When Covid19 started spreading in the United States it became apparent to everyone in March that it was not just another isolated scare. It did not affect my daily life until the second week of March 2020. I received an email from corporate communications at my current client stating that all employees except essential manufacturing workers, would be required to work from home. Saturday, March 14th I was scheduled to run what would have been my first 5k race in years. An email from the race organizers informed me that due to the virus the race would be cancelled. It figured that when I finally decide to sign up for a train for a race, it gets cancelled on me! But I was not upset about that. I needed the exercise anyway and the entrance fee went toward a good cause. What bothered me more was the uncertainty the effects of the virus would have on the economy, and on my friends and family.
I worried about a parent who was in the hospital with an illness unrelated to Covid19. How awful to be in a hospital coincidentally at a time when the virus was spreading in hospitals? I have another relative with chronic lung problems and other underlying health conditions that puts them at a high mortality risk. Another parent was in denial that the virus was even a problem. Plus, I have other family members and acquaintances who were at risk of contracting a contagious disease. Other people I know would be affected by an economy in recession. I had a couple relatives travelling outside the US and I wanted them to get back before borders were closed.
Personally, I was not as afraid of catching the virus or of losing my job. I knew my job was relatively secure, my expenses are low, I am a healthy individual, and I have savings. Working from home is no problem for me because I am accustomed to it. In fact, I felt like working from home more often than I was at the new client anyway. I have a roommate to keep me company. And selfishly, this was a chance to prove to some of the political right-wingers that sometimes having a competent government is a good thing. When Donald Trump said that the virus was a hoax created by Democrats and that the United States would have zero cases by the end of February, I knew Republicans were off to a bad start. It ended up getting worse and worse for them as time went on. I don't take joy from people suffering just because I can say "I told you so" when Republicans fumble around. But I do take pleasure in demonstrating in real time why it is important to elect competent people to government positions who believe the government serves an important function.
But the incompetent response the right-wing extremists worried me. Rather than keeping people informed by being honest about what was happening, Republicans kept denying reality for fear of causing a panic. When things started getting really bad in an unspinnable way, I was concerned that there could be civil unrest. Things seemed peaceful in my neighborhood. My friends kept their jobs, and nobody I knew was getting the virus. Still, I couldn't help but react nervously to the news from across the country that the virus was spreading rapidly, and in the process, harming the economy, disrupting supply chains, and causing people to behave in uncertain ways.
Maybe I have seen too many apocalypse themed movies; perhaps my affinity for dystopian novels has made me more sensitive to certain headlines; or maybe my imagination got the better of me and caused me to panic. I felt the need to protect myself with a weapon. I know, I know. Some people thought I was overreacting. But what if people started rebelling against quarantines? What if massive layoffs resulted in people stealing from others? We certainly couldn't rely on the President to keep people calm. He has used the virus to divide people even further. The problem was that all I had for protection was a small folding knife. Getting a gun would be difficult during this time because the places that provide training, licenses, and sales would be closing. I decided to at least start the gun license application. In the meantime, I went to a relative's house and picked up a compound bow and 6 arrows. Then I went to an outdoors shop and bought a hatchet and a machete. Bass Pro shop closed so I couldn't go to their location to get new arrows, arrowheads, or accessories. It did not matter though. Once I had the machete and bow and arrow, I felt much more secure. But why? There were still no imminent threats to my life. And all I had was a bow and arrow and a knife. Not a gun. Even though it was an overreaction, it made me feel more secure. My gun license is still pending because I need to go to a training course, and all the courses are closed until businesses can reopen. The hunting and firearm license I got in Mississippi in 2009 was not good enough for the state of Mass apparently.
Working from home every day was much more of an adjustment for my roommate than for me. He had only been working from home one day a week, whereas I have gone through periods of time working from home for months on end. And for the project I was on when the lockdown started, and which I am still on, I was having to go into the office Monday through Thursday. The commute to the office was one hour. In addition, I bought an SUV so gas was costing me quite a bit more than with my previous little sedan. Now I avoid commutes every day! Ideally, I prefer working from home at least two days of the work week, but for now I can save time and money because of the lockdown working from home every day.
Some of my coworkers with small children have had to become full time day care workers and teachers and still get their own professional work done. Perhaps some of their spouses have lost their jobs as part of the economic consequences of the lockdowns. I do not have a spouse, children, pets, or elderly relatives to look after.
Many of the things I enjoy doing in my free time involve me being at home anyway. During the lockdown I have been practicing piano, teaching guitar lessons virtually, playing computer games, catching up on TV shows, solving crossword puzzles, going for runs in my neighborhood, cooking, reading, among other things. To fulfill the need to meet with friends and family in person I have regularly scheduled video calls. They are a substandard replacement for meeting in person, of course; but in other ways they are more convenient. You don't have to leave your house or put on pants. You don't have to worry about the weather or what you will bring for the occasion. I suspect that everyone will be using video chat much more frequently after this quarantine is over.
How does a person learn piano? Answer: by sitting your ass down in front of a piano for hours per week. What kind of scenario would allow for a person to sit their ass down in front of a piano for hours per week? Ding! Ding! Ding! Correct! The answer is: lockdown due to Covid19. I have wanted to learn piano for a long time. I always admired those who could sit at a keyboard and just play something, the same way I got a thrill out of watching someone draw something on demand. The piano is a beautifully sounding versatile instrument. I have played the guitar since 2007. I have been teaching it since 2018. But I don't know how to read music! I tried learning to read official music notation on guitar. That proved to be too slow for me. For guitar, I just wanted to play songs using tabs and chords. Then I tried learning music using a recorder but didn't like the sound. Finally I decided to take piano lessons because it would teach me a new instrument I had wanted to learn for a long time, and would show me how to read music. A local business in Foxboro provided lessons. I emailed them for information, and within days I was attending regular weekly 1/2 hour lessons and playing Amazing Grace without looking! Now I can play easy versions of Love Me Tender, Fur Elise, Simple Gifts, Gentle Leaves, Clair de Lune, and a few others.
Not commuting two hours every day has saved me a lot of time. Working from home saves me time too because if I complete work early, and there are no meetings left for the rest of the day, I can use that time to do what I want. This is how the days were in high school and college and it's how I think they should be in the working world. Get done what you need to do in whatever time it takes. If you finish early, then your reward is to do whatever you want!
Less time commuting and unnecessarily staring at a computer screen has given me more time to read. For at least two years I have been alternating between reading a book in Spanish then a new one in English. And I have gotten much more into series lately. One series I have gotten into in Spanish are the the collection of the "cemetery of forgotten books" by Spanish author Carlos Ruiz Zafon. My Argentinian sister-in-law introduced me to the series starting with the book Marina. The genre is a kind of supernatural mystery-fiction. I fell in love with Marina and have since read The Shadow of the Wind and The Angel's Game. Next I want to read The Prisoner of Heaven and The Labyrinth of Spirits. My sister-in-law also gave me a novel called A Darker Shade of Magic by V.E. Schwab. Darker Shade is a fantasy novel involving a magical prince, his sidekick Lila, and their adventures between different versions of magically connected Londons. I enjoyed the first book so much that I purchased the other two in the series: A Gathering of Shadows and A Conjuring of Light. A Gathering of Shadows is a page turner, which I finished much more quickly than I usually finish a 500 page book. The last in the series is on my shelf just waiting until I finish Harry Potter 7! That's another series I have been reading for the last few years. For a long time I had dismissed Harry Potter as mere children's stories, but when I started to get interested in them I was amazed at how deep the Harry Potter story was and how dark the themes, how well written it was, how relatable the characters were! I had intentionally avoided the movies so as to not spoil the story. This was very difficult to do because, like Star Wars, Harry Potter references are everywhere in our culture. I wasn't able to avoid all the images, memes, and references completely so when I read the stories, the actors who portrayed the characters in the movies are the ones I pictured in my mind. On a few occasions I intentionally looked up the name of the character online to see how they were represented in the movie. I tried to read the first Harry Potter novel in Spanish back in 2016 but couldn't because my Spanish had not yet advanced to that reading level! Sure, the book was everywhere in English, but I wanted the challenge. Because I really wanted to read the novel, it gave me more motivation to learn more complex Spanish. I have incorporated the Harry Potter into my alternating English then Spanish reading list. Now I am on the last book of the series, The Deathly Hallows. It is very likely after I finish this book that I will read the Cursed Child and the other stories in the Harry Potter universe.
A perfect way to pass time (some might even say waste time) is to play games! My friend Claudia taught me how to play dominoes. Believe it or not, I had never learned how to play it. I play the USA Today crossword puzzle online sometimes. If I'm feeling smaht (sic) I'll try the WSJ one. Last year I bought a 300 count crossword puzzle book from Barnes & Noble with puzzles at various levels of difficulty. They range from "slightly harder than USA Today" to "way harder than WSJ." There are a lot of things that help improve your crossword game: having a wide vocabulary, knowing foreign languages, watching a lot of TV, watching Jeopardy, memorizing frequently used answers (like "oreo" and "Emir" and "PTA")and solving puzzles by the same authors multiple times. I got so proficient at the USA Today crosswords that I started challenging myself to solve them in under 10 minutes. My current personal record for a USA Today puzzle is 7:36. My friends and I have gotten back into retro Doom. I downloaded new packages, or WADs, for the old game and have played them on my PC. Sigil was an expansion created by John Ramero that I have played and beat. I'm at the very end of a WAD called S.T.R.A.I.N, a 1997 WAD that has been a lot of fun. Next I would like to either start a Minecraft server and get friends on it or perhaps get a PS4 and get back into Call of Duty. If I can't decide on those two, I will download another Doom WAD.
My friends and family and I have stayed connected during the lockdown using video chat. My brother's family in Arizona prefers WhatsApp video calls. My buddies and I who were meeting up more or less weekly before Covid19 decided to schedule weekly Monday night calls we call The Kumite, named after the infamous martial arts tournament portrayed in the Jean-Claude Vanne Damme movie Bloodsport. These Kumite's started as Google Hangouts calls. Now we use Google Meet, which works better. With my group of college friends I initiated a Zoom call two Saturdays in May. It had been a long time since we had seen each other so everyone was happy to participate and catch up. One member of our group is hosting the 3rd meetup tomorrow. For the last year or so I have been following Peter Caine Dog Training on YouTube. He posts funny, entertaining, and informative videos about art, animals, politics, sasquatch, among other topics. Other folks who follow Peter Caine have gotten in touch outside of his livestream chats to connect on other livestreams and social media accounts. Peter Caine streams live dog training classes on Saturday mornings. They are fun to attend because you learn something and you get to chat with internet friends. Connecting to people during isolation has been essential for me, and I think for everyone. As social beings, we need to stay connected even if we cannot do it in person. I have not been completely isolated during lockdown. I saw family for Mother's day, went to visit my parents one day since then to chat, I saw a buddy at his house, and I've met up with friends in parks.
The lockdown has challenged our sanity. It has given me a chance to focus on my own mental health. One thing I have done since the Coronavirus hit was to abstain from alcohol and marijuana. While others have increased their consumption of drugs and alcohol I have abstained! This has been essential to maintaining my mental balance. I feel better every day as a result of not drinking or smoking. I still drink caffeine and smoke tobacco (cigars and pipes) but those have less of an affect on me than alcohol and cannabis. I plan on continuing this abstention beyond the end of the Covid19 quarantine. My diet could use some improvement. I have been trying to exercise regularly.
In sum, Covid19 and the lockdown we are in has not been too bad for me. In a lot of ways it has been a positive experience. It has given me a lot of time back for not having to commute. I have been able to read, learn music, play games, exercise, and still stay in touch with friends. I welcome the passing of this virus though! Everyone wants things to get back to normal as soon as possible. When it's safe to do so, I will travel to visit my nephews in Arizona, go on a beach vacation, and hit up my favorite dine-in restaurants.
Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts
May 22, 2020
May 18, 2020
Thoughts on Coronavirus Covid19 2020
The year 2020 will be known as the year of the following: Covid19, Coronavirus, Lockdown, Quarantine, or just simply, "The Virus."
If someone had told me in 2019 that in 2020 I would be washing my facemask, I would have looked at you perplexed. Why would I be wearing a facemask so regularly that I would need to wash it?
