I don’t (in theory) have to have my car, so the insurance mandate is optional, but I do have to have my body (a fatal flaw in Obamacare?)

Perhaps the individual mandate was the fatal flaw in Obamacare.

From what I just read on the web, the Supreme Court justices, the conservative ones, plus the swing man, Justice Kennedy, a conservative whose vote can sometimes go either way, appear to be tipping their hands, via questioning, indicating they are quite skeptical of the individual mandate to buy health insurance. That of course threatens the whole Obamacare package, that is based on the premise that health care can be provided to all if everyone chips in.

But you never know about high court justices, they can indicate one thing, even in a final opinion, and then come smack down on the other side. But it does seem that the conservative majority is preparing to dismantle or severely weaken Obamacare.

A law requiring one to deal with a private company sticks in my craw as well. I am required to do so to buy car insurance, but theoretically I don’t have to have a car. I have to have my body.

I just cannot understand why Americans are so against some kind of cooperative scheme that would benefit us all. Health care is expensive and there seems to be no way to keep it in line. But a single-payer program (which Obamacare is not) would allow that single payer bargaining power.

I have personally witnessed people (I won’t name names) who have railed against government health care and who at the same time have used it to the max.

———————–

What follows is my previous and related blog post on the issue:

So, as the U.S. Supreme Court weighs into the Obamacare controversy, this thought comes to me:　

The idea of the government mandating that you buy health insurance from a private company draws heavy resistance (doesn‘t even sound right to me).

But the costs of health insurance continue to escalate and there seems no way to control them.

Some people choose not to carry health insurance, or some cannot afford it and/or it is not available to them.

But just because one does not have insurance does not mean the costs disappear.

Out of law and moral imperative, the medical establishment does not simply refuse to treat people over lack of insurance (in general — there are cases where people are denied certain types of treatment or face obstacles).

The costs of treating the uncovered people must be borne by those who are.

The cost of medical care seems to see no limit in its escalation, despite the ups and downs of the economic cycle, partly due to the ever-expanding technology available, that as wondrous as it is, is quite costly, and raises individual expectations on what constitutes reasonable and rightful medical care.

In an effort to both get everyone covered and have everyone pay his or her fair share into the pool, what is now called Obamacare was passed.

It is heavily opposed by conservatives, to include much or most of the business community, which usually is automatically considered part of the conservative contingent.

But I note that the trucking company I work for is a member of an insurance consortium made up of several trucking companies.

In an effort to beat the cost of private insurance for liability out on the road, where not only does one have to pay for the risk, but for the profit of a private insurance company, the business competitors have banded together, pooling their resources for the common good of each member. As I understand it, if a member racks up a good enough safety score, the member eventually gets money back.

So it seems to me if conservative business people (or non-conservatives, for that matter) can see the economic benefit and the logic of shared risk, minus the costly profit motive, then why cannot people see it for individual health care coverage?

Seems to me that having the federal government administer some kind of shared risk pool for health insurance coverage would not be a bad idea (and that is not really the Obamacare approach, but that is not the point here).

Or, perhaps, there could be some type of legal mechanism to allow for the creation of non-governmental, but non-profit, risk pools.

Just a thought.

P.s.

Insurance had its beginnings in non-profit risk pools.

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.

—————

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!”

So, can you and should you be forced to buy health insurance? It’s an important question for the Supreme Court

Now this is interesting.  A federal judge in Virginia has ruled — I just heard, well earlier today  – that the federal mandate to buy health insurance (that does not go into effect until 2014) is unconstitutional. While the government can use the commerce clause to regulate interstate commerce it cannot force someone to buy insurance, he held. Now this is just one judge, one court, and other federal judges have held otherwise,  I understand, and this matter will likely reach the Supreme Court, I also understand.

While I totally see the rationale of forcing people to buy insurance, there does seem something troubling about the government being able to force one to deal with a private entity. At least with mandated car insurance you could choose not to drive a car. But you can hardly choose what goes wrong with your body.

