Wednesday, July 29, 2009

Health care again

The idea that every American would save money if the government offered a public option for health insurance seems remarkably easy to understand. I question why so many people are having difficulty grasping the idea. Do people deliberately not want to understand because they are so partisan they don’t want to even consider an idea brought up by another party? Are the republicans so successfully muddying the waters with out and out lies that people are truly just confused? Perhaps the problem is that no one has laid out the idea in kindergarten terms so everyone can understand. I am going to attempt to do so now.
There are two ideas in health care reform. First, there is the single payer system that would be similar to every civilized nation in the world, the most often cited being Canada. This single payer system would save the citizens of the United States the most money by far but is not being proposed or even discussed by Obama, the Senate, or the House of Representatives. This option is completely off the table (except republicans keep bringing it up to confuse people and scare them). A single payer system will not happen in the U.S. anytime soon nor is it being proposed.
The only other idea that would truly reform health care and save United States citizens and businesses money is what is being called the “public option.” This is what Obama has been proposing for 2 years and what Congress has been debating. The public option would involve congress setting up a Medicare or V.A. style insurance that every American could purchase if they so choose to do so. It’s aim would be to provide insurance for those people who do not already have insurance. Everyone who already has insurance could keep what they have.
The question Americans have but are afraid to ask is: “If I already have insurance why would I want the government to have a public option.” My first response comes from my Christian belief system. If you care about the lives of other human beings then how could you possibly ask why they deserve to get medical treatment? If you describe yourself as “pro-life” how could you possibly be against allowing human beings to get medical care that they can pay for before their problem is critical? How could anyone who believes they are a moral person with a conscience want to deny other human beings access to life saving medical attention just because they are afraid something might change for themselves?
If the morality of the issue does not sway you then let’s look at what is in it for you…the American with health insurance. Currently we have a for profit system of health care. We buy insurance from a company that is attempting to make a profit. Currently health insurance companies and pharmaceutical companies make huge profits. They make so much money that they can afford to buy ad time during primetime shows and even the superbowl. Their executives are millionaires and these companies spend money on yachts, private jets and billion dollar headquarters. They make this money off of the illness of Americans. They have unchecked ability to set costs for medical procedures and medication because they have no competition. We saw this become a real problem in 2001 when health care costs rose 75%. This outpaced all other inflation and therefore was simply the health care companies taking advantage of the perfect opportunity to raise costs; a republican president and congress combined with a terrorist attack. This unchecked power is costing you, the person with health insurance thousands of dollars per year. It has made health insurance out of reach for many small businesses and has caused other small businesses to become stagnate or even consider closing down. It has even affected big businesses and local governments by forcing them to lay off part of their work force so they can continue to afford the cost of health insurance for their employees. Health care costs played a huge role in the demise of the American automakers who simply couldn’t compete with foreign companies who did not have the enormous cost of supplying their employees with health care. To compete in the global market many companies have chosen to ship jobs to other countries where they don’t have to pay for benefits. Our current health care system has cost America jobs for many years now and it is starting to catch up with us. It has cost small business owners their ability to make a larger profit and it has caused millions of Americans to declare bankruptcy (medical costs are the number one reason for private bankruptcies in America).
Another way our current system is costing us, the insured American, is at the hospital. Most hospitals are non-profit. They are charging you, the consumer, what it costs them to keep paying their bills. They, however, can not turn sick people away. People who do not have insurance can not see a regular doctor at an office or choose not to see a doctor because of the cost until they are so sick they must see a doctor. For example, someone who sees an abnormal mole on their arm may chose to ignore that mole because they know how much it would cost to see someone and have it removed. They may wait until they are having serious stage 4 cancer symptoms before they go to the ER to be treated. By then a simple mole removal has turned into stage 4 cancer treatment at the expense of the hospital. The only way for the hospital to recoup that money is to charge you, the insured person, more for you broken arm. This system has also flooded emergency rooms with people with common illnesses that need to be seen but can not afford to pay a doctor or who can not get into a doctor because they lack insurance. This makes you, the insured person with a broken arm, wait much much longer in the waiting room of the ER. Finally this system is costing you more at the hospital because the insurance company has set prices for what they are willing to pay for each procedure. Hospitals must recoup the money it costs them to see you, and the uninsured people that visited when you were there, so they are forced to increase the number of procedures they perform in order to get more money from insurance companies so they can pay the doctors and hospital staff that saw you that day. The hospital must also pay a large number of staff people to file insurance claims, and argue with insurance companies. This cost must also be covered by what you pay when you break your arm. To summarize, when you break your arm you are waiting longer, paying the insurance company enough to give them an enormous profit, paying the hospital enough to pay the doctor, the nurse, the radiologist, the technical people, the insurance claim department, and enough to cover the lady sitting next to you who doesn’t have insurance and has a severe sinus infection that she has had for 5 months and has now spread to her brain.
