Printed letters, December 5, 2013

Dr. Michael Pramenko’s commentary on Obamacare raises many interesting questions, but it fails to provide any answers, other than Obamacare is the best solution in all cases.

Many health care solutions are more realistic, less expensive and certainly less cumbersome than using a myriad of state and federal exchanges — most of which function poorly, if at all.

A simple solution would be an expansion of the Medicare program to cover all Americans, regardless of age, with a standard package of benefits and coverage as we currently insure our seniors.

To avoid the feared outcome of a single-payer system, private health insurers could bid to provide coverage to the Medicare system regionally, much as they do now for Medigap coverage, Medicare drug plans and Advantage plans.

This expansion of coverage demographically could be paid for by a modest increase in Medicare payroll taxes, amounting to much less than employees currently pay for their portion of employer-provided health coverage and what individuals pay in personal premiums.

Pramenko chides the Republican-controlled House for failing to pass any legislation improving Obamacare, yet he surely realizes that, with a Democratically controlled Senate and executive branch, it would amount to a moral victory at best.

Likewise, his statement that Obamacare is an alternative to socialized medicine is disingenuous, since the individual mandate and the requirement of individuals to pay for coverage they will never use, like childbirth coverage for elders, is in fact pure socialism.

He is accurate in his assessment that single-payer, socialist systems in developed countries provide higher quality and lower-cost health care.

His aversion, however, to this solution, with private insurers supplying the government with the operational and market support its exchange clearly needs, ignores an obvious alternative to Obamacare.


Grand Junction




Pramenko deserves the ink 
for his health care knowledge

Here’s the answer to Richard Rininger’s question, “Why does the Sentinel keep publishing Pramenko?”

On one hand, Dr. Michael Pramenko, M.D. — as a practicing primary care physician, past president of the Colorado Medical Society and former member of both Club 20’s Health Care Policy Committee and the Federal Advisory Board for Section 1322 of the Affordable Care Act — is perhaps the most qualified and knowledgeable local commentator available.

Consequently, Pramenko’s columns are consistently fact-based, and they carefully explain the public policy considerations that underlie that “market-driven” approach (originally conceived, endorsed and successfully implemented by “conservatives”) for extending affordable access to health care to 40 million-plus Americans.

On the other hand, local critics of the ACA — including Rininger and Gary Montgomery (“Obamacare website problems are just the tip of the iceberg”) — offer only unsubstantiated assertions of an “unworkable financial mess this law has created” and/or similarly unsubstantiated (but presumably dire) prognostications of “ultimate effects.”

Among the financial facts which Rininger ignores is that the ACA has already extended the actuarial viability of Medicare by reducing its future expenditures by more than $700 billion. It has already contributed to dramatic reductions in annual health care spending and cost increases, and average premiums for policies offered on ACA exchanges were 17 percent lower than expected, saving another $147 billion in subsidies.

Meanwhile, Montgomery’s “iceberg” floats on references to Cuba, Venezuela and a financially-independent Canadian provincial premier who (on his doctors’ advice) opted for heart surgery in Florida — in 2010. Beginning in 2014 under the ACA, Floridians (many for the first time ever) will also have access to similar quality care.

That’s why the Sentinel publishes Pramenko’s (and contrary) opinions.


Grand Junction


Ripped jeans inappropriate 
as part of medical attire

This letter is in response to the letter Nov. 29 to the editor headlined, “Medical assistants should change their greeting protocol.” What about what they are wearing?

I object to a nurse wearing jeans with many rips up and down the legs, even exposing bare skin. Why not wear scrubs?

I recently was in a clinic in Helsinki, Finland, where everyone wore dark blue scrubs, even the doctor and clerks. It looked “medical.”


Grand Junction


‘How are you?’ is a greeting, 
not a request to recite woes

This is in response to the letter to the editor published Nov. 29. Upon entering a medical facility, you are asked how you are by a friendly nurse or receptionist and you take issue with the greeting. Really?

