Could we just go to single-payer for health care and be done with it? The goal should be public health not profits…

June 28, 2017

NOTE: All I’ve changed on this post is the headline. But really no matter what, the government has to be involved in health care in order to ensure everyone has it and we all pay one way or another and unless you just say every man and woman for themselves and to heck with poor kids, why not single-payer (government) or socialized medicine? Is it the name that bothers people?

 


 

 

You know, ultimately single-payer healthcare, that is where the government pays for everything, might just be the way to go. Yup, what was once labeled “socialized medicine” or maybe “communism”.

I mean how else are we going to make sure everyone gets healthcare? (that is if we care if everyone gets healthcare.)

And let me go back, I did not mean we should go communist. But that pejorative was once tagged on anything conservatives opposed. Since the Soviet Union, the first nation to ever try communism, no longer exists, and since most of the few remaining communist regimes have resorted to at least some capitalism, socialism has replaced communism (which itself is a form of socialism) as the common pejorative used to oppose anything that does not please über conservatives.

So anyway, former president Barack Obama tried to come up with a way to provide health care to all via the Affordable Care Act, commonly known as Obamacare. I don’t know what his original intention was but it became a compromise between socialized medicine and the capitalist form of private insurance.

But the conservatives, especially the more modern reactionary no-compromise variety, it seems to me were nervous it might actually work and from the start fought it tooth and nail and spread what might be a big lie that it was a disaster. For sure, there were problems. And for sure health care costs have continued to go up. And for sure, still, not everyone is covered.

But I don’t intend to go into all the detail and complexity of the issue, except to note that it is indeed complex. There are a lot of players: the health insurance industry, the medical practitioners, the hospitals and other providers, drug companies, health care workers, and maybe many more.

Not everyone wants the same thing.

But here’s the deal. The goal of the lawmakers and the president should not be to satisfy the various special interest groups but instead to provide health care for all but in an efficient manner that can be economically sustained of course.

We are told that other Western style democracies seemed to have figured out how to do this but for some reason the United States is unique and therefore cannot just copy them.

Single-payer would be costly for the government no doubt. But all methods are costly and we citizens end up paying one way or the other.

It has often been easier, and maybe still is, for the indigent to get medical care than many so-called working poor or even lower middle class, who may not have access to a traditional employer-sponsored group plan, but who do not qualify for government help. But even with that those same people pay for health care for others through their taxes and the costs incurred by an inefficient system that are passed on to them by way of fees.

Also, people with group plans or even purely private plans have had to pay for care for those who could not afford care by way of taxes and the burden on the system that results in higher costs for everyone.

And all I am trying to say here is that in a responsible, civil, and humanitarian society we will continue to make sure that people don’t go without health care, even with the costs it entails.

I heard Kentucky Senator Rand Paul (a Republican with libertarian leanings) say that he thought both Republicans and Democrats want the same thing, basically universal health care or access to health care for all, but disagree on how to get there. And I did of course paraphrase what he said. It seems he is certainly right and in fact within the Republican Party, who has complete control of both houses of congress, there is quite a split.

It’s been said often that the Republicans never did have something workable to replace Obamacare, and now they seem to be caught in a trap of  their own making.

One idea Republicans often promote is health-savings accounts. The idea is that people could then decide to put money back tax free as kind of their own self-insurance. Not a bad idea really, at least conceptually, except if you had enough money to fund an adequate self-insurance fund, you would not need the tax-free savings account, it would seem. Such savings accounts might be adequate for normal medical expenses such as doctor visits perhaps — even then, though, it would seem they might eat up a major portion of the average person’s salary.

I have heard the argument for taking private insurance companies out of the picture, that they just add a layer of bureaucracy and expense. Hmmm, I wonder. Not sure. Unfortunately there will always be a bureaucracy, private or public. We might have more control over a private bureaucracy via the free market. But I am not at all sure about that.

I personally am at that stage in life where I am covered by Social Security under Medicare and I pay for a private supplement. I had employer-subsidized plans in the past and nothing in the way, way past.

I do think it is probably best that all people be required to have insurance, as is the case when you drive a car. It is not practical or fair that someone goes along and pays nothing but then expects to be covered and get top care or care at all, while others act responsibly and pay their premiums. Supposedly if everyone paid premiums the costs would go down or be controlled (would they?).

But at the same time it is wrong to force people to pay for something they cannot reasonably afford.

Having the marketplace determine the cost of health care also seems problematic to me. Personal health care is not something easily worked into a free market. You cannot know exactly when you will need it or what type of coverage you might end up needing and when. And you can hardly force private entities to take a risk that they know is not wise — such as covering people no matter what their likelihood of getting ill or their existing medical history, unless you subsidize the risk taker. A single-payer government insurance or health coverage would not have that worry. It’s concern would be helping people, not making profit. But of course it still has to be paid for somehow, and the marketplace does offer some efficiencies.

So the conundrum: private or public. We tried a blend and may have not given it a chance.

But as far as I am concerned, we should kick the special interests out of the congressional halls, kind of like Jesus kicked the money changers out of the Temple (and I will surely be corrected on that one).

What is good for the people is the important thing.

p.s.

