Mandatory?

In America we cherish individual freedom, but what we cherish is freedom of decision.

We don't want to be told what to do, but of course we can take suggestions.

This is the problem with Universal Health Care, even if it is in fact better for almost everyone.

Or current system is inefficient and expensive but it pretends to offer us some choices.

Those choices may be limited by your employer or by your income, but we think we get to decide.

In fact once a year we tend to have some open season where a certain number of options are provided.

It doesn't matter if these choices are restrictive, at an individual level it has the appearance of freedom.

Its the first hurdle that universal mandatory plans have to overcome.

We don't like mandatory.

Fixing Health Coverage?

The number of Americans without health insurance is on the rise.

LA Times Health Insurance

The failure to advertise the open season, the ending of penalties for not having coverage and the attacks on Medicaid have reversed the downward trend in uninsured and started an increase.

Not having coverage leads to failure in many cases to get preventive care and screenings that indicate problems early.

The fallback position for people without health care is normally the emergency rooms where care is most expensive and often conditions have become more dangerously progressed.

We were supposed to see a great new bunch of health plans that would be better, cheaper and more affordable.

We did not.

We do see some plans that offer very little coverage but cost at least as much as the plans that were on the exchange.

They don't receive a Government subsidy so they are cheaper for the Government, just not the user.

In fact we should not lose sight that the goal of the current administration and republicans in general is to protect businesses and wealthy people who object to having tax money help the less fortunate.

We see that in the tax reform that they passed.

The reform was to make our tax system less progressive and allow the rich to keep more of their money.

More houses, private jets, and yachts instead of health screenings for our citizens.

What's not to like?

Medicare For All Costs

There have been a number of articles recently and some misguided statements by proponents on both sides about the cost and implementation of "Medicare for All" or publicly provided health insurance.

It would be expensive, but mathematically it wouldn't require new money, just a switch form privately funded to publicly funded.

How that would happen is the real problem, if in fact we even see it proposed seriously as opposed to a talking point by certain politicians.

To be clear, the cost of health care reflects the cost of health services being provided.  Currently most is provided under private insurance plans which are obtained in any number of ways.

Ultimately this cost might rise if more people get covered or it might decrease if the preventive care leads to earlier detection and less late intervention.

That's a matter that can be argued but, the switch from private to public funding wouldn't have a particular impact on overall costs, although of course the cost would show up as a Government expense.

As a reference point the United States has the highest per capita health care costs of any country although Switzerland is close, per the World Health depending of how you value the currencies.

The cost has been going up but it is going up partly because of inflation but also partly because new
 and improved technology has been introduced.

By most measures health outcomes do not correspond to the high cost, not that they are bad, but in many measures we are relatively average.  Of course because of our profit model, we attract some of the very best specialists in every discipline if, in fact, you can afford them.

The point is unless we are increasing this per capita cost, the total cost will not go up.  It's only a matter of how we pay for it.

No Pay Health Insurance

They are going to offer people short term health insurance that doesn't cover very much to lure them away from the ACA.

Since we've eliminated the individual mandate, the people signing up for these will likely be actually looking for insurance, and depending on the individual policies they might get a bit of catastrophic coverage.

We know however that these plans will be offered by companies that are really interested in making quick profits, not providing meaningful coverage, so it going to be buyer's beware.

Policies like these were one of the things that was wrong with the health insurance industry so of course we are bringing them back.

They generally provide coverage in a very limited range, high deductibles and no free preventive care and low coverage maximums.

Of course anyone opting for these plans is effectively gambling and for some people they may actually be worthwhile.

It has a bigger consequence for the overall insurance pool since the best way to reduce premiums for everyone is to include everyone in the pool.

As we carve out young healthy people, we will see premiums rise as it increases the overall risk of he remaining plans.

Since much of this increase is paid by the Government subsidies, it impacts our taxes, or our deficit in a more indirect way.

