Posted tagged ‘universal health care’

Life Is Not That Complicated

January 28, 2014

Retiring Oklahoma GOP Senator Tom Coburn said in an interview that fixing the Affordable Care Act is necessary, and not so difficult.  He alluded to a GOP proposal which enshrines the elimination of “pre-existing conditions” exclusions and provides a path for all Americans to purchase their own coverage.  He justified his proposal on the basis that some two hundred thousand have signed up for ACA while over two million have had their coverage discontinued.  Under the GOP proposal, no one would be forced to do anything, and everyone would have the opportunity to buy coverage.  Hmmm

There is no evidence to date that defending ACA at all costs is worth the effort.  The ACA is only one of many ways to reduce the injustices and the potential to cap the out of control costs that our US health care delivery system is built around.  Without a doubt there are other good alternatives available short of adopting far superior systems found in most all other developed countries.  But taking Coburn’s comments lying down only sets Americans up to buy a bridge he might have for sale next.

So what must we recognize.

The 50 million or so Americans who were uninsured prior to ACA were composed broadly of those who chose not to buy any insurance, those who could not buy adequate insurance and those would buy insurance but lacked the financial capability.  The two million Americans that Coburn estimates have lost coverage result from a wide range of generally low wage paying companies who reduced employee hours to a level where these employers were not required to provide coverage.  These companies claim they could not afford to increase their benefit costs and stay in business.  Hmmm.

Now back to the GOP plan.  Allowing the young and healthy to opt out of insurance, by simple math, means that everyone else pays more.  It also leaves open the gravy train where the uninsured still use hospital Emergency Rooms driving up the hospitals’ costs and when many uninsured fail to pay, these costs find their way to everyone else through inflated billings.

The pre-existing cohort apparently under the GOP plan can buy insurance if they can afford the premium.  The GOP seems adamant that insurance companies must offer coverage even if the customer cannot afford it.   Hmmm.

The US spends around $2.9 trillion per year for health care services.  This equates to about $9,000 per person per year, man, woman, and child.  This is roughly twice as much as any other country in the world.  Hmmm.

It is simply a shame that our politicians spend so much time arguing about the Affordable Care Act when the entire health care delivery system is built upon an unsustainable financial model.

Health Care Insight

December 2, 2013

Last evening I had dinner with a millennium niece.  The conversation turned to health insurance, and then things exploded.  “Obamacare is the worst ever(!!!)”, my niece stated.  “This is the worst law ever”, she continued.

My niece is medically compromised with a complicated diabetes disease.  She works but earns relatively low wages.  She also has two children and the expense that go with them.  At her income level, she also receives State aid for her daily needs.  Fortunately, her employer provides health insurance which covers a large part of her medical costs.  She must, however, cover deductibles and certain durable goods related diabetes costs.

In her outburst, my niece claimed she would be taxed because her medical expenses were so high.   She would be categorized as having a “Cadillac insurance plan”.  She claimed her entire medical expense would be taxed.  Hmmm.

She moved on to the claim that policies found on the health exchange would simply be too expensive for her on her salary.  She wanted to keep her current plan.  Hmmm.

Now it must be said that my niece’s situation is extreme.  She is a brittle diabetic and earns a relatively low wage.  She is, however, not alone in the US’ 320 million population.  What is unique is in medical terms she is a sick person while her fiance comes from the young healthy camp who use little of no medical services.

She is also a young republican and quite aside from health care, thinks President Obama is a mistake.  Hmmm.

In an ironic way, my niece and her fiance are poster children for single payer, universal healthcare.  He is healthy and will use little medical services until he becomes injured or sick later in life.  She is genetically sick and will consume health care services throughout her life.  How can it be expected that a private, for profit, insurer can assign appropriate risk to each and offer a rate they could afford?

With this couple, there is the combination of “I don’t need insurance” and “I need a lot of coverage”.  Said differently, “I don’t need to pay anything” and “I can only afford this much premium cost”.

This is a microcosm of America.  It is also a microcosm of the industrial world.  In order to deal with this type of differences, single payer, universal healthcare systems evolved.  Modern countries have elected not to let the sick or poor starve or die needlessly.  To date (and including the Affordable Care Act), the US has not elected to follow that path.

Obamacare (Affordable Care Act) represents a step forward compared to what preceded it.  In my nieces situation, her employer’s plan is not a “Cadillac Plan” despite how much annual medical expense she consumes.  She will not face new taxes.  In addition, her employer employs less that 20 and is not required to provide health insurance.  (As my niece subsequently explained, her employer had already decided to eliminate coverage and instead provide an annual stipend to their employees.  This was an option before ACA and is an option with ACA.)