The irony of ironies in the current stalemate on healthcare is that many of the Republican lawmakers who have pushed so hard to repeal Obamacare have found that their own voters depend upon it or something like it. Ooops.

ANOTHER AFTER THOUGHT: Even in Democratic Party-dominated California where both the legislature and the governor’s office are in the party’s hands, single-payer healthcare is being stymied. Maybe the will for universal care is just not there yet, but unless the Republicans at the national level come up with an alternative, I think it one day, not so very long into the future, will be.

 

 

 

 

 

 

 

 

 

 

 

 

 


GOP inadvertently pushing U.S. toward real universal health care (maybe)…

May 3, 2017

UPDATE 5-7-17

NOTE: I add this addendum to my last post:

 

The Democrats had the power to finally give us universal health care when they held the majority in congress during Barack Obama’s initial term it would seem. But for some reason, maybe fearing it sounded too socialist (we used to say “communist” back in the Cold War days of my childhood) or worse yet “European socialist”, they opted for some tortured melding of public and private insurance and let the health care industry or insurance industry write most of the legislation. The public option, which had been discussed, was dropped.

It’s hard to make health care universal if private enterprise is running the show. Private business depends upon profit. And it is just not possible (I imagine) to write insurance on the private market that covers all for affordable prices. And if people cannot afford it or are not willing to pay the cost, then it is not universal — a vicious circle indeed.

For my money, so to speak, I wish the politicians tried to represent the public in general and left the health care industry out of it all. The idea should be how to help people have good health, not how to optimize profits for business. Now I realize the argument is that business has to be the number-one priority because it is the provider.

Well yes and no. Everything does cost money in this world (even in socialist systems). And unless the whole health care conglomeration from doctors to pharmaceutical labs was run by the government we are dependent upon the private sector. But let’s get back to the fact that the goal should be to make health care available to all (and if you do not believe that then don’t even bother reading any more — I can’t offer anything).

I say let private industry be private industry. One caller into a talk show I mention later in this post identified himself as a doctor who received training in Europe. He cautioned people to realize that universal health care European style is as he described it two-tier. There is public and then private. Basically those with enough money can get speedier (better?) service and everyone else at least has public health care. And I think he said that some people take advantage of both. If it is something not so urgent, they use public health care, but if it is urgent (or perhaps requires more expertise) they go the private route. He said some hospital doctors actually spend part of their day doing public work and then part of it doing the more lucrative for-profit work.

He also said that as far as the cost of medicine it is true that it is much more expensive in the United States than other places in the world but he claimed that such was the price we pay for rewarding development of breakthrough medicines that come primarily from the U.S.

So I myself don’t have much to add to that, but I would suggest maybe we here in the U.S. we should develop a universal health care system that is totally separate from the private system. And the rules for it should be made without the influence of the for-profit people. And I wrote more than once during the pre-Obamacare time that since the government issues medical licenses to doctors a requirement for that license should be a certain amount of pro-bono medical service.

Oh, and I know the concern expressed by anti-universal health care people was once the government got involved it would use its pressure to nuzzle out the private industry. But I think the private sector would always have a place. A major advantage of private enterprise is that people have access to top professional care because money talks. Not only rich people but people willing to invest (not everyone uses money in the same way) in private health insurance have access to the best care.

But that does not mean there cannot be a strong public health care sector too. If enough people are willing to pool their resources via taxes then they can have a tip-top system of universal health care.

That talk show host I mention is right wing and he seemed to lament that it looks like as far as health care goes we are going down the socialist path. Even people who identify as right wing or conservative these days still seem to accept the need for government health care. The talk show host asserted that people just don’t want to pay for their medical care. That might be true for some people but I rather think people just want a better deal.

President Trump has been all over the board on the issue and displays no knowledge whatsoever of it in reality. He only uses it as a political wedge. He used the defeat of Obamacare as a major campaign issue — not so much as Obamacare was so bad but that it symbolized the work of our first black president (that via innuendo), elitism and liberalism, and was a way of using racism as a wedge without having to mention race itself. Ironically though, it seems that Trump supporters or at least a lot of the Republican electorate does not want to give up its Obamacare (it just wanted to be against anything liberal and anything that symbolized the frightful black presidency without saying the frightful black presidency).

Enmeshed in their political party’s civil war, the Republicans after many tries finally this past week managed to push through their legislation to repeal and replace Obamacare in the House of Representatives. By all reports it takes away coverage from vast numbers of people and is highly unpopular (even within the GOP). It faces an uncertain future in the Senate. It may be amended. It may die there. It may also get the Democrats back in control of congress (unless they snap defeat from the jaws of victory as they are wont to do).

To confuse matters, President Trump just lauded Australia for having a better health care system than we have. They have, dare I say it? what we used to call (back in the Cold War days) a form of “socialized medicine”. They actually use our term of Medicare, and it co-exists with private health care.

Actually it was brought out during the last presidential campaign that Trump years ago had supported single-payer health care (government paid universal health care).

Wouldn’t it be ironic if Trump of all people was somehow, if inadvertently, responsible for finally moving us into universal health care — real universal health care?

The GOP might rue the day it made Trump its man (more than it already is ruing it).

