Children of Dune:

Children of Dune:

Wednesday, September 9, 2009

I got some email from an old friend in the San Francisco bay area listing some talking points, and felt moved to respond. Perhaps I should edit the response, but I am lazy.

Here is the email:

Friends and family,

These health care reform talking points below came from the White House. I subscribe to a newsletter from this obviously biased but official site.

I read these and see good goals and good reasons. I probably don't have all the facts or ideas. I think our current system is working to everyone's disadvantage. I want to improve it. OBTW, if single-payer becomes the only source, Lynn and I are out of income; might be worth it to re-invent ourselves if it helps so many.

If you agree with some or a lot of these, please forward to some of your friends.

If you disagree, please take the time and email me back with your reasons. I want know them and have a good discussion about them.
(by the way, a good discussion does not include frothing at the mouth about socialism, unamericanism, nazi yada yada, killing grandma or the boogie man. We are all adults (or doing the best we can) and can do better than yelling at each other.) (And the founding parents would have loved the discussion to be robust and about the issues.)

Thanks for any effort you make to keep up the rational discussion.

Here are the points:

8 ways reform provides security and stability to those with or without coverage
  1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
  2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
  3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
  4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
  5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
  6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
  7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
  8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.
Learn more and get details:

8 common myths about health insurance reform
  1. Reform will stop "rationing" - not increase it: It’s a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.
  2. We can’t afford reform: It's the status quo we can't afford. It’s a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.
  3. Reform would encourage "euthanasia": It does not. It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.
  4. Vets' health care is safe and sound: It’s a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.
  5. Reform will benefit small business - not burden it: It’s a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.
  6. Your Medicare is safe, and stronger with reform: It’s myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors.
  7. You can keep your own insurance: It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.
  8. No, government will not do anything with your bank account: It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you – and the same rules of privacy will apply as they do for all other electronic payments that people make.
Learn more and get details:

8 Reasons We Need Health Insurance Reform Now
  1. Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more:
  2. Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. Learn more:
  3. Roadblocks to Care for Women: Women’s reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care. Learn more:
  4. Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more:
  5. Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more:
  6. The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more:
  7. Diminishing Access to Care: >From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more:
  8. The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform.
And my Response:

Hi Pat,

Good Grief. I suppose you realize that you are asking an old fat programmer to address twenty four points put together by a dedicated and earnest staffer, you ask for more than the accustomed amount of typing.
When people start to talk past each other, my experience tells me that it is often caused by a lack of common ground. Folks tend to assume that their common notions are shared and obvious, but a dialectic required these notions to be overt and agreed. It is the reason that forensic processes have an early stipulation process.
I assume that we are talking about the current health care bills moving through our congress. There were four roughly parallel bills when I checked a few weeks ago: three bills in the house, and a senate bill. The bill I began to read is F:\P11\NHI\TRICOMM\AAHCA09_001.XML which was converted to a .pdf file for broadcasting on the internet.
I have read about 2/5 of the thing.
I think we can agree that health care is provided by health doctors, nurses, and other health care providers. Also Insurance companies provide insurance, congress provides legislation and regulation, and so forth.
Let us think for a moment about the rationing aspect of health care, or the rationing of anything. All things which are desired and not completely abundant are rationed in some way. The straightforward way to ration something now days is to set the price. It is as true for the Lincoln Town Car as it is true for a piece of bubble gum. There are lots of other ways to determine who gets how much of what. This is all obvious.
Those of you who know health professionals know that they are pretty busy on the whole, and a lot of new infrastructure will not pop into existence. So we will not get more health care with any health bill, although we can change who gets it. In this case, some will get more health care than would otherwise get, and some will get less health care than they would otherwise get if the bill is wisely crafted. It is possible for everyone to get less health care.
Insurance: A promise of compensation for specific potential future losses in exchange for a periodic payment.
Look at the first eight parts in general. They are not about health care, but about regulating the relevant part of the insurance industry by the federal government. This is a major sea change all of us in the country for reasons:
First, because insurance companies are heavily regulated by the several states. Where the states have severability clauses in their laws and regulations, the portions which are not voided by federal law will be added to the complexity of the several manifestations of the "health" bill. Which leads to the second reason.
Second, the authority to do so by congress seems to be missing from the enumerated powers of congress. This only important because a challenge based on a claim of reserved power by one of the fifty states might succeed in the supreme court.

