July 25, 2009

I never thought I would do this. That is, talk about politics on my blog.

First of all, I am terribly afraid of being wrong and I probably will get some things wrong. Maybe I'll make a fool of myself in public by talking about things that I don't understand. It's likely.

Secondly, I'm terribly afraid of offending people and causing conflict. I hate conflict, it makes me cringe.

Thirdly, I tend to have this kind of apathy when it comes to politics.

But lately I've had to ask myself, is that the extent of my patriotism? I'm an American. This is my country. Maybe I am in some small, but real way, responsible for it.

After all, this country has been handed down to me by others who sacrificed everything for it. It's the legacy I'm going to hand down to my children and my grandchildren. My husband is willing to give his life for this country. It seems to me that the least I can do is have an informed opinion.

I found some interesting answers to all of my questions and I will provide links and sources so you can pursue your own research and see where I am getting my ideas from and then form your own.

And I've only barely touched on these issues. I needed to in order to keep this blog somewhat readable. But there is so much else going on having to do with Health Care Reform. Don't be intimidated. If I could figure out even a part of it, you can too.

Here are the four main questions I asked:

What kind of health care reform is being debated right now?

What kind of impact has this kind of health care reform had in other countries that have adopted it?

Why is it being rushed through?

Lastly, is there another option for health care reform?

I found answers to all of these questions. I will include links, quotes and sources, in fact the bulk of this blog are other people's words. Any italics included in any quotes are my own.

One: What kind of Health Reform is being debated right now?

According to the President, he is looking to:

"-Reduce long-term growth of health care costs for businesses and government

-Protect families from bankruptcy or debt because of health care costs

-Guarantee choice of doctors and health plans

-Invest in prevention and wellness

-Improve patient safety and quality of care

-Assure affordable, quality health coverage for all Americans

-Maintain coverage when you change or lose your job

-End barriers to coverage for people with pre-existing medical conditions"
-The White House, Health Care, Guiding Principles.

Wow. Those are awesome goals. As responsible Americans, we all want to be able to provide this, to be able to say that our country achieved this. The debate is not about whether or not health reform is needed, but how to go about it.

Now it turns out there are three different ways of approaching health care coverage from a government wide point of view. One possibility is to have private companies only. The other is through a government program only. This is also referred to as "single payer" or universal health care program. The third option is a mix of the two, both private and government health care insurance and programs.

Surprising (at least to me) America is actually already on the third option. We have Medicare, Medicaid and SCHIP programs, in addition to private insurance companies that businesses voluntarily buy for their employees or that people buy as individuals.

What is being debated now (in part) is a "bridge" to cover people who do not qualify for the government programs already in place and yet who cannot afford to buy their own health care or do not have access to health insurance through their employer.

These government supplied health insurance agencies would be subsidized in order for them to be affordable to people who are in the "gap." When the government subsidizes something, it means that they artificially keep the price either low or high in order to have a desired effect.

The assumption with the proposed health care reform is, in part, that it would not be as expensive because it wouldn't cover the entire nation, just these "gap" citizens.

The main concern with subsidized government health insurance is that it would make it impossible for the private companies to compete. Let's say you can afford your health care insurance now, but it's pricey. If a government run health insurance became affordable at half the price with the same coverage, would you keep your private insurance?

"If a so-called public option is part of health-care reform, the Lewin Group study estimates over 100 million Americans may leave private plans for government-run health care. Any government plan will benefit from taxpayer subsidies and be able to operate at a financial loss—competing unfairly in the marketplace until private plans are driven out of business. The government plan will become so large that it will set, rather than negotiate, prices. This will inevitably lead to monopoly, with a resulting threat to the quality of our health care."
-Bobby Jindal, JULY 22, 2009, 4:20 P.M. ET, The Wall Street Journal, Opinion Journal, "How to Make Health Care Reform Bipartisan."


"A common myth is that universal government healthcare would be free or cost less than private healthcare. This belief violates several economic principles. First, the money to pay for health professionals, medicines, and facilities has to come from somewhere. If consumers don’t pay for these services directly, they will pay indirectly through higher taxes. Second, as the perceived price decreases, demand will increase. In other words, when people believe that they won’t have to pay for their healthcare, they will use more health services."
-David Thornton, July 2, 2009, The Examiner.com, The Problems with Universal Health Care

Another words, even if Health Care Reform is passed through that is not single payer, a government subsidized health care insurance program will put private companies out of business. They will do so because the private companies in no way will be able to lower their costs; they do not have access to tax payer money to make up for lost profit.

This will result in a single payer, universal health care program, or a monopoly on health care. We are all familiar with the economy principle of monopoly, right? For example, if there is only one company that can sell coffee makers, then that company does not need to rely upon consumer input to stay in business. It doesn't care if it sells crappy coffee makers, because it's either buy their coffee makers or go without coffee.

But we don't need to wait, even, for the economic consequence. The bill has assured that even if private health care companies don't die on their own, they will be no longer allowed five years after the passage of the bill.

