Who IS this guy?!
Political Talk Show Host and Internet Radio Personality. My show, In My Humble Opinion, aired on RainbowRadio from 2015-2017, and has returned for 2021! Feel free to contact me at niceguy9418@usa.com. You can also friend me on Facebook.
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Showing posts with label care. Show all posts
Showing posts with label care. Show all posts
Sunday, January 17, 2016
Saturday, April 4, 2015
How Pro-Lifers are killing women
Hey, William.... Remember when you said that there weren't any women having their health harmed by the Right's constant attacks on Abortion Rights?
Well, FUCK YOU.
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Globally, only a few countries have seen a rise in the rate of maternal deaths in recent years. Those include Afghanistan, El Salvador, South Sudan and the United States of America.
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Well done, Republicans, I hope you're happy. First you destroyed the traditional family unit, and now you're actually killing women.
How much longer do we have to suffer these psychopaths, America? How long before more of you start to realize what I've been saying all along: Right-Wing Conservative Republicans only come in two flavors : EVIL and STUPID. One's lying and the other's buying.
How much more damage must we let them do? How many more lives will we let them destroy?
Well, FUCK YOU.
“Today’s mothers are twice as likely to die of pregnancy- or childbirth-related causes than their mothers were. There is no reason, given our vast resources, knowledge and technology, why we should be going backwards in this area.” – Laura Gilkey, coordinator of The Safe Motherhood Quilt Project, a nonprofit based in Sarasota, Fla.
Globally, only a few countries have seen a rise in the rate of maternal deaths in recent years. Those include Afghanistan, El Salvador, South Sudan and the United States of America.
--------------------------------------------------
Well done, Republicans, I hope you're happy. First you destroyed the traditional family unit, and now you're actually killing women.
How much longer do we have to suffer these psychopaths, America? How long before more of you start to realize what I've been saying all along: Right-Wing Conservative Republicans only come in two flavors : EVIL and STUPID. One's lying and the other's buying.
How much more damage must we let them do? How many more lives will we let them destroy?
Saturday, August 20, 2011
Gotta love that free-market health care!
I'm not going to go into the details of why for-profit, free-market health DOES. NOT. WORK.
(And is just ill concieved and improperly motivated, right for the start.) We all know these already.
But here's another recent example of the failure of market forces to provide adequate health care.
(And is just ill concieved and improperly motivated, right for the start.) We all know these already.
But here's another recent example of the failure of market forces to provide adequate health care.
Wednesday, January 5, 2011
Welcome back!
Welcome back! I hope everyone had a safe and happy holiday. I spent about a week visiting relatives in Massachusetts. Since my parents live in Florida, we don’t get up to Massachusetts very often. So from that perspective, it was good to see everybody again. From another… Well, one thing I’ve noticed as I’ve gotten older and presumably, though probably not proportionately, wiser is that I’ve become more aware of what’s going on under the surface of things. Underneath that polite veneer that’s presented to the world, and which as a child I assumed there was nothing behind – that we were just a big happy family with no politics or strife. And that’s not to say that we aren’t, but my god… It drives me nuts just how much into everyone else business they insist of getting, and how much petty sniping goes on in terms of who’s thinks what, and who said what, and who didn’t go to who’s party, or who’s more generous or more stingy, who got the better gifts… Holy hot hopping hell, it’s like going around the table at Thanksgiving and everyone declaring how good everyone else has it! (And realize that these folks are all very well off! No one’s losing their house, or living on the edge.) But seriously, I could never stand having that many people up in my business all time! Oh my God… It drives you nuts after a while! (And the relative lack of that in my life is one of the advantages of living where I do!)
Anyway, we’re home now. And I must say that while overall we DID have a good time, there were some interesting political discussions that happened on this trip that I’d like to share with you all. I’ll say up front, that most of these I was little more than an observer or a devil’s advocate. For the most part I’m keen to let the family partisans fight it out – no one’s really listening to anyone else anyway, or has any intention of changing their position, so I’d rather not waste my breath burning bridges.
The first involved the Massachusetts State Law regarding care for the elderly. In Massachusetts, as in many other places, If a person cannot pay for their own long term care - and let’s face it: if you don’t have a lot of money, LTC insurance and a decent source of income into retirement, few can – then when you need to enter a nursing home, the state will provide this service, taking care of those elderly and indigent people who can no longer care for themselves. These facilities are not great places of course – the one in question was a real shithole. And yet… the costs are still astronomical. Well beyond what most people could afford even for a short time, let alone indefinitely. Now, when you are in these institutions, you are now a ward of the State. The State gets your pension, your social security, and gives you just a small weekly allowance (to spend on what, I wonder? No one ever leaves the building!) They also take any assets you have, to cover the costs of your care. If you own a house? The state will take it. Car? Same. (Etc…) There are ways around this, of course. Since laws are written by lawyers, to give more work to other lawyers, there are trusts and other estate planning tools that will allow your family to keep most or all of these assets. One has to wonder why you would write a law, and then immediately create another law whose sole purpose is to circumvent the first law, but that’s the biggest problem with politics and legislation. Beyond any Liberal or Conservative issues, the primary problem is that laws are written by legislators who are primarily – like 90% of them – LAWYERS. And their “secret agenda” is not Liberal or Conservative per se - it’s primarily to drum up more business for lawyers. If they can write a law that will result in more law suits? Or that can further complicate tax law or estate law and thus make even more work for tax and estate lawyers? They’re all over it.
ANYWAY… Feel as you will about the idea of the State taking your house, or about the fact that if you pay a lawyer to write up a new trust every couple of years, your family can keep the house, the fact is that caring for the elderly is expensive. And SOMEONE, SOMEHOW needs to pay for it! The real point of contention, and where my Father – a staunch Conservative, Republican, borderline Tea-Party type - started chiming in is that in addition to what I’ve mentioned already, Massachusetts does what they call a “five-year look back” to see if you made any large gifts over the past five years. And if you did? The State can go after the recipient to get them back! Again, this sounds really unfair, but MANY States have these look-back periods. They’re basically meant to prevent people from giving their assets away to family in order to get around paying for the care they’ll receive from the State. And, while it seems like it sucks at first, when you think about it, it’s basically FAIR. Well… My father’s having none of that: To him it’s bullshit that the State would take property, let alone look back five years and take it from other people! Now, he understood WHY they do this. He KNOWS that people could easily cheat the system, were it not for the look back system. So I asked him: How would you pay for it then? Shitty a lifestyle though it may be, this is a necessary, expensive service that’s being provided! Why is it wrong to ask the recipients of that service to pay whatever they can for it? I then added the kicker, reminding him that the alternative was socializing it, through higher taxes, spreading the cost across everyone, and making everyone pay for it. That’s a solution that I don’t really have a problem with: it would be part of my overall health care system. But I KNEW he’d never go for it. And, big surprise, he admitted that he had no ideas for alternatives, although he did point out that the family themselves used to care for their elderly relatives in house. (Yeah: Back when you could raise a family on one income, and people didn’t live nearly as long!) Anyway, I learned a long time ago that you can never get a Conservative to admit he’s wrong, but if you can get them to admit that they have no ideas? Count that as a win. For me? I just see it as evidence that Conservatives are basically whiny little bitches who want something for nothing. (And in this case a Government handout and socialized medicine! Imagine that!) But PAY FOR IT? What kind of liberal nonsense is that?!
Also hilarious, to me anyway, is hearing someone like my dad (a very wealthy man, I should add) talk about how we should just go to a “flat tax.” Now… first off all, he’s a deficit hawk, big time. Granted, he’s your typical Right Winger when it comes to the deficit: Lower Taxes (huh?), cut entitlements, trim defense (at worst), no earmarks, no pork, etc… in other words, basically shitty ideas that will do nothing to fix the deficit, and do great harm to the economy and to people’s lifestyles. But when he talks about a flat tax, I wonder if he’s even capable of basic arithmetic. Because if you assume a rate that doesn’t INCREASE the deficit, YES, his rate would go down, but the rates of ~98% of Americans would go UP. A LOT. When 1% of you population make 20% of the income (note: I just made that up – whatever the actual numbers are, it pretty bad) you cannot lower their tax bracket without raising everyone else’s, if you (1) want everyone to have the same rate. And (2) don’t want to increase the deficit / debt. So… why, you might ask would a Conservative be so much in favor or RAISING everyone’s taxes? I don’t have a clue. No, my dad’s not a stupid man. A bit self-centered in his perspective maybe, but he’s not DUMB. He just suffers for the typical Conservative’s disease of completely lacking logical consistently, self-awareness and principled pragmatism.
Another bit topic of conversation was the repeal of “Don’t Ask, Don’t Tell.” To which I say, “It’s about damned time, and what the hell took so long?!” But my Brother in Law was in the Navy and my Cousin was a Marine, and they’re both Conservatives – my brother-in-law to a kind of annoying, Sean Hannity degree, my cousin to a more psychotic G.Gordon Liddy / Mike Savage degree. And of course, despite the fact that they both served with gays, whether they knew it or not, this was of course going to signal the death knell of American Military Dominance. Putting aside of course that we spend twice on defense what England, France, Russia and China do combined. Putting aside that almost every other non-Muslim country has already done the same thing, and it’s had no impact. Putting aside that polls showed that even 70% of White Evangelical Christians supported its repeal… It all over. We’re doomed. And it seemed like everyone else (most of whom range from Massachusetts Democrats to Massachusetts Liberals) just LOVED to get my cousin torqued up about it, and get him going on one of his homophobic rants. Don’t get me wrong: I love a good rant as much as the next guy, even when I disagree with the speaker. It’s fun to see a man feeding off his own hatred, anger and fears. It’s fun to see someone just lose it. I know. I’m human too! But as I listened to him, a theme started to emerge that I found rather… disturbing.
I can’t really cite any one thing he said, but he acted like the Marines were their own entity. As if they were a club that could make their own rules and their own policies, rather than an arm of the democratically elected Government, created to enforce theirs. He acted like the Marines existed only to fight – which, yes, they do – but beyond that, as if their whole raison detre was fighting for fighting’s sake alone, or for any reason they alone saw fit, and that other factors, like actual foreign policy and actual American Values like freedom and equality were not the REASON they were fighting. I’m not going to suggest that he speaks for all Marines, but to hear him going off, in an almost thug-like, borderline-Nazi manner, you’d think he thought that it was the Marines, and the mentality of Marines like him that decided (not SHOULD decide, but ACTUALLY decided) what they should be fighting for, what the country stands for, and how the laws should be made and that somehow anything that goes against that fascist psychosis somehow constitutes a betrayal of our brave men and women in uniform. But answer me this: If you’re in the Middle East fighting a bunch of misogynistic, theocratic homophobes, and yet you DON’T believe in religious freedom, or equality, then WHAT THE FUCK ARE FIGHTING FOR?! At that point, you can only be fighting for fighting’s sake. I don’t believe, as he does, that America is betraying that part of the Military by allowing Gays to serve openly. I believe that for many years, large parts of the Military have been betraying American values by not respecting, supporting and fighting for what America actually believes and stands for: Equality and religious freedom.