WHAT FOLLOWS IS MY ORIGINAL POST ON THIS:

Health insurance is unique among insurances, isn’t it? I mean you can’t buy fire insurance when your house is already on fire — I don’t think you can buy earthquake insurance when the ground is already shaking or flood insurance as the water pours in, but I’ll be darned if people don’t buy health insurance or try to when they are already sick.

But we want to cover everyone for medical needs so the Obama administration pushed through Obamacare and it mandated that private insurers cover pre-existing conditions, among other things. To deal with that risky proposition insurers raised their rates.

That would seem to make sense. But raising insurance rates was not the goal of Obamacare.

(And I think there is some question as to whether or how much effect Obamacare has actually had on insurance rates but the going narrative is that it caused them to spike.)

Some providers are calling it quits citing the strain that risks imposed by Obamacare are causing.

With the mandate that everyone buy insurance (and premium subsidies offered some by the government) a lot more people than previously had been the case signed up for health insurance, thus bringing into the pool a lot of people with health problems who could now file claims.

Lest anyone reading this far think that I am trying to make a case against some type of government health care program, such is not the case. Actually I think in our modern, technologically-advanced and democratic (small d) society indeed health care should be a right, not because it is a natural right but because the consensus is that it is the decent and practical thing.

But private enterprise is hobbled by profit and it is difficult to make a profit by being forced to take bad investments or bets. It’s a bad insurance bet to just cover anyone without being able to at least jack up rates for high risks, and if a person has already been diagnosed with, say, cancer, it is no longer a risk, it’s more like a gift. But someone has to pay for that gift and that is all of the other customers, via higher rates.

Now I am already perhaps over my head in this, but I think I am correct in saying there was an attempt under Obamacare to create some type of high-risk pools that would somehow lessen the burden on the average insurance rate payer and the insurance providers. But Republican governors did not want the Democrats’ health plan to succeed so many did not play along.

And fast forward into the world on President Trump and several times the Republicans who won the presidency in part by beating the straw man called Obamacare have tried to pass a bill to repeal and replace Obamacare and have come up short, even though they have majorities in both houses of congress and have the presidency (actually they have been trying to defeat Obamacare for several years but it has become more popular under the threat of its demise). Their party is divided among those who really don’t even care for the idea of the government being involved in health insurance (except possibly for congressmen and senators) and the more moderate Republicans (and hooray there really are moderates in the GOP), who have some compassion and feel some need to address the needs of common everyday people who are their constituents.

(Oh, and as I write this, the GOP is giving one more try to repeal and replace Obamacare before congress goes on recess.)

I’m paraphrasing here but radio talk show host Tom Sullivan in puzzlement over why the GOP cannot seem to pass the bill on Obamacare replacement wondered why instead of doing something to help their constituents, something to help the public, legislators are afraid to pass such a bill for fear of losing their seats in congress. The only thing I can read into that is that congressmen must look at what is good for the people they represent but at the same time know if they vote the wrong way lobbyists representing things like big pharma and health insurance providers will exert pressure to oust them from their seats via campaigning with cash and other methods for challengers to remove the errant congressmen. There is a flaw in our system that makes our legislators more responsive to special interests than to the people they are supposed to represent.

(Oh, and I want to make it clear for those not acquainted with talk show host Sullivan: he is a business-oriented conservative and not a fan of Obamacare. His show is on the Fox network but I would not hold that against him. I find him to be a lot more intelligent and discerning than most of his callers. Alas I do not agree with most of his politics but he presents good arguments from the business perspective.)

As to my personal opinion I still cling to the notion that an expansion of Medicare is what would work better in the United States.

We also need to look at hospital costs. Hospitals are kind of like big oil. No one seems to be able to pinpoint how they come up with their pricing. Actually hospitals are worse in that they do not seem to even be connected to any kind of market pricing.

 

 

 

 

 


Vote that big bad Obamacare out, oh, but now what?

February 24, 2017

I don’t know what to think about the raucous town hall meetings Republican congressmen and women are having back home where people are yelling at them to “do your job” and are objecting to them trashing Obamacare.

I mean Trump supporters would like to say that it is just a liberal activist dirty tricks thing where they are flooding the town halls with what they like to call “non-organic” protestors — in other words hired people, including outsiders.

I imagine that could be the case to some extent. I don’t know. But I also have to imagine the congressmen are facing real people who have come to the realization that the Republicans had no intention of providing anything that looked like universal health care. Health care is just a free market thing to them. You got the money, you buy the product. You don’t have the money, do without.

I don’t even know what “access to health care” means. That is what some Republicans say they want to guarantee. You can’t have access if you don’t have the money.

Personally, I am not dependent on Obamacare at this time but that does not mean I would be willing to leave others without health care. Even if we are as cold as ice (and I hope that I am not), it behooves all of us to have a healthy nation. We need some form of universal health care. But for some strange reason our elected representatives could never quite get it together until Barack Obama came along. Obamacare, admittedly, even by its sponsors, was not perfect. It was a compromise of sorts. But it was a good start and it can be improved.

(And maybe after a lot of heated campaign rhetoric, using Obamacare as a straw man of sorts, the Republican majority in congress will just patch up Obamacare.)