When news started spreading (no pun intended) at the end of 2019 that a highly contagious virus was wreaking havoc in Wuhan Province, China, most of the world figured it was an outbreak like others. We have gotten used to pandemics appearing in the news cycle every few years. You remember SARS, Avian Flu, Swine Flu, Ebola, and others? Outbreaks would occur, but they would be isolated to a small group of countries, and leaders managed to get them under control within a few weeks. The world became so used to these outbreaks that when a more serious one like Covid19 erupted, we did not take it seriously until it was too late to stop a worldwide spread.
Public health officials, epidemiologists, and philanthropists whose focus is preventing the spread of contagious diseases, were not the least bit surprised by Covid19. In fact, they have been telling the world for years that a global pandemic was inevitable. There have been major outbreaks worldwide since the beginning of recorded history. It only makes sense that as the population increases concurrently with global commerce the human race becomes more and more susceptible to contagious diseases. Even with robust healthcare systems, childhood vaccinations, and effective public health initiatives, it is obvious that not every disease can be anticipated and prevented. The human organism is fragile.
The Black Plauge of the 14th century wiped out between 75 million and 200 million people. The Spanish Flu infected 500 million people worldwide in the early 1900s and killed between 17 and 50 million. Ebola caused a global scare when it spread in West Africa and some isolated spots internationally between 2013 and 2016. No matter how advanced a society is, it is always vulnerable to large portions of its population being wiped out by a contagious disease.
And these diseases were all transmitted from nature to humans. There are diseases that can be manufactured in a laboratory too! International treaties have been ratified to prevent the manufacture and proliferation of biological warfare agents. We ban biological weapons for the same reason we ban chemical weapons - the amount of suffering caused by the weapon is so great that it cannot ethically be allowed as an option for one group of people to fight against another.
When we fear something we write about it, tell stories about it, make art depicting it. Our fear of pandemics has permeated popular culture. The 2002 movie 28 Days Later was a post-apocalyptic horror movie about a highly contagious virus called "the rage" that decimated the entire population of England. The novel Inferno by Dan Brown is about a mad scientist who believes that in order for the human race to persevere, its population must be winnowed down. The mad scientist in Brown's novel believes that the world had be come too peaceful, too good at preventing pandemics and wars, and that population growth is the greatest threat to human existence. He creates a virus that will kill every third person it infects, on average. A famous book about Ebola called The Hot Zone brought that deadly disease to everyone's attention in the 1990s. Mobile games have been created where the player can try to spread a disease across the world as quickly as possible.
Artists who depict pandemics in popular culture remind me of the kinds of movies and novels that were created about nuclear warfare during the Cold War era. Dr. Strangelove. War Games. I remember a Twighlight Zone episode about a bunch of people preparing to board a spaceship to escape to a nearby planet to avoid the fallout from a nuclear war that had already begun. When the passengers asked which planet they were headed to, the captain replied that they were going to a place called Earth. The viewer assumes until that moment that the setting of the episode is on Earth and that the humans are trying to escape to a nearby planet that has been discovered. It turns out the "people" the viewers are watching are really aliens that look and act just like humans, but think that Earth will be a more peaceful place. Of course, the eerie thing about this is that Earth was struggling to contain its own nuclear tinderbox between the USA and the USSR, among other countries. After WWII up until the 1990s, the world was preoccupied with Communism vs Capitalism; nuclear power vs nuclear power; East against West. It wasn't until the collapse of the Soviet Union, the falling of the iron curtain, the breaking of the Berlin wall, and the September 11th attacks in 2001 that the world shifted its focus from nuclear war to terrorism.
9/11 caught the world by surprise even though there were clues that an attack coming from radical Islamists could happen. The world was still slowly moving out of its old Cold War mentality. Prior to the Cold War, it was about how big and agile your land army was. Vietnam disproved that conventional wisdom. Then the Cold War showed it wasn't the size of your army that mattered, but the size of your nuclear arsenal. Suicidal terrorism stemming from radicalized Muslims was not something we had been used to thinking about. Even if the intelligence communities in Western nations had taken seriously all of the clues leading up to 9/11, who is to say they would have responded any differently than they did? Instead of carefully reflecting on what mistakes were made and how 9/11 could have been prevented, the US government invaded Afghanistan, enacted the Patriot Act, created the TSA, expanded the powers of the NSA (spying, warrantless wiretapping, PRSIM, Snowden, etc.), then invaded Iraq. Years and trillions of dollars later, we can reflect on our decisions since 9/11 to determine which actions were effective, and which ones were counterproductive.
Here we are at a 9/11 type moment with Covid19. We finally see how a highly contagious disease can cause so much damage to the world population and the economy. Were there warnings that could have prevented Covid19 from becoming the monstrous problem that it did? Will we overreact to it the way we did after 9/11? It seems we are heading in that direction.
Already lawmakers in the US and UK, and probably other nations, are passing laws designed to track citizens more closely in an effort to contain future outbreaks. Will we have forced vaccinations? Will we have to identify ourselves as being virus free? Will we blame China for the outbreak and cause us to go to war with them? How we learn from this experience is up to us! We have so many resources at our disposal to help prevent or minimize the impact of a future outbreak. Let's focus on making carefully thought out policy decisions and avoid the knee-jerk reactions that we had after 9/11. I would recommend efforts to create universal health care, universal basic incomes as a way of avoiding major disruptions to our healthcare and economic systems.
If someone had told me in 2019 that in 2020 I would be washing my facemask, I would have looked at you perplexed. Why would I be wearing a facemask so regularly that I would need to wash it?
When news started spreading (no pun intended) at the end of 2019 that a highly contagious virus was wreaking havoc in Wuhan Province, China, most of the world figured it was an outbreak like others. We have gotten used to pandemics appearing in the news cycle every few years. You remember SARS, Avian Flu, Swine Flu, Ebola, and others? Outbreaks would occur, but they would be isolated to a small group of countries, and leaders managed to get them under control within a few weeks. The world became so used to these outbreaks that when a more serious one like Covid19 erupted, we did not take it seriously until it was too late to stop a worldwide spread.
Public health officials, epidemiologists, and philanthropists whose focus is preventing the spread of contagious diseases, were not the least bit surprised by Covid19. In fact, they have been telling the world for years that a global pandemic was inevitable. There have been major outbreaks worldwide since the beginning of recorded history. It only makes sense that as the population increases concurrently with global commerce the human race becomes more and more susceptible to contagious diseases. Even with robust healthcare systems, childhood vaccinations, and effective public health initiatives, it is obvious that not every disease can be anticipated and prevented. The human organism is fragile.
The Black Plauge of the 14th century wiped out between 75 million and 200 million people. The Spanish Flu infected 500 million people worldwide in the early 1900s and killed between 17 and 50 million. Ebola caused a global scare when it spread in West Africa and some isolated spots internationally between 2013 and 2016. No matter how advanced a society is, it is always vulnerable to large portions of its population being wiped out by a contagious disease.
And these diseases were all transmitted from nature to humans. There are diseases that can be manufactured in a laboratory too! International treaties have been ratified to prevent the manufacture and proliferation of biological warfare agents. We ban biological weapons for the same reason we ban chemical weapons - the amount of suffering caused by the weapon is so great that it cannot ethically be allowed as an option for one group of people to fight against another.
When we fear something we write about it, tell stories about it, make art depicting it. Our fear of pandemics has permeated popular culture. The 2002 movie 28 Days Later was a post-apocalyptic horror movie about a highly contagious virus called "the rage" that decimated the entire population of England. The novel Inferno by Dan Brown is about a mad scientist who believes that in order for the human race to persevere, its population must be winnowed down. The mad scientist in Brown's novel believes that the world had be come too peaceful, too good at preventing pandemics and wars, and that population growth is the greatest threat to human existence. He creates a virus that will kill every third person it infects, on average. A famous book about Ebola called The Hot Zone brought that deadly disease to everyone's attention in the 1990s. Mobile games have been created where the player can try to spread a disease across the world as quickly as possible.
Artists who depict pandemics in popular culture remind me of the kinds of movies and novels that were created about nuclear warfare during the Cold War era. Dr. Strangelove. War Games. I remember a Twighlight Zone episode about a bunch of people preparing to board a spaceship to escape to a nearby planet to avoid the fallout from a nuclear war that had already begun. When the passengers asked which planet they were headed to, the captain replied that they were going to a place called Earth. The viewer assumes until that moment that the setting of the episode is on Earth and that the humans are trying to escape to a nearby planet that has been discovered. It turns out the "people" the viewers are watching are really aliens that look and act just like humans, but think that Earth will be a more peaceful place. Of course, the eerie thing about this is that Earth was struggling to contain its own nuclear tinderbox between the USA and the USSR, among other countries. After WWII up until the 1990s, the world was preoccupied with Communism vs Capitalism; nuclear power vs nuclear power; East against West. It wasn't until the collapse of the Soviet Union, the falling of the iron curtain, the breaking of the Berlin wall, and the September 11th attacks in 2001 that the world shifted its focus from nuclear war to terrorism.
9/11 caught the world by surprise even though there were clues that an attack coming from radical Islamists could happen. The world was still slowly moving out of its old Cold War mentality. Prior to the Cold War, it was about how big and agile your land army was. Vietnam disproved that conventional wisdom. Then the Cold War showed it wasn't the size of your army that mattered, but the size of your nuclear arsenal. Suicidal terrorism stemming from radicalized Muslims was not something we had been used to thinking about. Even if the intelligence communities in Western nations had taken seriously all of the clues leading up to 9/11, who is to say they would have responded any differently than they did? Instead of carefully reflecting on what mistakes were made and how 9/11 could have been prevented, the US government invaded Afghanistan, enacted the Patriot Act, created the TSA, expanded the powers of the NSA (spying, warrantless wiretapping, PRSIM, Snowden, etc.), then invaded Iraq. Years and trillions of dollars later, we can reflect on our decisions since 9/11 to determine which actions were effective, and which ones were counterproductive.
Here we are at a 9/11 type moment with Covid19. We finally see how a highly contagious disease can cause so much damage to the world population and the economy. Were there warnings that could have prevented Covid19 from becoming the monstrous problem that it did? Will we overreact to it the way we did after 9/11? It seems we are heading in that direction.
Already lawmakers in the US and UK, and probably other nations, are passing laws designed to track citizens more closely in an effort to contain future outbreaks. Will we have forced vaccinations? Will we have to identify ourselves as being virus free? Will we blame China for the outbreak and cause us to go to war with them? How we learn from this experience is up to us! We have so many resources at our disposal to help prevent or minimize the impact of a future outbreak. Let's focus on making carefully thought out policy decisions and avoid the knee-jerk reactions that we had after 9/11. I would recommend efforts to create universal health care, universal basic incomes as a way of avoiding major disruptions to our healthcare and economic systems.
March 3, 2015
Latest Obamacare Challenge - King v. Burwell
The Supreme Court will hear a case Wednesday, March 4th 2015 called King v. Burwell in which the plaintiff argues the federal subsidies provided to some Affordable Care Act (ACA) enrollees are not legal and should be discontinued. The challenge arises from a technicality in the law which says subsidies will be provided to those enrollees obtaining insurance coverage from state exchanges, not federal exchanges. Enrollees from states without a local exchange relied on the federal exchange to purchase plans. A victory in the case would mean 6 million people will no longer receive health insurance premium subsidies.
Journalist Margot Sanger-Katz explains in yesterday's New York Times how this ruling against the ACA could drive up health care costs for everyone. In her article How an Adverse Supreme Court Ruling Would Send Obamacare Into a Tailspin she says if subsidies are removed only those who cannot afford not to have coverage will stay in their plans. They will be the oldest and sickest of the pool of previously uninsured. Meanwhile, those who went without coverage previously because they were healthy will forego the plans made pricier by the removal of subsidies.(1)
An Op-Ed from an assistant professor Nicholas Bagley at the University of Michigan published in the Times the same day argues the plaintiff's narrow reading is absurd, that no small line of a statue may be read in isolation, and demonstrates how the individual mandate phrase was not viewed this way.(2)
There is no question this case is problematic. If the judges rule against the ACA millions could lose subsidies. Those who cannot afford the full retail price of a health insurance plan may decide to opt out of a plan all together. But notice how the ACA is discussed in pieces like the ones above by Sanger-Katz and Bagley. They ignore where the subsidies are coming from in the first place.
