Monday, June 29, 2009

Can the US Provide Free, Public Medical Care Like Brazil?

Free public neighborhood health clinic in Brazil
where treatment is provided to all
as fundamental right.

I am not convinced that single payer is necessary to dramatically improve health care in the US. I believe that making health care a right (like the right to vote) - a right that is not means tested - is what we really need.

This morning in Brazil, I went to a Government public health clinic in my neighborhood, made an appointment to meet with a doctor tomorrow morning for a consult and prescription, and I will be charged $0.00 (zero) for this service, because health care is a right in Brazil.

I showed proof of address (because people must go to the health clinics in their neighborhoods - the clinics that are closest to them) and I showed proof of my identity (incidentally as a foreign permanent resident). I also showed proof that I am up to date with my vaccinations, which are provided for free at the same clinic. Tomorrow when I get the prescription, the medications will be provided for free.

There's still one question that an American really wants to ask here: Where's the cash register? At these clinics, there are no credit card swipers, cash registers, and no calls to any insurance companies or Government bureaucrats to confirm whether the patient is covered for one service or all services.

national health care,medical insurance,socialism,physician,medicine,free,public,appointmentAlign Center

At seven in the morning,
patients line up to schedule appointments
which may be from a day to a month away.

Crucially, there isn't even a check within Government records to confirm a patient's right to be served. Since Government-provided health care is a right for all that is not means-tested and is provided by the Government itself, there's no need to confirm people's insurance status. Health care is actually more of a right in Brazil than voting is a right in the United States, because there is no need in Brazil to show that you have "registered" to participate in the free services. And there is no crime a person can commit that would result in the loss of the the right to participate in the Government system.

The existence and operation of the free health clinics, hospitals and blood work laboratories is Brazilians' "insurance" that health care will be available to them. The government buys or manufactures medicines in bulk and provides them for free, either at this clinic or at the hospital downtown.

While waiting in line to schedule an appointment this morning, an elderly woman mentioned in passing that, in addition to having a home in this town, she also owns a summer cottage and land in the countryside. It doesn't matter here. Yet, if she said the same thing at a Medicaid office in the US, she would probably carried out by armed guards, tasered and/or arrested and charged with fraud.

And yet, even with the absolute guarantee that patients have a right to Government health care through this nationwide system of free clinics and hospitals regardless of income, assets or ability to pay, (some people sue the Government for failure to provide expensive care or new and expensive medicines for unusual conditions) there are still private insurance companies, doctors and hospitals for people who have conditions for which the state system isn't equipped to provide excellent and immediate care, and/or for people who want the "Cadillac" service that we really all should get wherever we are.

To make health care more affordable in the US, setting up a national system such as the one in Brazil, or in the Seattle / Puget Sound area, where all of the medical, nursing and administrative staff work for salary rather than as entrepreneurs, is the surest way to keep costs down. Along with doing away with the bureaucracy involved in means testing, charging individuals for insurance, making sure that they have paid, etc.

The crucial part is not that Government nationalize all medicine, but that Government set up a national system Government-owned clinics hospitals and pharmacies like the system Brazil has, or provide insurance to all Americans the way the French do, with patients accessing services from private providers and the Government paying for these services.

Sunday, June 21, 2009

Brazil's "Public Option" Health Care a Model for USA

Cross-posted at the Public Option Health Care Now blog.

Pardon me for sounding confused, but I just cannot understand the idea of requiring individual Americans to purchase health insurance. Here in Brazil, there is a "public option" that consists of community health centers in each neighborhood as well as often two public hospitals in cities under 100,000 population, with more public hospitals in larger cities. Anyone, even an international tourist, can go to these clinics and hospitals and it is unlawful to request or accept payment from patients.

In addition, common medications are given out for free at these clinics if they are available, with the only requirement being a prescription from a doctor, public or private.

No one is required to purchase this assurance that their medical needs will be taken care of. Instead, the program is paid for through various government taxes. It's worth pointing out that in Brazil people are tax-exempt until their income reaches three times the minimum wage, so it's fair to say that many of those receiving the benefits of the service are being entirely subsidized by other wealthier people who may use the public system or may prefer to use private doctors.

In light of my experience with this system, it seems rather absurd to me that we should require people in the US who are sleeping under a bridge to buy health insurance when they cannot even afford a cup of coffee. Government promises to provide such people with subsidies just make me think of a tidal wave of new bureaucracy to determine who needs what level of subsidy and who has paid their premiums and who hasn't. A public option designed this way may have all of the expensive bureaucracy of a welfare department, with an equal likelihood that many people will fall through the cracks when the need the care the most.

What the United States needs is what Brazil has: a system of public clinics and hospitals where anyone and everyone, regardless of their ability to pay, can come and receive treatment with no discussion whatever of their financial circumstances. In such a system, Bill Gates might lie in a hospital bed alongside Bill, the streetsweeper, each receiving from their Government the care they need without the bureaucracy they would abhor.

Friday, June 5, 2009

Afrosphere Petition Says, "Confirm Wise Latina Woman Judge Sonia Sotomayor Now"


Black bloggers are lining up in support of "wise Latina woman" Judge Sonia Sotomayor's nomination for the US Supreme Court. For example, African American blogger Atty. Francis L. Holland, whose previous efforts toward diversity in American institutions have been cited by the Washington Post, the Dallas Morning News, Black Enterprise, the American Prospect, the Columbia Journalism Review and the Pew Project for Excellence In Journalism, has posted an online petition in favor of Sonia Sotomayor's confirmation to the US Supreme Court.

Holland says he hopes the petition, which is reprinted below, will gain thousands of signatures from people of all skin colors, ethnic backgrounds and genders, just as President Barack Obama received pluralistic support across the board in November's presidential election:

The petition says:

Petition to Confirm Wise Latina Woman Judge Sonia Sotomayor Now

View Current Signatures - Sign the Petition

To: Members of the US Senate

I strongly support and urge immediate Senate confirmation of President Barack Obama’s nominee for the US Supreme Court: “wise Latina woman”, Judge Sonia Sotomayor, who now sits on U.S. Court of Appeals for the Second Circuit.

At present, the US Supreme Court has nine members, of whom seven are white men. This is unfair and unbalanced. According to the US Census, the nation is less than 33% white male, while it is approximately 51% female, 15% Latino and 13% Black. Although white males are the minority of America, they remain the vast majority of the US Supreme Court, just as was the case before women and minorities gained the right to vote.

It is impossible in a pluralistic society for a Court comprised of 78% white men to make wise, reasoned and sound decisions affecting the lives of a nation which is less than 33% white male. A wise and just Supreme Court requires a diversity of experiences, with the participation of representatives of the majority of Americans.

For far too long, there has been a quota system at the United States Supreme Court. The de facto quota system required that all or the vast majority of the nine members of the Court be white males. In the history of the nation, there have never been more than three members of the court who were not white males at any one time. The anachronistic white male quota system is no longer tenable as the nation strives to treat all Americans equally and to have a government all of whose branches have the consent and participation of the nation’s diverse populace.

The US Supreme Court cannot function wisely, justly, and fairly without the full participation of wise women and wise members of the nation’s minority groups, including the nation’s largest minority – Latinos. Therefore, we urge our elected representatives in the US Senate to immediately confirm the “wise Latina woman” who has earned our respect and support: soon-to-be US Supreme Court Justice Sonia Sotomayor.


The Undersigned

View Current Signatures