I recently blogged about the mandate to buy insurance under President Obama’s new health care law. I made the analogy with car insurance. It’s only fair that you be required to buy auto insurance when everyone else who drives is subjected to the risk and those who are responsible pay their share for insurance — so maybe it ought to be that way with health insurance. Maybe if you opt out of health insurance you ought to be made to sign a statement or waiver, as it were, to the effect you will demand no government care at taxpayer’s expense — ever, and that the government is not required to provide it for you. I don’t really think all that is practical or moral, though.

So, this notion of the government being able to force citizens to deal with a private company (buying health insurance) is certainly destined to eventually reach the Supreme Court. Meanwhile, there is no immediate effect both because the provision was not in effect yet and because the judge declined to issue any kind of injunction along with his ruling, as I understand it.

At the risk of being tiresome, I say again, the problem is providing health care to those who have no resources themselves and cannot otherwise obtain it. That, I think is a moral imperative. Personally I would not be against some type of national health care system, commonly referred to as “socialized medicine”  (well actually that label is pase’, so commonly called “socialism”). But our own unique American system, really not a  system, but a hodgepodge of public and private and employer-based insurance, is entrenched. So why could we not simply live up to our responsibility to the less fortunate (which in this economy could be nearly anyone of us) and move on?

Why does anyone still buy cigarettes?

Went back to the grocery store this evening to exchange a light bulb that was the wrong size, but they did not have the right size so I got my money back. But in so doing I was in the customer service line. The young man ahead of me was buying a pack of cigarettes, just as the older man ahead of him had done. I had not noticed this before, but apparently these days you can only buy cigarettes and tobacco products at that counter.

I don’t know how much cigarettes cost these days, many, many dollars per pack, and don’t even think about a whole carton — far more than the 25 cents to 30 cents per pack they cost when I was a teenager, which was relatively cheap even then.

————

Had a hard time getting a simple answer on the web, but apparently cigarettes these days cost as much or more than $50 per carton (10 packs), and in New York state because of new higher taxes they are upwards of $15 per pack.

————-

It’s hard for me to believe that in this day and age people actually still buy and smoke cigarettes. Ever since the 60s , or even 50s, at least, we have known that they lead to lung cancer and we know that they cause other lung disease, usually in the form of what these days is referred to as Chronic Obstructive Pulmonary Disease (COPD), a form of which can be Emphysema.

But people get hooked on them and then they go into denial, saying things like, “I know an old woman who has been smoking ever since she was a teenager and she’s a hundred years old, or, “if I quit something else will get me” (yeah, so go out and run in front of a train, something else is going to get you anyway).

Just as bad is what one of my late brother in-laws used to tell me: “heck I could quit anytime.” That begs the question, why didn’t he? Well he finally did after a doctor told him it was either that or imminent death. But he died a slow and painful and agonizing death from the effects of COPD. His death was not only hard on him, but those who loved him — most notably a son who was close to him and my wife. They both took care of him. But even then he was in denial, saying or implying that it was not really or not just the cigarettes that gave him lung disease. He had worked with all kinds of toxic chemicals in the construction business back before they had safety breathing equipment that was at all effective. And he may have been correct that other things damaged his lungs, but certainly the cigarettes played a, or the major role and probably hastened his demise.

If these smokers do not care about themselves or their loved ones, do they realize that it is society that almost always ends up paying a major portion of the medical bills due to their smoking-related or caused diseases?

And what about the smokers who litter the countryside with cigarette butts and emptied ashtrays that they just dump on the ground or pavement or what about the ones who carelessly throw burning cigarettes out their car windows and start raging wild land fires that kill people and wildlife and destroy property and burn forests and pollute the environment? And they are so indignant when they are told they cannot smoke in a public place.

They think it is their right even though it has been found by researchers that second-hand smoke non-smokers, often children of smokers, are forced to breathe is deadly. But of course they are in denial about this too.

It almost seems to me that anyone who now smokes should not be able to get health insurance, even private insurance, because protecting them makes everyone’s premiums cost more. And they should have to sign a waiver saying they will not be eligible for public health care of any kind related to their smoking.

For that older man buying those cigarettes it‘s probably too late.

