Some Ammo for Health Care Reform: A Little Help for Your Friends

Pathetically but predictably, the health care reform debate is not focused on health care or reform, but rather on imagery meant to trigger our reptilian responses. In another article, I shall address what the "debate" should really be about (hint: improved health!), but in the public interest, in the hopes of lassoing crocodile frenzy before it totally consumes its young, I offer help for those struggling with friends and family who may be shaken by what has occurred during our own August recess.

This is not to suggest that those who already believe that health reform is designed to kill Granny, or that the government just wants to "take over" Medicare are salvageable. Rather, that there may be increasing numbers of people who do not buy the inflammatory rhetoric, but do not know how to respond (to themselves) otherwise.

Here's a little primer on addressing some of the most absurd claims:

1. The government -- i.e., not private enterprise -- wants to kill Granny. Let us get this straight. The government wants to kill Granny and, by implied contrast, private enterprise, that we all learned in Economics 101 exist for the sole purpose of caring for each and every citizen, will look out for Granny's well-being.

Is this the same private enterprise that sells death (cigarettes), needing to addict 15,000 new children per month just to maintain revenues? Or, is it the same private enterprise that resisted selling safe cars? Or, perhaps it is the same private enterprise that would never pollute our air or water, or, if they did, rush to clean it up before they hurt anyone? Or, maybe they mean the private enterprise that imported toxic toys for children? Or, the private enterprise that so generously donates candy and soda pop machines to public schools?

We actually do know the private enterprise they mean -- it is the private insurers who try not to insure people who are or may get sick, try to drop them from their rolls when they do, and deny every claim they can when they cannot drop you from their policies. That's the private enterprise that has been caring for you for years.

And what about the government? Perhaps the evil government they refer to is the one that determined cigarette smoking caused lung cancer in the first place; or the one that established pollution controls and standards for clean air and clean water; or, perhaps it is the evil government, out to kill Granny, that administers Medicare with less than a 5 percent administrative cost compared to 25-30 percent for private enterprise; or, the evil people at the Food and Drug Administration that ensure the integrity of the food supply and the safety (and potency) of drugs people take to combat illness?

Let us concede, however, that the government does deliberately kill people. It is called the death penalty. And, although the goal is not to have our own people killed, war usually does a pretty good job of ensuring people die. So, if Granny refrains from committing a capital offense, and does not -- like the Limbaughs and O'Reillys and Bushes and Cheneys and Kristols and Lowrys and Buchanans and Chamblisses who love war so long as they do not get called to fight it -- volunteer for the armed forces, it is not the government she needs to fear for her life.

2. We cannot afford it. Here's a shocker--we are affording it today, paying for it now. Hospitals, doctors, pharmaceutical companies are not giving away treatment and medicine for free. They are not printing their own money (although the word "scrip" is indeed in prescription). They are getting paid.

Now, how can that be? Well, if you are among the 260 million Americans who have health insurance, you are already paying for the 47 million who do not. Health care providers overcharge you assuming a predictable percentage of bills will go uncollected. You see, along with your insurance exec's Gulfstream, you pay for the uninsured with your premiums for those higher charges.

But, you don't mind, do you? Because they never called it a "tax."

If we get universal coverage, there will be no unpaid charges. Charges per item or service could come down and, therefore, insurance premiums could come down -- unless of course the insurance execs wants a company yacht along with the Gulfstream, or just to report higher profits, then they won't. Wonder what a competing public option would do? Hmmm....

And, by the way, there are huge savings to be had just from improved efficiencies of a system in which total costs count more than the cost of one procedure or drug or intervention.

The secret reason they never called part of your premiums a "tax" is that if we ever got health care reform, and premiums declined, or at least did not increase more rapidly than other parts of the economy, then we might have called it a "tax cut." And one of the "Old Rules" is the only the right wing gets to say the word, "tax cut." (Are you listening, Bill Maher?).

But, they are correct that health care costs are spinning out of control and that one of the purposes of reforming the system is to reduce those costs. One of the best ways of reducing costs is improving outcomes. More on that in another article.

3. Let private competition solve everything: Imagining a world without Medicare

Ok, to test that hypothesis, let us examine what our world would be like without Medicare. One possibility would be that the elderly would be insured privately and randomly in the same plans as the rest of us. Care to guess how high your premiums would be if your plan carried those higher risk seniors?

