Category Archives: health care

I Trust Obama More Than I Trust Insurance Companies

 
 
What insurance companies have done since “Obamacare” registration went live, using loopholes in the law to cancel or raise prices on insurance policies people liked, has most likely been done deliberately to cause chaos and hopefully make the ACA look like a bad law. I am guessing lots of strategy meetings happened in health insurance circles to discuss how the industry could continue to maximize profits under the ACA and how they could make sure that the President’s promises (which admittedly he probably never should have made in the first place) were broken. I’m also surmising that this could have been devised as a campaign to undermine the law and put private insurers back in the driver’s seat. In fact, given the collusion among health care insurance providers in the old insurance market, colluding to deal with this new threat to profits seems more than likely.

We must steel our hearts and minds to resist these attempts to put health care back in the private sector. I know we are sort of fickle these days, with rather short attention spans, but surely we remember the way benefits under private insurers had been getting narrower and narrower with risk management winning out over good coverage. If insurance companies truly cannot cover patients with pre-existing conditions because they cannot make a profit, then we will get a chance to see this more clearly under the ACA. We may have to come up with a fund for catastrophic health care which we all pay into in the same way we pay into Social Security or Medicare. We just cannot go back to totally private health insurance again.

The bottom line in any privately owned company always has to be the profit margin, not the people the company serves. We know this by now and we know it well. How many companies have left our communities because they had to please stockholders and pay attention to profits? We aren’t happy about it but we are good little Capitalists and we understand it. We even believe that Capitalism presents the best environment for entrepreneurs and for competition and for overall economic health.

However, in the case of private health insurance the spiral of coverage went consistently downward and the prices spiraled consistently upward. Health care should not be a for-profit business in the same way that other businesses which sell products or services are. We need to hang in there for a while with the ACA because the advantages, if we can get this thing to fly, outweigh the disadvantages under the health care insurance marketplace that existed previously. As for the newest demands to delay the ACA for six months, we just cannot take that chance. Given the extreme opposition from the GOP and knowing that they will somehow turn a delay into the demise of the ACA, we have to try to fix the website while it is live.

I’m not absolutely sure who is to blame for the fact that people who did not want new insurance and who wanted to keep their doctors are finding that they must get a new policy or pay more for their old policy and that they may not be able to keep their doctor, but if I had to choose among the blameworthy, however, I would cast my suspicious eye on the private health insurers. I find it hard to believe that Obama wants to derail his own plan, and I find it hard to believe that he would lie quite so loudly and often to the American people when it is clear that such public lying always rebounds against the liar. I am guessing that Obama believed he was saying something that was true. Actually now, although no one ever likes to be told lies, it doesn’t really matter whether he lied or not; it is beside the point and the only person who really knows the answer is Obama. But, because the ACA looks like a step forward in terms of affordable and comprehensive health insurance that will provide almost all Americans with the medical care that allows us to stay healthy and solvent as medical costs rise and rise we have to stay with it and hope that it either works or that we get Universal Health Care if it doesn’t. It would seem to be in the interests of the private health insurers to help the President with the roll-out of the ACA because most of us are convinced that going back to all private coverage is not the answer.

Cooties

 
Republicans:

Circle, Circle, Dot, Dot

Now you have your Cootie Shot

 

Guess who the cooties are?

US – The American People
 

 

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If Republicans manage to shut down the Affordable Care Act, then all many Americans will be eligible for is guess what?

 

A Cootie Shot!
 
 
 
 
 
Yesterday I reached a milestone. My blog has now passed the 100,000 visitor mark. Thank you to all who have visited my blog.