What my niece (and her fiance) fail to acknowledge is that medical costs are high and rising.  Employers are being squeezed and across the board are adopting methods which maximize their financial exposure.  There is nothing about ACA that is accelerating this trend nor delaying it either.

The underlying message my niece has unknowingly sent is that politics and healthcare do not mix.  It may be ok to dislike or disapprove President Obama and his policies, but to indict the Affordable Care Act on anything other than comparisons to what preceded it or some ideal (such as Germany’s) health care delivery system will lead to false conclusions.

Healthcare Principles In Collision

October 30, 2013

There certainly has been heated, and at times, mind numbing disagreement over the Affordable Care Act’s nature and purpose.  To some, ACA represents a magnificent reform and to others, confirmation that the nation is headed towards socialism.  Both of these views miss the more fundamental question, “how can it be, in the riches country in the world with modern technology working everywhere, should basic healthcare be available to only those who can afford it?”

Let’s be clear, the question is not “should healthcare be free for everyone?”  Healthcare cost money and those who provide it must be paid.  How to pay for basic healthcare, is a fair question.  But let’s put that question aside until later and consider just the availability of basic healthcare now and under the Affordable Care Act.

The Affordable Care Act is a legislative attempt to provide basic healthcare coverage to all Americans.  The Act falls short of that goal but does extend the coverage compared to what preceded it.  So why the fuss?

News reports have focused upon the malfunction of the healthcare sign up website.  Reporters are breathless about the situation where some individual insurers who purchased policies since the ACA became law, will have to purchase new (and more expensive) policies because the ones they had purchased are deemed inadequate.

ACA opponents disingenuously are raking Obama Administration officials over the coals because the sign up rate is slow.  These opponents want to use Congressional Committees to investigate these matters.  They huff and they puff and assure the American public they only want the best healthcare for Americans.

Opponents have long put forward the view that basic healthcare coverage was a matter of individual choice.  Americans should be free to pick their coverage, including no coverage, these opponents say.  It’s the American way.

Individual choice allows younger and healthier individuals to say “no thanks” to insurance coverage.  This results in the rest of the insured pool to have higher healthcare costs higher insurance rates.

Individual insurance purchasers get his twice.  The higher costs for the pool (minus the younger and healthier cohort) further compounded because individual rates are higher than multi-person pools.   If an individual does not work for a business they in essence become a pool of one and must pay a higher rates than if they had been part of a larger employment group.  Hmmm.

Taking this a step further, an individual has a “pre-existing” condition, they will find most insurance companies unwilling to insure them, or willing but at an extremely high cost.  The consequence, not surprisingly, is that many who would pay for insurance do not and consequently, if they become ill and need medical services, face either personal bankruptcy or the prospect of using Emergency Rooms.  In both of these cases, the unreimbursed medical expenses are paid by the rest of us in the form of higher hospital, doctor, and drug company charges which ends up mainly in higher across the board insurance costs.  Hmmm

So, why are our political leaders having such a fruitless time debating the Affordable Care Act?

In my opinion, our political leaders fail to acknowledge the impact individual choice (to be insured or not) and the use of employers to provide healthcare insurance access has on everyone else.

Individual choice is present everywhere in America.  Some smoke, others run, and some are Vegans.  Some sky diver, others power walk, and some sit on park benches.  Americans makes thousands upon thousands of decision which in some way can impact their health and as a consequence impact their consumption of healthcare services.  Whether these life style choices offset each other is unclear but these are not the choices we can (or should) be concerned with.

Healthcare is a life long need.  Annual US healthcare costs is the sum total of what all Americans consume, young ones, old ones, and everyone in between.  Today this figure is close to $3 trillion or about $9,000 per capita.  The notion that a young individual could obtain a basic healthcare policy for $200 per month ($2,400 per year) means that someone else must pay more than $9,000 in order to offset the younger person’s lower rate.  There is no free lunch.

Most Americans receive the healthcare coverage through their employer, Medicare, or Medicaid.  Consequently almost no one in these groups can conceive of paying a family of four healthcare coverage at $36,000 per year.  So, to most Americans, there is little direct financial consequence for individual choice.  For those who buy their insurance in the open market, the question is quite different.

So maybe this political fight is just about how politicians see the public’s mindset.  Americans are for individual choice and individual responsibility.  They do not want to pay more because of someone else.  Health and healthcare, however, fall in a different category.  There can be no “individual” in modern society when it comes to healthcare.

