Point Counterpoint on Health Insurance Reform

Someone named M.B. McLaughlin just posted a very good point-by-point analysis of health care reform options in today's Washington Post online. This was in response to Louisiana governor Bobby Jindahl's op-ed piece, in which he basically says the Democrats are full of poo, then offers his own plan, which basically mimics what the Democrats have been saying all along on some points, and mixes in a few Republican articles of faith (e.g., tort reform) so he doesn't look too blue-state, and makes a couple of claims about what Americans want that don't seem to be backed up by any facts whatsoever. Jindahl is like someone who shows up to a meeting two hours late, takes the floor, and proceeds to blather on about things that were already discussed before he showed up.

Here's Jindahl's op-ed: http://www.washingtonpost.com/wp-dyn/content/article/2009/10/04/AR2009100402003.html
McLaughlin's response is below, just so you don't have to slog through pages and pages of online comments.

mbmclaughlin wrote:
This is a point by point response to Gov. Jindal's ideas (which, incidentally, would have better served everyone if they had been presented six or sevent months ago when we first started talking about health care reform).

-- Voluntary purchasing pools: This is one of Obama's ideas and is already in the Democratic health proposals in the form of insurance exchanges.

-- Portability: Allowing policies to cross state lines would ensure a "race to the bottom" that would gut all of the useful regulations that insurers are currently forced to comply with... things like covering mammograms, insulin, and smoking cessation materials and programs. If insurers cared about getting their policy holder's healthier, they would already "make more investments in prevention and in managing chronic conditions." The fact is that it's cheaper to drop people for misspelling something on a form than it is to cover them and it's easier to raise their rates so high they can't afford it than it is to treat chronic conditions.

-- Lawsuit reform: Every study I've seen says that lawsuits add no more than 1-2% to the cost of health care. Small price to pay when you consider that there are doctors out there who amputate the wrong limbs, leave sponges and surgical tools in people, and do all sort of other horribly incompetent things that maim and kill people. A better plan would be to develop basic, standard practices that doctors should follow for certain common procedures. Things like always have patients who require non-emergency surgery shower and scrub with antibacterial soap before the procedure, always wash your hands, and do a simple blood sugar test on patients with a family history of diabetes at least once a year.

-- Require coverage of preexisting conditions: Good, excellent, and it's already in the Democratic health proposals.

-- Transparency and payment reform: A majority of consumers get health coverage through their employer and thus only care about their copays. Most consumers are so busy with finding jobs, keeping jobs, making meals, getting the car fixed, paying bills, going to school, keeping an eye on the kids, and the myriad of other things that occupy modern daily life that even if the prospect of reviewing hundreds and hundreds of pages of efficiency studies and billing detail minutiae were exciting they wouldn't have time for it. Insurers should be making sure that the system works. But again, it's cheaper to just drop expensive patients than it is to question the details and try to save money.

-- Electronic medical records: Sounds good, as long as the system used is a secure one like the ATM network and not some insecure thing like most "online" systems. Also, how will you pay for it? Will our taxes go up or will it be another unfunded mandate that gets watered down due to lobbyists?

-- Tax-free health savings accounts: These are fine provided that you're well-to-do and can afford one. But the amount of record-keeping they entail makes them almost not worth it. Have you ever tried finding receipts for aspirin you bought a month ago? And what about the large amount of pointless medical care and purchases that happen at the end of each year as people who have these HSAs rush to try to spend the leftover money that disappears on Jan. 1? These are actually one of those nice ideas that work out rather terribly. We'd be better off giving everyone an extra $2,500 on their standard deduction. It wouldn't force people to buy care they don't need and penalize them if they lose some old, grease-stained receipt.

-- Reward healthy lifestyle choices: Sounds good. Why aren't insurers doing this already? Of course the only way to make them do it would be to mandate that they do it. Which I personally have no problem with but I expect many Republicans might.

-- Cover young adults: This seems like a good idea though young adults whose parents don't have health insurance won't benefit from it. Nor will many young adults who are in college. College's like to force really cheap, horrible "gulag" plans on students. Many insurers will refuse to cover children who have other insurance. Why not give young adults the option to buy in to Medicare?

-- Refundable tax credits (for the uninsured and those who would benefit from greater flexibility of coverage): Why is it OK to force people to buy insurance from private companies and anathema to allow them the option of buying it from the government? Why can't American families be given the choice of getting health insurance protection from our gov't? We get protection against invasion, crime, and fire from the government and those all seem to work just fine. How is it that we continue to support a for-profit health insurance system? The profits come from denying care to people. Every time they have to provide treatment, they lose money and their profits go down. Isn't it immoral to profit off of making people sicker and refusing treatment to sick people?
10/5/2009 1:26:38 AM

Toldja So

So I've seen some reader comments in the WaPo (as we call the Washington Post around here) saying that your average Joe could have told you years ago that the whole economic system was too messed up to hold together. Your daddy may have been a blue-collar working stiff, but he worked at the same job his whole adult life, and retired with a solid pension and enough savings to give his kids a small inheritance. Nowadays, both Joe and his wife Jane work full time just to keep up with the payments on the credit card bills. If there's something left over, they put it into their 401(k) or their kids' college fund and hope the market doesn't take a nose dive when the time comes for them to draw on those funds. Joe and Jane could lose their jobs for any reason or no reason at all, and a hospital visit or a hike in their mortgage payments could send their household finances into a tailspin. If the whole global economy depends on overstretched American consumers like Joe and Jane and everyone they know, why are you surprised that the whole thing is falling apart now?

