Health Insurance and Working Americans

Breaking news:  the latest Republican health care bill in the US Senate is now 2 votes short of passing.

And so goes on the health care political football.  When the Democrats controlled the Congress and White House, they forced through the Affordable Care Act (ACA).  Flawed in places and perhaps not stable over time, it let the health care genie out of the bottle.  

For the first time, many working Americans could afford the benefits of health insurance.  The could afford the medicine they need to treat their chronic conditions.  They could feel assured that they were not one bad diagnosis from loosing their home and the job and falling into poverty.  

Cancer, heart attacks, diabetes, stroke:  who knows when they may befall someone.  And without health insurance, any of these could take a productive, working American from a role of being a self-supporting, productive, tax-paying citizen of this land and make them a ward of the state, and burden to taxpayers.

But now the Republicans in Congress and President Trump want to repeal the ACA and replace it with some variation of the various plans that have seen the light of day, each of which would result in so many Americans loosing health insurance.  It seems their idea of freedom is the choice of not getting insurance and either (if you're healthy) spinning the wheel of chance that you stay healthy, or if not so lucky, perhaps unable to afford care, medicine or necessary procedures.

In this case, I don't know why they don't understand that a healthy working American is a productive and tax-paying member of society, something they value.  And for those in America who have to work for a living - which is the vast majority of those who voted for President Trump and those who voted for Hilary Clinton - affordable health insurance helps keep them productive and tax-paying.   Isn't that what Republicans value?

All I can figure is that got themselves twisted like a pretzel:  they couldn't participate in creating the ACA, so they must kill it!  They are convinced that's why they were elected:  to repeal the ACA!

But that's no longer in touch with their constituents.  Affordable health care ensures working Americans can remain productive, self-supporting and tax-paying even if bad health should befall them.

The people want affordable health care!  So, reform the ACA, make it better and sustainable, but don't deprive working Americans of the opportunity to afford health insurance.

Health Care Hangover

A major Health Bill passes, but few are satisfied. Worse, we see a breakdown in civil discourse, replaced with angry outbursts inside and outside of Congress.

How did we get here? Back a year or two, and the nation was behind some form of health care reform. Be it the ever rising cost of health care, the high cost of insurance if you don’t get it at work, or people dropped from insurance, or others who can’t get it due to “pre-existing conditions.” One bad illness can drive an uninsured family to bankruptcy. Does this make sense in the richest nation on earth?

But now we have a bill that promises many changes: keeping your children on your insurance until 26, preventing rejecting coverage for “pre-existing conditions,” and subsidies for some who can’t afford insurance, among others. Yet, there are so many vocal opponents.

How We Got Here: Three reasons:

1. Politics
2. Politics
3. Politics

Both parties chose to blow this out of proportion. Republicans and many ad-hoc groups (some of which are labeled “tea party” folks) see this as the wedge issue that can unseat many Senators and Representatives. And they hit the issue hard, early and often. They went heavy negative. They got media attention by being loud and to the point. And they gained a lot of support.

On the other side, the Democrats made this a “must pass” bill. Much as I believe G. W. Bush felt he almost had to invade Iraq to finish what his father started, Obama was painted into the corner of getting the bill past somehow, some way, at whatever cost.

With stakes so high and politics ruling the day over the interest of the people, there was zero hope of reasonable bipartisan reform.

Our National Loss: Civility? Have we lost the ability to have a national debate on major issues in a civilized manner? The thing that was great about this wonderful land we live in was our freedom of speech and our ability to have different points of view heard. Back when I was in high school, we had a great 10th grade social studies class where the teacher encouraged the airing of all sides of the issues. We had conservatives, liberals and moderates. And we had some very impassioned, yet civilized, debates on the issues of the day.

Right now, I fear that America may be lost. As a Libertarian and American, I believe we need to have respect for everyone’s Freedom of Speech. I wanted to hear the arguments for and against the bill and the various provisions.

But, what I heard was a lot of bullying: shouting down speakers in town hall meetings, including the epithets used against some representatives. When I wanted to hear the rational reasons why the bill may ill-conceived, I heard too much hyperbole or exaggerated claims (government takeover of health care, “baby killer” and “death panels”), and this strange concept that Obama is a fascist trying to obtain totalitarian power over the nation. Only occasionally, in the mists of the sonic bombardment of the opponents, could I once and a while find some rational substance why provisions of the bill are ill-advised.

