Friday, August 21, 2009

Some thoughts on health care...

This health care thing has been a hot topic lately in the news, and so I thought I would share some of my thoughts on it. This is going to be yet another of my beastly posts, so many of you will not read it, but it gives me something to do and allows me to have an intellectual channel for release.

For the longest time, I have been against government health care. For the most part, I am against the government getting involved in anything, because I think the government has an uncanny ability of bureaucratizing everything and running terribly inefficient (I wish it would run more like a business, but a balanced budget and every now and then, a bottom line). I also by my very nature am anti-authority and prefer to live my life by the spirit of the law, rather than the letter. And more than anything, I hate the feeling of entitlement that is prevailing in our country, especially with the youngest generations.

That being said, I have had kind of a change of heart in many ways over the last year that has made me think that maybe it's not such a bad thing after all. That is not to say that I SUPPORT it, but I now am most definitely not against it like the old me was. (I intentioanlly tagged many hardcore Republican friend--I know that saying this will ruffle a lot of feathers, especially against fellow Republicans and Libertarians; if you are already starting to feel your blood boil and are preparing your defense that you will write in the comments below, please at least do me the courtesy of hearing me out and reading my views...)

I still have some concerns, the major one being economical (of course). I am concerned about the shock effect that a national health plan would have on the economy and the markets, especially given the fragility of them during this recession. Many people don't know that insurance companies actually take your premiums and invest them, they don't just sit on a pile of cash waiting for claims to pay out). A new option for health would create more competition in the market, which would theoretically lower premiums, meaning insurance companies make less money, but also invest less in the markets. It’s IMPOSSIBLE to ever say what will or will not happen given a certain political or economic change, especially considering that finance, politics, and economics are “soft” sciences, depending on general and not concrete principles, and driven by largely irrational people. Not only that, even in hindsight it is impossible to determine causality between policy change and actual results, because there are so many different factors and variables on the systemic level. If there were absolutes and empirical answers, then we would see all financiers and economists sharing the same school of thought, but we don’t, which gives strong credence to the fact that there is no “right” or “wrong,” just many different preferences and different explanations of causality. IN A NUTSHELL: The impossibility of predicting the outcome of a change in a soft science is what scares me. I don’t like the uncertain, and I don’t much care for change.

Another thing is the planning for the overhaul that would be required. I can only hope that a public health option would be created, implemented, and maintained better than the Cash for Clunkers program. Sheesh.

But one thing that really bothers me is the flurry of misinformation and hyperbole that prevails in the discussion of national health. Misinformation is always bad, no matter where it comes from. There are a lot of people who hear something that something else has said or read something that someone posts on their blog somewhere, and then turn around and tell someone else, creating a wildfire sensation. It’s hard to get a lot of solid, factual details, so I understand where it comes from to some degree. But that doesn’t make it OK to spout it out. Hyperbole, on the other hand, can be good OR bad, depending on how it’s used. In my observation, there are two uses of hyperbolic examples: that which is spoken to illustrate a point, with the clear understanding that it is an exaggeration, and that which is spoken because it reflects a skewed perception of reality. If you use an extreme example to ILLUSTATE A POINT, I think it is acceptable, so long as there is a mutual understanding that you use the example to delineate the black and the white, and work toward a mutual understanding somewhere in the gray area. My big problem comes in the hyperbole that is presented as if it is fact or truth, when it clearly is not.
Here is an example: Leftist supporters will hyperbolically say that if we don’t involve the government in health care because the government screws everything up, let’s also not involve them in road-building, police protection, public schools, etc. Clearly, those are not valid concerns, and are not the topic on the table for discussion. But the point is to illustrate that in many regards, the government NEEDS to intervene for the betterment of all. I think this is an acceptable exaggeration because it illustrates a point based on experience that we can all relate to, if not agree. On the other hand, many right-wing radicals talk about how national health will flood the hospitals and clinics with patients, and there will be year-long waiting lists for people to see the doctor. I had one friend who posted as his Facebook tagline, “How many lives will be lost under government health care?” This is clearly fear-mongering at its best, and an inappropriate use of hyperbole because it does not illustrate a point. This is not to say that only rightists employ such techniques. Democrats are just as likely to describe the millions who are suffering and dying every day because they don’t have access to healthcare—yes, millions do not have access to health care, but not all of them are suffering and dying.