But the Republicans don’t want to give the Democrats any credit so they just have sought to scrap the whole thing, seizing on the fact that some people got a shock when their health insurance premiums jumped up. And they also seized on the fact the government was trying to force people to buy plans that were controlled by the government. And some people may have even voted for Donald Trump over the issue. And some of those people may have come to the realization — now what? You see, the Republicans never had a serious plan to replace Obamacare. If they did, they’d have passed it into law by now.

If it were up to me, and of course it is not, we would just have single-payer health insurance financed by the government, which is really us. And maybe people who wanted something a little better, a step up to keep themselves out of over-crowded clinics, could buy their own supplemental insurance.

I have written previously and still feel that a better solution for the United States would have been to expand Medicare to cover all people, regardless of age, who could not otherwise afford health care. Of course the rub is determining eligibility. And no doubt people would cheat in some way so they could get a free ride while others pay.

I think the problem is that no matter what, health care will always be expensive. There needs to be government oversight no matter what system we use. It seems that it is as hard to determine how health care providers, particularly hospitals, come up with their pricing as it was to figure out how the price for a gallon of gasoline is determined. The normal rules of supply and demand and the free market don’t always seem to apply.

Oh, but back to the Republicans: I thought that this was telling. In a CNN news clip of a town hall meeting by Republican Congressman Tom Cotton of Arkansas, a woman asked him that since he has promised to vote to repeal Obamacare would he commit to replacing it with something so people like her would not be left without coverage. His reply: “are there any more questions?” Kind of like: next question. The crowd roared at him, chanting “do your job”.

That does almost sound like he was set up. But he deserves it.

There is blame on both sides of the aisle for the health care debacle. On the one hand, the Republicans resisted health care reform because their tendencies are to represent those out for profit not necessarily the ordinary constituent. On the other hand, some on the other side of the aisle sneakily represented big health care industry forces (who dole out the money to politicians) and scuttled the idea of single-payer. One influential Democratic senator at least took millions of dollars from the health care lobby and had staffers with connections to the health care industry and was instrumental in scrapping single-payer and/or any public alternative and for inputting items favorable to the health care industry and big Pharma into the Affordable Care Act, or Obamacare as it is known. One of his staffers, it was reported, basically was the architect of the law and then went back to the health care industry as a lobbyist.

Pretty sweet for some private health insurance providers and drug companies — the government seeks to force you to do business with them and does not use its power to negotiate a better price for drugs.

And that often is how laws are made in this country — the special interests write them.

We might be better served if our congressmen and senators were simply citizens doing public service for a nominal salary — they would be people who had other jobs or who were retired — and who did not make a career out of writing laws. There would of course need to be rules blocking the big money influence of lobbyists.

 

 

 


Obamacare second high court victory is good, Republicans should actually breathe a sigh of relief

June 25, 2015

Even though I continue to be neutral on Obamacare I am pleased, very pleased, that the Supreme Court has made a second ruling in its favor.

In my mind the opposition is just afraid that it is working or will work and they are doing anything to stop it.

The court says that although some of the wording in the law, officially the Affordable Care Act, is sloppy, it was clear that the intent of the law was to provide all with healthcare or make it possible for all to have it.

Had the opponents had their way, federal subsidies in states that had not set up their own health exchanges but let the federal government do it would have been eliminated. The result would be counter to the intent of the law.

Now some opine that had the opponents had their way — and most of the opponents are Republicans — it would have had a negative impact politically with millions losing health care coverage. So some might think it would have almost been better, in a political sense anyway, for Obama to have lost this one. So Republicans really ought to breathe a sigh of relief.

But I am pleased that the act has been preserved.

I realize that so-called conservatives will always fight anything that smacks of socialism (and this is really not socialism in that it still depends upon the private market), but they need to get over this one.

What we really needed to do in my mind was expand Medicare and Medicaid  (although I cannot really say that would have not been without pitfalls).

Healthcare is vitally important to our society in order to keep it productive and to alleviate human suffering. Why are people against that? They are against the cost. But there is no free lunch either way. The old system clogged emergency rooms where people could get help when they could not afford a private doctor. And under the old system we have had a large portion of the society in poor health and not productive (this is still so, but hopefully it will change over time).

I will say that I have not seen evidence that Obamacare has done anything to cut down on costs — quite the opposite.

But getting everyone covered is the most important thing to me. I think there will be cost savings in that over the long run.

I don’t think fighting Obamacare is a good issue for the Republicans.


Wednesday’s high court hearing on Obamacare about politics more than law…

March 4, 2015

I want or wanted to write about the latest challenge to Obamacare, presented in a Supreme Court hearing today, and I at times past had thought I would have liked law school, but this has me wondering about that because I cannot seem to get a handle on this case, at least not in the legal context, other than it involves the seemingly literal interpretation of one clause standing alone in a voluminous statute vs. interpretation of the clause within the whole context of the law itself.

But what I do understand is the fact that the case is really just a continuing political struggle between those who believe in some form of universal health care on the grounds it benefits society as a whole and, too, is morally correct and those who apparently believe otherwise.

And more to the point, this is a political struggle between Democrats who tend to support all types of social programs to help the populace and Republicans who are somewhat less inclined to do so but who at the same time would support using public tax dollars to subsidize private capital (and I realize what I just wrote seems partisan on the liberal side of the equation, but I only mean to say we’re talking more of a political struggle here than prudent public policy).