Until we join the rest of the civilized world in providing all our people with adequate, complete health care we will see strategies like these played out.

Competition is medical services has been proven time and again to not work, and we see a system where profits are more important than health.

That's simply wrong.

Senate Continues to Save Health Insurance For Millions

Generally the headlines talk about how the Senate is failing to repeal and replace the Affordable Care Act but this failure is actually a success for many Americans who would lose coverage under any of the Senate plans.

You may feel that the Government should not be providing health insurance but if you do what is your alternative approach?

In the middle ages they used to collect the bodies of plague victims but don't think that's an acceptable alternative.

Do we allow the fortunate access to things like health care and education and condemn most of the population to poverty and disease?

That's not the world I want to live in, I want everyone to have opportunity and decent medical care.

The other way has been tried in the past and has always resulted in large populations of peasants or serfs or slaves who struggled to survive.

First of course you need to strip the poor of all hope and dignity and make them entirely dependent on the wealthy.

Lets try to avoid the same mistake here.

Health Savings Accounts

If you are in a certain income bracket, health savings accounts let you avoid some taxes while saving up for future medical emergencies.  I have no issue with them but the people they benefit are generally middle class and up.

They like to avoid paying taxes and they have disposable income that they can put away.

Of course, if you are struggling to make ends meet and can barely pay your bills, you aren't likely to put money into such an account, in fact statistics show you aren't likely to put money into a retirement account already.

Now the people who can benefit from these accounts are not "wealthy" per se, but probably live comfortably, have a good job and a good income.

The new Republican plan will allow them to use this money to pay for health insurance premiums, something that was prohibited under the current law for some reason I never understood.

So to benefit you have to have one of these accounts and buy your own health insurance vs am employee sponsored plan, where the amounts you pay in already get favorable tax treatment.

Its hard for me to estimate how many this will help and I'm pretty confident in saying that a tax break on your health insurance premium, while certainly nice, isn't going to be a life changer the way losing your health insurance entirely when you are poor is likely to be.

This was the big benefit touted by the party today, a nice little positive thing they can focus on but something which has very minimal impact.

The fact that this is what they are using as justification actually shows how bad the bill really is, you would think they would find something more meaningful, if it existed.

I guess it doesn't.

So funny except millions may die.

Another example of the show politics we now have instead of anything real took place yesterday.

Now I understand that in many cases one house will pass a bill knowing the other house may want to change some things.

However if the news reports can be believed the Senate isn't starting with the House version but crafting their own.

Now remember that the bill is passed using the reconciliation process which means it is only allowed to address budget items to avoid a filibuster.

One would think that if they had such good ideas for health care they could have gone bipartisan and come up with a plan that helps America.

But instead they passed a bill they don't really like to avoid the embarrassment of not being able to pass a bill.

How embarrassing.

Even more embarrassing is the president saying that Australia's universal health care is better than what we have.

He may have been talking about his misconceived vision of the Affordable Care Act, never can tell what is in that brain, but that statement as we watch the silly stuff in congress has to make you scratch your head.

Its like the congressmen have to get more money to their wealthy donors come hell or high water or at least be able to tell them they tried.

There is enough analysis of the plan to show how it will impact the people who actually need health care in bad ways.  Ultimately this is almost all of us and what many in the public and the congress don't seem to realize is that the people currently healthy are insuring themselves in the future by being part of a pool that includes older and sicker people.

As you age you start to reap the benefits of group insurance. 

Otherwise you simply die.

To Vote or not To Vote

Forcing a vote for a bill that is ill designed and unpopular seems like a strange concept.  Of course, you may believe that some who oppose it will be intimidated at the last minute and swing it to a victory, it seemed to happen in the November election.

Of course if it does pass, it still has to go to the Senate and the drama will continue.  If it fails or they cancel the vote, they can move on to the rest of their rob the poor agenda.

