Health Care Mess in US

Everybody is talking about the healthcare reform in US these days. I just want to write my point of view on this. Here in US if you are rich or if you’re poor you will be fine in getting the access to the health care. Rich have great insurance and poor have Medicaid/Medicare program to pay for their health.

In Medicare, medical bills are paid from trust funds which those covered have paid into. Tax payers pay certain percentage of their income to fund the trust. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.

Medicaid is the federal/state program where it gets the fund from federal state and local tax to serve the low income people of any age. This means the tax payers pay the health care of the poor and low income people who most of the time doesn’t pay taxes. If your income is not qualified to get the Medicaid, you have to get your insurance from the private insurance companies. These are several types of private insurance companies and most come is Blue Cross Blue Shield (BCBS).

If you’re rich you don’t have problem in getting the better private insurance plan. But if you are a middle class and your income is barely above the lower income group then you may not afford for any kind of insurance. Even if you can afford to get certain type of private insurance your pocket expense will be very high if you or family members get sick.

In US emergency care charges 3 or 4 times more than the regular clinic visit. For example if you don’t have the insurance and you take your child to a regular clinic for runny nose, the cost of seeing a physician will be around 60 dollars. But for the same condition if you go to ER it will cost you 250- 300 dollars.

I would like to categorize how different income level plays a role in the healthcare system in USA


Poor and lower income:

Insurance: Medicaid plan-Paid by the Tax payers
Emergency care: No need to pay. Fully covered by Medicaid plan
Tax: They don’t pay taxes even if it is they pay it should very small
Pocket expense for sickness: None
Medications: No need to pay – Medicaid pays
Surgery: No need to pay – Medicaid pays
Seeing a specialist: No need to pay – Medicaid pays

Contributing to their future insurance-after 65years (Medicare): None


Lower- middle class:

Insurance: Most of the time they cannot afford any kind of private insurance
Emergency care: Pays from pocket
Tax: Pays tax
Pocket expense for sickness: A lot
Medications: Pays from pocket
Surgery: Pays from pocket
Seeing a specialist: Pays from pocket
Paying insurance for others (Medicaid) by paying tax: Yes
Contributing to their future insurance-after 65years (Medicare): Yes

This group doesn’t have the insurance of their own but they have to pay the insurance for poor and lower income people via Medicaid. They also have to contribute to their own federally funded insurance program- Medicare for which they can be eligible only after 65years of age. These group most of the time suffer without any health care and they go bankrupt very often.

Mid middle class:

Insurance: Some kind of private insurance with high co pay
Emergency care: Depends on how much insurance covers. Most of the time
they pay significant amount from their pocket.
Tax: Pays tax
Pocket expense for sickness: Depends on how much insurance covers. Most of
the time they pay significant amount from their pocket
Medications: Depends on how much insurance covers. Most of the time they
pay significant amount from their pocket
Surgery: Depends on how much insurance covers. Most of the time they pay
significant amount from their pocket
Seeing a specialist Depends on how much insurance covers. Most of the time
they pay significant amount from their pocket
Paying insurance for others (Medicaid) by paying tax: Yes
Contributing to their future insurance-after 65years (Medicare): Yes.

Even though this group has some kind of insurance they still pay a lot for their health care cost and even some of the goes bankrupt in this group because of their healthcare cost.


Upper Middle Class:

Insurance: Good Insurance-Private
Emergency care: Pay less from the pocket depends on the insurance
Tax: Pays tax
Pocket expense for sickness: Fair
Medications: Covered mostly by insurance. Pays a little from pocket
Surgery: Covered mostly by insurance. Pays a little from pocket
Seeing a specialist: Covered mostly by insurance. Pays a little from pocket
Paying insurance for others (Medicaid) by paying tax : Yes
Contributing to their future insurance-after 65years (Medicare):Yes


Upper Class:

Insurance: Very Good Insurance-Private
Emergency care: Pay less from the pocket depends on the insurance
Tax: Pays tax
Pocket expense for sickness: Almost none
Medications: Covered by insurance. Pays a very little from pocket
Surgery: Covered by insurance. Pays very little from pocket
Seeing a specialist: Covered by insurance. Pays very little from pocket
Paying insurance for others (Medicaid) by paying tax : Yes
Contributing to their future insurance-after 65years (Medicare):Yes

Note: There is no clear income definition for middle and upper class in US


How we got into it ?