My old calculus teacher who I love and respect posted the following information on one of his Facebook notes. All of this was taken from the White House website (going straight to the source is always the best policy):

**8 ways reform provides security and stability to those with or without coverage:
1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.
Learn more and get details:

**8 common myths about health insurance reform:
1. Reform will lead to rationing: Rationing means that if treatment gets too expensive, the government will deny your claim because that money to treat you is better served helping others. It’s a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.
2. We can’t afford reform: No, it's the status quo we can't afford. It’s a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ENDING BIG SUBSIDIES TO INSURANCE COMPANIES; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.
3. Reform would encourage "euthanasia": It does not. It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.
4. Vets' health care is at risk: It’s a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans. It will also not affect TRICARE military health plans.
5. Reform will burden small businesses: It’s a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.
6. Medicare is at risk: Medicare is safe, and stronger with reform. It’s myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors.
7. Single-payer Plans: It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them. It’s not going to be one big government program.
8. The government will take money out of your bank account: It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you – and the same rules of privacy will apply as they do for all other electronic payments that people make.
Learn more and get details:

**8 Reasons We Need Health Insurance Reform Now:
1. Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more:
2. Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. Learn more:
3. Roadblocks to Care for Women: Women’s reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care. Learn more:
4. Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more:
5. Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more:
6. The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more:
7. Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more:
8. The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform.
Learn more:

When put in perspective that way, with information right from the source (the website also has a lot more details on the proposed plan), it doesn’t seem like that bad of a plan. Again, I am not saying I am 100% for it, but I don’t disapprove of it. But I hate when people have their minds closed to the idea from the beginning without giving it a fair appraisal. I just want the most good for the most people, and I want the wants and needs of the true majority (as opposed to the vocal minority) to be fulfilled. If the majority of the people want national health care, then that is what we should have. If not, then I am just as fine without it. However, I absolutely feel that even without “Obamacare,” there needs to be some definite reform in the health insurance industry.

