Healthcare Band-Aids

This article explains two bona fide problems with healthcare and uses them as a reason to support healthcare overhaul as it stands today: You Do Not Have Health Insurance

The main points of the article, in my words, are:

• People who buy their insurance through their employer are not truly insured against health problems because a change at their job could end their insurance at any time.
• Health overhaul should not be viewed as a program for the poor (as I say it should be) because most Americans are poor when it comes to healthcare in the sense that they would have trouble paying their expenses in the event of a job loss or other emergency.

These two claims are true problems. We should be solving them rather than looking for a work-around.

If we had to choose between doing health insurance through employers or doing the overhaul proposed by Congress, maybe we should go with the overhaul. An easier solution is to transition away from employers providing benefits. Money was invented so people would not have to be paid in bartered services. Much of this problem would disappear if people were paid in money. Employer-captive is the real problem.

The part about many Americans being unprepared for life’s financial ups-and-downs is true too. Again, the solution is not to find a Band-Aid to manage this fact. The better approach is for people to be prepared, i.e. set aside money to cover life’s ups-and-downs.

It seems like supporters of the current overhaul proposal offer complicated Band-Aids to deal with healthcare problems but do not address the problems themselves.

Are Bizarre Criticisms of Healthcare Reform Part of a Conspiracy?

It’s interesting that the debate on the proposed healthcare overhaul seems to be focused on stupid urban-legend-style e-mails about putting the ill in concentration camps. I also read about people shouting “socialism” in public forums about the overhaul. The White House sends regular e-mails debunking the stupidest criticisms imaginable.

What about the legitimate criticisms? What about citizens who agree with elements of the proposal but want to lobby for changes to the still in-progress plan? There is not much discussion of that. It makes me wonder if somehow supporters of the overhaul are behind some of the bizarre and obviously silly attacks. It helps push the debate toward straw men and decreases serious discussion. Supporters come off looking good just by dismissing claims about death squads for the elderly. They don't have to get into the finer points.

All things being equal, if something looks like a complex machination or sheer stupidity, it's usually just stupidity. But I’m keeping an open mind. These criticism are so stupid that they work mostly in overhaul proponents’ favor. I suspect at least some supporters of the healthcare overhaul plan welcome these bizarre criticism-- the stupider, the better.

Comments on NYT Health Overhaul Primer

The New York Times ran a nice primer on the details of health reform. Based on what I learned, I oppose the overhaul in its present form. Here are some points

The claim that the reform will not affect existing insurance is an out-and-out lie.
The House bill sets limits on deductibles and copays. The Senate bill allows plans outside the limits to be grandfathered in, with no new contracts made outside the limits. If either bill passes, if I want insurance against very expensive illnesses, I will need to buy insurance against trivial expenses too. This matters because it will bring insurance companies into the deals I make with my healthcare providers on small expenses. Bringing another party to table just complicates things and increases inefficiency.

Because of incentives and penalties for employers, about 3 million more people will go on employer-captive insurance plans.
We will have to see more details as the legislation congeals. In general, employer-captive limits people’s right to buy the insurance they want and are a bad thing.

An additional 10 million people would enroll in Medicaid.
This is very good. The point should be to provide healthcare to people who can’t afford it. Medicaid is program tasked to do just that. There are more than 10 million people without adequate healthcare. Hopefully they will be picked up by other elements of the package.

Overhaul will attempt to be deficit neutral.
This is very good. I don’t mind the surtax as long as it doesn’t cause marginal rates to exceed 45%.

The plan will massively cut Medicare.
After watching the battle with Gingrich in 1995 over this issue, it is ironic that the Democrats want to cut Medicare more than Republicans did in ‘95. I thought it was lame that Republicans called it “saving Medicare” instead of cutting Medicare. I am unclear as to whether these proposed cuts would be used to ensure Medicare’s long-term solvency or so that Medicare tax monies could be used for non-Medicare programs. Medicare’s long-term solvency is an important issue. Democrats should be honest with people, though, that cutting the budget 40% will result in at least some decrease in services.