To qualify for Medicaid your gross income should be less than 13,000 dollars/year i.e. you should be below 133% of poverty level. For better private insurance you need a gross income of $70000-90000 dollars/year. Average American gross income is 50,000 dollars per year- as of 2007 income data. These means most of the American don’t have good insurance. Lot of them doesn’t have insurance at all but still they have to pay for the poor and low income people. To me this is unfair. You pay for others but you don’t have one for yourself. It is like you have to put your money in a pot to keep it full all the time but it has been constantly drained and enjoyed by people who don’t contribute to that. You may go bankrupt because of your healthcare cost but you have to still take care of others healthcare who don’t even pay a single penny to it.

Why healthcare cost so much?

In this country most of the time physicians are not free to think and do what is right for the patient. This is because people sue the physician for everything. Physicians are constantly under the watch by the lawyers for the malpractice. Since there is always a fear of malpractice sue among the physicians, they ordered bunch of lab test to avoid any malpractice sue even if it is not needed. Doctors charge more because insurance pay them back less than what they asked for. Moreover they also have to pay for their malpractice insurance. They have to bill all these expenses on the patient .In addition to that, drug companies don’t want to let their drugs go generic or reduce the price of their branded drugs All these expenses fall on the patient’s pocket and ultimately to the society


What do we do about it?

There are no real solutions to these issues. This is what I think we can do to make the healthcare system better. There should be a federally/state/locally funded universal health care available for every American irrespective of their income. Option of choosing a private insurance instead of universal health care should be offered to every American. But everybody has to contribute whether they want to participate in the universal healthcare system or not. This way tax payer gets their benefit of paying the tax by getting healthcare for themselves instead just paying for others. That funded program should act like Medicare to all age group.

Currently everybody has to contribute to Medicare which pays the health care to seniors 65years or older irrespective of their past and present income. In current Medicare you can supplement your coverage by buying more private insurance. Same kind of principle should apply to the all the age group under the universal healthcare. This way people have the option of choosing either the universal health care system as their sole insurance or supplementing their universal health care system with other private insurance.

Universal health care means is healthcare for everybody but also giving the choice supplementing it with other insurance. It should not be literally free otherwise people started abusing it. Every body should be charged some kind of co-pay to the clinic visit, ER visit and prescription based on the income status. Even for lower income have to pay some co-pay. For ER visit co-pay should be higher than the regular clinic visit this way we can avoid flooding the ER for just simple health condition which would have been treated next day in the outpatient clinic. If you charge even 10 dollars as a co pay for ER visit to the lower income you will dramatically reduce the healthcare cost burden.

Malpractice lawsuit should be regulated. Malpractice amount cap should be imposed. To avoid lab errors and doing unnecessary labs, universal electronic health record system should be implemented. Universal electronic health record makes the any doctor anywhere in US to access the patient’s record. This will reduce repetitive test and labs on a patient.
Doctors doing unnecessary lab test should reimbursed less on their payments and good doctors should be rewarded with better reimbursement. Universal healthcare should pay only set number sick visits to the clinic and ER. Extra visits and other privileges can be supplement by buying additional private insurance. More emphasis should be placed on yearly screening.

Exploring I- நான் Part II A Religion without a Name

I have always wondered why our religion called as Hinduism. Why people are calling as Hindus? Is that the real name for us? Sri Chandrasekharendra Saraswathi- Sankaracharyar explained that in detail in his book “Deivatthin Kural”.