To those of you not paying attention, the basic republican philosophy is to give more to the rich, because they make things happen and it encourages more people to become rich. 

If it was only so easy.

Now, They don't have enough rich people to get elected so they have to fool the not so rich into thinking they will also benefit.  Some might if they don't mind a society where the haves and the have-nots keep getting further apart.

It is much more likely that these people will become a have-not then that they will become wealthy and trying to stay in the middle is really pricey.

Which brings us back to health care, the one thing most likely to cause a financial catastrophe.  Now a country where a bad diagnosis can mean not only a fight for your life but also a chance to impoverish your family is hardly a civilized place. 

Losing your job is of course also a terrible blow but one you have some chance of recovering from.  But a significant illness, can impoverish you while also possibly killing you.  A certain number of people have decided it was better to end it rather than put up with the treatment and the financial danger.  I don't know if we have enough data to figure that out, but I believe it is significant.

It doesn't seem like the vote today, if it happens will be successful because the changes aren't harsh enough.  A bunch of well off old white men think anyone who happens to get pregnant should have to figure out how to pay for it, and they have to have the baby by the way.

The fact that so many Americans vote for these people is the really sick thing.  Many just vote for the party thinking it represents them, but of course if they aren't wealthy it really doesn't.

We have almost two years of this before we get to vote again, lets pay attention.

Its Simply Stacked Against You

In general the Health Care industry has every advantage possible when it come to dealing with individual patients.  They are big, they deal with important and complex issues which are vitally important to the patients, and they do it all the time while each patient does most of it just once.

It is a stacked deck and while you can try to do your homework and try to even the odds a bit, its not like most other things where you know, for example, that you plan to buy a car, its more like your car died and you need one today.

When you get subjected to a real health emergency you are faced with decisions and details that are difficult to deal with, especially since it is of vital interest to you and you really don't know what they are telling you.

Obviously some things like routine physicals and minor illnesses are easy to deal with, but when you go in for a sore throat that won't go away and get subjected to a series of tests and referrals that ultimately tell you that you have a serious illness and need surgery followed by post surgery treatments, you are pretty much in a no win situation.

You can get a second opinion, or try to deal with the situation via non traditional means, but the vast majority of us simply do what they tell you to do.

I should also point out that up to this point health care was probably just something that you didn't think about much except to complain about how much it cost or how expensive it was.

However, when faced with a serious illness, the expensive really kicks into play and that insurance you paid for becomes a real bargain, assuming you can actually keep it.

This is why Government has a role to play in health care and why most civilized countries take the responsibility to make sure all residents have access to health care without worrying about the cost.

Faced with a life threatening illness, cost becomes no issue, until in fact you can't pay anymore.

Universal insurance makes all of us pay a bit more so that the truly sick don't have to sell their homes or go into financial ruin trying to stay alive. 

The United States is fairly unique in not guaranteeing health care to its residents and its likely we are getting ready to in fact make health care less available and affordable while returning about $800 billion dollars to wealthy people who of course have great coverage.

The answer is of course, don't get sick.

Monte Python Insurance

On the British comedy show, Monte Python, there was a skit where a customer was trying to file an insurance claim.

The duologue follows:

Vicar: But my car was hit by a lorry while standing in the garage and you refuse to pay my claim.
Devious: (rising and crossing to a filing cabinet) Oh well, Reverend Morrison, in your policy... in your policy... (he opens the drawer of the filing cabins and takes out a shabby old sports jacket; he feels in the pocket and pulls out a crumpled dog-eared piece of paper then puts the coat back and shuts the filing cabinet).... here we are. It states quite clearly that no claim you make will be paid.
Vicar: Oh dear.
Devious: You see, you unfortunately plumped for our 'Neverpay' policy, which, you know, if you never claim is very worthwhile, but you had to claim, and, well, there it is.

Now in many ways the new republican health insurance seems to have the same basic premise.  People who aren't likely to file claims get to pay less.  However people who really need the insurance are going to pay more, in some instances a lot more.

