Monday, December 28, 2009

Twas the Night Before Christmas

When all through the House,
Act'lly it was the Senate, sorry for the rouse;
With congress in session for the first time in years
The parties were separate, sitting only with peers
Healthcare was the debate, as long it had been,
Still no common ground, no mutual win;
Conservatives scoffed at everything brought,
Democrats trimmed away things that they sought;
Amid cries of "redneck" or "you lame communist"
Nobody would bend, to what others wished.
In the end there was a vote, along party lines
The bill "IT HAS PASSED" despite all the whines.

So, obviously I'm not lyrically gifted, but considering the season, I thought I'd try for a little parody. Maybe it comes from my complete disgust of popular media's relentless moaning over healthcare reform. Regardless, I think a couple of things need to be made clear - an insane number of people do not have healthcare coverage; the current healthcare system is not effective because it leaves too many people without coverage; healthcare premiums continue to increase, while the coverage continues to decrease; access to medical care is a RIGHT; all rights are tethered to responsibilities.

According to estimates by the Congressional Budget Office (CBO), more than 45 million people will be without health insurance in 2009. I'll be upfront about "estimates" and that I think one can manipulate statistics readily to tell a story, however, this can only be done to a point. So let's say for arguments sake that the CBO has inadvertently doubled the amount of people without health insurance so that there are actually only 22.5 million without it. That's only 8 times the population of the state of Utah, so a much more palatable number. Be it 22 million, or 45 million, that's a ridiculous amount of people to have no coverage. Luckily we are able to help some of them with medicare and medicaid.

Oh, I forgot to mention, about 10 million of those people are actually children, so it's hard for me to swallow the argument that those without coverage are lazy bottom-feeders that are looking for a free ride.

Of those of us that still are able to pay for some kind of a plan, the rates continue to rise, while the coverage falls. I'm not just citing ostensibly biased surveys, but my own personal experience. My rates for a private plan (from IHC) increased every year from 2002-2007, after which we moved to an employer-based plan that also increased its yearly premium from 2007 to the present. What concerns me is not just the increase (inflation explains part of it), but the necessity for rates to go up so dramatically (>130%). Translating that means that if you spent $100 ten years ago, then this year you would be upwards of $230 with less coverage.

I am extremely disappointed that universal healthcare has been dropped from the current proposal. The majority of developed countries (by majority I mean 97%) already have some form of universal coverage in place. This is my favorite map. Glad that we are on par with Africa and Southeast Asia. The entire European Union has adopted various forms of universal healthcare because they agree that medical access is a right of each of their citizens. Don't confuse my support of universal healthcare with the pretense that all these systems are without flaw. I case-by-case analysis of each form would be fantastic, and beneficial in developing a system for the United States. Why must we re-invent the wheel?

I digress. The point is that as a population moves away from despondency and poverty, the trend is for an understanding that all citizens (as part of the "life" clause) deserve healthcare. If private industry could guarantee that, I would advocate the system. Fortunately governments "were instituted of God for the benefit of man". Unfortunately, I don't think that equal coverage or access can be guaranteed on a State level, but will require the intervention of the Federal government. Hence the current reform.

Lastly, a few good things I like in the current bill (which is difficult to read, but should at least be read by EVERY individual, D or R or I, voting on the bill) -

- establish strict federal standards for insurance companies
- limitations on the amount of profit per premium dollar
- insures can not deny coverage because of a person's medical condition
- higher premiums can not be charged based on gender or health status
- companies can not rescind coverage when a person gets sick or disabled

It's a start.

16 comments:

Anonymous said...

I'm sure that it's just a difference of opinion, but I don't understand the attack on the insurance companies. Just like any other company out there, they are providing a service to us.

Why are we (US Government) limiting the amount that they can make? They provide a service, if you want that service you pay for it - if not you go to another service.

Why can't an insurance company deny service or at least charge a lot more for somebody who smokes, drinks and drinks gallons of lard every day?

It's really nice of congress to worry so much....but they've gone way too far!

Reed Winters said...

Great post Shawn. And excellent poem ;)

I think the bill has some good things to offer. Its just that the public option and extended medicare coverage were the best things about the bill, and it's a real shame they're gone now.