I support only the part of this plan that makes more people eligible for Medicaid. The vast majority of people should handle their own expenses and pay reasonable taxes to help the needy. Yes, people might not do a perfect job of buying healthcare, but the government doesn’t always do a perfect job either. In life, just as in engineering, you have to accept some inefficiencies.

Reality Check Debunks Every Straw Man Criticism of Health Reform

The Obama administration sent out an e-mail today debunking some of the scare tactics being used against healthcare reform. It links to a website called Reality Check, which reads at the junvenile level of someone who might actually believe the scare tactics.

It was nice that they addressed the main concern I have – that the contract I have with my insurance company will be proscribed by the new law. This "Reality Check" website promises, in no uncertain terms, that there will be no changes for people who like their plan. In the administration’s previous e-mailing, they said that high deductibles would be disallowed. Maybe they meant they would not be allowed in the gov’t option, but people who currently choose a higher deductible can keep their policy.

I want to support this thing. The administration's 10-year-old-reading-level website has no effect either way. The plan costs $100 billion per year, and we need to understand exactly what they are planning to do with that money. How are they going to keep the public option from becoming like states' existing high-cost public options (HIRSP, in my state) for those who are already sick? We need details.

Breastfeeding Dogma Used to Promote Paid Maternity Leave

I received another e-mail from Momsrising.org. I’m not sure how I got on their list.

This message was calling for paid maternity leave based on the argument that it supports breastfeeding. For followers of the breastfeeding dogma, nothing in life is more important than breastfeeding.

My friend was dedicated to breastfeeding exclusively for the 6 months recommended by doctors, but she shared with me that, "If I hadn't had time off work, I probably would have given up."
[snip]
Breastfeeding expert Dr. Jerry Calnen argues, "If we are serious about improving our breastfeeding rates, a national paid maternity leave policy will be absolutely necessary."

There is some scientific evidence to suggest breastfeeding is better than formula feeding, but scientists have not been able to prove causality. If more affluent parents tend to breastfeed, we can’t be sure there’s not something else associated with affluence besides breastfeeding responsible for improved infant health. The preponderance of evidence, though, is that there is at least some minute benefit to breast milk over formula milk. Breastfeeding dogmatists turn this fact into a 21st century version of “a woman’s place is in the home”.

Setting aside the breastfeeding argument, I have mixed thoughts on paid leave. It has worked well for other countries. I don’t understand, though, who pays for it. If employers need to eat the cost and just need to understand that when hiring a women, you’re likely not to get as much work per year, we should expect employers to pay women less. That’s equal pay for equal work, expect for women who don’t use the benefit.

I don’t have a good program in mind to help the poor deal with the costs in time and money of having a baby, although I see the potential benefits to society of having one.

The reason I am writing this post, however, is so much modern advice on parenting indirectly calls for women to focus on child-related things. The advice doesn’t say where the money comes from while the woman is focused on breastfeeding.

The issue of how much parent time will be dedicated to caring for infants is a huge question. The most obvious choices are a) one parent quits work and focuses on the baby or b) the baby spends most of his waking hours with someone else caring for him while his parent(s) work. Breastfeeding dogma and proposed policies that would pay women not to work push us toward option A with the "one parent" being the woman.

We should be cautious of any policy that pushes us back toward the restrictive gender roles of the past.

Cash for Clunkers Program Is a Disgrace

I hope the Senate does not authorize further funding for the “Cash for Clunkers” CARS program. This program pays people several thousand dollars to destroy cars by running their motors with sodium silicate in the oil. These are cars that could have been sold (or perhaps given) to poorer people who need cheap transportation. Instead we’re purposely burning up their motors.

The program pays people a few thousand dollars to trade in an old car for one with good fuel economy. The person buying the new car receives a few thousand dollars from the government plus whatever salvage value their old car is worth after having its motor intentionally trashed.

Environmentalists say: Reduce, Reuse, Recycle. Trashing working items is the opposite of reusing. We should reuse stuff where possible because it takes energy to make new products and to salvage the old ones. The justification for the CARS program is improved fuel economy, but does this really offset the loss of value from trashing decent old cars? Why doesn’t the government simply buy carbon offset credits to offset the emissions from older cars?

