Don Davis

On Fighting The Madness, Or, Send This To A Deather

Filed By Don Davis | September 07, 2009 6:00 PM | comments

Filed in: Living
Tags: deathers, health care reform, town halls

We are coming down to the home stretch on health care, and we have seen the results of the first couple of rounds of crazy that have been sent forth in an effort to stop the process.

In addition to the Town Halls, opponents are flooding the email inboxes of America's "low information" voters with no end of lies. Those emails are getting passed around and around and around, and by now some of them have probably appeared in your inbox.

But it's summer... and who has time to respond to this stuff?

Well, guess what, Projectors: I've already done the hard work for you.

Today's story is an email response that you can send right back to your "inbox friends". It's a reminder of some of the frustrations that we all share in this country and some explanations of what's being proposed... and a few words about socialism, to boot.

So get out there and copy and paste and forward and reply, and let's see if we can't fight the madness, one email at a time.

There is a whole lot of talk about health care reform these days, and a lot of it is designed to be confusing, instead of helpful.

To cut through some of that confusion, let me ask you a simple question: is your health insurance stressing you out more than it should?

If you worry about paying for drugs you might not be able to afford, if you don't go to the doctor as much as you should because you recently pawned your last gold bar to cover a margin call on your AIG stock...or if the odds of getting your insurer to take care of what you thought they'd cover are lower than hitting 13 on a double-zero roulette wheel...we need to talk.

This conversation won't be about death panels or secret camps or black helicopters or any of that silly stuff. Instead, let's talk about a few things that we're probably all worried about, and then let's talk about some ideas that might make things better.

So first off, why do we even need reform?

How about because we pay about twice what the rest of the word pays for health care--and we don't get good value for the money.

The US spends almost three times as much as the UK, and twice as much as Canada, per person, for health care--and of the top 50 countries in life expectancy...we come in 45th.

Canada, the UK, Cuba...and 40 other countries...also have lower infant mortality rates than the US.

the doctor.jpgThat is not good; and over the long term it's killing businesses and, by extension, the larger economy. Not to mention, as consumers, we deserve better.

We also want to provide for the nearly 50 million Americans that have no coverage at all, for a couple of reasons:

First, it's extraordinarily expensive to have uninsured people showing up at the emergency room. For a good example, consider the cost of treating a relatively simple cholesterol problem with drugs instead of a paramedic response, an ambulance ride, and heart surgery followed by a stay in the hospital.

The average family with health insurance is today paying about $1,000 a year in extra premiums that they wouldn't be paying if we could find a way to cover those 50 million people--and if my guess is correct, there are a lot of families that could use the extra $1,000.

And for what it's worth, not having insurance is already killing about 18,000 Americans every year.

So that's the uninsured...but what about the insured?

Right off the bat, here's something you should think about: we can expect the cost of the average family's health insurance premium to double by 2020 to roughly $23,000 a year...which is almost $2,000 a month.

If we can't slow that rate of growth, there's going to be a whole lot fewer people getting health care through work--and for several years now employers have been trying to get workers to bear a larger portion of their health care costs.

Plus, insurance companies are increasing profits by looking for more and more ways to cut off policyholders, or by refusing to renew insurance for those clients who do file claims.

And once you get cut off, no one else is likely to allow you to purchase insurance...which means the number of uninsured is growing all the time.

hospital ward.jpgWe have also seen the cost of deductibles go up (with $5,000 to $10,000 deductibles looking like the wave of the future)--and all of this means that insurance companies are doing great, while the customers are getting the short end of the stick.

Did you know that more than 60% of the Americans who filed for bankruptcy in 2007 did so because of medical bills? That's not all: more than ¾ of those 900,000 or so newly bankrupt families had health insurance when they went broke.

What about this whole "putting bureaucrats between me and my doctor" thing?
bureaucrats.jpg
How many people have health insurance that requires pre-approval for procedures or pre-approval to see specialists, or drug formularies that charge different prices for generic and brand-name drugs?

All of those things exist because of insurance company bureaucrats that at this very moment sit between you and your doctor.

So those are some of the problems.

Here are some ideas about how to make things better:

We could tell health insurers that they can't use "preexisting conditions" to deny people coverage, and that they can't just cut people off for the crime of needing care. This allows more people to have access to health care, and it also reduces bankruptcies, since insurers wouldn't be allowed to simply deny coverage when claims come in, leaving families to pay both the health insurance premiums and, later, the medical bills.

This is the least controversial part of the reform plans before Congress today.