I know we cannot discuss the merits of the core of every issue whenever some aspect of it is brought up, but since the ACA is so new I think it's worth mentioning again.
Let's call the ACA what it really was - a health insurance reform bill. It did not focus on reducing the cost of care but on getting everyone into an existing, expensive system through a combination of mandates and subsidies. Where do the subsidies come from? You and I will pay taxes which will be forwarded to US health insurance companies who are charging a lot of money for health insurance plans.
I wanted to see how much a subsidy is worth so I went to a random exchange to see how much I would get in subsidies if I had to buy a plan on the market. In Maryland's exchange I typed in my age and put a low figure - $20,000 for income. As a result I would get $134.31 in subsidies each month.
I could get a Silver plan with an $1100 deductible for $165.00 after the subsidy. This works out very well for everyone except the taxpayer who must pay a portion of their income to pay the premiums of someone else's insurance plan. (I understand the cost to the taxpayer for someone who does not have care using the emergency room. This maybe be a more efficient means of taxing to provide a benefit to others, but it is a tax nonetheless.)
I would like to know if the true cost of the plan in Maryland is $134.00 + $165.00 or if there are some behind the scenes funds the federal government is paying to these insurance carriers. It doesn't matter because even $165/month for a plan is 10% of a $20,000 gross income.
Today I received a notice of creditable coverage in the mail from my health insurance company. My plan is employer-sponsored so I don't see the full price anywhere except this mailing.
The monthly premium for my health insurance plan for 2015, combining my portion and my employer's portion is $562.45 per month. On my pay stub I see that I only pay $142 per month and my employer pays $420.45. Let's say my wage was the Massachusetts equals the 2014 median household income of $66,768. That means my health insurance premiums (total shared $562.45) are 10% of my gross income. Of course, I don't pay for my entire premium and the premium I do pay is pre-tax income. Still, 10% is a lot of money to go toward an insurance policy. If I had to pay for my entire premium it would be my second largest expense after housing!
So a Silver Plan in Maryland with a reasonable deductible costs $300 per month, pre-subsidy for someone making $20,000 - that would be 18% of that person's income . My plan in Massachusetts is $562.45 per month for a plan with a reasonable deductible. Based on median Massachusetts income of $66,768, the premium equals 10% of annual income.
The point is not whether the premium is paid by an employer or subsidized on an exchange, the point is why did the ACA just try getting people into an expensive system? Why should health insurance cost double-digit percentages of our incomes?
I wish more commentary would address this failing of the ACA when cases like King v. Burwell occur. Instead, all we read about is what people would lose if the act was changed. By discussing the impact of losing a subsidy without discussing where the subsidy comes from or why it is necessary we miss the chance to address the real problem of cost.
(1) http://www.nytimes.com/2015/03/02/upshot/how-an-adverse-supreme-court-ruling-would-send-obamacare-into-a-tailspin.html
(2) http://www.nytimes.com/2015/03/02/opinion/in-king-v-burwell-the-plaintiffs-misread-obamacare.html?ref=opinion
Journalist Margot Sanger-Katz explains in yesterday's New York Times how this ruling against the ACA could drive up health care costs for everyone. In her article How an Adverse Supreme Court Ruling Would Send Obamacare Into a Tailspin she says if subsidies are removed only those who cannot afford not to have coverage will stay in their plans. They will be the oldest and sickest of the pool of previously uninsured. Meanwhile, those who went without coverage previously because they were healthy will forego the plans made pricier by the removal of subsidies.(1)
An Op-Ed from an assistant professor Nicholas Bagley at the University of Michigan published in the Times the same day argues the plaintiff's narrow reading is absurd, that no small line of a statue may be read in isolation, and demonstrates how the individual mandate phrase was not viewed this way.(2)
There is no question this case is problematic. If the judges rule against the ACA millions could lose subsidies. Those who cannot afford the full retail price of a health insurance plan may decide to opt out of a plan all together. But notice how the ACA is discussed in pieces like the ones above by Sanger-Katz and Bagley. They ignore where the subsidies are coming from in the first place.
I know we cannot discuss the merits of the core of every issue whenever some aspect of it is brought up, but since the ACA is so new I think it's worth mentioning again.
Let's call the ACA what it really was - a health insurance reform bill. It did not focus on reducing the cost of care but on getting everyone into an existing, expensive system through a combination of mandates and subsidies. Where do the subsidies come from? You and I will pay taxes which will be forwarded to US health insurance companies who are charging a lot of money for health insurance plans.
I wanted to see how much a subsidy is worth so I went to a random exchange to see how much I would get in subsidies if I had to buy a plan on the market. In Maryland's exchange I typed in my age and put a low figure - $20,000 for income. As a result I would get $134.31 in subsidies each month.
I could get a Silver plan with an $1100 deductible for $165.00 after the subsidy. This works out very well for everyone except the taxpayer who must pay a portion of their income to pay the premiums of someone else's insurance plan. (I understand the cost to the taxpayer for someone who does not have care using the emergency room. This maybe be a more efficient means of taxing to provide a benefit to others, but it is a tax nonetheless.)
I would like to know if the true cost of the plan in Maryland is $134.00 + $165.00 or if there are some behind the scenes funds the federal government is paying to these insurance carriers. It doesn't matter because even $165/month for a plan is 10% of a $20,000 gross income.
Today I received a notice of creditable coverage in the mail from my health insurance company. My plan is employer-sponsored so I don't see the full price anywhere except this mailing.
So a Silver Plan in Maryland with a reasonable deductible costs $300 per month, pre-subsidy for someone making $20,000 - that would be 18% of that person's income . My plan in Massachusetts is $562.45 per month for a plan with a reasonable deductible. Based on median Massachusetts income of $66,768, the premium equals 10% of annual income.
The point is not whether the premium is paid by an employer or subsidized on an exchange, the point is why did the ACA just try getting people into an expensive system? Why should health insurance cost double-digit percentages of our incomes?
I wish more commentary would address this failing of the ACA when cases like King v. Burwell occur. Instead, all we read about is what people would lose if the act was changed. By discussing the impact of losing a subsidy without discussing where the subsidy comes from or why it is necessary we miss the chance to address the real problem of cost.
(1) http://www.nytimes.com/2015/03/02/upshot/how-an-adverse-supreme-court-ruling-would-send-obamacare-into-a-tailspin.html
(2) http://www.nytimes.com/2015/03/02/opinion/in-king-v-burwell-the-plaintiffs-misread-obamacare.html?ref=opinion
April 22, 2014
Uninteded Consequences of Socialized Health Care
Socialized medicine in its truest form is government ownership of health care facilities, government employment of physicians, and government control of financial transactions between doctor and patient.
A less extreme form of socialized medicine has either privately run health care facilities receiving payment from public funds or publicly run facilities receiving private funds.
A more moderate form would entail a mixture of government run and private facilities receiving payments from both public and private funds. This form closely resembles the current system in the United States. VA hospitals are government run facilities with federally paid health care workers whose patients have a mix of private and public insurance plans to pay for care. For-profit hospitals accept Medicaid, Medicare, private insurance, and self-pay patients.
The Affordable Care Act (ACA) took this current, more moderate system and simply added a bunch of mandates and subsidies to it. By forcing citizens into insurance plans by threat of a tax penalty the ACA will drastically reduce the number of uninsured. Since our health care reformers in Washington DC have determined that insurance is a necessary middleman between patients and physicians, one can see from their perspective why forcing citizens into plans is a good thing.
Opponents of the ACA argue that the act is an infringement on personal liberty but have failed to explain how. Just saying that citizens should not be forced to purchase something is not a solid argument against it; after all, the government can force us to do all kinds of things like purchase car insurance if owning a car.
An overlooked infringement Republicans should be explaining is how a move toward true socialized medicine grants the government the authority to dictate what citizens eat and the lifestyles they choose to adopt.
If the government is paying for and/or providing health care it has a vested interest in promoting healthy life choices. An obese person long ago would choke on their own fat and die a premature death. A stuntman could bankrupt his family after suffering a debilitating injury. A poor person could be refused life-saving emergency care for failure to provide proof of payment. This was a harsh system, but one that encouraged people to independently make good decisions or else they, and no one else, would suffer the consequences of their actions. Under a government run system that covered everyone, these three people would drive up costs to the system. The obese person would have their diabetes meds, heart problems, and weight-loss surgeries paid for by the government. The stuntman would be pieced together like Humpty Dumpty after each fall, driving up system costs. The poor man who contributes little, if anything to the government run pool would be granted the life-saving care at the expense of every taxpayer in the nation.
The government wants to promote a healthy society in the same way in wants to promote an educated society. But when the health of a society becomes a budgetary issue, its intrusion into private lives could become more than even the most liberal proponent of socialized health care would want.
Higher utilization of care puts a strain on the health care system. Who uses more care than anyone? The sick, elderly, and daredevils. Washington DC, as the collector and payor of health care services in a more socialized system, has an interest in meeting its budget every year. A growing health care budget can be met by increasing premiums (taxes), diminishing services, and influencing a patient's lifestyle choices. Those citizens using the system more often - the sick, elderly, and daredevils - would be targets in this budget balancing act.
Sometimes the fear of being unhealthy is not a sufficient incentive by itself to promote healthy lifestyle choices. In fact, if cost is no issue to the individual, there is even less incentive to be healthy and avoid risk. Here are some ways in which the government could try to control a citizen's lifestyle in order to keep health care costs down:
Checking grocery items purchased under a shopper's card
Targeted mailings to households in areas with statistically higher obesity rates
Banning hazardous recreational activities like base jumping
Verifying purchases of prescriptions from Rx databases
Monitoring those with criminal records with drones
Keeping tabs on purchases for "sinful" services like prostitution, gambling, and drugs
Web purchase history
Frequency of clubbing, going to bars, or partying using geolocation
Checking online dating profiles for signs of risky behavior
Outlawing the most unhealthy foods like ice cream
Euthanasia/hospice/chronic elderly care decisions contrary to what an individual would choose
Some might dismiss these potential controls as paranoid. It cannot be denied that the technology for this type of intervention exists and is currently being used by advertising agencies and law enforcement.
Private health care has its own set of problems, the main one being the refusal of services to thsoe who cannot afford to pay. This can be addressed in its own time. Right now if Republicans want to start fixing our health care system they must acknowledge it is not working well, propose a way to fix it, then demonstrate how the ACA will only make things worse. The ACA can only be effectively opposed if there is a better alternative and if Republicans can show not just that the ACA will be more expensive but that it could lead toward greater government intrusion into people's lives.
A less extreme form of socialized medicine has either privately run health care facilities receiving payment from public funds or publicly run facilities receiving private funds.
A more moderate form would entail a mixture of government run and private facilities receiving payments from both public and private funds. This form closely resembles the current system in the United States. VA hospitals are government run facilities with federally paid health care workers whose patients have a mix of private and public insurance plans to pay for care. For-profit hospitals accept Medicaid, Medicare, private insurance, and self-pay patients.
The Affordable Care Act (ACA) took this current, more moderate system and simply added a bunch of mandates and subsidies to it. By forcing citizens into insurance plans by threat of a tax penalty the ACA will drastically reduce the number of uninsured. Since our health care reformers in Washington DC have determined that insurance is a necessary middleman between patients and physicians, one can see from their perspective why forcing citizens into plans is a good thing.
Opponents of the ACA argue that the act is an infringement on personal liberty but have failed to explain how. Just saying that citizens should not be forced to purchase something is not a solid argument against it; after all, the government can force us to do all kinds of things like purchase car insurance if owning a car.
An overlooked infringement Republicans should be explaining is how a move toward true socialized medicine grants the government the authority to dictate what citizens eat and the lifestyles they choose to adopt.
