Un-Un-Cat — Episode 26. The M in HUMAN

last shreds of the American middle-class

The M in HUMAN stands for Access to Medical Care as a Right.

Starting on day one, January 20th, 2021 as announced by the Vice President at the inauguration, the emergency provision providing Medicare coverage for all uninsured Americans and refugees in our care, had made a significant impact in reducing the costs of emergency rooms and ambulance services across America.

While critics of the Green Administration debated about how they were going to fund Medicare for all uninsured people; President Green was more concerned with how they were going to staff all the city hospitals and rural clinics needed to provide access to medical care for everyone.

Since 1972, the US Department of Health and Human Services has offered a National Health Service Corps loan repayment plan. The work-study scholarship paid for four years of college in exchange for two years of service in a community that needed nurses, dental hygienists, therapists, and other qualified practitioners in medicine.

The battle in Congress to fund the NHSC loan repayment work-exchange had stopped being contested as a compromise to postpone the passing of a national health insurance program via the Medicare for All Act, as written in 2019 by the Vice President when he was serving in Congress. Senators who had in previous years requested an increase in funding for NHSC were now able to increase the scholarship to up to 8 years of medical school tuition room and board in a qualified college program. This was important and strategic funding to prepare for the aging of the boomers and the increase in medical staff that would be required for their care.

In the dimension where a 150 pound,(20+ pounds of cat hair), 5 foot 2” walking talking cat meme was elected POTUS in 2020, and HUMAN 1st economics was happening, it was the corporate giants who were on their knees begging for mercy, not the American working poor. “Money, money, money” hissed President Green when she got tired of going over line items on the budget.

Everyone in the west wing knew this was as close to cursing as she got. President Green smoothed over the ruffled fur of her right ear with one paw and walked over to the digital whiteboard wainscotting in the oval office. “We need a brainstorm of all the non-critical expenses in the US healthcare system and how to safely economize.”

In 2017–2019 the US spent too much of our total national tax revenue on health care, 17–18% of the federal budget on medical spending. That’s a lot for such limited programs that do not even come close to covering all of our nation's people. This is bad, especially when compared to the countries ranked in the top 10 in medical care in the world that offer universal health care to all of their people. France, Italy, and Japan only spent 9 to 11% of their budgets. And this 9 to 11% is for the top ten list of WHO rated, best healthcare in the world while the USA was ranked 37th of all developed nations?! These embarrassing statistics are only part of the reason why President Green had requested a brainstorm of non-critical costs.

“Nothing is too small, in fact, the smaller the better.”

One suggestion brought to her attention by retired nurses was to support better market competition for non-essential items used by patients staying in the hospital. For example, a cheap bulk toothbrush that cost pennies for an off-brand medical supplier to make could show up on a hospital stay medical bill listed between $20 and $100 dollars (or more depending on who owns the medical facility), the same for dental floss, and those little boxes of tissues set beside patient beds. A patient or their family should have the option to buy a toothbrush and other non-medical items available at any grocery store, at cost, or at least at fair market value, with all price tags transparent and visible.

To inadvertently add a $50 dollar mini-pack of scratchy generic tissues to the bill of their family member or dying friend, or “buy” a $12 juice box, the patient “gave” to their visiting child is not very “American-free-market” for an industry making billions in profits per year, especially while medical bills are the number one cause of families facing bankruptcy in the US.

Non-medical items bundled into the total bill are only a small fraction of the high price Americans pay for healthcare. The costs of all medical procedures are hidden from the public. It is nearly impossible to price check before seeing a specialist, going in for yearly screening or having a non elective surgery.

Another area that could reduce the overall cost of healthcare in the US without having an adverse effect on the quality of medical care provided is how we handle medical bills. The entire billing process of submitting a claim, following up on submitted claims: covered, not covered or partially covered. Then appealing claims is a time and paperwork intensive cycle, cruel to the public. A redundant back and forth loop processed multiple times by offices often not on-location nor in the same healthcare system as the processor of the original claim, like for example tests sent from a hospital or clinic to a laboratory. The insurance billing cycle is a waste of the most valuable and scarce resource in the entire medical system — “labor”. And in the case of healthcare, it’s the time of skilled medical practitioners, nurses and doctors that is most costly to waste.