Sorting Out Some Perspective: If we can leave the shouting behind, here is my perspective on the bill:

• Some of the desired reforms that will provide one way that more people can obtain health insurance. It’s not the only road to reform, but it is a road that does have the Federal and state governments have a heavier hand in the making it so. (So, as opponents claim, there is an expansion of government’s role in this bill).
  
• I’m glad that something’s being done about “pre-existing” conditions as I have one. I can’t get life insurance anymore (luckily, I bought it when I was young). But the most ridiculous thing about it is my pre-existing condition is a little dot of skin cancer (about the size of the eraser on your pencil) that was removed in a couple of minutes in the doctor’s office. It was truly itsy bitsy, but because it was the BIG “C”, I can’t get insurance. So, I’m inclined to use anything, including the expansion of the Federal government to banish this “existing condition” provision!
  
• It remains to be seen how it will be paid for. Right now I don’t believe a single politician on either side about how the costs will work out. But where there are subsidies, the revenue has to come from somewhere.
  
• I don’t yet see a threat to the typical employer-based health plans like I have. Maybe some union jobs still have “Cadillac” plans (that will be eventually taxed), but not my cheap employer! We pay a lot and have high co-pays, but at least I have insurance! The funny thing was listening to one conservative opposing reform as it might do away with their great employer-based health care plans, as he had really low co-pays and it was about as perfect as it could be. But only 1 1/2 years ago conservative Republican candidate John McCain campaigned on health care reform that would get rid of the employer-based system and we’d all have to compete on the free marketplace to find a plan. Short are some people’s memories!
  
• Notice that the insurance companies are silent. They know there’s more regulation, but there’s more customers coming. I’ve already seen TV ads encouraging people to apply for new plans that will be available under this new bill. The insurance companies will make out on this. First, they get more revenue from customers. But there is little to stop them from frequent increases in premiums, so there is more revenue. So, even if regulation cost them some additional overhead costs (to figure out all this red tape) or some limits on plan costs, they can make it up by increased revenues.
  

So, Is It Good or Bad? A pure Libertarian would say it’s inherently bad as it uses government to create reform, thereby expanding the role of government. And it forces people to buy insurance in a nation that should leave everyone alone. (Then again, a pure Libertarian would take us back to the 4 original Federal Departments (Defense, State, Treasury and Justice) and jettison Education, Commerce, Labor, Transportation, Environmental Protection, etc.

But I’m not a pure Libertarian. I believe government is a tool. It’s not the solution to all problems, but it can be a good solution to some. For example, who would really propose selling off the nation’s roadway system to private interests because government at any level (federal, state, county, or local) shouldn’t be in the transportation business?

So, what to do about health care? Republicans gave us the health care savings account. They assume we have a crystal ball and know our health care needs for the upcoming year. They like tort reform – always some ridiculous settlements that get any reasonable person to say “enough!” But how much will that really save? They like expanding the sales of insurance across state lines.

But that still doesn’t get to the fact there is not real capitalism (many buyers, many sellers) when it comes to health insurance, as there are too few sellers and any one individual is in a weak negotiating position. It’s not like going to the farmer’s market and bartering for price of 10 pounds of potatoes.

In the absence of true capitalism, often our nation has turned to the power of government regulation to try to level the playing field. This goes back to regulating the railroads when they had the collective monopoly on the nation’s transportation. Then, starting in the 1930s (and again in the '50s and '60s with the interstate system) the government stepped in with the “public option” of the day: federal funding of highways. But I ask you, who among the Republicans, conservatives, or tea party folks want to repeal the “public option” in transportation? Public roads represented a big expansion of government into a sector (transportation) that previously was highly privatized. But were public roads the death of freedom in America? Quite the contrary, as the car commercials portray driving on public roads as “freedom.”

So, I have to say I am not philosophically opposed to the hand of government in health care. I don’t believe it is the “wonder drug” that will make things perfect. But, we still needed to do something. I’m not too happy with the bill that passed, that’s why I’m feeling this health care hangover!

Health Care Reform: Debating the Public Option

After months of debate in the House and Senate over health reform, what is left to debate? The public options, of course.

The Public Option
The public option seems to be finally out of the bill. The House passed the Democrat-backed option. The Senate seems likely to drop it to get some bill to the floor for a vote.

I like the idea of a public option as competition between the private and public sectors. Many Republicans and some Democrats say it’s a bad idea. But what about the examples of the “public option” that are offered today:

• Medicare for elders
• Health care for members of the House and Senate
• Health care for our armed forces

The irony of the Opposition
How many Representatives and Senators who are firmly opposed to you and me having a public option would voluntarily opt out of their public option and buy private insurance on the open market? When they put their personal health care on the line, maybe I’ll listen to their whining and talking points about the evils of public health care.