“How are you” is a salutation, not an invitation for a recitation of your woes.




Commenting is not available in this channel entry.
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Kevin Cochrane’s critique (“Better ways than ACA to improve health care”) of Michael Pramenko’s commentary on the Affordable Care Act (“ACA”) loses credibility, first, by distorting its content; second, by glibly asserting that there are “simple solutions” to complex health care problems implicating 16% of our economy; and, third, by conflating “insurance” with “socialism”.

First, neither Dr. Pramenko nor any serious policy wonk claims that “Obamacare is the best solution in all cases”.  Rather, of the two comprehensive approaches vetted by the “conservative” Heritage Foundation and Senate committees – “single payer” (“Medicare for all”) versus competitive “market-driven” health insurance exchanges – the latter had apparent bipartisan support, offered the best chance of implementation, and had proven successful in Massachusetts.

Second, while Cochrane’s hybrid approach may have merit – see, e.g., Representative Alan Grayson’s (D-Fl) H.R. 500 (the “Medicare You Can Buy Act”) – the Republican House has had two-plus years to evaluate “better ways than the ACA”, but petulantly wasted it all.

Thus, “Pramenko chides the Republican-controlled House” – not just for “failing to pass any legislation improving Obamacare” – but (as did Congressman Scott Tipton) for publicly but disingenuously touting their so-called “alternative”, which (just as may Cochrane’s)  turned out to be virtually non-existent and so fraudulent in its meager substance that it still languishes in House committees because its proponents are reluctant to have it properly “scored” by the CBO lest their perfidy be even more publicly exposed.

Likewise, Cochrane’s equation of the ACA with “pure socialism” is particularly dubious. The purpose of the “individual mandate” is to promote an aggregate “risk pool” that minimally discriminates among insureds, allowing them to selectively purchase health insurance from either not- or for-profit insurers on competitive exchanges – definitely not “pure socialism”.

Of course, presumably, if Cochrane’s “simple solution” were really so “obvious”, then Republicans would have already jumped on it!

Bill Hugenburg why do WE need Obamacare in the first place. So our government can control our lives? So our government might decide life and death? So our government will have more power? I agree that our government is broken. I see all parties as wasting 2 years. Certainly your implication that it is the “republicans” and “conservatives” is are the problem totally inaccurate. The entire government is at fault. Period. Pramenko’s assertion that the “republicans” have NOT passed any legislation improving obamacare in the house implies that the democrat controlled senate would have passed it as well. This is just another attempt by Hugenburg to tell us how great obamacare is. Americans know that obamacare is no where close to the answer. Nor should it be. He so gleefully forgets, conveniently, that the senate AND house were controlled by democrats when it passed. Pelosi told us “lets pass it so we can see what is in it.” Really? Lets play craps and see what we can win with America’s mandated health care system. Why not just say it like it is? Obamacare is NOT supported by the majority of Americans. Obamacare is NOT liked by the majority of Americans. Now that the dice have been rolled Americans are subjected to every bit of the consequences of that roll of the dice. Obamacare is merely a vote grabbing attempt. Obamacare is just another crapshoot sending America further to a WELFARE state.Blame for the obamacare disaster has no one culprit. Blame is the fault of the ENTIRE government. Majority rules. Please stop espousing the greatness of democrats. They are, indeed, as sorry and broken as is our entire government.
Reid exempted his entire staff from its tenets. A positive indication to me that the entire law SUX.  Our so-called “leaders” are exempted from it. Why? Because it sucks and the government knows it, has known it from its inception and continues to know it. Obamacare is worthless. A true American travesty. It should be repealed and replaced by a comprehensive system decided by leaders working “together as Americans” to come up with an adequate solution.
Our American government IS BROKEN. Period. Worse than kids fighting over a stick. Playing with American lives. Playing with American money. All for the sake “of the party.” Appears to me that if America falls party will NOT matter.
I do NOT WANT my government in POWER over any aspect of my life. I am more than capable, as a man, to decide whether or not I need pregnancy health coverage. I do not need my wealth redistributed. I do not need to be told which firearm I may own nor how many bullets I may carry.
Byline—Hugenbergs cheap shot at Rep. Tipton is just that. Therefor I will fire about 50 cheap shots at Udall. Udall voted for and screams obamacares virtues to the high heavens(bet he is regretting that with reelection comin up. Udall is now losing. LMRO).

