Monday, August 17, 2009

Health Care In America - A Reality Check

Please read through the two following blog posts on the debate (or lack of it via Our Modern Media, which instead aims their cameras at train wrecks rather than dig into the facts and figures of a handful of proposed bills -- and recall that None Yet Have Been Voted On By Congress) --

First, some Facts:

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."

Meanwhile, Vibinc voices a more urgent reality:

"I know this whole “death panel” thing has been going on for weeks now, but I’ve gotten to the point where I want to slap someone every time I hear them talk about Government pulling the plug on granny because she’s too expensive. What bullshit.

We already have death panels you douchenozzle, they’re called INSURANCE COMPANIES.

As The Memphis Liberal points out the Supreme Court has ruled that

Inducement to ration care is the very point of any HMO scheme.

The argument on the right is that you can sue an insurance company. Perhaps, but you’re still dead if you don’t get the treatment you need because some corporation hedged their bets.

It’s not like it’s ever happened before or anything.

Oh, and how does a lawsuit play with conservative notions that tort reform will magically fix what’s driving up the cost of healthcare. Come on people be consistent.

Nope, the reality is we’re talking about two different cultures. One that believes corporations are going to do what’s right for people and that the government can’t do ANYTHING right, and one that believes government’s role is to provide an equitable foundation for all Americans and that corporations are more interested in protecting shareholders than doing right by regular folks.

Which one sounds more realistic?

Seriously, conservatives have been working for 30 years to protect shareholders and corporations far more than help regular Americans. Their perspective is that if the corporation benefits, somehow so does everyone else. From the union busting that the Reagan Admin. engaged in, to trade deals that have sent American jobs hither and fro, with the help of conservative and largely southern Democrats that have served as compliant enablers, the conservative ideology has destroyed America’s manufacturing base and left us in a position where good jobs for regular people are going the way of the dodo. All the while this same “Conservative ideology” is largely responsible for a tenfold increase in the national debt over the past 28 years.

Somehow, this is supposed to provide a better quality of life for all us little people. But aside from making really affordable “cheap plastic crap” made in places most people couldn’t find on a map, the only real benefit has been the availability of second rate goods to people who used to make a first rate version of the same damn thing.

So when we apply this ideological difference to the healthcare “debate”, if that’s what you want to call it, you have some people talking about healthcare, and others talking about something else entirely. Sobeale hit on this back in June when talking about the difference between the left and the right on the healthcare debate.

Progressives want to give everyone healthcare. The other side wants to give everyone health insurance.

Healthcare. That’s what I’m talking about, not insurance. Insurance is the ONLY thing in the world you buy and pray you don’t have to use. Healthcare is something EVERYONE NEEDS, but that a growing minority of working Americans DON’T HAVE ACCESS TO. Sure, they can go to the doctor or the hospital, but if it’s something serious, they’ll likely go bankrupt. That’s the reality, and 50% of the people who go bankrupt every year are in that situation.

So now that the Healthcare industry has dumped some $130m since April into putting the kibosh on any plan that includes a “public option” by stirring irrational fears and mobilizing a vocal but largely uninformed group of people to disrupt anything and everything that might further the “public option”. The debate has shifted from providing healthcare to all Americans to providing Americans with insurance, something they don’t want to have to use.

This is just plain madness.

The right wing reactionaries that show up in force at Town Hall meetings across this nation are grounded in the same ideology that has helped bankrupt this county and millions of it’s citizens. They are not there to debate, they are there to debase the process, to incite fear, and ultimately, deny you a right to affordable treatment when you need it most.

This is not the huge movement that the media would play it up to be. They are not taking to the streets demanding that things stay the same. They are a couple of hundred people per district, out of some 600,000+ constituents, mobilized to make a good show of strength for a very short period of time. It’s media manipulation at it’s worst, and the media is playing the role of compliant enabler, just like those conservative Democrats who are paralyzed with fear anytime someone proposes a change that they might have to defend.


  1. Once again Mr. Powell you clear the asleep feeling with a cup of Joe. I wish there had half as much debate over the Invasion of Iraq.