And one point he actually said, “I don’t judge them [gays], but they’re deviants!” Remember what I said about lacking self-awareness?
Of course, the TSA and Muslim profiling came up. At which point I had to point out (again) that the terrorists were not the ones with long beards and turbans, but rather the clean-shaven ones wearing suits. Also that a turban was rarely indicative of a MUSLIM, and far more often indicative of a HINDU. And that the average Hindu hates Muslims even more that then average American bigot does. Now this lead to a brief conversation about other religions, and which point my Mom asked me what religion “those kids I went to school with were.” I knew the ones she meant: The ones who wore turbans and never, in their life, have cut their hair. To which I answered that they were Sikhs. My brother-in-law chimed in, adding that they “wear daggers around their necks” which is technically true, but also a grossly misleading oversimplification. After which my Father commented that it was a religious with “weird beliefs.” I asked him, “What religion DIDN’T ask you to believe weird things?” and then said, “Do you know what you call a religion without weird beliefs? SCIENCE. (And maybe Philosophy.)” That earned me a wink and a nod from my Uncle, by far the most liberal man in the room, and one of the most liberal men I know.
Speaking of weird beliefs… Do notice how some people will believe anything about someone they don’t like politically?
There was an article – on the front page of the Boston Globe no less – about the fact that the late Senator Edward Kennedy’s dog died. (Yes the Kennedy’s are still royalty in Massachusetts to the point where the death of a dead Kennedy’s dog is front page news!) Now… I noticed something in the article that, I thought, revealed either a gross display of bad taste, or a complete lack of self-awareness on the part of the late Senator. The dog’s name? SPLASH. Seriously. A guy who will forever be remember for driving his car off a bridge, drunk, into a river and allowing a female campaign aid worker to die in the icy water… named his dog SPASH. Now… although I’m not a particular critic of the late Senator, I found this point to be at least a bit perversely humorous - my favorite kind of humor - so I pointed it out. At which pointSean Hannity my brother-in-law started talking about how Kennedy often used to “joke about killing that woman,” and how he was such a scumbag, etc… Now… He works at the Pentagon. And he does occasionally rub elbows with people who actually may have had conversations and even a relationship with the late Senator. But the way he told the story? “I heard,” “People say,” that sort of thing? Just makes me file it under “People will believe anything about someone they disagree with politically.” I don’t know if it happened or not. I have no idea. It could have. But what I do know? Is that a Conservative’s burden of proof is fairly low, when it comes to bad things being said about Progressives or Liberalism.
Anyway, while it was still a good time overall… It’s definitely good to be home
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BTW… There’s was this John Stossell thing that ran on Fox while we were up there that I’d like to debunk, but this post is long enough, and that’s a post that should probably be its own post anyway.
Anyway, we’re home now. And I must say that while overall we DID have a good time, there were some interesting political discussions that happened on this trip that I’d like to share with you all. I’ll say up front, that most of these I was little more than an observer or a devil’s advocate. For the most part I’m keen to let the family partisans fight it out – no one’s really listening to anyone else anyway, or has any intention of changing their position, so I’d rather not waste my breath burning bridges.
The first involved the Massachusetts State Law regarding care for the elderly. In Massachusetts, as in many other places, If a person cannot pay for their own long term care - and let’s face it: if you don’t have a lot of money, LTC insurance and a decent source of income into retirement, few can – then when you need to enter a nursing home, the state will provide this service, taking care of those elderly and indigent people who can no longer care for themselves. These facilities are not great places of course – the one in question was a real shithole. And yet… the costs are still astronomical. Well beyond what most people could afford even for a short time, let alone indefinitely. Now, when you are in these institutions, you are now a ward of the State. The State gets your pension, your social security, and gives you just a small weekly allowance (to spend on what, I wonder? No one ever leaves the building!) They also take any assets you have, to cover the costs of your care. If you own a house? The state will take it. Car? Same. (Etc…) There are ways around this, of course. Since laws are written by lawyers, to give more work to other lawyers, there are trusts and other estate planning tools that will allow your family to keep most or all of these assets. One has to wonder why you would write a law, and then immediately create another law whose sole purpose is to circumvent the first law, but that’s the biggest problem with politics and legislation. Beyond any Liberal or Conservative issues, the primary problem is that laws are written by legislators who are primarily – like 90% of them – LAWYERS. And their “secret agenda” is not Liberal or Conservative per se - it’s primarily to drum up more business for lawyers. If they can write a law that will result in more law suits? Or that can further complicate tax law or estate law and thus make even more work for tax and estate lawyers? They’re all over it.
ANYWAY… Feel as you will about the idea of the State taking your house, or about the fact that if you pay a lawyer to write up a new trust every couple of years, your family can keep the house, the fact is that caring for the elderly is expensive. And SOMEONE, SOMEHOW needs to pay for it! The real point of contention, and where my Father – a staunch Conservative, Republican, borderline Tea-Party type - started chiming in is that in addition to what I’ve mentioned already, Massachusetts does what they call a “five-year look back” to see if you made any large gifts over the past five years. And if you did? The State can go after the recipient to get them back! Again, this sounds really unfair, but MANY States have these look-back periods. They’re basically meant to prevent people from giving their assets away to family in order to get around paying for the care they’ll receive from the State. And, while it seems like it sucks at first, when you think about it, it’s basically FAIR. Well… My father’s having none of that: To him it’s bullshit that the State would take property, let alone look back five years and take it from other people! Now, he understood WHY they do this. He KNOWS that people could easily cheat the system, were it not for the look back system. So I asked him: How would you pay for it then? Shitty a lifestyle though it may be, this is a necessary, expensive service that’s being provided! Why is it wrong to ask the recipients of that service to pay whatever they can for it? I then added the kicker, reminding him that the alternative was socializing it, through higher taxes, spreading the cost across everyone, and making everyone pay for it. That’s a solution that I don’t really have a problem with: it would be part of my overall health care system. But I KNEW he’d never go for it. And, big surprise, he admitted that he had no ideas for alternatives, although he did point out that the family themselves used to care for their elderly relatives in house. (Yeah: Back when you could raise a family on one income, and people didn’t live nearly as long!) Anyway, I learned a long time ago that you can never get a Conservative to admit he’s wrong, but if you can get them to admit that they have no ideas? Count that as a win. For me? I just see it as evidence that Conservatives are basically whiny little bitches who want something for nothing. (And in this case a Government handout and socialized medicine! Imagine that!) But PAY FOR IT? What kind of liberal nonsense is that?!
Also hilarious, to me anyway, is hearing someone like my dad (a very wealthy man, I should add) talk about how we should just go to a “flat tax.” Now… first off all, he’s a deficit hawk, big time. Granted, he’s your typical Right Winger when it comes to the deficit: Lower Taxes (huh?), cut entitlements, trim defense (at worst), no earmarks, no pork, etc… in other words, basically shitty ideas that will do nothing to fix the deficit, and do great harm to the economy and to people’s lifestyles. But when he talks about a flat tax, I wonder if he’s even capable of basic arithmetic. Because if you assume a rate that doesn’t INCREASE the deficit, YES, his rate would go down, but the rates of ~98% of Americans would go UP. A LOT. When 1% of you population make 20% of the income (note: I just made that up – whatever the actual numbers are, it pretty bad) you cannot lower their tax bracket without raising everyone else’s, if you (1) want everyone to have the same rate. And (2) don’t want to increase the deficit / debt. So… why, you might ask would a Conservative be so much in favor or RAISING everyone’s taxes? I don’t have a clue. No, my dad’s not a stupid man. A bit self-centered in his perspective maybe, but he’s not DUMB. He just suffers for the typical Conservative’s disease of completely lacking logical consistently, self-awareness and principled pragmatism.
Another bit topic of conversation was the repeal of “Don’t Ask, Don’t Tell.” To which I say, “It’s about damned time, and what the hell took so long?!” But my Brother in Law was in the Navy and my Cousin was a Marine, and they’re both Conservatives – my brother-in-law to a kind of annoying, Sean Hannity degree, my cousin to a more psychotic G.Gordon Liddy / Mike Savage degree. And of course, despite the fact that they both served with gays, whether they knew it or not, this was of course going to signal the death knell of American Military Dominance. Putting aside of course that we spend twice on defense what England, France, Russia and China do combined. Putting aside that almost every other non-Muslim country has already done the same thing, and it’s had no impact. Putting aside that polls showed that even 70% of White Evangelical Christians supported its repeal… It all over. We’re doomed. And it seemed like everyone else (most of whom range from Massachusetts Democrats to Massachusetts Liberals) just LOVED to get my cousin torqued up about it, and get him going on one of his homophobic rants. Don’t get me wrong: I love a good rant as much as the next guy, even when I disagree with the speaker. It’s fun to see a man feeding off his own hatred, anger and fears. It’s fun to see someone just lose it. I know. I’m human too! But as I listened to him, a theme started to emerge that I found rather… disturbing.
I can’t really cite any one thing he said, but he acted like the Marines were their own entity. As if they were a club that could make their own rules and their own policies, rather than an arm of the democratically elected Government, created to enforce theirs. He acted like the Marines existed only to fight – which, yes, they do – but beyond that, as if their whole raison detre was fighting for fighting’s sake alone, or for any reason they alone saw fit, and that other factors, like actual foreign policy and actual American Values like freedom and equality were not the REASON they were fighting. I’m not going to suggest that he speaks for all Marines, but to hear him going off, in an almost thug-like, borderline-Nazi manner, you’d think he thought that it was the Marines, and the mentality of Marines like him that decided (not SHOULD decide, but ACTUALLY decided) what they should be fighting for, what the country stands for, and how the laws should be made and that somehow anything that goes against that fascist psychosis somehow constitutes a betrayal of our brave men and women in uniform. But answer me this: If you’re in the Middle East fighting a bunch of misogynistic, theocratic homophobes, and yet you DON’T believe in religious freedom, or equality, then WHAT THE FUCK ARE FIGHTING FOR?! At that point, you can only be fighting for fighting’s sake. I don’t believe, as he does, that America is betraying that part of the Military by allowing Gays to serve openly. I believe that for many years, large parts of the Military have been betraying American values by not respecting, supporting and fighting for what America actually believes and stands for: Equality and religious freedom.
And one point he actually said, “I don’t judge them [gays], but they’re deviants!” Remember what I said about lacking self-awareness?
Of course, the TSA and Muslim profiling came up. At which point I had to point out (again) that the terrorists were not the ones with long beards and turbans, but rather the clean-shaven ones wearing suits. Also that a turban was rarely indicative of a MUSLIM, and far more often indicative of a HINDU. And that the average Hindu hates Muslims even more that then average American bigot does. Now this lead to a brief conversation about other religions, and which point my Mom asked me what religion “those kids I went to school with were.” I knew the ones she meant: The ones who wore turbans and never, in their life, have cut their hair. To which I answered that they were Sikhs. My brother-in-law chimed in, adding that they “wear daggers around their necks” which is technically true, but also a grossly misleading oversimplification. After which my Father commented that it was a religious with “weird beliefs.” I asked him, “What religion DIDN’T ask you to believe weird things?” and then said, “Do you know what you call a religion without weird beliefs? SCIENCE. (And maybe Philosophy.)” That earned me a wink and a nod from my Uncle, by far the most liberal man in the room, and one of the most liberal men I know.