—————–

And while going back over what I posted I read portions of the Supreme Court transcript from today (Wednesday, March 4, 2015) and got tired of wading through the legal gibberish and word play — I mean I know this is how law is decided, but  it seems to have little to do with coming up with policy to do good for the American people — form without substance.

But it occurs to me that perhaps what might result from this is that the high court will once and for all clear the challenges to the health care law and let it succeed or fail on its own. It seems doubtful to me that even this court with its conservative majority would end up handing down a ruling that would throw the whole system into disarray and cause trouble for all parties involved: supporters, opponents, and even the indifferent. I think a ruling is expected in June. Don’t know what the outcome will be of course…

——————

If it were only the fact that one clause, a few words, was sloppily written, it could be amended. But the opposition, all Republicans (isn’t that correct?), would rather gut the law. They do not believe in universal health care but rather health care for those who can afford it (and who thus “deserve it”).

Surprisingly, the conservative Chief Justice Roberts saved the day for Obamacare (the Affordable Care Act) in the last challenge, disagreeing with his conservative colleagues on the bench.

This time around his position is reportedly unclear because he had virtually nothing to say. However, conservative Justice Kennedy (who has a history of going between the conservative and liberal sides, a swing vote) seemed to indicate, according to reports, that he might not go along with the plaintiff’s arguments challenging Obamacare. No one knows what is in his mind, or course.

The troubling thing in all of this is the fact that history so far has shown that Republicans as a whole have no desire to implement any type of health care program (except of course Romney did on the state level but opposed it on a national level, but conservatives don’t trust him anyway). Obamacare opponents have presented no credible alternative plan that I am aware of.

I personally continue to think it would have been wiser to expand Medicare to cover those who could not be insured otherwise due to economic inability.

And I have little patience for those who simply just wait for something bad to happen to them with the idea that if worse comes to worse they can check into an emergency room and the taxpayers will foot the bill but in the meantime pay nothing. Someone has to pay for them.

I also think it is important for health care consumers to have to pay something or sacrifice something — you need to have some “skin in the game”, otherwise you tend to waste vital and scarce resources.

There is no such thing as free health care. Someone pays for it.

So in summary, the current challenge, as the last one, is all politics and has little to nothing to do with constitutional or legal issues.

If congress as a whole was more responsible, it would have not passed such a complicated law which its members did not understand in full and at the same time would be ready to amend it if there are inadvertent errors in it.

In the end, though, voters may have to step up to the plate and make their desires better known.

Because they don’t, congress responds to the pressure of big money and special interest groups and lobbyists.

P.s.

I did not bother to summarize or brief the exact case in question here, although perhaps I should have. I may go into more of that with my opinions later, but for now the above seemed the important issue.

P.s. P.s.

Well I read paragraph after paragraph of the petitioner’s brief or whatever (the argument supporting the Obamacare challenge) and it just makes one’s head swim, or at least it does mine — and that is not to say there is no merit. So then what?

I mean what the challengers really want is to end Obamacare. So let congress do that legislatively (not that I would support that).

And I can’t seem to end this post because I failed in consolidating the issue into something understandable.

It does seem apparent that a lot of things were said to make the hard sale on the bill that ultimately became the Affordable Care Act, or Obamacare. Opponents charge deliberate deception. They found a whole in the whole program via one clause and hope if interpreted their way it will in effect gut the whole program.

 

 

 

 


Latest high court ruling shows a problem with health insurance tied to work…

June 30, 2014

Note: I’ve dashed this off without really knowing the full extent of the latest high court ruling on Obamacare, that is exactly who it applies to, but I can revise later. The points I have below would apply anyway I think. Okay, now I’m reading that this was a narrow ruling that only applies to certain for-profit religious run or connected corporations. I’ll take the easy way out here and add this partially explanatory excerpt from an NBC News story: The U.S. Supreme Court, in a limited decision, ruled Monday that closely held, for-profit companies can claim a religious exemption to the Obamacare requirement that they provide health insurance coverage for contraceptives.

For-profit corporations — including Conestoga Wood of Pennsylvania, owned by a family of Mennonite Christians, and Hobby Lobby, a family-owned chain of arts and crafts stores founded on Biblical principles — had challenged a provision of the Affordable Care Act.

——————-

Now back to my own words:

For most working people it is a somewhat uncomfortable but accepted fact that employers pretty much run their lives — even more than government maybe.

They determine what days you work and how much you work, either not enough or too much, and how much you will get paid and therefore what kind of lifestyle you can live.

Now with the latest ruling from the U.S. Supreme Court, employers have even more control, especially if you are female. Since so many people have their health insurance through their employment, employers can now decide whether you will have access to birth control. The court has in effect revised an Obamacare  provision requiring employer health plans to provide birth control provisions — in some cases (some) it can be ignored on religious grounds.

The controversy arises from the objection of employers who have religious convictions against birth control, as in God wants you to be fruitful and multiply.