I am remiss. I HAVE done my research. If OBAMACARE is SO great then why does the president spend every waking hour trying to convince Americans of its greatness? Why are many constantly espousing its greatness? Why does it need defending? Seems to me that if it were the next BIG thing that phones lines (since the web site sucks) would be burning up with people wanting to get some of it. Why is the Colorado health care exchange (thanks to Hickenlooper) such a miserable failure? Hmm? Maybe it sucks? Maybe our government is trying to force feed us with vaseline? Hmmm.

Because Jerry Sanders still resides in a fact-free bubble, he no longer recalls why both Democrats and Republicans have struggled with health care issues since the late 1980s.

Because profit-driven health care costs were rising incessantly, private health insurance premiums were rising at double-digit annual rates and projected government expenditures for Medicare and Medicaid threatened to bankrupt both programs.

As a result, millions of Americans could not afford genuine health insurance, millions more could not obtain it due to “pre-existing conditions”, health insurers competed “on price” by offering low-cost “junk policies”, and millions of uninsured Americans were forced to rely on hospital emergency rooms for even basic primary care.

As a result, despite John McCain’s false assurances in 2008 that “we have the best health care system in the world” – and even though those who could afford it did have access to world class health care – we had no bona fide national health care “system” (other than Medicare, Medicaid, and CHIPs), but rather were spending twice as much per capita on health care as other industrialized countries, but lagging far behind in medical outcomes.

After 8 years in which George Bush doubled the national debt with profligate deficit spending—leaving President Obama with the largest national debt and annual deficits in our history, and the worst financial and unemployment crisis since the Great Depression
—the projected future costs of Medicare threatened to bankrupt the federal government.

The Republican “solution” was to “end Medicare as we know it” by converting it to a “voucher program” and sending seniors into the private market to shop for coverage.

However, that “insurance market” was rife with abuses – in which unsuspecting health insurance purchasers found themselves without coverage when they needed it, because of annual/lifetime limits, arbitrary cancellations, and our belatedly discovered “pre-existing conditions”.  Indeed, most of the some 1300 private health insurers employed doctors for the sole purpose of scrutinizing medical records to find grounds for denying claims.

Thus, our purported “health care system” depended on health insurance companies who were actually in the business of collecting premiums and denying (not paying) claims.

Consequently, there was bipartisan agreement that we needed comprehensive health care reform so that health insurers could no longer “control our lives” or avariciously “decide between life and death”, and to bring profit-driven health care costs under control.

