Health-care in 3,200 Words or Less

The Democrats still have the upper hand. If they don’t support a bill it can’t pass, but their total control over the legislative process has been broken by the election of a Republican senator from Massachusetts. So those we elect to represent us now have a choice. What we have had for the last year was World Wide Wrestling. Now it is time for chess. My question is, are the Democrats and Republicans going to play politics or statesmanship?

Both parties acknowledge we need health-care reform. There is a legitimate issue as to whether now is the time to pursue it. We have an unprecedented budget deficit, severe unemployment and a shaky economic recovery to deal with. All three of which are arguably more urgent than health-care reform, unless you don’t have health insurance and are or become sick. On the other hand, health-care is on everybody’s mind now. This may be the time to pass a reasonable plan to improve the health-care environment. But are the members of either party willing to set aside extreme positions and pass something reasonable, at the risk of giving the other party a partial victory? I have a few suggestions.

First of all, there needs to be some kind of tort reform. Between malpractice insurance premiums and the need, whether perceived or real, to practice defensive medicine, the cost of litigation drives up the cost of health-care. Actual damages certainly need to be covered, but there ought to be a limit on punitive damages.

Drop the barriers to cross-state purchasing of medical insurance. Let the money flow to where the best coverage, services and prices are. The market will reward those who do well and punish those who don’t.

Make all health insurance premiums tax deductible to the payer of those premiums.

Make it illegal for an insurance company to drop somebody for other than non-payment of premiums, or to deny coverage.

People need help in paying for medical care, but if they are responsible for the cost of care, they will make better health-care decisions. Therefore, make it easier for anybody to buy a high deductible health insurance policy in conjunction with a Health Savings Account (HSA). For those below a certain income level have the government make an annual deposit into their Health Savings Account equal to the premiums plus a portion of the annual deductible. As their income increases above a certain threshold phase out the government paid deposit into their HSA at the rate of $1 lost for every $4 earned over the threshold. Mandate that health-care providers accept payments at low or no interest from patients below some specified income level. These provisions will address the adverse selection problem posed by the mandate to take all comers, as well as eliminate the need to force people to buy insurance that is in the current bill.

Allow insurance companies a reasonable and generous profit, but require that they pay out a certain percentage of revenue in benefits in order to participate in the cross-state sale of their products.

Get rid of the absurd taxes that have been proposed on health-care devices and insurance plans. If you want to hold the cost of something down, you need to lower the cost, not increase it.

There you go. In less than 3,200 words I have just written a comprehensive health-care plan that addresses cost and availability. It does not put the government in the health-care business and it does not gut a system that has produced many of the greatest advances in health-care anywhere in the world. I don’t know what the cost of this would be. It is possible that it could not be implemented until we get the economy rolling better, but it is a whole lot better than what has been proposed to date.

Shades of Things To Come

Like me, you may have thought it was about better statistics on breast cancer detection and survival. It wasn’t. It was a cost benefit analysis. Stay with me on this, because this article is not about breast cancer or mammograms, but we need to go there to get to the point.

It turns out the U. S. Preventative Services Task Force, which had recommended in 2002 that all women over 40 receive screening mammograms decided last week that only women between 50 and 75 should receive the tests unless there is an underlying history to indicate otherwise. Routine mammograms have reduced the incidence of breast cancer in women by 30%. According to the Wall Street Journal, 40% of patient years saved by mammograms are for women under 50, but it takes 1,904 mammograms to detect one case of cancer for women in their 40s and only 1,339 to detect a case in a woman in her 50s. Of course the number would decrease for a woman over 75, but the task force decided that she was so close to the end of her life that we would be wasting money on her. According to the op-ed article in last Thursday’s Wall Street Journal, the task force has no oncologists or radiologists, but they decided that the cost was too great to have women in their 40s or over 75 undergo the tests.