Or, suppose no insurance company really wanted to insure the elderly and they were without insurance. Then Granny gets sick. Who pays? Do you let Granny go untreated? Does Granny "allow" you go bankrupt, and deprive your kids, her grandchildren(!), of their college funds, to pay for her care?

Or, suppose there are insurance companies only covering the elderly? Their insurance premiums would be ... oh, doesn't seem to work does it? Very few would be covered since it would be unaffordable, so we are back to no coverage.

How about this? Your children can be covered to the age of 18 under your policy. What about your parents getting covered under your policy once they hit 65? Think we are back to sky-high premiums with that one.

I know, I know, I know (says Newtie), let's give each Medicare recipient a lump sum, and let them go out and buy private insurance with it. For starters, about 20-30 percent of that is no longer going into actual care, but into "administrative" costs, so their coverage would decline.. Then again, if a person is ill, the insurer may not wish to cover him; if there were a law against such discrimination, we are back to both skyhigh premiums few could afford and the contribution coming from Medicare being insufficient.

Now, for the most likely scenario without Medicare. Granny is covered, premiums are higher but not outrageously. Why? Because when Granny does get ill, the insurance companies will deny coverage, or drop her. So, you can have the wonderful experience of paying higher premiums and then going bankrupt a bit sooner, all while Granny is wondering how she could allow herself to do this to you, and her grandchildren. Now that would really kill her.

4. The free market can solve everything, and at lower cost. No, it cannot. First, and most convincingly, it has not. Since most systems tend toward equilibrium, it might have been surmised that, after all these years, everything would have already been solved. The purists would say that there are government programs around (like Medicare) that have distorted the system so that free markets cannot reach an equilibrium solution. But, that is nonsense. See # 3 above.

Secondly, though, free markets are genetically incapable of providing high-quality, low-cost, health care for all. Why? Because most people incur most of their health care costs when they are old. By the time they are old, health care prices have risen (even if at a normal rate), whereas their incomes were earned way-back-when wages and salaries were not nearly as high. Hence, even if they had saved prudently for the inevitable rainy day, it is unlikely most people would have enough saved from wages during their youth and middle age to cover the costs that they are now charged in their old age.

In addition, the costs of an illness can be, and often are, catastrophic to individuals, and only the very wealthy would have the money to pay for the total costs of care.

Ok, the free-market-solve-everything crowd would say, they would all purchase insurance. But, that is today's system, not everyone purchases it, not everyone can afford it, and private markets in search of profits do what would be expected: they weed out those most likely to add costs.

5. Your health care will be rationed. Don't know how to break this to you, except to say it in a whisper -- your health care is rationed today. Insurance companies do not cover everything, and, when they do, it is often just up to a point. Medicare likewise has certain rules about the level of nursing care required to qualify for reimbursement.

For example, we now know that highly intensive, properly guided physical therapy can restore motor function in people after strokes. A different part of the brain is trained to take over motor control. Here is a real-life case: A professor had a stroke. He is otherwise young and vigorous, formerly a champion-level athlete. But, his insurance will not cover the costs of 12-16 weeks of the highly intensive physical rehabilitation required to recover motor function. He gets just 3 weeks, only one hour on alternate days, but not even at the facility closest to his home, he has to go to one the insurance company approved.

One of the benefits of a comprehensive system is that treating this man for 12-16 weeks so that he can recover his motor function is not only better for the patient but, in the long run, is also much less expensive than forcing him, because of lack of coverage, to remain partially paralyzed. For any given insurance company, however, it is not less expensive, because he is likely to get passed into a different company. Thus, outcomes are worse and costs are higher.

6. Medicare is bankrupt ... or will be in 2042.

Name the private insurance company who is funded for all the healthcare expenses it will have to pay for the next 33 years, and I'll buy you 3 cheeseburgers, freedom fries deep-fried in beef fat with all you can drink Mountain Dew.

Ok, now go to your family and friends, and let them hear it from you.

Happy August!

Comments

[creolechild]

If you are concerned about receiving "real" health care reform in this country, please take the time to watch a video on our current system. The video was created by Oregon physicians who are advocating for the single-payer option. The video is very informative and helped me to gain a better understanding of various aspect of health care, as we know now it.

https://www.madashelldoctorstour.com/Mad_as_Hell_Video.html

These Oregon physicians are in the process of organizing a caravan designed to inform the public about the benefits of the single-payer option. At last count they will be stopping in approximately 23 states, on their way to demonstrate in Washington. They need volunteers and our support. Please spread the word.