PART 1. In Bill Hugenberg’s letter, once again we get to see what Economics-101-clueless libs jocularly refer to as “reason”. Hugenberg alleges that Michael “Pramenko’s columns are consistently fact-based.” Of course they are not. That’s the problem with lib ideology: for them, reality is whatever they can get you to believe. The problem with modern libs is that they are neither “liberal” nor “progressive. They are, for the most part, fiercely fascistic.
As Murray Rothbard wrote, “the object of the classical liberals [see “On Liberty” by John Stuart Mill - JRW] was to bring about individual liberty in all of its interrelated aspects. In the economy, taxes were to be drastically reduced, controls and regulations eliminated, and human energy, enterprise, and markets set free to create and produce in exchanges that would benefit everyone and the mass of consumers. Entrepreneurs were to be free at last to compete, to develop, to create. The shackles of control were to be lifted from land, labor, and capital alike. Personal freedom and civil liberty were to be guaranteed against the depredations and tyranny of the king or his minions.”
Let me go out on a limb here and say it’s a mathematical certainty that Obamacare isn’t going to happen as advertised by cheerleaders of the Pramenko-Hugenberg ilk. For one thing, a huge majority of Americans (especially the millions who have had their health insurance policies canceled) hate it. For another thing only Medicaid recipients are signing up. For yet another thing, the all-important (to expanding the risk pool) immortal/invulnerable youth contingency is not signing up. That means fascist police-state “gubmint” will have to increase the fines, become even more fear-mongering and coercive, driving us closer to violent civil war.
Both Pramenko and Hugenberg completely (and blithely) ignore the global currency wars. The bright financial prognosticators I pay attention to have predicted that in the early part of 2014, Russia, China and India are going to stop accepting U.S. dollars. That means overnight gold will be $50,000/ounce and America will become a third world country with something like 50% unemployment for at least a generation. Successful professional investors have predicted that market forces will defeat the global central banking criminal oligarchs. Pretty soon — it’s already happening —nobody will want our dollars if we keep making them worth less and less.
While on one level it is true that the cost of the entire healthcare industry could theoretically be monetized, that can’t be done without radically further debasing the already debased dollar, which will only hasten the day of reckoning when other countries stop playing the central banksters’ psychopathic and evil little debt-as-money, currency-of-last-resort game. At that point, all “rah-rah” theories about Obamacare become laughably irrelevant.

PART 2. Obamacare was designed by evil psychopaths a whole lot smarter than Mssrs. Pramenko and Hugenberg to confiscate the assets of the middle class. As millions of Americans are discovering (to their chagrin), there is zero chance that healthcare costs will be reduced. Captive (as in “individual mandate” and “employer mandate”) markets can only guarantee that prices will increase. Millions of Americans with modest incomes simply can’t afford to buy Obamacare.
According to the natural laws of economics, the one and ONLY defense the individual has against the price of something being too high is the freedom/right to not buy it. You see, not buying a product has the gravitational effect of driving the price lower. Being forced to buy a product has the gravitational effect of driving the price higher. This stuff is not rocket science, folks, even though the collectivist, Economics-101-challenged blitherings of such as Pramenko and Hugenberg would have you believe otherwise.
The facts/realities of healthcare would militate to the Republicans’ side, if they were smart enough (and honest enough) to even have a “side” (aka politically recognizable committed position). Many folks have offered libertarian-leaning free-market solutions to health care prices, including me. (To reiterate briefly, healthcare costs could be reduced by 80% overnight by abolishing the FDA and “unauthorized practice” of medicine, and implementing a Freedom of Self-Medication amendment to the U.S. Constitution.) But you will never see the likes of Pramenko and Hugenberg talking about such things.
It’s time for a serious gut check. Bottom line: neither doctors nor duopoly government political hacks are all-knowing gods. If I am going to die in some grand experiment, I would very much prefer that it be my own experiment.
Reluctant as I am to say so, in my opinion, and with all due respect for their basic humanity, Michael Pramenko and Bill Hugenberg simply aren’t smart enough to run my life better than I can. And I take offense at their apparantly thinking otherwise. And if they should claim to not think they are smarter than everybody else, why do they keep flapping their ideologue jaws cheerleading such an obviously unsustainable, unrealistic and unworkable collectivist plan as “OKenyancare”?

Thank you Mr. Hugenberg. Why not just tell the truth? You are for a socialist state where government dictates our entire lives. I noted that you selected my issues to respond to. Why not admit it. You are, indeed, a self perceived, elitist who lives for “the party”, works for the party and regardless of fact damn the torpedoes full speed ahead. Listen now. This is it. AMERICA was founded upon the guiding principal that we would be FREE FROM AN OPPRESSIVE GOVERNMENT. Not you, nor any party has the right to dictate my life, what I may and may not have nor when I may utilize the facilities. If health care was an issue then our elected government SHOULD HAVE TOGETHER in order to resolve. I am SURE that there are many GOOD and REASONABLE ways to fix healthcare.