Here are a few personal reasons why I think the health industry needs reform, based on the experiences and knowledge that I have:
♦ Shortly after I got married, I went to buy health insurance for my wife and myself. After looking at all of the different options and all of that hassle, we decided on a company (Aetna) and started the buying-health-insurance process. One of the first things that left a bad taste in my mouth was that they had a travelling-nurse-type person come to our house and take our vitals, etc. Well, when it came time to measure my height and weight, she measured my at 5’7” (I’m 5’9”) and weight at 190 pounds (at the time I was no more than 175, and even now that I have put on weight, I am 185). These measurements indicated that my Body Mass Index was in the “Obese” category, which means I was a higher risk and paid higher premiums. *OBESE*, WTF? (According to BMI measurements, I would have to weight 168lbs to even be on the HIGH side of “normal” weight [not obese or overweight], which I have not weighed since I was in high school.) When all was said and done, our premiums were over $200/month for two of us, which for poor, part-time college students was over 15% of our income (most of which was student loans). Ouch. Well, we paid 3 months upfront and enrolled in automatic payments, but 6 months later we were dropped out of the blue without having made a single claim or visited the doctor once. As it turns out, they said it was for non-payment, even though they had not sent us a bill or ANY paperwork in the entire 6 months. So we were out 3 months’ premiums and health insurance, but luckily we have been free from accident since them. To add fuel to the fire, our HSA account had a 2% monthly load on it that we had not been told about, so out of the money we put into it, we got about 88% back after 6 months. Heck, I could have used a credit card to pay my medical bills if I wanted 24% APR! So needless to say, I am bitter to the system, and although my case may not be the norm, it is not unique.
♦I work as a medical translator for Chinese immigrants who need to see a doctor but can’t speak English. In my time there, I have seen some pretty snakey things from the insurance companies. Take one man, Mr. Chen, who slipped a disk and needed to see the doctor. He was seeing the doctor and receiving his medical benefits as outlined in his policy, but one day he missed an appointment, and according to a Colorado state statute, if you miss an appointment without informing the insurance company within 24 hours, your case is closed. So the insurance company (Farmer’s) was able to get out of the payments from that point on, and Mr. Chen and his wife were left with the full cost of treatment. The trouble comes in the fact that he is now disabled because his back problems were never fixed, and he can’t work, so he can’t pay off the $36,000 that the insurance company did not pay. He will be a slave to debt for the rest of his life.
♦Mr. Gao came in because he was having severe headaches. After several visits and several expensive tests, they determined that he had a small tumor in his head. Based on the size of the tumor and the estimated growth (I have no idea how they even determine that), they concluded that he had had it for 2-3 years. However, he had only had his insurance for just less than two years (the time that he had been a permanent resident). Not surprisingly, the insurance company (Humana) decided to deny his claim based on “pre-existing condition,” even though he didn’t even know he has this condition.
♦And finally, there is just the simple fact that 95% of all of the clients that I translate for (almost all of which are alien or permanent residents, not actual citizens) qualify for medical coverage through Medicaid, Medicare, or CICP (Colorado Indigent Care Program), all of which are already paid for by your tax dollars. If you opposed government health because you oppose the tax increase, you’d be wise to understand that your tax dollars and outrageous medical expenses are ALREADY subsidizing the low-income and needy’s healthcare. If anything, you would think that you would want to support a national plan that would at least require the people receiving Federal Aid to contribute something to the pot.

For the rest of this note, for those of you still reading by this point, I would like to address my view on some of the points made by those against a national health plan.

FIRST, government health is a “socialist” maneuver, and will take away everything that makes America free and great. plans I think it's a sneaky tactic that many right-wing fanatics call it "socialized health care," because it makes us seem like we will become socialists if we incorporate some kind of national health care plan. However, there are many countries worldwide that provide national health care, and they still enjoy many of the freedoms that we do. Yes, of course there are horror stories (which ironically, mostly seem to emanate from Canada), but obviously there are horror stories to the other side of the coin as well. However, when it comes time to make our own decision, we generally base our decisions off of what we know and what we have experienced, not what others know and have experienced. Britain and Japan both provide public health, and both are still powerful, influential, and innovative countries. Even a little economic tiger like Taiwan has public health, and from my experience with it, it works wonderfully, and doesn’t have any of the negative side effects that others predict.

