Category Archives: Health Care

Illness/Shooting/Rights

It’s the first honest-to-God weekend that I’ve had in a while.  I had work through the weekend over most of January and February, and before that was sick with what felt like the flu.

I woke up New Year’s Day with a mystery rash, on top of otherwise feeling rotten.  (No, not drunk.  I had gone to bed around 8 p.m., and woke up briefly around midnight to watch the ball drop on television.)  Feeling a little panicked, I went to the hospital.

Did you have chicken pox?” the doctor asked.

“Yeah… when I was six,” I answered.

The rash was apparently shingles, left over from 50 years ago.  The doctor prescribed some pills that, as far as I could tell, did exactly nothing.  The rash faded, very slowly, and I got better under my own power, drinking lots of orange juice, and tea instead of coffee.

Six weeks later, I got a note from my insurance company: the hospital had charged about $3000 for my little jaunt, of which I will have to pay $1000.

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More recently, a troubled young man shot up a high school in Florida, killing 17.  Another nut with a gun: it’s the kind of event that seems to be happening more frequently, and the usual response from the media and politicians is for more gun control.

I have to disagree.

I’ll grant that, among the things that government can do, gun control is relatively simple.  But what about controlling the nut: the troubled young man behind the trigger?

School shootings appear to be almost exclusively limited to the United States, in the past 20 years or so.  Somehow, other places in the world seem to do an adequate job of nut control.  We did, too, in the past.  What changed?

To be sure, nut control, unlike gun control, can’t be done by fiat. It’s the responsibility of parents, siblings, teachers, friends, and anyone encountering a troubled young person in need of help.

But there’s more than that.  I’m coming to believe that something—likely more than one something—in our way of bringing up young people is causing young men to become nihilist exterminators.

Why not young women?  (All the school shootings I’m aware of have been perpetrated by males.)

That may be a clue.

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My son, who has a more liberal outlook than I do, was mumbling something the other day about the National Rifle Association (NRA).  In the wake of the Florida shooting, the NRA has been denounced as an agent of the gun manufacturers, who are simply interested in selling more product.

Perhaps they are.  They are certainly lobbyists, seeking to influence the government to advance their agenda.

But their agenda is the Second Amendment, which states plainly, ‘the right to keep and bear arms shall not be infringed.’  The Founders included the Second Amendment for some very good reasons, and it’s not something to cast aside lightly.

I live in New York City and I don’t own a gun: I don’t feel a practical need for one, and it’s too much trouble (so much for ‘shall not be infringed’) to acquire and keep a gun in my home.  But I reserve the right to arm myself, should I find it necessary, and if I can’t do so legally, I’ll move.

For that reason, I’m considering joining the NRA, even though I normally don’t think much of lobbyists.  The next time my son mumbles something about the NRA, I could show him my membership card and say, “Do you mean… me?”

And as far as the Second Amendment, I’d rather see an honest debate about repealing it than yet another measure nibbling around the edges.  If you believe that guns are a public health menace and should be banned on those grounds, and that the Second Amendment’s time has passed, stand up and say so.

No Repeal

I railed against Obamacare (officially the Patient Protection and Affordable Care Act) in these pages when it was enacted in 2010.

On the other hand, it really hasn’t had much of a practical impact on me and my family.  For just about all my adult life, I’ve had health insurance one way or another.  Going without is not an option: a trip to the hospital for almost anything costs tens of thousands of dollars.  Many of the features of Obamacare (equal premiums for men and women, no exclusion of pre-existing conditions, etc.) were already the law in New York.  I didn’t have a health insurance plan that I was particularly attached to, so it didn’t bother me when the insurance company changed my plan at renewal time to something compliant with the new regulations.

In fact, the only thing I really noticed was that there was a little bit of a lull in premium increases for a couple of years (and even a cut at one point, on changing plans), and then the premiums resumed their skyward march (between about 7% and 22% every year).

In one of my posts, I anticipated that health care might end up swallowing even more of the nation’s GDP than the 17% or so in 2010, but that hasn’t happened: health care as a percentage of GDP has remained steady since Obamacare was enacted.

