Get Educated

Election season is here!

In the spirit of unravelling the catch-phrase drivel and countering the seemingly unchecked and exaggerated statements we see on TV...
Poll shows plenty of Americans still unclear what was in health-reform law

Some Health Care Stuff

The link below is a good resource for anyone who wants a relatively concise explanation of some of the new health care bill's provisions, particularly as they relate to Medicare, the CHIP programs, and the low-income persons and families that participate.

http://ccf.georgetown.edu/index/cms-filesystem-action?file=ccf%20publications/health%20reform/health%20reform%20package%20final.pdf

I am interested to see if and how opponents' perspectives might change about the reform bill as some of the benefits begin to become apparent.  I have a feeling some folks who have been opposed to reform in principle might find some of the provisions quite beneficial, particularly if they have health problems, problems finding affordable insurance, or are currently unemployed.  I could be wrong about that; only time will tell, I suppose.

Consitutional Issues in Health Care Reform

For those of you who read here regularly, you know that I am unabashedly in favor of some manner of health care reform.  And I think a lot of folks would agree that, even if they are happy with their personal health care coverage, the system itself needs reform in order to ensure more Americans receive even a portion of that care. 

I am also not afraid to say that the resulting bill is turning into a big hot mess.  Questionable negotiation tactics - such as the "Cornhusker Kickback" that supposedly won Sen. Nelson's vote - and closed-door meetings have a lot of folks questioning the final product that will emerge from the Capitol.

Beyond questions of ethics and policy, the bill may have a greater hurdle to hurdle - namely the U.S. Constitution, as the two linked articles below discuss.

Mike Coffman: Health care bill an affront to Constitution (Denver Post)

George F. Will: That rock in the health care road? It's called the Constitution (Washington Post)

Thinking out loud about who really drives policy

I have been thinking quite a bit lately about who drives practical policy decisions in this country.  I am not talking about health care reform or climate change legislation or any other hare-brained scheme that may or may not actually emerge from Washington, D.C., at any point in my lifetime.  Rather, I am referring to actions and reactions, how those become ingrained in our lives, and the unwitting consequences that flow therefrom.  Two illustrations will help.

(1) The first is a story that ran in the Denver Post and later garnered national headlines about a health insurance provider who refused to cover an infant because of its weight.  The child measured in the 99th percentile for weight, and the parents' insurer rejected coverage based on a preexisting condition of obesity.  Eventually - no doubt after its ridiculous policy made national headlines - the insurer reversed course and extended coverage to the baby.  But permit me to muse for a few moments about some of the messages that could be drawn from this story. 

First of all, while obesity is definitely a health concern among adults and children, I find it absolutely absurd that an insurer would even have a policy with weight-based preexisting conditions for infants.  Having a small child of my own, and having more than handful of friends with children in close proximity, infancy is probably the only time in life in which a hefty waistline is not considered a medical problem.  Spare me the 265-pound infant tabloid headlines.  I am attempting to be serious here.  What mother is going to complain about her infant maintaining a healthy weight?  None that I know.  In infants, weight gain and maintenance is indicative of so many aspects of good health.  Why on earth would an insurer punish a child for being healthy?

Secondly, the baby in question was exclusively breastfed at the time he was denied health coverage.  This, no doubt, contributed to the weight "problem."  The great irony here is that, despite any drawbacks from his weight (if there were any), this baby is probably ten times as healthy as children of the same age who are exclusively formula-fed, even if those other infants fit more nicely into the insurer's percentile charts.  Infants who are exclusively formula-fed miss out on a host of health benefits from mother's milk early in life, not the least of which is antibody and immune boosters from the mother.  That's right, there's a good chance the obese baby will have fewer sick-child visits at the pediatrician's office.  That's right, insurance company, the baby you initially rejected will probably  cost you less money over time than the 50th percentile babies you take without a glance.

As I said, the insurer in this case eventually reneged and covered the infant, but the cynic in me wonders if that would have happened without the negative publicity.  In that vein, think about the messages that an average person could draw from the insurer's policy.  Do I need to deny my child food to keep their weight within acceptable limits?  Do I need to change what I feed them, even if that means taking away the most nutritive option, to keep them within an insurer's policy? 

Even if the insurer's policy was based on sound criteria - a big if - do we want insurance company policy determining what infants are fed?  I said - but did not promise - that I would avoid opening the can of health care reform worms, but the relevant question today is "Who is driving policy?"  In the medical field, it seems clear that insurers have at least as heavy a hand as care providers, if not more so.  Without the insurance, there may be no access to the care provider.  To pare down the message: money drives policy.  And that is unfortunate.  Opponents of government-sponsored health plans cry that a bureaucratic health care system would remove the human element from medical decisions.  Frankly, I do not see how the two would be all that different.