If the government is paying for and/or providing health care it has a vested interest in promoting healthy life choices. An obese person long ago would choke on their own fat and die a premature death. A stuntman could bankrupt his family after suffering a debilitating injury. A poor person could be refused life-saving emergency care for failure to provide proof of payment. This was a harsh system, but one that encouraged people to independently make good decisions or else they, and no one else, would suffer the consequences of their actions. Under a government run system that covered everyone, these three people would drive up costs to the system. The obese person would have their diabetes meds, heart problems, and weight-loss surgeries paid for by the government. The stuntman would be pieced together like Humpty Dumpty after each fall, driving up system costs. The poor man who contributes little, if anything to the government run pool would be granted the life-saving care at the expense of every taxpayer in the nation.
The government wants to promote a healthy society in the same way in wants to promote an educated society. But when the health of a society becomes a budgetary issue, its intrusion into private lives could become more than even the most liberal proponent of socialized health care would want.
Higher utilization of care puts a strain on the health care system. Who uses more care than anyone? The sick, elderly, and daredevils. Washington DC, as the collector and payor of health care services in a more socialized system, has an interest in meeting its budget every year. A growing health care budget can be met by increasing premiums (taxes), diminishing services, and influencing a patient's lifestyle choices. Those citizens using the system more often - the sick, elderly, and daredevils - would be targets in this budget balancing act.
Sometimes the fear of being unhealthy is not a sufficient incentive by itself to promote healthy lifestyle choices. In fact, if cost is no issue to the individual, there is even less incentive to be healthy and avoid risk. Here are some ways in which the government could try to control a citizen's lifestyle in order to keep health care costs down:
Checking grocery items purchased under a shopper's card
Targeted mailings to households in areas with statistically higher obesity rates
Banning hazardous recreational activities like base jumping
Verifying purchases of prescriptions from Rx databases
Monitoring those with criminal records with drones
Keeping tabs on purchases for "sinful" services like prostitution, gambling, and drugs
Web purchase history
Frequency of clubbing, going to bars, or partying using geolocation
Checking online dating profiles for signs of risky behavior
Outlawing the most unhealthy foods like ice cream
Euthanasia/hospice/chronic elderly care decisions contrary to what an individual would choose
Some might dismiss these potential controls as paranoid. It cannot be denied that the technology for this type of intervention exists and is currently being used by advertising agencies and law enforcement.
Private health care has its own set of problems, the main one being the refusal of services to thsoe who cannot afford to pay. This can be addressed in its own time. Right now if Republicans want to start fixing our health care system they must acknowledge it is not working well, propose a way to fix it, then demonstrate how the ACA will only make things worse. The ACA can only be effectively opposed if there is a better alternative and if Republicans can show not just that the ACA will be more expensive but that it could lead toward greater government intrusion into people's lives.
March 27, 2014
Defense of Private Health Insurance
What is so nefarious about the Affordable Care Act that Federal Congressmen would hold the government hostage in order to de-fund a program its supporters hail as a monumental achievement of social justice? How can right wing news outlets decry the law as an infringement on personal liberty while liberal news outlets celebrate every new enrollee?
The Affordable Care Act was enacted to address two problems: the inability of Americans to obtain health insurance due to a pre-existing health condition and the growing cost of health insurance that renders it unaffordable for many Americans.
In my opinion the arguments for or against the Act are illegitimate because the Act was a poor attempt to fix a real social problem in America - the high cost of health care services. It is the high cost of health care services which has led to expensive health insurance, and since insurance companies are not themselves providing the health care, they should not be the primary target of reform.
The debate was flawed from the beginning because each side of the argument accepted the current health care delivery system when it realized it could not magically create its own ideal system. If the Democrats had been given a magic wand to reform health insurance, they would have created a single-payer, Medicare-for-all program that outlawed private insurance companies. A single payer system could have addressed the problem of the high cost of health care services from the top-down. Reform was not a priority for Republicans so they could not be expected to automatically propose an alternative.
Republicans are by nature adversaries to sweeping social reform, especially when it involves moving away from privatization toward government control. They have opposed funding for government run health care programs such as Medicare and Medicaid. Their hostility toward these programs and their defense of private industry led them to a position against Democrats in the health care reform debate which equated to more or less a defense of the status quo. Republicans were too concerned with issues like Iran, the economy, and the budget deficit to try and find solutions to the rising cost of health care services.
Democrats were unwilling to try for a single payer system because they wanted to have some Republican assistance in reform, or at least they wanted to minimize the level of heated opposition. Democrats even removed the public insurance option to garner Republican support, but in the end the vote ran along strict party lines anyway! So their ideal solution was not tried, and their watered-down reform of health insurance was heatedly opposed too! Instead of risking thinking big and trying to address the real root of the problem by completely overhauling the entire delivery system with a universal, single payer plan, and doing the hard work of conducting a carefully crafted debate while generating populist appeal, they decided to just accept the current delivery system, flawed as it was, and manipulate it the way a puppeteer controls a marionette by slapping all sorts of mandates on everyone participating in the health care delivery system. Their lack of courage and creativity meant they would just accept the current system while legislating countless mandates on consumers and providers within that system.
Even though Republicans were blamed for blocking reform I suspect the partisanship of the Democrats and their inability to start a healthy discussion of the root causes of the problem contributed more toward of Republican reticence than the Republican's defense of the current system. Even if Republicans wanted to reform the system in some way, the smell of partisanship was so strong that they knew it would be better to defend it than participate in a solution they knew would be too heavy on mandates. I am not letting Republicans off the hook here. Republicans did not oppose the Affordable Care Act because it failed to address the root of the problem; they opposed it because of the level of government intrusion into the market - an understandable position to take, but they missed the point just like the Democrats did. The reason to oppose the Act was because it would not work, but that had to be demonstrated thoughtfully!
So Democrat unwillingness to find an idealistic leftist solution led it to a tacit approval of the current system which the party then decided to reform around the edges while Republicans had no choice but to defend that system. This is where the grounds for debate got completely muddled. Each side had to accept the current health care delivery method! (By "that current system" and "health care delivery method" I am referring to the inefficient way in which health care services are paid for.) From the time the Act was first mentioned until the present day, every time a news organization prints or broadcasts a story for- or against the Act, the journalist or commentator accepts the Act as a given, as a legitimate attempt to solve a problem, and then tries to show how the Act is either working or not working by giving examples of how difficult the law is making the lives of Citizen X while supporters show how much it is helping Citizen Y.
I would like to show why the Act is illegitimate by peeling back the layers of the main problem the Act should have addressed - the high cost of health care services (not insurance) in America. I will do this by highlighting the role the private insurance industry plays in the purchase of health care services. In order to defend the private insurance industry it is necessary to first demonstrate what an insurance company is and how its business model relates to other types of goods or services we purchase. In the end I will show why attacking this financial intermediary between doctors and patients is the wrong target.
Picture a community in which each resident is a sole proprietor and each is the only owner/employee of his or her respective business. The town has enough sole proprietorships to meet the needs of everyone in the community.
They agree to a common set of laws to protect themselves from each other and from hostile outsiders. The residents do not simply live together for safety but also benefit from each other's expertise. The Barber can cut the hair of the General Store Owner in exchange for smoked fish the General Store Owner has obtained from the Fisherman. An exchange takes place for the following reasons:
1. No man will work for free so he wants something in return for his services
2. No one man can provide every possible need himself
3. Even if he could provide every need himself it would be so time consuming that life would be very difficult
4. Those enforcing safety within and without the town must be compensated, for they will not work for free either (this is the government)
The ease with which one good or service is exchanged for another is improved by creating a mutually agreed upon measure and store of value called money. Money makes it easier to quantify the value of each individual's good or service; in addition, it also allows for everyone to store up value for something that might be needed in the future. A bank is created to safely guard this money. In exchange for this storage, the bank lends money to residents who desire expensive items that can be used while the owner pays financial installments for them over a period of time. The bank charges interest on the money to cover the cost of lending the money for that time period and to protect customer deposits in a central location.
In a very short time we have created a group of individuals with occupations, a government to safeguard that population, and a means of exchange by which residents can purchase and store the value of their goods and services.
What is the incentive for each resident to work and not mooch? Who determines how many sole proprietors are in each field? How are the Safety Enforcers (the government) elected and held accountable? and What guarantees the store of value will not be stolen by the banks?
Man's desire to work stems from two primary motivations: the need to survive and the desire to perform meaningful work. The motivation to achieve these two goals are sufficient reasons to acquire the necessary knowledge and training to perform the role.
What determines the role is determined partially by the desire to follow one's personal interest and partially to meet a need in society. If society is flooded with Police Officers, one can obtain the knowledge and training to become a Police Officer, but unless the individual can prove himself more worthy than an existing Police Officer or there is a strong need for another, pursuit of that occupation will be a failed endeavor and he will be forced to either stay in the community and die or move to another community with an unmet need for Police Officers.
Safety Enforcers, or government officials, will be elected and held accountable by residents who place them in charge of enforcing laws which protect residents from each other and from outside threats.
Banks are one of the entities bound to abide by these laws that protect customers from theft.
The value, and therefore the price, of each good or service is determined strictly by the need in the community and not by any centrally planned amount. Prices develop organically and are subject to change. If the Barber charges 5 sheckels for a haircut but gets no customers because patrons like the Lawyer and Fisherman have determined it is too expensive. The Lawyer makes 12 sheckels per day and the Fisherman makes 5 sheckels per day and they determine that 3 sheckels for a hair cut is a good deal. The Barber has no choice but to lower his price to 3 sheckels. Seeing the lower price, the Lawyer and Fisherman can stop poorly cutting their own hair and decide pay for the service once again. The amount of sheckels each man receives is based on how difficult the occupation is to perform and how important the job is to the community.
At a very basic level this is an example of humanity living in a free market economic system under the protection of laws overseen and enforced by a democratically elected government. Next, I will demonstrate how one occupation provides its services.
There are two Doctors who provide all of the health care services in the community. The occupation is one of the most advanced, requiring years of study and apprenticeship; consequently, the work is difficult but it pays handsomely. On average, a Doctor will make 15 sheckels per day. The pay can vary widely because each service costs a different amount and there are periods of time like the winter when there are more sick people visiting him.
Prices for all services are written in a book and the most common services are displayed on a giant chalk board above the Doctor's desk at his office downtown.
Regular physical evaluations are common and only cost 1 sheckel for the 15 minute visit. Every service is paid for out of pocket after the visit with no financial institution facilitating the transaction. If a person is unable to pay for a service the customer has the option of asking the Doctor to provide the service for free or for a reduced amount. The Doctor is under no obligation by the community or the Safety Enforcers to provide a service for which he is not compensated. When asked why he will not perform his services for free he retorts, "Must you provide your expertly crafted _____ to me for free?"
The Affordable Care Act was enacted to address two problems: the inability of Americans to obtain health insurance due to a pre-existing health condition and the growing cost of health insurance that renders it unaffordable for many Americans.
In my opinion the arguments for or against the Act are illegitimate because the Act was a poor attempt to fix a real social problem in America - the high cost of health care services. It is the high cost of health care services which has led to expensive health insurance, and since insurance companies are not themselves providing the health care, they should not be the primary target of reform.
The debate was flawed from the beginning because each side of the argument accepted the current health care delivery system when it realized it could not magically create its own ideal system. If the Democrats had been given a magic wand to reform health insurance, they would have created a single-payer, Medicare-for-all program that outlawed private insurance companies. A single payer system could have addressed the problem of the high cost of health care services from the top-down. Reform was not a priority for Republicans so they could not be expected to automatically propose an alternative.
Republicans are by nature adversaries to sweeping social reform, especially when it involves moving away from privatization toward government control. They have opposed funding for government run health care programs such as Medicare and Medicaid. Their hostility toward these programs and their defense of private industry led them to a position against Democrats in the health care reform debate which equated to more or less a defense of the status quo. Republicans were too concerned with issues like Iran, the economy, and the budget deficit to try and find solutions to the rising cost of health care services.
Democrats were unwilling to try for a single payer system because they wanted to have some Republican assistance in reform, or at least they wanted to minimize the level of heated opposition. Democrats even removed the public insurance option to garner Republican support, but in the end the vote ran along strict party lines anyway! So their ideal solution was not tried, and their watered-down reform of health insurance was heatedly opposed too! Instead of risking thinking big and trying to address the real root of the problem by completely overhauling the entire delivery system with a universal, single payer plan, and doing the hard work of conducting a carefully crafted debate while generating populist appeal, they decided to just accept the current delivery system, flawed as it was, and manipulate it the way a puppeteer controls a marionette by slapping all sorts of mandates on everyone participating in the health care delivery system. Their lack of courage and creativity meant they would just accept the current system while legislating countless mandates on consumers and providers within that system.
