Insurance competition is not enough…

To call it the American health care system is an oxymoron – there is no “system” to it as a whole. No wonder the House bill is 2,000 pages long. Such a multi-faceted issue is not as simple as whether or not to have a public option.

The shared goal of all our federal legislators for health care reform, as they would tell us, is greater accessibility at lower cost. (I won’t go so far as to say they all agree on “universal” access and affordability. That’s what you and I want, but we don’t get tax-free tips from the health care industry.)

So in those 2,000 pages we see odds and ends of “reform” for who pays, who provides, who insures, what is successful treatment, what’s a fair price, when do you get a subsidy, what does a given service cost, who gets taxed, who’s responsible for supervising, who negotiates, what’s covered, and on and on and on. Reminiscent of herding cats. Where to start?

Americans spend twice as much per capita on health care as the next most expensive country. But we don’t get anywhere near the best care, despite what we pay.

Have you checked the rate-per-hour of a surgeon lately? Thousands! Yet doctors of my acquaintance say they’re barely making it at today’s rates of reimbursement. The cost of their training takes years, decades perhaps, to pay back. Then there’s the cost of all the high tech equipment they need, the medical staff, the liability insurance, the bookkeeping staff. Indeed, some hospitals have pointed out that they have more billing staff per bed than they have nursing staff. Doctors and hospital administrators all live pretty well by my standards, but I will take their word that it’s not like it used to be.

In any case, they pass on to the “payer” the cost of all that. Ultimately, that’s you and me, not them.

No doubt the so-called system today encourages over-testing, over-treating. That’s certainly due in part to their legal liability. Tort reform is an element of reducing the CYA component of health care costs, but it’s not the only fix needed.

So what does either the Senate or House bill do to curtail the CYA practices, and impose industry standards, or “best practices”? Numbers show we over test, and that does NOT improve outcomes. “Evidence-based medicine” requires a payment structure that guides what is seen as potentially helpful and what isn’t. Medicare does it, and it works very well. The docs are relieved of some the legal liability if a government entity decrees a standard that is “evidence-based,” and they follow it. That doesn’t mean they fail to perform tests or treatments they deem necessary for a particular patient. It means they don’t take a shotgun approach when a sighted-rifle will do the job.

Hospitals used to be non-profit. Amazing how the costs of an aspirin and a bandaid provided during your hospital stay have skyrocketed out of control since they became for-profit care providers, isn’t it?

Pharmaceuticals show record profits, but government (Medicare) isn’t allowed to negotiate prices? They can sell their stuff in South America for a fraction of what they sell it to us? How do these bills address this ridiculous situation?

Then there’s the issue of anti-trust exemptions. Insurance companies are allowed to control a market in a specific state. But changing this won’t guarantee more competition; there are different regulations and secured funds requirements in each state; it’s expensive to set up shop in a new state. A few bad customers in a small state (think millions in medical bills for someone with several significant lifelong issues) can kill the profitability of a company with a small market share in that state. Perhaps if they were in every state they could spread the liability around, but surely we can all see that this won’t reduce premiums overnight.

And we come to profits for Insurance Companies. They claim their profits are only 2%. Seems pretty reasonable, doesn’t it? How can we expect them to decrease profits?

I submit that’s creative accounting. That’s what they report to the IRS, not what they report to their shareholders. Wouldn’t a large discrepancy like that raise a few eyebrows if it were offered by a person, not a corporation? Special tax rules for corporations with lots of cash to flash in Washington and throw at campaign offices across America?

And executive salaries are considered expenses, remember? No limits there, of course. That’s just overhead. 30%. Is there any real attempt to limit profits and overhead in the health insurance industry in either bill?

Fiscal conservatives, you should like the idea of letting Bean Counters make the decisions about appropriate care and legitimate overhead -- especially when it’s tax dollars that are paying, like in a “public option.” But that’s not what Blue Dogs and Republicans are jumping on. Truly cutting costs means suggesting that a patient can’t just get every drug and procedure and test they’ve seen on TV. That’s a hard sell to the American public who already have insurance that someone else pays for.

So since we all share the same goals of greater accessibility and lower costs, you might think the Blue Dogs and Republicans would support a plan that gives this highly controlled option not only to Medicaid recipients, but also those too cheap to buy insurance who mess things up for the rest of us. They should get “rationed care” as dictated by the Bean Counters. So that’s where the fiscal conservatives jump in, right? But no, they say forget the public option. Let’s stick with what we’ve got. Gotta save those tax dollars – right? Regardless of the people who pay for that attitude with their health, indeed their very lives. 40,000 die every year from lack of health care coverage and the outrageously high cost of care.

Hate to be a broken record, but the only way to even begin to fix ALL these things is a single-payer system. Truly, a system. Would it be perfect? Of course not. Ask people in countries that have one. But would it cost less? Ask those same people and they’ll give you a resounding “Yes.” Would it improve access to health care? Duh. See previous answer. Would it improve the health of the American people? Just check the statistics that show we rank 37th in the world, behind every country that has a universal single payer system.

But we can’t even consider such a thing. It’s socialism, remember? Best practice, when it comes to health care, is apparently not good business, it’s socialism, according to the Blue Dogs and Republicans. And you know what THAT would mean! Better, faster, cheaper. We can’t have that in America!