This is just a give away to car manufacturers. We need to get away from building so many cars. We need to get away from throwing stuff away and replacing it with new items for questionable reasons. We need to use our money wisely where it can have the most impact on the environment, because the impact of carbon emissions today will be very costly to future generations. The CARS program goes against everything environmentalism stands for.

Healthcare Reform Needs Clearer End Goals

This week President Obama’s administration sent tweets and e-mails touting the benefits of healthcare reform. It’s clear that they haven’t worked out the details of what they’re calling for, perhaps because they do not know what’s politically palatable in Congress. As a result, the list of eight basic consumer protections is vague.

No discrimination for pre-existing conditions
This makes no sense to me. What’s to stop someone from carrying no insurance or little insurance, and then buying a high-end plan once they get sick? The idea behind insurance is that you pay on a regular basis and make a claim in the unlikely event a peril affects you. If there truly is no discrimination for people who are already sick, premiums will be significantly higher.

No exorbitant out-of-pocket expenses, deductibles or co-pays
My insurance policy has a $4800 deductible. I’m guessing they’d consider that exorbitant. So even though the insurance company and my family are happy with the contract we have had for the past four years, the agreement would be disallowed. We would have to buy a more expensive plan with a higher premium even though we don’t want to pay for insuring minor things.

No cost-sharing for preventive care
This means insurers have to pay for most or all of preventative care. My plan already covers a good deal of preventative care, probably because the insurer thinks this will decrease claims that exceed the deductible. I don’t see why the government has to mandate this. I’m either going to pay for regular checkups when I get them or as part of my premium. Why does the government want to mandate that I pay it as part of my premium?

No dropping of coverage if you become seriously ill
I think this is already how it works. My understanding of the agreement I have with my insurer is that I pay them a significant bit of money each month, and they will pay if I get sick. They can’t end the agreement just because I get stick.

No gender discrimination
I do not know what this means. I guess it means they can’t charge women of child-bearing age more because of the increased risk associate with a possible pregnancy. This spreads the cost of this risk to men. I don’t think this is a big deal either way.

No annual or lifetime caps on coverage
Whenever I buy insurance, they always offer me different lifetime caps. I can choose a lower one to save money. I have always chosen a high cap. Under Obama’s plan, I won’t have a choice. I will have to buy the more expensive plan with a higher cap. It won’t affect me, but why take away my options?

Extended coverage for young adults (on family plans)
I don’t see how this matters one way or the other. This lets parents pay one big premium instead of having the parents and kids pay separately. This makes no difference.

Guaranteed insurance renewal so long as premiums are paid
This is a good policy. Employer plans always make me nervous because if I change jobs I will have to change insurers within 18 months. What if I got sick before changing jobs? The peril would have already happened, so I couldn’t buy insurance against it. I ought to be able to maintain the insurance I have. The risk of a protracted illness should be something the insurer takes on when they accept you as a client.

So what’s going on with this e-mail the administration sent out? My gut feeling is the problem is modern healthcare is expensive, but people wish it weren’t. Politicians are moving the pieces around as sort of a shell game hoping that if they can rearrange the rules just right, paying for this expensive service will seem less onerous. Here’s my impression of the front-runner plan politicians are cooking up to help people avoid reality:

1. Make basic inexpensive plans illegal.
2. Tax very expensive plans that provide for “executive” medical care.
3. Borrow $100 billion a year to offset the cost of premiums, pushing the cost of paying our premiums to the next generation.
4. Increase taxes on the wealthy to offset the cost of premiums.
5. Pretend premiums are being reduced through increased efficiency due to technology and through better bargaining with providers.

This is disgraceful. I always dreamed if someone like Obama were elected president and we had a Democratic Congress we would do something like declaring “war” on poverty again. Instead they’re spending all their efforts trying to offer the middle class ways to weasel out of paying for something they want.

The healthcare plan is still being worked out. I am optimistic it could be a lot better than what I’m imaging. Politicians need to write up something analogous to an engineer’s “product requirements document” calling out exactly what they’re trying to accomplish with this reform. Then they need to draw up a spec of how they’ll measure success. Every engineer knows it disastrous to start a project based on vague marketing promises. The president and groups within Congress need to state clearly what their end goals are with healthcare reform.