Ways to fix illegal immigration. Ways to fix leaving SEALS and Ambassadors to die. Ways to fix NSA leaks. Reasonable and honorable people WORKING FOR AMERICA CAN do it. It takes a TEAM. Individuals working and compromising. I AM NOT WORKING for republican democrat or nazi. I AM AMERICAN. I am NOT democrat nor republican.

Obviously referencing Bush was, in some fashion, your attempt at diverting attention from real issues in order to advance democrat. Until we realize we are ALL IN THIS TOGETHER we are doomed. You, sir, included. Regardless of your blowing as opposed to sucking OBAMACARE IS A FAILURE. PERIOD. AMERICA needs and deserves much better.

Footnote: I direct your “fact finding” to the recent HARVARD study which shows that were it possible this president would be recalled. Also the HOPE AND CHANGE millennials are scrambling, regretting their votes, and avoiding OBAMACARE.

There you have it. My stance. AMERICAS GOVERNMENT, ELECTED OFFICIALS AND HONOR ARE BROKEN. PARTY ADVANCEMENT IS LUDICROUS AT THE EXPENSE OF AMERICA. WE ARE AMERICANS. WE MUST WORK TOGETHER. And now you, possibly, will STOP with selected miniscule facts and issues in an effort to belittle, confuse and buy votes.

To continue responding to Jerry Sanders, the “system” President Obama confronted left both taxpayers and providers (especially hospitals with emergency rooms) “on the hook” for the costs of providing medical care to the uninsured – and to those who thought they were insured, but weren’t.  As a direct result of the housing market crash, equity vanished and millions of Americans were “one illness or accident away from losing their homes”.

Apparently, this is the broken “system” that Jerry and his ilk would have us return to.

Fortunately, a majority of Americans disagreed with him.  In 2008, both Senators Obama and Clinton campaigned on a pledge to reform health care.  While Hillary favored the “individual (and employer) mandate” approach, Obama favored a “public option”.  At the time, there were no other comprehensive options available – other than doing nothing.

Liberals and Progressives also favored the “public option” (“Medicare for all”) – which would have put the federal government in direct and arguably “unfair” competition with private insurers, constituted a real government “take-over” of the health care system, forced rapid consolidation of for-profit insurers to cut administrative overhead costs, led to massive layoffs in that industry in the midst of the Bush Recession, and been properly decried as “socialism” – because the government would really have had “more power”.

Faced with that political reality (but to the disappointment of many of his supporters), President Obama embraced the “market-driven” approach conceived and documented by the conservative Heritage Foundation, endorsed by Colorado’s Blue Ribbon Commission and our own Club 20, and successfully tested in Massachusetts as “RomneyCare”.

Thus, the Affordable Care Act (“ACA”) retains but reforms the private health insurance industry, while incentivizing insurers to compete with each other for customers – thereby leveraging downward pressure on premiums to compel insurers to squeeze out of the system the billions in excess costs and overcharges routinely billed by providers.

While Jerry admits “that our government is broken”, he insists on ignoring the expanding body of evidence that Republicans (who are ideologically convinced that “government is the problem” and thus must be shrunk by defunding it) – not Democrats – are at fault.

For example, in 2009-2010, the Senate committees entertained dozens of Republican amendments as the ACA was being drafted in committee – including one that required designated government employees to participate in ACA exchanges and another that authorized Medicare to reimburse physicians for annual “end of life” counseling of hospitalized seniors.  The latter was falsely decried by Sarah Palin and Senator Chuck Grassley as constituting “death panels” and (in an act of political cowardice) excised.