 

Suspense

What will the Supreme Court decide about The Affordable Health Care Act? This is the week that the court will deliberate, hear evidence, etc about this issue which has been at the center of debates for the past two years. Will they decide that there are no really serious constitutional problems with the health care mandate or will they declare it unconstitutional?
The mandate is only part of the Health Care Act but it is a very key part. Making sure people who were using expensive emergency room treatment because they had no health care provider will be covered by health insurance so their care will not be as huge a burden for taxpayers, was the raison d’etre for the entire plan. Will there be enough value left in the plan without the mandate?
How much does the Conservative agenda inform the Supreme Court? Here is the breakdown

Conservative        John Roberts              G. W. Bush Appt.           Chief Justice
Conservative        Antonin Scalia             Ronald Reagan
Cons/Swing          Anthony Kennedy        Ronald Reagan
Conservative        Clarence Thomas         George HW Bush  
Liberal                   Ruth Bader Ginsburg   Bill Clinton
Liberal                   Stephen Breyer             Bill Clinton
Conservative        Samuel Alito                  George W. Bush
Liberal                    Sonia Sotomayor           Barack Obama
Liberal                   Elena Kagan                    Barack Obama    

There are 6 male justices and 3 female justices; there are 6 Roman Catholics justices and 3 Jewish justices. In light of these demographics it will be interesting to see the results. The Court is not dominated by Conservatives in the way it is dominated by Roman Catholics but as “court followers” try to decide which way each justice will decide there are certain justices who seem to be unpredictable and none are perfectly predictable. Justice Kagan has recused herself from most decisions since she was confirmed because her questioners were worried that she had dealt with some of these cases outside of the Supreme Court or some such conflict-of-interest concern. It sounds like we will remain in suspense until the opinions are handed down in June.
I have butterflies in my stomach; how crazy is that? Whatever decision is made life will go on. Will the Obama presidency go on? I don’t know and it does mean a lot to me to reelect Obama so he can save us from the extreme revisions the GOP wishes to impose on America. I don’t think most of us will fare at all well if the Supreme Court decides against the mandate and therefore against Obama and the dominoes start to fall like those well-planned displays, until America belongs to the wealthy and the rest of us are left to shift for ourselves in the muck at the bottom of the empty pond.

How Will Democrats Save Medicare?

Paul Ryan, our very serious Republican extremist (who is looking a little less possessed and edgy these days) has designed a budget which includes all the usual GOP requirements – no tax increases (in fact it suggests only two tax brackets, 10% and 25%) and it cuts the corporate tax from 35% to 25%. It also includes unspecified changes to unspecified loopholes. Mr. Ryan would restore all the monies that Obama cut from the military and would put the military back in the active mode that is it currently expected to stand down from. He would change Medicare completely and give it to a private entity to manage. He would subsidize our payments to this insurance conglomerate (with our own money) and, if I remember correctly there would be an oversight group.
This plan is not new. It includes all the delights the Republicans have been promising us. Unfortunately this budget makes us feel like this is Paul Ryan’s government instead of the people’s government. Fortunately we are assured it should not pass in the Senate.
Of course, I don’t favor this budget and I am crossing my fingers that it absolutely will fail in the Senate. However, it does bring up the constant worry we all have about Medicare. Everyone tells us that Medicare cannot continue forever as it is. I often think that I would like to see a version of Medicare for all of us. Right now, with such high levels of unemployment, putting everyone in the health insurance business and everyone who supports the health insurance business out of work is probably not a good move. Obama’s Affordable Health Care Plan was not really designed to save Medicare; it was designed to insure the uninsured. Perhaps the savings we get from this plan will be enough to rescue Medicare, but we’re not feeling it and I think we need to hear many more specifics about this from the Democrats. They need to reassure us by sharing how the “Affordable” plan will save Medicare or they need to come up with their next installment of a plan that will save Medicare. If they don’t speak up people might think the Republicans are the only ones who have any idea what to do, even if their plan will include forcing women to rediscover primitive ways to take care of their business.  You know what they say about “a bird in the hand”.  Where are the Democrats? This might be a good time to speak up.

