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.

 

 

 

 

 

 

 

 

 

 

 

 

 

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Talk about fake news, it appears most health insurance premiums did not soar due to Obamacare

March 9, 2017

I feel so guilty. My only consolation is that my blog readership is to put it mildly not huge. I think that I have casually written or implied that a lot of consumers saw their health insurance skyrocket as the result of Obamacare.

But a story in the New York Times today claims that in reality just 3 percent of the people on Obamacare had premium increases resulting from Obamacare. Hope I don’t get this wrong, but I believe those were people who were not able to take advantage of state insurance exchanges because their Republican-controlled state governments did not set up insurance exchanges.

The story said that, in fact, people on group plans through their employment did not see big jumps in their premiums (that is not to say their premiums did not go up somewhat, but that would be the case without Obamacare). It could be a lot of people just assume that any increase in their premiums is attributable to Obamacare.

Since I am not enrolled in Obamacare I am not personally attuned to the situation.

I think what seems to be a canard that Obamacare has caused insurance premiums to skyrocket has moved into a kind of meme. It is just a story passed on that has become a truth, even if it is not true.

Whatever the case is, monkeying with people’s’ health insurance from one year to the next just does not work. One has to have continuity and predictability in coverage in something ongoing like your health. And we all only have a precious little time on earth. We can’t just try out a plan and then the next month or year go to another model. We do not know when we will come down with something and we need to be covered at that time.

I do know that in all of my 67 years conservatives have been trying to prevent any form of what used to be called “socialized medicine”. If something even resembles it they are against it and no amount of reasoning will change their minds.

But depriving people of health care based on income is not only immoral but impractical. People not only need to be tended to when they are already sick or injured but they need preventative care that might save us all in the long run.

People deprived of preventative care clog up the public clinics and hospital emergency rooms and put us all in danger. So even if you have no sympathy for the less fortunate, you would be helping yourself to help them.

And now those anti-Obamacare folks can’t agree on something to replace it, when in reality it probably does not need to be replaced but instead improved.

When you have doctors and hospitals defending the existing Obamacare, you have to wonder why some Republicans are so all-fired up to repeal it — but not as fired up to replace it.

So if I have this right, Obamacare does not work as well in states whose Republican governments failed to go along with all the provisions of Obamacare.

And what we now know of a possible replacement plan from the Republicans indicates a lot more people will see their rates go up. Yes, this too could be wrong. It is a complex subject, as President Trump himself admitted recently.

We need to get it right.


Republican health care plan seems a bit cold hearted…

March 8, 2017

Really what this health care law thing is all about is a difference in philosophy between conservatism and progressivism.

You really don’t have to know much more than that to understand what the fuss is all about.

Conservatives in general think it is up to people to take on responsibility and pay for health care coverage themselves. They do allow that people have to have some kind of access to health care plans and that there needs to be something to choose from out there.

Progressives tend to think that health care is so important that no one should be left without it and they realize that not everyone can afford it on the open market and not everyone is fortunate to work somewhere where it comes with the job.

Conservatives think that people have to make hard economic choices and sometimes might have to forego other things they might want in order to buy health care coverage. Of course some of those so-called conservatives are in government and we pay for their health care. Others are people lucky enough to have good health care coverage though their work.

Then there is the military where health care coverage has been part of that life for a long time. I heard one caller on a talk show claim that he was a retired colonel and that he had good coverage though Uncle Sam and that he “deserves it”.

I think that pretty well sums up the feeling of a lot of people, even out of the military, people who have good insurance through work. They feel they deserve it.

I myself have benefited from health care coverage through work and nowadays benefit from Medicare and a supplement that I pay for.

Even though I think people ought to have some skin in the game, so to speak, so that the resources of health care, always expensive, are not over taxed, causing problems for all of us — I mean when you have to pay part of the cost, you tend to make more careful decisions — I also feel that it is best for society in a practical way for all to be covered. In addition it is the only moral thing to do, that is to see that all are covered.

And if a people decided they could get more efficient and less costly health care by banding together in a cooperative effort, why not?

Conservatives think the free market provides the most efficiency and the highest quality. I don’t know that such is true in the field of health care. Certainly it does provide incentives to providers. But it tends to leave a lot of people out in the cold.

What I am seeing so far in the Republican plan to replace Obamacare is the willingness to leave some people out in the cold.

And that seems cold hearted to me.

p.s.

Although single-payer insurance by the government would always be a tremendous burden on the taxpayer, does anyone think that health care on the private market will ever do anything but jump up in cost by leaps and bounds each year? I don’t know what the solution is. I do think, though, that health care is something that does not fit neatly into the normal economic laws of free market capitalism, or then again maybe it does, and that is the problem.