[FdeBear]

Make copies of your medical bills, letters from insurance companies that reject coverage and other relevant correspondence and send it to the White House and every legislator on the Hill. Pay a little extra for a delivery receipt (make them sign for it). Do not fax it or email it because they can jam the fax and ignore your emails. For my brothers and sisters out there with no coverage or with preexisting conditions that make you uninsurable, send them a photo of yourself and/or your family with a brief bio and the statement "I/We need a single payer health care plan" . Let's flood the White House and Capitol Hill with REALITY. You may also consider making a little poster with your legislator's picture with the caption, "This person enjoys a government sponsored single-payer healthcare plan at my/our expense". Pair it with a picutre of yourself/your family with a brief description of your situation i.e. "No health care security for me/us". Send as many as you can afford. Help each other. This is not expensive. If you can handle it send them a copy of the funeral program or obituary of a loved one who passed away because the insurance company refused to pay for treatment.

[pollyx]

I'm ignoring the news and the Debbie Downers, still fighting for the public option (though single payer is the real way to go). I think it's a mistake to throw in the towel.

[nellyb stl]

76% of Americans are FOR health care reform. The rest either don't know how to read; can't think logically; or hate any kind of a future for their grandchildren. These people vote and breed !!!

[BrighterStar]

You say that 76% are for healthcare reform. But you assume that all of those people believe that the reform should be done by the federal government and that the reform should consist of the government running healthcare. Your are very wrong in this assumption.

[adamnb]

or maybe you can't add. Medicare, the closest thing we have to a public option, is ten times less expensive for the same coverage that insurers offer. Proof: I'm on Medicare and pay $78 p/mo for full coverage from Kaiser. My wife is privately covered, also a Kaiser member, but she pays $750 p/mo.
Same coverage, same health care. That's why the AARP, the single largest elderly membership organization is behind the public option. They know the difference. It's also why insurers are afraid to talk about anything but costs. And by the way, I never met a government gate keeper who tells me what treatment I can have, because they don't exist, but they are the mainstay of private insurers.

[Emmory]

First off, it's the government that makes the most money off of things like "death cigarettes" so lets not pretend other wise. AND they don't have to invest a penny to get it.

Second, what does your statement about "improved efficiencies in the system" actually mean?
It's a bold statement that sounds hip but is ultimately meaningless. Who decides what will be "improved" and made more "efficient?" The government? That sounds just great...

Third, why on earth do you think that the GOVERNMENT will all of the sudden be able to pay for medical treatments the insurance companies now won't? AND according to you we will all magically also be paying less!
Are you kidding?

[BrighterStar]

Improved efficiencies by turning it over to the government? How dumb does he think people are.

[Paul Abrams - Huffpost Blogger]

Here's an improved efficiency: right now, 10% of medicare recipients consume 67% of the costs. Those 10% have 4 or more chronic diseases (heart, lung, diabetes, etc). It has been shown that merely organizing the care, providing a single physician that manages the specialists, and home visits under a program called "Independence at Home", that $10-15B per year can be saved by improving the health and thus decreasing the need for emergency room visits and admissions to hospitals. That's $100-150B right there for the next 10 years which is how this is being calculated (i.e., the $900B needed is $90B per year for 10 yrs).

And, yes, govt WILL be able to pay for medical treatments that private insuranc companies do not, or will not, because it doesn't spend $25 of every $100 on administrative costs--advertising, high salaries, profits--and can put that toward healthcare.

Govt runs Medicare. Almost everyone likes Medicare. Read article about what it would be like if we didn't have it.

[Emmory]

This is a total fantasy of mystery finance that you've pulled out of thin air.
I'm not buying it.

Are you actually saying that the GOVERNMENT, our government will spend LESS on administrative costs than an insurance company would?
That's never been the case before, why on earth would our government all of a sudden get really good at organizing "specialists," "home visits," etc now?

The Government also runs the VA hospitals so I suppose you think those are all top notch too?

