Monday, February 15, 2010

Heath Reform: The Ugly Truth

I’m really getting sick of hearing the word “bungled” associated with health reform. The Democrats haven’t “bungled” reform—the Republicans have stone-walled it every step of the way, from the day Obama entered the White House. Apparently that’s good and effective politics, since it’s succeeded in making a lot of Americans cynical about the whole process and snide about Washington—a situation that never bodes well for incumbents.

In spite of giving lip service to the need for health reform, every blessed one of the Republican House and Senate members have refused to cooperate on any part of a health reform package—and that’s after 12 years of ignoring the whole issue while they were in the majority. Now, a year into the new administration, I hope they’re proud of what they’ve accomplished—or not accomplished, depending on how you look at it.

Conservative estimates are that about 45,000 people die each year from lack of access to health care—in other words, they can’t afford it. We know that a large percentage of personal bankruptcies—some say as many as 60%—result from debts due to lack of adequate and affordable health insurance. If projections of bankruptcies filed during 2009 are anywhere near accurate, that means that the 100% failure of the Senate Republicans to negotiate in good faith about health reform is at least partly responsible for 840,000 economic tragedies for families and small businesses.

That’s over 1,000 deaths of individuals and 21,000 bankruptcies per Senate Republican (and Joe Lieberman, whatever he is these days—I can’t keep track). In all fairness, it has to be said that some of the lily-livered “Conserva-Dems” from conservative districts have to share some of the blame for dithering and hiding behind the backs of the more out-and-out, true “conservatives” (or, as I suggested yesterday, “reactionaries”). So maybe not every Senate Republican can be blamed for 1,000 deaths and 21,000 bankruptcies.

But how many is enough?

Come on, people. Let’s just get this damn thing done.


Six said...

As for healthcare that YOU (CJ) believe in... what does it look like?

Should hospitals, clinics, and Urgent Care Centers just be free for anyone to walk in to anywhere? Would that include only US Citizens, or anyone and everyone?

Is this something you have to sign up for? So do you favor what the president favors in making it a crime to NOT have health insurance? And if we force Americans to buy this insurance through threat of criminal prosecution, do they at least get to deduct it on thier income taxes?

What about taxing 'cadilac' plans offered by employers - so if you have a sweet congressional-style plan, you have to pay taxes on it for reciving that additional 'compensation' from your employer (unless you are a member of a union - the president and many on the Blue team want to exempt them from that additional tax - those of us not in a union would not recieve the favorable tax treatment) - should we tax those?

Would you favor forcing every American on to a medicare/medicaid program and just doing away with private medicine all together? Sort of a UK approach to medicine?

And finally - what is healthcare? Is having an abortion healthcare that should be paid for by every American? What about ED? Treating anxiety? Acu-puncture? Homeopathy? Gastric-bypass? Shoot - while we are at it, what about vitimins? Gym memberships?

How do we determine what the collective state should be responsible for paying for and what the individual should pay for?

I switched a while ago to an HSA Plan - I love it. It's cheaper, I can self-refer and I love the incentives I get for being careful about what healthcare services I consume. It makes the costs of everything much more transparent and I love that I can choose to spend my healthcare dollars out of our spend-account on acu-puncture which works great for my wife. So should I be able to keep this plan if I want?

So CJ - what does your ideal plan look like?

Citizen Jane said...

First, the Republicans in Congress know perfectly well what's in the proposed bill as it currently stands, and it includes many of the measures they claimed to be for--that is, BEFORE Obama was in favor of them, too. The whole thing is online, if you'd care to read it.

So as long as it's not your mom who can't afford her life-sustaining medications, or your wife who's afraid of the cost of getting a suspicious symptom checked out--or you who's in denial about chest pain (wanting it to be indigestion)--then the status quo is okay? Have you looked at it like that? What if your child needed expensive, life-saving surgery but your insurance wouldn't cover it?

I think every Senator who's refused to deal on health reform during the past year should attend every funeral in his district for people who are dying because they weren't among the chosen when it comes to adequate health insurance. It's at junctures like this where morality meets politics.

Do you really think most people in Canada, England, or France would willingly trade their system for ours--even though their systems are much more expensive than ours is projected to be?

Even the Bush administration worried out loud about the astronomical cost of doing nothing--but with a Democrat in the White House, it seems the whole Republican Party is determined to do just that--nothing.

Let's all watch C-SPAN this week and see who's dithering and who's dealing.

Sue said...

Jane, I'm a strong believer in the need for true healthcare reform in this country. However, I think "bungled" may not be to strong a word for what the Democrats have come up with. First, their program isn't "healthcare reform," it's a mandatory insurance requirement. That's quite a different critter.

Second, it doesn't address the lack of access to heath care experienced by too many people because of where they live. Most rural areas are seriously under served and even in more populated areas, the availability of care can vary significantly from place to place. It's not just lack of health insurance that causes many of those deaths from lack of access to health care.