Revolution level battles have been fought over how to streamline funding for healthcare in other countries. In this area, America could benefit from evaluating how the best-ranked healthcare systems in the world spend substantially less tax revenue and provide better medical care. We could “copy & paste” aspects of the best national systems for billing patients and adapt other nations’ hard-earned lessons learned to accommodate our population.

Where do we even start with actions that will result in better and more affordable healthcare for the American people? This walking talking Cat-meme of a President did what she had the power to do. First, the Green Administration removed government healthcare coverage from Congress and all state health commissioners. No government healthcare plans for those responsible for the post-Affordable-Health-Care-Act provider debacle. They would be required to shop the private health insurance marketplace in their states for themselves and their families until they figured out a better system to pay for healthcare for the nation.

Second, she contracted the most profitable corporate tech giants to overhaul the medical records system for the Veteran Affairs Hospitals and active duty Military. Medical records for the VA was pretty high on the list when President Green asked for areas of improvement for the armed services on her first few weeks as Commander in Chief.

But getting it done was going to require a reach into the technology sector. Years before the election, during her campaign and as the nominee no one expected to win, President Green had announced USTeK for text communication and public streaming protocols for sports and news to heal the digital divide. All the internet providers, cellular and wireless companies in the US had wanted in. And had later eagerly joined in negotiating for contracts, not wanting to be left behind as all Americans gained access to the “new” internet.

In contrast, negotiating for contracts to build the new computer system for the military to digitize the mountains of government paperwork and the VA hospital’s records was not a job many were salivating for. But, the contracts were to be billed as tax payments made. And why were they motivated to do it? Because at the same time President Green asked for support on the contracts, the IRS and FBI were at work, closing loopholes for stashing money in offshore accounts or shuffling corporate locations via PO boxes and shell companies in tax haven states in the US. Instead of fines and taking some major US corporations to court, wealthy multi-billion-dollar corporations “settled”. Those who owed back taxes could pick-up government contracts and “pay” taxes publicly and directly. Over the four years of President Green’s first term as POTUS, the top seven tech giants, “Oodles”, “Bit-fruit”, “Face-blank”, “Big-softie” and “The Initial Corporations” tech giants, paid a combined 7.8 billion dollars worth of taxes by loaning skilled engineers and designers with salaries paid in full by the corporations, to build computers designed to spec for the military and manufactured in the US.

Together, with the cooperation of many smaller companies, all the out-dated computer systems and paperwork in the military-industrial-complex was brought into the new millennium. Four years is fast for an overhaul of this scope, but, many systems had been out-dated for decades. Plans to up-grade had already been mapped-out, waiting for the funding and the backing of the US computer companies and the most skilled engineers in the computer industry under their employ to get to work.

What does this have to do with healthcare in the US? A lot, actually. As the military upgraded their entire computer network they were able to successfully implemented stream-lined billing practices including commissary line-item purchasing of incidental items, transparent administrative costs, and medical records owned by the patient that can travel from doctor to doctor to stream-line treatment and reduce errors as the military personnel moved around while they served. The result eliminating costly medical billing back-and-forth and more importantly clearly told new doctors who was missing preventive care and screening between government and private healthcare systems.

Proprietary medical records and billing software impedes communications between competing hospitals, clinics, and doctors' offices. This is an area in American healthcare that can drastically improve care and reduce costs.

As the military systems on bases got up to speed and running efficiently then they would implement beta programs in civilian populations in the surrounding towns. The pilot medical billing and digital records programs for the public started North in Anchorage AK, and West in Honolulu HI, then on to Tacoma, WA and Colorado Springs, CO, and spread East from there.

Meanwhile, a series of class-action lawsuits were in progress against insurance providers and the entire healthcare industry that had seen record profits from 2017 to 2019 at the same time as the life expectancy in the US dropped.