Speaking of weird beliefs… Do notice how some people will believe anything about someone they don’t like politically?
There was an article – on the front page of the Boston Globe no less – about the fact that the late Senator Edward Kennedy’s dog died. (Yes the Kennedy’s are still royalty in Massachusetts to the point where the death of a dead Kennedy’s dog is front page news!) Now… I noticed something in the article that, I thought, revealed either a gross display of bad taste, or a complete lack of self-awareness on the part of the late Senator. The dog’s name? SPLASH. Seriously. A guy who will forever be remember for driving his car off a bridge, drunk, into a river and allowing a female campaign aid worker to die in the icy water… named his dog SPASH. Now… although I’m not a particular critic of the late Senator, I found this point to be at least a bit perversely humorous - my favorite kind of humor - so I pointed it out. At which point
Anyway, while it was still a good time overall… It’s definitely good to be home
----------------------------------------------------------------
BTW… There’s was this John Stossell thing that ran on Fox while we were up there that I’d like to debunk, but this post is long enough, and that’s a post that should probably be its own post anyway.
Friday, July 9, 2010
Another failure of free-market economics and health care...
By now y'all are well aware of my disadain of the for-profit, free-market model of health care.
Here's another example of just how utterly uselss it is. The same kind of thing applies to rare diseases. Get a disease that "only" kills a few hundered people a year? Well, sucks to be unprofitable you.
Here's another example of just how utterly uselss it is. The same kind of thing applies to rare diseases. Get a disease that "only" kills a few hundered people a year? Well, sucks to be unprofitable you.
Tuesday, March 16, 2010
The Health Care Bill
Things have been busy at work the past couple weeks (the car makers must be making up for last year!) and I've hardly had any time to put my two-cents in over of MMFA lately. (Which is a good thing: in this economy, and in Michigan of all places, I'd rather have too little time on my hands than too much! LOL) So I was really rushed in this thread, so I wanted to come back and put my piece on the table regarding the pending health care legislation...
...and I don't suppose too many people, on either side of the issue, will like what I have to say about it. So let put a few "givens" out there, right up front.
1) I HATE insurance companies. We all know the multitude of ways that they screw people over, and I'm no different. My story? My two sons have autism. The insurance company paid for the diagnosis, but the minute they "autism" label was stuck on them, they wouldn't pay for shit in terms of therapy. (I came across THIS once, and it really hit home.) You know... Cause they don't get any better. (1) First of all: tell that to Temple Grandin. (2) Second of all, neither do AIDS patients or Diabetics or Schizophrenics or Transplant Patients or a million other patients who are on medication or medical therapy for life. But we all know that they'll throw any bullshit they can at you just to get out of paying. It doesn't have to be logical, scientifically correct or even make sense. They hold all the cards, so you're at their mercy.
So if anyone things I'm in the pocket of the insurance industry, I dare you to say it my face. (And I'd then advise you to them DUCK.) I HATE. HATE. HATE. those scum-sucking bastards. They turned their backs on my kids. So fuck 'em.
2) The Right, the Conservatives, The Republicans, the Insurance Lobby and Fox have all told so many lies about this whole issue, that I really don't even care what they have to say anymore. (I never really did, but it's less than background noise now.) They're so far out in Right Field it's not even funny anymore. It's pathetic and sad. Death Panels? Lie of the year. Deficits? Lie of the day, just depends on the issue you're discussing. Government Takeover? I only WISH. And I swear I'm going to punch the next person I hear crying about "socialism." So this in not, in any way, intended to argue with the idiots on the Right. 90% of them have no fucking idea what they're talking about, and the other 10% are lying for their paychecks. And even if every concession was given to them (and it basically has) they'd oppose it even if their own mother's life depended on it, just to see Obama and the Democrats "lose." They're despicable bastards without heart, soul or brains. So I'm done with them.
I want to take issue with the LIBERALS, who at this point are ready to jump ship on it.
Now... don't get me wrong. IMHO, the only PRINCIPLED, EDUCATED opposition to this bill, and anything in it has come from the Left. And I've laid out my own plan, which is about as close as you can get to single-payer, and yet not have the gov't run it, and still use market forces to keep costs DOWN, rather than UP as they do now. So you know I'm no libertarian when it comes to this issue. All that being said, in my humble opinion...
THIS IS IMPORTANT LEGISLATION. THIS IS GOOD LEGISLATION. AND THIS COUNTRY NEEDS IT TO PASS. NOW.
I can't remember where I read it (and it may have been in this blog, so please forgive me if it was you and I forgot) but I recently read where someone call Health Care Reform the "New Deal" of our generation, and went on to call Gay Rights the "Civil Rights Movement" of our generation. I absolutely agree, 100% with that analogy, and that is exactly what drives my thinking here: The New Deal was not a single piece of legislation. Neither was 'Civil Rights.' Both represented sweeping changes in HOW WE THINK. They represented paradigm shifts in out whole legal, economic, political and social philosophy. They both occurred over MANY bills, MANY laws, and even MANY court cases, both in support of and in opposition to. And there was no point at which ANY single piece of legislation SOLVED THE PROBLEM. (We still have both economic instability and racial issues today, after all, and we probably will 100 years from now.) So you could take ANY piece of legislation, in either of those two cases - the first, the last or any in between - and find some fault with it. It doesn't go far enough. It makes too many concessions. It makes things worse. But just as well, in each case, each step had to be taken, as it was, because at each stage they had to take what they could get and keep moving forward.
And that's where I part with the idealists on the Left: I'm a pragmatist. Do I agree with Michael Moore, and Keith Olbermann and Dennis Kuccinich? In principal? Yes. But in practice, I do not accept the conclusion that this bill makes things worse.
Will the insurance companies profit from this? Yes, I'm sure they'll find a way to. They always do.
(I don't mind that they make a profit. What bothers me is that the currently profit more by denying care. That's the dysfunctional incentive.)
Will some people remain uncovered? Yep. A good 20 Million as I understand it.
(That's still half what it is now, however.)
Do I like the individual mandate? Not without a public option I don't.
(But whether or not it's constitutional, is a matter for the courts to decide, not a reason to oppose it.)
BUT... I also see this bill as a NECESSARY first step. We'd all like single-payer. Wasn't going to happen. Personally, I prefer MY PLAN. Not going to happen. (Wasn't even on the table. LOL) Public Option? Might have happened, if Harry Reid had any balls, Nancy Pelosi was worth a damn and President Obama wasn't the pragmatist that I figured him for when I voted for him, despite the Right's attempts to brand his as the most moon-bat liberal homo-sapient of all time. And while I'd certainly have have liked it, maybe even participated in it, I can live without it, even with the individual mandate.
Why?
Pre-existing conditions. If you want to force them to cover pre-exsisting conditions, (and we need to, with everyone switching jobs, getting laid off, etc...) and not let them totally jack up the premiums to cover them, and you DON'T want your costs to skyrocket, the only way to achieve that is to have EVERYONE pay-in. You need healthy people who right now, whether by choice or by circumstance, aren't putting in to ante up and get covered. And to all you wanna-be micro-economics majors out there, this is yet another instance where market forces work in strange ways. You see... It doesn't cost more to COVER more people. COVERING PEOPLE is a source of REVENUE. The increased demand for coverage does not necessarily lead to higher costs. What increases costs is more (and more expensive) CLAIMS being filed. Does universal coverage lead to more, and more expensive, claims? On average, per person, not really.
Remember - this gets a lot of currently HEALTHY people on board. That will only LOWER the [insurance company's] cost, on a per person basis. And all those uninsured SICK people? As I laid out in my earlier health care posts, right now they wait until their on death's door and then show up in the ER. And they then run up HUGE bills, that then don't get paid. Well, first of all: Guess who pays them? WE DO, though higher premiums, as hospitals try to recoup unpaid bills by soaking insurance companies! They don't just write it off, and even if they do officially, they still try to recoup it from US - the insured. Second of all, if these same people were covered, they'd go to the doctor EARLY ON, when [whatever it is that they have] can be fixed CHEAPLY and EASILY, with FEWER COMPLICATIONS and better PATIENT OUTCOMES. Which is exactly what we WANT THEM TO DO because it COST LESS THAT WAY! It's ALWAYS costs more, not to mention has more negative outcomes, to treat a disease in the later stages. It's ALWAYS better, and cheaper, to catch it and treat it EARLY. So the idea that we'll be paying for something that we're not already is misguided, no matter what model you're looking at.
Is this bill perfect? No. No way. Is it even good? Debatable, certainly. But is it NECESSARY?
Yes. I firmly believe it is.
And to some extent the details don't matter. (And I realize there are some doozies.) This will not solve all of our problems, but neither would a public option and neither would even single payer. But about the only idea I've heard that would make it WORSE was John McCain's '08 campaign idea to let people buy across state lines. THAT, and some of the more "free market" solutions I've heard, would make it WORSE. Much worse. And I just don't believe this bill does. Not in any BIG PICTURE kind of way. It has it's warts, but at this point, and really at any point, we need to take what we can get, celebrate the victory, and move on to the NEXT STEP. Because whoever succeeds Obama, and whenever that happens, will STILL be dealing with health care. No matter WHAT happens, or even might have happened with this bill.
I actually, honestly believe that we'll get to single payer eventually (though still I prefer my own model.) But we're not going to get there in one bill. (Shit, we might not get there in my lifetime!) This will be, and has to be a gradual process. And the necessary FIRST STEP, really the first two steps, has/have to be:
1) Everyone needs to put it / Nobody is allowed to opt out. (And help the ones who truly can't afford it.)
2) The insurance companies can't be allowed to refuse anyone, and can't be allowed to gouge anyone.
Now... we're not there yet. But this bill brings us closer. And we can't get on with the REAL reforms until we've achieved those first two steps. And come November? It's likely the Republicans will make some gains, and the already uphill climb will only get steeper. We need to take what we can. We need to start moving in the right direction. We need to get the ball rolling. And we need to do this as soon as we can.
We NEED this legislation, warts and all. I don't LIKE it... but I do believe it's necessary.
...and I don't suppose too many people, on either side of the issue, will like what I have to say about it. So let put a few "givens" out there, right up front.
1) I HATE insurance companies. We all know the multitude of ways that they screw people over, and I'm no different. My story? My two sons have autism. The insurance company paid for the diagnosis, but the minute they "autism" label was stuck on them, they wouldn't pay for shit in terms of therapy. (I came across THIS once, and it really hit home.) You know... Cause they don't get any better. (1) First of all: tell that to Temple Grandin. (2) Second of all, neither do AIDS patients or Diabetics or Schizophrenics or Transplant Patients or a million other patients who are on medication or medical therapy for life. But we all know that they'll throw any bullshit they can at you just to get out of paying. It doesn't have to be logical, scientifically correct or even make sense. They hold all the cards, so you're at their mercy.