Sadly, for the younger guy, it‘s also probably too late.

Some people never really do get the message.

P.s.

I even find it hard to believe that among people who are heavily addicted to cigarettes, that the realization of that slow and agonizing death and/or a shorter life span, added to the tremendous monetary cost of the habit is not enough to make them quit. But if those factors are not, then someone needs to talk them into reconsidering their smoking lifestyle, then we could all breathe easier.

P.s. P.s.

I was young and foolish once myself. I tried to get the habit, but it just wouldn’t take.

P.s. P.s. P.s.

And I know, once you start telling people they cannot do dangerous things to their bodies such as smoking, others will say then what is to stop the government from telling them not to drink alcohol (the U.S. has been there and done that back in Prohibition days).

But there really is a difference. There is just nothing safe or redeeming about smoking and the cost to society is too high.

Federal requirement for individuals to purchase health insurance seems the only practical option…

A few days ago I blogged that I thought the American people ought to give Obamacare a chance at least, since no other credible reform had ever been suggested and there was no question that we needed reform in that at some point most would not even be able to afford health care.

I still pretty much feel the same way, but I wanted to address the contention that it is wrong for the government to require citizens to carry health insurance, that is to require one to do business with a private company (health insurance provider), as mandated by 2014 in Obamacare (which is now the law of the land).

At first blush I would be against such a requirement.

But I think it comes down to this: Most states (if not all) require that drivers carry auto insurance because someone has to pay for damages and it is unfair and not at all practical to allow some folks to drive around without any insurance (although many scofflaws do) and cause damage to others but then turn around and claim they can’t pay or actually try to collect money when they are injured, while never paying for insurance themselves. Also, a large pool of uninsured people just makes insurance for those who pay their premiums more expensive.

That same argument can and is used in support of requiring all to purchase health insurance, even if it means the government requring you to do business with a private company.

One federal court has now ruled that such a requirement is NOT unconstitutional. http://www.scotusblog.com/2010/10/health-insurance-mandate-upheld/

It supports its argument using the interstate commerce clause in the U.S. Constitution. That clause is pretty much of a catch-all that allows the federal government to do a lot of things if they can be somehow construed as connected with interstate commerce. But I am not interested in getting into some kind of legal analysis here (and I am not a lawyer either).

I think in practical terms everyone has to pay something, at least according to his or her means, into some type of insurance pool for health care, whether it be in the way of premiums for private insurance or taxes or whatever.

As a society we demand the best health care available and at the same time we in good conscience cannot bring ourselves to think we would simply turn people away because they cannot afford care (although to a degree that is done quite often).

I personally would have preferred that we had gone to some type of government-paid national health insurance or simply retained our current patch-work system with the only change being that we covered gaps in which people were left out of coverage because they did not qualify for existing social programs but did not have enough money to pay for insurance and care on their own.

The Republican opposition offered little to nothing in the way of reform except resistance to any measurable change (if I am wrong here, send me the evidence) in the then current unsustainable and unfair system.

The only thing we are left with is to see if Obamacare works.

Well, I suppose there is some chance that in the coming elections we could wind up with enough Republicans and/or Tea Partiers that Obamacare could be altered or done away with.

If that were the case, I have to wonder if the American people would be satisfied with what would likely happen: everyone on their own, you get the kind of medical care you as an individual can pay for.

That might not be good for the health of our society and would not be good for our productivity either.

P.s.

It occurs to me that an alternative might be to retain the requirement that all purchase health insurance if somehow real competition in the marketplace could be created or assured. And maybe that in essence is what some Republicans have suggested (maybe not the government mandate part, except the mandate would exist as a practical requirment for survival, nonetheless). But it is not the role of private enterprise to provide equitable and fair service to all. It is the role of private enterprise to make the most money it can. Private enterprise with a strong middle class is the model that has provided the highest standard of living for the most people in history and it is the model that has led to what we consider democracy in the western world. But the alarming inflation in the cost of health care is in itself a threat and a cause for the erosion of the middle class. Sometimes even in a free market individuals have to band together for the common good.

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.

————————————

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.

———————————————–

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.

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.)