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Footnote: Then there’s our ol’ pal Joe Lieberman. What I want to know is, where are the protests from Connecticut? 64% of those folks, according to the polls, want at least a public option in the health care reform bill. 64% of the people he represents. And he won’t even let the Senate have an up or down vote on the subject? I should be able to hear the screaming all the way down here in South Carolina. He absolutely does not deserve to caucus with the Democrats, much less be chairman of the Homeland Security committee, or even keep his seat in the Senate. Can you impeach a senator, Connecticut?

JM

A Fiscally Conservative 3rd World Country?

Bernie Sanders, Independent Senator from Vermont, has said America is becoming a 3rd world country. In speaking on the subject of health care reform and the vociferous objections of so-called fiscal conservatives who steadfastly refuse to spend another dime to ensure a healthy population, he marveled at how quickly they were willing to reduce existing tax revenue streams, and authorize un-paid-for expenses that will climb to $3 Trillion for a completely unnecessary war in Iraq.

The tax cuts that were the hallmark of the Bush Administration, were quite specifically geared toward the wealthiest Americans. During those 8 years, the rich got inexorably richer, and the middle class became the working class, and the working class became the poor. The poor stayed that way.

Those reduced taxes translated to less money flowing to state governments, so while the rich got a luxurious tax break, local property taxes skyrocketed. Middle class families were stuck making up the difference with increases in the taxes on their homes and cars.

Here’s another angle. Scheduled to expire in 2010, thanks, again, to the Bush Administration, is the estate tax. You may not recognize that term, because those orchestrating the repeal drive a few years back sold it as getting rid of the “death tax.” Sound familiar?

This outrageous tax, they declared, would destroy family farms and small businesses across America, when they were handed down to the next generation.

Voters bought in to the story, shedding tears over the tragic losses of multigenerational 200 acre farms. Fiscal conservatives whipped the sympathy into a frenzy and passed a tax cut on estates. Few of us ever learned the fact that by simply exempting such passing on of entrepreneurial enterprises, we could have avoided those tragedies, Instead, we now face a loss of a trillion dollars from tax revenue over the next 20 years because the tax break will be extended to the richest of the rich, less than 0.3% of Americans.

The middle class will have to make up that trillion dollars, too.

In 2007, Warren E. Buffett, the billionaire chairman of Berkshire Hathaway, urged Congress to keep the estate tax. He opined that plans to repeal the tax would benefit the very few richest American families, and widen income disparity in the United States.

Rather than call it a “death tax,” he said it should be called a "death present.""A meaningful estate tax is needed to prevent our democracy from becoming a dynastic plutocracy." And this is coming from one of the richest persons in the world.

Here’s the reality: having a job doesn’t protect you from being poor and unable to pay your bills and buy food. Having two jobs in a family doesn’t protect you from losing your house. Having four jobs between two people doesn’t guarantee you can afford the health care you need just to stay alive. No matter how hard you work, no matter how you try to save, no matter if you don’t smoke or drink or eat fried foods, there is no guarantee you will live the American Dream come true. It has not been less true since the dawn of the industrial revolution and rise of the middle class.

But you will pay taxes on the money you earn from those jobs. And those taxes will be used to build highways, educate children, pay firefighters, defend the nation from enemies, control air traffic to prevent collisions, inspect food processing plants, bail out banks and fund research for cancer cures. Everyone in the country will benefit from the money you contribute, rich and poor alike.

Yet people who didn’t work a day to collect the millions their great-great-grandfathers earned 100 years ago seem to think they should receive this unearned cash tax free. And the rest of us can go to hell. As Marie Antoinette never said, “Let them eat cake.”

Then there’s the capital gains tax, which we discussed a few weeks ago on this blog, You take some money, leverage it to the hilt, and move it from one electronic account to another, make more money, and “earn” a capital gain. The fiscal conservatives would like to ensure you don’t pay a dime of tax on that “earned” capital gain. It doesn’t matter what benefit you might get from the use of those tax dollars. It certainly doesn’t matter what OTHER people might benefit.

Those same fiscal conservatives were quite happy to raid the coffers of the social security system back in the days we contributed more than we paid out. All that “excess” money was supposed to remain untouched for any purpose other than social security because economists recognized that as the baby boomers aged, that money was going to be necessary to meet the need. Instead, it was used to buy missile defense systems and fight wars of choice. Now that we’re running short, their answer is to dispense with the system and let people invest in an unregulated Wall Street.

I think you can see where I’m going with this. Senator Sanders is right. Our elected representatives (if they can be called that) have gone to great lengths to ensure that the middle class will disappear. We’ll have the powerful upper class, and the powerless poor who work for them. Just like in 3rd world countries.

But we have one hope to prevent this. A very American hope. The vote. The self-styled fiscal conservatives may have money and power, but there aren’t very many of them. The rest of us can change the course of history, apply the brakes to the widening disparity in the distribution of wealth.

At no time has this been more possible than it is right now, by confronting the obstructionism of the Blue Dog Democrats and Republicans with regard to health care reform. When they cry for a halt in spending on things that help us little guys, but continue to throw money at wars and cut taxes on the rich, we can let them know that they will pay for it at the polls. Call, write, email, march, but don’t let them get away with this. They’ve already gotten away with enough.

JM