The US will have universal (EU and Canadian style) health care one day. Guaranteed.

Anonymous:

"They provide a service, if you want that service you pay for it - if not you go to another service."

The problem is that the service they provide is crucial to human life, and that they abuse their power. What if companies owned the water? They provide you with a service (clean drinking water to your home), and "if you want that service you pay for it - if not you go to another service." The other service being the company on the other side of town that will also give you clean drinking water.

If suddenly you were fighting every month to afford the water you drink each morning, then you're going to be upset.

Right now you're thinking that I'm making a radical comparison between the right affordable drinking water and the right to quality health care. But health care is every bit as crucial to our living these days as water is. How many can have a child and raise it healthy without doctors and hospitals and x rays and surgeries and emergency care and on and on and on.

You wouldn't want companies controlling the water supply, and charging you whatever they wanted for it. We don't want health insurance companies doing the same thing.

Molly said...

I just cannot understand why you would prefer the Federal government regulate our every breath we take and completely demolish private enterprise. Will you enlighten me?

Reed Winters said...

Molly, I think your question was addressed to the author, but I might as well give a quick thought.

Here's my simple, basic answer:

"I just cannot understand why you would prefer the Federal government regulate our every breath we take and completely demolish private enterprise."

This post is not about abolishing the entire private sector. Let's be sure to keep on subject.

I do prefer a government run system of health care though. Is that what you mean to question? Super quick answer why it's better than leaving it to the private sector:

Government run health care can (CAN) cover everyone. Everyone. And I believe everyone deserves to be covered. Privatized health care cannot do that, by definition. These companies are out to make money, and they are not going to cover people that won't give them that money.

Unfortunately there are millions of those people -- the ones who won't give them that money, because they simply cannot afford it.

Government-run, not-for-profit, universal health care is the only way to cover everyone.


I'd hardly call anything I said "enlightenment." You were probably well aware of the fact that private health care won't cover everyone. Perhaps you don't think everyone ought to be covered. I don't know.

But that's the answer, nonetheless.

Jacob S. said...

I'm with you, Molly, I don't want the federal government regulating my every breath and demolishing private enterprise. Luckily, nothing even close to either of those things is happening anywhere in the United States.

Perhaps you can enlighten us as to why you put so much trust and faith in an insurance industry that leaves millions uninsured, denies coverage to people with even very modest pre-existing conditions, denies payments on clearly covered medical expenses to those with insurance, annually increases premiums at rates exponentially higher than inflation and wage increases while simultaneously cutting benefits, and on and on. This is who you are defending?

We are talking about issues of health, life, and death, not just selling video games or vacuum cleaners. This is not a market-wide attack on free enterprise. Believe it or not, sometimes unfettered capitalism simply doesn't work, sometimes the competing demands and desires of the free market cause harm to consumers, so sometimes we demand something different.

So spare us the apocryphal gloom and doom of complete government control of our lives and the end of capitalism. You can still go out and frolic in the immense green pastures of capitalism, only now small the weed-infested corner called "insurance industry" will have a new caretaker and the consumers previously ensnared in its thorns and vines will be set free.

Reed Winters said...

Well said Jacob. The only problem, unfortunately is that:

The weed-infested corner called "insurance industry" does not have a new caretaker and the consumers previously ensnared in its thorns and vines will not be set free.

At least not yet. Not with this watered down bill.

This bill does some good, but it's not that good. We need single-payer before we can go that far.

Jacob S. said...

Agreed, I went a little too far. But I found a metaphor I liked and was powerless to rein it in. Thanks for your contributions, by the way.

Daniel H said...

The bill's not perfect, and I'm not entirely happy with it, but I'm glad we made the step in this direction.

I would love to see us have a system like Switzerland, where the insurance companies are required to cover everyone, they're not allowed to deny pre-existing conditions, and if they don't pay out in 5 business days on a claim, they have to pay your next month's PREMIUM.

It doesn't have to be government run, IMHO, but it has to cover everyone, and none of this pre-existing condition crap.

Reed Winters said...

Jacob: It was a good one, I don't blame you for running with it ;) Hahah. I just wanted to make sure we didn't start thinking that all (or even the majority) of the problems with our health care system are going to be solved with this particular bill.