So if anyone things I'm in the pocket of the insurance industry, I dare you to say it my face. (And I'd then advise you to them DUCK.) I HATE. HATE. HATE. those scum-sucking bastards. They turned their backs on my kids. So fuck 'em.
2) The Right, the Conservatives, The Republicans, the Insurance Lobby and Fox have all told so many lies about this whole issue, that I really don't even care what they have to say anymore. (I never really did, but it's less than background noise now.) They're so far out in Right Field it's not even funny anymore. It's pathetic and sad. Death Panels? Lie of the year. Deficits? Lie of the day, just depends on the issue you're discussing. Government Takeover? I only WISH. And I swear I'm going to punch the next person I hear crying about "socialism." So this in not, in any way, intended to argue with the idiots on the Right. 90% of them have no fucking idea what they're talking about, and the other 10% are lying for their paychecks. And even if every concession was given to them (and it basically has) they'd oppose it even if their own mother's life depended on it, just to see Obama and the Democrats "lose." They're despicable bastards without heart, soul or brains. So I'm done with them.
I want to take issue with the LIBERALS, who at this point are ready to jump ship on it.
Now... don't get me wrong. IMHO, the only PRINCIPLED, EDUCATED opposition to this bill, and anything in it has come from the Left. And I've laid out my own plan, which is about as close as you can get to single-payer, and yet not have the gov't run it, and still use market forces to keep costs DOWN, rather than UP as they do now. So you know I'm no libertarian when it comes to this issue. All that being said, in my humble opinion...
THIS IS IMPORTANT LEGISLATION. THIS IS GOOD LEGISLATION. AND THIS COUNTRY NEEDS IT TO PASS. NOW.
I can't remember where I read it (and it may have been in this blog, so please forgive me if it was you and I forgot) but I recently read where someone call Health Care Reform the "New Deal" of our generation, and went on to call Gay Rights the "Civil Rights Movement" of our generation. I absolutely agree, 100% with that analogy, and that is exactly what drives my thinking here: The New Deal was not a single piece of legislation. Neither was 'Civil Rights.' Both represented sweeping changes in HOW WE THINK. They represented paradigm shifts in out whole legal, economic, political and social philosophy. They both occurred over MANY bills, MANY laws, and even MANY court cases, both in support of and in opposition to. And there was no point at which ANY single piece of legislation SOLVED THE PROBLEM. (We still have both economic instability and racial issues today, after all, and we probably will 100 years from now.) So you could take ANY piece of legislation, in either of those two cases - the first, the last or any in between - and find some fault with it. It doesn't go far enough. It makes too many concessions. It makes things worse. But just as well, in each case, each step had to be taken, as it was, because at each stage they had to take what they could get and keep moving forward.
And that's where I part with the idealists on the Left: I'm a pragmatist. Do I agree with Michael Moore, and Keith Olbermann and Dennis Kuccinich? In principal? Yes. But in practice, I do not accept the conclusion that this bill makes things worse.
Will the insurance companies profit from this? Yes, I'm sure they'll find a way to. They always do.
(I don't mind that they make a profit. What bothers me is that the currently profit more by denying care. That's the dysfunctional incentive.)
Will some people remain uncovered? Yep. A good 20 Million as I understand it.
(That's still half what it is now, however.)
Do I like the individual mandate? Not without a public option I don't.
(But whether or not it's constitutional, is a matter for the courts to decide, not a reason to oppose it.)
BUT... I also see this bill as a NECESSARY first step. We'd all like single-payer. Wasn't going to happen. Personally, I prefer MY PLAN. Not going to happen. (Wasn't even on the table. LOL) Public Option? Might have happened, if Harry Reid had any balls, Nancy Pelosi was worth a damn and President Obama wasn't the pragmatist that I figured him for when I voted for him, despite the Right's attempts to brand his as the most moon-bat liberal homo-sapient of all time. And while I'd certainly have have liked it, maybe even participated in it, I can live without it, even with the individual mandate.
Why?
Pre-existing conditions. If you want to force them to cover pre-exsisting conditions, (and we need to, with everyone switching jobs, getting laid off, etc...) and not let them totally jack up the premiums to cover them, and you DON'T want your costs to skyrocket, the only way to achieve that is to have EVERYONE pay-in. You need healthy people who right now, whether by choice or by circumstance, aren't putting in to ante up and get covered. And to all you wanna-be micro-economics majors out there, this is yet another instance where market forces work in strange ways. You see... It doesn't cost more to COVER more people. COVERING PEOPLE is a source of REVENUE. The increased demand for coverage does not necessarily lead to higher costs. What increases costs is more (and more expensive) CLAIMS being filed. Does universal coverage lead to more, and more expensive, claims? On average, per person, not really.
Remember - this gets a lot of currently HEALTHY people on board. That will only LOWER the [insurance company's] cost, on a per person basis. And all those uninsured SICK people? As I laid out in my earlier health care posts, right now they wait until their on death's door and then show up in the ER. And they then run up HUGE bills, that then don't get paid. Well, first of all: Guess who pays them? WE DO, though higher premiums, as hospitals try to recoup unpaid bills by soaking insurance companies! They don't just write it off, and even if they do officially, they still try to recoup it from US - the insured. Second of all, if these same people were covered, they'd go to the doctor EARLY ON, when [whatever it is that they have] can be fixed CHEAPLY and EASILY, with FEWER COMPLICATIONS and better PATIENT OUTCOMES. Which is exactly what we WANT THEM TO DO because it COST LESS THAT WAY! It's ALWAYS costs more, not to mention has more negative outcomes, to treat a disease in the later stages. It's ALWAYS better, and cheaper, to catch it and treat it EARLY. So the idea that we'll be paying for something that we're not already is misguided, no matter what model you're looking at.
Is this bill perfect? No. No way. Is it even good? Debatable, certainly. But is it NECESSARY?
Yes. I firmly believe it is.
And to some extent the details don't matter. (And I realize there are some doozies.) This will not solve all of our problems, but neither would a public option and neither would even single payer. But about the only idea I've heard that would make it WORSE was John McCain's '08 campaign idea to let people buy across state lines. THAT, and some of the more "free market" solutions I've heard, would make it WORSE. Much worse. And I just don't believe this bill does. Not in any BIG PICTURE kind of way. It has it's warts, but at this point, and really at any point, we need to take what we can get, celebrate the victory, and move on to the NEXT STEP. Because whoever succeeds Obama, and whenever that happens, will STILL be dealing with health care. No matter WHAT happens, or even might have happened with this bill.
I actually, honestly believe that we'll get to single payer eventually (though still I prefer my own model.) But we're not going to get there in one bill. (Shit, we might not get there in my lifetime!) This will be, and has to be a gradual process. And the necessary FIRST STEP, really the first two steps, has/have to be:
1) Everyone needs to put it / Nobody is allowed to opt out. (And help the ones who truly can't afford it.)
2) The insurance companies can't be allowed to refuse anyone, and can't be allowed to gouge anyone.
Now... we're not there yet. But this bill brings us closer. And we can't get on with the REAL reforms until we've achieved those first two steps. And come November? It's likely the Republicans will make some gains, and the already uphill climb will only get steeper. We need to take what we can. We need to start moving in the right direction. We need to get the ball rolling. And we need to do this as soon as we can.
We NEED this legislation, warts and all. I don't LIKE it... but I do believe it's necessary.
Wednesday, October 21, 2009
A couple more ideas on health care...
I wanted to add a few ideas to the health care proposal I laid out before. The first two have to deal with malpractice. Malpractice is a big part of health care costs and, because of the surplus of lawyers in this country, it really doesn't act in any ways that bring us better care. And, according to the theory of macroeconomics, if you can lower the cost of production, holding the price steady, you can increase supply. And THAT would help us achieve better care. So here are a couple of areas we could address.
The first is anything stemming from a decision or recommendation or test interpretation that your doctor gives you. The kind of "you DO have cancer / you DON'T have cancer" kind of thing. As part of the plan I've laid out, I would automatically cover SECOND OPINIONS. So if you have a lump, and he says, "it's not cancer," there would then be four possibilities.
1) you accept that information, and he's right.
2) you accept that information, and he's wrong.
3) you get a second opinion and the second doc reaches the same conclusion
4) you get a second opinion and the second doc reaches a different conclusion
In case (1), no problem. In case (2), because you waived the second opinion that you were entitled to, in doing so you are also waiving your right to sue for anything resulting form that information. In case (3) you have confirmation, but they could still BOTH be wrong. Guess what? STILL can't sue. Why? State of the Art. If two (or more) doctors reach the same conclusion - WITHOUT CONSULTING WITH EACH OTHER (obviously) that this would fall under the category of "technology just isn't advanced enough" or "you had a really weird case." Sucks to be you, BUT: It's not the doctor's fault! Your medical expenses from here out are covered anyway, and in absence of entitlement to punitive damages, what are you going to sue for? If you end up in case FOUR, well... time to start asking QUESTIONS, and being part of the process of deciding what the right option is for you: 'Wait and see' or 'Play it safe, but risk the more invasive option.' Depending on the possible risks, you may choose one way or the other, but you have to OWN your choice - can't sue - so ASK QUESTIONS. Find out if one doctors tends to follow one philosophy or the other, find out which one suits your own, after all: the final decision belongs with the PATIENT.
And for anyone who thinks this would put a huge strain on the system, I don't think it would. Most of the things we hear from the doctor we just accept. I don't need a second opinon for a broken arm, or antihistamines for allergies or stitches for a laceration. And if two sets of eyes is what I need to feel at ease about that suspicious lump? Then so be it. Get a second. (In case (4) I'd even cover a THIRD.) Knowing they can't be sued merely for giving an opinion, more Doctors would be likely to GIVE one. So the supply issue will mostly fix itself.
The other major areas for malpractice is mistakes and negligence. Now right of the bat, I want to say that the burden of proof for this would be a lot higher. One of the things that a patient accepts when s/he goes under the knife is the very real possibility that they'll stay there. We usually take for granted that nothing will happen, but every patient must be informed of the chances of death or other complications when they decide to go through with a procedure. (Remember the philosophy that drove the first section? Same thing applies here: You take your chances!) So the mere presence of a dead body DOES NOT entitle someone to some money. And remember: all subsequent medical expenses are covered anyway, so there's no need to sue for that. Unless it's something as obvious as "he left an instrument inside you when he stitched you up" chances are, it's just one of those things that happen. Not everyone can be saved. BUT...
What do you do about BAD DOCTORS? Well, part of Obama's plan that I really like is the requirement for electronic records. I'd take this a step farther a keep records of all of the procedures that a Doctor performs, along with any preexisting complicating factors in the patient and the outcome. To keep it simple, each outcome would be given a 1-5 rating. Something like...
5) No complications, full recovery.
4) Minor complications, full recovery after treatment.
3) Serious complications or only partial recovery.
