Why isn’t the medical profession more active in health insurance policy?

I sometimes wonder why doctors, the medical profession, are not in the forefront of the issue of how to provide medical care for the populace. While they often complain they do not get paid enough by insurance, especially government insurance, from my perspective they take a back seat when it comes to how to resolve the problem.

From what little conversations I have had with doctors about this, I get the impression that they are reluctant to commit themselves because they fear if they go too far they might end up with a situation that would not maximize their profits. In this poor economy with so many people having lost their health insurance they may be hurting, but economies are cyclical things and if the economy comes back maybe more people will have insurance and the money will come rolling in. So let’s don’t get hasty about things and push for some form of all-inclusive government health care where we all will be at the mercy of Uncle Sam and Medicare.

Yes, I know we have Obamacare now, but I still have not figured that one out, that is what it does — in my personal case nothing that I know of.

I am not trying to be critical of doctors and at my age and with my health condition, which is having what I am told is an incurable, but slow-moving, cancer, I’m greatly appreciative of them. But it does seem to me that if they would take the long view of it all they might be more active in the issue. And I don’t think Obamacare has settled the issue and I think there is a good chance a Republican will be in the White House in a little over a year (not sure, just have a hunch) and all the candidates, as far as I know, have vowed to do what they can to dismantle Obamacare — then what?

What prompted this post is an article I just read in the online version of the Sacramento Bee newspaper about local dentists feeling the pinch of the economy with so many patients not being able to afford treatments. For some reason, I have noticed, dental insurance is hard to get and is paltry in its payments. I know mine, through work, is. I used up my big $1,000 in yearly allowance and just forked over a pile of bills out of my pocket for further treatment — it you wait on dentist work, the tooth decay and gum recession does not and it costs a lot more or you go without any teeth (that was my thinking). Anyway, it occurred to me that maybe those poor dentists should have been a little more concerned about how to provide dental healthcare to the public at large in the past.

I know that both medical doctors and dentists are busy professionals who spend a lot of time providing care for their patients and maybe feel it is up to the politicians to figure out public policy. Well you can leave it up to them and this is what you get.

But should any of my doctors read this — again, I am not criticizing, really I’m just writing words — it’s my form of recreation, but maybe it is something to ponder.

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About dentists losing business to economy:

http://www.sacbee.com/2011/10/23/3998013/dentists-patients-feel-economys.html

As Dr. Phil might say: How’s that Obamacare working for you? And as I say, where’s the savings?

I just got a letter with my last paycheck statement from my employer that says health insurance rates are going up this year — no big surprise, that’s what they always do.

The letter said that Blue Shield was raising its rates. The letter did not say directly whether that meant I would see more money coming out of my paycheck (I pay part of the premium and the employer pays part). What it did say was that in reaction to the rate raise the company was changing to another Blue Shield Plan. I don’t know what all that means yet. I suspect it means less coverage for more money — that has usually been the case.

OKAY, I just called and found out. I could stay on my current plan, but I would be facing a 60-plus percent rate increase out of my own pocket, but I can move to another plan with a higher deductible and actually get a slightly smaller premium than I am currently paying. Like I said, I basically have to pay more money for less coverage (as Dr. Phil would say: how‘s that working for you?).

Again, I ask, where is the savings?

I also have to wonder why it is that health insurance is going up when the annual rate of inflation is going down, from past years. During most of my life inflation was considered to be a big problem in the economy. Now most everyone is concerned about deflation, well, except not in the health care industry, I guess.

This post is a kind of continuation of one I did a few days ago on Obamacare — and by the way, I want to make it clear that I am not necessarily against Obamacare. For all I know it may actually be positive — I just don‘t know yet (and at 61 with incurable cancer, but thankfully presently kind of dormant, I may never find out). All I really said in that post was rates seem to be going up and medical specialists are reportedly looking for other work since government payments are going down.

 

 

 

 

http://tonywalther.wordpress.com/2011/01/08/does-new-health-care-law-improve-things-hard-to-tell/

Subsequently I was forwarded an article from one of my readers suggesting that a positive effect of the new health care law is that small businesses are flocking to get coverage for their employees as the result of a tax break being offered in that law.

 http://blogs.forbes.com/rickungar/2011/01/06/more-small-businesses-offering-health-care-to-employees-thanks-to-obamacare/

That was interesting, but it was obvious that the author of the article was an advocate for Obamacare. Also, why would anyone work for an employer who did not offer health insurance or why would an employer not offer health insurance if the employer cared anything about its employees — being that we do not have full-blown government health care for everyone (socialized medicine if you will)? The answer is some of us have to take what we can get and some business people actually do not care.

But anyway, while the article seemed to suggest that Obamacare was inducing small businesses to take a positive step, I also note that the tax breaks are temporary and that past 2014 some businesses will actually face a penalty if they do not offer health care (and since society as a whole seems to think health care should be tied to employment, I would think the mandate is correct).

Not that it makes any difference, but I am certainly willing to give Obamacare the benefit of the doubt. But I will be tiresome here and repeat that I think they should have just extended Medicare to everyone. Now of course that has to be paid for. So pay for it through taxes like we do everything else for the shared benefit of society.  At least it would (or should) be tax money well spent — good health for all.

In the end, it really broke down to this: supporters of Obamacare (Democrat and Republican) wanted to pass something that would provide health care to all and without going to a strictly socialist approach, leaving in private health insurance as a major component of the whole system.

Opponents represented primarily those who just did not want to give Democrats a victory and thus political advantage, as well as the Scrooge set.

