Friday, September 11, 2009

Obama’s Health Care Plan

Once again the antics of a clown are threatening our ability to have a rational debate. The sad part about it is I’ll bet the idiots in South Carolina that elected Representative Joe Wilson are applauding his making a fool of himself.

The speech provided a justification for Health Care Reform and a lot of promises. I got the why and the what, but, to be honest, it was a little short on the how.

I was actually glad to see some tough talk. He should have held up a picture of Sarah Palin when Wilson yelled out liar and said “oh, you mean her?”

He’s trying. Unfortunately the Republicans will probably figure out a way to crucify him for the effort and take the credit for anything useful that emerges.

In parallel with the speech I got an e-mail from the White House summarizing the promises and asking me to nudge my congressional representatives. I did nudge them but I already know that Scott Garret isn’t voting for any Health Care bill that he can’t put a price tag on.

The summary includes a lot of assertions. If all the assertions are true, it would be a wonderful thing. Unfortunately I see no evidence that all, or even most, of the assertions are in fact true. Here’s the list, with commentary.

If You Have Health Insurance, the President's Plan:

Ends discrimination against people with pre-existing conditions.
So who ends up footing the bill? Ignoring humanitarian considerations, pre-existing conditions pretty much guarantee the insurance company will lose money by insuring this individual. Someone has to pay for that red ink. The only way to make it up is to raise premiums for everyone else. It may be the right thing to do, but it will cost everyone else money.

Limits premium discrimination based on gender and age.
I have the same observation here as for pre-existing conditions. Actuarial facts don’t change and the only way to make up the difference is by raising everyone’s premiums. Nor am I really sure that in this case it’s the right thing to do. Why shouldn’t those with a higher statistical cost expectation pay more for health care insurance?

Prevents insurance companies from dropping coverage when people are sick and need it most.
Aha, the typical nefarious insurance company gambit. There are rules today that they manage to get around and I’m sure there will be similar situations tomorrow. Still, making some of the more obvious ploys illegal would be a good thing.

Caps out-of-pocket expenses so people don’t go broke when they get sick.
I don’t understand how this would work. Who pays once the cap is reached?

Eliminates extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money.
Preventative care makes good health sense but it probably doesn’t save money. Regular testing of everyone for everything costs more than the cost of the actual cases because usually only a tiny percentage of people actually contract any given illness. If you don’t pay a premium for elective care, guess who ends up paying for it? Do you notice a trend here?

Protects Medicare for seniors.
From what I’ve heard much of the funding is going to come from eliminating Medicare waste. While no one would argue that no waste or inefficiency exists in Medicare, it has been my experience that any time there is an attempt to eliminate waste and inefficiency, invariably there are some unintended negative impacts as well.

Eliminates the “donut-hole” gap in coverage for prescription drugs.
To be honest, I’m not sure what this means.

If You Don’t Have Insurance, the President's Plan:

Creates a new insurance marketplace — the Exchange — that allows people without insurance and small businesses to compare plans and buy insurance at competitive prices.
Can’t they do this today? Any number of sources exist that allow comparison shopping. Is it that this would make it easier? Sounds like a good idea but who pays for maintaining and managing it? Do insurance companies pay a fee to be included? Do companies or individuals pay for using it? Is there a sort of “finders fee” if someone buys insurance from the Exchange?

Provides new tax credits to help people buy insurance.
Again, somebody has to pay for this.

Provides small businesses tax credits and affordable options for covering employees.
I hate to sound like a broken record, but again, someone has to pay for this.

Offers a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice.
This is far and away the trickiest part of the whole idea. If this is a true option of last resort that no one in his right mind would chose when there are other options, then it might work. The biggest potential problem that I see here is that businesses on the edge can’t be allowed to drop health care, or water it down so much they force their employees to prefer the public option, in order to cover some of their red ink. This is dangerous, but probably necessary.

Immediately offers new, low-cost coverage through a national “high risk” pool to protect people with preexisting conditions from financial ruin until the new Exchange is created.
This sounds very similar to the “high risk” auto insurance pools. But, two points, first people insured by the high risk auto insurance pools pay massive premiums and still the insurance companies lose money on the pools. Would you like to guess who makes up for the red ink? You got it, all the rest of us.

For All Americans, the President's Plan:

Won’t add a dime to the deficit and is paid for upfront.
Sorry Barack, as much as I love ya man, I don’t believe this at all. This conclusion could only be reached by looking at the issue through special rose tinted Washington D.C. glasses. None of us that live in the real world are buying this one.

Requires additional cuts if savings are not realized.
Additional cuts where?

Implements a number of delivery system reforms that begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality.
Any cost improvements usually take a while to be realized. In the short term this probably means cost will go up before it goes down. Still, it’s probably the right idea in the long run assuming the system reforms actually work.

Creates an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system.
Oh boy, another coffee klatch of bureaucracy. No, only kidding. Actually this might make a lot of sense.

Orders immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine.
This is definitely a good idea. How about we break this one loose and pass it on its own so we don’t have to wait until the rest gets ironed out?

Requires large employers to cover their employees and individuals who can afford it to buy insurance so everyone shares in the responsibility of reform.
I agree with the rationale behind this idea. It’s like requiring auto insurance. It protects everyone else from having to foot the bill because someone is trying to play the system.

So what’s the bottom line? The bottom line is there is no question in my mind that this is essentially a Socialist policy intended to spread the costs for the few among the many. Personally I don’t see a problem with this for two reasons.

First, it’s simply the right thing to do. Period, end of discussion, we’re not talking an enormous amount of money that would have to be chipped in per family because it would be spread among so many. If it costs me an extra $100 a year or so to help those who need help, then so be it. If helping out our friends and neighbors who, for whatever reason, can't get adequate health care on their own is Socialism, then so be it. Just make damn sure that you don’t degrade my health coverage while we’re at it.

Second, I don’t like being ranked 37th in health care by the World Health Organization. That’s just above Slovenia and just behind Costa Rica. Yes, you heard that right Virginia, Costa Rica is ranked ahead of the United States in health care. That’s despite the fact that we spend the most on health care per capita. Yes, that’s right; we spend the most money on health care and end up in 37th place.

Would you like worse news? One of the major factors taken into account in considering the adequacy of health care is the rate of preventable deaths per 100,000 people. In a recent study of 19 industrialized nations supported by the Commonwealth Fund the United States placed dead last. Allow me to repeat that, dead goddamned last.

Now here’s one more for you. Let’s talk about infant mortality rate. You know, that thing that’s such a big problem in third world countries? Well the U.S. is ranked 46th according to the CIA World Factbook.

Would you like a list of some of the 45 countries that do better? How about Cuba at 44th, Portugal at 30th, Slovenia at 19th, the Czech Republic at 14th, Hong Kong at 5th and Singapore at #1.

I’d like to also point out that this is not a matter of a fraction of a percent here or there. The U.S. has 6.26 infant deaths per 1,000 births. Singapore has less than half that many at 2.31. Cuba, goddamned Communist Cuba run for 50 years by a frustrated baseball pitcher, has an infant death rate of 5.82. WTF guys? What is wrong with this picture?

The next time some right wing yahoo claims that our health care system is the envy of the world and Obama is trying to destroy it, tell him to STFU and check the facts.

Reform is necessary. Get that through your heads. “Do nothing” is not an option here. As for the Republican Party, how about you guys stop being obstructionist and help get the job done? I don’t trust the Democrats to come up with a plan this complicated and expensive without adult supervision.


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