  1. Ends Discrimination for Pre-Existing Conditions: This first talking point points up the great flaw in trying to solve health care problems using insurance: one who is ill is not experiencing a potential future loss of health. This is not a person who needs insurance, this is a person who needs a doctor.
  2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: The second talking point uses the word exorbitant; well, lets think about that. Part of the problem that we have globally is that modern medicine can cure so many more things, some of which require teams of people and expensive machinery. You can probably get someone to bleed you pretty cheaply for an example of older technology. There is the issue of price caps which are a bad idea very well understood as an economic no-no.
  3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge...? A business faced with exactions of this type will treat the exaction as a business expense if it can, otherwise will leave the line of work altogether. Examples of this are places like New Jersey and New York which have driven most insurance companies out. The ones that remain don't offer much.
  4. Ends Dropping of Coverage for Seriously Ill: I don't understand this one. Is it a straw dog? What the insurance company covers is described by contract. If you don't like the policy, buy a different one. Oh wait, the policy you want is illegal by the laws of your state. (It happened to me.)
  5. Ends Gender Discrimination: This one doesn't make any sense either. The insurance company will charge more to persons who will get more. Actuarial calculations take place.
  6. Ends Annual or Lifetime Caps on Coverage: Caps on coverage are placed there in order to offer cheaper insurance. The insurance companies would be glad to give you the more expensive policy in a perfect world where they were no prevented from providing those services by state mis-regulation.
  7. Extends Coverage for Young Adults: The argument against this point is much the same as the last one. Insurance companies would cover kids to the age of ninety if they are paid for it. As a practical matter, they love covering kids, who don't get sick much. Kids of twenty six.....heh heh heh.
  8. Guarantees Insurance Renewal: If you pay insurance companies, they will be glad to cover your risk.
Ok, we going into an argument with three eights, or trips as poker players like to call them, or sometimes a set. Let us look at the next three.

  1. Reform will stop "rationing" - not increase it: This is flat statement not an argument. I already disposed of this "idea" above in the second paragraph after So....
  2. We can’t afford reform: This is a straw dog argument. It is hard to find anyone who supports the current interface of regulation and health. I know I have never seen anyone try to support current regulation. Don't get me wrong, I like the idea of cutting waste, fraud, and abuse within existing government health programs. I don't see the necessity of tying these admirable goals to this particular bill.
  3. Reform would encourage "euthanasia": Take a look at the bill on pages 425 through 429. Some of the language seems to have a compulsory quality. And that is the language which disturbs some. It doesn't use the word euthanasia, Decide for yourself.
  4. Vets' health care is safe and sound: The health care that veterans get is nothing to write home about. I am a vet and am somewhat familiar with the process. I have an interest in keeping my health care from starting to look like the health care that veterans get.
  5. Reform will benefit small business - not burden it: I just gave a cursory reading to this part. It looked as though the government would add process that the small business would have to go through, and establish employee number brackets which would cause a small business to hesitate to add employees at the margins of the brackets.
  6. Your Medicare is safe, and stronger with reform If you look elsewhere in the bill you can see that recent changes to medicare will be rolled back. And portions of part D seem to be excluded. It's complicated, but it seems that persons relying on part D to be as written are going to get skrewd.
  7. You can keep your own insurance Just not true. The entire bill is about changes to your insurance over time. As the changes take effect your insurance will not be the same. Looking at these changes, it seems likely than Companies will not offer products with this sort of restriction.
  8. No, government will not do anything with your bank account I don't know what they are on about with this complaint. I haven't seen it. The government feels free to do things to your bank account. If you don't believe me, try going to war with the IRS. I could give you other stories. My assumption is that they will do what they will with your bank account if they feel it in in the national interest. And I'm not too concerned about it.

Now lets take a look at the terminal eight.
  1. Coverage Denied to Millions: Thought I already did this one. It is number one of the first eight.
  2. Less Care for More Costs: Thought I already did this one too. He keeps confusing health care with insurance. Its hard to see how driving up the costs on insurance with rather arbitrary regulation is going to help.
  3. Roadblocks to Care for Women: Did this one too.
  4. Hard Times in the Heartland: If you think health care is worth moving for, go somewhere where you like the health care. It is one of the disadvantages of rural life. People living in rural America also have advantages. It is a trade off.
  5. Small Businesses Struggle to Provide Health Coverage: It is more expensive for a small business to buy insurance because it costs the insurance company more to service them. Lots of small businesses form an insurance pool.
  6. The Tragedies are Personal: All tragedies are personal. I seem to be missing the point. What does this have to do with insurance reform.
  7. Diminishing Access to Care: Does not seem to be giving the full story. The learn more did not clarify much to me, and I was forced to guess. We have been having lay offs, perhaps lots of young healthy people did not feel like paying for COBRA. Perhaps struggling businesses offered less health insurance in order to stay afloat. I don't know
  8. The Trends are Troubling: I have to agree, just not with solution.
Well Pat, Just looking at the talking points, I didn't get the impression of writer(s) looking for dialectic; further, there is a disturbing belief in Washington that because the goals are good that any sort of legislation in the area will be wise.
This bill is incredibly complicated. Lots of the rules look arbitrary. I am willing to bet that at this point, more ordinary Americans than congress persons have read the thing.
Hope this helps.
Each of these points could take a good deal more elaboration and research. I personally was more interested in some of the points than in others. Not pleased with the phrase health care system with its connotations of structure. And I too would like our health care to be more rational and efficient, but have very different ideas about how to do that.
If you folks want more input or enlargement on any of these points, just let me know.

Nice to see your name,
Oliver Shank