Now the numbers look like an overall reduction because of all those young people who seldom file a claim.  Now the idea of the affordable care act was to make insurance more affordable for all by including the young and the old, the sick and the healthy in one pool. 

Yes this means if you are young you pay more, but since you are likely to be old at some point in time it eventually sorts itself out.  However, being old and sick now means that you are never going to be young and healthy again, so guess the republican solution is that you should hurry up and die.

When you take away the subsidies that made the insurance affordable for poor people, you of course save money.  Take away mandated coverage and you allow insurance companies to offer tailored products.

In other words the "Neverpay" policy is making a comeback.  At least its affordable.

Health Care Follies

The new plan rolled out by the Republicans has an uncertain future since it doesn't have support by progressives and the fiscal conservatives don't like it.

The issue is that in the spectrum between no Government involvement and a single payer, everything else will have opponents.

Some want the whole thing eliminated as they don't believe Government should play any role.  This view goes against the concept of Government in every other civilized society and is promoted by selfish rich people.  Oh they may give money to charity, but they don't like having the Government decide who needs help.  Maybe greedy is a better descriptor since they want to keep control over all their money.  The fact that some people would die is no concern of theirs, guess they just picked the wrong parents.

Single payer is a system that actually works in most of the world but we can't do it since it would reduce profits to many businesses.  They would still have a role to play in administering the system and selling supplemental insurance, but the idea of Government health insurance with basic costs paid by taxpayer dollars is a step too far, or maybe it isn't.  It would be a step in increasing our competitive position since business would get out from under the health care cost that burdens them.  It is by far potentially the cheapest and best way to provide health care tot he greatest number of people but is still considered by many a Government takeover.

The Affordable Care Act was an attempt at a compromise that failed because the republicans at the time rejected any such attempt.  It actually includes many things that were included in republican proposals previously but which they immediately attacked.  of course they also attacked things that were never part of it, such as death panels and made claims that have been proven false but there is plenty of information about the ACA for anyone interested.  It wasn't a disaster and by most measures was quite successful in reducing the number of uninsured. 

The current republican proposal is now forced to include the successful popular elements of the ACA while convincing the more strident members of their party they have gutted it.  Throw on top of this a president who seems unable to absorb reality or actual facts although it has come to his attention that health care is complex.  Apparently he believed in a simple solution, cover everybody cheaper.  Hard to argue with that really, just like its hard to dislike Santa Claus if you don't come from Philadelphia.

In fact, one of the things that the president is used to from his construction background is inflated estimates.  So maybe he should go around telling people in the health care industry to just charge less.  It would at least keep him busy.

Health Reform

If you consider the issues that face the United States, we have some that have the potential to weaken the very fabric of our nation. Now, one of the things that makes America great is that we don't all have to agree on anything, but we all normally want to treat each other fairly. There is an ongoing debate between those who oppose Government involvement in just about anything and those who favor Government involvement.

Last night the President gave a speech to a joint session of congress and the nation of his proposal to fix health care in this country. For most Americans, health care is represented by the relationship they have with Doctors, Nurses, Dentists and other providers. They don't much think about the business of health care, until something happens that causes them to bear unexpected costs, either because they lose health coverage or have some other catastrophic event.

For some Americans health care simply is something they either do without or provide to themselves. Now, I'm not talking about those who believe in alternative medicine or holistic approaches. I'm talking about people who are not poor enough or old enough to get Government health care and don't have affordable health care options via their employee or on their own.

These folks are working Americans or small business owners who simply are unable to afford health insurance and gamble that they won't need it until they can afford it. Now, sometimes they win and sometimes they lose. After all, insurance is a gamble by its very nature. You can pay premiums for many years and never use the benefits, or use them much less than average. The real purpose is to provide protection from unusual costs that can not be covered from normal income.