"The (health care reform) bill clearly states that within five years of passage all employers must switch you over to a government managed health care plan. If you refuse, you’ll be fined by the Federal government. It will cost another trillion dollars (we are already $11 trillion in debt now) and still won’t cover every American."
-Carolina Politics Online, July 24 2009


"Also, within five years all Americans would be subject to the individual mandate to either purchase "qualifying coverage" or pay a fine."
-Edmund F. Haislmaier, July 23 2009, The Heritage Foundation, "Micromanaging Americans' Health Insurance: The Impact of House and Senate Bills"

(By the way, please read that article and click on the footnotes, they will will direct you to the section numbers of the bill actually being debated right now. I did it, because I didn't quite believe what I was hearing.)

But this is the government right? The government will surely provide quality services, right?

How many of you have parents or grandparents on Medicaid/Medicare? How many of you remember the government's response to Hurricane Katrina? Anybody been to the DMV lately?

How about looking at how other countries have set up their own systems.

Two: What effect has Universal or Single Payer health care systems had on other countries?

It costs way more that predicted and to see this, we don't have to look outside of our own country. The following is talking about the state of Massachusetts.

"The subsidized insurance program at the heart of the state's healthcare initiative is expected to roughly double in size and expense over the next three years - an unexpected level of growth that could cost state taxpayers hundreds of millions of dollars or force the state to scale back its ambitions."
-By Alice Dembner, February 3, 2008, The Boston Globe, Subsidized Care Plan's Cost to Double

How about California, where Governor Arnold Schwarzenegger's "universal" health care plan recently died in the legislation?

"Like collapses in Illinois, Wisconsin and Pennsylvania, this one crumpled because of the costs, which are always much higher than anticipated. The truth teller was state Senate President Pro Tem Don Perata, who thought to ask about the price tag of a major new entitlement amid what's already a $14.5 billion budget shortfall.

An independent analysis confirmed the plan would be far more expensive than proponents admitted."
-The Wall Street Journal: Opinion Journal. Editorial, January 30th, 2008 "Terminated"

Secondly, countries that have adopted universal health care systems are facing reduced benefits and rationing of services.

"Canada's Medicare program arrogantly asserts that Canadians get "medically necessary services," yet the facts show Canadians endure scandalously long wait times and a dangerous lack of access to modern diagnostic and treatment-related technologies, ultimately costing lives.

"British citizens suffer under the rule of their National Health Service, directed by their House of Commons Task Force, which recommended "techniques for determining the cost-effectiveness of new technologies" with "nationally approved standards for the commissioning of new technologies."

"Western European nations, where government dictates drug prices to the end result of pitifully reduced innovation, have less access to new cancer-curing drugs, so, consequently, patients die earlier from those diseases when compared to the U.S. There is no mystery here--it has been proved the world over that when government dictates prices on services, those services become unavailable."
-Scott W. Atlas, July 21, 2009, Forbes. com, "Rationing Health Care"

And-

"Now, however, the European welfare states are slashing benefits in the face of rising health care costs.

"A recent front-page story in the New York Times detailed the European cutbacks. According to the article, Britain, France and Germany are all being forced to limit access to care. Rationing, already extensive, is increasing."

-Michael D. Tanner, This article appeared on cato.org on September 23, 1996, A Hard Lesson on Socialized Medicine, The Cato Institute.

And-

"Great Britain's National Health Service (NHS) was created on July 5, 1948. As with all government programs, bureaucrats underestimated initial cost projections. First-year operating costs of NHS were 52 million pounds higher than original estimates1 as Britons saturated the so-called free system.Many decades of shortages, misery and suffering followed until 1989, when some market-based health care competition was reintroduced to the British citizens2."
-The Problems with Socialized Health Care

Secondly, they face incredibly long wait times for treatment.

"In Massachusetts, which mandated universal health care in 2006, patients wait an average of 63 days to get an appointment with a primary care provider. That is seven times the wait in Philadelphia or Atlanta."
-Tom Donohue, July 21, 2009 The Huffington Post, "Achieving Responsible Health Care Reform"

"My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care."
-David Gratzer, summer 2007, City Journal, "The Ugly Truth about Canadian Health Care"

Ok, so it's clear there are some really serious and complicated issues concerning universal health care. If so, why for God's sake rush it through Congress?

Three: Why the rush?

"There are genuine reasons the public is concerned about the state of health care in the United States. Good and fair-minded citizens may agree or disagree on the most urgent priorities and means to achieve them. But a rush to enact a massive plan hardly digested by members of Congress, let alone the public, does no service to any of us."
-Christina Fadden Fitch, July 24 2009 Syracuse.come "No Need to Rush Through Health Care Reform."