2) Serious complications, with lifelong or chronic issues
1) Fatality
And in doing this, you can compare any given doctor's performance against the industry standard. In really simple terms, if the "average" for triple-bypass surgery is 4.5 and you've got a doctor who's been a 2.5 for, say, two years now, the answer is NOT to simply pay off patents anyway. The answer is: STOP HIM FROM PERFORMING TRIPLE BYPASSES! He could still practice medicine, but not that procedure. Only maybe only that procedure in a supporting role. And when stripped of the "why's" and "what happened's" you end up with an objective score that the doctor's can't conspire among themselves to fix or hide. (As many suspect happens when a hospital investigates an incident on it's own.)
Now... if it CAN be determined that something went fantastically wrong: they amputated the wrong leg, for example, or sewed up a retractor inside of you, then YES, you can still be compensated - but by the SYSTEM. And the SYSTEM will determine on it's own how to handle the DOCTOR.
We need to get rid of this "us versus them" mentality that we have right now. It doesn't help us, and it doesn't improve our care.
I've got some other ideas about 'tort,' but I'll save those for a later post. Let me know what you think!
The first is anything stemming from a decision or recommendation or test interpretation that your doctor gives you. The kind of "you DO have cancer / you DON'T have cancer" kind of thing. As part of the plan I've laid out, I would automatically cover SECOND OPINIONS. So if you have a lump, and he says, "it's not cancer," there would then be four possibilities.
1) you accept that information, and he's right.
2) you accept that information, and he's wrong.
3) you get a second opinion and the second doc reaches the same conclusion
4) you get a second opinion and the second doc reaches a different conclusion
In case (1), no problem. In case (2), because you waived the second opinion that you were entitled to, in doing so you are also waiving your right to sue for anything resulting form that information. In case (3) you have confirmation, but they could still BOTH be wrong. Guess what? STILL can't sue. Why? State of the Art. If two (or more) doctors reach the same conclusion - WITHOUT CONSULTING WITH EACH OTHER (obviously) that this would fall under the category of "technology just isn't advanced enough" or "you had a really weird case." Sucks to be you, BUT: It's not the doctor's fault! Your medical expenses from here out are covered anyway, and in absence of entitlement to punitive damages, what are you going to sue for? If you end up in case FOUR, well... time to start asking QUESTIONS, and being part of the process of deciding what the right option is for you: 'Wait and see' or 'Play it safe, but risk the more invasive option.' Depending on the possible risks, you may choose one way or the other, but you have to OWN your choice - can't sue - so ASK QUESTIONS. Find out if one doctors tends to follow one philosophy or the other, find out which one suits your own, after all: the final decision belongs with the PATIENT.
And for anyone who thinks this would put a huge strain on the system, I don't think it would. Most of the things we hear from the doctor we just accept. I don't need a second opinon for a broken arm, or antihistamines for allergies or stitches for a laceration. And if two sets of eyes is what I need to feel at ease about that suspicious lump? Then so be it. Get a second. (In case (4) I'd even cover a THIRD.) Knowing they can't be sued merely for giving an opinion, more Doctors would be likely to GIVE one. So the supply issue will mostly fix itself.
The other major areas for malpractice is mistakes and negligence. Now right of the bat, I want to say that the burden of proof for this would be a lot higher. One of the things that a patient accepts when s/he goes under the knife is the very real possibility that they'll stay there. We usually take for granted that nothing will happen, but every patient must be informed of the chances of death or other complications when they decide to go through with a procedure. (Remember the philosophy that drove the first section? Same thing applies here: You take your chances!) So the mere presence of a dead body DOES NOT entitle someone to some money. And remember: all subsequent medical expenses are covered anyway, so there's no need to sue for that. Unless it's something as obvious as "he left an instrument inside you when he stitched you up" chances are, it's just one of those things that happen. Not everyone can be saved. BUT...
What do you do about BAD DOCTORS? Well, part of Obama's plan that I really like is the requirement for electronic records. I'd take this a step farther a keep records of all of the procedures that a Doctor performs, along with any preexisting complicating factors in the patient and the outcome. To keep it simple, each outcome would be given a 1-5 rating. Something like...
5) No complications, full recovery.
4) Minor complications, full recovery after treatment.
3) Serious complications or only partial recovery.
2) Serious complications, with lifelong or chronic issues
1) Fatality
And in doing this, you can compare any given doctor's performance against the industry standard. In really simple terms, if the "average" for triple-bypass surgery is 4.5 and you've got a doctor who's been a 2.5 for, say, two years now, the answer is NOT to simply pay off patents anyway. The answer is: STOP HIM FROM PERFORMING TRIPLE BYPASSES! He could still practice medicine, but not that procedure. Only maybe only that procedure in a supporting role. And when stripped of the "why's" and "what happened's" you end up with an objective score that the doctor's can't conspire among themselves to fix or hide. (As many suspect happens when a hospital investigates an incident on it's own.)
Now... if it CAN be determined that something went fantastically wrong: they amputated the wrong leg, for example, or sewed up a retractor inside of you, then YES, you can still be compensated - but by the SYSTEM. And the SYSTEM will determine on it's own how to handle the DOCTOR.
We need to get rid of this "us versus them" mentality that we have right now. It doesn't help us, and it doesn't improve our care.
I've got some other ideas about 'tort,' but I'll save those for a later post. Let me know what you think!
Saturday, September 12, 2009
A little more on the free market, and health care...
I just realized that I'd forgotten a few things about why free market theories don't really apply to health. I mentioned the flat demand curve, and relatively static supply, but there are two other equally, if not more, important points that I forgot.
FIRST...
For a free market to really work, I need to KNOW what something costs and be able to compare, or shop around. Now in SOME CASES you might be able to do this, but consider this: You've cut yourself. You're bleeding. You need stitches. There's a hospital a block away, so you go there. Do you know it's going to cost? At best, you might know what % your insurance is supposed to cover, but % of what?! Chances are, none of the doctors you see will even be able to give you an estimate of the cost. And even if they did, that doesn't mean they know what price the hospital negotiated with the insurance company. Bottom line: You have NO IDEA what a trip to the hospital will cost until you get the bill. You. Have. No. Idea.
And if you did, what would you do? SHOP around?! Do you have time for that? Would you drive and hour to save $100? You might if you were buying a sofa, but YOU'RE BLEEDING! (Or having a stroke, heart attack, seizure, etc...) And even if you could shop around, do you have any objective way of determining quality? Not really. Anecdotal evidence, if you're lucky. (Or go online.) And that's about it. Is Dr. Smith better than Dr. Jones? There is basically no way to find that out! None!
So you can't compare quality and you have no idea what it costs. Some efficient market that will make!
SECOND...
A free and efficient market CAN be a beautiful thing. But we don't have one when it comes to health care, and we really never had. Putting aside that many of us have our choice of doctor narrowed down by our insurance company or HMO, most people DO NOT CHOOSE their insurance company. THEIR EMPLOYER DOES! To get a better plan, you have to change jobs.
And that's not the same as saying, "Get a better job." If I want a Mercedes, I very well might need a better job - one that pays MORE. But to get a given health care plan, it's not a function of the money I make, because I'M NOT BUYING IT! I can't buy it! Employers pick up about 80% of the cost of premiums, so THEY are the ones that choose the plan. To get a given plan, I might have to go to a worse job that pays LESS, just because that company might be the only one that offers the plan I want!
There is no other 'market' that operates that way. None. So it's NOT a market. Not for individuals anyway. And getting back to the idea of risk pooling, the only way to get the best care for the lowest price is to get as many people as possible into one plan. That's why even if I could afford what some other company pays for their employees' coverage, I won't be able to get the same price. Insuring one person is extremely expensive. But insuring a whole bunch of people is cheap, at least on a per person basis. So there's no benefit to everyone going around and negotiating their own plan. Risk pooling will always, automatically get you a lower cost than you'll ever be able to find (or negotiate) for yourself. Better coverage too. So a market just won't work, and really doesn't exsist anyway.
If you're still not convinced, I offer this: The micro economic factors that I've already mentioned here and in previous posts worked to make health care so expensive in the first place that being sick became something that we need to insure against. Market forces made that insurance so expensive that the only way to sell it way with employers paying for most of it. NOW insurance is so expensive that HUGE, BILLION DOLLAR corporations can no longer afford it. (GM? Chrysler? Yeah, pretty much killed by health care costs.) And it is not despite market forces, but precisely BECAUSE OF THEM that we have the situation that we do. And this trend is thirty years in teh making. I little deregulation isn't going to reverse it.
The 'free market' just won't work in this case. There are many areas where it will (almost all, in fact) but Health Care is one of the rare exceptions.
Oh yeah...
I also want to deal with a common talking point: That since medicare is going broke, that means that gov't health care 'doesn't work.' Here's the thing: Everyone's health care costs are going up. There's no denying that. Private companies just raised their rates. And yours went up too, I guarantee it! But what are you going top do? It's not like you had a choice, remember? But for MediCare's budget to go it means MORE TAXES. So while there costs have gone up, they haven't been able to increase their revenue the way insurance companies can. And THAT'S why it's failing. But with my plan, costs can fluctuate. And if, in future, the taxes you pay for gov't health care go up, this is in lieu of your premiums going up: so your still no worse off!
As for the whole government efficiency remember: Insurance companies run it; like contractors. But they won't have the same dysfunctional profit motives that they have now. They can still make money, but it won't be like before. No more huge salaries for CEO's, not generated by health care premiums anyway! They'll want as many new babies as they can get, since that lowers their average cost, and increases their revenue, so they won't risk losing those to their competition by over bidding.
FINALLY...
I want to, once and all, eviscerate the idea that Senator McCain (R) proposed on the 2008 campaign trail that we could benefit by eliminating state boundaries. Now... this COULD work, in the short term. I live in Michigan. I have two autistic sons. At the moment, speech theraphy is not covered for Autistics in Michigan. So I could, say, buy from Florida, where it IS covered. Sounds great right? Two problems.
First of all: I'M NOT BUYING IT! It's still going to be up to my employer to buy it. And THEY are likely to choose the cheapest plan, which is likely in the state with the leats regulation and least mandated coverage. So there goes my coverage! What's more, in the long term, if anyone can buy form any state, then the insirance companies will all move their plans to the one state with the least regulations. (So Autism reform, for example, won't happen for ANYONE unless ALL FIFTY states pass it! And when was the last time Alabama and Massachusetts agreed to do anything together?!)
So, Mr McCain, all your plan will do is make it IMPOSSIBLE for a given State to regulate it's insurance industry. And here I thought Republican's were all about states rights. Ha!
FIRST...
For a free market to really work, I need to KNOW what something costs and be able to compare, or shop around. Now in SOME CASES you might be able to do this, but consider this: You've cut yourself. You're bleeding. You need stitches. There's a hospital a block away, so you go there. Do you know it's going to cost? At best, you might know what % your insurance is supposed to cover, but % of what?! Chances are, none of the doctors you see will even be able to give you an estimate of the cost. And even if they did, that doesn't mean they know what price the hospital negotiated with the insurance company. Bottom line: You have NO IDEA what a trip to the hospital will cost until you get the bill. You. Have. No. Idea.
