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24. March 2010 by admin.
Alas, the President signed health care reform into law yesterday in an elaborate ceremony with 22 pens. It isn’t the end of the world; it isn’t even the end of the US republic.
But it will drive preposterously high insurance premiums still higher, and ultimately affect the care and insurance arrangements we currently have in effect (Our Fearless Leader’s assertions to the contrary notwithstanding).
I’m still on the Barack Obama mailing list, and I received a missive Monday that asserted:
…every American will finally be guaranteed high quality, affordable health care coverage.
No, what we’re guaranteed is access to health insurance, because we’ll be required to buy it. What the insurance will ultimately be good for–and even what the insurance we currently carry will be good for–is another question.
Arbitrary premium hikes, insurance cancellations, and discrimination against pre-existing conditions will now be gone forever.
In fairness, some of these represent genuine problems. It clearly isn’t right for an insurance company to initially provide coverage and then, when you get seriously ill, refer to your adolescent acne, or something similarly irrelevant, as a ‘pre-existing condition’ and rescind your coverage. And nobody likes arbitrary premium increases.
But premiums rise to reflect increases in the cost of providing care, which has gone up far faster than the general rate of inflation. Unless you do something to actually reduce health care costs, what about the non-arbitrary premium hikes?
And if insurance companies can’t discriminate against pre-existing conditions at all, and insurance will still be expensive, what will prevent people from waiting to purchase insurance until they’re seriously ill? This will result in substantial, non-arbitrary premium increases.
And we’ll finally start reducing the cost of care — creating millions of jobs, preventing families and businesses from plunging into bankruptcy, and removing over a trillion dollars of debt from the backs of our children.
Just one question: how? We’re going to mobilize trillions of dollars of private and taxpayer funds to pay for health care. How does that make costs go down?
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12. March 2010 by admin.
It looks like Our Fearless Leader will get his way and ‘health care reform’ will soon be the law of the land. Heaven help us.
Health care reform–the campaign promise–was intended to address a practical problem: it costs too much. It costs the government; it costs private insurers (who pass the cost along); and woe unto that poor soul who gets seriously ill without insurance. He’ll end up broke: lacking the clout to negotiate a better deal, he will have to pay full price.
Imagine a community beset by monsters, who come out at night, wreck buildings, eat the cows and chickens, and the occasional small child.
To deal with this obvious danger, the government mandates that everyone carry monster insurance. It works like this: when monsters attack your home, you call for help, and within three minutes, the Monster Insurance crew arrives at your home in a truck with a tank of strawberry-flavored Ensure. The monster is hosed down with Ensure; he licks it off his belly; and contented, he slinks back into the night.
What will this do the population of monsters? They’ll find it easier to feed, and grow stronger, and reproduce in greater numbers. The Monster Insurance crews will need bigger trucks, and premiums will go up. Moreover, when the monsters get tired of strawberry-flavored Ensure, the crew will have to bring other flavors.
‘But wait!’ I hear you scream. ‘We’re not talking about monsters, we’re talking about medical treatments that save people’s lives!’ That’s true. But what kind of life is it if all you’re going is earning money to pay for health care? And what happens when all your taxes–if you’re healthy enough to earn a living–go to pay for other people’s health care… and the government still can’t balance its books? (We’re closer to that in New York State than most people care to admit.)
Right now, health care is about one-sixth of the economy, considerably more than in other industrialized countries. I’ll predict that if health care reform passes, within ten years, health care will be at least one-quarter of the economy, and the cost will still be bankrupting all of us.
Now is the time to face the monsters, rather than figure out better ways of feeding them.
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25. December 2009 by admin.
Just for the record, we had a good Christmas. I didn’t start my shopping until the day before yesterday, but somehow it all came together, and my wife presented her Christmas program, as in past years, and it all came out well.
Yesterday morning, I watched the party-line vote on the health-care bill. The last time I stopped what I was doing to watch the wheels of government grinding was when President Clinton was impeached and tried before the Senate. I returned to my work that day feeling that justice had been done: that whatever peccadilloes our President had been involved in, they represented nothing even close to grounds for removal from office.
This time I was observing a travesty. Health-care reform is bad for the country. For myself as an individual and as a business owner, I see nothing but higher costs, worse health care, and fewer options.
The only good thing is that the vote is not the end of the road. While we were led to believe that Obama would be signing the health-care bill into law while enjoying his Christmas turkey, that isn’t happening. The House and Senate versions must still be reconciled, which won’t happen until February or so.
Perhaps this mess will be derailed, after all….
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22. December 2009 by admin.
The health care reform bill passed the Senate on Monday morning, and is close to becoming law. The Democrats, by their numbers, have simply silenced any effective debate on the measure.
The poorer among us will be covered by an expansion of Medicaid. Funding for Medicaid is provided jointly by the Federal government and the states. As a result, most states will be mandated to support the cost of a broader Medicaid program. However, Senator Nelson of Nebraska got, as part of the price for his support of the measure, that the Feds would pay Nebraska’s increased Medicaid costs so the state wouldn’t have to. Meanwhile, with New York State going broke even without new Medicaid mandates, our esteemed senators, loyal Democrats that they are, didn’t get us one thin dime. (Senator Nelson also insisted that the Federal government not pay for abortions through insurance subsidies, but that’s within the realm of reasonable politics.)
The rest of us will have to purchase insurance for ourselves or get it through our employment. Those who don’t will have to pay a penalty tax. Given that insurers won’t be able to decline coverage for pre-existing conditions, or adjust rates to the age of the insured to properly reflect the actual risk, insurance will become very expensive. New York has similar rules as part of state law, so insurance is already expensive here, but premiums are expected to rise still further.