Arguing whether the Affordable Care Act is a magnificent accomplishment or a utter failure misses the most important point.  Until the US adopts a “universal” healthcare delivery system, like found in over two dozen other modern countries, we will be arguing over who should receive basic healthcare coverage and who should be left to fend for themselves.   We will miss the most fundamental points that current healthcare costs are the world’s highest and the healthcare outcomes just mediocre.  Worse still, the US will be stuck with the financial outcomes that are slowly bankrupting the country, financially and morally.

How Long Will The Grand Bargain Take?

July 31, 2013

I can understand some of the critical reviews of President Obama’s time in office.   The more serious reviewers find him as only an average chief executive.  His opponents find him an utter failure, worst ever.  Hmmm.

The expectations for this “post racial” President were very high indeed.  Living up to the hype would be very difficult for anyone.    President Obama’s shortcomings, however, lay not so much in his goals (what he wanted to do), but in how he has tried accomplished his agenda.  As chief executive, he has proposed legislation and Congress has said “no thanks”.

The President identified (correctly in my opinion), healthcare, as the most important strategic objective.  He wanted to correct health care injustice and get control of its spiraling cost.  For example, Obama pointed to upwards of 50 million Americans who had no coverage, to Americans who were denied coverage on the basis of a “pre-existing condition”, and to millions who were one illness away from complete financial failure.

His goals were worthy but his actual achievement, the Affordable Care Act, is a pigmy compared to what is actually needed (and what is found in the rest of the modern world), and ACA is still a fight he must wage every day.

Compounding his problems, the President has been pushing on a rope trying to get anything through Congress.  The GOP has lapsed into a “just say no” approach.   In their zeal to blacken (get the pun) President Obama’s record, Congress has turned its back on the needs of the greater USA.  The President has tried to stand above the “food fight-like” Congressional behavior but instead has too often appeared aloof.  (It took former President Bill Clinton to adequately explain President Obama’s first term because Obama either couldn’t or wouldn’t try.)  The end result, no action.

Today the New York Times published an article comparing the US performance on global inequality measures.  Simply stated, the US appears to be “exceptional”, unfortunately in a disappointing way.

Comparing other countries, the US rated on (1) Income inequality (5th worst), (2) literacy inequality (5th worst), (3) Infant mortality (4th worst), (4) child poverty (4th worst), and (5) single parent families (worst).  Hmmm.

The President has said often “we can do better”.  And for sure doing better is not lower taxes for corporations or the top 2%.  Rather “doing better” is far more likely linked to increasing the economic strength of the middle class which should raise all boats (even those of the top 2%).

Improving the middle class’ economic strength will require a greater share of corporate returns being shared with ordinary workers.  It must also involve bringing under control the staggering cost of health care, particularly the annual increases.   A revamped health care system such as a universal system like Germany’s would replace Medicare and Medicaid and allow the US to focus on the costs of a single health care delivery.  If the US could find the resolve to move to a system like Germany, health care costs would drop by as much as 50% while health outcomes would increase.  Businesses would no longer be saddled with contributing to health care through employee contributions, and the Federal Budget could more easily be studied with Medicare and Medicaid eliminated.

Regrettably, there is no interest in Congress.  To improve the US position in these “inequality” measures will require an interested and dedicated set of public servants.  And to turn the current crop of Congress Members into public servants seems just as remote a possibility.

So maybe all that is left for President Obama is to lay out just how exceptional the US really is (pretty nice place for the top 2%), and what strategic changes need to be made (much less income inequality, tax reform (including new taxes), sharply lower health care spending, and corresponding reduction in government spending (Medicare, Medicaid replaced by universal health care).

The chances for any serious action seems not timely at this moment.  I wonder how long it will take?


The Toughest Choices

July 2, 2013

In Philadelphia, an heroic, but almost certain tragedy is playing out.  A 10 year old, born with Cystic Fibrosis is barely clinging to life following two lung transplants.  Compassion and admiration for the child’s parents is all around.  Better patient advocates, one could not ask for.

Unfortunately, new lungs won’t cure Cystic Fibrosis.

The complicated part of this story is that there are costs that go with this heroic surgery.  There are real dollars and cents costs which would bankrupt any normal person.  Who’s paying is not clear.  (And, to say the hospital is not charging the parents is only to say the hospital is charging everyone else a little more.    The hospital simply smears these unpaid for costs over all other hospital budget areas).   Hmmm.

There is also the missed opportunity cost.  The two lungs could have gone to someone else had they not been given to the 10 year old.  Would the prognosis for those sick individuals been better?

And there is the question of whether getting on the adult transplant list was a cost or an investment?  Children under 12 have previously been restricted to a child’s list and could get a transplant only when another child donated the lungs.  Apparently this is much rarer than the availability of adult lungs.