On the other hand, an editorial writer for another publication (whose name escapes me now) thinks this kind of thinking is just Democrat gloating over the mess those darned Republicans have made. He calls it the flip side of the Republican gloating during the heyday of Newt Gingrich, and those eight years of you-know-who that just ended last month.

This doesn't feel like gloating, though. In order to gloat, you have to be standing outside the mess looking in. Unfortunately, there's no ground to stand on right now that is outside this global mess. If you're going to indulge in schadenfreude, there has to be some freude. Otherwise, it's just schade, and we're all pretty much knee-deep in schade right now and sinking fast. No, this feels more like Jeremiah warning of dire things and getting thrown down a well for his efforts. Jeremiah was just as broken-hearted as everyone else when he turned out to be right.

We still have a few die-hards on both sides of the aisle in Congress and on the talk radio shows (and apparently one guy who is keeping my sister's print shop afloat by spending scads of money printing up anti-Obama stickers). They throw parties when they are up and throw tantrums when they are down. Most of the rest of us are rolling up our sleeves and picking up our mops and buckets. We were right, we saw this coming, you didn't listen, but we're all in this mess together, so we might as well start cleaning things up. Maybe you'll listen next time, but we rather doubt it.

Are we Safe Yet?

Over the last several years, we have put up with an awful lot in the name of keeping us safe. Especially in the DC metro area, we have concrete barriers and security checkpoints enough to outfit a military base. So are we safer?

Let's see. There haven't been any more airplanes crashing into high-rise office buildings, true. But there was that one lulu of a flood in New Orleans, and that collapsed bridge in Minneapolis, and let's not forget all the good folks who won't be coming home from Iraq and Afghanistan.

Al Qaeda hasn't been able to demolish our way of life, true. But greedy bankers, corporate executives, and crooked politicians have that base covered pretty well. It's getting harder and harder to stay in the shrinking middle class these days, what with all the cutbacks and layoffs and life savings evaporating into the ether. And the next few generations will get to share in the fun as they try to keep up with the interest payments on all that debt.

Bottom line: whether you get blown up by a terrorist, or go to an early grave because you can't pay for good health care, or crash to a watery death because the bridge rusts out from underneath your car, you're just as dead one way as another.

I'm just sayin'...

Magical Thinking and the Vanishing Middle Class

This current economic upheaval got me to thinking about how hard it's gotten to live a middle class life lately. As is often the case, one thought ties in with another, and this particular thought latched itself onto a ballot issue that Maryland residents will be voting on next Tuesday -- do we want the state to install thousands of slot machines to raise revenue for our schools, save the horse racing industry, and keep those gambling dollars in-state?

I'll explain. When I was growing up in the sixties, it was relatively easy to get a good solid job without an advanced degree, and to hold that job until you were ready to retire -- with a proper pension, of course. You didn't have to aspire to a six-figure salary or put in a 60-hour workweek just to keep the wolf away from the door. If you were the ambitious type, you could start out working in the company mailroom, work your way up the company ladder, and go as high as your talents and temperament would allow.

That doesn't seem to be the case any more. Many of the people I know are one pink slip or one medical crisis away from the edge. Many of my friends owe a year's salary or more for credit card bills, medical bills, car payments, you name it. And not all of them are out-of-control spenders. Employees are considered disposable commodities, and if the stock market tanks just when you were planning to retire, you can watch your 401(k) vanish before your very eyes.

Here's where the slot machines come in. My theory is that when people feel helpless and out of control, they turn to magical thinking. Maryland is in need of some serious tax money right now, and they are hoping to get it from folks who are hoping against all evidence that they are going to hit that one big win that is going to put them on easy street. Or at least pay off a few bills. When all your other options are in the dumpster, gambling starts to look pretty good.

You see a lot of magical thinking going on with all the "reality shows" on television. Contestants perform in talent contests, eat worms, bicycle across New Guinea, whatever, trying to win that million-dollar prize. Some of them are quite good, but others make you wonder what the heck they were thinking when they signed up. They all want that big chance at fame, that wad of money, whatever that one big thing is that will get them out of their humdrum everyday lives.

Magical thinking takes over when there's no clear path to lead you upward. That path has been slowly but surely erased over the last 30 years. Remember "rightsizing" and "flattening the organization" from the 1980s? The organizations didn't really flatten so much as they raised the top levels, lowered the bottom levels, and shaved the supporting pillars between the two levels until they were pencil-thin. With no middle levels, you either had to be born at the top, get incredibly lucky, or work like a maniac to make that one big leap. Don't even think about settling down in a nice mid-level job -- those jobs are a vanishing breed. Come to think of it, don't even think about settling, period. Because that pink slip may come at any time. When your whole future is looking like a crapshoot, buying those lottery tickets and playing those slot machines starts to look less and less irrational.

My hope is that once these financial castles in the air have finally crashed down to earth, we can all get busy and start building solid foundations again. Real people making real stuff and earning real incomes so that they can pay real money for the things they really need. Is this idea any more hopelessly naive than the idea of building an entire society on debts, derivatives, and slot machines?