the state's general revenues.” For the same year, we paid less than $24.1 million in federal taxes (10–11% of our state budget), and we rank sixth in the nation for federal dependency.

But we rejected insurance subsidies for the poor (90% of whom are Latino/Latina, African-American and Native American ) because we are fiercely independent rebels fed up with federal spending?

Do these contradictions and the hypocrisy matter?

Not to those opposed.

Not a drop.

5. I can explain how Social Security, Medicare and disability are not handouts, but self-funded insurance programs with qualifications and benefits directly tied to how much you paid in special taxes.

I can elaborate on how miscasting them as welfare is not only untrue, but their erosion shafts those who paid taxes over the longest time, so that they file bankruptcy at a higher rate than any other demographic.

This not only adds to the deficit, but it becomes another variable in a vicious cycle that contributes to escalating medical costs and premium spikes.

Do they not understand or do they not care?

I do not know but I think not because I do not hear a peep.

(I hear from a few humans, but I read more rhetoric than responses).

6. I can elaborate on how Medicare premiums are deducted from your Social Security or disability check even after you worked and already paid for them over decades, receiving a pittance in return when compared to the taxes you invested in the system.

But it seems to have no relevance to their lives.

Again, I am baffled, left to wonder, “Don’t you have grandparents?”

7. Then we have the CHIPS program, which was not funded the first round.

Public outcry mounted to a shrill pitch before they silently compromised (cannot publicly compromise with a political opponent anymore) to cover children living in poverty for another budget cycle.

If you can throw children under the health care bus, I want to see your humanity but I cannot.

8. As final point, we blame the poor for the costs.

In truth, primary care providers contribute equally to unnecessary emergency room referrals, so its not just the poor driving these costs.

The private sector is shifting their cost burden to the public coffers.

But the poor make easier scapegoats.

To make it worse, John’s Hopkins University analyzed over 12,000 emergency doctor’s records and found as follows:

“On average, adult patients (in emergency room visits) are charged 340 percent more than what Medicare pays for services ranging from suturing a wound to interpreting a head CT scan.

A report of the study’s findings, published in JAMA Internal Medicine on May 30, also notes that the largest hospitals markups are more likely made to minorities and uninsured patients.”

But we wonder why costs are out of control, and blame them on those who seek or are forced to go to the emergency room?

What saddens me the most?

That we cannot reach any compromise (a practice fundamental to a functional democracy) means we no longer are one, and we no longer share the same universal humanitarian values that once made us a great nation.

When we HATE each other so much the idea that the human costs cause a sad plurality of citizens to scoff and sneer?

We have come to a tragic impasse.

We are beggars to our own demise.

And everyone has already lost!

We can say as much about the American style of 'Capitalism,' ..........but that is a story for another day. (The great recession of 2008 was caused by this fucked up system! The United States is a great place to live if you have lots of money............. otherwise, not so much!)

The way I see it anyway!