If it’s good enough for our Troops, isn’t it good enough for you and me?
Our brave men and women fighting overseas and supporting the effort worldwide get their health care from this same federal government. They have federally operated hospitals with doctors and nurses on the federal payroll. So, if it’s good enough for our brave troops, why is it bad for us?

But what will the reality be like?
The only problems with any health care program, be it private or public, are the complexity, the confusion, the paperwork, and the bureaucracy. I have to deal with Medicare and Medicaid as my mother is in a nursing home. It’s baffling and there’s no one to lead you through the maze of bureaucracy. So, my only fear with a public option is the same level of complexity that will make even its most ardent supporters cry for something easier.

So, would a public option be what we need to counter the money-making insurance companies? Is it inherently flawed? Or, is a good idea in theory, but once it makes it through the House and Senate. would it be so complex and full of red tape as to be not worth it?

Health Care Reform?

Well, the House of Representatives has passed a health reform bill (HR 3962) by a slim vote of 220-215. At this point, I don't know whether it's real reform, or just the culmination of political grandstanding by both parties and President Obama.

The Vote

The Democrats voted 219-39 while the Republicans were 1-176, with Rep. Joe Cao of Louisiana casting the lone “yeah” vote. Not exactly a resounding vote. Nearly 1/5 of Democrats voted against the bill. And it seems a lot of the moderate "pro-life" Democrat votes were "bought" by allowing them to vote "yeah" on an amendment prohibiting paying for abortions in the public option or in the insurance exchange pools. In all, it seems to me that everyone was voting with one eye on the 2010 midterm elections.

The Democrats want to report they gave the people health care reform. The moderate to conservative Democrats get a favorable "pro-life" check mark on their scorecard so the remain elegible for the litmus-test voters.

And the Republicans can say they did all they can to oppose socialist healthcare.

What's Still Baffling about the Republican Position

I'm still baffled about Republican mantra that this is a "government take-over" of health care. There is a public option, but that remains an option.

Clearly, the words "government take-over" are fighting words for conservatives. Clearly, politicians favor slogans and getting the base energized by charged slogans over a fare discussion of the pros and cons.

Between this tactic and the screaming opponents at the town hall meetings, it seems to me the Republicans don't like the essence of democracy: a fair and open discussion of the issues!

We also need to call out the Republicans on this: if government-run healthcare is so bad, why do the Republican representatives and senators accept it?

I don't think any bill the Democrats have proposed has been anything near perfect. Still, I think we have to call out the Republicans as being obstructionists in the public debate.

Republican Proposals

The Republican proposals, to counter the Democrat's bill, have read like the pile of scrap wood from the RNC party planks. Start with tort reform (limit those rare, but big settlements), throw in some enhanced competition among insurance companies, but leave the reality of many remaining uninsured. (After all, being uninsured is something you should be free to be.)

A Couple of Good Things to Say

It does appear that the new proposal will increase the number of people insured. And it does address the issue of denial of coverage to those with "pre-existing conditions." As someone with a "pre-existing condition" that precludes me from getting certain insurance coverage, I feel strongly about this aspect of reform.

The Mess We're In

The more I look at it, the best we can expect is to tack on a few modifications to the existing healthcare system. Perhaps, system is too kind a word. Some people have employee-provided insurance, some have government-provided insurance (Medicare, Medicaid), a few buy it, and many are uninsured.

Just as the "system" is so complex, the solutions only add to the complexity. There is no clear vission of a simpler, more understandable system. Instead, we're adding some additions to a structure built on a shaky foundation and with a questionable structural integrity. As an engineer, it doesn't appear to be a sound proposal.

The Shout in the House

On Tuesday, U.S. Rep. Joe Wilson was formally rebuked on Tuesday by a vote in the US House of Representatives. No matter what else he does in life, Rep. Wilson will always be know for shouting "You lie!" during Obama's speech to Congress on September 9th.

While I don't agree with Rep. Wilson's views on health care reform, I don't think a Congressional rebuke was necessary.

I think of his shout as an analog "micro-tweet." It was more an interjection than an interruption. Unlike the protesters at some of the recent town hall meetings, the representative did not prevent the President from finishing his speech. He merely interjected a two-word tweet.

And it doesn’t stand up to fact checking.

So, I’d leave it at that.