SECOND, strict constructionists (those who interpret the Constitution very literally, very letter-of-the-law) argue that:
“That government does NOT have a right to steal property [collect taxes] to pay for teachers, build roads, or pay Social Security. As the article outlines, a people would willingly pay taxes when they knew that the money being taken from them was going toward, and only toward, the protection of their private property, including their own bodies. The police and the military are there, or should only be there, for the protection of what we already have. On the other hand, teachers, roads, or Social Security coerce one's own property from their possession to give to another. Not only is that Constitutionally and morally wrong, in a utilitarian sense, it's unnecessary, inefficient, and cuts into or possibly destroys a sector of the economy that would have been much more efficient.”
Yes, according to the Constitution, all of this is correct, technically. But most people can see the ludicrousness of this argument. A loose constructionist could just as easily prove their arguments “Constitutional” by quoting the elastic clause—that the power to tax exists as a matter of pragmatism (I am a Hamiltonian, so I agree to this school of thought: See Federalist Paper #44(?)). Take a couple of examples:
USPS vs. FedEx; if you need to mail a letter, which one are you going to use? No, USPS may not be as efficient, but it sure is a lot cheaper than FedEx. And get real, the pittance of a tax that you pay isn’t enough to cover the difference in price if there were no USPS.
Colorado State University vs. Denver University; which one is cheaper? Even if I paid absolutely no tax on anything, I would not be able to make up the difference between public and private university tuition [BYU excepted]. And if you think you are getting a better education by going to a private school, that’s not necessarily true, either—Businessweek ranks CSU’s undergraduate business program 67th in the nation, above private schools such as Xavier, Hofstra, and DU.
I-25 vs. E-470; yeah, if you are in a hurry, the toll roads are mighty speedy. But who wants to have to pay a toll every few miles just to get where they are going? Not only that, the toll on many tolls roads increases during high-traffic times. Yes, that proves the law of supply and demand, but honestly, not many people could afford an extra toll or two on their commute to work. Yes, DOT may not be the most efficient road builders, but even the little tax that an individual pays is far better than the price you would pay if roadbuilding was privatized.
So yeah, you can get into an argument about natural rights, and what the government should and should not do, but it’s mighty hypocritical to use the postal system, drive on the roads, get a public education (at least 13 years of it, generally) and then say that the government should not tax people to pay for things besides physical and property protection. Remember that there is a difference between a person’s “rights” and the “right” thing to do.
As a kind of tangent, if I hear the “no taxation without representation” argument one more time, I am going to punch someone. That is taken WAY out of context, and isn’t even really applicable today, because we all DO have representation, albeit in Republican form and not a true democracy. So put your teabags away, protestors, or I’ll SHOW you a teabag.

THIRD, some people say that with public health, there would be a huge influx of people trying to get in to see a doctor, and we can’t support that. To me, that presents two issues: First, if SO MANY people instantly see a doctor after receiving “free” healthcare, then that to me indicates that there are SO MANY people now who are not receiving treatment who need it, and that is a major problem. Also, if the roads had twice as many cars on it, they would become packed and traffic would get very bad, especially in certain places. However, would your proposed solution be to put an artificial control on supply of cars by affording them only to the wealthy, or would you just build more roads? Both are viable options to reduce traffic, but one helps everyone, while the other only helps those “rich” enough to afford a car with an artificially-high price. Sure, there will be growing pains, and there are opportunity costs to infrastructure growth, but there is also an opportunity cost to inaction.

FOURTH, health care already is universal. No one can be refused treatment if they go to the hospital with a problem, whether they have insurance or not. The thing is, if they don’t have insurance, they either pay out of pocket or declare bankruptcy when the bills get too high (or just use government health plans that are already in place). However, that cost is passed on to those WITH insurance through high premiums and outrageous expenses at the hospital (you know, like paying $40 for a shot that costs $3 to manufacture). And those being aided through Medicaide, Medicare, and CICP (in Colorado), is given courtesy of money that comes largely from property taxes. So you either pay for national health with the left hand, or it’ll be taken out of your right.

FIFTH, insuring more people would actually lower the premiums paid, because the risk is shared over more people. For example, I currently do not have health insurance (though as soon as I graduate and can afford it, I’d be an idiot not to have it), but I am also in good shape and great health. We I to be a part of a larger group of insured persons, I would share the risk of them, and though I would pay a higher premium than I would by myself, older, riskier people would now pay lower premiums. The more healthy people in the mix, the lower the premiums go. However, many of the people that DON’T have insurance now are part of this healthy cohort. If you required all and sundry to have SOME sort of insurance (just like we do for car insurance), it would effectively lower the rates for everyone. Imagine how expensive car insurance would be if it was optional and old reckless drivers bought it, because the careful drivers knew [thought] they wouldn’t need it.

Anyway, I guess that’s all for now. I’d love to see some feedback below, especially the critical kind. I like to see where weaknesses in my logic and follies in my understanding are. I wouldn't have tagged you if I didn't respect your opinions! And I'd also like to see what rebuttals I can come up with to the things that you think...

Additional reading: (is healthcare a right?) (crap, does ANYTHING work right in Canada?) kind of “budget cuts” that Obama is using to move toward a balanced budget, 九牛一毛) (an op/ed; opposition to national health, a good read)

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