Does new health care law improve things? Hard to tell…

Just got back from my primary care doctor and have come away with this slant on the effects of the new health care law, often referred to as “Obama Care”:

The doctor would refer me to a specialist if necessary but many of them, the doctor warns, are demanding pay up front and that the patients hassle with the insurance later on their own, this due, I understand, partly because of cuts in what the government will pay.

Some specialists are actually going out of business or changing to primary care because with reduced payments there is not as much money in specialties.

If the result is that the trend goes back to general practitioners, the old family doctor, that might be a positive trend — except when you really need a specialist.

I don’t know if this is really in direct relation to Obama Care or just the current realities in the business/field of medicine, but that was the inference to be drawn, that is it is the result of the new health care law.

Right as it was passed an elderly woman in my apartment complex told me that her Medicare supplement insurance premium jumped way up unexpectedly.

The way I see it, if the government totally runs health care it can call the shots (although it would have to find the doctors to cooperate), but if not, there is no law that says an insurance company has stay in business or keep offering health coverage if it does not want to, and a doctor does not have to practice medicine if he or she does not want to.

I’m all for health care reform, but I am not for making things more complicated than they already are.

It seems politically this nation, the United States of America, does not support socialized medicine, even though it has gotten used to Medicare, a variant of that.

I just saw something on the CBS Evening News that suggested that health insurance rates are going way up, but the health insurance companies say it is not about the health care law, but about higher costs and the fact that when higher costs make healthy people drop out of the health insurance market, that leaves unhealthier people in the pool and that costs the insurance companies more money.

(Of course I don’t think people on employer group plans tend to drop out, but a lot of people are unemployed or are self-employed or work at places that do not offer plans.)

I tried to do some research to make sense of the new health care law, but it seems like just too much to wade through and no clear answers (remember, congress passed it without reading it).

I did hear one business leader, who runs a company that is actually hiring, though, say that he thought the Republicans were wrong to pick the health care fight. He indicated that they should instead cooperate with Obama to zero directly in on the economy.

And I still do not understand why the business community would not stand wholeheartedly behind some form of single-payer government health care in order to take the monkey off their backs (except I suppose that would mean higher taxes). But of course they do not want a law that would lock them into providing health care no matter what the rates.

It’s all very confusing.

While the threat by the Republicans is to repeal the new health care law in total or in part, my bet is that if economic conditions improve over the coming year, fervor to monkey with the new health are law will die down.

But I still would say improve or expand Medicare, but don’t ruin health coverage that already has existed and worked.　

And as I have always maintained, I am no more, or little more, concerned about a government bureaucrat making decisions on my health care than a private company bureaucrat, except that theoretically in the free market you can go elsewhere, but when you are already into your illness it is a little late.

It is all really quite a mess. One wonders how long one can afford to live.

In fact, that elderly woman who said her Medicare supplement insurance premium skyrocketed reacted this way when I told her my mom was turning 100:

“Goodness, I couldn’t afford to live that long!”

At least give Obamacare a chance, or should we just get sick and die?

While I was not a strong supporter of what is sometimes called “Obamacare” by its detractors, but the new federal health care law by others, for the life of me I cannot understand why the average American could be so enraged by it or want to repeal it.

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ADD 1:

Now that I think about it I don’t even know what average Americans think about Obamacare — I just hear some of the rantings of the Tea Party and opportunistic Republicans.

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It hasn’t even been given a chance to work yet. And the status quo was only good for those who could afford it or those who accepted free care.

I don’t even know if I am benefiting from it or will, but I do know that without some type of change most of us would be priced out of the market and millions would not be able to get insurance because millions of people have lost their jobs and their company health insurance along with it. And on that, I am not even sure that Obamacare helps.

Republicans and tea partiers would have you believe that Obamacare is bad for small businesses, whom they claim to represent or support. But I heard a spokesman for a small business group on television say that quite the contrary, that the new law actually takes some of the burden off of small business in offering health insurance, I guess by creating the insurance pools that are supposed to eventually bring costs down or hold them in check. He said that as things had stood businesses could not afford the ever-escalating costs of providing health insurance to their employees.

Personally, while I accept that it is the practice in this nation that health insurance goes along with employment (and I know that is certainly not always the case), I have never thought that was practical. In my own case I was lucky to work for a company at the time I was diagnosed with cancer that paid my health insurance premiums 100 percent (not much of that anymore). And the insurance paid a lot of the cost. But unfortunately I was out too long and lost my job — and that good insurance that went with it.

I work for a previous employer now and have company health insurance, with part of the premium paid by me. Each year the premiums go up and the benefits are adjusted downward.

But as I understand it, the new law is designed to make health care delivery more efficient and hopefully over the long run more economical.

I also understand the law is convoluted and full of compromises that have weakened what was originally hoped for by its proponents.

But a lot of those who are being convinced by others with ulterior motives that Obamacare is so terrible are the same ones who may find themselves sick and without insurance or money and will be the first in line to demand or sign up for government assistance. And they will all claim they paid into it via taxes through the years.

Or they may be the people who never took any responsibility to purchase health insurance even though they could have but take advantage of the charity of health care providers who sometimes do perform surgery and offer treatment without charging the patient. But of course in reality someone pays for it.

There have been so many advances in health care over the years that have been a boon to patients but have also made costs skyrocket and there has been so much inefficiency in the delivery system that it seems to me the only practical way to provide health care for everyone is through a cooperative effort paid by us all via the government. But something that would be called national health care or socialized medicine cannot fly in our political climate.