And if you did, what would you do? SHOP around?! Do you have time for that? Would you drive and hour to save $100? You might if you were buying a sofa, but YOU'RE BLEEDING! (Or having a stroke, heart attack, seizure, etc...) And even if you could shop around, do you have any objective way of determining quality? Not really. Anecdotal evidence, if you're lucky. (Or go online.) And that's about it. Is Dr. Smith better than Dr. Jones? There is basically no way to find that out! None!
So you can't compare quality and you have no idea what it costs. Some efficient market that will make!
SECOND...
A free and efficient market CAN be a beautiful thing. But we don't have one when it comes to health care, and we really never had. Putting aside that many of us have our choice of doctor narrowed down by our insurance company or HMO, most people DO NOT CHOOSE their insurance company. THEIR EMPLOYER DOES! To get a better plan, you have to change jobs.
And that's not the same as saying, "Get a better job." If I want a Mercedes, I very well might need a better job - one that pays MORE. But to get a given health care plan, it's not a function of the money I make, because I'M NOT BUYING IT! I can't buy it! Employers pick up about 80% of the cost of premiums, so THEY are the ones that choose the plan. To get a given plan, I might have to go to a worse job that pays LESS, just because that company might be the only one that offers the plan I want!
There is no other 'market' that operates that way. None. So it's NOT a market. Not for individuals anyway. And getting back to the idea of risk pooling, the only way to get the best care for the lowest price is to get as many people as possible into one plan. That's why even if I could afford what some other company pays for their employees' coverage, I won't be able to get the same price. Insuring one person is extremely expensive. But insuring a whole bunch of people is cheap, at least on a per person basis. So there's no benefit to everyone going around and negotiating their own plan. Risk pooling will always, automatically get you a lower cost than you'll ever be able to find (or negotiate) for yourself. Better coverage too. So a market just won't work, and really doesn't exsist anyway.
If you're still not convinced, I offer this: The micro economic factors that I've already mentioned here and in previous posts worked to make health care so expensive in the first place that being sick became something that we need to insure against. Market forces made that insurance so expensive that the only way to sell it way with employers paying for most of it. NOW insurance is so expensive that HUGE, BILLION DOLLAR corporations can no longer afford it. (GM? Chrysler? Yeah, pretty much killed by health care costs.) And it is not despite market forces, but precisely BECAUSE OF THEM that we have the situation that we do. And this trend is thirty years in teh making. I little deregulation isn't going to reverse it.
The 'free market' just won't work in this case. There are many areas where it will (almost all, in fact) but Health Care is one of the rare exceptions.
Oh yeah...
I also want to deal with a common talking point: That since medicare is going broke, that means that gov't health care 'doesn't work.' Here's the thing: Everyone's health care costs are going up. There's no denying that. Private companies just raised their rates. And yours went up too, I guarantee it! But what are you going top do? It's not like you had a choice, remember? But for MediCare's budget to go it means MORE TAXES. So while there costs have gone up, they haven't been able to increase their revenue the way insurance companies can. And THAT'S why it's failing. But with my plan, costs can fluctuate. And if, in future, the taxes you pay for gov't health care go up, this is in lieu of your premiums going up: so your still no worse off!
As for the whole government efficiency remember: Insurance companies run it; like contractors. But they won't have the same dysfunctional profit motives that they have now. They can still make money, but it won't be like before. No more huge salaries for CEO's, not generated by health care premiums anyway! They'll want as many new babies as they can get, since that lowers their average cost, and increases their revenue, so they won't risk losing those to their competition by over bidding.
FINALLY...
I want to, once and all, eviscerate the idea that Senator McCain (R) proposed on the 2008 campaign trail that we could benefit by eliminating state boundaries. Now... this COULD work, in the short term. I live in Michigan. I have two autistic sons. At the moment, speech theraphy is not covered for Autistics in Michigan. So I could, say, buy from Florida, where it IS covered. Sounds great right? Two problems.
First of all: I'M NOT BUYING IT! It's still going to be up to my employer to buy it. And THEY are likely to choose the cheapest plan, which is likely in the state with the leats regulation and least mandated coverage. So there goes my coverage! What's more, in the long term, if anyone can buy form any state, then the insirance companies will all move their plans to the one state with the least regulations. (So Autism reform, for example, won't happen for ANYONE unless ALL FIFTY states pass it! And when was the last time Alabama and Massachusetts agreed to do anything together?!)
So, Mr McCain, all your plan will do is make it IMPOSSIBLE for a given State to regulate it's insurance industry. And here I thought Republican's were all about states rights. Ha!
Some of the more sticky questions about my health care plan...
Ok. Many of you probably think that MediaMatters is nothing but a bunch of pinko, commie, liberal, lefties. Well, they are a lot of them over there, and I fit right in with 'em! But they also have more than a couple regular posters who lean sharply conservative. I've locked horns with many of them over the past couple years, and some of them have posed some very reasonable questions that deserve answers.
So here goes.
Why should abortion be covered? You say you don't cover other voluntary procedures, why cover abortion? Isn't abortion a 'voluntary procedure'?
First off, let me say that if you feel abortion is IMMORAL, I'm with you! The thing is... so are most liberals and pro-lifers! MORALITY isn't the really key issue here, it's LEGALITY. And the difference between a liberal (like me) and a pro-lifer is that while I BELIEVE (meaning, IN MY OPINION) that abortion is immoral, I DO NOT feel the need to infect my opinion onto anyone else. If you don't like abortions? DON'T HAVE ONE. No one will ever force you to and whatever anyone else does is none of your business to tell them one way or the other.
Second... There is more to excluding voluntary procedures than just the fact that they're voluntary. It's also because they're EXPENSIVE and there's no reason anyone else should have pay for them! The alternative to having a boob-job is NOT having one: Which costs nothing. The alternative to abortion is BIRTH, which always costs MORE. I'm not begrudging those who wish to have children (another voluntary decision, mind you!) BIRTH will always be fully covered, but if a person wants to ASK LESS of the system by terminating the pregnancy early, as long as the procedure remains legal there is no rational reason not to do this! (Fair enough: If you managed to OUTLAW it, it won't be covered. Of course, in theory, it won't be PERFORMED either, so the question of coverage is moot either way.
Which brings me to the next part of the question:
What if I don't want to subsidize someone else getting one?
This is just stupid for many reasons. First of all, if you currently buy private insurance, chances are you're already doing this. You are not paying for anything other than YOUR COVERAGE and YOUR FAMILY'S. So mind your own business and stop worrying about the choices other people make with theirs! And again, we can't have individuals deciding what they do and don't want to cover for themselves, or you lose all the benefits of risk pooling - which is how our CURRENT SYSTEM works! I'm sure 90% of AIDS patients didn't think they'd ever get AIDS, and thus may have been tempted to exclude AIDS coverage if they could save a few bucks a months. And while SOME may have changed their behaviors, most would still eventually get the disease. (And where would THAT leave them now?)You can't have people estimating their own chances of getting something. That's what insurance companies are for and they have thousands of experts crunching reams of data all day long to figure it out. So let THEM figure that out. Just take you gold-star, universal coverage and stop whining about it!
This same line of reasoning, BTW, applies to pharmacists who refuse to fill prescriptions for birth-control pills (for example) for religious reasons. This is BULLSHIT. Anyone pharmacist who refuse to fill a doctors prescription for moral reason should lose their license and business. PERIOD. Why, you ask? What about respecting people's beliefs, you ask? Again, BULLSHIT. If you're Catholic (for example) and you believe the use of birth control is a sin, then YOU can't use, and YOU can't be partners with someone else who does! The Catholic Church's prohibition of contraception DOES NOT (and by the First Ammendment to the Constitution, CAN NOT) APPLY to non-Catholics, and isn't observed by 99% of practicing Catholics anyway! A pharmacist refusing to let SOMEONE ELSE use contraception is nothing more than him or her forcing their religious beliefs onto another person. Someone else's sin is not theirs and don't give me any hogwash about enabling it, either. What's next? Holding gun manufacturer's responsible for every murder that's committed? Not THIS liberal!
Why do we even need this? What wrong with the FREE MARKET setting the price? Wont this lead to RATIONING?
First things last. The 'free market' IS a system of rationing. That what market forces DO. They give resources to those willing (and able) to pay the marker price for a given good or service. Those that aren't willing (or able) to pay DON'T GET the good or service. And the volume available (supply) is only a function of the market price. It is not a function of actual need - the opposite in fact, the more something is needed, the HIGHER the price. In this way the free market serves to ration EVERYTHING.
And that is EXACTLY why it's a lousy way to manage HEALTH CARE: Because the demand curve for health care is essentially flat. Here's what that means in English: Let's say a bag of Doritos cost $100. What would happen? First of all, a WHOLE LOT of people would start making Doritos! But who would pay that much when POTATO CHIPS still cost $1? You see? There a diminished demand for certain goods at higher prices because I have COMPETING CHOICES. And thus the price is kept low, to compete with those alternatives. If I can't afford a Mercedes, I can buy a Chevy. If I can't afford a house, I can rent an apartment. If I can't afford fillet, I can buy chuck.
But if I can't afford chemo... (and I'll give you a clue: nobody can)... then I DIE.
Now, death may be the low-cost alternative to most health care procedures, but it's not one I'm ever likely to choose, is it? It's basically not an acceptable alternative for anyone. So HOW MUCH will your triple-bypass cost? Well... How much do you have?! Since I know that you won't go without, and I know that there's no competing alternatives, there's nothing to reign in my cost. 'Give me all you got and more!' is therefore the only answer one can expect from a free market. (Thankfully, most hospitals are non-profits entities!)
AND not only is the demand curve FLAT, but the SUPPLY curve is unique as well. You see, the supply of oil, potato chips, cars or beef can fluctuate. If demand for something goes UP, we can usually just make more. But the number of DOCTORS we have at any time doesn't really go up with demand, because doctors come from MEDICAL SCHOOLS and med schools take only a very small percentage of applicants. And medical fellowhips (needed for specialties) only take a small percentage of applicants from that pool! And they're not about to lower their standards just because doctors salaries have gone up and more people want to be doctors. So we can't really allow the supply to fluctuate like a regular commodity does, because it takes to long to increase the supply!
What about the unemployed? Or illegals aliens? Why should I pay for them?
First off, you already are. The unemployed already get coverage: Medicaid. And you already pay for that. You still will, but in a less dysfunctional system. You also already subsidize the UNINSURED (which includes illegal aliens) in exactly the way I've already described. SO get over it. Better they get GOOD TREATMENT that costs everyone LESS than get lousy treatment that costs everyone more.
And we REALLY don't want hospitals to put off treatment until they verify legal status, do we? Imagine you've had a stroke or heart attack. Every second counts. Do you really want there to be ANY possibility that your treatment is delayed? That could be fatal! So, just as they are now, hospitals will treat their patients according to medical need, NO QUESTIONS ASKED. They don't have to worry: THEY'LL GET PAID. And is there really any benefit to saying, "Sorry, that guy was an illegal, so we won't pay you for treating him?" NO! Now we're right back to the hospitals baking in unreimbursed expenses, just as they do now, and WE END UP PAYING ANYWAY!!! So get over it. There's no way to avoid it without screwing everything up with red tape and you won't save a single penny anyway!
