Every day I practice medicine I get a new story.

 

Today I attended a "pod group" meeting over lunch.  Billed as meetings of primary care providers hosted by our local medical group to allow us to get together and share items of importance to our practice, the meetings instead have degenerated into coaching sessions about how to "code" patient encounters in order to maximize income, for the medical group and, secondarily, for us.

 

The care provided by family practitioners, pediatricians, and general internists--primary care providers-- is known to be the most cost effective in medicine.  We know our patients.  We understand where they are coming from.  We can use this knowledge to tell, often, when a belly ache is a sign of serious disease, when a serious investigation is needed, or when reassurance and a little "tincture of time" is all that is needed.

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President Obama will run huge deficits in the coming years.  This is a necessary response to a desperate economy.  However, those of us concerned with equity must beware how the United States goes about repaying this debt in the future.  Roughly 45% of the debt is owned by the federal government itself.  A lesser observer may claim that a practical response would be to let the government default on the debt it owns itself.  We must not let this happen.

That debt is owned by entitlements savings accounts that are funded by the regressive payroll tax. That is to say that low-income earners pay a greater percentage of their income towards the tax.  The payroll tax is a 15% tax levied on all earnings up to $97,000 dollars.  Every dollar earned on top of this amount is not taxed.  Consider the person earning $35K.  This person will pay 15% of his income towards the payroll tax.  Now consider the person earning $200K.  This person will pay roughly 7% of his income towards the payroll tax.  This is justified (not making judgement just stating the rationale) by the fact that benefits for entitlements are funded in a progressive manner in that lower income households benefit much more from entitlements (ie. the progressivity of the Social Security benefit formula).

These funds are being borrowed from these savings accounts to pay for discretionary general fund expenditures.  The general fund is funded by the progressive income tax.  That is to say that higher income taxpayers pay a greater percentage of their income.  Therefore, as of now, the federal government is borrowing from low-income families to pay for expenditures that should be funded by higher income families. 

If the federal government were to default on this debt, it would effectively be a transfer from low-income families to high-income families.  Thus, it is absolutely essential that the federal government not default on its debt to entitlement programs. 

In a victory for our folks, Saxby Chambliss won the Georgia runoff. Thank goodness. Our folks took a beating on Nov. 4th as the other folks voted for one of their own. A few years ago, the idea that one of the other folks could become president was unthinkable. But the recession, which was obviously caused by the other folks who forced our folks to lend them money, caused some of our folks to foolishly vote for one of the other folks. Our folks who voted for him may also have been influenced by the other-other folks who attacked us on 9/11 and forced our folks to invade one of their countries. The other-other folks then not only refused to show us the love but also lacked the decency to have the WMD's they promised. In other words, the laziness and financial imprudence of the other folks and the intolerance and mendacity of the other-other folks led our folks to help elect one of the other folks (whose middle name proves that he's also one of the other-other folks). Capiche?

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Cross posted at dagblog.com, where I have proclaimed the end of an era, and no one is named Saxby .

This is one link to the GAO report.

Comments are off until the data mining is over.  Then we'll share.

(Come back if you want to get scared.)

As many of you know we provide advertising for any business that offers a discount.  We take your discount and create a mobile coupon available on our website, gopons.com and on every mobile carrier in the US.

For the three days beginning Black Friday, our mobile coupon hit count was 72% higher than the previous three weeks combined.  It appears a lot of businesses are offering a discount.  Not to be outdone, we will be giving out our service FREE for the rest of 2008.  Anyone who signs up will get a free listing for the next six months.

These are tough times, and any we feel that any creative help we can give is just in time.  I'm convinced that we can make it through these difficult times if we help each other out.

I am an old white man who knows this aint over.

Thirty five years ago I was driving to Arizona from Minnesota with my 6 month old daughter and my wife in my VW bug.  We were taking an interstate to Texas and then prepared to hang a right. We got just outside of Oklahoma City and  my car started experiencing problems. It was overheating but beyond that I cannot say. I looked back and my baby was passed out.

 I saw a pay phone on the hill ahead of us and the bug just made it to that hill. I parked and ran to the phone and an ambulance arrived shortly. I mean shortly.  We were whisked to a medical center in Oklahoma City and these people saved my child.

For some reason I walked back to the car so it could not have been more than a couple of miles from the city. On my way back, walking on the freeway, two or three cars full of youth were whooping and hollering.  I never thought about it.  Shortly a police car stopped and yelled:
"Hey boy. What the hell you doin?  Don't you know this is nigger country?"

I went up to the car and explained what I was doing and they yelled at me again and opened the car door and let me into the back seat and drove me to the hospital.

I had not thought about this in years.  My daughter is in her thirties and doing fine.  I remember that Oklahoma City saved my daughter's life.  I remember that we did not have significant problems getting that car fixed and I know I was grateful for the hospitality of Oklahoma City.

I never forgot those cops and I never forgot that I was witnessing a real war going on in Oklahoma.

Now I practiced law up here in Minnesota for 25 years. People think only Swedes with a smattering of a few Jews live up here.  Untrue.  Regular Black City segregation--de facto, no de jure.  Although the de-jure existed in the County Registrar's office in the form of restrictive covenants that were blacked out--excuse the pun--with magic markers sometime in the mid '50's.

Do you know you can still go down to those offices in counties all over the state and you can read the racism right through the magic markers.  I never thought about it, but somebody in a high place in state government wanted the blocked out provisions in those deeds to remain readable.

At any rate, I was never a particularly gifted attorney and I made my money on SS and PI and so I was always stuck doing some misdemeanor work.  I represented a lot of poor whites, black and Amerindians.
 
I will never forget a white housing inspector I represented  who was fired for cause.  These people were always dirty.  They actually would cite buildings for non compliance and then have their buddy buy the place after it was condemned and fix it up for pennies and make money.  These guys were crooks.

At any rate this inspector was assigned to keep a young journalist occupied and ordered by his county boss to  'show her the town'.  When he got to Franklin Avenue--the single poorest place in Minneapolis, at least the south side--he turned to the young woman and told her welcome to Franklin Avenue, this is where the Indians live.

"  Forgive them, they used to be able to shit all over the place and then move their tepee."

 Direct quote in the city's newspaper and the son-of-a-bitch and a mason who once made the cover of their magazine, was fired.  I know he remained fired but I cannot remember how the matter was decided.

I still am grateful for how Oklahoma City saved my daughter's life. But I never forgot those cops. I remember being surprised because I thought all that shit went on on the other side of the Mississippi.

I know that the senators form Oklahoma, today, are among the worst five or six senators in the country. I follow them a little bit on C-Span.

But I would think that PC would not allow the police to speak like they did 35 years ago. My point of course was that pc would not allow any official in Minnesota to speak like that in public, even in the seventies.
I do know that segregation de facto has not gone away and I do not think the situation has changed that much in 30, 40 or one hundred years. I have driven through L.A., Detroit, Boston, Chicago...
I did not vote for Barack O'Bama as a compromise candidate. I saw him like a Ralph Nader, someone who could never be elected.  Of course, I had to back him.  I wondered what those cops in Oklahoma City thought of this election or even what that Minnesota Mason thought, if they still live.

The President-Elect will stand at an open air podium in about 50 days in front of four or five MILLION  people.  I predict 100 or 150 Million Americans are going to watch this inauguration on TV, on computers, on phones, on radio.....And I predict that a billion people across the world are going to be watching the same live program on their gadgets. In other words, more people might be watching this speech than witnessed the landing of the first man on the moon.

I  cannot believe that this is not going to make a difference. Thank you for your patience.

I am a JoeManiac.  I looooovve me some Biden. Always have.  Always will.  I was excited when then Senator Obama chose then Senator Biden as his running mate.  On top of the obvious political advantages of having someone with a blue collar background and ties to Pennsylvania, the pick really solidified my belief that Barack Obama cared about the nuances of public and foreign policy. 

For all of Vice President-Elect Biden's shortcomings (which often make him more appealing to a guy like myself), he has very attractive credentials that Barack Obama should avail himself of.  The first is obvious: foreign policy.  Anyone trolling through tpm blogs at 10pm probably already know about Mr. Biden's credentials in this area so I don't see any need to dwell on them.  The second is that he would be a very useful liason to the senate where he has many powerful connections on both sides of the aisle.  Thirdly, his time in Washington should make him a go to guy on all matters political, from the intricate process of policy development and implementation, to agenda setting. 

JoeManiacs like myself are feeling pretty concerned that Obama will not use Mr. Biden efficiently.  This concern is probably wholly without merit, as all of my intuition about the President-Elect tell me that he is a man that values smart people and their opinions.  However, I guess we were hoping that Mr. Biden would play a large role in the administration.  As it looks right now, the roles that he would be most suited for seem to be getting crowded out by larger personalities like Senator Clinton and Rep. Rahm Emmanuel.  So I guess the point of this posting is thus - how bout letting us know what Joe is going to do? 

SleepinJeezus

Dissociated Press

December 2, 2008

 

(Detroit, MI) Citing "opportunities that exist in this new economy," Former Fed Chairman Alan Greenspan announced today that he is coming out of retirement to embark on a new career as an entrepreneur. Greenspan and partners - including major names drawn from the mortgage banking industry such as Henry Paulson and Ben Bernanke  - rolled out their plan for a soup kitchen in Detroit to be called "Krewl Grewl."

 

"We've taken stock in America, and we're serving it up in Detroit," said Greenspan. "Our feasibility studies showed that the American consumer is moving steadily away from diets rich in flavor, calories and diversity and is looking instead for a more sustainable diet. Krewl Grewl will offer the consumer a range of selections of soups and porridge with a price tag they can afford."

 

A menu of items to be served at the spare, but attractive, Art Deco style building showed bargains were available, including the "Ayn Rand Grand? Ragout" for a nickel per serving. According to the menu, this offering is made with a "fresh water broth into which is introduced just a hint of beef and vegetables, all seasoned with care to enhance its substance. This recipe is so popular that diners not only stand in line to order a bowlful of this light offering, but find themselves soon wanting to come back for more!"

 

Continuing the Art Deco theme, Krewl Grewl has commissioned a new line of glassware to be used in the restaurant. These items were on display, and were not only joyously colored but were in fact crafted to a mirror finish sufficient to offer diners a reflection of themselves as they sit before these Depression Glass style plates and bowls.

 

"We're excited about this opportunity to participate in this economy and to create jobs and investments in our communities," Greenspan remarked. He then suggested that the Detroit opening of Krewl Grewl will be only the first of what he expects to be many within a nationwide franchise.

 

"We expect to be as omnipresent in our communities from coast to coast as Starbucks once was, only with more 'staying power' in the market. I have faith that my partners in this enterprise will  bring their talents to bear to assure such success for the future of Krewl Grewl, destined to become the venue of choice for American's looking to satisfy their appetite."

 

 Coming up:  "Soup's On!: Greenspan Cooks Up a Rich Stew"

Learn how the former Fed Chief's experience in the free market helped Krewl Grewl leverage "17 dollars, small change, and some pocket lint" to gain nearly $25 billion in government assistance to grow this exciting franchise.

 

ALSO: Newswoman Andrea Mitchell of NBC researches conflict-of-interest concerns raised over government funds being awarded to the same people in charge of disbursement. "We're not conflicted at all about receiving these funds," declares Treasury Secretary Paulson in assurances made at Congressional oversight hearings.

Crossposted at Projectile Politics

Yglesias brings up a good point about today's Governor's Association meeting in Philadelphia. Biden issued a speech laying out some reasons that we should promote public transportation, specifically rail transit. Focusing Obama's stated desire to promote public works projects on public transportation would be incredibly smart. There are still many American cities that have sub-par transportation systems within the city and almost non-existent rail options from the 'burbs.

Jumpstarting a massive rail construction program would kill many birds with one giant, expensive stone. It would prompt suburbanites who live outside the city to visit and spend on urban businesses and entertainment; it would provide cheap, public transportation for urban workers who live outside the city; and most importantly, it would drastically reduce the number of people who commute in personal vehicles, and thereby benefit our degraded, asthma-ridden natural environment.

Seattle is a good example of the need for more rail-centric public transportation. Within the city, it is fairly easy to get around using the bus system. But there is no rail transit besides the monorail that goes about three blocks and was created as spectacle for the World's Fair in 1962.

But a Light Rail will be completed next year to transport people from SeaTac airport to downtown Seattle and back. I'm very glad that this is happening, but its impact will not reach its potential unless complemented by a more extensive rail program becuase traffic west into Seattle from the Eastside is awful for hours every morning and evening. And the same goes for along I-5 north of the city center. Both are areas that the Light Rail will not service.

Biden's suggestion for developing more rail transit would help cities like Seattle develop their rail programs to benefit workers, drivers, and the environment.

Cross-posted at River Twice Research.

The current economic crisis has claimed many victims, but what has changed most is the way that the United States is viewed, perhaps permanently. That isn't ideology; it isn't declinism; it's a fact. For all the talk in past year about the shifting balance of power globally, until now it has been just that, talk. Saying that the emerging world of China, India, Brazil and the rest have assumed a new place is like saying that a new army is well-equipped with sharp uniforms and cutting-edge weapons. That doesn't mean it can fight. Until tested in battle, it's just a guess. The economic crisis of the past two months has been such a test, and the results are clear: talk of the emerging world as the wave of the future isn't just speculation; it's a permanent reality.

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Amongst all the mortgage mess/credit crunch/bank bailout/global recession palaver the condition of the distressed homeowner continues to get short shrift.

 

This is perhaps because to pay too close attention to this problem is to be reminded of how we got ourselves into this mess. Not just that the meltdown in home values precipitated the current crises, but that the artificially prolonged housing bubble was a main structural prop in our economic house of cards.

 

We took a real truism - that property values in the United States always end up going up, and made ourselves believe that they continuously go up. We had to engage in this collective delusion because the tens of thousands of dollars the average American family extracted from their semi-annual refinance was--except for national borrowing--the only thing keeping our society's financial boat afloat.

 

To accomplish this feat our financial wizards invented complex new financial instruments better suited to creating the illusion of wealth than actually creating it. "Masters of the universe", preying upon the almost primal yearning for one's own home, cynically exploited those desires in order to keep the charade going for yet one more round.

 

And we all joined in.

 

My main purpose here is to point out that the stretching of a basic truth beyond recognition does not alter that basic truth; in this instance, that home values in America always end up going up. I emphasize this idea because it is central to my modest proposal: the federal government should, yes, exploit, that belief/fact to help us out of our present difficulties.    

 

The Fed would create a program wherein every resident homeowner who owes more on their home than it is presently worth is given the option to refinance their mortgage at the home's present value, and at a 30 year fixed rate. In return--with an eye toward that eventual price rebound--the homeowner will sacrifice some equity opportunity for a fixed period of time.

 

The Federal program would require participating banks, mortgage companies, investment banks or packaged securities holders (the bank) to offer the restructure deal to all eligible homeowners who opt to participate. No cherry picking.

 

The average value of a home in the U.S. has fallen approximately 20% from its high in 2006. For our purposes then, we'll use as our example a home where the original mortgage was $500,000, and the home is presently worth $400,000. The bank would refinance the home at $400,000, at a fixed rate.

 

The Fed provides banks 2/3 of the difference between the original mortgage and present value; in our example: $66,000. This punishes banks ($34,000 or about 6.5% of their original investment) in a modest but meaningful manner for their irresponsible lending, but enables them to replace a toxic asset with a relatively strong one, as well as providing a jolt of desperately needed liquidity, which when multiplied by most of their eligible mortgages, would significantly add to the banks' health.

 

The homeowner is relieved of $100,000 in debt, and has the remaining $400,000 put on significantly more affordable terms. In exchange the homeowner signs a 7 year (could be 5 or 10?) "equity note" where he gives up any equity accrued (above $466,000) during that period.

 

To recoup its money, the Fed packages the notes, and issues 7 year bonds (or some other instrument?) backed by the notes. Investors worldwide who have confidence that the U.S. housing market will bounce back in that timeframe will purchase these bonds. At the end of the bond's term the Fed will pay the bond holder the difference between $400,000 and the home's value at that time. The actual payouts would, of course, be based on an average of notes from all over the country.

 

The homeowner would not be required to actually refinance the home at the end of the 7 years. The Fed gets repaid when the homeowner eventually sells the home, or when she refinances at some point to free up equity accrued above the amount at the end of the 7 years. Her mortgage remains based on the $400,000 principle until that time. What the Fed will likely do to pay the bonds is just issue some simple interest debt backed by the liens on the participating homes, then pay off that debt as it is paid when the homes sell or refinance.

 

The 7 year term is a best guess. It is based on the average U.S. home value having fallen approximately 20% from its high in the summer of 2006. Certainly, lesser "underwater" figures will mean shorter notes. But the general question remains the same: what length of term(s) would give the housing market the chance to make enough of a comeback to make the notes attractive to investors and fair to homeowners? Finally, there would almost certainly need to be some limited form of guarantees on these notes and mortgages from the federal government.      

 

My thinking is that there would be a self-fulfilling aspect to this plan; the massive injection of liquidity would spur more housing purchasing, which would in turn raise home values. I would hope that this effect would go a long way toward assuaging the frustrations of those homeowners who do not directly benefit from the plan.    

 

This proposal is meant as a starting place in an attempt to help out distressed homeowners, put a floor under the housing market, and infuse a huge amount of liquidity into the credit markets without that infusion coming in the form of more national debt. I've obviously left out tons of detail, but the general idea is all here. If there are fundamental flaws in the idea, or any ideas for improvement, please let me know.

     

On the heels of Dr. Warren's New York Times assertion that any fix to the economy needs to be a fix for households, (Thank you!) I would just like to clarify one point for the TPM readership who may not be following this issue closely.

When Paulson and his colleagues talk about issuing mortgage loan guarantees, they aren't talking about anything calculated to prevent homeowners from losing their homes. They are talking about ways for mortgage companies and investors to get paid even if (or more precisely, when) homeowners default on their loans and are foreclosed upon.

This is one reason banks aren't making significant loan modifications for homeowners, and why the much-touted "Hope for Homeowners" plan has only 42 applications to date. If you were a bank, would you make significant loan modifications for homeowners when you can foreclose on them and then get the entire amount of their loan plus interest from the government?

Unless we come up with a useful plan for keeping people in their houses, nearly every loan undertaken from 1998 forward will soon be underwater because of the huge amount of unsellable real estate on the market. (Since the number of people who now qualify for a mortgage is less than the number of people who qualified in previous years, those foreclosed-on houses aren't going to fill back up anytime soon.) 

If you think this is crazy, please call your elected representatives and demand a plan that will keep people in their homes and neighborhoods.

Synopsis:  Proposal for a Single Payer Partnership, funded equally by employer and employee, modeled after self-insured industries, administered by insurance companies selected through competitive bidding in the respective States.   

The insurance industry has fought to continue the present system, because it is profitable. Employers famously complain that it's getting too expensive to provide workers with health insurance.  Too many working Americans must buy insurance they can't really afford or risk losing everything because of major medical expenses.  How about a plan that will protect each of these groups while providing basic health care for all Americans?
    I propose a single-payer system, call it a Single Payer Partnership, funded by equal contributions from employer and employee (á la Social Security) plus taxes most people will agree to, such as on cigarettes, whiskey and killer bullets. Each State (no Big Government threat here!) would solicit proposals from individual insurance companies or consortiums to administer that State's share of the fund; the best qualifying proposal in each State would be awarded the contract for that State--subject to review and renewal as are other government contracts--under which the winning bidder would be paid to administer the fund.  
    PRESTO!  Health care for everyone, administered by those most experienced in doing so. Part of the cost savings is immediate, with insurance premiums eliminated, but with the insurance industry still a major partner and thereby continuing to make money; employers will not have to foot the whole bill because employees will (gladly) contribute a fair share; and the uninsured are now included.  Those already covered by Medicare and related plans--children, the elderly, the disabled, the indigent and certain low-income workers--are brought into this universal plan, along with their present health care funding (e.g., Medicare, Medicaid, VA, SSI).  There would be additional savings realized when everyone is under one umbrella.  
    The insurance companies should welcome this plan, because it will keep them in the loop at a lesser risk to them (if in fact health insurance is as risky as they would have us believe). And there will still be a need for "gap" packages such as are now being sold to Medicare recipients as Part B -- as well as a market for new policies of life insurance for those who now can afford it!  
    It is reasonable for employers, large and small, to contribute to their employees' health care, since a healthy work force benefits the employer as it benefits and advances the greater society.  But no doubt the employer will write off its share of the insurance fund, and perhaps raise the price of pizza by 50 cents.  We can live with that.
    The benefit to the economy, in addition to controlling out-of-bounds medical costs and freeing up more money for voluntary spending, will derive in part from increased job stability and work force quality. Many people now take jobs they don't want, or leave jobs they like, due to health insurance concerns; it will now be easier to attract and keep quality employees.  On the other hand, more folks will be able to become self-employed because of the safety net, and this would lead to more jobs being available.
 
As anyone with Medicare experience knows, that plan actually works quite well.  You choose your own doctor.  You can choose to buy a "gap" policy, or not.  You can choose your treatment.  Freedom of choice is everywhere.  Obviously, Medicare could be the model for a single-payer health care system.
    As another model, my own present health insurance plan might be seen as a microcosm of the Single Payer Partnership proposal; it is already common in U. S. industry, and it works. Specifically:

The employer is self-insured--that is, the company maintains its own fund for payment of medical expenses for all employees, and pays a major insurance group to administer it.  How blessedly simple!  The employer saves money by hiring a manager instead of paying premiums to an insurance company that must pay for management and also provide a profit to its shareholders.  For a $15 co-pay, I can go to whatever doctor I choose, undergo whatever procedure I choose, and if the procedure is not covered and/or I go to a doctor who has not agreed to the fee structure set by the insurance company it will still be available but will simply cost me more.  I contribute to the monthly premium and have a $250 annual deductible for optional procedures--all quite manageable for the average working person.  

So long as frightened parents have to go on television to beg for money to save a child's life; so long as people with diabetes, cancer or heart disease can be denied medical insurance or be obliged to pay thousands of dollars a year in increased premiums; so long as millions of Americans drudge along in jobs they hate and/or put up with poor working conditions just to get or keep insurance, there is a crisis.  
    In this rich country of ours, there is no excuse for anyone going without decent medical care, yet we lag behind the rest of the industrialized world in providing for our own.  

Illinois politics is strange.  Last week the state's progressive Democratic Senator Dick Durbin initiated an effort to get the sentence of imprisoned former Republican Governor George Ryan commuted by George W. Bush.  The unpopular current Democratic governor, Rod Blagojevich endorsed Durbin's effort. Ryan is currently in his second year of a 6 1/2 year sentence for various infractions relating to fraud and corruption.

Today, Rep. Mark Kirk of the Illinois 10th district in the Chicago suburbs wrote to Bush urging that he ignore Durbin's entreaty and keep Ryan in the slammer.  The head of the state GOP, Andy McKenna has also come out against the clemency bid.

So we have two top state Democrats asking Bush to practice leniency on behalf of a corrupt Republican and the state's Republican establishment seeking to block it.

Of course we can't ignore the fact of political posturing here [Kirk referred to Ryan as "Federal Inmate Number 16627-424" in his letter to Bush].  Blagojevich--whose approval ratings are actually below Bush's--is thinking of running for a third term in 2010.  Given the fact that his administration has been under a cloud of corruption for the better part of three years suggests Republicans are trying to gain some credibility as reformers.

Fortunately for Democrats, the only thing more dysfunctional in the state than their own party is the Illinois Republican party--remember these are the folks who, four years ago, wound up recruiting Alan Keyes to run against Obama for the Senate after being spurned by the meathead football coach Mike Ditka!

[Personal Report and Public Health Commentary]

The new cancer center opened this summer.  I didn't go to tour it when it opened.  Who knew?  It's a stunning building, with one long curving glass wall that overlooks a couple of ponds and beyond that to a small campus of red brick buildings across the street.   Beautiful in the new snow yesterday morning.  I'd call it a very healing setting - especially having now seen it from the inside.

The whole process was really ideal.  Not that I would have known what "ideal" would be beforehand.  But looking back on it, from my perspective, we received a lot more than meetings with doctors and nurses and office staff.  There was evidence someone had actually looked through a chart and knew many things beforehand.  There was lots of time for questions and answers, and two physical exams - one by the resident, another by the radiation oncologist, and a long talk with the surgeon.  Careful thinking through of alternate options, side effects, drawbacks, and reasons for this and for that, along with a final recommendation for surgery were discussed.  Everything was explained.  People were as kind and informative as you could possibly want.  And he's scheduled for surgery next month, with the expectation that the small, but relatively aggressive cancer will all be removed along with the prostate.

Those are the plain facts.  A very caring medical setting.  Attention to the needs of the patient (and family).  Even a stress questionnaire in case referral for social work or other assistance might be needed.  But as we sat waiting, afterward, for the kind clerk, who was setting up appointments, I couldn't help but think about the people who aren't on Medicare, who maybe need to wait for an authorization, not knowing if or when it will be approved.... meanwhile the cancer might be getting the upper hand.  I thought about how this might have gone before he was on Medicare, how the private insurance we took 9 years ago had ruled out any coverage for this specific organ - as pre-existing - so they could hedge their bets and cover only for things he'd never been treated for.  I thought about the fact that we had just paid the yearly premium for his secondary insurance (to pick up what Medicare doesn't pay) and I pondered who might not be able to afford that - this year or any year.  I wondered how many people who came to the cancer center maybe couldn't really appreciate all the care and consideration, due to worrying how they'd pay for it.

Imagine all the people.  I'm thinking of that song.

Imagine  Public Health:  So no one falls through the cracks.