And perhaps private enterprise under government oversight is the way to go for us.

If Obamacare really does not work it can be repealed, but one would think it ought to be given a chance. The status quo is bankrupting us and is not providing health care in any kind of equitable fashion. And I never did hear any credible alternatives put forth by the opposition other than let the free market work when so far it had not worked so well.

　

P.s.

I have heard disquieting reports about premiums skyrocketing and insurance providers dropping coverage in anticipation of implementation of the new rules.

Conservatives by their own named designation would prefer to go back to the old ways. You get sick and die — end of story.

P.s. P.s

Actually the status quo was probably alright for the rich and those who had good insurance and to some extent those who gamed the welfare system, but not so good for the vast majority of working people, a large number of whom were not even offered insurance through their work. Again, I don’t even know if the new rules address the problems adequately — but they are an attempt.

Should we go back to the old sailing ship days in health care???

ADD 1:

Sometimes I post a blog and then think: “what I should have said is this…”

That’s the case here. What I should have said is the fact that some seem not to care if other folks can get health care reminds me of reading both fiction novels and true accounts of the old sailing ship days when hearty sailors were out to sea for years at a time. Back then if you were an able bodied seaman and you were injured you were no longer worth anything to the ship’s captain and its owners. You lost your pay and had to depend upon the pity of your fellow sailors, even for a scrap of food (a good reason to get along with your fellow employees for sure). Seems like a hard core and hard-hearted way of doing things to me. But I suppose some would prefer that method for today’s society, maybe on the grounds that too many take advantage of the generosity and compassion of others while failing to do what they can for themselves. But somehow I have to think many of the so-called tea party protesters either do or will at some point find themselves in need of help from public programs and will think nothing of signing up. And of course I know what they will say in their own rationalizations: “I paid for it.” Yes, and so do we all. You’re welcome. 

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I wish the health care reform issue was over. From the news reports it appears as the most contentious issue ever to face the public in my lifetime (60 years).

Nearly everyone wants excellent health care, but people just don’t agree on how it should be paid for and what their own responsibility, if any, should be outside of themselves and their family members. And most agree that the cost of health care is a problem but there seems to be no consensus on what to do to control costs.

While I am not one of those who thinks the so-called “free market” solves all problems, it is kind of hard to tell because we seldom have a “free market” in anything, due to government regulation on business, much of which is, truth be told, promoted by business to get advantage in the marketplace. It occurs to me that the black market may be the only free market (because there is no government control).

While I do not know if government-sponsored health care is always the best way to go, I kind of think it would have been better had this nation (the United States) done so a long time ago. We did not, totally, anyway. We do have Medicare and Medicaid and military insurance and so on, though, and it seems to work for those involved – yes I know, Medicare is running out of money. But I think anytime one says Medicare or Social Security has a funding problem, it is more an issue of priorities than anything else. It is no secret, for instance, that Social Security funds have been robbed over the years for all types of things other than the intended purpose.

And as in the private sector, the public sector has depended too much on borrowing as if the day would never come when it had to be paid back or when revenues dropped too far down to pay the cost of interest on all that borrowing.

Maybe what we need for health care is indeed a free market. But there would have to be government oversight. I mean what good does it do if you are asked to pay health care premiums but can have your coverage denied or dropped because of pre-exiting conditions? And how can you say there is a free market when you can’t buy private health insurance across state lines – and who put that provision in the law in the first place?

As I have stated several times before on the subject, I think President Obama would have done better to simply put forward a program in which two things would happen – health care coverage would be made available to all with consumers expected to pay the cost of premiums, and in cases where people truly could not afford coverage (and that is sometimes subjective, but there has to be a legal cutoff point) the government (yes, the taxpayers) would step in. In some sense that is what we already have, but the problem is that there are cracks people fall through or loopholes. People often have to end up liquidating their own hard-earned assets to pay for health care and/or to qualify for assistance.

And there really needs to be a law that health insurance is mandatory. Why? Because so many people without health coverage flood the emergency rooms and the law does require that they be attended to (a hospital in my town has been under fire by the government for supposedly failing to meet that obligation to the full extent to the law). To cover the cost of the uninsured, hospitals and other medical providers have to charge those who do pay at a higher rate to offeset the costs of those who don’t, and the government of course has to raise taxes to cover the cost too.

I get the impression now that health care reform or at least some type of adjustment is coming. It will be watered down from what ultra liberals want and it may be too restrictive for conservatives, but if it at least meets the goal of offering – and mandating – coverage for all, I think that would be an improvement.

A truly free market in health care coverage would have the advantage of allowing people to decide just how much they want to be covered. Do they want to pay extra for a plan that pays nearly all costs or do they want to be more economical by simply protecting themselves from catastrophic incidents? I know if I or my family members had to pay for the full cost of my own bout with cancer none of us could meet it.

And a free market where consumers decided about and had the responsibility to pay for coverage would free employers of the burden of offering health care coverage and would allow small employers to feel free to take on more employees, not having to consider that if they do they might fall within one of those proposed mandates that employers of a certain size provide coverage.

In fact, the system in which so many have or had generous coverage is a large part of what led to so much inflation in health care costs in the first place. When those who offered services – hospitals and doctors and others – knew that consumers did not directly deal with or even see the costs, they tended to inflate the bills.

And one more thing: while the president may be to the left of many, his willingness to compromise but at the same time his insistence to get something done plays just right with me. To those who feel he is ramming something down their throats (so to speak), I say elections have consequences. Your guy won last time, the other guy won this time.