[WinterParkMom]

The basis for any public option should be:
Coverage for EVERYONE who applies
Structured premium payments of not more than 100 per individual, 300 per family
Deductibles capped at $2000 and based on income (means testing every year like the va)
No mandates forcing people to purchase insurance (a windfall for private carriers)
No triggers (also a windfall to private carriers)
No subsidies to private insurance carriers
No taxes on employer provided benefits
If someone has private insurance and wants the public option, they can drop private with no problem and be covered immediately under public.
No mandates on employers to buy into the public option to cover employees. Has to be free choice.
Everyone with coverage gets treated for new or pre-existing conditions.
Fairly negotiated reimbursement to private pracitce, specialty doctors and hospitals
Fairly negotiated prices for medications, even on name brand stuff which has no generic equivalent.
AND IT HAS TO BE EFFECTIVE IMMEDIATELY. Within 1 month of the above bill passing, Americans must be able to start buying in and using it.
It must be administered by an autonomous federal agency. Monies paid in must not be co-mingled with any other money, does not go into the general fund so it can be looted.
The ONLY payouts from this fund will be for: payments to practicioners, pharmacies and admin. In 5 years if we see significan overages, those overages will be used to suplement medicare and fund medical research.
See my next post on funding

[WinterParkMom]

47 million un insured
20 million under insured
Subtract 10 million poor/indig­ent/mental­ly ill, etc, who are uninsured and will have to get free care = 37 mill un-insured who can pay.
18.5 million can pay $50/mo = 925,000,000
18.5 mill can pay $100 = $1,850,000,000
20 mill under insured will switch and can pay $100 = 2,000,000,000
That is a grand total of $4,775,000,000
That is FOUR BILLION, SEVEN HUNDRED SEVENTY FIVE MILLION DOLLARS IN PREMIUM PAYMENTS PER MONTH. FIFTY SEVEN BILLION THREE HUNDRED THIRTY MILLION PER YEAR IN PREMIUMS FOR ONE SET OF PEOPLE.
That does'nt count the millions who'll switch from private companies if they can pay $100 or 200 per month and have their entire family covered even with pre-existing conditions. Repeal bush tax cuts asap another 700 billion.
After thinking about it more, institute a 1 penny federal sales tax on EVERY item. I can hear the opponents shouting about making the poor poorer, but my statement is 1 cent on each item NOT on every dollar or hundred dollars. From candy bars to big screen tv's to your house. 1 cent on everything. If your grocery bill was $100. for 53 items, your bill would be $100.53. That's not putting people in the poorhouse especially when we've been dealing with price increases. Also, if you're saving 300-500 per month on insurance, you have that money to spend and put back in the economy, save, or invest.

[Emmory]

Why not make it a two cent tax on everything, then ALL of our problems would be solved by the never ending government gravy train?

[blueken]

Say what you will, but the tea leaves say, "No change this time around." Fear has replaced logic. Facts don't mean a thang. The drug and insurance company get more money. Premiums go up, co-pays go up and service goes down. That's what is in the forseeable future. Just look at the news. Health care reform is dead. It would be ironic if the Republicans had to finally fix the system. Won't that be scarey?

[hrholmes]

To continue with a broken system complete with existing death panel clerks is just madness and nothing will change. Objectors like Sarah Palin have State provided health insurance, Oil Company provided health insurance and a witch doctor! A person that doesn't know what she reads is not able to even fathom an issue like health care. People on Medicare and Medicaid and VA running around objecting to a government sponsored OPTION for all need serious mental health counseling.

[Rhetticent]

While the fringes debate about death panels, and whether its the government or the health insurance companies that are the most evil, meaningful debate is once again obliterated.

Government forces insurance companies to operate in one state only. Why in theworld can we not remove that impediment, which will significantly lower administrative expenses and allow for nationwide competition? We drove down auto insurance that way. Then, let's abolish the American Rule for attorney fees, and adopt the time-honored English Rule that allows the winner in tort litigation to recover attorney fees and costs, thereby placing a down-side risk on frivolous lawsuits. Third, provide inducements for groups of physicians who wish to emulate the Mayo and Cleveland Clinics, establishing salaried doctors and rigorous protocols for care that eliminates excessive tests and fees. Finally, strip all the state-mandated coverage, and create a simple, catastrophic health care policy that is affordable (think "liability-only" auto coverage) and then require everyone to buy it. Bingo, with the addition of SCHIP, Medicaid, Medicare and VA, we have coverage for everybody, with no expense of tax dollars. Why not just TRY THIS, and then do drastic modification if it doesn't work?