JUST TAKE YOUR UNIVERSAL COVERAGE AND STOP WHINING!!!
BTW, this is one of my pet peeves with conservatives on a lot of things... They're always more concerned about making sure that the WRONG PEOPLE (whoever they are) don't benefit, than they are are making sure that the RIGHT PEOPLE (whoever they are) don't get hurt. In this case, they'd create a whole system of gov't bureaucracy that will end up killing someone who was entitled to care just to stop someone who isn't from receiving it. Not only is this a senseless trade off, going against the very conservative Principal of limited gov't and making the conservative's fear of a gov't bureaucrat getting between you and your health care a reality, but WHAT IS SO WRONG with saving a life?! Why should the HOSPITAL get punished, by not being paid for services rendered (and costs incurred,) just because they saved the wrong person's life. That's just... psychotic. So get over your xenophobia, conservatives. And besides, there's no reason that the Mexicans would flood over our borders just to get free health care... THEY ALREADY GET PUBLIC HEALTH IN MEXICO!
SO let me knwo if you have any other questions. I'll do my best to satisfy you. I've spent a lot of time thinking about this from many different angles, and I'm confident it's the best way to go. So I'll take all comers!
Now let me have it!
LOL
So here goes.
Why should abortion be covered? You say you don't cover other voluntary procedures, why cover abortion? Isn't abortion a 'voluntary procedure'?
First off, let me say that if you feel abortion is IMMORAL, I'm with you! The thing is... so are most liberals and pro-lifers! MORALITY isn't the really key issue here, it's LEGALITY. And the difference between a liberal (like me) and a pro-lifer is that while I BELIEVE (meaning, IN MY OPINION) that abortion is immoral, I DO NOT feel the need to infect my opinion onto anyone else. If you don't like abortions? DON'T HAVE ONE. No one will ever force you to and whatever anyone else does is none of your business to tell them one way or the other.
Second... There is more to excluding voluntary procedures than just the fact that they're voluntary. It's also because they're EXPENSIVE and there's no reason anyone else should have pay for them! The alternative to having a boob-job is NOT having one: Which costs nothing. The alternative to abortion is BIRTH, which always costs MORE. I'm not begrudging those who wish to have children (another voluntary decision, mind you!) BIRTH will always be fully covered, but if a person wants to ASK LESS of the system by terminating the pregnancy early, as long as the procedure remains legal there is no rational reason not to do this! (Fair enough: If you managed to OUTLAW it, it won't be covered. Of course, in theory, it won't be PERFORMED either, so the question of coverage is moot either way.
Which brings me to the next part of the question:
What if I don't want to subsidize someone else getting one?
This is just stupid for many reasons. First of all, if you currently buy private insurance, chances are you're already doing this. You are not paying for anything other than YOUR COVERAGE and YOUR FAMILY'S. So mind your own business and stop worrying about the choices other people make with theirs! And again, we can't have individuals deciding what they do and don't want to cover for themselves, or you lose all the benefits of risk pooling - which is how our CURRENT SYSTEM works! I'm sure 90% of AIDS patients didn't think they'd ever get AIDS, and thus may have been tempted to exclude AIDS coverage if they could save a few bucks a months. And while SOME may have changed their behaviors, most would still eventually get the disease. (And where would THAT leave them now?)You can't have people estimating their own chances of getting something. That's what insurance companies are for and they have thousands of experts crunching reams of data all day long to figure it out. So let THEM figure that out. Just take you gold-star, universal coverage and stop whining about it!
This same line of reasoning, BTW, applies to pharmacists who refuse to fill prescriptions for birth-control pills (for example) for religious reasons. This is BULLSHIT. Anyone pharmacist who refuse to fill a doctors prescription for moral reason should lose their license and business. PERIOD. Why, you ask? What about respecting people's beliefs, you ask? Again, BULLSHIT. If you're Catholic (for example) and you believe the use of birth control is a sin, then YOU can't use, and YOU can't be partners with someone else who does! The Catholic Church's prohibition of contraception DOES NOT (and by the First Ammendment to the Constitution, CAN NOT) APPLY to non-Catholics, and isn't observed by 99% of practicing Catholics anyway! A pharmacist refusing to let SOMEONE ELSE use contraception is nothing more than him or her forcing their religious beliefs onto another person. Someone else's sin is not theirs and don't give me any hogwash about enabling it, either. What's next? Holding gun manufacturer's responsible for every murder that's committed? Not THIS liberal!
Why do we even need this? What wrong with the FREE MARKET setting the price? Wont this lead to RATIONING?
First things last. The 'free market' IS a system of rationing. That what market forces DO. They give resources to those willing (and able) to pay the marker price for a given good or service. Those that aren't willing (or able) to pay DON'T GET the good or service. And the volume available (supply) is only a function of the market price. It is not a function of actual need - the opposite in fact, the more something is needed, the HIGHER the price. In this way the free market serves to ration EVERYTHING.
And that is EXACTLY why it's a lousy way to manage HEALTH CARE: Because the demand curve for health care is essentially flat. Here's what that means in English: Let's say a bag of Doritos cost $100. What would happen? First of all, a WHOLE LOT of people would start making Doritos! But who would pay that much when POTATO CHIPS still cost $1? You see? There a diminished demand for certain goods at higher prices because I have COMPETING CHOICES. And thus the price is kept low, to compete with those alternatives. If I can't afford a Mercedes, I can buy a Chevy. If I can't afford a house, I can rent an apartment. If I can't afford fillet, I can buy chuck.
But if I can't afford chemo... (and I'll give you a clue: nobody can)... then I DIE.
Now, death may be the low-cost alternative to most health care procedures, but it's not one I'm ever likely to choose, is it? It's basically not an acceptable alternative for anyone. So HOW MUCH will your triple-bypass cost? Well... How much do you have?! Since I know that you won't go without, and I know that there's no competing alternatives, there's nothing to reign in my cost. 'Give me all you got and more!' is therefore the only answer one can expect from a free market. (Thankfully, most hospitals are non-profits entities!)
AND not only is the demand curve FLAT, but the SUPPLY curve is unique as well. You see, the supply of oil, potato chips, cars or beef can fluctuate. If demand for something goes UP, we can usually just make more. But the number of DOCTORS we have at any time doesn't really go up with demand, because doctors come from MEDICAL SCHOOLS and med schools take only a very small percentage of applicants. And medical fellowhips (needed for specialties) only take a small percentage of applicants from that pool! And they're not about to lower their standards just because doctors salaries have gone up and more people want to be doctors. So we can't really allow the supply to fluctuate like a regular commodity does, because it takes to long to increase the supply!
What about the unemployed? Or illegals aliens? Why should I pay for them?
First off, you already are. The unemployed already get coverage: Medicaid. And you already pay for that. You still will, but in a less dysfunctional system. You also already subsidize the UNINSURED (which includes illegal aliens) in exactly the way I've already described. SO get over it. Better they get GOOD TREATMENT that costs everyone LESS than get lousy treatment that costs everyone more.
And we REALLY don't want hospitals to put off treatment until they verify legal status, do we? Imagine you've had a stroke or heart attack. Every second counts. Do you really want there to be ANY possibility that your treatment is delayed? That could be fatal! So, just as they are now, hospitals will treat their patients according to medical need, NO QUESTIONS ASKED. They don't have to worry: THEY'LL GET PAID. And is there really any benefit to saying, "Sorry, that guy was an illegal, so we won't pay you for treating him?" NO! Now we're right back to the hospitals baking in unreimbursed expenses, just as they do now, and WE END UP PAYING ANYWAY!!! So get over it. There's no way to avoid it without screwing everything up with red tape and you won't save a single penny anyway!
JUST TAKE YOUR UNIVERSAL COVERAGE AND STOP WHINING!!!
BTW, this is one of my pet peeves with conservatives on a lot of things... They're always more concerned about making sure that the WRONG PEOPLE (whoever they are) don't benefit, than they are are making sure that the RIGHT PEOPLE (whoever they are) don't get hurt. In this case, they'd create a whole system of gov't bureaucracy that will end up killing someone who was entitled to care just to stop someone who isn't from receiving it. Not only is this a senseless trade off, going against the very conservative Principal of limited gov't and making the conservative's fear of a gov't bureaucrat getting between you and your health care a reality, but WHAT IS SO WRONG with saving a life?! Why should the HOSPITAL get punished, by not being paid for services rendered (and costs incurred,) just because they saved the wrong person's life. That's just... psychotic. So get over your xenophobia, conservatives. And besides, there's no reason that the Mexicans would flood over our borders just to get free health care... THEY ALREADY GET PUBLIC HEALTH IN MEXICO!
SO let me knwo if you have any other questions. I'll do my best to satisfy you. I've spent a lot of time thinking about this from many different angles, and I'm confident it's the best way to go. So I'll take all comers!
Now let me have it!
LOL
The Solution to the Health Care Problem
The health care debate rages on. President Obama took yet another opportunity to make his case, and yet all the media can focus on was Representative Wilson's outburst, "YOU LIE!" (Never getting around to letting there audience know that Rep. Wilson (R) was, in fact, LYING.) So Democrats keep trying to compromise, the Republicans keep trying to obstruct and the media remains complicit with the RIGHT WING but still refusing to inform people about the ACTUAL BILL, in favor of repeating RIGHT WING LIES... like those death panels on page 425? Yeah: THEY AIN'T THERE! But you won't get that form the media who would rather report on a fight than actually INFORM people.
So once against the media's forfeiture of credibility, the Republican's lack of brains and the Democrat's lack of balls have doomed us all. And that's not even to say that I LIKE Obama's bill, it's just better than anything ELSE I've seen so far...
Except for MY SOLUTION. Which would solve everything, and satisfy everyone. Over on MediaMatters, even the conservative posters had to concede to it's quality. So here's MY PLAN:
PART ONE: The Government's Role
The primary role of the GOVERNMENT, meaning the LEGISLATURE is to DEFINE the COVERAGE. Put in the simplest terms: Everyone & everything is covered. You could make this 100%, with NO out of pocket expense or could have a SMALL (~$20) co-pay, just to deter some idiot going to the ER for a hangnail.
Now... Just some common sense details: No, I wouldn't cover elective/non-reconstructive cosmetic surgery. I wouldn't cover any 'alternative medicine' (which is all BS anyway!); and I'd also be sorely tempted to exclude lifestyle drugs (Cyalis/Viagra/Levitra?) but I guess I could be persuaded to include those. Abortion would be covered. If you don't like that? Grow up. Seriously. (I'll address why this is the case in another post, "Questions Answered about My Plan, because people have asked.) And mental health would get the same level of coverage as everything else. There's no reason to treat the brain any differently from any other organ that has something go wrong with it. (Currently most Ins.Co shaft mental health drugs big time.) Many things not currently covered, like Speech therapy to treat Autism, would also be covered.
The exact details on every little things can be worked out later, but the GUIDING PRINCIPLE is: If you're sick, and we can heal you, your healed. No fuss, no muss and little to no out of pocket expense! No one dies of anything we can fix, and no one EVER goes bankrupt for getting sick. Period.
PART TWO: So who actually RUNS it?!