Another reason you should care is that you may soon be one of the uninsured. An insurance company can cancel you coverage the minute they think you are going to start costing them more money than they can make from you. If you get heart disease or cancer you may find yourself uninsured just when you need that insurance most. Or perhaps you will experience what millions of Americans experienced this year. You may just lose your job and your health insurance right along with it. When that happened to me COBRA was going to be $1400 per month. Unemployment will not even cover my mortgage payment so health care is out of the question. Obama has reduced this cost with a program to force companies to pay a portion of COBRA for 18 months but with a mortgage and electric and gas bills and no job who can afford to pay for insurance. Once you find another job the new insurance company may not be willing to cover you and good luck finding private insurance if you have even the slightest problem that requires medication or a doctor visit. You may very well be one of THOSE people who doesn’t have health insurance and therefore can’t see a doctor in an office because they don’t see uninsured people. You may be one of those people who puts off seeing the doctor for all but the most devastating of symptoms because you can’t afford a $140 office visit and whatever tests or medications that might accompany that visit. You could be one of THEM. I bet then you would care a lot.
So what will a “public option” do to reduce all of these problems? What can a public option do for you? First, it will mean that every American can go see a doctor if they are sick. A sinus infection or a mole or a child’s severe headache will be dealt with by a doctor in an office in a reasonable time frame which will prevent future, more expensive procedures, tests, medications, and possibly even prevent death. Diabetes, heart disease and high blood pressure will be caught earlier and may be managed with diet, exercise or an inexpensive pill rather than surgeries, hospital stays, and expensive medications that must be taken for a lifetime. Overall our population would be healthier and therefore less expensive. The hospital ER could focus on emergency problems and could get out of the business of being a free clinic. Hospital costs will go down because the hospital no longer would need to cover the cost of all the uninsured people. Hospital costs would also go down because the public plan would be nonprofit and therefore would pay reasonable costs for procedures without the need to deny treatment in order to make money. Your chance of getting appropriate treatment would go up because the plan would pay for procedures you need to make you better rather than paying only for procedures that are cheap while denying treatment for anything that might cut into their profits. In order to compete with this public option insurance companies would have to start increasing services while reducing costs. This will cut into their excessive profits while costing you less out of your pocket.
The funniest scare tactic being put forward by republicans right now is that the public option is out to kill the old people. They claim this public option will deny procedures to old folks and therefore kill them. This is hilarious because anyone over 65 won’t be eligible for the public option. Everyone over 65 is already enrolled in a public option….it is called Medicare! If Medicare hasn’t been out to kill old folks all these years I’m not sure why it would be now. Medicare was created to solve the problem of retired people who lost their company health insurance and therefore could no longer pay for medical treatment at a time when they needed it the most. A public option for people who do not yet qualify for Medicare will only make Medicare better by increasing the government’s ability to reduce the overall cost of procedures and medication through competition and….dare I say, the open market. By streamlining the system and cutting out the waste of paying for the uninsured and the extra procedures that do not increase health the public option will improve Medicare.
The public option will help small business, big business and local governments who are struggling with health care costs. Several months ago I suffered through an hour long monologue by a very upset right wing small business owner who bemoaned the fate of America if we get a “socialist” health care system. I asked him, as a small business owner, how much he pays for health care for himself and his employees. He explained that he pays $6000 per month for himself and his top level employees who receive health care at work. His lower level employees have no health insurance. This man is losing $72,000 a year profit to the health care companies (not to mention the thousands of dollars he and his employees are paying in premiums, co-pays, out of pocket expenses and medication costs. The $72,000 is just what his company is paying. What if this small business owner could buy public health care for himself and each of his employees could do the same? He may be able to hire another employee and take on more business. He may be able to expand his business to another location and see even more profit. He may be able to give each of his employees a raise. His employees that currently don’t have health insurance may be healthier and more reliable. They may also be loyal to him and not look for a job that provides health insurance. Perhaps this small business owner doesn’t want to give up private insurance. He may see a sharp reduction in premiums due to the competition with the public option. His employees without insurance would still likely get the public option and be healthier. Also, under the current reform measures his private plan would not be able to drop him if he gets ill and would not be able to deny his new wife coverage because she has a pre-existing condition such as asthma. Frankly, I don’t see a down side for angry right wing small business owner.