The child’s parents went to the media and ultimately to a friendly court and got the Hospital protocol lifted so that the child could be put on an adult transplant list.  The question is was this ethically correct to tamper with a protocol already developed by medical ethicists?

I do not know the answer and don’t mean to imply it was or it wasn’t ethical.  Rather, I want to call attention to where our overall health care delivery system is headed.

Currently the US spends twice as much on health care as other modern countries.  The US health outcomes are mediocre in comparison, and not all residents are covered.  Logically there seems no other future than to fix the amount of medical resources and force residents to make better use of this limited resource.  There will have to be methods of choosing who gets what treatments, where, and when.  Hmmm.

Every time universal health care is mentioned there is a howl about “socialized medicine” ruining American health care.  You are lead to believe hospitals and doctors would be trying to make life difficult for everyone.  And the unstated comment is what happens if nothing changes and each of us has to pay for health care when the current system goes bust?  I suspect each of us will make a lot of medical unsound decision about what procedures to elect and which ones to pass over.  Hmmm.

We are often told this new world is the free market world.  Each of us are free to compete for medical care.  Hmmm.

I wonder in that new world how we would allocate new lungs?   When the operations is simply beyond ones means, I guess like in the free market, the new lungs go to the person with the most money?

The Health Care Fault Line

May 20, 2013

Many hours have been spent discussing the Affordable Care Act (Obamacare) with dire predictions from those who have opposed it.  It is not clear how anyone can object without offering an alternative which fixes the faults.  Clear or not, this has been a political mantra… “repeal Obamacare”.

Arguing that Obamacare will cost too much and may bankrupt many small businesses is a valid concern.  Also those who predict that due to higher insurance premiums, many Americans will elect to take less coverage or none at all.  These predictions suggest that fewer Americans will be insured under Obamacare than prior.  Hmmm.

As valid as these concerns may be, I am still waiting for alternatives that deal with pre-existing conditions, the omission of millions who do not have health care insurance, and the tendency of healthcare to treat illness as opposed to prevention.  Those with concerns about Obamacare would do everyone a great service if they included a description of a better system.

What another study?

My guess is that describing an alternative to Obamacare would not require a huge study.  Just look at what has been said already.  Costs, millions of Americans without coverage, and tinkering with best health care delivery system in the world.  True, true, false.  Hmmm.

There are about 20 other modern industrial countries with healthcare systems which cost about one half of the US, provide coverage for all residence, and deliver equal or better health outcomes when compared to the US.  Hmmm.

So… what about a bi-partisan effort to replace Obamacare with a universal health care patterned after German’s or France’s?  While this would lead to great success at much lower total cost, and would eliminate Medicare and Medicaid, there is little or no chance that Obamacare critics would propose such a solution.  Healthcare is big business and big business are willing to finance candidates to preserve the current system.

Americans are left with only an indirect method to bring on a truly better health care system.  Whenever the GOP votes to repeal Obamacare, demand that those voting in favor explain what they would propose as a better system.  Measure these recommendations (if these crafty politicians offer any) against the everyday experience in Germany or France, or 18 other countries and judge for yourself.

Knock-Knock, Anyone Home?

March 28, 2013

Today’s newspaper carried an Associated Press article which makes you wonder.  The article covered a just released report by an “actuary group”.  The bottom line, the Affordable Care Act would result in increase of over 30% for certain health insurance policies.  Whoa.

The AP reported that this increase was do largely to the inclusion of previously uninsured “pre-existing condition” Americans.  Hmmm.

A 30+% increase is quite large.  But what a quandary that presents.  Repeal Obamacare, save the 30% and dump several million Americans back in the land of no health insurance.  Hmmm.

One might also remember the huge fight that took place over the individual mandate.  Government officials told us that everyone needed to be insured so that the new revenue from previously uninsured Americans could cover the cost that this mostly healthy cohort would cause.  In essence, the individual mandate was supposed to be a sop for insurance companies.

Consider the following.  Most everyone of us will go through a cycle of being healthy and low cost (to insurance companies) when we are young to varying degrees of “unhealthiness” and much higher cost when we are older.  Everyone.

So why do insurance companies not use “average” health cost by placing all of us in the same pool?  Why should someone working for a large employer pay less for insurance than an individual who is self employed?

There are many reasons given.  One of the most popular is that Americans who take care of themselves (healthy lifestyle) deserve to pay the lowest possible rate.  Hmmm.  For sure there is some truth about lifestyle choices, but most medical opinion is that “genes” are the real game changers.

If this AP report’s prediction turns out to be correct, it may hasten the necessary questions to be asked.

How can this “exceptional” country, USA, be satisfied with health care that is the most expensive in the world (twice as much or more), receive mediocre outcomes, and still not include all Americans?