There are proposals to create more competition among insurance providers, the idea being to use market forces to keep private insurance companies from drawing so much money out of the system as profit. This would be in the form of one or more insurance plans, operated by some new entity, for which members of the public would be able to "buy in" and get coverage that they can't get today.

The idea here is to create a large new pool of insured persons, which allows the insured group to negotiate for better prices on drugs and procedures and office visits and medical equipment--and if you allow anyone to sign up it can force private insurers to either match the price of the "public option" or lose customers.

Businesses would be required to either pay for coverage for their workers or a tax if they don't. Small businesses would be exempt, but we are not sure how small exactly "small" would be as of today.

This public option proposal is very controversial, and insurance companies are spending over a million dollars a day to shut the idea down before it gets out of Congress.

The most controversial reform proposal is to create a "single-payer" system, which is what Canada has today. At the moment, this is not likely to be part of the program that comes out of Congress, if any program does.

In the Canadian system, people keep their own doctors and the Province where you live becomes the insurance company. You go to your doctor, who then bills the Province. Everyone is entitled to an insurance card, which means everyone has coverage. All of this is paid for with tax dollars.

That's also how Medicare works, and there are people who suggest the best way to do healthcare reform would be to simply enroll everyone in Medicare.

The catch would be how to control costs while providing care for all, and that's the last thing we'll talk about here.

Right now it looks like it would cost about $1 trillion, over ten years, to provide coverage for roughly 50 million people.

Remember the conversation we had about how treating high cholesterol problems with drugs is cheaper than treating heart attacks? It turns out it's so much cheaper that about $700 billion of that $1 trillion can be found with that change and other similar changes, like treating people before they have diabetes instead of dealing with the disease later.

That leaves us roughly $250 billion short. In 2003 we gave a substantial tax cut to people with especially high incomes, and Obama has proposed ending that tax cut. This would cause people making more than $1.2 million a year to return to the same tax rates they had from the 1990s until 2003.

If the public option is made widely available, the insurers tell us, private industry could never compete...but that's not as certain as insurers would want you to believe.

Consider the electricity market: in Washington State, Puget Sound Energy, a private company, operates side-by-side, literally, with "public options" like Seattle City Light and Snohomish PUD, and seems to be doing just fine--and they've been doing just fine for roughly a century.

socialist demonstration.jpgA final point: there is a lot of talk about how government providing health care is "socialism".

Maybe it is.

But you know what? In America we also have socialized police and firefighting and EMS, and socialized streets and roads and libraries and sewers and airports and Post Offices...and socialized National Defense.

And if you really want to talk about the Founding Fathers and socialism, consider this: among the original 13 Colonies were the Commonwealths of Massachusetts, Pennsylvania, and Virginia.

Add in the Commonwealth of Kentucky, and four of the 50 stars on our flag today represent places that are known not as States, but instead as "Commonwealths." Which, oddly enough, is both about as American and as socialist as you can get.

How's that for a lot of stuff to digest?

To finish, let's summarize what we have.

There are a lot of reasons we want to do some sort of reform:

  • we pay more than anyone else in the world for health care, but lots of other countries have longer life expectancies and lower infant mortality rates.
  • we need to do something about the nearly 50,000,000 Americans who have no access to care outside of the emergency room, both for moral and for economic reasons.
  • in 10 years the cost of health insurance will be somewhere around $2,000 a month for the average family. Businesses cannot afford this, so as time goes on more and more people who now have coverage through their jobs...won't.
  • if nothing changes those who are able to keep their insurance at work should expect their employers to move to plans with $5,000 to $10,000 deductibles.
  • every year, almost 900,000 American bankruptcies are related to health care costs. 3/4 of those people had insurance, but their insurers refused to cover their medical bills, and they went broke.
  • if you have a significant claim, or you lose your job, you stand a good chance of losing your insurance, which means you are not very likely to be insurable again.

We talked about some reform ideas, with protections against "preexisting conditions" and cutting people off for having claims being the most likely reforms to be turned into law, a "public option" being less likely, and "single payer" being highly unlikely.

There is money available to pay for this. Roughly 2/3 would come from treating the uninsured in cheaper ways than we do today, and the other 1/3 could be raised by letting a tax cut for very wealthy people expire.

The good news here is that lots of other countries are doing better than we are, and spending half the money we are doing it; which means there are solutions available that do work and do save money.

If we can put some of those solutions to work here, it would probably help us, too.


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Interesting, very interesting and give lots of answers to the questions.

thanks--and right now is the perfect time to offer a few reasonable answers to combat the recent foolishness that everyone has been seeing.

