The Incompleat Curmudgeon

There is something seriously wrong in America. According to the U.S. Census Bureau, 45.7 million Americans had no health insurance for the entire year in 2007. CNN reports that Families USA did a study and found that 86.7 million people were uninsured at some point during 2007 and 2008, three-quarters of them for more than six months. That’s one third of Americans under 65.

We are the richest country in the world. And we are the only industrialized country in the world that doesn’t provide high quality healthcare to all of its residents.

Most of you think of yourselves as having a pretty good moral character. You know I’m not a Bible thumper, but I remember an injunction somewhere about being openhanded toward your brothers and toward the poor and needy in your land.

Can you stand by while one third of Americans under 65 get substandard healthcare, have to choose between medicines and food, or file for bankruptcy because of exorbitant medical bills? I can’t.

Some people don’t have health insurance because they don’t think they need it. One of these days they’ll wake up with a backbreaking load of debt, and realize that they should have planned ahead–and then they’ll go bankrupt. Even if you think they deserve it (I don’t) remember: their problems are costing the rest of us money in higher premiums and taxes.

Others don’t have health insurance because they don’t make enough money to both eat and pay the premiums. If they have jobs their employers can’t afford to give them health benefits because the premiums have skyrocketed in the last few years, doubling, tripling, even quadrupling over the course of a year or two. Still others don’t have jobs. They live hand to mouth, depending on the charity of friends and family—or perfect strangers, and they get little healthcare. What they get is usually from hospital emergency departments—a very expensive way to get healthcare.

Do I need to tell you who pays for the bad debts and the indigent patients? You and I do, because the cost of care for people who can’t pay is reflected in hospital rates, and those rates are reflected in the insurance premiums we pay.

Well, we’re the richest country on the planet, right? But healthcare costs are going up, up, up…faster than wages, faster than inflation. According to the Kaiser Family Foundation, spending on health care is projected to be 17.6% of the U.S. gross domestic product (GDP) in 2009. That’s $8,000 per U.S resident. It has consistently grown faster than the economy overall, and by 2018, it will be at more than 20% of the GDP, which is $13,100 per resident! (In 1970 it was about $356 per resident.)

You probably didn’t notice that healthcare is taking $8,000 out of your pocket this year, because only some of the money is health insurance premiums you pay. Some is health insurance premiums your employer pays, and some of it is taxes. But one way or another you’re paying it.

Can we afford it? No. Not as individuals, not as a country. Our healthcare system is broken and needs to be fixed.

President Obama has proposed a solution. The Congress is working on it. Perhaps the most complete and (for now) the most stable solution is a bill under consideration by the House Ways and Means committee, HR 3200.

I pretty much agree with that bill, partly because it puts needed constraints on the health insurance companies, and fosters competition. But the insurance companies don’t want healthcare reform; they’re fighting back by putting out a lot of misinformation, using scare tactics and phony “grass roots” organizations to disrupt the civil dialog we should be having, and lobbying members of Congress by reminding them of the large contributions they got from the healthcare industry.

Opponents of healthcare reform make some strange claims. They claim the bill would provide health insurance for illegal aliens. It would not, and they know it: The bill specifically excludes anybody who is in the U.S illegally from receiving federal dollars for health care.

Another canard is that the bill provides for “death panels” that would decide who gets end-of-life care and who does not. That is totally untrue. Medicare would be required to pay for counseling sessions between patients and their own physicians to discuss the options for life-sustaining treatments and end-of-life care, and to encourage patients to make the decisions in advance.

The decisions may be recorded in a “living will” or “advance care directive,” and everybody ought to have one. If you don’t have one, illness or accident could force you or your family to make critical decisions under the worst possible circumstances. Yet the bill doesn’t force people to plan ahead; it allows them to do so, with or without the (free) expert advice of their physicians.

And there are other misrepresentations of what is in the bill. My Representative came up with a list of goodies that he said must be put into the bill before he would vote for it. He implies that they’re not there, but every provision he talks about is already there! (My letter to the editor on this subject is published below this article.)

The opponents of healthcare want you to vote based on fear and ignorance. I’m not going to go over all the myths and outright lies that are circulating, but if somebody tells you indignantly that he’s opposed to healthcare reform because it does something he hates or because it doesn’t do something it should…take a look at the bill. If you’d like to read it for yourself, the text is here, on the House Ways and Means Committee web site, which also contains a lot of discussion and analysis done by committee staffers (who watch each other like hawks).