Sure, it was rude. Sure, a grade school kid would know better. And I and most rational folks wouldn’t want to set a precedent of encouraging anyone to interrupt a speech because of a difference of opinion.

But he knows what he did. He apologized to the President. His actions have been judged in the court of public opinion (not to mention the late night comedy circuit).

Most think he was out of line. A minority applaud him. These are folks who don’t like the Obama Administration and like the idea of someone “putting to him." I say the rebuke only makes him more a martyr for their cause. The rebuke may be counterproductive and energize the opposition to reform.

Most importantly, the whole issue of the shout and rebuke is a major distraction from the debate over the important details of reform.

So, let’s put the Shout in the House in the past and let's get on with a civil discourse where all opinions are heard on this important topic of reforming health care!

Health Care - Do What's Best for You

The health care debate goes on and on. Tonight, President Obama spoke to Congress and the nation to describe his proposal. Using a combination of reason and passion, he tried to dismiss the misconceptions and outline what he's really like to see for reform.

Now, overall, I like his proposal for a number of reasons, but the two main reasons are:

1. It leaves in place the existing coverage that many are satisfied with. No one has to change policies or try to get re-insured. So I can keep my good employer-based insurance, unlike a proposal floated by candidate John McCain.
   
   
   
2. It adds a government-run program to compete with private policies. Now, this is excactly the kind of experiment I'm most interested in: direct competition between the public and private sectors. My philosophy about government is that it should do what it can do better than the private sector. So, let's see which approach is more cost-effective in providing health insurance.
   

Here's another interesting perspective (courtesy of Thomas Friedman, New York Times, Sept. 9, 2009): Obama's proposal is largely based on two Republican initiatives, yet it is widely decried by Republicans. The proposal closely resembles the health insurance program put into place here in Massachusetts by Republic Governor Mitt Romney. It adds in an idea for funding taken from John McCain's proposal.

But will the plan pass Congress? And if it does, what will it turn into in the Congress --- will it get overcomplicated, diluted, or heavy with bureaucracy? Even with a Democratic majority in both houses, the necessary compromises may result in a bill that barely resembles Obama's proposal.

And probably for the worst, it will receive no Republican support. This is highly unfortunate. With a greater balance in power in Congress, a more bipartisan bill might have emerged. Maybe on that would be more effective in addressing the full range of needed reform.

But, to me, it is clear that the key to the Republican strategy for gains in the 2010 midterm elections is to ensure the Obama health plan fails, or if it passes, that it is widely disliked by the public. So, I'm not optimistic about the success of true health care reform.

So, we may all still be where we are now: some of us will have decent employer-provided insurance. The elderly and disabled will have Medicare. Many will try to get individual policies. And many will remain uninsured.

If reform fails, health care will amount to doing what's best for yourself (if you can)!

More on Health Care Reform

The national debate on health care reform has provided the most entertainment in the political circuit since Sarah Palin’s debut last year, just about at this time.

We had the new version of the “do nothings” shouting down politicians and their fellow citizens alike at town hall meetings. We have the wild and crazy campaign of misinformation featuring the “death panels” who will decide who deserves treatment and who will be left to die. Other misinformation includes the idea that the government is taking over health care (therefore people would lose their existing coverage).

Perhaps most amusing is the right wing pundits comparing Pres. Obama to the Nazis. This last one is especially absurd if you recall the Arian supremacy plank of Nazism and happen to notice we now have an African American President.

Legitimate Concerns

There are some legitimate concerns about change. Many of us have good coverage at work and don’t want to see an end to this. (See my post on this topic.) Also, many like me have pre-existing conditions and may not be able to get coverage if we lost what we have.

So, there are many that have good or decent coverage who don’t want government messing with it. With this I agree.

Need for Reform

The basic need is simply the rising cost of health care. Not far behind this is the clear cross-subsidies where those covered are paying for those without insurance or those whose policy does not pay the full cost of insurance.

While many realize this problem, I’d say many are content to keep the status quo. After the recession and market fall, the rich and middle class are still risk adverse. Thus, even people who have rationally examined the issue are not open to change.

Basis of Proposals

As President Obama has explained, the idea is not to replace existing coverage, but rather to add a government program to compete with the private sector plans (e.g., employer plans, individual plans, group plans).

As a point of reference, today, there is a large, popular and successful federal government-run medical insurance program known as Medicare. This flies in the face of many of the arguments of adding another national program.

Possible Political Tactic

So, why all this opposition, particularly that organized by the right and by Republicans?