Even though Republicans were blamed for blocking reform I suspect the partisanship of the Democrats and their inability to start a healthy discussion of the root causes of the problem contributed more toward of Republican reticence than the Republican's defense of the current system. Even if Republicans wanted to reform the system in some way, the smell of partisanship was so strong that they knew it would be better to defend it than participate in a solution they knew would be too heavy on mandates. I am not letting Republicans off the hook here. Republicans did not oppose the Affordable Care Act because it failed to address the root of the problem; they opposed it because of the level of government intrusion into the market - an understandable position to take, but they missed the point just like the Democrats did. The reason to oppose the Act was because it would not work, but that had to be demonstrated thoughtfully!
So Democrat unwillingness to find an idealistic leftist solution led it to a tacit approval of the current system which the party then decided to reform around the edges while Republicans had no choice but to defend that system. This is where the grounds for debate got completely muddled. Each side had to accept the current health care delivery method! (By "that current system" and "health care delivery method" I am referring to the inefficient way in which health care services are paid for.) From the time the Act was first mentioned until the present day, every time a news organization prints or broadcasts a story for- or against the Act, the journalist or commentator accepts the Act as a given, as a legitimate attempt to solve a problem, and then tries to show how the Act is either working or not working by giving examples of how difficult the law is making the lives of Citizen X while supporters show how much it is helping Citizen Y.
I would like to show why the Act is illegitimate by peeling back the layers of the main problem the Act should have addressed - the high cost of health care services (not insurance) in America. I will do this by highlighting the role the private insurance industry plays in the purchase of health care services. In order to defend the private insurance industry it is necessary to first demonstrate what an insurance company is and how its business model relates to other types of goods or services we purchase. In the end I will show why attacking this financial intermediary between doctors and patients is the wrong target.
Picture a community in which each resident is a sole proprietor and each is the only owner/employee of his or her respective business. The town has enough sole proprietorships to meet the needs of everyone in the community.
They agree to a common set of laws to protect themselves from each other and from hostile outsiders. The residents do not simply live together for safety but also benefit from each other's expertise. The Barber can cut the hair of the General Store Owner in exchange for smoked fish the General Store Owner has obtained from the Fisherman. An exchange takes place for the following reasons:
1. No man will work for free so he wants something in return for his services
2. No one man can provide every possible need himself
3. Even if he could provide every need himself it would be so time consuming that life would be very difficult
4. Those enforcing safety within and without the town must be compensated, for they will not work for free either (this is the government)
The ease with which one good or service is exchanged for another is improved by creating a mutually agreed upon measure and store of value called money. Money makes it easier to quantify the value of each individual's good or service; in addition, it also allows for everyone to store up value for something that might be needed in the future. A bank is created to safely guard this money. In exchange for this storage, the bank lends money to residents who desire expensive items that can be used while the owner pays financial installments for them over a period of time. The bank charges interest on the money to cover the cost of lending the money for that time period and to protect customer deposits in a central location.
In a very short time we have created a group of individuals with occupations, a government to safeguard that population, and a means of exchange by which residents can purchase and store the value of their goods and services.
What is the incentive for each resident to work and not mooch? Who determines how many sole proprietors are in each field? How are the Safety Enforcers (the government) elected and held accountable? and What guarantees the store of value will not be stolen by the banks?
Man's desire to work stems from two primary motivations: the need to survive and the desire to perform meaningful work. The motivation to achieve these two goals are sufficient reasons to acquire the necessary knowledge and training to perform the role.
What determines the role is determined partially by the desire to follow one's personal interest and partially to meet a need in society. If society is flooded with Police Officers, one can obtain the knowledge and training to become a Police Officer, but unless the individual can prove himself more worthy than an existing Police Officer or there is a strong need for another, pursuit of that occupation will be a failed endeavor and he will be forced to either stay in the community and die or move to another community with an unmet need for Police Officers.
Safety Enforcers, or government officials, will be elected and held accountable by residents who place them in charge of enforcing laws which protect residents from each other and from outside threats.
Banks are one of the entities bound to abide by these laws that protect customers from theft.
The value, and therefore the price, of each good or service is determined strictly by the need in the community and not by any centrally planned amount. Prices develop organically and are subject to change. If the Barber charges 5 sheckels for a haircut but gets no customers because patrons like the Lawyer and Fisherman have determined it is too expensive. The Lawyer makes 12 sheckels per day and the Fisherman makes 5 sheckels per day and they determine that 3 sheckels for a hair cut is a good deal. The Barber has no choice but to lower his price to 3 sheckels. Seeing the lower price, the Lawyer and Fisherman can stop poorly cutting their own hair and decide pay for the service once again. The amount of sheckels each man receives is based on how difficult the occupation is to perform and how important the job is to the community.
At a very basic level this is an example of humanity living in a free market economic system under the protection of laws overseen and enforced by a democratically elected government. Next, I will demonstrate how one occupation provides its services.
There are two Doctors who provide all of the health care services in the community. The occupation is one of the most advanced, requiring years of study and apprenticeship; consequently, the work is difficult but it pays handsomely. On average, a Doctor will make 15 sheckels per day. The pay can vary widely because each service costs a different amount and there are periods of time like the winter when there are more sick people visiting him.
Prices for all services are written in a book and the most common services are displayed on a giant chalk board above the Doctor's desk at his office downtown.
Regular physical evaluations are common and only cost 1 sheckel for the 15 minute visit. Every service is paid for out of pocket after the visit with no financial institution facilitating the transaction. If a person is unable to pay for a service the customer has the option of asking the Doctor to provide the service for free or for a reduced amount. The Doctor is under no obligation by the community or the Safety Enforcers to provide a service for which he is not compensated. When asked why he will not perform his services for free he retorts, "Must you provide your expertly crafted _____ to me for free?"
When the Doctor provides a service to a resident in exchange for money it is no different than the Lawyer purchasing fish from the General Store Owner. The General Store Owner is not obligated to give the Lawyer the fish for free, but only for the price that is determined in the marketplace, which is based on the need for fish in the community and the difficulty in obtaining the fish from the sea. In the same way the Doctor is not obligated to fix the Lawyer's broken arm for free, but instead charges him 9 sheckels, the advertised price, which is based on the need to fix broken arms in the community and the difficulty of providing such a service.
In order to provide better services the Doctor must learn how to improve his services. This involves studying new subjects and investing in new technology. One area of improvement the Doctor is determined to focus on is infant mortality. He has learned of a new technique for delivering babies that increases the chance of survival and reduces pain for the mother. Using the new method will require hours of study and an investment in a new machine that costs 85 sheckels. To compensate for the improved baby delivery, the Doctor increases the price for that service from 20 to 22 sheckels.
Over time other improvements are made that cause an increase in prices but residents do not complain because have never been healthier. Meanwhile, the rest of the community has seen an improvement in their own occupations because of advances in technology and an increase in the population. Residents pay more for shovels from the General Store Owner because the new model he carries is made with a metal that makes the shovel last twice as long as the older models. The overall standard of living has increased so while prices have increased so have the quality of goods and services.
The rate of the prices charged by the Doctor have outpaced prices for other goods and services because of a more rapid investment in technology and a high level of need in the community. While most in the community are still able to afford the basic services like checkups, fixing broken bones, and medicine by paying out of pocket at the end of a visit, there are some services like baby delivery and major surgeries that cost more than what a person can pay at once. The cost of a baby delivery has risen to 65 sheckels and surgeries can be as high as 100 sheckels for life-threatening situations.
Since these large sums are only needed once in a while some members in the community decide to pool some of their monthly pay to a fund that can be used to cover these services when they occur. Pooling the resources transfers the risk of having to pay a high amount at once to a third party entity that can manage the funds, keep track of who is involved, and pay the Doctor at the end of the visit for services rendered. This marks the beginning of the creation of the Health Insurance Proprietor
The Health Insurance Proprietor is just like any other individual in the community. He begins his career wanting to be a Banker but finds there are too many other Bankers and his passion is more for health related issues. When he hears some members of the community are pooling money to pay the Doctor for more advanced emergency services he writes up a plan to start a business. The Health Insurance Proprietor will collect an affordable amount of sheckels from the Fisherman, General Store Owner, Lawyer, and others and pay the Doctor for the expensive service when the need arrives. The Proprietor's business is similar to that of the Bankers in that it keeps some amount in reserves to pay claims while investing the rest in other things.
In order for the Health Insurance Proprietor to stay in business he must successfully collect premiums from participants, invest the money responsibly, and pay for services in a timely manner. The amount of money going toward services must be less than the amount of money being collected by participants. If at any point the cost and volume of expensive services charged by the Doctor exceeds the amount of money collected and reserved for his customers, the Health Insurance Proprietor will have no choice but to go out of business.
To protect himself from going out of business and to ensure that the prices for the insurance can be affordable, the Proprietor develops a conditional underwriting standard. This standard asks a series of questions to the applicant who wants to join the pool that render the applicant eligible for participation. If the applicant has a condition like kidney failure that requires the Proprietor to pay the Doctor 60 sheckels per month but the applicant can only afford 15 sheckels per month in premium then the Proprietor can deny entry into the pool. Agreeing to allow the applicant into the pool would be the equivalent of the Doctor offering his services for free. The Proprietor knows if he must pay the Doctor 60 sheckels per month while only collecting 15 sheckels per month from the customer he will quickly go out of business. And just as the General Store Owner cannot be forced to price his fish lower than what it costs him to obtain the fish from the Fisherman, so the Health Insurance Proprietor is not forced to offer his service for less than what it costs to provide it.
Residents are not demanding the Doctor reduce his prices because they value the service he is providing. What residents want is a means by which they might budget for an unforeseeable medical emergency that costs more than what they can pay at one time. Eventually the automobile business develops its own version of insurance and an Automobile Insurance Proprietor is born. And just as the Doctor still gets paid out of pocket for basic procedures like physical checkups and pain pills and reserves insurance only for very expensive services, so the Auto Mechanic continues to receive out of pocket payments for oil changes and popped tires while reserving insurance payments for major accidents.
An American Health Insurance Company as we know it today is a corporation made up of a CEO who could be considered the initial sole proprietor who has hired employees to act as extensions of himself to handle the thousands of policies he cannot possibly handle on his own. Their collective expertise involves taking small, affordable monthly payments from individuals, and then paying for expensive services listed in a contract when that service is required. This contractual relationship transfers the financial risk from the customer to the insurance company. In order for the insurance company to continue to exist it must collect more premiums than it distributes. To do this is must make sure it is only accepting those into the pool who meet the entry requirements. If the customer would end up getting more benefits than they could possibly pay in over time, the Health Insurance Company has the right to refuse entry into the pool. The customer says, "I am healthy. I will pay X for this plan in exchange for this company Y amount for services should the need arise. I am under no obligation to remain in the plan, and the insurance company must keep me for as long as the terms and conditions indicate in the contract."
The insurance company is not obligated to accept anyone but wants to accept as many as possible so as to have a thriving business with a greater pool of resources. It is not the facilitator of all financial transactions between a doctor and a patient but only those deemed too expensive for a customer to afford all at once at the time the service is provided. The service should not purchased by employers as a tax free benefit but by individuals in the marketplace. The insurance company is not an enemy, a health care provider, the facilitator of all transactions, the determinant of prices charged by doctors, nor are they to be taken for granted. They are to be perceived and treated like any other business in the free marketplace.
At one time private insurance companies in America resembled the Health Insurance Proprietor of our theoretical town. Like auto insurance companies of today it only paid for very expensive health care services. When employers started giving health insurance as a tax free benefit it took it off the private market, distorting the price. When insurance companies became the facilitators of all health related transactions, not just the expensive ones, it became equated with health care services, and thus a gatekeeper between you and the doctor. When the Affordable Care Act went into effect it kept the insurance company in this role instead of bringing it back to the Health Insurance Proprietor is had always meant to be.
