Hope for HCR -- ot

[northernlights]

I know many of you are waiting for the fallout on HCR, and many don't dare venture into GD what with all the bombs flying right now. But I picked up on something out there that has totally changed my view of what's going on, and I think it's really, really good news.

At the last minute a change was slipped into the HCR package. I apologize if I get details (such as #s) wrong, I'm going totally from memory here, the thread this was posted in disappeared and I don't have time to go searching. Anyway here is the gist of it:

* There currently are about 350 community healthcare centers in the US that provide low-cost health services and probably languishing from de-funding for the last 30 years. They are open to all. I never knew this, and learned that right now the nearest one to me is 15-16 miles away.

* At the last minute, the dems slipped in a change to the HCR to build 13,500 new community healthcare centers. They not only will provide low cost health services, they also will be teaching centers for healthcare students. The change also includes increased funding for grants and student loans for health care students.

This is critical to providing universal healthcare, given the current shortage of healthcare providers (one of the problems made glaringly evident by Mass. reform disaster) and insufficient infrastructure. Note that these are *community* (eg government run) health centers. I suspect this is the first step to single payer. I could be mistaken, but suddenly the *penalty* for not buying *private health insurance* is starting to look like the *tax* for a down payment on a fledgling *single payer* system. Likewise the *tax* on company-sponsored health insurance is part of the down payment. :D

It's also notable that this is a prime example of Obama's building *stimulus* into his programs. 13,500 health care facilities is a heck of a lot off construction work and materials. Far better use of resources than, say, building more ostentatious McMansions!

Suddenly I think I *get* what Obama is doing, and as such the GD wars *really* don't bother me any more. :D I had said very early on that I thought he needed to cozy up to TPTB because they knew where the land mines are and where the keys to the kingdom are. But recently I have despaired because it certainly appeared as though he's one of them and totally in their pocket, or that they were holding guns to his head or his children's heads...or something.

Now I think he needed it to appear that way, and the more the left screams in anguish at his seeming betrayal right now, the better. While Goldman Sux and the rest of the beancounting industry is laughing at the left, salivating over 45 million new insurance policies, and preparing to take over the insurance industry trough, I strongly suspect Obama has just outflanked them and snuck in the infrastructure for a single payer system by some other name. The insurance/financial industry sees 45 million people forced to buy their crap product. I see more and more people opting to pay the "penalty" and get low cost health care at the brand new facility built nearby. I also see more and more companies getting the financial talons out of their backs by deciding to simply give people raises in place of subsidized private health insurance, so they can go out and buy their own insurance. And more and more of those people will opt for the "penalty" and go the nearby health center. The private insurance industry will be left with the uber-wealthy cadillac policies...and the very sick who need the most expensive care right now and whom they can no longer drop :rofl:

Keeping your friends close and your enemies closer comes to mind.

The provision slipped in is apparently modeled after *Vermont's* healthcare system. I suspect Dr. Dean and others from Obama's original team were "banished" to Siberia and ambassadorships in order to help Obama gain the confidence of the enemy. An overly confident enemy is much more easily vanquished. :D And just because they're in "banishment" in know way means they can't talk to Obama.

I also, personally, feel as though my letter was actually read last spring. After the election, Obama sent a "health care transition team" around the country to hold forums where health care providers could provide input. Students were invited as well, but my schedule conflicted. Instead, I visited the webpage dedicated to it, where I was able to submit written input. I don't have a copy of what I wrote now (although I'm pretty sure I posted it in GD back then), but the gist of it was that healthcare providers put themselves at risk every day facing virulent, antibiotic-resistant pathogens, work horrific hours, and when the rest of us stay home during a blizzard or evacuate from a hurricane, the medical staff lives at the hospital caring for those who can't go home or evacuate. Health care is essentially a *community service* and as such should be funded by the community. To bring down the costs of doctors and healthcare staff, we need to make their education less expensive and train more of them. Young people shouldn't be forced to start out in life burdened with loans the size of a mortgage in order to perform a community service. Likewise, middle-aged people returning to school to start over after their industry has crashed should not be forced to spend their retirement savings or take on loans the size of a mortgage in order to perform a community service. On the other hand, their are insufficient slots for students. The training bottleneck is in the *clinical* training: you can expand on lectures as much as needed, but hospitals can only take on a very few students at a time for clinical training given the need for very close supervision. With more funding for education and with more places where students can go through clinicals, we can bring down the costs for services through "competition" and by not burdening the students with large loans to be paid off.

I was more eloquent back then, but had more time and space to devote to it. Anway, while right now HCR looks pretty ugly on its face, I think behind the scenes the above is what is *really* going on. :D

[Sanity Claws]

1. Your message is a Christmas gift to all of us

Really. I think you're right and what you described sounds exactly like how Obama works.

Merry Christmas, Happy Solstice, and whatever else you may be celebrating.

[OneGrassRoot]

3. +1000!

I couldn't agree more. The unique insight you offer, NL, regarding this specific topic is invaluable...a very helpful way to connect the dots.

We shall see, but this perspective is indeed a gift to me this Christmas Eve.

Thank you so much!

:hug: :hug: :hug: :hug: :hug:

[rosesaylavee]

2. Right there with you on this...

And I know for a fact that the existing health care facilities - many are being renovated or getting building additions via the stim package. My day job gives me access to reading about construction projects so that is why I know this. AND, there are several that are being newly built too. So, that 13,500 is in ADDITION to what they have already started putting in place.