I cannot fix dunce. My references to ANYTHNG party wise is just examples of both parties. Jeez. Get a grip. YOUR solution(s) are NOT the answer. My statement that AMERICAN GOVERNMENT IS BROKEN was not a reference to republicans. Boo hoo. Just another misleading attempt by Mr Hugenburg attempting to make my comments into some sort of political party workings. It does NOT work Bill. You are a die hard, buried in the mud democrat blowing more smoke and mirrors than Penn or Gillette. I am NOT buying. The DAMNED parties are using AMERICA for their own elitist and lucrative gains. BOTH PARTIES. I am tired of all of you who put the DAMNED PARTY over the whole of AMERICA. And I damned sure do NOT want GOVERNMENT dictating my life. If OBAMACARE is so damned good for ALL of AMERICA then why, as before, I ask are not ALL Americans burning up phone lines to get some of the next BIG THING. 18-29 year olds are running away. Dang. Do you have it now. THEY ARE ALL SELF PERCEIVED, like you, ELITISTS. Until technology caught up our government has been silently sending our tails down the river. ALL PARTIES. YES DEMOCRATS TO. AND REPUBLICANS. AND MY DOG. AND MY just are not worth anymore of my time until next time.

Continuing to respond to Jerry Sanders, the bogus “death panel” meme (“pull the plug on Grandma”) began the cynical Republican misinformation and obstruction campaign that prompted 46 futile votes to repeal and/or de-fund the ACA, to the threatened debt-ceiling default in 2011, and finally to the government shutdown in 2012 – costing billions of dollars and thousands of jobs.

Thus, we can now properly conclude that when Jerry punctuates a declarative sentence (“The entire government is at fault”.) with a “Period”, that is proof positive that the preceding assertion is more false than true.  While there is fault enough to go around, there is no question in the minds of most Americans who has been more irresponsible.

Thus, contrary to Sanders’ misinformed assertion, the fact that House Republicans have passed no constructive legislation regarding the ACA is not dependent on whether the Senate would also have passed it.  Rather, any such legislation could have required a conference committee at which substantive – rather than bogus – issues could be aired and negotiated.  However, because the “Tea Party Caucus” decried the very suggestion of possible “compromise”, under Boehner’s “leadership”, House Republicans deliberately avoided any “conference committees”, lest their bogus “alternative” and misinformation campaign be publicly exposed on CSPAN – preferring staged press conferences instead.

Likewise, at no time have I ever suggested “how great ObamaCare is”.  Rather, both Dr. Pramenko and I have repeatedly re-emphasized the still undisputed fact that only three policy options were realistically available:  public option, market-driven, or do nothing.
While I personally preferred the “public option”, the ACA is better than doing nothing.

Meanwhile, it is all-too-easy to for Republicans disingenuously claim that there are better “alternatives” to the ACA – without having to submit the particulars of their proposals to detailed “scoring” by the CBO (as required by the Budget Control Act).

And, an increasing percentage of Americans are coming to realize that the ACA is closer “to the answer” than anything Republicans have proposed.  Thus, contrary to Sanders’ assertions, a majority (54%) of Americans are optimistic about the ACA’s eventual success and overwhelmingly reject his critiques.

Sanders “gleefully” ignores the facts that – contrary to “shooting craps” – the concepts embodied in the ACA had been thoroughly vetted by the Heritage Foundation, publicly endorsed by both Colorado’s Blue Ribbon Commission and our own “conservative” Club 20, successfully test-implemented in Massachusetts, and carefully considered by the b bipartisan Senate committee.  Although Republicans knew full-well what was in the bill, they all feigned ignorance and voted against their own ideas in furtherance of their determination to deny President Obama a second term.

Touche Mr Hugenburg. I am now watching FOX NEWS. And what are the republicans concerned with you ask? They are concerned with what stance they should take in this upcoming election cycle ie 1) Scrap Obamacare 2) try to fix Obamacare. All for the sake of their party. Reelection. Power. Sickening. However the democrats are doing the same thing. Both of them think it MUST be this way or no way. Garbage. We NEED AMERICANS WORKING for AMERICANS. Your harping, blowing and sucking about how great our democrats are is pure smoke. Neither side is worried about AMERICANS they merely want to be reelected. Obamacare was supposed to do that for democrats grab for the Poor” people and the KIDS. Republicans are no beter and in my view neither are your “absolute” ideas.

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