  2. Thanks for the props!

  3. Anonymous5:41 PM

    This system is tried around the world Canada, Britain, etc. and it fails terribly. All these "conservatves" making up stories trying to scare Americans are actually just reporting facts from around the world. If you read the bill death panels were in the bill. That stupid Palin read the bill and complained loud enough to get it taken out. I guess you are too busy patting yourself on the back and listening to your friends tell you how smart you are to read it. Iraq had two congressional votes and passed overwhelingly both times. Boy it must be nice to live in the revisionist world where only us evil consevatives make unpopular decisions. You know a large part of Americans did not want to enter WW II. History did not start the day you were born.

  4. ANON -
    what system are u talking about? there are currently 4 bills pending before Congress and yet not ONE have been passed -- so what 'system' are you talking about?

    "death panels" -- ask ANYONE who has private insurance just what happens when a patient/family member is approaching their final days -- they meet with doctors to discuss options, and more than that, it is REQUIRED by health insurance companies (and many hospitals) - in fact, many companies decide all on their own that they will only pay a certain amount of cash for a patient in critical care - in other words, my friend, private insurance already conducts "end of life counseling, aka kick the patient out the hospital because this is a place for people to get well and not for them to die."

    you think Palin has some influence? really? despite the fact she is a documented liar?? the language in some bills being considered merely said any such 'counseling' should be something covered by Medicare, not paid for from the families in crisis - and the bills, still under debate - call for it to be VOLUNTARY not MANDATORY.

    then there was Sarah Palin's plan to promote "advance directives", a proclamation she signed in April 2008 (before she quit office to shill for the GOP) -- see:

    for some facts on that.

    it reads, in short,
    "WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to PLAN AHEAD for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions. [...]

    WHEREAS, one of the principal goals of Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities, and hospices to participate in a statewide effort to provide clear and consistent information to the public about advance directives, as well as to encourage medical professionals and lawyers to volunteer their time and efforts to improve public knowledge and increase the number of Alaska’s citizens with advance directives.

    WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives."

    the TPM web link above also notes:

    Though this proclamation is now deleted from the Alaska governor’s website, it shows that Palin’s current fear-mongering is purely political.

    Palin is not the only conservative leader completely flip-flopping on this issue. Merely months ago, Gingrich too endorsed end of life counseling. At a conference in April of this year, Gingrich said advance directives can “save money” while also helping to “decrease the stress felt by caregivers.”

  5. Anonymous9:21 PM

    The government run system. It does not matter what the details of the bill are it will not work. I want govt. to leave me alone except for those things the constitution tells them they can do. Govt. does nothing on the social side that works properly and this much money being poured into a black hole is waste.
    Palin has a lot more influence than want her to havew she is the only reason McCain did as well as he did. She is a consertative that fought the Republican powers and won and still wins. So yes she is a force to deal with.

  6. OXYMORON4:49 PM

    """I want govt. to leave me alone except for those things the constitution tells them they can do""

    Well, Anon you have had 8 years of a theoretically hands off government and you can see where we are now. Of course I know most folks like you blame that queer in Mass., Barney Frank for the housing meltdown, the oil price spike and the migration of the manufacturing sector, though each of these phenomena has bit us economically since the 70's though not as horribly as this time around.

    You are welcome to the kind of government you want when the majority of people like you place people like you to carry out your will. I hope it doesn't happen again any time soon.

    AIG was an insurance company. Doesn't that give you pause to how competent the private sector is sometimes?
    Our entire financial system melted down thanks to the people in power: the GOP ignoring the lessons of economic history, and he laws of human nature to enable the speculation and stupidity to bring this fiasco which isn't over by a long shot about.

    Medicaid works, the VA works, our government would work a lot better if there were fewer people who though repeating jingles make wisdom as you do in your post. Thanks to you the GOP assumes a portion of the voters will swallow any swill if it feeds your self righteous delusions.

    BTW the Canadians and Europeans LIKE their health care systems. Of course they are basically healthier counties than the US, no thanks our present insurance system which helps keep cigarettes on the shelf, fast food booming and drugs flowing to addicts by underwriting the risks of these abuses.

    You admiration of Palin makes me think of the phrase "stupid is is as stupid does."

  7. palin did as well she did?
    you mean lose??