Not Death Panels, Just the Bottom Line

Scientists are working every day to prolong life, and to solve the thorny health problems that can make living longer expensive and perhaps miserable. I am not sure why they are doing this given the amount of frustration older folks seem to engender in the rest of the population. Old people are not really revered in this culture. Although we may love our own elderly relatives, we usually do not appreciate those who are not related to us. Old people are slow, they are sometimes cranky, they can be stubborn, they – well you know we can always find many traits to complain about. Watching my mom try to justify her existence at the age of ninety-four is sometimes illuminating and often poignant. She does not do much housework these days, but her guilt about being so “lazy” is endless. She keeps asking, “Why am I here?” But when we visit with her she is still quite good company, and it is so nice that she gets to enjoy her great grandchildren, who are very sweet with her.
However, I find myself asking a question that my mom would understand. Why are scientists fighting so hard to prolong life if no one really wants to put up with old people anyway? Many of the meds and procedures that are used to prolong life are so expensive that when people want to take advantage of them they find that their finances may never recover from the costs, or the insurance company is unhappy or totally unwilling to cover these pricey procedures. Are these life-lengthening discoveries only intended for the very rich? Is this another way we will widen the divide between the rich and the poor? If the bottom line determines who gets exceptional care and who doesn’t, it will turn out to be one way to thin out the ranks of the poor, however unintentionally. Common sense tells us that performing lots of procedures helps perfect technique and bring down prices. And the more people who test experimental meds the more data we have about their effectiveness and the price will also come down. These factors argue in favor of using the poor as somewhat expensive guinea pigs, unintentionally of course.
We probably cannot expect insurance companies to cover these procedures if they remain as expensive as they are and if they are needed by so many people in order to make it into that privileged group who live past their 90’s. What we resent is that the decision seems to belong to the health insurance companies instead of being a medical strategy planned between a doctor and a patient. Can we really be pragmatic about something that is so personal and emotional? I am sure of one thing. We won’t stop trying to figure out how to prolong life.  We are the generation that was told to “live long and prosper” after all. We are human. Our curiosity about our universe is hard-wired into us. We can’t stop trying to figure things out; we apparently must keep tinkering to change things that feel like absolutes. We are doomed to open Pandora’s Box over and over again and then we must learn to deal with both the good things and the bad things that pour out of that box into the world. Every discovery is a double-edged sword and living longer is no exception.
Based on the rising costs of health care and of the technology required for effective contemporary diagnostic tests and medical procedures most likely we will have to decide who gets to opt for an expensive procedure and who doesn’t? In fact people are involved in decisions like this every day. This decision may gradually (or quickly) become strictly one of finances. If you can afford it, you can have it. The meds or the procedure will be a luxury only affordable by the rich.
The option of a carefully designed procedure for euthanizing those who choose not to pursue expensive, radical, and/or painful end-of-life options might help level the field assuming that the rich might need to partake of this choice as often as the poor. But there is that double-edged sword again. There are so many opportunities to abuse a system like this.

The Immortal Soul

Mary Margaret and I used to sit together on the school bus when we were in high school. We talked about many things, but, occasionally we talked about “being Catholic”, because Mary Margaret was very Catholic. I found Catholicism appealing. The Catholic Church was the nicest one in my small town, all dark wood, furniture wax, and stained glass. It had upholstered kneelers that reminded me of the jump seats in Dad’s dilapidated Packard because they could be tucked out of the way beneath the forward pew. The service, the very few times I attended, was mysterious, exotic, and full of religious theater. They had these small missals, so desirable to my overly romantic younger self, and white dresses and rosary. They spoke Latin. I was already half prepared to convert.
Mary Margaret tried to help convert me but her lessons in catechism had already taught her that even if I converted the best I could hope for was purgatory. You had to be born Catholic. I listened with something between awe and disbelief. I didn’t think for one minute that this was true, but if it was I thought it was a very poor way to win converts, so they must not need to win new members, and I was awed by the arrogance of it all. We spoke often of mortal vs. venial sins and of the things that could qualify someone to skip purgatory and go straight to the place with the name we weren’t supposed to say.
Now, here, at the beginning of the 21st century I find myself again considering the difference between a mortal and a venial sin. Actually, it is no longer me and Mary Margaret in this discussion. It is Obama and the Catholic Church and, you guessed it, The Republicans, who are suddenly champions of the Catholics.
Although most women in America of every religion have caved to the lure of birth control pills and other contraceptive devices, the Catholic Church still believes it is a sin to do anything that might end a pregnancy or even prevent one. Since they believe that murder is being committed I’m sure this is considered a mortal sin. So when the Catholic Church, even in a world with 7 billion people, and despite what we know about the sad outcomes of many unwanted pregnancies, puts the souls of Catholic women in mortal jeopardy by insisting that using contraceptives is a sin, they do it quite quietly, because otherwise Catholic women might be forced to leave the church in droves.
But Obama shook up the bishops last week when he insisted that they would have to offer health plans that would supply contraceptives to any of their non-Catholic employees. Since all other women are now eligible for contraception through their health insurance plans, it seems a reasonable and fair demand. The bishops were not amused. They are, after all, the defenders of the immortal souls of Catholics (and apparently of non-Catholics who work for any church-sponsored business) and all the rest of us too (even though we can only look forward to purgatory). I must assume that the immortal souls they are actually trying to protect are their own.
You won’t believe how quickly the world population will reach 9 billion “immortal” souls. I just don’t see how any women can be at all religious. Religions are not kind to women.