As a result, insurance will be so expensive that most ordinary people won’t be able to afford it without help. So the Federal government will subsidize part or all of the cost.
Meanwhile, the government will also define what constitutes an ‘acceptable’ health insurance policy. As a result, when the cost of medical care goes up (as it certainly will, because there are no direct measures to contain costs), Federal regulators will respond by identifying ‘appropriate’ treatments that will be covered by ‘acceptable’ insurance policies. And expensive treatments will be limited or made unavailable as a result. The government may also institute a rule, similar to current Medicare, that a doctor who takes insurance money may not contract independently with patients for treatments that insurance won’t cover.
Yes, insurance companies will remain, and they will ‘compete’ for your business. But with the benefits to be provided set by government, and the actuarial performance set by government, they won’t be able to compete on the actual attributes of their insurance.
So what we end up with is government control of the health care system, just like socialized medicine. But instead of the government paying directly for health care, the control is accomplished through regulation of insurance, which everyone is required to buy.
And there’s nothing I can do about it. I could write my Senators and Congressman, but they’re true loyal Democrats, totally in favor of the plan. They didn’t even try to wheedle some extra benefits for their home state like Senator Nelson.
I should save my breath to cool my porridge.
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13. December 2009 by admin.
When I wrote my last entry, about three months ago, I had written some brief observations about the proposed ‘health care reform’ legislation, and said that I would write more about it shortly.
Three months later, the legislation has passed the House and is now under debate in the Senate. The Republicans hate it, but since the Democrats have 60 of the 100 seats, how the Republicans feel about it doesn’t matter.
Basically, the scheme is that all Americans will be required to carry health insurance that meets certain standards, either on their own account or through their employment. If they don’t have a satisfactory plan, they will have to pay a penalty to the Feds.
In addition, health insurers will not be able to discriminate against people with pre-existing conditions. That sounds really nice, but we already have a rule like that in New York, and one of the main effects of it is to make health insurance preposterously expensive, as it encourages normally healthy people to wait until something goes wrong before buying insurance. I once priced health insurance on an individual direct-pay account for my family: it cost over $2500/month. I was able to make a better deal than that, but it’s still very expensive. Most assessments of the new legislation concur that it will raise health insurance costs for most Americans.
Meanwhile, it doesn’t seem to do anything to actually contain health care costs, other than to cut Medicare reimbursements, something that has been on the books for several years, but is always overridden by Congress so that it has no practical effect. And the heavy lifting of actually providing coverage for people who legitimately couldn’t afford it is accomplished by expanding Medicare and Medicaid.
I would have understood, and even supported, a measure that would bring a Canadian-style system to this country, complete with measures to contain costs, as long as such a system did not preclude one from purchasing health care with one’s own funds or private insurance.
But we can’t do that, because we want to have our cake and eat it too.
* * *
Friday night, I watched the movie Kate and Leopold with my wife on the tube. (Silly question: when I ultimately get a flat-panel TV to replace the big heavy Sony in our bedroom, will I still call it ‘the tube’?) In the movie, Leopold, the Duke of Albany, is transported from 1876 to 21st-Century New York City to great comic effect.
What’s so funny about a guy from 1876? He speaks contemporary English; his dress is overly formal by our standards, but not too outlandish. But what makes Leopold funny is that he has what seems to us as an exaggerated sense of integrity and honor.
He speaks the truth when we in the 21st Century would issue jaded cynicism. He is asked to promote a product, and when he discovers the claims made about it are false, he flatly refuses. Most people today would either go forward with the promotion (one has to earn a living, after all), or make an exaggerated show of refusing (you see, people, I have integrity!).
Perhaps integrity and honor have beome anachronisms….
Posted in Health Care, Navel-gazing | No Comments »
19. September 2009 by admin.
I have been wanting to write something about President Obama’s health care plan, but have been having trouble getting all my thoughts in order. I know:
Some first thoughts:
More to follow….
Posted in Health Care, Dysfunctional Government, Barack Obama | No Comments »
23. July 2009 by admin.
I could give chapter and verse on how rotten I believe health care is in this country. I had the devil’s own time getting health insurance when I went into business for myself, and the premiums went up about 20% when the policy renewed this spring. Hospitals are most unpleasant places; most of them seem to run on the ragged edge of malpractice.
And the price of all this rottenness? Governments (Federal, State, and local) in the US collectively spend more per capita than in countries with ’socialized medicine.’ Private payers spend again as much: in total, we spend more than twice as much per capita on health care than in other industrialized countries.
And the cost goes up and up, faster than the general rate of inflation. My insurance company isn’t raising my premium by 20% to tick me off: they do it because their costs went up similarly.
This is the ‘unsustainable’ condition that President Obama is warning us about in his efforts for ‘health care reform.’ Unchecked, the costs will upend government budgets, and indeed the private economy as well.
Last night, Our Fearless Leader addressed the nation to address the issue. He sounded all the right notes, but one thing troubles me:
The President noted that we pay more for health care than in other countries, and that lowering health care costs is a key goal. He then asserted that two-thirds of the cost of health care reform is what is currently being paid in the existing system, and that one-third will have to come from cost savings or taxes or some other new funding.
So he’s contemplating a 50% increase in expenditures.
How, exactly, is this a savings?
Unfortunately, a real solution to this problem necessarily involves limiting the actual cost of health care, and nothing in the current plans seems to do more than nibble around the edges.
The problem is that the current system is an immense self-licking ice cream cone, and there are are politicial constituencies that earn their living from it. Until an effort is made to actually contain costs, and not just find newer and cleverer ways to fund them, we’re still stuck.
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