 

 

 

 

 

 

 


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.

 

 

 


Call it Obamacare, call it Republicare, Trumpcare, we need to maintain coverage for everyone…

January 8, 2017

CORRECTION: In my original post I wrote that the Democrats pushed through Obamacare (with Republican help) — I should have left out the Republican help thing in parentheses because a subsequent check of the history shows the final version of the Affordable Care Act, a.k.a. “Obamacare”, received no Republican votes. You can look up the history in Wikipedia and other sites of course — it’s kind of convoluted as most things in congress are. Anyway, I apologize for the error. I try to be accurate — in this I failed.


While I have never been an all-out supporter of Obamacare, I have always recognized the need for some type of universal heath insurance. All citizens need health coverage and it is to the benefit of us all that all citizens have it (and by citizens I simply mean residents of the nation).

Human decency should be enough of a reason. But also there is the issue that the health of one segment of society can affect the rest of us and a productive society must be healthy.

I do think it is necessary or at least helpful that users of health insurance have some skin in the game, so to speak, so that it is not abused, so that emergency rooms and doctors’ offices are not clogged with too many people seeking relief from every little minor ache and pain or sniffle or because they refuse to live a healthy lifestyle and abuse alcohol and drugs, although nothing is liable to control human nature as evidenced by the latter.

The intention of the Affordable Care Act, so-called “Obamacare”, was to provide universal health coverage and to try to hold down costs by requiring everyone to have insurance, thus enlarging the risk pool for private insurers.  And it was thought that involving the private sector rather than simply going to a completely government-operated program would soften resistance and provide the perceived advantages of the private sector. There have been two highly-popular, if not business-like provisions in Obamacare. One is that insurance companies cannot refuse insurance due to pre-existing conditions. In a purely private market this would be insane. The insurance business is the business of taking a risk. The insurer takes a gamble you will not need the insurance or at least not so many people will make claims all at once. Selling health insurance that includes treatments for cancer to someone who already has it, for instance, would not be a very good gamble. However, if everyone has to buy insurance then hopefully not everyone will be diagnosed with cancer and enough money can be brought in to pay for the claims of those who do contract cancer. The other popular provision was to allow adult children to stay on their parents’ group plans for a specified time.

But the Democrats, who pushed through Obamacare, did not win the election and now the Republicans are hot to do away with it. Why? Cynicism for the most part. I think their opposition is more symbolic than anything else. They think it smacks too much of socialism. But then again, so does Social Security. Anyone who ever tries to mess with that does so at his or her own peril.

Whatever, this health insurance issue needs to be resolved promptly, once and for all. You only live once, and the continuum of life does not stand still for breaks in health care coverage. One is not usually in the position of casually shopping for a health insurance plan, free of the threat something will hit him or her or a child in the un-covered interim.

Obamacare does have its problems. First there was the discovery that despite Obama’s explicit promise that “if you like your current plan (pre-Obamacare) you can keep it.” But some people found they could not keep a plan that no longer existed because it disappeared under the weight of Obamacare regulations. And then more recently, the cost of some of the Obamacare plans handled through state health care exchanges skyrocketed. It seems that the large number of sick people putting such a demand on insurance all at once, thanks to the requirement and opportunity to have health insurance, resulted in hefty and not-fully-anticipated rate hikes by insurers who did not drop out of the system.

I read an article in the New York Times that a survey among voters in the rust belt who voted for Donald Trump, who vowed to do away with Obamacare, found those Trump voters actually like Obamacare in general, but they are unhappy about the rising premiums, various uncovered expenses within their plans that have come to them as a surprise, and they don’t appreciate the logic of spreading the risk in the health insurance requirement.

Of course I could sum up the average attitude toward health insurance coverage: “everyone wants to go to Heaven but no one wants to die”. Or everyone just wants free coverage, period. Ain’t going to happen. Somehow it all has to be paid for.

Oh, also, the survey found that people thought it unfair they had to pay premiums while those on Medicaid did not. I can understand that. But then again, there has to be an advantage somehow to not having to depend upon Medicaid — one would think. I don’t think there is much of a percentage in being jealous of the poor.

I should mention, even under Obamacare we have not reached full-universal health care. There are loopholes that leave some without coverage.

It will be fascinating to see if the new administration and if the Republican-controlled congress can actually come up with something better than Obamacare. I would have thought simply improving it would suffice, but the Republicans have backed themselves into a corner by their anti-everything-Obama attitude. But President Obama himself has vowed to support any Republican plan that tops his own Obamacare.

He’s giving them more respect than they will ever give him.

p.s.

And remember, some of the most ardent opponents of universal health coverage were shamed into supporting Obamacare because they had their own cozy taxpayer-paid plan as members of congress.


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.


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.