Posted by: inforodeo | September 7, 2009

The Requisite Health Care Commentary

Truth be known, I know very little about the healthcare reform debate that has America fiercely divided. My wife says there are three separate bills going around, but I’ve only seen one so far.

Like everyone else, I don’t like some aspects of our current healthcare system.  In switching from a big corporate job (where I worked for someone else) to good old fashioned American self-employment, we learned three terrible truths about healthcare:

  1. Insurance companies give big companies large discounts for their employees because it brings in premiums from hundreds of people rather than a single family …
  2. Insurance companies have dramatically different rates in different states (even through the same company), and “poorer states” are generally charged higher rates than “wealthier states” …
  3. Insurance companies can refuse you if you have a pre-existing condition (like pregnancy) or bad credit (or no credit).

We literally went from incredibly good coverage to incredibly terrible coverage (with a $7500 deductible per person), and our premium quadrupled. We were fortunate to add employees after a year, and that enabled us to get on a plan that had a lower rate (still about twice that of the prior employer’s plan).

Our luck changed for the worst when we were forced to let our employees go. Our insurance provider dropped us (we no longer qualified for their plan because we were only bringing them four customers rather than nine), but told us we could re-apply at a higher premium. Those plans weren’t as good, but we finally settled on one, just before the uninsured window ended, and mailed our forms.

We received notification three weeks later (a few days after the window closed & made it so we would have a harder time applying for insurance) that my wife didn’t qualify because she was expecting our third child.

Pregnancy as a pre-existing condition is ridiculous, especially for our family. We do that whole “natural birth” thing (have our babies at home), and none of the insurance providers in our state cover out-of-hospital birth, so we pay for it out of our own pockets anyway.

So here we are, coming up on a year without health insurance for our family. We pay for all of our doctor/dentist visits out of our own pockets, pay for our medicine the same way, and have been blessed not to have any major medical emergencies or expensive treatments.

I subscribe to a lot of conservative/republican/right-wing websites, blogs and email lists, so when I began seeing all the “behind the myth” stories on the major news sites, I was a little shocked. I hadn’t received a single email claiming “death squads” or any of the other bizarre stories allegedly coming up at the healthcare revival meetings. I could hear minor grumblings over the plan, however, so I knew a lot of people had some sort of issue with the plan & wanted to see for myself what the problems were.

Around this time I caught a story on NPR (yes, even I listen to left-wing radio sometimes!) about Canadian healthcare problems. It may be a moot point to bring up what I heard since (allegedly) the Obama plan is nothing like Canada or European healthcare plans, but it was interesting nonetheless. To summarize, some Canadians have had to come into the United States to receive the healthcare they needed because in Canada there are waiting lists and government decision-makers determine what priority your illness is in the long list of patients. Some Canadians who are proud of their system claim that those persons who have come into the United States for treatment really weren’t dying, but one Canadian woman with a brain tumor seemed to feel otherwise.

Because I’d heard most of my life how great Canadian healthcare was, I was a little shocked, so I went online to learn more. I learned that Canadian healthcare is paid by the province (state), not by the national government, and when you move from one province to another, there is a waiting period before you get on the new healthcare. Because these local governments have to cover the bill, and they have unequal budgets, strange things happen (sort of like the “Rape Kits” in the US that began being billed to victims after the Biden-sponsored bill that removed federal funding from local precincts and bounced the cost to state and county governments). One of these strange outcomes is that the province, having to be mindful of its budget, has to decide which medicines are, on the average, most beneficial to most people, and then it excludes all others from coverage. Unfortunately, because of the diverse nature of mankind, a medicine that works for 60% of the population doesn’t always work for the remaining 40%. This discretionary process also prevents or hinders the use of “experimental” treatments, which is one of the reasons why the US – not Canada – is the world leader in medical innovation.

As I mentioned before, the rumor (given by supporters of healthcare reform) is that the Obama plan is nothing like Canada (and that Canadian healthcare is not “socialized medicine”, as some are fond of saying). So what, then, is actually the plan being sold by these tax-payer funded traveling salesmen?

I found a few answers on a website that claims to provide facts about political issues, and here’s what I learned:

  1. Employer-provided healthcare would remain in place. Most of the country gets their insurance through work, and that is working just fine for them, so it should stay that way.  I wonder how many hard-working Americans who have a good healthcare plan will feel comfortable giving up more of their paychecks to help other Americans (and illegal aliens, if the current trend holds up) have health insurance. While it is a great idea to help those in need, charity is not charity when it is forced. It is against the purpose of mortality to be prohibited from making the choice between right and wrong.
  2. The government would set up a regulated (to prevent discrimination based on pre-existing conditions) “Health Care Exchange” that would be a virtual comparison-shopping tool to help private individuals and small businesses select the best plan for their needs.  This sounds like a great idea, and as a consumer, I would love to have a good, straight-forward tool (kind of like eHealthInsurance, but built by the government) that would help me sort through my healthcare options.
  3. The government would create a public healthcare option that would compete with others in the exchange. The advantage for consumers being that the government’s package will likely be the least expensive, which in turn will draw the current healthcare packages prices down through the competition. I also agree with most people who have reviewed this – having a cheaper government option is very likely to drive down healthcare costs *if* the government can stand their ground and not raise prices to be competitive (the opposite of the intended effect). If this public healthcare option is created, the consumer should also benefit by having more choices, which is a good thing.
  4. Eligibility for existing programs (like Medicaid) will be expanded so more people can take advantage of these programs. I worry about this, because when eligibility for a government program that is already weighing down society and creating a crutch for people who may have been able to support themselves without it is expanded, more people suffer, both those who become dependent on the system and those who are burdened with even more taxes to pay for it. On the other hand, right now there are some who really ought to qualify (as well as some who do qualify and shouldn’t). I wish there was a provision in the bill for better sorting those out.
  5. The government will require all people to purchase healthcare unless they qualify for a hardship exemption. People who don’t buy insurance will have to pay a penalty on their taxes.  There’s that penalty again. While this would indeed work to make (not “let”) more people have access to healthcare, I think it is a bad idea.  There are some people who, for religious reasons, avoid healthcare. While I may not agree with their motivations, this particular point in the bill would unjustly and unconstitutionally infringe on their freedom of religion. This provision in the bill also weakens the “it will help people” argument, because it would force citizens to enroll in the program, and if the program doesn’t work as well, our freedom to bow out of it is taken away.
  6. The government will create or help create an electronic record system so health records can easily be shared between doctors and hospitals.  I understand the fear in this. I understand the fear that our personal health records will be floating around for any hacker to grab, or that hospitals might sell them to advertisers working for pharmaceutical companies. I understand the fear of these records being used to prevent people from scamming the medical industry, and their potential for eliminating narcotics abuse. I think having an electronic network of medical records is an awesome idea, though, and I’m sorry to anyone who disagrees.  After Katrina, tons of people permanently lost their medical files.  Every time I’ve moved, I’ve either had to start fresh with my new doctors or go through a long process of getting my medical records released or transferred. Prescriptions and surgeries are sometimes mixed up – often with deadly results – and having a clear electronic medical records system that gives the pharmacist information about what you’re being treated for and what the pharmacist across town put you on last week will help more people than it will hurt.  Those persons who fear their medical histories will be used against them have yet to realize how damning their facebook and twitter accounts are, that their online purchases and travel destinations, library accounts, and physical characteristics are already easily accessible not only to the government, but to anyone with a few bucks and the right websites at their fingertips.
  7. The government will research what treatments are most effective, and then make the results public so insurance providers can drop those treatments which are not as effective. Here is one of the bigger dangers of the bill, and the very piece that DOES sound a lot like the failed Canadian healthcare system. In determining which treatments are most effective, the natural consequence is that some treatments will be considered less effective, and therefore dropped from eligibility.  Since more and more science is recognizing that the wide range of human beings do not all react the same to certain medicines, some of the “less effective” treatments may actually be the “most effective” for a handful of people, but will be dropped because the higher percentage of the population responds better to a different treatment.  This has some weird sci-fi potential to selectively thin out the human race until we are left with a ‘model human’ that responds well to a specific set of treatments.  Sci-Fi aside, however, the lack of options in Canada is why Canadians come to the US for treatment. It’s also why the US is the leading innovator in medical technology and pharmaceuticals. Supporters of the bill claim that this will only affect the government option, but what is to stop insurance companies from following the government’s list of “less effective” treatments to save themselves a buck?
  8. Doctors involved with Medicaid will be paid for good outcomes rather than for quantity of patients seen, which should increase the quality of care. Great idea, huh!? Great like “No Child Left Behind”! “No Patient Left Behind” has pretty obvious potential to ruin the healthcare industry the way it’s ruined education. Just like schools losing their funding for poor test results, hospitals and clinics could lose their funding for poor patient results. While the hearts of both are in the right place (accountability is good!), the function of each does not truly address the problem. Instead, it merely holds one piece of the overall system accountable. It ignores variables (is the student doing their homework? Is the patient taking their medication?), and attempts to place all the blame on one point in the overall process. Should we make a “no constituent left behind” act and see how well the politicians fare?
  9. The plan will cost billions of dollars per year, so Obama has proposed reducing or eliminating tax deductions for the wealthy. New taxes or tax increases on existing taxes that all Americans pay may be required in order to fund the new government programs. Despite other things to worry about in the bill, I think most of the opponents are most fearful of this. Any time a government program is born, the taxpayers have to add its cost to their dollar whether or not they support the program, and regardless whether or not they will ever use it. How much will it really cost? Who will really benefit?  How much will really change? Will the cost increase over time?

There needs to be reform in our nation’s healthcare.  To what degree that reform needs to come by way of government intervention is debatable. I think whatever the final package is, it needs to not cost the taxpayers any more than they are currently paying.

I don’t think people should be penalized for not taking on healthcare.  It’s like penalizing them for not living in a house or drinking milk. We should have the right to deny healthcare, just like healthcare has exercised its right to deny us. Forcing Americans to have some form of healthcare coverage necessitates a definition of what healthcare is, and could lock some out of their choice. Does a healthcare savings account count? What if i stock up on herbs and remedies? What if my neighbors make a network of alternative medicine healers, therapists and midwives and I join. Does that count?

I think someone needs to take a long look at what isn’t working in the structure of the system itself, and fix that.  Require insurance providers to offer the same coverage for the same prices across state lines. (Currently a provider can have completely different packages in different states, often charging more in ‘poor states’ than ‘wealthy states’. Eliminate “pre-existing conditions” (like pregnancy!) and penalize substance abuse (alcohol and tobacco) instead.  Or eliminate the need for insurance altogether, and create affordable medicines, practices and clinics by regulating costs.

I think that healthcare should expand to include preventive care.  Offer tax credits for healthy groceries, gym memberships and yearly check-ups. Instead of taxing the people to pay for these programs, increase taxes on unhealthy food items, like soda pop, potato chips, fast food and cookies. If you want to penalize someone, have mandatory drug/alcohol tests and add tax penalties to those who consumed a harmful substance.

These are all socialist solutions however. The best option all around is to scale back government and put the federal government back in its original function: to regulate and standardize commerce between states and protect the people.

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