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.