I’m not sure but what I don’t agree with the court on this one — well actually now I have just hurriedly scanned the opinion and may change my mind. I mean you can’t just not follow the law of the land by claiming religious exemptions for things you don’t agree with, such as paying taxes. Anyway this all demonstrates a problem with having your health care dependent upon your place of work. Health care has come to be seen as a right and Obamacare seeks to implement that right. But why should employers be able to mess with that right? But then again why should employers be in the health care business anyway? I know it all began after World War II when employers in boom times were adding incentives to attract workers and health care was one of them.

But these days the world is more complex and health care has expanded so much and the costs are so high and the work place has changed — so many more women in the workplace for one thing — and the nature of work has changed. People are often forced to move from one job to another and unemployment runs high. It sometimes is difficult to have continuous health care coverage on the health insurance attached to work scheme of things.

And now if the employer can determine what you will be covered for and what not — really that is not practical or even right. But I agree I think that an employer should not have to violate religious convictions, except that maybe that is what the employer takes on when the employer hires from the general public who have First Amendment rights on religion.

And are we talking about employers as individual real people or the imaginary personhood of corporations? That is another subject. But from my limited understanding of constitutional law the personhood of corporations is merely a legal device to confer certain rights and protections in business dealings and should not be construed to confer all the rights upon a corporation  — which is nothing but a set of legal documents — that a real live human being has (except the majority on the high court and Mitt Romney believe corporations are “people too”). But like I say, that is another subject.

So to sum it up, I think health insurance tied to one’s work can be problematic.

P.s.

Here is a link to the ruling:

Click to access 13-354_olp1.pdf

 


Government commits fraud in Obamacare in California (and this is not your typical anti-Obama rant)…

February 9, 2014

So I was travelling down the road in my big truck and listening to 1070 on the AM dial out of LA and all day long they were repeating this story that Covered California, the state’s health insurance exchange under Obamacare, had taken down some list of insurance companies and doctors that their policies worked with because the list turned out to be bogus. I mean people signed up for the insurance, paid their premiums, and then found out the doctors listed were not approved by their insurance. But Covered California is not going to be helping them get any refunds. Well that is outright fraud.

I at one point promised to study up on Obamacare but it is just too convoluted. The good news for me is that so far I don’t seem to be affected by it, at least not directly (I don’t have to navigate the website or do anything). I still have my employer-sponsored coverage (for which I kick in a way too hefty sum) and through some odd quirk (which I need not explain here at this time) I am also on Medicare (some say I am crazy to have both — but all I know is that when I show my cards to the doctor offices it sure seems to satisfy them. I still get bills. And I do a novel thing. I pay them. I think, or I would hope, they are happy with that too).

Now I still think even with all the problems or at least purported or reported problems, Obamacare may in the long run work fine and become sacrosanct as Social Security, but I also think that it was overkill. The problem was that some people could not get insurance. So help them already. But the federal government has interfered with the marketplace for all and may have screwed things up for all in the process (and don’t I sound Republican, and I am not). And then I keep reading or hearing these stories that there are people somehow caught up in a catch 22 in which they cannot afford insurance but also are offered nothing under Obamacare — this was not supposed to happen. I know that problem supposedly has something to do with some states opting out of Obamacare or the Medicaid expansion or something (a Republican tactic to thwart Obama’s signature legislation). I really don’t care. It just sounds like an incredibly reprehensible and absurd situation that only politicians could have created.

Now I have often written that I would prefer or thought it would be better to have some kind of single-payer insurance funded by the government for everyone. It is hard to have an open market in medical coverage because it tends to lean toward monopoly and there is no realistic price setting structure. But the reality in the United States seems to be that we will continue to resist so-called “socialized medicine,” notwithstanding that many would say Obamacare is a major step towards that or is that.

The problem was that President Obama and others who wanted some type of universal coverage guaranteed by the government or provided by it could not figure out how to get it done without the help of the medical insurance establishment. The insurance establishment captured them — some politicians joined the enemy and became lobbyists for the enemy.

And that is the problem. As long as we have people trying to be representatives of the people not with the purpose of public service but instead to line their own pockets, the interest of the public at large will not be served.

I have suggested before — but have been a little hesitant, but I no longer am– that political office should not pay a salary, only a stipend. There would be a danger of paid staff filling a power void with their institutional knowledge, but the people’s representatives would have to be intelligent and vigilant people themselves who could thwart all that.

Maybe that is impractical. But when I read about the Obamacare mess as I described, I just feel like throwing up my hands or just throwing up.


Obamacare false promise could be biggest political blunder ever…

November 18, 2013

Sometimes someone says or writes something that I just can’t put into my own words better (well quite often), so with that in mind I just have to dash off this quotation ripped right out of an article in the Huffington Post, with attribution following:

“The ancient Greeks liked to say that character is fate. The colossal mess that Obamacare has become reflects both the character of the legislation and that of the president who sponsored it. The Affordable Care Act, as a government mandate for people to purchase private insurance with an array of possible subsidies, had too many moving parts. It was an accident waiting to happen. As many of us wrote at the time, Medicare for All would be simpler to execute, easier to understand, and harder for Republicans to oppose. But this was not to be. Instead we got a program that was poorly understood by the public because it was almost impossible to explain and even harder to execute.”

Those words were written by Robert Kuttner, co-founder and editor of “The American Prospect”.