P.s.

In my previous post I wondered if Obama would present a little more clarity to his proposals. I think he did. That is he presented a clear outline of what he wants. It apparently is still a work in progress, and even though congress often does not read all the details of what it votes on – who would? And to the tea party protesters: if you are sincere and if there are enough of you – and it’s not just charade orchestrated by the ditto head Rush Limburger or Glen Heck or Hannity Insanity (not their real names) blowhards — you may well have an effect. Public pressure – even outside of actual elections — also has its consequences.

Health care reform under protest — I give up

I don’t know whether to be proud of all those citizens showing up at the town hall meetings, many to voice their protest over proposed health care laws, or whether to be disgusted with all the demagoguery going on, such as that from those Republican lawmakers who voted for a provision in 2003 they now claim to be against and further claim is a measure promoting euthanasia.

I know there is legitimate concern over proposed revisions to our health care laws but there is so much lying on all sides concerned that it is depressing.

Facing my own health care insurance problems, I feel nearly helpless and hopeless – although not quite.

But I know I am not in a unique position, and that only further confuses me. Surely so many others must be facing the bewildering position of being between insurances and knowing that if you let one lapse a new plan may not accept pre-existing conditions. I might be going on Medicare if due to my medical condition (cancer) I cannot work, but that would put me into poverty,that is not being able to work,  but without help I can’t possibly pay private insurance on my own. And reading over all of the terms and restrictions of private insurance is bewildering. One would have to be the proverbial Philadelphia lawyer to understand it all, and even that would not help, unless one specialized in health care law.

While I fully appreciate anyone taking part in the protests if they know what they are talking about or at least have legitimate concerns based on some semblance of fact, I have nothing but contempt for the know-nothings who simply spout off FOX News or right-wing Republican talking (propaganda) points.

And I am not afraid to say something else about all of this: there is a lot of greed among the health care providers, to include doctors, and insurance companies.

It’s hard for me to criticize doctors because I have needed them so much and I know that taken as a group they do so much good for society and I know that to be a good doctor is a rare enough skill and talent that it has to be or should be well rewarded. But it also seems to me that doctors are the ones who could do more than most to help straighten out the health care crisis. But the doctors whom I have spoken with seem to feel they are too busy and someone else needs to handle reform and that in so doing whatever way it comes out they have to be compensated at the level to which they are accustomed. I have not had long and detailed discussions with doctors, but I have mentioned my concerns. And although they indicate concern and sympathy they also convey the attitude that they must be rather well compensated otherwise it is just not doable or worth the bother.

As to the issue of abuse in malpractice litigation adding to high medical costs, while I am sure there needs to be reform there, I imagine it is more of a red herring used by opponets of health care reform who prefer the status quo.

But at some point on an individual basis one has to face reality and go along with the program, such as it is.

And one more thing: I think a vast majority of the public wants FREE health care or at least health care that seems free, such as employer-provided. They do not want to think that they have to pay for it and they for sure do not want to be taxed for it. A big concern among many – and perhaps somewhat legitimate – is that their tax dollars will go to health care for others and not themselves.

It is true, I believe, that there is a class of people in our society who take public assistance for granted. They along with greedy drug companies and others in the health care industry are adding to the poison in the atmosphere against health care reform. Many are concerned that too much government involvement will throw us all into the government free clinic zoo. Many working people work simply to not have to live in that nether world of the “sick”, “lame” and lazy. They fear that Obamacare (and actually there is no identifiable program) would throw them into the community clinic.

And there most likely would have to be some type of health care rationing under a government program — how else to control the costs? There already is rationing in the private system anyway — it’s called cost, availability, exclusions and so on.

While President Obama may believe what he says, that he does not want to take away anyone’s insurance, I have to admit it does seem that a so-called government option would overpower what the marketplace could offer and would offer employers a way out of providing for their employees. And actually employer provided insurance is probably where we went wrong in the first place. When it really was free (to the patient) the medical community had a bonanza, they could and did, and heck, still do, charge anything they want. And they want a lot.

I give up already – I’ll go along with the program to the extent I can.

Health care: entrenched system hangs tough against change…

Soaking the rich for universal health care won’t fly. And it should not. Taxing existing health care plans via the employer deduction or through the employees’ individual income is counter productive and unfair, and borrowing more dollars from China is not wise, to say the least.

I’m not sure where that leaves things. But it seems that the cost of health care needs to be a shared thing, not left on the shoulders of just one group, because for one thing they will resist and for another they will get out of it, and soaking the rich is not really right anyway. If health care is to be provided universally then it should be paid for that way. Of course not everyone has equal means to pay.

And I should note here that there is a practical question as to whether there can be a system in which everyone gets identical care, that is everyone has the same level of care available. I personally have always assumed that those with means are going to have an advantage. They can pay cash and/or have better, more expensive, health plans.

And how much is too much to pay for health care? When it comes to your own life or that of a loved one, you can’t come to that ultimate figure, except by what you have available or can raise. But what if someone else is in dire need but has to get help from you through your taxes? As big a heart as you may or may not have, that is where one is liable to think a little more rationally (and ration, as in rationing, is part of that word).

This question becomes especially troublesome when we are only prolonging life for a limited amount of time.