Obama is a caring and intelligent man... or so I continue to hope. We will see in the next month or so how this plays out but I do think they have a strategy behind what they have been doing... or so I hope.

[get the red out]

4. Thanks northernlights!

That would be a very good thing. More immediate access to care for people who absolutely need it.

I read a book a few years ago that was about health care in this country and how the current system had evolved and health care coverage was given to people in place of increased salaries when it originated, at least according to what I read.

[northernlights]

5. I think 1,350, not 13,500 (blush)

:blush: I remember figuring we'd end up with about 5 times as many centers as currently exist. That's a more realistic bucketload of community health center / teaching hospitals to build.

(I haven't been able to find the thread it came from. You know how it goes up on GD.)

[get the red out]

6. I don't know if this means anything

But I sense that teaching hospitals may already be working toward expanding enrollment. The one at the university in my city has been working on that for some time, there has been a forecast in a need for additional medical personnel and they have been building a huge new university hospital and increasing enrollment in the medical school, nursing school, and pharmacy school. If universities around the country (and I doubt the university here got that idea all by itself) are already working on plans to produce more Doctors these new clinics could be coming at a very good time. A confluence of helpful endeavors.

[Cleita]

7. Bernie Sanders managed to get this into the bill in exchange for not

filibustering it as he had threatened. I believe it will be a back door that we can use to eventually expand single payer through. I'm keeping my fingers crossed. The final bill is still not done and the same group of obstructionists like Lieberman and Nelson still have to approve of it. We need to keep our thoughts and manifesting abilities on the prize so that all will not be lost.

http://sanders.senate.gov/newsroom/news/?id=86B9C347-79ED-4C79-9626-D7709F840967

[villager]

10. Yup-- Bernie-the-indie, not the Dems, put in this bill's best provision...

As someone who sits on a board for a non-profit community clinic -- and whose seen the struggle to fund these centers of "growing need" - this is about the only thing that I can unreservedly like about this "reform..."

[northernlights]

8. aha! the REAL numbers...better late than never

The good news is more health centers than I remembered. The bad news is I see no mention of providing actual clinical training slots...which are desperately needed to increase the number of health care providers, and which I did see mentioned in the thread that had referenced this. For example, our nursing school has a 2+ year waiting list to get in, and MLT is catching up fast.

http://sanders.senate.gov/newsroom/news/?id=30b2a415-4ade-4367-af7d-4c3306e31b58
Release: Primary Health, Dental Care for 25 Million More Americans

December 19, 2009

$10 Billion More for Community Health Centers will Revolutionize Care

WASHINGTON, December 19 – A $10 billion investment in community health centers, expected to go to $14 billion when Congress completes work on health care reform legislation, was included in a final series of changes to the Senate bill unveiled today.

The provision, which would provide primary care for 25 million more Americans, was requested by Sen. Bernie Sanders (I-Vt.).

He said the additional resources will help bring about a revolution in primary health care in America and create new or expanded health centers in an additional 10,000 communities. The provision would also provide loan repayments and scholarships through the National Health Service Corps to create an additional 20,000 primary care doctors, dentists, nurse practitioners, physician assistants and mental health professionals.

Very importantly, Sanders also said the provision would save Medicaid tens of billions of dollars by keeping patients out of emergency rooms and hospitals by providing primary care when then needed it.

Sanders has worked with House Majority Whip James Clyburn (D-S.C.) to include $14 billion in the House version of the legislation.

Sanders is also working with Sen. Ron Wyden (D-Ore.) to improve language already in the bill to provide waivers for states that want to provide comprehensive, affordable health care and curb rapidly-rising costs for money-making private health insurance companies. The waivers could clear the way for a state-run, single-payer system.

For the health centers, the $14 billion in the bill that the House of Representatives approved on Nov. 7 would increase the number of centers from 20 million to 45 million over the next five years.

The investment would more than pay for itself by saving Medicaid $23 billion over five years on reduced emergency room use and hospital costs, according to a study conducted by George Washington University.

The system of Federally Qualified Health Centers began four decades ago under pioneering legislation by the late Sen. Edward M. Kennedy. Community health centers now provide primary health care, dental care, mental health counseling and low-cost prescription drugs for about 20 million Americans. The centers offer basic services like prenatal care, childhood immunizations and cancer screenings. Open to everyone, the centers care for patients covered by Medicaid, Medicare and private insurance as well as those who have no insurance.

Dan Hawkins, senior vice president of the National Association of Community Health Centers, testified before Congress earlier this year that the cost of care at health centers is 41 percent less than what is spent to care for patients elsewhere. The savings would grow if health centers were expanded to serve more patients, according to Hawkins.

In Vermont, eight health centers and 40 satellite offices provide primary health care to more than 100,000 patients regardless of their ability to pay. Sanders said that with the additional health care funding it was very likely that new centers would be established in Addison County, Bennington County and perhaps Windham County.

[Flying Dream Blues]

9. northernlights, this is the most hopeful thing I've read in forever.

Thank you for bringing it here because I surely would have missed it on the main boards...I can only rarely bring myself to visit these days over there.

Thanks again!
:hug: :hi: