The reality is that the care of Esmin Elizabeth Green as highlighted by Tim Foley (http://healthcare.change.org/blog/view/rationing_health_care_to_keep_wall_street_happy) was public care.  Kings County Hospital is a city institution perhaps affiliated or not with a state medical school, SUNY Downstate.

Even before the case of Ms. Green, there was a suit against Kings County Hospital for its negligent care.    

Kings County Hospital has been fundamentally dysfunctional for over a hundred years.  It is a site of institutionalized government corruption and incompetence.  It may well be the worst medical institution in the western world.  Only possible in America.  It is a carry over of segregation in the North, county hospital charity care for the poor.  

It is not even clear that Kings County Hospital and SUNY Downstate are affiliated so byzantine are the government relationships.

I know all this because I have followed this institution for forty five years since high school.

This hospital alone is reason enough for us to reform our health care system.  I began writing to Mr. Obama about this hospital as soon as he became a candidate for President.

It is GOVERNMENT health care at its worst.  People who fear a public plan or a single payer are fearful of being forced to go to such institutions.  Those fears are justified and real.  The whole notion of a public hospital in the USA is tied to incompetence, urban corruption, cronyism, segregation, etc. 

The hope is that once care would become universal with the same identity, another hospital on other principles could be built to replace it.  Kings County Hospital unfortunately has been too big to fail.  At one time it saw something like three percent of the ER cases in the USA. 

Universal insurance on the Canadian or any other model would provide a passport to the unfortunates of Brooklyn to go to any other hospital in the city for better care.  When I worked there as a physician I would carry subway tokens to give to patients to go to other hospitals. I knew they could not get care there.

But, unfortunately, single payer advocates with their incessant chants are oblivious to the realities of American medicine and the genuine fears within the American psyche.

On the other hand, President Obama is not moving beyond segregation.  He is going to maintain Medicaid, the IHS, Medicare, the VA, private insurance, and perhaps a public health plan.  He has not gone beyond the separate but allegedly equal form of segregated American health care.  In reality, President Obama and American society at this time are not capable of going become segregationism when it comes to health care. 

That is how far we have to go when it comes to reform.

If anyone doubts my knowledge of Kings County Hospital, I will send you the medical records (if you can call them that) of Esmin Elizabeth Green from her fatal ER visit.

Bohdan A. Oryshkevich, MD, MPH    

My comment should state beyond segregationism rather than become segregationism in the last long paragraph. 

Also, in an earlier paragraph it should state identity card rather than just identity.

I get fired up everytime I read about Kings County Hospital.

Bohdan A. Oryshkevich, MD, MPH

I'm not sure if you've posted on this already, but see my blog link below for a link to stories from all over the country about the need for Healthcare reform NOW.

http://stellawordpainting.blogspot.com/2009/06/why-we-need-healthcare-reform.html

Thanks!

Testimony of Wendell Potter, former executive at Cigna, before the U.S. Senate Committee on Commerce, Science and Transportation June 24, 2009

http://commerce.senate.gov/public/_files/PotterTestimonyConsumerHealthInsurance.pdf

My name is Wendell Potter and for 20 years, I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick – all so they can satisfy their Wall Street investors.

I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand—or even to obtain—information we need. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world. I hope you get a real sense of what life would be like for most of us if the kind of so-called reform the insurers are lobbying for is enacted.

Harold has hit the proverbial nail on the head. 

We must all insist that health care is a human right and the free market approach does not support that idea. In no case has the free market afforded us universal equitable access or a sustainable  system. Current reform plans are primarily driven by a sense of economic necessity and they fall short because they believe health as a social goal can be realized as by products of fragmented, market based services. We must never be intimidated into believing that calls for a human rights approach to health care is socialism, idealism or any other adjective they can toss in our direction.

Single payer as proposed in HR 676 is as good a place to start in "building a uniquely American solution" to reform as any place. The goal is to create a sustainable, affordable provision of health care. We cannot afford to waste dollars on insurance middlemen and other corporate interests that inflate prices and deplete resources through bureaucracy, marketing, and profit-making. We also must all consider the resource of health care and not use services in  a frivolous manner. We all need to consider that with our rights comes a responsibility to use our resources wisely.

Fareed Zakaria had an interesting piece on capitalism in the June 22 issue of Newsweek, and it relates to the issue of health care reform. He states that no system can work without a sense of ethics and values at its core. no matter what reforms are put in place, without common sense and judgement and an ethical standard they will prove inadequate. He postulates that one of the great shifts taking place in america has been away from the old guild system of self-regulation. Once upon a time, law and medicine and accounting viewed themselves as private sector participants with public responsibilities. As we have seen, these professions have fallen short in their sense of "public responsibility" as have a host of other businesses and professions. 

This failure at self-regulation in the health care sector, be it insurance or medical providers or the recipients of care themselves has brought us to this point in history where people die because of lack of insurance or they become financially bankrupt in spite of it. The whole thing stinks and there is enough blame to go around. 

Also, a nod to Dr. O, minorities do bear the brunt of health care inequality in this country. Upper middle class whites who forgo insurance can usually bear the expense of moderate medical services. Some even have money set aside for medical emergencies. For many, however, this is a luxury and even a minor medical situation may prove financially burdensome.

Harold is correct when he states how we treat each other all come together in this discussion over health care. The results of this reform debate will define us as a nation well into the future. I am hoping and praying that we can all advance together towards a more humanistic society.

Values? Ethics? Do we in the health industry even know the meaning of these words? As a nurse of 39 yrs, I have seen caring, compassion go down the tubes. Its a business in the true sense, profit. Even with insurance get in a car accident through no fault of your own be semiconscious and the first word the paramedic ask you is do you have insurance? Not where is the pain, how are you feeling, but how they are going to be paid and what hospital they will take you to. After the 80/20 that the insurance pays the 20% was $150,000 leaving my children and myself homeless, credit messed up and insurance dropped. The dollar and being upperclass is where you need to be if you are sick in America. The poor get state appointed health care. What does the average American get? No insurance due to a preexsisting condition. Watch Sicko

I have to admire President Obama for even allowing a "public health plan" to be considered as an option, while continuing the health plans (Medicaid, Medicare, VA etc.) we currently have in place. Although I can acknowledge that our nation is not ready to throw in the towel for a single payer public health plan, I still have to say "WHY NOT?" Initially, I believed a public plan option would be enough. Now I am not so sure. I am lucky to be on Medicare, but I have a secondary insurance from the school system I retired from, which basically pays for my prescriptions and some other costs. This secondary insurance is a constant reminder of the bureaucracy of the insurance industry, and is a real pain. Every six months or every year the insurance changes, or the number of the policy changes. Because it sometimes takes 6 months or longer for claims to be paid, and errors of denial occur quite often, I have  had to go back into my records, make phone calls, and prove I was insured. Even if, as was determined, the bill would be paid, I would still receive past due bills, because it still would not get paid for several months. My husband received a duplicate number for two separate policies, and BOTH of them claimed the other did not exist. Several phone calls, and much stress, never resolved the issue. Then there was the problem of actually collecting Social Security, due to a disability. Having to prove over and over again that I was disabled, submitting the same very lengthy documents over and over again, explaining just what I did every day to "prove" I cannot work, eventually hiring a Social Security lawyer to work on my behalf, all of these things needed to be done while I was in no physical or mental condition to deal with these matters. I am still battling the bureaucrats, and I believe I always will. For the past several years I have found myself wishing that this situation could be remedied, or at least be made easier, but the way insurances are run, it won't be. IF we are offered a public health option, the one important benefit would be that the insurance companies just may have to streamline their practices to make it easier, affordable and practical for anyone who needs coverage to be able to turn to them them as a viable option. It would force them to make their own internal reforms. If nothing else, the competition would either make or break them. It is no wonder they are fighting the public option tooth and nail. I also believe a single payer outcome will be the eventual result, as it will be the most cost effective, and it will guarantee that all of us will have access to health care.

There are those who claim that this would just be socialized medicine, which in reality, is a simplistic misnomer. What this really is guaranteeing is the health of our nation, which is in our best interest if we are to survive at all. Any nation, particularly one that claims to be a democracy, MUST guarantee the health and well being of its citizens. It cannot pick and choose who gets well or stays well. It cannot discriminate medical care, based on social staus or financial solvency.

I agree with all of your comments. Think how much better off all of us would be if the one thing we did not have to worry about was getting sick!

i hope everyone on this thread keeps pressuring their legislators. went to a meeting with my legislator last week. of course, the party line was eschewed, but he did say that the single payer opinion was being heard. being heard. well, folks, we have to keep letting them "hear it".

my legislator was talking about a "commonwealth" approach to reform...i guess that is the new buzz word along with "uniquely american". supposedly, this commonwealth approach is a recognition that we are all in this together and we need to provide a collective health care provision that is public to operate alongside the private plans blah blah blah blah blah. of course, the devil is in the details. afterwards, i asked him if i could meet and discuss the concept with him and compare the commonwealth approach to a human rights approach. he agreed to that meeting.

now we all realize that creating a sustainable health care provision runs contrary to the for-profit market based approach. legislators are doing their damnedest to scare people into thinking that unless you have "competition" people are not going to like the reform AND our entire marvelous system of health care will shrivel up and die for lack of "innovation". i don't know what is in these legislator's corn cob pipes, but they must be smoking something different from the rest of us.  even more insulting is that these folks think this argument is enough to make us think, "gee, maybe our system isn't so bad after all". we must work to convince legislators that this insinuation is nothing more than mere illusion. 

from my perspective, our best bet is insisting that health care equality is a human rights issue. considering the dismal numbers coming out of the CBO and the confusion surrounding those numbers, our only firm foundation is our government's responsibility to insist that health care is in the public good and should not be treated as a commodity. my legislator referenced  how "reforming" health care will be the ultimate expression of equality in america. he stated that women's rights and slavery were issues that were once challenged amidst much protest. the civil rights legislation in the 60's were another example he gave the crowd. i was amazed at his readiness to place the reform argument in this arena because the next logical step is to create health care as a public good.

no reform movement in this country has ever been accomplished without the crying and whining of a bunch of people who are just fed up with it all. as the voices of these people grow louder, more begin to "hear" the message and share in the philosophy. reform will not occur because of some magic actuarial maneuver. it will come about as americans begin to move toward the more perfect union we've been hearing about.  our message is reaching people as my legislator's remarks attest. health care is a human right.

Please check out European systems for Health Care - my mother was a housewife and not employed for salary her whole life and even after my dad passed away she still gets treatment for a sum of 10.- Euro per month to the state insurance - what happens to tax payers' money in your Great Nation ???

Rahm Emanuel has been floating idea of "trigger" since January.  What a traitor to Change and REAL health care reform!  The "trigger" is a trap to kill health care reform. It would delay the public option for years, even though we're facing a health care crisis now.  Single-payer is a moral and fiscal imperative; Single-payer NOW !! 

Bravo! You are the only one on Change.org that gets it.

Call your reps and ask them to support John Conyers and HR 676. Not the obama plan. Single payer or leave medicare alone period.