We should all make medical decisions based on our own cost benefit analysis. There are a whole host of tests and procedures that we don’t do because the cost and inconvenience of going through those tests doesn’t compute for us. But we make those decisions with our own lives and our own money. What we have here is a panel whose decisions are generally accepted by Medicare making that decision.

President Obama and many of his fellow Democrats in congress have been assuring us that there would be no rationing with their version of health-care reform. But there will have to be guidelines adhered to. It may not be unreasonable to weigh the cost of a procedure against its potential benefits, but when we put an impersonal government agency in charge of determining costs, benefits and eligible recipients of care, we are putting our vary lives in the hands of a government that does not know us personally. When that happens, you can count on sacrificial lambs as budget deficits increase and resources become scarcer.

Is Medicare a Good Model for National Health Care?

It is a rhetorical technique to state a debatable issue as if it were fact. It puts opponents at the disadvantage of having to play defense, and those who may be less well informed will have a tendency to assume your statement is true.

I keep hearing proponents of a government option in health care use Medicare as an example of how well it will work. The President did this Wednesday night. So, just how well does Medicare work?

Many doctors will not take new Medicare patients because the program underpays so severely as to make it impossible to earn a living if they see too many patients. Not impossible to earn a good living. Impossible to earn a living. Some Medicare reimbursements are so low that, depending on the doctor's overhead, each patient visit can be a few dollars either side of break even. It requires those of us with the kind of insurance that the administration and some in congress are villainizing to pay our doctors enough for our visits that they are able to afford to see Medicare patients at all.


Medicare is due to start bleeding money faster than it is taking in money in just a few years.


The President thinks there is so much "waste and abuse" in Medicare and Medicaid that cutting it out will fund nearly all of his new plan. If there is that much "waste and abuse" in Medicare, why not cut it out now?

Part of the reason is that in any bureaucracy there will be waste and abuse. The larger the bureaucracy, the more waste and abuse there will be. That is just the nature of the beast. Nothing runs perfectly and the larger and more complex the organization, the less perfectly it will run. It is fantasy to think you will eliminate waste and abuse any more than you can eliminate gravity. In order to get money out of Medicare he is going to have to cut payments in a system that already underpays to the extent that health care is now being rationed to the elderly by virtue of doctors not accepting new patients.

The President promised that a government run plan will be self-funding. That is the way the Postal Service works.

How long did you have to stand in line the last time you went to the post office? Postage rates have been increasing annually for the last few years and still the Postal Service is losing money. Rather than resolving the problems by being more competitive and customer friendly, they are talking about cutting delivery services to 5 days a week and closing some post offices. This is what happens when the government runs something. There are no competitive forces at play to compel creative thinking. It doesn't become a matter of providing better services to the customer. Do we really want to replace what is arguably a good health care system in need of improvement with a government monopoly similar to the Postal Service or Medicare?

Presidential Speech on Health Care

He may not be succinct, but The President does deliver a good speech. As was true for his campaign for office, he articulated many positions most Americans can agree with. Who wants to see a woman denied coverage in the middle of her cancer treatments? Who doesn't agree that everybody should be able to obtain affordable health care? Who would object to a government run health plan that was completely self-funding, did not compete unfairly with the private sector, and only covered the poorest 5% among us? Who would not want all of those things and have it not cost any money? Who doesn't want there to be a Santa Clause?

The goals the President laid out Wednesday night are accepted by Democrats, Republicans and independents. The debate has always been about how to get there from here. He threw in something of an olive branch on torte reform, though it was either so vague, or I was so stupid that I'm not sure what exactly was being offered.

To continue to demand a government option in the face of the public opposition to it is either dogmatism, arrogance, or political expediency. Expediency being the least objectionable of the three. After all, if he can't get enough votes in his own party to support a bill without a public option, he can't get the bill. He did leave a crack in the door but it is a narrow one. Some think he insisted on the public option then threw it out. That is not the way it sounded to me, but we will see.