English Version:

We speak of the "Hindu religion", but the religion denoted by the term did not in fact have such a name originally. According to some, the word "Hindu" means "love"; according to some others a Hindu is one who disapproves of himsa or violence. This may be an ingenious way of explaining the word.

In none of our ancient sastras does the term "Hindu religion" occur. The name "Hindu" was given to us by foreigners. People from the West came to our land across the Sindhu river which they called "Indus" or "Hind" and the land adjacent to it by the name "India". The religion of this land came to be called "Hindu". The name of a neighbouring country is sometimes applied to the land adjacent to it. Let me tell you an interesting story in this connection.

In the North people readily give alms to anybody calling himself a bairagi. The bairagis have a grievance against Southerners because they do not follow the same practice. "iIlai po po kahe Telungi" is one of their ditties. "Telugus do not say "po, po" but "vellu" for "go, go". "Po" is a Tamil word. Then how would you explain the line quoted above? During their journey to the South, the bairagis had first to pass through the Telugu country (Andhra); so they thought that the land further south also belonged to the Telugus.

There is the same logic behind the Telugus themselves referring to Tamil Nadu as "Arava Nadu" from the fact that a small area south of Andhra Pradesh is called "Arva". Similarly, foreigners who came to the land of the Sindhu called all Bharata beyond also by the same name.
However it be, "Hinduism" was not the name of our religion in the distant past. Nor was it known as "Vaidika Mata" (Vedic religion or as "sanatana dharma" ( the ancient or timeless religion). Our basic texts do not refer to our faith by any name. When I thought about it I felt that there was something deficient about our religion.

One day, many years ago, someone came and said to me: "Ramu is here. " At once I asked somewhat absent-mindedly: "Which Ramu? " Immediately came the reply : " Are there many Ramus? " Only then did it occur to me that my question, "Which Ramu? ", had sprung from my memory of the past. There were four people in my place bearing the name of "Ramu". So, to tell them apart, we called them "Dark Ramu". When there is only one Ramu around there is no need to give him a distinguishing label.

It dawned on me at once why our religion had no name. When there are a number of religions they have to be identified by different names. But when there is only one, where is the problem of identifying it?

All religions barring our own were established by single individuals. "Buddhism" means the religion founded by Gautama Buddha. Jainism was founded by the Jina called Mahavira. So has Christianity its origin in Jesus Christ. Our religion predating all these had spread all over the world. Since there was no other religion to speak about then it was not necessary to give it a name. When I recognised this fact I felt at once that there was no need to be ashamed of the fact that our religion had no name in the past. On the contrary, I felt proud about it.

If ours is primeval religion, the question arises as to who established it. All inquiries into this question have failed to yield an answer. Was it Vyasa, who composed the Brahmasutra, the founder of our religion? Or was it Krsna Paramatman who gave us the Bhagavad-Gita? But both Vyasa and Krsna state that the Vedas existed before them. If that be the case, are we to point to the rishis, the seers who gave us the Vedic mantras, as the founders of our religion? But they themselves declare: “We did not create the Vedas.” When we chant a mantra we touch our head with our hand mentioning the name of one seer or another. But the sages themselves say: "It is true that the mantras became manifest to the world through us. That is why we are mentioned as the 'mantra rishis'. But the mantras were not composed by us but revealed to us. When we sat meditating with our minds under control, the mantras were perceived by us in space. Indeed we saw them (hence the term mantra-drastas). We did not compose them. "[The seers are not "mantra-kartas".]

All sounds originate in space. From them arose creation. According to science, the cosmos was produced from the vibrations in space. By virtue of their austerities the sages had the gift of seeing the mantras in space, the mantras that liberate men from this creation. The Vedas are apauruseya (not the work of any human author) and are the very breath of the Paramatman in his form as space. The sages saw them and made a gift of them to the world.

If we know this truth, we have reason to be proud of the fact that we do not know who founded our religion. In fact we must feel happy that we have the great good fortune to be heirs to a religion that is eternal, a religion containing the Vedas which are the very breath of the Paramatman