(2) Enough ranting about health care, and on to the second illustration.  An editorial ran in the New Year's Eve edition of the Denver Post relating airline baggage fees to terrorism.  Simple comparison, right?  If not terrorism, baggage fees must at least be some kind of crime.  In all seriousness, though, the editorial opined that the increase in checked-bag fees has, obviously, led to more travelers carrying more luggage onto flights.  In turn, this means more items for TSA officers to inspect at security checkpoints.  (If any of my loyal readers post a comment stating that they are just willing to wait longer in security lines,  I will know that those readers do not fly that often.)  The point of the editorial was that both of these consequences of the checked-bag fees - more luggage in the cabin of the plane plus less time for security officers to spend on each piece of luggage or individual - expose flights to a greater risk of criminal or terrorist activity.  When two and two are put together in one sentence, that seems like a commonsense proposition.

The Post editors urged airlines to reconsider their policies in light of the Christmas Day terrorist attempt.  But somehow I have a feeling that the $740 million in bag fees collected in the third quarter of 2009 alone will speak just as loudly.  (That stat is from the L.A. Times, via the Post editorial.)  Look, I know that airlines and the air travel industry have suffered mightily since 9/11.  And I know that they have to put measures in place to ensure they can still provide some services.  But at what cost to the rest of us?  When a bottom line drives policy, those with no stake in that line often shoulder the consequences.  In this case, it appears travelers are left with the options of longer security waits and more invasive screening procedures or further heightened fear.

I do realize what I am advocating by arguing against policies like those illustrated in the two instances above.  Do I absolutely and universally favor a heavy government hand in all aspects of life?  No.  But if the alternatives are limited, I may have no choice at all.  The Post editorial summarized the incongruity succinctly and poignantly: "It would be a shame for the industry to be regulated into doing what is best for all concerned, but it very well may come to that."

NY Times Op-Ed: In This Together

Roger Cohen published a very thoughtful and timely op-ed in the NY Times on Monday entitled "In This Together."  His piece touched on several themes that I have written about on this site, including the moral considerations that are inseparable from the debate over health care reform. 

He also broaches the subject of disconnectedness within our culture.  This is a topic that I have personally been mulling lately through the writing of Wendell Berry.  Cohen says:

But the more I thought about it — and thought of the repeated Earth-to-Mars experience of trying to get through to my kids when they’re on their laptops, and thought of how often people thumb-typing on their Blackberries bump blindly into me on New York sidewalks, and thought about how technology now trumps community in the United States (even when that community is 39,000 feet up) — the more I felt those Northwest pilots were symbolic enough.

"Technology trumps community."  That is a telling statement, and a convicting one for a person who spends as much if not more time busily pecking away on a keyboard than I do actually interacting with other people.  I believe that is why the words of Wendell Berry have spoken to me lately.  In his writings, Berry emphasizes the importance and necessity of community.  Through community, individuals can find (and offer) healing, wisdom, learning, support, and commonality that fosters a fulfilling way of living.  From Berry's essay "Health is Membership," published in The Art of the Common-Place: The Agrarian Essays of Wendell Berry:

I am not ‘against technology’ so much as I am for community. When the choice is between the health of a community and technological innovation, I choose the health of the community. I would unhesitatingly destroy a machine before I would allow the machine to destroy my community.
 

I believe that the community – in the fullest sense: a place and all its creatures – is the smallest unit of health and that to speak of the health of an isolated individual is a contradiction in terms. 

Without going too far afield, Cohen's message, at least the message that I draw, is that the disconnectedness that has seeped into almost every aspect of our culture is obliterating the community of this nation.  Rather than seeing common ground and common good, we are instantly drawn to the philosophical divergences and the distinctions evident among one another.  So Cohen reminds us today that we are indeed "in this together."  The solutions we seek to the array of problems facing this nation  will not and cannot be universally pleasing.  But they still can be universally beneficial if given the chance. 

   

Health Care Debate Terminology

A nice summary from Time.

http://www.time.com/time/healthcaredebate

Two Thoughts on the Progress of Health Care Reform

As action cranks up again in Washington, I have been thinking in the last few days about the progress of health care reform and all that I have read and heard about the issue. All aspects - from philosophy, to goals, mechanics, and international comparisons - has been hashed, rehashed, twisted, and distorted so many times that, if you are like me, it makes your head spin, stomach turn, and brain hurt. Pushing all that aside, there are two primary aspects of this debate that I try to keep in the forefront of my mind.

1. The most important goal of reform should be lower costs for those paying for health care coverage. Easier said that done, right? Right. There a whole host of avenues for potentially accomplishing cost reduction. I have discussed some of these in the past (here and here). The reemergence of a public option in the Senate proposals is encouraging. While health insurance providers are not by any means solely to blame for the recent and continued increase in the cost of health care, they are certainly one culprit. A public insurance option might be the best way to keep insurance companies honest. And let's clear the air - a public option is not, and should not be called, a government takeover of health care. This would be particularly true if Sen. Reid's proposal finds its way into law; his bill includes a opt-out clause for states who do not want to participate (or, ahem, do not want their citizens to be able to participate) in the public option. (As the linked article explores, that opt-out of a federal program could have much more far-reaching consequences for other areas where federal law applies universally.) Opponents of the public option cry that it might run private health insurers out of business. My answer to that is . . . PRECISELY! In its best form, the public option would be a low-cost player in the market that forces other players to examine business practices and make adjustments to remain competitive. Is that not what our economic system is built on?