Libertarians will have a difficult time with the idea of compelling people to buy insurance. I am among them, but I am a libertarian with a small "L". I am practical too. There are likely three purposes for the mandatory insurance.

First of all, in practical terms everybody is insured now, since it is illegal to deny medical care to those in need. So those who are uninsured can show up in an emergency room and get taken care of without paying for it. So even these people are receiving a minimal level of care now and paying no premiums. Although they may see the doctor less often, when they do see one, it is under the most expensive circumstances.


The second purpose is likely the fact that in order to prohibit insurance companies from denying or canceling coverage, you have to deal with something called adverse selection. That is the tendency of healthy people to postpone buying insurance until they need it. That gaming of the system destroys the concept of insurance as a risk pool, where we all contribute now because we don't know who will need the pooled money (premiums) we have all contributed or when that money may be needed. If we allow people to do that I don't know how we are going to be able to keep premiums at an affordable level.

The third reason is related. That is the additional healthy insureds are a carrot to get the insurance companies to support the program. Thus, this provision may actually be a means to keep the government option out of the final bill because insuring everbody means lower premiums for everybody, thus keeping down health care costs. So I am conflicted about this provision of the plan. There are practical reasons to support it, but their are philosophical reasons to oppose it.



For the sake of brevity, I will only deal with these items for now, but there will be more to come.

Don't Let Politicians Divide Us Into Opposing Teams

Why do we insist on choosing up sides in order to decide what we believe? During the last Presidential campaign somebody sent me a You Tube link that showed several Obama supporters interviewed on the street, being asked questions like, "What do you like most about Obama, the fact that he is pro-life or that he selected Sarah Palin for his running mate?". I'm sure there were plenty of people who caught on & were therefore edited out of the video, but there were certainly enough who supported both of his supposed positions to make an entertaining several minutes. These people didn't support Barak Obama because of his positions on the issues. They supported him because he was a Democrat, or because he was a liberal, or because he was black, or because he was articulate, or because their friends supported him. These people went along & allowed other people tell them what to believe about Obama and, presumably what to believe about McCain.

The most recent example is the healthcare debate. People are lining up on this, and stridently defending positions outlined by what appears to be their party of choice. A few days ago several people on Facebook had posted, ""No one should die because they cannot afford health care, and no one should go broke because they get sick. We are only as strong as the weakest among us." If you agree, please post this as your status for the rest of the day." This is a sentiment most if not all of us can agree with. But this quote seemed to be being used, by and large, to promote a particular version of healthcare & to imply that those that don't support provisions in the bills now before congress are opposed to healthcare. But pay attention. Republicans have advanced several proposals to make healthcare both affordable and available to all Americans.

We can agree on many things that political teams in Washington DC want us to believe we cannot agree upon. If we refuse to let them set the agenda for us, we will be able to come up with something reasonable and bi-partisan.

We Aren't Enemies

I was debating politics with my step-father several years ago, when part of his argument rolled around to the fact that Barry Goldwater had opposed Medicare. This was meant to be an indictment to prove that Senator Goldwater was opposed to providing medical care for the elderly. The fact of the matter was that the senator from Arizona was in favor of another bill that he believed did the job in a better way.

Recently another relative asked me how families were supposed to afford health insurance if not by the passing of the healthcare bill now before congress. So I gave her a list of things that could be done without gutting and undermining our current system.

In an effort to win votes and support for their side, politicians and interest groups often paint their solution as the only solution to a problem. The corollary is that if you oppose their solution you are opposed to solving the problem. Don't let this hocus pocus fool you. Many, if not most, politicians and Americans want to address inequities in our society. They want to protect us from terrorists, and preserve our civil rights. They want to encourage prosperity for all and provide for a social safety net. The arguments, for the most part, revolve around the methods of resolving problems and ranking priorities. The demagoguery comes into play once a proposal is made by one side or the other and then both sides begin a game of deceit and gamesmanship in order to preserve power and prestige for their party or ideology.