The 2011 Republican Budget

Centers for Medicare and Medicaid Services (Me...Image via Wikipedia

The Republicans want to give Medicaid to the states and privatize Medicare. I’m trying to take an objective view of this because I really want to try to be open-minded. I realize these programs cost huge dollars and require a complex bureaucracy so I can see why the federal government would want to cut these programs in size. They would, according to the plan, give grant money to each state for Medicaid and they would give subsidies to seniors that they could use to help with paying for private health insurance. I can see that this all falls right in line with the Republicans’ endless dialogue about small government. From a purely financial point of view it is attractive.

If a government really was a business it would be an easy call. A government, however, is not a business. In the case of America the government belongs to the people. We give our money to our government and then we elect people to spend our money for our needs. Government is a social contract between our leaders and our people. These Republicans are talking about spending our money as if it were theirs. That is one problem I have with this.

Another problem I have with this is what we know about the nature of private health insurance. Health insurers only care about risk management and profit. They are in the people business but their bottom line matters most. We will be back to the bad old days of services denied for pre-existing conditions, of cheaper services and inferior plans for people with less money, of out-of-control pricing and assembly line service. We have been there before. The nature of the beast is well known to us and, without regulation, the beast will rise again.

If we don’t have a reliable safety net for poor Americans then we put everyone at a risk of epidemic level illnesses, not to mention the proliferation of people living with life threatening illnesses who will flood our world. If we don’t have a reliable safety net for older Americans then people have nothing to look forward to in their old age and we can expect the quality of life for seniors to decline. I do not want our government to leave us to the un-tender mercies of the carnivorous health insurance companies. Find another plan please.

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Should we pay fines for smoking or gaining weight?

Apparently there is an article in Time magazine about a discussion in Arizona to fine people $50 if they smoke a cigarette or gain weight. CNN was asking for people’s comments about this. A number of people seem in favor of this. I am stunned. This is so obviously the work of health insurance providers that it is starting to make me agree with the people who say we should get rid of all health insurance and go back to the old pay as you go system, even though I know we cannot go back there.

This potential law should scare people. It is so against the freedom that is America’s pride, and, it won’t work. Prohibition didn’t end drinking, it made it more titillating. Obama’s health care reform would require the person to have insurance and the person would have to pay a fine to opt out or pay a fine to remain in. I don’t know if I want to live in this America. I know that “they” will say, “then leave.” But I bet you won’t want to live in that America for very long either.

We all have weaknesses and we all make poor choices. Some people are bad parents. It costs us all money to help the children raised by bad parents overcome their difficulties. Maybe they need psychological treatment, or special classes, or tutors, or they end up in the criminal justice system. There are many outcomes and a number of these can be costly. Divorced people should pay fines because one partner or the other may need job training, or welfare, or other assistance. Again children may require expensive help in making adjustments.

People who do risky things like ski, climb, snow mobile, jetski, sky jump should be fined because their risky behavior may lead to expensive rescues or costly injuries. Athletes have more injuries than the rest of us. They should be fined.

It is ridiculous to have multiple fast food options available in every neighborhood and then to fine people who eat improperly and gain weight. Close the restaurants, mandate menus, weigh people before they go in the doors and turn them away if they are off the charts. I hope you are seeing that is this crazy and I hope you are thinking that we should not do this.
We cannot make health insurers happy. It is their business to minimize risk, but almost all human behavior is risky. We can’t up their profits without drastically limiting our freedom.

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