And yet it is being rushed through:

"In Rep. Paul Ryan’s (R-WI) easy-to-follow opinion piece in the Milwaukee Journal Sentinel, he wrote that before members of Congress even had time to read the 1,000-page bill, it already had cleared two major House committees. They didn’t even know the cost. So expensive, so complex, and potentially so powerful as to forever change the role of the federal government, and yet they’ve fast-tracked it?"
-Gorden Deal, Wall Street Blogs, July 24, 2009, 7:41 AM ET Health Care Reform: Cost and Controversy

Here's one opinion why (but just one). I happen to share this opinion. I could be wrong.

"President Obama’s Chief of Staff Rahm Emmanuel has insisted that a vote on the House health care disaster will take place prior to the August recess. There is a very simple reason for this. Obama knows that Americans are opposed to this bill coming out of the House and these Congressmen are going to catch hell when they get home over the recess. The odds are better for House passage if the vote takes place before they are all confronted with their constituents."
-Caroline Politics Online, July 24 2009

However-

"The top Democrat in the Senate says health reform legislation will not be approved before the August recess. A White House fast-track approach to passing the legislation by Aug. 7 has caused divisions among Democrats, and it appears to be on the verge of failing. In the House, an uprising by conservative Democrats appears to be threatening the ability to pass the bill before the recess."
-NYSSA SmartBrief 07/24/2009, Smart Brief, Fast Track for Health Care Reform is Derailed

To sum up (because, really, they said it better than I could. And read this article, it's great. Very down to earth.)

"It’s a remarkable thing. We are in the midst of trying to redesign the largest health care system in the world, and we’re barely debating the merits of it. How many members of Congress will have read the 1,1018-page bill once they vote on it? How many Americans will understand what implications it has for their health care if it — or something like it — becomes law?"
-by EvanFalchukJD, July 18 2009, Get Better Health.com, "Rushing Healthcare Legislation Through Without Consensus"

We all agree that health care reform is badly needed. And as soon as possible. But certainly not before Congress knows what they are voting on. Certainly not before we, who will be paying for it, know what it is about; before we can learn about the implications of putting it through, what it really means.

Four: Are there other options?

The short answer is, yes. There are. Here are some, I thought, interesting starting points and I love how commen sense they are. They are easy to understand:

"...there is general agreement among Republicans and Democrats that we need health-care reform to bring costs down. This agreement can be the basis of a genuine, bipartisan reform, once the current over-reach by Mr. Obama and Mrs. Pelosi fails. Leaders of both parties can then come together behind health-care reform that stresses these seven principles:

•Consumer choice guided by transparency. We need a system where individuals choose an integrated plan that adopts the best disease-management practices, as opposed to fragmented care. Pricing and outcomes data for all tests, treatments and procedures should be posted on the Internet. Portable electronic health-care records can reduce paperwork, duplication and errors, while also empowering consumers to seek the provider that best meets their needs.

•Aligned consumer interests. Consumers should be financially invested in better health decisions through health-savings accounts, lower premiums and reduced cost sharing. If they seek care in cost-effective settings, comply with medical regimens, preventative care, and lifestyles that reduce the likelihood of chronic disease, they should share in the savings.

•Medical lawsuit reform. The practice of defensive medicine costs an estimated $100 billion-plus each year, according to the American Academy of Orthopaedic Surgeons, which used a study by economists Daniel P. Kessler and Mark B. McClellan. No health reform is serious about reducing costs unless it reduces the costs of frivolous lawsuits.

•Insurance reform. Congress should establish simple guidelines to make policies more portable, with more coverage for pre-existing conditions. Reinsurance, high-risk pools, and other mechanisms can reduce the dangers of adverse risk selection and the incentive to avoid covering the sick. Individuals should also be able to keep insurance as they change jobs or states.


•Pooling for small businesses, the self-employed, and others. All consumers should have equal opportunity to buy the lowest-cost, highest-quality insurance available. Individuals should benefit from the economies of scale currently available to those working for large employers. They should be free to purchase their health coverage without tax penalty through their employer, church, union, etc.

•Pay for performance, not activity. Roughly 75% of health-care spending is for the care of chronic conditions such as heart disease, cancer and diabetes—and there is little coordination of this care. We can save money and improve outcomes by using integrated networks of care with rigorous, transparent outcome measures emphasizing prevention and disease management.

•Refundable tax credits. Low-income working Americans without health insurance should get help in buying private coverage through a refundable tax credit. This is preferable to building a separate, government-run health-care plan.

These steps would bring down health-care costs. They would not bankrupt our nation or increase taxes in the midst of a recession. They are achievable reforms with bipartisan consensus and public support. All they require is a willingness by the president to slow down and have an honest discussion with Americans about the real downstream consequences of his ideas. Let’s start there."
-Bobby Jindal, JULY 22, 2009, 4:20 P.M. ET, The Wall Street Journal, Opinion Journal, "How to Make Health Care Reform Bipartisan."

But I'll bet you this is not the only other idea out there. This is America, after all. We embrace diversity, are innovative and we love a challenge. We put a man on the moon, after all. We can figure this out and we don't have to borrow other countries' faulty blueprints or bankrupt our grandchildren to do so.