Third, it continues to tie health insurance to employment, which I believe to be one of the major weaknesses of the present system. Yes, it will allow people to continue to purchase coverage if they leave the provider's employment, but at what cost? Nor does it mandate the level/type of coverage to be provided by employers, so there's still a vast inequity in the coverage. The small company where I work can't begin to offer the quality of coverage large firms can. Not that we don't want to, and not due to the cost, but because the best programs are only available to large employers. And the coverage options change every year -- deductibles and copays keep going up. One friend's employer just switched from a HMO type plan to one with a $500 deductible. Now, that may not seem like a lot of money to benefits managers or senators, but to someone who's just squeaking by, that can be the deciding factor as to whether to seek care for a condition that's still minor or whether they wait to see a doctor when a problem becomes major, possibly life-threatening, and much more expensive to treat.

Fourth, there is no apparent provision for consistent, equitable coverage throughout the country. Many people have suggested including the ability to "cross state lines" for purchasing coverage; that shouldn't be necessary. Anyone who is legally in this country should be assured the same health care as everyone else.

Fifth, cost is not being adequately or equitably addressed. It looks like a greater burden will be placed on employers (making insurance mandatory is a significant cost increase for those who don't currently offer it and not many employees are going to be willing to trade cash for coverage). For those who are not employed, are underemployed, and who have dependents who aren't covered, the cost will continue to be prohibitive. Tax credits can go just so far in reducing the burden.

Finally, special interest groups, from unions to insurers, are being placated (if not pandered to) by the proposed plan.

Unless these key issues are addressed, I'm not going to support the so-called health reform that Congress is offering. With a 2000-plus page bill, I fear we'll be worse off rather than better off with the proposed plan. I still think we need universal health CARE (opposed to health coverage) but let's not blame the Republicans for opposing the monster that's being created. Everyone of sound mind should oppose it.

Six said...

I ask you what your ideal health care plan would look like and you respond by opening with railing against Republicans and finished by invoking Bush? and continuing to rail against Repubpicans. Haha - nice.

I realized I loaded it up with lots of questions, but I was/am genuinely curious to exactly what you support. So I am guessing that by your response, you support the plan perfectly and exactly as the Democrats put forth? (And which - the House or the Senates?)

Everything is blue-team/red-team to you...

Oh and yes, I think there is a substantial amount of people in the UK and in Canada who would choose to come to the US for thier healthcare if they could... then again, I am not arguing we should have no changes to our system either, so not sure I follow your point?

Citizen Jane said...

Sue, I'd be interested in knowing your sources for your information about the nature of the proposed health reform legislation. Are you talking about the House or the Senate version? Neither is likely to be "the bill," if the stalled process can be jump-started to allow for compromise.

Six, you're right. You did ask what my "ideal" health reform bill would look like. I guess I overlooked the question because my "ideal" version was scrapped before it ever had a chance to be debated. My ideal be one-payer system, or at the least, a strong public option. It would look something like Medicare for everyone, with private insurers competing with the government but everyone guaranteed preventive, routine, emergency, and responsive care.

What I care about most is that 1) everyone is covered, 2) insurance companies can't deny coverage or raise rates on a whim (like the 56% increase many Californians are facing right now), and 3)that it helps the economy rather than putting it in jeopardy.

The health care "summit" starting this week should clarify some of the proposals and some people's positions. I suggest that we all do as much listening as we can to primary, unfiltered sources.

Sue said...

Jane, my comments regarding the proposed legislation are gleaned from a number of sources. I don't know of any one site that would provide a good summary for you, but you might look at articles in the NY Times, the New Yorker, America Magazine, AP articles, etc.

As to either bill becoming "the bill" I did read a comment the other day that one way around the Democrats' loss of a "filibuster-proof" majority in the Senate would be for the Senate to accept the House bill. They have more than enough of a majority for that. Interesting concept.

But I agree with you that we should have at the very least a strong public option. Without that, I really don't see "health care reform." I think I'd rather keep the current system -- broken as it is.

Six said...

So CJ - something similar to the Swiss system?

And if there was a government option, why would you care if the insurance companies did such awful things like raising rates? Competition would decide whether or not that was a good thing, wouldn't it? I mean, if there was a government option, people could always go back to that government option if they didnt like the rates being raised, thereby the evil private company loses its customers? I know I am overly simplistic, but I still cannot understand how my dog can recieve state of the art cancer treatment for about 2%-3% of the cost as it would have been if it were me.

Which reminds me, since you mention T. Freidman so much, what do you think of his suggestions and idealization of the Indian healthcare system with thier abundance of doctors?

Citizen Jane said...

Hi, Six,

Friedman's degrees are in Middle Eastern affairs, and he can speak to people in that part of the world in their own languages. I've been very interested in his recent dispatches from Yemen. Two of his three Pulitzer Prizes have been for his foreign correspondence, and he has a lot of authority and credibility when it comes to world economics and GCC. I haven't paid much attention to whatever he may have said about health care systems--although the guy's a pretty good observer. I take what he says seriously, but based on what I know, I don't always agree with him.

Citizen Jane said...

Oh--and I agree about the government option--if we had such a simple, reasonable plan in place, competition would help to control rates--and everyone could afford to treat their families at least as well as they treat their pets!

That fine idea was scrapped at the outset, however, because of the untold billions of dollars the insurance industry has spent lobbying Congress.