I have not even read the entire article. I am going to in a minute and then later add to this post. I still have hope for Obamacare at this time but continue to be amazed at its poor implementation and sometimes ask myself: “what were they thinking?” And I am glad to hear that others were thinking: “why not Medicare for all?” (well, I actually have suggested an expansion of Medicare for those who could not get insurance any other way).

And now I will finish that article…

Well, that was quick. I read it and it was interesting. If I interpreted it correctly on first read I think one of his points in the body of the piece was that comparing Obamacare to the success of Social Security and Medicare was not an apt comparison because the former were public public, while the latter is something called private public, in that Obamacare is a partnership and really a subsidy to the private insurance industry.

And in my own words I would say that, yeah, private enterprise can be more efficient at times (and maybe most of the time), but it has to stand on its own two feet and be private.

And I am tired of writing about Obamacare and will move on to something else soon.

Okay, one more thing: if Obamacare falls, it’s death knell will have been the cancellation of private insurance policies despite the claim by Obama that such would not happen. It does not matter if it is only a relative minority that affects or whether in reality they could get better and more cost effective insurance via Obamacare. The argument that Obamacare would destroy private insurance, would be a government takeover, a move toward total socialism, was one of the primary weapons Obamacare opponents have used. They have to be overjoyed that in some instances their projections seemingly are coming true. This could go down as the biggest blunder in politics ever. If the Republicans did not have so many crazies in their party, they could already count on total victory. And they might wise up and clean house yet.

P.s.

Here is a link to the full Kuttner article: http://www.huffingtonpost.com/robert-kuttner/obamacare-republicans_b_4293314.html

P.s. P.s.

And to add insult to injury here and through the magic of the computer I go forward in time from when this post was originally posted to now on 11-19-13. I just read a CNN story that says that President Obama cited an Affordable Care Act success story involving a woman in Washington State. But then, and we go to the story:

From CNN:

But in the days that followed that presidential shout-out, Sanford received letters from Washington state’s insurance exchange, notifying her she did not qualify for a tax credit she was originally told she would be getting.

After looking into Sanford’s matter, officials with the exchange admit they made a mistake calculating her benefits, along with those for thousands of other Washington state residents.

“The Exchange would like to sincerely apologize to Jessica Sanford and all those affected in Washington State by this error,” Washington Health Benefit Exchange CEO Richard Onizuka said in a statement provided to CNN.


All ills or changes in the health care market blamed on Obamacare; free market is great but does not work for everything…

November 14, 2013

I did not watch the president on TV this morning announcing possible changes to his Obamacare but of course I am familiar with the whole story.

Here’s what I think. The free-market conservatives are right in that you don’t want the government trying to take the place of the free market. You really cannot have a free market, capitalism at its best, when the government steps in to run things.

But the free or open market does not always fill the need. If people cannot afford something they really need, such as health care, the market itself is not going to be there for them. So the only choice left without government health care coverage is to cut back on one’s health.

So sometimes the government does step in. That is why we have Medicare, for instance. If the marketplace simply took care of that we would not have Medicare.

Obamacare actually uses the open market with its health care exchanges, but our whole health care/insurance system is highly complex and convoluted. It just evolved that way.

Opponents of Obamacare, or technically the “Affordable Health Care Act”, started their propaganda war early, before it became law, and have been inundating us ever since. A lot of people have no idea what Obamcare is about or what it intentions were, they just know from all the propaganda that it is bad and if they have any problems with health insurance it’s because of Obamacare.

And there is no doubt there is mass confusion out there. And to some extent I am sure that Obamacare has caused problems for people. But I also can see that just the word “Obamacare” is thrown around by people trying to explain away things, sometimes out of ignorance, sometimes laziness, and sometimes malice. I know someone who was told she could no longer use the free health clinic she had been using. She was told it is because she is on Obamacare and they don’t take it.Come to find out it was because she did not qualify because she had moved and lived in a different county. She is not on Obamacare anyway.

Another woman I am somewhat acquainted with was told she could no longer get a medicine she had been taking because she is now on Obamacare. But as far as I know, she is simply on Medicare (which is not affected by Obamacare), and that is not Obamacare. Now there could have been changes in her Medicare, but she is still being misled.

At my own doctor’s office I was asked to sign a notice about some new policy. When I asked what it was all about the receptionist said: “it’s just an Obamacare thing.” Actually I don’t think it was. I think they were simply telling me that they would no longer handle Medicare Advantage plans, which were initiated under the George W. Bush administration (No problem to me. I am not on that). According to a Medicare website (not the Obamacare website), Advantage plans are still acceptable under the new law — but apparently not at my doctor’s office.

That is not to say that Obamacare is not messing some things up. I am not sure but whether I may be affected. I’m going through some changes right now in my own health insurance situation and I have that on my mind. I should know, but to tell you the truth, reading through and trying to understand health insurance material is almost or maybe worse than having a root canal as far as I am concerned.

I have an appointment to see an insurance agent today. I am dubious about it. I have talked to him and others previously. I never do understand them. I don’t care what anyone says. Health insurance is not simple to understand. There are all kinds of limits and exclusions (notwithstanding Obamacare’s abolition of exclusions on pre-existing conditions), and percentages from this to that on one end of the bill and that to this on the other end of the bill, and coverage of some doctors and facilities and not others (and if you are really sick you often don’t have any way of deciding who takes care of you at the moment, especially if you are stuck in a hospital bed, and yet you can be told that one of your providers was not on your health plan). I mean why can’t we just be covered no matter what?