[CaptainFrogbert]

BREAKING: Gutless, feckless, worthless Democrats fight themselves to the death. Ensure the horrific deaths and suffering of millions of Americans. Republicans look on in disbelief, laughing until the urinate in themselves. Democrats lose again.

One American dies every 24 minutes because of Republican health care policies.

One American family goes bankrupt every 12 seconds thanks to Republican health care policies.

Single payer healthcare will save trillions of dollars and tens of thousands of American lives over ten years.

These simple messages were too complex for the brain dead Democrats to deliver to the public.

So the Democrats lost and are now personally responsible for more deaths than Osama bin Laden.

Way to go Obama. You suck.

[hoosier96]

They are simple. Very simple. Like Lennie from Of Mice and Men simple.

[Dark Sphere]

Here's some ammo, Canadian Medical Association President denounces their own system...

http://www.google.com/hostednews/canadianpress/article/ALeqM5jbjzPEY0Y3bvRD335rGu_Z3KXoQw

[hoosier96]

Yeah, I was real surprised that this wasn't on the list of news stories on the HuffPo front page.

[ConcernedAboutRFuture]

Thanks for the "ammo".... however, I fear that those already duped by the fear mongering are too far gone to even retionalize with. I will try to pass this onto those I know that simply... seem nuts at this point.

Thanks again!

[hoosier96]

Forget fear mongering. Let's talk common sense (I know, big jump for alot of people here). See, in the real world we have this thing called scarcity. This means there is only a finite amount of product even though people have limitless demand. Prices are set by the constant shift in quanity and demand in the market. Now, the government comes along and says "Hey! We're going to give everyone quality healthcare for virtually nothing!" Sounds great, but given that there is limited healthcare (i.e. doctors, drugs, equipments, hospitals, etc.) and an ever expanding demand (including EVERYONE legal or not in this country as well as a quickly growing senior citizen demographic) one of two things will happen.

1) Obama will wave his magical wand the pixies gave him and expand healthcare for everyone for all eternity OR

2) Costs will rise and rationing (serious rationing) will follow.

Understand?

[kitkatborn]

The only scarcity seems to exist between your ears. Did you even read the article?

[hoosier96]

I'm sorry but your points are pointless. Yes, we know we are paying for health insurance now. Yes, we understand that we don't get EVERYTHING we want paid for. Wow, you figured that out, good for you.

And I love how you put everything in terms of absolutes so you can easily dispute them. You know, "the free market can solve everything" or "private insurance can solve everything". Except, very few are arguing that. Why don't you just admit that Medicare WILL be insolvent soon and THIS program should be rehauled and fixed before you even consider expanding it to everyone whether they want it or not.

Oh, and your precious Canadian system you libs like to tout, check this story out:

http://www.google.com/hostednews/canadianpress/article/ALeqM5jbjzPEY0Y3bvRD335rGu_Z3KXoQw

[Irmanator]

Ouellet wants to expand privatized health care so doctors can make more money. As head of the CMA he is looking out for the doctors first, as that is his job. Like any union leader, he constantly bemoans the current conditions his members are working under, trying to gain public sympathy and negotiating leverage.
He, and Doig, may very well have some good points and ideas but you have to be aware of their motivation.

[hoosier96]

Hey, READ THE ARTICLE. They are asking for MORE competition, not less. This drives prices DOWN.

[UNCLEJOE]

Here are the reason Obama will fail in getting any Health Reform worth the title:

When Obama started this crusade for health Reform he started a piecemeal Reform that alienated several groups from his support. If the President had come right out with Nationalized Health care for all Americans based on the Healthcare our Congressmen get, he would have had a great majority of Americans supporting his program.

The way his original bill was presented he divided the Haves from the Have-nots, by teling them you can keep your insurance if that is what you want, but you will have to pay higher taxes to help pay the Healthcare insurance of the 20 million who don't have it and can't afford it. It was the Republicans who talked him into a 'Divide & Conquer' strategy that diminshed the ranks of his supporters.

And the more Obama cut the Reform benefits down the more divided his support became. Obama surrounded himself with Federal Reserve lackeys and they led him down the precipice of failure. The Fed owns the Pharm. conglomerates. Insurance companies are the Feds biggest customers, bigger that the banks, but no one knows this until they need to borrow a few billion to build a Mega shopping mall and the only place they can get that kind of loan is through an insurance company. I learned this when I was a practicing Real Estate Broker in the 1970-80s
The Fed Must Go !