Daniel: Hm, I seemed to have forgot about that possibility. I suppose a system like that could be possible, but I still think a single-payer plan would be superior. Even if both options do cover everyone.

NPR did a piece on Swiss health care, and it's applications to our current health care woes. You can read it at the following link if you're interested:

http://www.npr.org/templates/story/story.php?storyId=92106731

But Switzerland's system is still far better than what we've got right now. Hopefully our bill will at least follow through on addressing the pre-existing condition issue.

Reed Winters said...

Oh, and I thought I'd just share two more links, if you haven't seen them already.

Howard Dean on bill:

http://www.washingtonpost.com/wp-dyn/content/article/2009/12/16/AR2009121601906.html

President Obama's reply to "Liberal Critics" like Howard Dean:

http://www.kaiserhealthnews.org/Daily-Reports/2009/December/24/Obama-on-NPR.aspx

Anonymous said...

Jacob S: "Perhaps you can enlighten us as to why you put so much trust and faith in an insurance industry that leaves millions uninsured, denies coverage to people with even very modest pre-existing conditions, denies payments on clearly covered medical expenses to those with insurance, annually increases premiums at rates exponentially higher than inflation and wage increases while simultaneously cutting benefits, and on and on. This is who you are defending?"

The problem is that the government usually if not always does more poorly with the money that they are given. More often than not the money is going into the wrong hands. At least with the insurance companies we know what we're getting - a company who is trying to stay in business, keeping the bottom line low.

Daniel H said...

Anonymous - this is one thing that I don't understand...people don't complain about the government funding of roads, water, sewer, and other infrastructure, but they'll readily complain about the social programs.

Is it then an aversion to social programs in favor of a "capitalist utopia"?

Reed Winters said...

Anonymous: "The problem is that the government usually if not always does more poorly with the money that they are given. More often than not the money is going into the wrong hands."

A point we've all heard anonymous. But I'd echo Daniel: If the government is as horrendous as the latest conservative/Glenn-Beck-faux-libertarianism culture would have us believe, then why not privatize the roads and their maintenance? The entire postal system? The fire departments and their services? The Police and their services? The water system? The Armed Forces?

The government is nowhere near perfect, and efficiency could absolutely be improved, but do you really think they are worse than allowing a pocket full of mammon driven corporations to handle it?

"At least with the insurance companies we know what we're getting - a company who is trying to stay in business, keeping the bottom line low."

1) Keeping the bottom line low? That's obviously not working, and it's not the case, or else we wouldn't have a problem, now would we? Health care wouldn't be an issue right now if companies were "keeping the bottom line low."

2) That worked well with the Auto Industry, right?

peter said...

This is a late entry, so probably no one will read it, but I'd like to make a couple of comments. Some of this I've said before, but it bears restating. I will have to post in at least two segments because there is a lot to say. Kristy

1. The idea of everyone having health care coverage is great and important, but mandating it at the current inefficient health care spending levels (Jake documented this in an earlier post) and in effect further bankrupting our country so that everyone can have that inefficient health care doesn’t make much sense. Honestly, everyone has access to care in emergencies as part of our current inefficient system (I’m not suggesting this is the ideal situation) so mandating across the board coverage without accompanying systemic improvements is a joke.

2. As pointed out by Jake in an earlier post, many European countries have “better” health care at lower dollars per capita spent. He suggested that this was due to their universal healthcare systems. I would suggest that it could be more attributed to the primary care based systems that their government run health care dictates as opposed to our increasingly specialty based system. In a primary care based health care system, a primary care doctor acts as a gatekeeper and coordinator for an individual’s medical care. This steamlines talk and patient care between the specialists (which can often become time consuming and complicated) and provides a “home” for the patient’s records. It can also cut down on extraneous visits to specialists (which cost more than visits to primary care doctors) for patients trying on their own to determine which specialist they need for their particular problem. Patients like the choice of being able to see any physician in any specialty they think necessary, but this can generate numerous unnecessary visits that add to health care costs.

peter said...