What about big business and local governments who are struggling to pay employees and their benefits with much less money coming in. Companies who are doing fine will likely do nothing. Offering private health insurance to employees will continue to be a selling point when selecting the best candidates and therefore companies will continue to do so. Companies that are struggling to stay afloat may need to cut benefits to employees in order to keep employees. Ultimately, though, wouldn’t you rather keep your job and buy insurance from the public option than to lose your job and your health insurance? If Timken could have kept 700 jobs in May by simply cutting health insurance benefits (if there were a public option to buy) wouldn’t all of those 700 people still have jobs, still be purchasing stuff which would support the jobs of the car industry and the restaurants and the retail jobs, and still be paying income taxes which would keep the local government afloat? If GM could have cut benefits knowing that their employees could still have access to insurance perhaps they would not have had to go bankrupt. Perhaps more Americans would have been buying cars because more Americans would have had jobs. Paying for benefits is putting our businesses at a disadvantage internationally because this is an expense their competitors do not incur.
Local governments are cutting services to taxpayers due to decreased tax revenue and the increased cost of benefits. School districts find 33% or more of their costs paying for employee benefits rather than teacher salaries, materials and building maintenance. No one thinks these employees should not receive benefits but when school districts and cities must lay off half their staff and cut out services to the taxpayers in order to afford health care costs for the remaining employees then we have a serious problem. These health care reform critics don’t want their taxes paying for someone else’s health care. I have news for them. Much of what we pay in taxes helps to pay for health insurance for teachers, bus drivers, custodians, police, firefighters, military men and women, utility works, city workers, state officials, judges, IRS employees and other federal workers and your Senator and Congressman (who have a public option health insurance). Taxes have always paid for this health insurance but now that insurance rates and health care costs and prescription costs have gone up, a larger percentage of our tax dollars go to pay this cost while a lesser proportion of our tax dollars go to fixing roads, teaching kids and hiring police officers. A single payer system would bring the most benefit for our tax dollars but unfortunately that option is off the table. The second best system would be a public option that would automatically provide for all government workers. This could potentially save school districts, cities, and states millions of dollars and could increase the services they could provide. They could hire more teachers or pay them more (or even lower the amount we pay in taxes). I just read in the paper that they have decided to send kids to school later in the day in Massillon, OH, in order to save money because they can decrease the time the bus drivers are employed to part time and therefore not pay benefits. Is this really the best use of our tax dollars?
What about all those family values type people out there? How does this benefit them and their ideals? First, many families send both spouses to work simply to get health insurance. One spouse may have a job that does not provide insurance (such as my friend who is an IT consultant or my friend who owns his own clinic). These men can provide for their families and their wives would really like to be home with their young children rather than pay for childcare. Instead the wives must work in order to get health insurance. They don’t make enough to be the primary bread winner but they must put their kids in day care and go to work to get that precious insurance. How is it strengthening families to force families into a two working parent scenario when they do not wish to be in that situation? Finally, there is the pro-life issue. Babies in 39 other countries, including Morocco and Cuba, have a better chance of living through their first year than babies born in the US. This is directly tied to, not only pre-natal care (care after the woman is pregnant) but also to the health of the mother before she becomes pregnant. Time magazine did a cover story on this very topic last week that I suggest you read. Also, many women have abortions simply because they can not afford the costs associated with birth and care of a child. Affordable health care would help reduce the number of abortions in this country.
You’ve heard this a million times in the past 2 years. The United States pays more for health care than any industrialized nation yet we have poorer health outcomes, we have higher infant mortality and we are more likely to die earlier than people in 39 other countries. This is solely because we rely on for profit health care and for profit insurance companies to keep us healthy. Their interests are not in keeping us alive but are in making a profit. Actually, we are much cheaper to them if we die from cancer quickly than if we stay alive for 20 more years with the possibility of a cancer recurrence. Once we get sick we are worth more to them dead than alive. Insurance companies deny procedures and medications to Americans all the time because they cut into their profits. How many times have you been told that the medication your doctor prescribed will not be covered by your insurance company because of the cost. Republicans have been attempting to scare you for months about government coming between you and your doctor. There has been someone in between you and your doctor for years, an insurance company, and he is only out for making a profit, not for making you healthy. A non profit option would change the dynamics of that system. No longer would your care be based on the profit of your insurance company but instead on the best possible health outcome for you. A public option would be focused on keeping Americans as healthy as possible in order to reduce costs and avoid high priced procedures that result from emergency care. How do we, as Americans, lose in that situation?

1 Comments:

At 11:29 AM, Blogger Ted said...

Mostly I agree. But if there was a public option out there. What would stop most companies from ditching BCBS and telling their employees to go get the public option? And would that be bad?

That is just a question. Mostly I agree. I think you made a good point about the over 65 issue. Also I haven't heard any one talk about mental health coverage which of course is near and dear to my heart.

 

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