And here’s a problem on a personal level. I’m weighing my options (if I have any) as to whether I can go back to work after being out on disability with cancer (that is not cured and cannot be). My COBRA plan (the federally-mandated program that allows one to keep group health insurance from a job by paying the full premium) is due to run out three or four months before I would be eligible for Medicare. I can extend my insurance beyond COBRA but it will not cover as much and it will cost more, my insurance carrier has told me (what a deal offered by private enterprise).

If I am able to go back to work, I can have a company-sponsored plan (not entirely free for me as in my last job that is no longer available) that will cost me less, but will my employer continue to offer the now tax deducible plan if my employer would have to pay taxes on it as some are proposing? Not likely, especially in this bad business climate. Will the government cover me then? And what hoops and how much waiting is involved in getting on a government plan? It’s two years for Medicare. Taxing health plans as one current Democratic plan seems to be calling for contradicts President Barack Obama’s campaign promise not to mess with anyone’s existing insurance plan while offering some type of government option.

I keep thinking that the point of this whole thing has to be availability and then cost, which sometimes amount to the same thing.

As much as I distrust and even resent at times the health care industry, I think messing up the current system where the majority of people have private or so-called group plans through their work is not the way to provide universal care, if for no other reason than the offering of a universally available plan from the government would probably wipe out private plans, especially if the government plan was free or at a much-reduced price to the consumer, even if it was more bureaucratic and not as good as private coverage (and I don’t mean private coverage is not bureaucratic – it is). Employers are not likely to offer health plans if they know everyone can be covered by the government.

The way to provide universal care – and here I go again – is to cover people who are not able (not just don’t want to bother) to buy their own insurance. While I would not be against in concept, say, a single-payer, government health care system, that seems unlikely when a different system is so entrenched and accepted by the majority.

Yes, Medicare is said to being going broke. But, it would seem the most cost effective and quickest way to extend coverage would be through Medicare, a system already in place.

And now we are being bombarded with the story that people in Canada, Great Britain, and Sweden and other places that have what is often called “socialized medicine” (provided through the government) have to wait for critical care or procedures for months or years or are flat out denied and sometimes resort to going to the U.S. to get care. That’s interesting. You still have to have the money to pay and if you have the money to pay, what’s the problem? The whole problem is people cannot afford medical care without health plans and health plans, whether they be privately run or run by the government, have to have some means of cost control or they would go broke. Waiting can be part of that cost control, as well as outright denial. I am not sure why just because some other country might have a plan that is not consumer friendly why the U.S. cannot improve upon that plan, but still offer universal coverage.

Medicare needs to be improved, to include offering broader coverage (vision, dental), and it needs more funding. Of course that will put a larger strain on the budget. But doing any improvement will necessitate spending more money. Improving an existing and quite workable program would seem to offer the most cost effective solution. 

We face two major needs: one is for everyone to be secure that he or she has health coverage. The other is for everyone to realize that he or she has a responsibility to help fund that coverage to his or her ability. As it is now, we who pay for health insurance share in the cost of health care for all in that we pay higher premiums to help medical providers help defray their mandated care of the indigent and others who do not pay and we are taxed for Medicare and the other public health programs. We need a simpler and more efficient and more equitable way to do all of this.

It’s estimated that current legislation on health care change going through congress could cost $1 trillion over a decade. Strange that it matches with the projected cost of the Iraq War. That war has been rightly called, I think, a war of choice. One wonders why the health of our citizenry was not considered the better choice. Our health care system is pricing people out of the market and people are losing coverage each day due to the current economic catastrophe. It’s estimated that as many as 14,000 people a day lose their insurance due to job cuts (from and article out of the Wall Street Journal online).

An oft cited figure for the uninsured is about 50,000, but a significant part of that is young people who earn enough money but don’t want to pay for insurance, figuring, I guess, that they are healthy. So when something bad happens the rest of us have to pay. We also pay for people who are in this country illegally. One study estimated that insurance ratepayers fork over some $1,000 extra per year to cover the expenses of the uninsured (from an article in the Wall Street Journal online).

Stories like the one I heard today on CNN do not help support the public option. It was revealed that Medicare pays at least one private company a thousand dollars to rent a wheel chair for a year when the same model can be bought for $300 or less from that same private company. That’s because when congress made the deal it was lobbied by the industry on price schedules and bidding procedures. So the same private industry that rails against public health care realizes when it is inevitable and profits from it.

I appreciate the president’s even handedness and willingness to negotiate, but sometimes leadership calls for putting together a workable plan and not letting it be diluted or emasculated by allowing the opposition (which likes the status quo) to get its hands on it, and then sticking to your guns to support your own plan (you have to have your own plan too).

One problem in all of this is that no one seems to identify exactly what the proposed plans supposedly being debated in congress would look like. And most people, quite understandably, do not want to lose what they have if they have it. Another problem that I see is that the president does not seem to offer an identifiable plan, other than in broad generalities, and his own party, the Democrats, have various plans afloat. The Republicans, as far as I can tell, are mostly pretending to be concerned or to want health care reform, but are primarily interested in carrying the water for the health insurance industry (to be fair, sadly many Democrats seem to be in the pocket of the health care industry lobbyists too).

Health care is such big business. There is so much money to be made. It is hard to fight the establishment, even for the yes we can man.

P.s.

Have you noticed that the Harry and Louise ads on health care from the 90s are back but this time that concerned upper middle class couple wants change? (Things have deteriorated somewhat in their formerly protected world, apparently.)