3. The government can actually help effect this change by restructuring reimbursement schedules for physician visits and procedures for those on Medicaid and medicare. (Turns out that most insurance companies take their cues from the government.) These rates are set by the government and are currently skewed enough toward specialties to discourage physicians from choosing primary care in favor of specialties. For example, a surgeon can do an appendectomy (a procedure he can do practically with his eyes closed) in twenty to thirty minutes and be paid in the 200-300 dollar range for his time. A primary care physician in the same amount of time can see a patient to manage their diabetes (which can be very complicated) and receive 6-12 dollars for their time. This example does not just extend to physician pay, but to nurses, hospitals, physical therapists, and all of healthcare. Procedures pay. Don’t get me wrong, specialists are necessary and important and should be paid more than primary care because they’ve had more training, however, I don’t think that the gap should be quite so wide. And I don’t think that the majority of the physicians in the country should be specialists (the majority of medical students leaving medical school now are choosing to train as specialists.) A restructuring of pay scales would place more emphasis on primary care and bring down healthcare costs.

4. Transparency by insurance companies would go a long way to evening the playing field. We should be able to look at the company and see their internal workings, know where their money is going and know how much a procedure is going to cost.

5. You don’t want rate increases for people with pre-existing conditions, fair enough. Can we charge people more for stupid life style choices that are going to increase the cost of their healthcare exponentially? Things like smoking, doing illegal drugs, eating fast food at every meal and never leaving their couch (except to get the fast food?) These destructive behaviors that are choice based add millions of dollars of healthcare expense every year. Shouldn’t they pay more based on the choices they make, knowing that they are going to lead to excess healthcare costs?

peter said...

6. I know that they lawyers in the government shiver at the mention of tort reform, but it needs to be addressed and could lead to great cost savings. Malpractice is an important asset for patients and should be available, but a nationwide, rational approach to the malpractice process could have many benefits. For example, Indiana’s malpractice laws state that any case needs to be brought before a panel of independent physicians who practice in the specialty that the case involves. If they see no merit, the case is dismissed before it even goes to court. A cap on “pain and suffering” awards should also be considered. Pain and suffering awards are not based on anything quantifiable, but on how sorry the jury feels for the person who was injured and is on top of any other monetary awards that can be enumerated and quantified, such as days of work lost, etc. Minimal changes like these, but applicable across the country could have a great impact on the cost of health care.

7. How? First of all, defensive medicine is a big problem when considering unnecessary health care costs. Physicians order tests and medicines that are not indicated by the symptoms the patient presents with because they want to “cover their rear” in case the person decides to sue for some reason. There is so much inefficiency involved with this method of practicing and a lower lawsuit threat would reduce the practice of defensive medicine and lower healthcare costs. Also, if there was less threat of lawsuit, primary care doctors could do more for their patients. Often a primary care physician will send their patient to a specialist for something they can do themselves to protect against the possibility of being sued by someone looking for anyone to blame. Even if a suit has little merit, a physician or hospital will settle out of court to avoid the drawn out court procedure (not because they were at fault.) All of this adds to health care costs.

8. And let’s not forget the drug/medical device companies. They peddle drugs and tests to people as necessary when they have often not been proven effective for a specific group of people or more effective than the current generic that is available. I could cite examples of this, but I’m running out of time, but they would include osteoporosis, heart medications, and others. People have been sold on the need for such-and such a test or drug and don’t believe their physician when he tells them it isn’t necessary in their case. A recent example is the uproar over the change in mammogram/self breast exam guidelines. The guidelines are based on actual clinical studies that the increased number of self breast exams does not increase your chance of finding cancer to a rate that is statistically significant. But people are in an uproar that their health is being compromised. I could elaborate more (and maybe I should) but I’m short on time.

9. I think that the creation of a not-for –profit insurance companies not run by the government are an excellent idea. I know it seems that the government should be involved, but I can’ think of many things the government does efficiently.

10. I think everyone should have to pay something for their healthcare, depending on what they can pay.

I think that health care reform is imperative, but I don’ t think that merely focusing on whether everyone has healthcare or not is as important as making the process more efficient so that everyone can afford health care. The problem is that there are so many people trying to protect their own interests that we can’t get to the root of the problem and work out some real solutions. We’ve politicized the process so much that the resulting mess doesn’t really solve anything. I’d submit that from what I’ve seen from Washington, neither the Republicans nor the Democrats have it right. I just hope this legislation doesn’t make the problem worse.