We forget that we are all on the same side. Remember the mood of the country on September 12, 2001? You can argue about some of the decisions that came out of that mood, but we recognized that more important than whether we were Republicans or Democrats, labor or management. we were Americans & there were real enemies out there whose quarrel with us wasn't the methods of achieving our goals, but the goals themselves.

When somebody holds up a banner that says "Healthcare for All", we can all agree with that goal. Just don't get confused and begin to think that if we oppose the present legislation we don't want anything done. That is just a ploy to scare you into supporting something that you may not understand, or with which you may not agree. It is an effort to make you believe that those who oppose this bill are against quality healthcare for all Americans. Be assured, that isn't the case.

We Can't Afford Another Entitlement

Within days of his inauguration President Obama asked Congress to pass an economic stimulus bill. He said that it had to be done quickly and he wanted it to be bi-partisan, but left the details up to the Democrats in the House of Representatives. When Republicans offered to confer on what should be included in the bill, Speaker Nancy Pelosi said, "we won, we'll write it". The result was a bloated bill, filled with virtually everything on the Democratic wish list they have been wanting for years. Most of the spending in that bill would not take place until long after the immediate crisis was expected to end. Because of the perceived urgency in the economy, the bill was passed without most in congress reading it in its entirety.

In the midst of what has been called the worst economic crises since the Great Depression, The President asked that a cap and trade bill be passed by congress. The house has passed that bill which, if passed by the Senate, will reduce greenhouse emissions in the United States, and move those emissions to other countries who will get the jobs we will lose with less regard for the environment than what we have here in the United States. So global warming will not be helped & a weak economy in the USA will be weakened further.

Now the President wants us to pass a healthcare bill that will establish another entitlement in our system. We are facing the bankruptcy of both Social Security and Medicare, and he wants another, more pervasive and costly entitlement. He says it will help our economic predicament, as if his saying so will make it true. It will not.

Each of these bills deal with goals that most Americans can agree need to be addressed. But they can be done in a way that is reasonable rather than partisan. The healthcare bill before congress is something we can't afford. Remember when we didn't buy things we couldn't afford? This is one of those times. There are things we can do to improve the healthcare delivery system without creating a universal entitlement. Because the Democrats won large majorities in both houses and the Presidency does not mean they ought to rule as despots. They can try ruling as statesmen.

Do We Want Government In the Healthcare Business?

Where do people go to obtain cutting edge, state of the art healthcare? More than any other country, the answer is the United States. That healthcare is expensive. Not everybody can afford the most sophisticated care or the newest drugs. That makes some of the rest of us feel that we are being treated unfairly. But the medical care and medicine we get today was cutting edge & state of the art several years ago. Where would we be if those technologies & drugs had never been developed?

There will always be inequities in the world. Some of us will always have less and some of us will always have more. That isn't fair, but that is life. The trick is to address the needs of those who need help without inhibiting the system that develops the kind of medical treatment people come from around the world to get.

The biggest thing you can do to inhibit that innovation is to make the government an insurer. As Lord Acton said, "power tends to corrupt, and absolute power corrupts absolutely". Making government both the rule maker and the provider in the medical care arena, gives government all the power with little opportunity to check it. With government in the game as an insurer, private insurance will, over time, be crowded out of the market. That would leave you and me with only the government as our insurance company. When the government is in charge they will have a conflict of interest. On the one hand, they will be providing benefits for the country's healthcare, on the other hand, they will be responsible for all the costs. We are already doing this with Medicare, and Medicare underpays to the extent that many doctors will not take on any new Medicare patients. I heard one doctor recently say that his net profit on each Medicare patient is $4 per visit. that kind of profit will not permit the innovation that will cure cancer or diabetes.

There is much in the healthcare system that needs fixing. But the current bill before the House is not the only way to fix it. Don't let anybody convince you that it is their way or the highway. We can fix healthcare without a government option.