Raise tariffs, re-tool America, lower retirement age, and go for universal health care…

I watched Charlie Rose last night and heard Bob Woodward say that President Barack Obama has not really been tested by his own crisis yet. He said that he did not know what crisis might be in the offing, but perhaps unemployment might be it. And today I read that unemployment has reached 10 percent in 15 states. I know it is higher than that in my local area, and maybe in yours. If unemployment remains high, I think the Obama administration will be seen as a failure. Actually we are already in an unemployment crisis — so let’s see how Obama handles it.

Raise tariffs and provide tax incentives to U.S. industry that employs people right here in America, lower — not constantly raise — the retirement age to increase job opportunities for younger folks, and relieve businesses of providing costly health plans and thereby at the same time free up workers to more easily go to better or more suitable jobs by providing some type of universal health care scheme not tied to employment.

And so the doctors, and others, will not gripe that government bureaucrats (as opposed to private health insurance bureaucrats?) are dictating health decisions, let doctors serve on public boards to oversee the government-guaranteed health care. Notice, I have not written “government-sponsored”. Actually I assume that under any scheme to guarantee that everyone has health care coverage there will be government funding.

How about those ideas to put America back to work and get the economy going?

And while I don’t want to just concentrate on health care, I can see from my own personal experience that health care rules so much in our lives (it’s the cost and availability).

So I will address health care and then go back to some of the other economic recovery ideas.

The only way I can see that there is ever going to be health care for everyone is for the government to be involved, the free market can’t seem to do it.

I watched part of a documentary on PBS some time ago about how other nations handle health care, but it was kind of hard to follow or at least remember, except that it seems to have a lot to do with attitude of the public. For some reason maybe the rest of the world is just crazy, but they see a role for their governments to serve the interests of their citizens. For all the need and talk about health care reform in this nation, I sometimes get the idea that the general public is not into it as much as one might imagine, that is until something bad happens in one’s personal life, but then you’re so mired in your own mess, it’s hard to see the forest for the trees. But if the public really cared as much as it is reputed to, I think we would have had reform long ago. I keep hearing that Teddy Roosevelt ( a Republican – a progressive one) pushed for some type of national health care. That’s a century ago.

I’m extremely surprised the business sector has not pushed for national health care, seeing as how providing health care coverage for employees is such a major expense. And if employees don’t have coverage they will eventually be less productive and certainly it would seem more vulnerable to worker’s comp claims, which really can cost employers a lot.

Right now with so much of the work force out of work, huge numbers of people are without or soon to be without health care coverage or are trying to figure out how poor they have to let themselves get to become eligible for government programs.

Health care has become so expensive but is so necessary that it has become one of the most important, yet hard to meet, requirements in life, darn near beating out food and shelter.

Unless you have the fortune required to pay out of your pocket for all health services you might need, you generally have to join together with others in some type of group plan. So why can’t virtually the whole nation join together as a group? Yes it is going to cost, and everyone should have to pay a fair amount according to their means. And the amount of taxes raised for health care cannot be unlimited. So, yes, that means that decisions as to what is covered and how much the insurance will pay will have to be made. They always are, even in private insurance.

Taxing the rich (and who figures out what rich is?) to pay for health care is a bad idea. Social Security, the one program with “social (ism)” in its name that seems to have near universal support or at least acceptance, was designed so everyone (almost) pays for it and everyone is eligible and everyone has a stake in it.

A doctor who writes a column for my local newspaper said he dreaded any type of public option because the government would be telling him how long or what kind of treatment he can give his patients. Not any more than private or so-called group insurance does. And no one would tell him how long he can spend with a patient. That is up to him. He’s talking about his reimbursement. He can spend longer with his patient than the reimbursement covers (the government or other insurance entities only limit the money, not the time), and he can charge the patient the difference (and that is what is often done). Whether the patient can pay that extra amount is always in question (and do doctors consider themselves mere hourly employees?). And it might seem nice to compare the medical care market with any other consumer offering, but, you know, there is just not much competition. In fact, a lot of doctors do not accept new patients.

There is a concern that the number of family practitioners is dwindling because there is just not the money in the field there once was (still better than when they used to accept chickens from farmers). Maybe there needs to be more incentives to create new family practitioners, such as subsidized training for promising students. And maybe if the private sector cannot offer enough services, there needs to be government clinics staffed by well trained doctors and support personnel.

Such clinics would have to be well funded, because if not, you get the stereotypical zoo.

And then there is the problem – who wants to go to a cut rate doctor?

I got off the track on this medical thing. I was really wanting to put another pitch in for the re-industrialization of America. I know all the learned economists and political historians will tell you that raising tariffs is “protectionism” and protectionism is a bad thing because it leads to retaliatory protectionism from other countries and stymies world trade and leads to even more economic hardship and that there is precedent that proves it – the Smoot-Hawley Act of 1930 and the Great Depression. But that notion has been brought into question by some. And besides, that was then and this is now. I love history, but we live now and maybe things are slightly different today.

What so-called free trade has brought us is unbalanced trade where the U.S. competes with nations with a much lower standard of living and it continues to drag the U.S. down. Free trade was sold partly on the idea that other nations would prosper and come up to our standards. And I have to admit that in my ignorance I once thought if something can be made cheaper elsewhere, so be it, I’m generally for it. But there is such a thing as buying value (something that is hard to find these days – except in foreign cars), and there is such a thing as keeping the wealth in one’s home country. In our own greed we may have been tricked into giving up the store by becoming a nation of bargain hunters rather than a nation of those who produce or support in the production of quality products  and who share in the wealth that the demand for quality brings. Developing nations may develop, but they also may surpass us while we are not paying attention.

And even though a lot of money is made out of war, our current wars are a net drag on our economy and it is morally wrong to base our economy on war anyway. We should work to get out of war situations as quickly as possible and avoid wars when we can. And we are finding out that in today’s world rapidly moving events all over the globe can cause us to be overextended easily.

Kind of a scatter shot approach here. But just some thoughts.

P.s.

I heard someone mention on a TV news talk show that even with all the hubbub about whether a health care plan will make it through congress this term, even if it did it would be five years before anything went into effect. That’s absurd.

I still think everyone is trying to make this whole thing too complicated. Complication is not what we need. And it is hard to shop for health care, especially when you need it (think about it).

Just expand Medicare for those who cannot afford to pay for private plans now on the market. The market has no interest in providing health care for those with no means to pay. In fact, left to its own devices, the private health care industry would avoid offering coverage to anyone who might actually want to use it.

The great chicken 2,000-mile bird monopoly or how health care becomes a crisis when an employer shuts down…

Read a story about a chicken plant in a Georgia town closing down and something caught my eye.

The local medical center in Douglas, Georgia stands to lose the annual $2.3 million in revenue from the plant’s employee health insurance. Now it is facing the prospect of a huge spike in uninsured patients. The plant employed 1,000, but total employment in the town linked to the plant is estimated at 2,000, and I don’t think that counts the local chicken farmers who went out of business. Actually nearly the whole economy of the town is linked to the chicken plant, the story indicated.

So the quick points here are that there is a big problem in having health insurance tied to employment and having a town’s economy so intertwined with one employer.

But on the health insurance, I just thought of something. Maybe employer-sponsored health insurance is not such a bad idea (I know, who said it was?). Having employers pick up the tab (or at least a large part of it) for health insurance is kind of like a tax. I think I’m correct is saying that businessmen in general are opposed to government-sponsored universal health care because it would create the need for higher taxes.  (ADD 1:  Walmart is now reportedly supporting part of President Obama’s health plan that requires large employers to provide health insurance, but that is a tactic that other heretofore opponents have adopted in the face of  likely changes  — they want to at least be part of the program if change is to come.) Thus far at least the larger employers have evidently considered offering health insurance a cost of doing business. So if they are comfortable or at least accepting of that cost, which as I said is essentially the same as a tax, maybe that is the way to go – but with one caveat, since people need health insurance even if their job disappears or especially when they lose their job due to health problems, then the employer ought to be obligated to continue that health insurance. But that could be quite a burden on an employer. So maybe at that point the government could step in and help subsidize continued insurance.

Employers began offering group health insurance way back when premiums were not nearly as high and when there was more competition for labor. And that is in large part what led to the mess we have today. So many people at one time had what they called “free” health insurance from their employer that medical costs skyrocketed, maybe from overuse, and so did the services that could be offered. All folks had to do was show an insurance card, and voila! Everything is paid for. That was then and this is now. Nowadays there is not much “free” insurance left. Even most employer-sponsored insurance costs a huge amount to employees. And many have lost that insurance along with their jobs anyway.

The good thing these days is that we have so much more technology in medicine, financed of course by patients and their insurance. The problem is that the costs are exceeding the ability of people to pay and are absorbing an ever-increasing share of the gross national product.

There is much talk to the effect that any change in the system to make it more efficient will lead to health care rationing. Well of course it will, to some extent. Isn’t that the problem we have already? that is to say everyone wants everything no matter what the cost. The insurance companies could not stay in business if they simply doled out everything that anyone wanted at any time. So they deny certain things and figure out ways to get out of paying (a little too much emphasis on that, I think, to say the least). But that is rationing. It has been taking place for a long time. You can’t get care unless you can pay for it or someone else pays for it. That’s rationing.

So, bottom line, we have a inefficient system, but it works for those who are covered. So as I have been blogging lately, maybe the best idea is to cover those who are not and move on to other things, such as improving the economy.

The whole issue of health care is confusing in that recent polls show a vast majority of people support some public option and it is thought that pressure from the public option would force private plans to become more competitive in cost. But for some reason the health insurance lobby seems to hold more sway in congress than voters (so far). Why is that? I don’t really fully understand that. The only thing I can figure is that polls are suspect in that respondents are liable to be responding to leading questions. And never underestimate the power of propaganda put out by lobbyists.

Originally, after reading the article on the chicken plant I wrote the following:

I think having a home-cooked chicken dinner was cheaper in grandma’s day. And I’m going way back in time because my parents were older than most when they had me and grandma was gone by the time I was born.

But the way dad told it, down on the farm in the early 1900s grandma had a cane and would pull in one of the many chickens that ran around the yard, the unlucky one of the day I guess, and whack its head off with a hatchet, pluck it and cook it. I said cheaper, not easier.

But today more than likely you buy what here where I live in California is a dead bird that has been hauled maybe 2,000 miles or more to the supermarket having been processed by some chicken conglomerate. And judging by a story I just read in the Wall Street Journal online version, that conglomerate is doing its best to control the price of chicken by trying to stifle competition.

Seems the demand for chicken is not what it had been so one of the major conglomerates, Pilgrim’s Pride, has filed bankruptcy and closed down plants, but is refusing to sell the closed plants to competitors in order to cut down the capacity, thereby keeping the price of chicken up. And it has apparently worked to some extent. Prices are up slightly (the power of the agribusiness monopoly).The creditors are supporting that scheme because they feel it will help make Pilgrim’s Pride a more viable company and therefore they stand a better chance to get their money back.