The insurance company is not obligated to accept anyone but wants to accept as many as possible so as to have a thriving business with a greater pool of resources. It is not the facilitator of all financial transactions between a doctor and a patient but only those deemed too expensive for a customer to afford all at once at the time the service is provided. The service should not purchased by employers as a tax free benefit but by individuals in the marketplace. The insurance company is not an enemy, a health care provider, the facilitator of all transactions, the determinant of prices charged by doctors, nor are they to be taken for granted. They are to be perceived and treated like any other business in the free marketplace.
At one time private insurance companies in America resembled the Health Insurance Proprietor of our theoretical town. Like auto insurance companies of today it only paid for very expensive health care services. When employers started giving health insurance as a tax free benefit it took it off the private market, distorting the price. When insurance companies became the facilitators of all health related transactions, not just the expensive ones, it became equated with health care services, and thus a gatekeeper between you and the doctor. When the Affordable Care Act went into effect it kept the insurance company in this role instead of bringing it back to the Health Insurance Proprietor is had always meant to be.
In 2014 the Affordable Care Act took effect. Here is what it has done:
It forces the Health Insurance Proprietor to accept every applicant.
It tells the Proprietor what services it must cover.
It maintains the status of the Proprietor as the facilitator of the most basic services that should be paid for out of pocket.
It continues to favor tax-free employer payments as the main method of purchase.
It equates the Doctor with a Health Insurance Proprietor under the term "health care."
It blames the Proprietor for the high prices charged by the Doctor.
It takes the occupation of the Health Insurance Proprietor for granted, demonizes it, then tells it what to do.
By "It" I mean the Safety Enforcers - the elected officials - the lawmakers - who will fine the Proprietor for failure to comply with its demands until it is fined into bankruptcy. This is health care reform in the United States.
The act gives the Safety Enforcers who know nothing about the Health Insurance Proprietor or the Doctor the authority to determine what services are necessary, what services should cost, how services should be provided.
So when evaluating the pros and cons of the Affordable Care Act, please take into consideration what is actually being debated. If you believe that every American should have access to affordable health care, that is quite a different thing than the Safety Enforcers making the Health Care Proprietor let someone into its pool while also forcing the General Store Owner and Fisherman and Barber to purchase that service from the Proprietor. If you believe that every American does not have the right to affordable health care, that is quite different than giving preferential tax treatment to employers who purchase plans from the Health Insurance Proprietor whose role has drifted from risk pool manager to service denier and premium hiker.
Further, if a healthy society is not a desirable goal because a proposed solution to fix the system contains allegedly socialist undertones, perhaps having an educated society is too socialist and therefore the public school system as we know it should be completely privatized as it was before the adoption of a national public school system. Under that old system, only the rich could afford a quality education. Can you imagine if we had that system today and some in the government wanted to take some of the richer people's money to educate the public? The move could be perceived as too radical so its proponents would settle for a hybrid system where private teachers would be forced to teach some quota of poor students while also forcing the parents of poor students to attend those classes.
Further, if a healthy society is not a desirable goal because a proposed solution to fix the system contains allegedly socialist undertones, perhaps having an educated society is too socialist and therefore the public school system as we know it should be completely privatized as it was before the adoption of a national public school system. Under that old system, only the rich could afford a quality education. Can you imagine if we had that system today and some in the government wanted to take some of the richer people's money to educate the public? The move could be perceived as too radical so its proponents would settle for a hybrid system where private teachers would be forced to teach some quota of poor students while also forcing the parents of poor students to attend those classes.
These are the grounds on which the debate should have taken place in Washington D.C. Instead, politicians decided to accept the current delivery system while forcing everyone involved to do something at the point of a gun. Employers have to offer minimum coverage or pay a penalty, individuals have to enroll or pay a tax, insurance companies have to cover everyone regardless of medical condition or pay a fine, and states have to provide exchanges or lose Medicaid funding. And why? How did the purchase of a service from a doctor turn into fining and mandating everyone do something? To make matters worse the price of services are still high and the cost of insurance is still high.
Current news stories updating the public on the Act are providing evidence for or against the Act within the context of that poor debate and poor solution. So when we get angry about insurance companies dropping plans because of the mandates or individuals paying higher premiums than before we are getting angry about the wrong things!
In spite of this criticism, the Affordable Care Act has accomplished what it set out to do. It has forced the Health Insurance Proprietor to accept everyone into its pool of customers regardless of the cost. It has also made the previously uninsured Fisherman and Barber get plans at an income-adjusted monthly price. Congratulations Washington! The Safety Enforcers are now intimately involved in the health care delivery system because they force everyone to participate while taking a small amount of money from the income of the Lawyer and redistribute it to the Fisherman and Barbers to make their insurance plan cheaper.
In order to reform something you must first identify the real problem. Only by stripping away the layers of complexity can this be achieved. In the end the market favors private health care, private health insurance companies with individuals making the choices, not the government. The social impacts and solutions to the problem of pre-existing conditions can be addressed concurrently with the private solution. If a society believes that the need for public health is similar to the need for public education, the debate must still go back to basic principles and its merits should be debated in a bi-partisan way with true leadership that brings everyone together.
Current news stories updating the public on the Act are providing evidence for or against the Act within the context of that poor debate and poor solution. So when we get angry about insurance companies dropping plans because of the mandates or individuals paying higher premiums than before we are getting angry about the wrong things!
In spite of this criticism, the Affordable Care Act has accomplished what it set out to do. It has forced the Health Insurance Proprietor to accept everyone into its pool of customers regardless of the cost. It has also made the previously uninsured Fisherman and Barber get plans at an income-adjusted monthly price. Congratulations Washington! The Safety Enforcers are now intimately involved in the health care delivery system because they force everyone to participate while taking a small amount of money from the income of the Lawyer and redistribute it to the Fisherman and Barbers to make their insurance plan cheaper.
In order to reform something you must first identify the real problem. Only by stripping away the layers of complexity can this be achieved. In the end the market favors private health care, private health insurance companies with individuals making the choices, not the government. The social impacts and solutions to the problem of pre-existing conditions can be addressed concurrently with the private solution. If a society believes that the need for public health is similar to the need for public education, the debate must still go back to basic principles and its merits should be debated in a bi-partisan way with true leadership that brings everyone together.
December 12, 2013
Martian Health Care
Young man sitting on step of a doctor’s office with his head
down as a Martian passes him on the sidewalk.
“What’s the matter, Earthling?” the Martian asks.
“I am sick but I don’t have any health care,” the young man
says.
“There appears to be a doctor’s office is right here. Just go in and tell them what you need.”
“But I said I don’t have health care.”
The Martian was puzzled.
“Health care is performed by the doctor inside. They might be able to help you.”
“You don’t understand,” says the young man. “I need to have someone
else pay the doctor for me.”
“What do you mean?” the Martian asked. “Why can’t you pay for it yourself?”
“Because the service is too expensive to pay for directly out
of my own pocket.”
“Why?” the Martian asked again.
“I don’t know. It
just is.”
The Martian wished him the best and wondered why Earth was
so complicated.
November 11, 2013
Endless Q & A Over the Affordable Care Act
NPR's Julie Rovner has done an excellent job covering the Affordable Care Act to the point where I would wager she knows more about the ACA than many members of Congress. The amount of coverage dedicated to explaining the ACA has been helpful to those affected by the law, but it goes to show how complex the law is.
And does it need to be this complex? Listening to Morning Edition this morning, I heard David Greene asking listener questions to Ms. Rovner about the ACA. The interview can be heard here:
http://www.npr.org/blogs/health/2013/11/11/243987330/self-employed-and-with-lots-of-questions-about-health-care
Questions came from small business owners who are often caught between a subsidy and a higher priced plan. I couldn't help but think as I was listening to the answers: Does it need to be this hard?
How messed up is our health care system that instead of focusing on improving the cost of care or the quality of the services we are putting all of our effort into the financial intermediaries between us and the providers of the services?
If the cost of health care services (not insurance) was lower to begin with there would be less of a need for insurance companies to play such a significant role in the process. So how can we get the cost of care down?
The President and proponents of the ACA have paid some attention to the cost of care but have instead focused most of their efforts on getting people into insurance plans - public or private, which has increased the role of insurance companies without putting enough pressure on the cost of services. I suppose the President wants to worry about that later.
What are the possible ways of reducing the cost of care?
1. Federal laws dictating prices for each procedure at the provider level
2. Federal laws dictating reimbursements at the reimbursement level
3. Reduction in demand from the consumer level
4. Voluntary proactive demand for price reduction from consumers
5. Voluntary proactive demand for price reduction from insurers
It would be too difficult at this time to get back to a time when health insurance was only used for catastrophic purposes. We could get there eventually. What I would propose first would be much simpler. We should stop subsidizing health care providers with tax dollars and no health care plan should receive favorable tax treatment. Getting rid of favorable tax treatment would eliminate the incentive for employees to request plans from their employers. Insurance plans would then have to compete on a private marketplace in the same way car insurance plans do.
Over time the competitive insurance marketplace would help to keep the cost of services down. At that point we could explore making plans more catastrophic with high deductible health savings accounts paying for less expensive services.
_________________________________________________________________________
The goal of the ACA appears to be getting people into insurance plans by accepting most of the current system as non-negotiable. To get people into plans the government is pointing a gun at insurers saying they must offer a minimum plan that doesn't max out and one where they cannot turn down applicants for pre-existing conditions. There is a gun to the head of the states to expand medicaid to cover the poor. There is a gun to the head of consumers to buy insurance or else pay a tax. There is a gun to the head of the taxpayer saying they must subsidize plans for those making too much for medicaid.
The administration has decided that health care is too necessary, health insurance is too expensive, and not enough of the population have access to it. Hmmm this is starting to sound like the necessity of public education, something which was at one time totally privatized. When having an educated population became a national priority public schools were created. Hmmmm...............
And does it need to be this complex? Listening to Morning Edition this morning, I heard David Greene asking listener questions to Ms. Rovner about the ACA. The interview can be heard here:
http://www.npr.org/blogs/health/2013/11/11/243987330/self-employed-and-with-lots-of-questions-about-health-care
Questions came from small business owners who are often caught between a subsidy and a higher priced plan. I couldn't help but think as I was listening to the answers: Does it need to be this hard?
How messed up is our health care system that instead of focusing on improving the cost of care or the quality of the services we are putting all of our effort into the financial intermediaries between us and the providers of the services?
If the cost of health care services (not insurance) was lower to begin with there would be less of a need for insurance companies to play such a significant role in the process. So how can we get the cost of care down?
The President and proponents of the ACA have paid some attention to the cost of care but have instead focused most of their efforts on getting people into insurance plans - public or private, which has increased the role of insurance companies without putting enough pressure on the cost of services. I suppose the President wants to worry about that later.
What are the possible ways of reducing the cost of care?
1. Federal laws dictating prices for each procedure at the provider level
2. Federal laws dictating reimbursements at the reimbursement level
3. Reduction in demand from the consumer level
4. Voluntary proactive demand for price reduction from consumers
5. Voluntary proactive demand for price reduction from insurers
It would be too difficult at this time to get back to a time when health insurance was only used for catastrophic purposes. We could get there eventually. What I would propose first would be much simpler. We should stop subsidizing health care providers with tax dollars and no health care plan should receive favorable tax treatment. Getting rid of favorable tax treatment would eliminate the incentive for employees to request plans from their employers. Insurance plans would then have to compete on a private marketplace in the same way car insurance plans do.
Over time the competitive insurance marketplace would help to keep the cost of services down. At that point we could explore making plans more catastrophic with high deductible health savings accounts paying for less expensive services.
_________________________________________________________________________
The goal of the ACA appears to be getting people into insurance plans by accepting most of the current system as non-negotiable. To get people into plans the government is pointing a gun at insurers saying they must offer a minimum plan that doesn't max out and one where they cannot turn down applicants for pre-existing conditions. There is a gun to the head of the states to expand medicaid to cover the poor. There is a gun to the head of consumers to buy insurance or else pay a tax. There is a gun to the head of the taxpayer saying they must subsidize plans for those making too much for medicaid.
The administration has decided that health care is too necessary, health insurance is too expensive, and not enough of the population have access to it. Hmmm this is starting to sound like the necessity of public education, something which was at one time totally privatized. When having an educated population became a national priority public schools were created. Hmmmm...............