The President proposal basically provides that these people will form a group and because of the size of the group, they will be offered affordable insurance. It will become mandatory for people to have health insurance, similar to auto insurance and there will be a concerted push to eliminate waste from the current system while pushing preventive medicine to further reduce cost.

There are of course other ways to solve the problem we face and there is still time to discuss them. The providing of cheap catastrophic protection is a good idea and should not only be used temporarily, but makes sense as one of the options is an ongoing insurance exchange.

What we do need it honest debate and honest commitment by all Americans to help solve the problem and move forward. We need to assure all Americans have access to health care in an affordable way and we also need to change the cost growth curve. Lets do it.

Health care debate

Right now in this country we are trying to decide the future of health care. I believe that everyone agrees that the current escalation in costs can't continue and I would also like to believe that everyone agrees that everyone is entitled to adequate health care. Now, if some people want to continue to see costs escalate, or feel that some people should be denied health care, I don't understand why and would be interested to hear their reasons.

What I believe is under debate is the best way to achieve these outcomes. Clearly there is a fairly clear divide between the best way to control cost and the best way to provide health care to all. Some argue that a pure free market would accomplish this. Now, I don't think it would since in free markets there are always winners and losers. In health care, losers die or at least go broke. Currently, the system provides that if you get sick enough and don't have the right health care coverage, you will become poor and the taxpayers and health insurance companies will end up paying for what you couldn't manage to pay.

I don't find this result satisfactory. Now I should say, that I have what I consider quite wonderful health coverage. I don't have any reason to think the coverage will end so my position isn't dictated by the fact that I need coverage.

Going back to the pure free market approach, the main flaw in it is that knowledge is simply not equally shared. Those who have enough information and knowledge would do quite well while many others, possibly the majority, would be persuaded by questionable sales tactics and end up with inferior, overpriced products.

One way to address this, and this would be my preferred method, is simply to set up rules related to health insurance and also to make sure that any plan sold to the general public was held accountable for the claims it made, lets call it truth in advertising. Now some may feel that we don't need this since consumers and customers have some legal rights now, but arguing or suing a company following a serious illness is not a satisfactory solution if you were denied adequate care when you needed it.

While choosing health care can be complex and deciding whether you want an HMO or a PPO or are willing to pay more for even more choices should be made easier by knowing that the promises made by the plans were in fact legitimate. It would also seem important to me that any plan covered preventive medicine and catastrophic insurance.

Will this cost more? I think it should cost less, especially if the preventive medicine part is effective. Now when I say it should cost less, I am talking about the total amount spent on health care in this country, not the way that cost is proportioned. Currently we have a significant part of the population who utilize the most expensive type of health care imaginable, trips to hospital emergency rooms. Of course many of these trips are absorbed in the costs we already pay.

Now, it is possible, that costs could go up. The increased demand for health care may result in price increases. I think this won't happen, but the simple question remains, do Americans really think some people are not entitled to care?

Certainly there should be a debate about the amount of Government involvement and whether there should be a Government plan as part of the mix. However, I would like to think we could have that debate in a rational way. Currently, we are seeing activists trying to prevent debate by using tactics intended to disrupt meetings. This tactic is designed to get press coverage and influence the public. It may or may not work, but those who advocate it are clearly not proponents of honest debate and democracy.

July 4th

We are approaching the 4th of July weekend and since it falls on a Saturday this year, Friday is a holiday for many. The 4th of July celebrates our Declaration of Independence from England but we should remember that there was a long struggle between the declaring of Independence and the actual achievement.

There have been many times of crisis in this nation since then but probably only a few really threatened its survival. I would think the War of 1812 was one since it was so soon after the revolution, and after that, the Civil War was probably the only other one.

Some would argue that the various financial and economic crises should be added but really, did any of them really threaten the existence of this nation? Certainly despite the gloom and doomers out their, the current crisis is simply not going to cause the dissolution of this nation. During the depression, there was a read fear of Communism, but it never got very close to a real possibility. World War 2 was terrible, but, and maybe it felt different at the time, it never really seemed like we were at danger of going out of existence.