My theory is they are following the 1994 playbook. First, they put up a strong opposition to the Clinton health care reforms. Once this opposition was seeded in the populous, it was not long until this translated into widespread opposition of Clinton programs and then midterm victories for the Republicans.

As I see it, this full-court press on health care is not about health care. It’s a strategy to swing the American popular opinion from the Obama camp to the Republican camp, paving the way for Republican gains in the House and Senate in 2010.

Why Can't We Debate Health Care in a Civilized Fashion?

Why, in the greatest democracy in the free world, can't we have a civilized, intelligent discussion of a very important national issue?

There have been reports of disruptions of town hall forums on the topic of health care reform. The disruptors shout down any discussion that is attempted. These demonstrations have been focused on Democrat Congressmen, particularly those supportive of reforms.

Accompanying this school-yard type bullying are the propagation of misleading information and outright lies about proposed changes. For example, some false rumors say you can't keep your existing private insurance or that the proposal is a single payer system (whereas it's a government alternative to private insurance). Today, President Obama spoke out about this misinformation.

Perhaps worse is the rhetoric of Rush Linbaugh and his ilk, comparing the proposed changes to Nazi programs, even comparing the logo for the proposed health program to the Nazi swastika. Rachel Maddow recently reported on these outrageous comparisons.

But isn't it ironic that Rush Linbaugh and others are labeling the Obama health care proposals as "Nazi" inspired while supporting this "mob rule" tactic of shouting down all civilized discussion. But, which is the really fascist tactic? Obama proposing a program that will be debated in Congress and throughout the country --- or, protestors shouting down any discussion of the issue? Add to that the death and other violent threats against Congressmen. As a result, some of these representatives are canceling public appearances to discuss health care.

What happened to democracy, where all sides are free to make known their opinions on current events? Why do these protestors prevent other citizens from exercising their democratic rights to debate this issue? Oppression of the practice of democracy sounds like fascism!

If the opponents of Obama's program have good points to make, why can't they present them to the nation in a civilized manner? If they have important facts and strong arguments, why do they resort to schoolyard tactics of intimidation and bullying?

So, again I say why, in the greatest democracy in the free world, can't we have a civilized, intelligent discussion of this very important national issue?

We have to say NO! to the bullies shouting down discussion at town hall meetings!

We have to say NO! to those knowingly propagating outlandish false claims!

We have to say NO! to schoolyard antics of shouting down anyone who doesn't agree with you!

We have to say YES! to acting like adults and having a lively debate about the real issues.

Why Kill Employer-Based Health Benefits?

“If it ain’t broke, don’t fix it” is a popular, common-sense expression that summarizes why the McCain health proposal lacks common sense!

One of the strangest proposals from the McCain team is the plan to substitute a $5,000 tax break for employees for the current tax break for employers who offer health benefits.

A majority of the middle class in our nation receives health care benefits through their employer. It’s not always perfect, but it does cover a lot of people at a far more reasonable price then if each of us were to get a plan by ourselves.

But that’s what McCain wants us to do. Without the tax incentive, employers would drop the offering of group health care programs (and the cost to administer them) and each of us would be on our own, trying to buy a very expensive individual policy that would cost far more than the $5,000 tax break.

Maybe the tax break is a good idea for those without employer-based health benefits. But not for those of us who have these benefits.

If it ain’t broke, don’t fix it!!!

I bet even Gov. Sarah Palin has that one in her folksy vocabulary!

So, I can’t figure out why this other wise common-sense Governor from Alaska signed onto the McCain health plan disaster.

This plan really will be bad for the Republican base and swing voters – the conservative and middle-of-the-road working and middle class folks who actually work for a living and probably get their health care at work!

Let me count the ways that the McCain plan is bad:

1. Instead of buying into group coverage with low rates, each person is on their own and the rates will be higher.


2. Employees that are older or who have pre-existing conditions (e.g., heart problems, cancer, etc.) may not be able to get coverage at all.


3. Employees lucky enough to get new coverage may be with a new carrier or HMO and therefore have to choose new doctors and specialists instead of the ones who know them and their health issues.


4. Younger folks who are healthy may opt out of getting coverage.


5. Those who are financially strapped may not be able to afford coverage.
   
6. When the uninsured have untreated symptoms that grow into a serious medical condition, they end up at the Emergency Room, costing more money than if they had preventive care covered by a health plan.

I could go on, but the point is this plan is bad for all workers. And it’s especially bad for the very political base of conservative folks who work for a living that McCain needs to win.

Sen. McCain: Employer-based health care ain’t broke, so don’t try to fix it!