Choice and Coverage

Perhaps the most important thing about the bill is that it provides choice. You may keep your current providers (doctors, hospitals, etc.) or choose new ones. In fact you’ll have a wider choice of providers than you do now, because the bill requires insurance companies to increase the sizes of their networks.

You choose your own health insurance company. Keep the one you have, if you wish, or shop around for the best deal. A caveat here: if you have healthcare insurance through your employer, you may not be able to switch unless you lose your job or change jobs.

But if you’re an individual or a small employer you can use the Insurance Exchange established by the bill. This exchange makes it easier to compare plans and prices—thus fostering competition, so that you can make a choice among competing companies.

One of the choices would be a government-run healthcare plan something like Medicare. Particularly important if you live in a part of the country where there are few insurers, it will be financed only by its premiums and subject to the same restrictions as private insurance plans. It will compete for your health insurance dollar—but you are the one who makes the choice.

But no matter how you get your insurance, they can’t drop you because you get sick, refuse coverage because of preexisting conditions, or impose annual or lifetime maximums.

The bill establishes an advisory committee chaired by the Surgeon General and composed of practitioners and other healthcare providers. This committee will come up with a basic package of healthcare benefits that must be in every plan, including preventative service (available with no cost-sharing) mental health services, and oral and vision services for children.

The costs—and paying the costs

In addition to specifying minimum benefits, the package will put a cap on the amount of money a person or a family must pay for services in the basic package over a year. But there are other ways that the bill will minimize the costs of healthcare.

Medicare reform will modernize Medicare to reward efficient healthcare providers, and to reduce (and eventually eliminate) the “doughnut hole” in supplemental prescription plans. It will enhance subsidies to low-income patients, reduce subsidies to Medicare Advantage plans, and improve the accuracy of payments made to other providers. In addition the bill provides for additional controls to reduce fraud and abuse, and will reduce and simplify the paperwork required of healthcare providers.

The public option program will follow similar procedures to make it an effective and efficient provider of health insurance services. And the competition from the public option program will encourage private insurance companies to be more efficient and lower their premiums to meet the competition.

But the bill provides for insuring virtually every legal resident of the United States, and that’s not cheap. The non-partisan Congressional Budget Office estimates the cost of the bill at $1.042 trillion.

The Congressional Budget Office estimates that the savings coming from the provisions of the bill will cover about half of that. The rest will come from a revenue package that will raise your taxes—if your adjusted gross income is more than $350,000 a year. If, like most of us, you make a whole lot less than that, you will see no tax increase at all.

Competing Philosophies

If we ignore the lies and misrepresentations, the arguments against healthcare reform, or at least against this bill, seem to center about the contention that government should not and cannot run healthcare programs. We’re told that the reform amounts to a government takeover of healthcare, and that it’s socialized medicine.

I disagree. Governments the world over run single-payer healthcare systems, and despite the occasional horror stories, their citizens get healthcare that’s just as good as ours. (You want horror stories? There are plenty of those about our system too!) Other countries also pay less than we do, and that tells me there’s something wrong…with our system.

I would be in favor of a single-payer system—eventually—but it’s not on the table now, and there are some very good reasons. Implementing a single-payer system would cause chaos in a healthcare system that is so complex, with so many interrelated pieces, that I doubt if anybody understands it. What the president has proposed, and what HR 3200 implements, is a system that includes a public option, but that keeps the private insurance companies and providers that characterize our system.

It keeps them, but restricts what they can do. The people who run the companies that make up the healthcare system don’t care about the patients who depend on them. They care about their boards of directors and their stockholders. As they should.

But in their single-minded pursuit of profits they are running roughshod over the rest of us, and one of the functions of government is to protect the public from the tyranny of private power. We, the people, can control the government; we cannot control the big corporations.

As individuals, of course, we have little say in what government does. But we have a weapon the big corporations do not have: the vote. Believe me, our elected representatives (and their appointees) know that, even though they usually act as though we’re impotent.

As individuals we are nearly impotent, but if we join together—if we write, phone, email our legislators and members of the administration—they will get the idea, and they will act accordingly.

I hope my position is clear: we need healthcare reform, and we need it now. The bill written by the House Ways and Means committee is far from perfect, but it is a very good start. We need to pass that bill, and once it’s passed we can worry about changes and improvements.

I urge you in the strongest terms to tell your legislators and the committee members how you feel. It is important, folks. This is a defining issue.

Let’s get the job done!