So if our nation and our system of Government are going to continue, we simply have to pull together to make this a better place for our citizens. The crises that we should be worried about are the ability to provide a decent retirement for our seniors, health insurance for all and opportunities to succeed.

It wasn't very long ago that some felt Social Security should be dissolved and the accounts should be turned into the equivalent of 401k's. Imagine if we had done that? Social Security needs to provide a safety net for our seniors that can and should be supplemented either by their own savings or employee pensions. If we don't do it via social security, we will end up doing it via SSI or welfare. For those who don't think we can afford to do this, I believe there is a solution if we simply go to a consumption based tax system.

Health Insurance needs to be viewed as a right, not a privilege. There are ways to do this that provide choice, but, I would ask, why is Education consider a public obligation but providing Health Care a private matter? To a large extent our approach here is primitive and hardly worthy of a modern industrialized nation. It is also very costly to have our health system operated this way. Health care providers are entitled to earn a wage that rewards them for the time and effort it takes to become a doctor or nurse and we need to encourage development of better drugs and techniques.

Finally we need to assure that there is still opportunity to succeed in this country. To get the economy back on track and to restore growth we really need to change the method of taxation and our dependence on foreign oil. Taxing business and individual incomes is onerous and encourages the exportation of jobs and cheating on taxes. If we tax products sold in this country, it would level the playing field for everyone who wanted to compete. Further, we need to have significant investment in our renewable energy industries. Every reduction in oil imports is a good thing for most Americans.

I never know if anyone ever reads these posts and to a large extent I use them as a place to simply capture thoughts I am having. However, for anyone who has given up on this country or for those who actually would like to see the country economy collapse so they can profit, this country will thrive and prosper in the future even more than it has in the past. The problems aren't nearly as bad as you would like them to be.

Hope everyone has a great 4th and I encourage all to help make this country even greater!

Health Insurance

We are currently in a situation in this country where we have two groups, the haves and the have nots. The haves are the people who have adequate health insurance. The have nots are those who don't. Now, the number of haves is not as large as they think they are as this article in the New York Times illustrates. Health insurance comes in many flavors, some will protect you and some won't.

We are currently trying to decide if the Government should provide health insurance to all the uninsured citizens. In effect it already does, the only thing being that before you can get Government health insurance you have to turn over all your assets to the hospitals so you qualify as poor, or, you have to be old enough to get Medicare.

Now this idea that we should have a system that bankrupts certain people for getting sick, is terribly expensive for everyone and provides a varying level of care depending on how much money you have or where you live seems popular with a lot of people. They argue that if we tried to fix it it would cost trillions of dollars and drive up taxes.

Well, lets face it, someone is already paying for all the health care provided. It is possible that if everyone had health insurance more people might use the benefits thereby increasing demand and driving up costs, but that may actually end up preventing more expensive illnesses caused by not getting preventative care. However, either way, the money for health care is coming from the economy somehow.

No one wants to eliminate choice, however, it might be the Government's obligation to prevent scams and cons being perpetrated. So, suppose the Government simply qualified those who offered adequate care and then allowed all citizens to pick one of the policies? This would require that all money currently used to pay for health insurance be transferred to the Government and it would still allow people to have supplemental insurance to cover things like deductibles and co-insurance or preferred care (i.e. private rooms) but it would preserve our current system and allow choice while assuring all health insurance offered met some pre-determined standards.

Now, there would have to be taxes to cover the cost of this, but health insurance would no longer be a cost of doing business, except of course that it would be a tax for all, and it level the playing field for everyone doing business here.

If you don't think we can afford to do this, I would argue that as a society we are morally obligated to pay for it and I think the time has come. I actually think that a system constructed properly will have a net reduction in cost, but that is an argument that ignores the moral obligation.