But not only is this manipulation of the market not helping consumers it’s not helping all the laid of chicken plant workers in places such as Douglas, Georgia where a plant has been closed down. Not only the plant workers are affected, but so is the rest of the community that depends upon the dollars those workers made and that was otherwise circulated in the community from the chicken plant operation. That includes the area’s chicken farmers too.

We do have a couple of major chicken producers in California, but it’s a big state with millions of consumers, so that conglomerate’s actions affect us.

Douglas and its economic development authority would like to attract another chicken plant operator but Pilgrim’s Pride sometimes won’t even let others look inside the plant, citing trade secrets, and has turned down bids to buy the operation.

Seems like to me the laid off chicken workers should pool their resources (except they probably don’t have enough) and get the city to condemn the shut-down plant and buy it themselves and operate it as an employee-owned business. The U.S. Supreme Court’s Kelo vs. New London decision of 2005 in which a Connecticut city condemned private property for use by another private owner but for the economic development of the city might work here.

Pilgrim’s Pride’s actions in closing their plant and not allowing anyone else to buy it so they can hold down the production of chicken is what gives free enterprise a bad name. You could say it is none of the government’s business, but does not the business depend upon the governmental-run system of bankruptcy protection?

And not only that, but the the Douglas Development Authority, a public entity, gave the land to Pilgrim’s Pride and bought its equipment in the first place to lure it into town.

You’d think that in this time of recession and high unemployment chicken, usually a low-priced meat, would be in demand without the great chicken monopoly resorting to OPEC tactics.

Maybe a better idea for the displaced workers would be to move onto something else. Too bad they can’t raise chickens like grandma did, at least they could put dinner on the table.

Obama caught (kind of) on claim his health care plan (what plan?) would not eliminate private plans or force doctor changes…

I’m not an anti public health care (or anti socialized medicine) partisan, but I noticed that President Barack Obama got caught in Tuesday’s news conference on his long-offered promise, all thorough his campaign and all through his young presidency, that you won’t have to give up your own health care plan or your doctor if you’re satisfied under his proposed health care plan.

And let me just inject here, we still don’t know what the actual Obama health care plan is (except if you are a Republican and call it socialized medicine).

In answering a question he all but conceded that in fact you might end up losing both your plan and doctor if private insurance decided it could not compete with a public option and/or if your doctor decided he or she could not afford to accept the provisions (payments) under the public option, or if your employer decided to drop a private plan and let you take advantage of the public plan. He tried to slip out of the trap by saying it would not be the government putting the kibosh on your plan or dismissing your doctor, that would be up to the insurance companies and doctors and employers.

The idea that has been put forward lately (or I guess for a long time) is that any public option would have too much advantage over private health insurance – patients would get care for too low of a cost – can’t have that.

But despite any sarcasm I might have concerning the poor private health plans and the doctors who might suffer, I do see the point that indeed a public option and a continued private option might not be able to co-exist because they would not be on a level playing field. The government can raise taxes and promulgate rules to lower costs.

Surprisingly, even with all the money thrown at the anti-public option movement recent polls show something like 72 percent or even more of the public supporting a public option. And polls indicate support for higher taxes to pay for it, to an extent. Not surprisingly people are apparently somewhat hypocritical because there seems to be less enthusiasm when specific cost figures are mentioned. Well of course any option no matter what, unless you just deny health care to anyone who cannot afford it, is going to be expensive. In case you haven’t noticed, people who go to medical school expect to make some big bucks. And we keep developing expensive new procedures that require expensive equipment and we have to pay other highly trained and skilled medical personnel along with not so highly skilled and highly paid folks (but a lot of them). And it does cost a lot of money to get a new medicine on the market and the investors want to recoup their investments and then some.

Of course if we have large numbers of sick folks we cannot be as productive of a nation as we should be, and right now it is apparent that we need to start being more productive. Also, since we at least have laws that require folks to get emergency medical service those emergency rooms will continue to be clogged and the costs will mount if we don’t do something.

No one actually knows how much the Obama plan (which is not really spelled out — being a continued work in progress) would cost, but figures of $1 trillion and even $1.6 trillion over ten years have been suggested. Gee what a waste. We could fund a war with that kind of money (sarcasm again).

Costs concerns notwithstanding, the public does seem to be coming around. That’s probably because health care even with employer-sponsored insurance has become so expensive and the fact so many people don’t get employer health insurance either because it is not offered or they have lost their jobs.

Another strange thing is that lawmakers seem to listen to lobbyists more than average people (probably because average people don’t generally make big campaign donations). It’s sad that the voters have to take a back seat to lobbyists. Of course if campaigns were more sober presentations of proposed policy rather than highly expensive glitzy propaganda wars, and if voters were willing to listen to fact rather than empty or misleading rhetoric that would not be such a problem.

What I would be for, most would call socialized medicine (there I’ve said it – please don’t call me a communist – or does anyone use that epithet these days?). But I’d settle for some type of plan that simply provides health care benefits to those who truly don’t have access to a private plan or resources to pay for one.

I think we may be trying to do more than we need to. I begrudgingly admit that we have a system of sorts in place and probably don’t need to mess it up.

So for the umpteenth time I ask the question: why can’t we just extend the Medicare and Medicaid programs to those who need coverage they can’t pay for?

I’m waiting for the answer.

——————

Clarification:

In the original version of my last post I incorrectly spelled the name of a Huffington Post blogger, but I corrected in a later version. The blogger is Nico Pitney.