November 3, 2013
Health Care Reform by "Professor" Jamison
Various US Presidents have tried to reform health care in the United States. President Obama succeeded in passing the Affordable Care Act. In this video I explain why I believe the Affordable Care Act will not fix this country's health care problems.
October 1, 2013
Catching Up To Do Health Care in the United States
Despite being number 2 in the world in per-capita spending on health care, the United States health system ranks 39th out of 191 countries, according to the WHO (1). A 2013 study by National Academy of Sciences determined the US ranked 17 out ...of 17 affluent nations. Furthermore, the US is one of the only countries in the developed world that does not have a public option or universal health system (3.)
The Affordable Care Act will not fix this problem and neither will repealing it with no alternatives. We need to get rid of employer-based plans, link compensation to quality of care, and have more transparency as to where our per-capita spending is going.
March 29, 2013
The Rising Cost of US Health Care - Part 1/2
"When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?" - Steven Brill, "Bitter Pill: How Outrageous Pricing and Egregious Profits Are Destroying Our Health Care"
The Affordable Care Act, which passed on March 23, 2010, was a bill designed to address problems with the health care system in the United States. Proposed by President Obama and backed almost exclusively by Democrats on Capitol Hill, the bill addressed a variety of issues that have plagued the system for decades, most notably covering the uninsured, eliminating lifetime limits on coverage, and banning insurance companies from denying coverage based on pre-existing health conditions.
One provision in the Act, the individual mandate, was so controversial that its constitutionality was appealed to the Supreme Court. In June of 2012 the court ruled in favor of the mandate. The public was evenly divided on the ruling, with 46% in favor and 46% against. (1)
As of the writing of this post many provisions have taken effect with the rest scheduled for 2014. What continues to frustrate those of us who are concerned with the US health care system in spite of this impressive effort by our federal government is the issue of prices. Democrats appealed to the American people for support of the Act on the basis that everyone deserves to be covered by an insurance plan so they might have access to necessary care.
Blanket access to care comes at a high price to individuals, families, and Joe Taxpayer. In 2006, Massachusetts implemented a mandate to cover all state residents, complete with similar provisions in the Affordable Care Act such as setting up health insurance exchanges, imposing penalties for avoiding coverage, and providing subsidies for low-income residents. But it has come at a high cost.
"On a per capita basis, we have one of the most expensive health care systems in the country," Andrew Dreyfus, president and chief executive of Blue Cross Blue Shield of Massachusetts, told a recent conference in Boston of the Association of Health Care Journalists. "If we do nothing, we're going to bankrupt this state."(2)
Massachusetts Governor Deval Patrick is focusing on "cost containment" as part of the ongoing reforms. 98% of Massachusetts residents are now covered, but costs continue to climb. The same cost problem will be seen across the country when the entirety of the national Affordable Care Act is in place.
(1) http://www.politico.com/news/stories/0612/78031.html
(2) http://www.hispanicbusiness.com/2013/3/24/massachusetts_healthcare_experiment_enters_second_phase.htm
The Affordable Care Act, which passed on March 23, 2010, was a bill designed to address problems with the health care system in the United States. Proposed by President Obama and backed almost exclusively by Democrats on Capitol Hill, the bill addressed a variety of issues that have plagued the system for decades, most notably covering the uninsured, eliminating lifetime limits on coverage, and banning insurance companies from denying coverage based on pre-existing health conditions.
One provision in the Act, the individual mandate, was so controversial that its constitutionality was appealed to the Supreme Court. In June of 2012 the court ruled in favor of the mandate. The public was evenly divided on the ruling, with 46% in favor and 46% against. (1)
As of the writing of this post many provisions have taken effect with the rest scheduled for 2014. What continues to frustrate those of us who are concerned with the US health care system in spite of this impressive effort by our federal government is the issue of prices. Democrats appealed to the American people for support of the Act on the basis that everyone deserves to be covered by an insurance plan so they might have access to necessary care.
Blanket access to care comes at a high price to individuals, families, and Joe Taxpayer. In 2006, Massachusetts implemented a mandate to cover all state residents, complete with similar provisions in the Affordable Care Act such as setting up health insurance exchanges, imposing penalties for avoiding coverage, and providing subsidies for low-income residents. But it has come at a high cost.
"On a per capita basis, we have one of the most expensive health care systems in the country," Andrew Dreyfus, president and chief executive of Blue Cross Blue Shield of Massachusetts, told a recent conference in Boston of the Association of Health Care Journalists. "If we do nothing, we're going to bankrupt this state."(2)
Massachusetts Governor Deval Patrick is focusing on "cost containment" as part of the ongoing reforms. 98% of Massachusetts residents are now covered, but costs continue to climb. The same cost problem will be seen across the country when the entirety of the national Affordable Care Act is in place.
(1) http://www.politico.com/news/stories/0612/78031.html
(2) http://www.hispanicbusiness.com/2013/3/24/massachusetts_healthcare_experiment_enters_second_phase.htm
June 26, 2012
Romney Wants to Repeal Obamacare
When Mitt Romney was governor of Massachusetts he came to the same conclusion about health care that Barack Obama has come to as president: More people need to be covered, and any solution should be based on the current system we have where most are covered by their employers (160 million).
Obama's health care overhaul, called the Affordable Care Act, has the power to expand coverage to the uninsured. The coverage will come at a cost since many will require a subsidy based on their income level. Medicaid, health insurance for the poor, will need to be expanded to cover those who have low income.
The constitutionality of the Affordable Care Act is currently being decided by the Supreme Court who will issue a judgment on the law this week. The most controversial aspect of the law is the individual mandate that requires every person in the country to buy coverage by 2014 or face a penalty.
The mandate that Mitt Romney approved in Massachusetts must not be good enough for other states since he does not support a mandate coming from the federal government. Why would Romney support a local mandate but not a national one? As a person who understands budgets, how does he believe a health care system is supposed to work when individuals are buying coverage just before they need to use it? The same moral hazard applies nationally as it does locally.
If the court favors the bulk of the Affordable Care Act but decides to strike down the mandate what we are left with is a way to cover everyone but with skyrocketing insurance premiums. John Q. Citizen will be able to purchase insurance with pre-existing medical conditions just prior to an illness and then dump it after he is healed. The premiums paid by the healthiest people will not be collected because they will not be forced to purchase it.
Those who disagree with the federal government's ability to require citizens to purchase something need to think about the kinds of things we are forced to buy. I will use one simple example - the state mandate to purchase auto insurance. How comfortable would you feel driving down the road if only half the people driving by you had coverage?
I disagree with both Obama's and Romney's solutions to the health care problem, but at least let's get real about the kind of problems we face, and let's start hearing some real, long-term solutions to fix health care.
Obama's health care overhaul, called the Affordable Care Act, has the power to expand coverage to the uninsured. The coverage will come at a cost since many will require a subsidy based on their income level. Medicaid, health insurance for the poor, will need to be expanded to cover those who have low income.
The constitutionality of the Affordable Care Act is currently being decided by the Supreme Court who will issue a judgment on the law this week. The most controversial aspect of the law is the individual mandate that requires every person in the country to buy coverage by 2014 or face a penalty.
The mandate that Mitt Romney approved in Massachusetts must not be good enough for other states since he does not support a mandate coming from the federal government. Why would Romney support a local mandate but not a national one? As a person who understands budgets, how does he believe a health care system is supposed to work when individuals are buying coverage just before they need to use it? The same moral hazard applies nationally as it does locally.
If the court favors the bulk of the Affordable Care Act but decides to strike down the mandate what we are left with is a way to cover everyone but with skyrocketing insurance premiums. John Q. Citizen will be able to purchase insurance with pre-existing medical conditions just prior to an illness and then dump it after he is healed. The premiums paid by the healthiest people will not be collected because they will not be forced to purchase it.
Those who disagree with the federal government's ability to require citizens to purchase something need to think about the kinds of things we are forced to buy. I will use one simple example - the state mandate to purchase auto insurance. How comfortable would you feel driving down the road if only half the people driving by you had coverage?
I disagree with both Obama's and Romney's solutions to the health care problem, but at least let's get real about the kind of problems we face, and let's start hearing some real, long-term solutions to fix health care.
April 7, 2010
Governor Deval Patrick Denying Insurance Company Rate Hike Requests
When Massachusetts decided to mandate all residents to purchase health insurance it decided to deal with the increasing cost of care at a later date. The cost of care has gone up and insurers are raising rates to keep pace. Rates are putting pressure on subscribers who have little say in what they are charged per month. But insurance companies cannot raise rates without state approval, and the Patrick administration has recently rejected 235 of 274 requests for premium hikes, calling them "excessive."
Some of the premium increases were double-digit hikes. Small businesses that drive the Massachusetts economy feel the pinch, especially in a down economy. Critics of Deval Patrick call his move political, and that blaming insurance companies for high premiums is not getting at the heart of the problem.
Barbara Anthony and Lora Pellegrini went on the Emily Rooney show on April 6th to debate the issue. Anthony is the undersecretary of state for the mass office of consumer affairs and business regulation. Her concern was that insurers were not raising rates to keep pace with the cost of care, but were doing it to maintain high returns for investors who expect profits from these companies. She was also asked what would happen if an insurer was mismanaged, how premium increases could be used to subsidize poor management.
Pellegrini, president of the massachusetts association of health plans, came at the problem from a different, more sensible angle. She said rather than blame insurance companies for the cause of high health care prices, hospital networks and providers should be scrutinized for the way they move into suburbs, monopolize services, then charge Boston rates. Providers can bill insurance companies whatever they want, and if the companies refuse to pay, subscribers get angry because it would reduce their choice of doctors and hospitals.
This is one of the huge problems we may face on a national scale with the new mandate to buy health insurance as stated in Obama's health care reform bill. When the government subsidizes care and mandates all people be covered it also has some say about the prices insurers are allowed to charge.
Sent from my Verizon Wireless BlackBerry
March 22, 2010
The Health Care Bill
Last night the US House of Representatives approved a health care reform bill designed to make coverage more available and affordable for Americans.
Watching cable news last night it was hard to tell what was being voted on. There was so much cheerleading coming from the congressmen and similar partisan commentary coming from the panels on CNN and FoxNews that one had the impression that this reform was either the best or the worst thing ever to happen in this country.
I wish Washington could start over with health reform since there are so many problems with our current system. But politics has poisoned the process yet again. All those Ph.D's in that Capitol Building. All those Ivy-Leaguers and businessmen. All those connections. All those experts. All of them poisoned by their ideologies.
Sent from my Verizon Wireless BlackBerry
February 8, 2010
Headlines from "Here and Now" Radio Program
On my way into work I will usually listen to NPR to get caught up on the most recent news. I do not read the newspaper, and do not check the news before I leave the house on my computer or TV. One of the programs I listen to is called "Here and Now" and it's on from 12:00 Noon to 1:00PM on WBUR 90.9FM. The show follows up on developments in the morning news stories and mixes in some other current events. Today the four headlines were:
Investigation Begins Into Connecticut Gas Explosion
Sifting Through New Credit Card Rules
Alaskan Village Sues Oil Companies Over Climate Change
Do Calories Count?
The first story reported on developments in yesterday's power plant explosion in Connecticut. At the end of the interview, the host asked the guest what rules would be put in place to prevent this in the future. The guest said there had been new codes that were ready to go into effect but had not yet been made law. This is after the guest had gone in depth explaining the tragedy of the incident, how the community had been devastated by the loss of life. Of course the business will suffer as a result of this incident. Why the automatic assumption that proper codes will prevent these kinds of accidents?
For the Credit Card story, a Chicago Tribune personal finance columnist, Gail MarksJarvis, was interviewed. MarksJarvis had poured over new rules that would change the way credit card companies would do business. Among the things changing were consent from cardholders to have overdraft protection, new rules about how overpayment would apply to current balances, and how fees would increase on many transactions to make up for the loss of business after the financial crisis. Part of the rules will be helpful to consumers because there will be more communication to the cardholder prior to account changes. However, many of the rules now allow the companies to make changes to your account unless you respond. Part of me wants to say, let the companies do what they want. If someone is stupid enough to get a credit card they can't pay off, they should suffer the consequences. But I can't say that because as someone who has had to deal with unscrupulous credit card practices, I know how harmful the companies can be. In my view, consumers need more protection in this area, not so much to protect people who do not pay, but to protect the people who do from becoming locked into a spiked rate because their neighborhood demographic changed, or they get hit with a fee because instead of declining a purchase when the cardholder reached their limit, they let it go through and charge a balance overage fee.
