Back in 2009 while Obama's healthcare proposal was still being discussed, including the non-profit (e.g. single payer) option, I wrote an article about the healthcare debate which got published online by an independent source. I even wrote a letter to the editors of the New York Review of Books which got published along with a defensive and typical CYA response from the authors of the article I wrote the letter about (i.e. their shallow coverage of the non-profit option).

Alas, Sen Lieberman (D) blocked the public option and ACA/ObamaCare was enacted without it. This single ommission is probably the primary reason medical bankruptcies have continued to rise and far outpace other OECD nations on a per capita base. Given that medical bankruptcies constitute a whopping 66% of all US bankruptcies (while the nearest comparable country Canada has just under 20% medical bankruptcy rate), you can see why one man, Sen Lieberman, has singlehandedly ruined millions of lives in the past 15 years and many more in the future.

Thank you Sen Lieberman for a gift that keeps on giving! On the positive side, Americans can emigrate to any number of countries to get superior and affordable universal healthcare that doesn't ruin their lives or just do some medical tourism if moving permanently to another country seems too drastic and they prefer expensive healthcare, expensive education (that can incur loans that can't be discharged through bankruptcy) and/or want to keep their guns.

Notes:
1. While some claim that only 17% of US bankruptcies are due to medical costs, they are playing fast and loose with the truth which is that over 65% of US bankruptcies are directly or indirectly connected to medical costs.
2. Others have estimated that only 10% of Canadian bankruptcies are due to medical costs (despite the universal healthcare system which BTW does not cover all medical problems).

I am proud to know PJ Parmar and I wish I was half the man he is. Here is his 10 minute TED talk from 2018, and a 2021 Denver Post article about his Ardas family clinic and Mango House. In a previous lifetime, he wrote this book: 101 Countries. Snippets from his TED talk:


A study by Merritt Hawkins found that only 20 percent of the family doctors in Denver take any Medicaid patients. And of those 20 percent, some have caps, like five Medicaid patients a month. Others make Medicaid patients wait months to be seen, but will see you today, if you have Blue Cross. This form of classist discrimination is legal and is not just a problem in Denver. Almost half the family doctors in the country refuse to see Medicaid patients.

This is Mango House. My version of a medical home. In it, we have programs to feed and clothe the poor, an after-school program, English classes, churches, dentist, legal help, mental health and the scout groups. These programs are run by tenant organizations and amazing staff, but all receive some amount of funding form profits from my clinic. Some call this social entrepreneurship. I call it social-service arbitrage. Exploiting inefficiencies in our health care system to serve the poor. We're serving 15,000 refugees a year at less cost than where else they would be going.

PJ's dedication reminds me of another great MD: Paul Farmer and his liberation theology. I highly recommend "Bending the Arc", the documentary about him and Partners in Health.

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