Is there a way to cut it down some? I've found that most people willing to run with a conspiracy theory are usually too lazy to bother reading something that long. Could you break it down Dr. Suess style? ;)

the basic problem is that i write about topics that often require education, just to create the needed context to make the rest of the story work.

this is an issue with which i forever struggle, and one solution has been to try to "serialize" the stories.

more on this topic in a bit, but i'm out running errands at the moment.

this story could well have been divided at the point where the problems are laid out, with part two walking through solutions, and i'll make it a point to use that structure more as we go forward.

put a cliffhanger in the middle, and hopefully people come back for part two.

It is truly heartbreaking when I hear the tales/stories of individuals who can not afford
health insurance/care. On a very personal level,
I feel something should be done to easy their burden. As my Grandmother used to say: "Life is too
short" (for all this non sense that is occurring).

i recently did a story that's posted here that adds to this story by walking through the costs of long-term care...and for those of you who think we have problems paying for today's care, well, there's more bad news coming, and it affects all of us.

if we don't get after these issues today, we'll wish we did.

Angela Brightfeather | September 8, 2009 2:35 PM

Don,

Lets talk "gap insurance" for a minute also.

If the so called "socialist" programs are changed and/or beaten down and Obama backs down on single payer and/or public option plans, we are left with pretty much what we have right now with some exceptions.

Gap insurance is the insurance one person buys to cover the things that Medicare does not cover. For most people my age of 63 or older who are on Medicare or about to enter into it, that means that if I fall down and break my hip, Medicare will pay for most of that care including an orthopedic hospital during recovery, for a period of 30 days only. After that, your on your own, unless you have gap insurance, which pays for anything that Medicare does not pay for in that 30 days, plus, tacks on additional time that they will cover expenses. That also depends on exactly what kind of gap insurance you buy, which varies from company to company and costs go up as coverage gets extended out.

So, here is the fly in the ointment. If there is no sweeping reform, then you will need gap inurance at 65 when you qualify for Medicare. That will be a "must have". My mother in law who is 93 has been paying gap insurance and recieves $987/Mo. from Social Security, which is her only income. She presently pays 30% of her SS check for that inusrance, which is far from the best kind of gap insurance she could get, which is more like 50% of her SS check. That leaves her $112.00 for all other bills and expenses, like food.

The only way to head of the increasing costs of gap insurance is with the single payer or pubic option plans, which will make it unneccessary. If that does not exist in Obama's plan and gap insurance is not addressed, then get ready to get raped again by the insurance companies, because that is exactly what they will do. If he leaves that door open for them, then seniors today and in the future will continue to face higher costs for insurance, well beyond their ability to be covered or to pay for it.

Gap insurance costs have to be capped for the next 25 years at a minimum, or the majority of Americans who will become senior citizens on Medicare starting in 2011 (exactly 65 years after WWII, which marks the beginning of the Baby Boomer period) will be paying constantly increasing costs for gap insurance. After 25 years, the general population of America will take a monumental tumble due to the legalization of birth control, and insurance companies will have to keep their charge for gap insurance down at that point, due to a smaller and more competitive population base.

Then there is that other insurance plan. The one that says that in 2012 the world will come to an end and no one will need insurance, and we are all history. You have to wonder what kind of insurance they are going to sell us to cover that.

bil was right to point out that this story ran too long, and i removed a lot of the original text to get to this length.

some of that was discussion that mirrors what you're talking about here: particularly that single-payer is my preferred option, but with a caveat.

enacting single-payer is no guarantee of a successful reform. that's because the real key here is how much funding will congress provide for coverage as we go forward.

this is the problem canada has today--a good system that suffers from excessive waiting lines for routine procedures because of chronic underfunding.

the funding issue will be particularly problematic during the times that republicans control the reins of power, and the challenges of getting money out of a congress that won't want to raise taxes at any cost will be the long war that follows today's battles over getting reforms passed.

i hope to have a conversation about the politics of all this up fairly quickly, but the long and the short of it is that we are either at a point of retreat and needless compromise--or we have a chance to use this to push for what we want now and/or to set the stage for a better political situation in january.

another quick comment about all of this: in addition to your observation regarding medicare and gap insurance, moving to a single-payer system would also eliminate the need for champus, the va hospital system, and the indian health service.

of course, you could also turn those existing military and va hospitals and clinics--and clients--into the core of a national "public option" hmo.

in such a system you might automatically enroll military and va-eligible persons and then allow others to buy in to a program that provides care at reduced rates within that newly-created "network", which would be large enough to create the kind of price competition that is just what a public option is supposed to provide.