The story about the Alaskan village suing Exxon-Mobil, Shell, and other big energy companies who, in their view, contribute to greenhouse gas emissions which cause climate change which causes weather which erodes the shores of their island from rising sea levels. Matt Pawa, the prosecuting attorney, said that the energy companies defense that everyone who uses energy in this world is responsible in some way to climate change is a myth, and that the companies themselves need to pay for the damage they do. I couldn't believe what I was hearing. Singling out few energy producers, who are producing goods people want, are being punished for something that may not be happening because climate change anyway!
Lastly was another story about putting labels on food. A report that by listing the caloric content of food, people's consumption of foods that contribute most to obesity drops 6%. The guest said that even though it's a small number, anything that can help reduce diabetes is positive and the cost to the companies is very low compared to the benefit it has to society. Easy for him to say I suppose. He's not the one paying for the labels and his is not the business that will lose as a result. What I have always said about rules banning food or making demands on restaurants to label foods in certain ways is to just let people make their own choices. People who were interviewed after they found out how many calories were in Panera food were shocked that a the cookies there have 500 calories. I thought to myself, "Hmm, a cookie that is twice or three times as large as a regular homemade cookie has a lot of calories. Wow I never would have guessed!" And aren't cookies generally not a healthy choice? These food police need something else to do.
December 11, 2009
Attention Democrats:
Two plus two does not equal three. The current health care legislation is too expensive. Health and Human Services says so in a new report.
http://www.msnbc.msn.com/id/34382286/ns/health-health_care/
http://www.msnbc.msn.com/id/34382286/ns/health-health_care/
October 20, 2009
Giving Senior Citizens the Bird
The Obama administration has basically given old folks the bird with a 15% raise in Medicare premiums and a proposed 20% cut in Medicare's reimbursements to doctors.
Sent from my Verizon Wireless BlackBerry
Sent from my Verizon Wireless BlackBerry
October 19, 2009
Employer Health Plans
It's open enrollment for employer sponsored health plans. Which raises the question, why are employers buying insurance for us in the first place?
There is an obvious advantage of scale. The more people in a plan the lower the price for each individual on the plan.
Insurers cannot exclude anyone from the plan if a large group is applying for coverage at once. This means some who may be uninsurable on the individual market could get coverage in the group.
But outside of these advantages, is having health insurance tied to employment more of a problem than a benefit?
What if instead of providing coverage, companies just paid employees more so they could purchase their own plan?
This way when people lose their jobs they have to deal with the loss of income but not necessarily the loss of health coverage.
Sent from my Verizon Wireless BlackBerry
October 7, 2009
In Case You Are Still Interested in the Health Care Debate...
President Obama's deadline for health care reform has come and passed. CBO has just come out with estimates of how much the reform will cost, and members of congress are still finalizing bills on which to vote. By now much of the country is just fed up with the proposals, as can be seen in the polls with a majority of Americans not supporting the current reform efforts. I was tuning out of the debates recently because I came to the conclusion that whatever the final bill would be, it would be so tainted by the lobbyists and special interests that it would just be a more expensive version of our current system. But upon hearing a recent presentation in a podcast from the Commonwealth Club of California (of which I am a member) the idealist inside of me was inspired to see hope on the horizon. Even if we do not get it right this time, Americans know the issues much better now and are much more prepared on the next go round. And if we could all hear this presentation it would make the decision making a little easier:
http://www.commonwealthclub.org/archive/09/09-09reid-audio.html
This gentleman outlines four basic models of health care around the world. It is surprising how socialized our system actually is and how privatized the European model is. Further, I never thought of how our system in the US is a conglomeration of many systems, rather than one based on who can afford insurance coverage. My opinion on health care has been changing recently due to a discussion I had with an Albanian co-worker of mine. He had grown up partly under the European system and had some insights into how health care is delivered there. But more on that later. Just listen to the podcast through the link. Or you can listen to it via iTunes.
http://www.commonwealthclub.org/archive/09/09-09reid-audio.html
This gentleman outlines four basic models of health care around the world. It is surprising how socialized our system actually is and how privatized the European model is. Further, I never thought of how our system in the US is a conglomeration of many systems, rather than one based on who can afford insurance coverage. My opinion on health care has been changing recently due to a discussion I had with an Albanian co-worker of mine. He had grown up partly under the European system and had some insights into how health care is delivered there. But more on that later. Just listen to the podcast through the link. Or you can listen to it via iTunes.
September 2, 2009
Barriers Between Doctor and Patient
I am 100% opposed to Obamacare. A free market solution to the problems in the healthcare system is the only one that would be fair, effective, and long-lasting.
But the Republican Party has had its chance to fix it and they decided not to. First, they did not attempt to fix healthcare from 2000 to 2008 when they were in the White House. They were too busy spreading democracy around the world. In fact, they compounded the healthcare problem by passing an entitlement program called Medicare Part D in 2003. This is a government prescription insurance program that was not paid for in the budget. And now they deny there is any problem with our current healthcare system. "It's the best in the world! Nothing's wrong!" One of the fears Republicans have is a government bureaucrat standing between you and your doctor. But our current access to doctors is not without its obstacles.
I recently moved back to Massachusetts where I got a new job and a new health insurance plan. It has been a while since I have been in the area so I needed to get a new doctor and get a physical. Simple, right? Wrong.
I haven't gotten my ID card yet, and I was not sure which doctors at the Newton-Wellesley Medical Center were in the network with my CIGNA plan. So I had to go through these steps on multiple days of my work week, and I still have not been able to make an appointment. If you don't want to read the list line by line, you'll get the idea pretty quickly.
Step 1. Find out which doctors at the practice take the plan. I called up the doctor's office to see which doctors took my health plan. They said I had to ask my insurance compnay. The receptionist gave me a tax ID for the facility and then told me to call CIGNA.
Step 2. I called CIGNA to find out which doctors at the facility were in the network. The CIGNA customer service rep said he couldn't search by practice, and that he had to search by a doctor's name. I didn't have a list of the doctors so I had to call back later and give them four random doctor's names I got when calling back the Newton-Wellesley Medical Center. I found out that one doctor from that random four was in the network.
Step 3. When I called the doctor's office back they say that doctor is not taking new patients! Then they give me the only two who were taking new patients. I then had to call CIGNA back to find out about those two.
Step 4. CIGNA told me that one of the two is in the network. SWEET! I could finally schedule my physical. (I'm doing all this calling on my breaks since I have been working 8am-5pm M-F).
Step 5. The doctor's office was glad to hear that the one doctor was in the network. They took my SSN, DOB, Name, Address, Phone. Then they asked, "Your CIGNA policy number?" I told them I haven't gotten my card yet so I didn't know my number. The receptionist said she could not schedule me without my insurance information. I asked her "What happens if people don't have insurance?" She said they are scheduled in as self-pay. So I asked her to put me in as self-pay then I'd show my card when I get there or call her back when I got my ID cards. She said she couldn't schedule me that way so I asked to speak with the manager.
Step 6. Transferred to the manager who was not in. On the voicemail I left my name and number twice, very slowly, then said I just wanted to schedule an appointment. I said why does a person have to present all this information up front? I haven't gotten my card yet and I wasn't going to be coming to the office for a whole month. I could call back before that to give my ID number. Well, she never called back.
Step 7. Called CIGNA back and gave them my SSN, DOB, Name, Address. Then they said they could not tell my my ID number for privacy reasons, but that they would request a new card be sent to my house in 7 business days. Then they gave me an account number I could give to the doctor's office for me to temporarily get an appointment scheduled.
Step 8. Well, I have not called the doctor's office back because I have a feeling that this account number will not be good enough for them to pencil me in.
Why all these barriers? What is going on here? Can't I as a customer purchase a service that is keeping the facility in business? Whether I have insurance or not shouldn't matter! I will have to pay somehow!
And based on my experience with health plans and doctor's offices, once I go for my physical, I will have to wait a long time, be seen mostly by a nurse, then they will lose whatever samples I leave, then they won't call me back with the results, then they will bill me for the copay I paid at the time of the visit.
Listen up Republicans - if it's not the premiums people are complaining about with our current system it's the cumbersome process everyone has to go through just to get a service they are paying for. At least admit there' s a problem with the system, and don't just try to kill the current bill. You can do both at the same time.
But the Republican Party has had its chance to fix it and they decided not to. First, they did not attempt to fix healthcare from 2000 to 2008 when they were in the White House. They were too busy spreading democracy around the world. In fact, they compounded the healthcare problem by passing an entitlement program called Medicare Part D in 2003. This is a government prescription insurance program that was not paid for in the budget. And now they deny there is any problem with our current healthcare system. "It's the best in the world! Nothing's wrong!" One of the fears Republicans have is a government bureaucrat standing between you and your doctor. But our current access to doctors is not without its obstacles.
I recently moved back to Massachusetts where I got a new job and a new health insurance plan. It has been a while since I have been in the area so I needed to get a new doctor and get a physical. Simple, right? Wrong.
I haven't gotten my ID card yet, and I was not sure which doctors at the Newton-Wellesley Medical Center were in the network with my CIGNA plan. So I had to go through these steps on multiple days of my work week, and I still have not been able to make an appointment. If you don't want to read the list line by line, you'll get the idea pretty quickly.
Step 1. Find out which doctors at the practice take the plan. I called up the doctor's office to see which doctors took my health plan. They said I had to ask my insurance compnay. The receptionist gave me a tax ID for the facility and then told me to call CIGNA.
Step 2. I called CIGNA to find out which doctors at the facility were in the network. The CIGNA customer service rep said he couldn't search by practice, and that he had to search by a doctor's name. I didn't have a list of the doctors so I had to call back later and give them four random doctor's names I got when calling back the Newton-Wellesley Medical Center. I found out that one doctor from that random four was in the network.
Step 3. When I called the doctor's office back they say that doctor is not taking new patients! Then they give me the only two who were taking new patients. I then had to call CIGNA back to find out about those two.
Step 4. CIGNA told me that one of the two is in the network. SWEET! I could finally schedule my physical. (I'm doing all this calling on my breaks since I have been working 8am-5pm M-F).
Step 5. The doctor's office was glad to hear that the one doctor was in the network. They took my SSN, DOB, Name, Address, Phone. Then they asked, "Your CIGNA policy number?" I told them I haven't gotten my card yet so I didn't know my number. The receptionist said she could not schedule me without my insurance information. I asked her "What happens if people don't have insurance?" She said they are scheduled in as self-pay. So I asked her to put me in as self-pay then I'd show my card when I get there or call her back when I got my ID cards. She said she couldn't schedule me that way so I asked to speak with the manager.
Step 6. Transferred to the manager who was not in. On the voicemail I left my name and number twice, very slowly, then said I just wanted to schedule an appointment. I said why does a person have to present all this information up front? I haven't gotten my card yet and I wasn't going to be coming to the office for a whole month. I could call back before that to give my ID number. Well, she never called back.
Step 7. Called CIGNA back and gave them my SSN, DOB, Name, Address. Then they said they could not tell my my ID number for privacy reasons, but that they would request a new card be sent to my house in 7 business days. Then they gave me an account number I could give to the doctor's office for me to temporarily get an appointment scheduled.
Step 8. Well, I have not called the doctor's office back because I have a feeling that this account number will not be good enough for them to pencil me in.
Why all these barriers? What is going on here? Can't I as a customer purchase a service that is keeping the facility in business? Whether I have insurance or not shouldn't matter! I will have to pay somehow!
And based on my experience with health plans and doctor's offices, once I go for my physical, I will have to wait a long time, be seen mostly by a nurse, then they will lose whatever samples I leave, then they won't call me back with the results, then they will bill me for the copay I paid at the time of the visit.
Listen up Republicans - if it's not the premiums people are complaining about with our current system it's the cumbersome process everyone has to go through just to get a service they are paying for. At least admit there' s a problem with the system, and don't just try to kill the current bill. You can do both at the same time.
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