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Insurance providers had ripped to shreds the affordable health care act’s limits for premiums as a percentage of employee’s household monthly income. By forcing employers to pay higher prices for the same health insurance plan than the same employee could buy in the marketplace. Greed, pure and simple is why premiums and profits in the healthcare industry in the US rose so steeply during the corrupt POTUS’s term. As patients paid more and more in premiums they were able to afford to “buy” less and less care. While the profits from artificially pushed premiums grew Americans rationed their health care: skimping on dental care, wearing their glasses or contacts for longer than they safely should have, family members took turns going to the doctor, cut pills in half or quit taking needed medication when they could no longer afford them. The least able to process the billing system, overworked and underpaid, the mentally ill, and those with dementia were preyed upon by duplicate billing for the same procedures by the broken claims systems and sent to collections. People self-medicated. People went undiagnosed or ignored, and many, many people died. Do you understand how many young people have to die to cause the life expectancy to drop?! The only age group that didn’t see a significant statistical increase in deaths was the oldest Americans. Please, stop dying young people!!!

Do you really get it? This is not even close to okay for a country with an advanced health care system and well-trained doctors and nurses as we have here in the US. This is beyond shameful. We should all be taking up our pitch-forks and torches and smoking out the top earners of profits made by the American health care industry during this time of national suffering.

But, instead, the medical industry hid behind medical privacy laws written to protect the patients. And suicides, overdoses, and accidental fatalities rose in the top causes of deaths in the US.

US Suicides in 1999. 29,199 people,… year 2014. 42,772 people… year 2017.47,117 people.

US Drug overdoses in 1999. 16,850 people. … year 2007. 36,010 people…Year 2017. 70,237 people.

(The Trump administration has greatly limited access to death statistics since 2017. The World Health Organization list of ranked health care by each country in the world has been stripped off the wikipedia page. The 2018-2019 information I used to write this episode last year in 2019 is gone. The gap in removed information now in August 2020, starts at 2013)

Back in the fictional universe with the Cat POTUS, President Green wasn’t in the White House to focus on the negative. She was there to demonstrate what good could be possible.

As the new medical records and billing systems spread across the US, doctors, and nurses saw the improvement in their ability to care for their patients. State by state, class action lawsuits spread whenever hospitals refused to upgrade.

The new digital medical billing system causes the actual costs of procedures and medications to be visible to the public for the first time. Transparency of billing cost forced fair medical pricing across the US.

This transparency in medical costs opened the floodgates in favor of the people, breaking wide a series of lawsuits against prescription drug manufacturers. Many of these cases against opioids and EpiPens had started decades ago and had been clogged up in litigation by teams of high powered corporate lawyers pitted again underfunded state attorneys. But with access to medical care for everyone, the full force of the market crashed on the most greedy and corrupt corporations. Forced liquidation of assets (collected by state-owned generic drug manufacturers) and long overdue prison time for the deaths caused by their greed was celebrated tearfully by victims' families.

At the same time on the opposite battlefront for the health of the American people. ‘Big Sugar’, and ‘Big Corn’ were losing to popular demand, and diet changes in the market aimed at mitigating climate change had a positive impact on healthcare, via weight loss, and a reduction in the numbers of heart attacks and type 2 diabetes cases. Short term results in over just four years time, but good numbers are worth celebrating when those statistics are a decline in suffering and death because of a marked improvement in the health of the people of a Nation.

P.s. The subject of access to medical care for all as a right is too-close-to-home as one of the 1-in-every-2 American’s whose lives have been cut into by cancer. I could go on, and on like the “crazy” person I am. About the American workweek and stress, or the American processed food diet because of that relentless boot-on-our-necks, as the working-poor, forced to survive pay-check to pay-check with no benefits of sick leave, vacation time or family time after a birth or a death. And I haven’t even touched on the subject of mental health care. But, I’ll stop here and move forward to lighter subjects. The A in HUMAN is next, and that stands for the Arts!

Q: What do humans do better than AI or robots?

A: The arts and literature.

2019–2020 Un-Un-Cat story episodes are science fiction prototyping about ‘How to postpone the apocalypse’, Cat seriously has a plan to save the humans.