But back to my first point. For me, the mechanism is less important than achievement of the overall goal of lowering costs. In another post, I highlighted a statistic from Newsweek claiming that in the next few years, twenty percent (20%) of the U.S. GDP will be spent on health care related services. Twenty. Percent. Health. Care. The administration's economic recovery strategy has targeted automobile purchases, home loans, and debt relief. While those are no doubt problematic aspects of many consumer's economic portfolios, the government would be remiss, if not negligent, if it blows this opportunity to impact what is doubtless a huge expense for many consumers.

2. At the core, health care is a moral issue. Despite attempts to relegate health care reform to the pens of political issues or economic matters, the provision of basic, affordable health care should be a addressed as a moral issue. Our nation is founded on the principle that every person should have the right to pursue life, liberty, and happiness. I have never seen any qualifiers applied to that right. To clarify, I certainly do not believe that anyone has the right to have life, liberty, or happiness handed to them. But in the United States, we guarantee people that right to pursue them. To me, that means removing roadblocks, particularly those to obstruct only certain members or classes of our society.

Let me describe a scenario that I play over and over in my mind. While I will concede that it is an extreme, worst-case scenario, it is nonetheless one that is unnervingly close to reality for an increasing sector of the population:

Bill has a job. Its a good job, not great, but it pays the bills, and his employer provides group health coverage. Bill works hard and has managed to put away some money over the years, but he'd be far from comfortable if he lost his job. Due to the economic climate, Bill's employer is forced to make some hard decisions and has to lay off Bill and several other employees. Bill doesn't qualify for Medicaid and cannot find an private insurance plan that he can afford, so opts to play the odds and go without health coverage until he can find a new job.

Bill gets a job interview. It goes well, and he leaves the interview hopeful. The interview was downtown. Bill is cheerful as he walks from the office building toward his car, parked two blocks away. Bill stops at a crosswalk and proceeds after the traffic signals indicates he may do so. About halfway through the intersection, Bill hears car horns and looks up to see Fred's car speeding through a red light into the intersection. Fred plows into Bill, severely injuring him. Fred was wasted and hardly had any idea what was going on when the police pulled him out of his car. He vomited when he saw Bill, bleeding and motionless, lifted onto a gurney and hoisted into an ambulance.

Bill's injuries are terrible, but he recovers well enough after spending two weeks in the hospital, including a couple days in the ICU. A few weeks after discharge, he receives a bill from the hospital. Obviously, Bill can't afford the tens of thousands of dollars he now owes the hospital, ambulance service, and other care providers. He hires a lawyer on a contingent basis and files a civil suit against Fred. The case is a classic "open and shut." In frustration, the judge throws the book at Fred, literally, and the jury finds that Fred was reckless in his actions that day. They order him to pay all of Bill's medical fees and then some.

But Fred has the last laugh. He has no auto insurance. He also has nothing to his name. No assets. No bank account. No job from which to garnish wages. All he had was his beater car, which he totaled when he smashed into Bill. Bill has a judgment in his favor, but that's it. Bill's savings are far from sufficient to cover his debts, and he files for bankruptcy. Bankruptcy - over the medical bills he accrued through no fault of his own. Bill comes through bankruptcy with nothing except a black mark on his personal credit.

Extreme? Yes, I'll give you that. Silly? Maybe. Unlikely? Maybe. Impossible? Hardly. Heck, the story doesn't even have to include an insured pedestrian. It could be about one whose insurance company denies the claim after getting the price tag - also not unheard of. It could be someone with a high deductible plan provided by his employer. A run of hard luck, and he doesn't have the funds to meet the deductible. The point is that we live in a country where you or I could find ourselves bankrupt because of another's poor judgment. The Newsweek articles I cited in another post explain that the U.S. is the only Western nation where that is allowed to happen. We're a wealthy nation. We're a nation that places itself on a moral high ground. I cannot find any reason for that possibility to exist.

OK, deep breath . . . and . . . I'm done. Almost. I tell that story simply to illustrate some of the principles our current health care system implicitly endorses. They certainly are not principles which seem to comport with the pursuit of life, liberty, and happiness. I will say this once again: I do not believe that those "inalienable rights" require the government to give handouts, freebies, or whatever. But I do believe it requires the government at least alleviate obvious obstructions put in place by other parties that hinder some individuals from pursuing those dreams.

As I said in opening, the details and rhetoric of the health care reform debate can be overwhelming and nauseating. But keeping a few guiding principles in mind can hopefully keep us and our lawmakers focused on the ultimate prize.