Utilizing the enormous network of health care cast negotiators that already exists, the program will be managed by the insurance companies, much in the way they do now. The big difference is that they can't refuse coverage. Everyone gets treated, and the hospital (doctor, etc...) gets paid for everyone they see. DONE.
They will adjust their premiums to figure out what it would cost and then bill the government for that service. What stops them from just GOUGING the government? Simple: COMPETITION. They will have to bid to cover people. And once they get someone they have them for LIFE. SO: Every time a baby is born, they will want to snatch up as many babies as they can since, once born and vaccinated, most babies represent about 30 years of little to no cost. Since they'll be paid to cover them ANYWAY, they'll want as many of those babies as they can get. If their price is to high, their competitors will snatch them up and their current case load just gets older. (Which in the health care world is a disaster! If you can get paid the same for babies as for the over 65's, YOU WANT THEM!)
So they will negotiate prices. The difference between what they negotiate and what the government pays - THEY KEEP. So there's still a profit motive and opportunity. (But for PROVIDING care, not DENYING it!) Going back to PART ONE, to maintain "universal coverage" and to avoid both rationing and robbing people of control over their own care, they will be required to reimburse doctors/hospitals/etc... at a level that (for example) insures that any given person will have a choice of at least three doctors within 50 miles of their home (100 miles in rural areas) that will perform a given test or procedure at no additional cost to the patient. (Save for ~$20 co-pay, if applicable.) Some Doctors can still charge more, if they think the market will bear it, but the difference will have to be paid by the patient. But the standard payment will have to be enough to make sure I have at least three Doctors to choose from with no additional expense. This gives doctors an incentive not to gouge insurance companies because there will be great pressure for them to be among the "free" providers - or at least very close to "free."
Now - I've also thought about how to reimburse at a higher level for specialists. First off, we'll need some way of identifying who the specialists are. It could be years of service, education, experience... whatever. The HOW isn't really important. It would likely been done however it's done now. So let's say someone has a complicated case and needs a specialist. Teh specialist won't be working for the regular rate. So does that mean that the patient now has to pay? NO. Here's how it would work: Specialists get reimbursed at a higher rate, to the point where the "choice of three" doctrine is maintained. So who decides is you get to see the specialist? Not the government (as you may be suspecting, but) YOUR DOCTOR. That's right. You see the regular doctor. When he sees your complicated case, assuming he's not a specialist himself, he'll think "No way am I dealing with THAT, for what they're paying me!" (Since he's only getting the base rate) and he'll refer you to a specialist or three. If a doctor is willing to give up the chance to make a little money (because he judges that what's really needed is beyond what he's getting paid, and thus he'll be at a loss) that's good enough for me. Off to see the specialist!
PART THREE: So how do we PAY for it?
OK, you guessed it: The government will pay the insurance bills with increased taxes. But stay with me now! It's not nearly as bad as you think. In fact, YOU MAY NOT EVEN NOTICE. And corporations may even prefer it!
The increased taxes will be offset by the fact that you're no longer paying premiums. This new tax would be structured such that most people's take home pay would not be affected + or -. This tax would be partially based on income (to give a break to anyone making under median income) but would also vary with martial status and number of children, much the way your premium does now. But the guiding principle here is that your take home pay will be as close as possible, to what you're taking home now.
Corporate taxes increase will increase to, such that the revenue generated will be the same as what is currently being paid in premiums - this is meant to be revenue-neutral. The benefit of this is that in the form of a tax, it will not have to be paid by struggling firms, who would otherwise still have huge, fixed health care costs, and more of the bill will be footed by companies doing really well. Who could just as easily have a tough year next year, and be in the other boat themselves. (Don't believe me? As late as the 1990's it was UNTHINKABLE that GM, still the worlds largest and richest corporation at the time, would EVER declare bankruptcy.) So while ExxonMobil might not like the increased taxes now, 5 years from now (let's say) when they're approaching red ink, rather than BIG FIXED COSTS for health care, their cost will be... NOTHING! And that can easily be the difference between making a profit and taking a loss!
PART FOUR: So what controls costs?
Cost are controlled automatically, through market forces in a more functional manner than they are today: Doctors will charge what the market bears, but will have an incentive to be among those that are "free" to the patient. Insurance companies will be in competition with each other to bid for new babies to cover. Free market principals apply, but will be used to insure coverage, as well as control cost. But rather than let supply and demand drive price, we'll use price to drive supply, and competition to keep Price down.
YOU see a DOCTOR. The DOCTORS deal with the INSURERS. The INSURERS deal with the GOVERNMENT. And the GOVERNMENT bill YOU (and your EMPLOYER.)
That's the basic structure. I'm going to do a separate post on strengths and benefits and also for any questions I get here, and for questions I've gotten from the MediaMatters posters.
So once against the media's forfeiture of credibility, the Republican's lack of brains and the Democrat's lack of balls have doomed us all. And that's not even to say that I LIKE Obama's bill, it's just better than anything ELSE I've seen so far...
Except for MY SOLUTION. Which would solve everything, and satisfy everyone. Over on MediaMatters, even the conservative posters had to concede to it's quality. So here's MY PLAN:
PART ONE: The Government's Role
The primary role of the GOVERNMENT, meaning the LEGISLATURE is to DEFINE the COVERAGE. Put in the simplest terms: Everyone & everything is covered. You could make this 100%, with NO out of pocket expense or could have a SMALL (~$20) co-pay, just to deter some idiot going to the ER for a hangnail.
Now... Just some common sense details: No, I wouldn't cover elective/non-reconstructive cosmetic surgery. I wouldn't cover any 'alternative medicine' (which is all BS anyway!); and I'd also be sorely tempted to exclude lifestyle drugs (Cyalis/Viagra/Levitra?) but I guess I could be persuaded to include those. Abortion would be covered. If you don't like that? Grow up. Seriously. (I'll address why this is the case in another post, "Questions Answered about My Plan, because people have asked.) And mental health would get the same level of coverage as everything else. There's no reason to treat the brain any differently from any other organ that has something go wrong with it. (Currently most Ins.Co shaft mental health drugs big time.) Many things not currently covered, like Speech therapy to treat Autism, would also be covered.
The exact details on every little things can be worked out later, but the GUIDING PRINCIPLE is: If you're sick, and we can heal you, your healed. No fuss, no muss and little to no out of pocket expense! No one dies of anything we can fix, and no one EVER goes bankrupt for getting sick. Period.
PART TWO: So who actually RUNS it?!
Utilizing the enormous network of health care cast negotiators that already exists, the program will be managed by the insurance companies, much in the way they do now. The big difference is that they can't refuse coverage. Everyone gets treated, and the hospital (doctor, etc...) gets paid for everyone they see. DONE.
They will adjust their premiums to figure out what it would cost and then bill the government for that service. What stops them from just GOUGING the government? Simple: COMPETITION. They will have to bid to cover people. And once they get someone they have them for LIFE. SO: Every time a baby is born, they will want to snatch up as many babies as they can since, once born and vaccinated, most babies represent about 30 years of little to no cost. Since they'll be paid to cover them ANYWAY, they'll want as many of those babies as they can get. If their price is to high, their competitors will snatch them up and their current case load just gets older. (Which in the health care world is a disaster! If you can get paid the same for babies as for the over 65's, YOU WANT THEM!)
So they will negotiate prices. The difference between what they negotiate and what the government pays - THEY KEEP. So there's still a profit motive and opportunity. (But for PROVIDING care, not DENYING it!) Going back to PART ONE, to maintain "universal coverage" and to avoid both rationing and robbing people of control over their own care, they will be required to reimburse doctors/hospitals/etc... at a level that (for example) insures that any given person will have a choice of at least three doctors within 50 miles of their home (100 miles in rural areas) that will perform a given test or procedure at no additional cost to the patient. (Save for ~$20 co-pay, if applicable.) Some Doctors can still charge more, if they think the market will bear it, but the difference will have to be paid by the patient. But the standard payment will have to be enough to make sure I have at least three Doctors to choose from with no additional expense. This gives doctors an incentive not to gouge insurance companies because there will be great pressure for them to be among the "free" providers - or at least very close to "free."
Now - I've also thought about how to reimburse at a higher level for specialists. First off, we'll need some way of identifying who the specialists are. It could be years of service, education, experience... whatever. The HOW isn't really important. It would likely been done however it's done now. So let's say someone has a complicated case and needs a specialist. Teh specialist won't be working for the regular rate. So does that mean that the patient now has to pay? NO. Here's how it would work: Specialists get reimbursed at a higher rate, to the point where the "choice of three" doctrine is maintained. So who decides is you get to see the specialist? Not the government (as you may be suspecting, but) YOUR DOCTOR. That's right. You see the regular doctor. When he sees your complicated case, assuming he's not a specialist himself, he'll think "No way am I dealing with THAT, for what they're paying me!" (Since he's only getting the base rate) and he'll refer you to a specialist or three. If a doctor is willing to give up the chance to make a little money (because he judges that what's really needed is beyond what he's getting paid, and thus he'll be at a loss) that's good enough for me. Off to see the specialist!
PART THREE: So how do we PAY for it?
OK, you guessed it: The government will pay the insurance bills with increased taxes. But stay with me now! It's not nearly as bad as you think. In fact, YOU MAY NOT EVEN NOTICE. And corporations may even prefer it!
The increased taxes will be offset by the fact that you're no longer paying premiums. This new tax would be structured such that most people's take home pay would not be affected + or -. This tax would be partially based on income (to give a break to anyone making under median income) but would also vary with martial status and number of children, much the way your premium does now. But the guiding principle here is that your take home pay will be as close as possible, to what you're taking home now.
Corporate taxes increase will increase to, such that the revenue generated will be the same as what is currently being paid in premiums - this is meant to be revenue-neutral. The benefit of this is that in the form of a tax, it will not have to be paid by struggling firms, who would otherwise still have huge, fixed health care costs, and more of the bill will be footed by companies doing really well. Who could just as easily have a tough year next year, and be in the other boat themselves. (Don't believe me? As late as the 1990's it was UNTHINKABLE that GM, still the worlds largest and richest corporation at the time, would EVER declare bankruptcy.) So while ExxonMobil might not like the increased taxes now, 5 years from now (let's say) when they're approaching red ink, rather than BIG FIXED COSTS for health care, their cost will be... NOTHING! And that can easily be the difference between making a profit and taking a loss!
PART FOUR: So what controls costs?
Cost are controlled automatically, through market forces in a more functional manner than they are today: Doctors will charge what the market bears, but will have an incentive to be among those that are "free" to the patient. Insurance companies will be in competition with each other to bid for new babies to cover. Free market principals apply, but will be used to insure coverage, as well as control cost. But rather than let supply and demand drive price, we'll use price to drive supply, and competition to keep Price down.
YOU see a DOCTOR. The DOCTORS deal with the INSURERS. The INSURERS deal with the GOVERNMENT. And the GOVERNMENT bill YOU (and your EMPLOYER.)
That's the basic structure. I'm going to do a separate post on strengths and benefits and also for any questions I get here, and for questions I've gotten from the MediaMatters posters.
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