Personally I don’t think the profit motive is good for health care. But the reality in this country is that is our system and I don’t think we are going to change it.

I think the president has good intentions with Obamacare, but I am sad that he and his administration have bungled it so badly so far. If they don’t rescue it soon they will have not only ruined Obamacare but any chance of health care reform in the foreseeable future.

The Republicans are wedded to the profit motive. While they may or may not want a system where all get some kind of protection, their first priority is to protect profits.

Many people identify with that because they abhor or fear socialism. But some at least mild forms of socialism have been with us for a long time — Social Security being a prime example. If the free market could take care of everything we would not have Social Security.

I believe wholeheartedly in free markets, in capitalism. I also believe that the market does not work in some limited areas.


I’m trying to understand, but Obamacare becomes more confusing to me…

November 9, 2013

This Obamacare thing gets more confusing all the time. Now a story I read said that in some states that have opted out of Obamacare the working poor are caught, well just like they always are, with too much income to get help and not enough to purchase health insurance on the open market.

I had thought that although the Supreme Court had ruled that states could opt out, the federal government would somehow step in with expanded Medicaid offerings, but I guess if the state’s refuse that does not happen.

It’s really all very confusing. It’s like the message one Obama disliker acquaintance of mine (hate is an ugly word) sent me that showed Nancy Pelosi’s famous “we have to pass it to see what’s in it…” line concerning the Obamacare legislation and a doctor’s purported retort: “that’s the definition of a stool sample”.

I have been trying my darndest to give Obamacare the benefit of the doubt — but I’m having doubts.

However, I am pretty certain there are bogus or misleading stories galore about people losing health care coverage over it, well, even though President Obama now has apologized to any who have actually lost coverage, being as he spent a whole campaign promising that no one would. Starting his presidency with apologizing to the world for George W. Bush (and others) and now this, he may go down in history as the “Grand Apologizer”. And I really want to like him.

A long time ago I promised to read up on Obamacare. I failed in that. I am not going to apologize, though. I mean if those who passed it into law don’t understand it, I doubt I could.

There are some big positives in Obamacare, such eliminating exclusion of coverage based on pre-existing conditions.

And this law, this new way of doing health care coverage may well work out, but it is not having an easy run of it in the early going…

——————————

What follows is my previous post on health insurance:

Talking about health insurance, here’s one down and dirty:

For the second time in my life I face this dilemma:

I’m having to take some time off work due to health reasons. Problem is, my health insurance is tied to my job. I pay part of the monthly premium and my employer pays the rest. But if I can’t work my employer will drop my insurance because I will not be contributing anything from my paycheck, which I won’t be getting because I am not working. I can elect to pay the full premium myself but how am I going to afford to do that if I have no income, save for a woefully minimal one I might get on state disability (where I live, California, at least we do have disability insurance)?

Once before I was faced with this. But at that time I was in a job where my employer paid all the premium and continued to do so for more than a year that I was off work (that is not usually the case, though). Eventually, though, I was faced with the same dilemma I am faced with today. But as you can see, I survived. It helps to have family, and it helps to be on good terms with them.

Now don’t worry about me. I’m just using this as an example as to what is usually the case. I mean you have insurance through your job but when you need it because your are sick or injured and cannot work, you lose it, or are liable to, because now that you are not working you can’t afford to pay the premiums.

(And I am not addressing on-the-job injuries and worker’s comp. That is another issue.)

Having your health insurance tied to your employment is absurd, especially these days when so much employment is precarious due to the economy and all the constant changes and upheaval brought on by globalization.

To me, that’s a good argument for single-payer government health care. Of course it would not be free. It never is. But all of us pooling together and guaranteeing each other permanent coverage no matter what our current employment status is would seem to be far more practical. Oh, yeah, no one wants to government to run his or her health care because you can’t make our own decisions and government is not efficient. Well how many decisions do you make now? The private insurance companies make the decisions even more so than the medical professionals. And private insurance has to make a profit so it has to charge a lot more.

And all of this is not about Obamacare. I don’t know what to think of that. It may be a step in the right direction, albeit a clumsy one so far.

Personally I am not in any kind of crisis now. I was just using my own plight to make an argument or comment. I don’t want to go into my personal situation any further, other than to say I am still covered and have options.

From what few comments I have heard from just regular people, one of their main objections to Obamacare or any attempt at government health care is centered around having to pay for those who refuse to work but yet expect the government, and thereby the taxpayers, the working people, to pay for them.

Well here’s the deal. There will always be freeloaders and cheats regardless of the system. We need to strictly enforce eligibility standards. No able-bodied person who simply declines to work should get full coverage. We are always going to provide emergency coverage because that is our moral imperative.

We will likely have to let Obamacare play out. If the Obama administration does not get its act together it might die, but it can likely be made to work. But this deal of having your health insurance tied to your job is silly. I am surprised employers are not more in favor of unburdening themselves from it.

Hey, good health.