Nevertheless, although my objections are more philosophical than practical, I still consider Obamacare the worst public policy decision of our time.  For years, the Republicans railed against it, and swore they would repeal it, given the chance.

Last week, they tried, and failed.  A bill was drawn up, then withdrawn as there were not the votes to pass it.

And now, all sides are engaged in pointless posturing.  The Democrats are crowing that they saved Obamacare from the jaws of the Republicans; President Trump is blaming everyone but himself.

But the plan to ‘repeal’ Obamacare was fouled up from the beginning:

  • House Speaker Paul Ryan went to great lengths to discuss the process by which Obamacare would be undone, but there was little discussion about what the Republicans would do. (Not coming across anything in the press, I finally had to turn to Wikipedia for a coherent explanation.)
  • As a result, the opposition was able to seize the narrative: they’re trying to take your health care away from you!
  • The most salient feature of the American Health Care Act was that it dropped the requirements for individuals to carry insurance, and for large employers to make it available to their employees. But many if not most of the people for whom this is an issue have the means and the inclination to secure their own health insurance (whether on their own or through their employers), and would do so even in the absence of a mandate.
  • The most toxic features of Obamacare, including the requirements to issue insurance regardless of pre-existing conditions and to allow children to remain on their parents’ policies until halfway to middle age, are the most politically popular, and were taken off the table by President Trump before any of the negotiations started.

Ultimately, it’s on the Republicans to present a compelling alternative to Obamacare, rather than nibbling around the edges.  Sadly, I’m not sure that’s possible.

When countries have implemented ‘socialized medicine,’ there have always been limits.  Whether they are designed into the program to begin with, or are worked out in implementation, there are necessarily limits, because the resources of even a prosperous nation are finite.  But under Obamacare, everyone has the right to health insurance that can, in theory, provide infinite benefits.  (After all, one’s health is priceless!)  This theory hasn’t been tested yet, but that will come in time.  And while Obamacare does admit administrative limitation of benefits, that hasn’t happened yet.

Consequently, the Republicans are in a position where they must compete with the theoretically infinite benefits of Obamacare.  They can’t argue that Obamacare is unsustainable, not only because the problems haven’t emerged, but because the whole Federal government, on its present course, is unsustainable.  They’re constrained to keep the elements of Obamacare most in need of change because those elements are politically popular.  And ultimately, they can’t practically propose to really repeal Obamacare, and they’re stuck with uselessly fussing with it.

At this point, we’ll have to wait until the whole enterprise keels over to try again.

Disgustipated

My mother used to say ‘disgustipating’ to refer to things that she thought were really rotten.  I hadn’t thought of it for a while, until this week.

Yesterday, the Supreme Court issued a decision that gay marriage is a Constitutional right, and that the remaining states where gay marriage is forbidden will have to allow it.

Hooray for Marriage Equality
Hooray for Marriage Equality

While I was out this morning, I saw the sign above at a parking lot.

I really have no problem with gay civil marriage: gay people should be able to express their commitment to each other, and secure their legal rights with respect to each other, the same as heterosexual couples.

But is it ‘marriage equality’?  Hardly.

All but a tiny handful of the seven billion of us walking the planet today are here because, at some point in the past, a man and a woman came together and caused us to be.  Not all of them were married, but it is that essential fact of our existence that is the origin of marriage.

And until and unless there is a race of literal Amazons who reproduce through parthenogenesis, so it will continue to be.

What bothers me about yesterday’s Supreme Court decision is that, first, there is nothing in my reading of the Constitution that infers a right to gay marriage, either directly or indirectly.  Many, many decisions are made (in business, politics, and life in general) by coming up with the answer first, and assembling whatever arguments are needed to support it.  But I expected the Supreme Court to be above that sort of crap.

What’s far worse, though, is that the government is now empowered to clonk those of us who believe that ‘equal under the law’ is not ‘the same thing’ upside the head and tell us to get with the program.  We already have laws preventing discrimination based on sexual orientation: those, together with yesterday’s decision, mean that gay civil marriage will not be containable as ‘civil’ for very long.

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The other disgustipating Supreme Court decision concerned Obamacare.  The law, as written, indicated that subsidies would be available for individuals who had purchased insurance through ‘an exchange established by the State.’  We normally don’t say that in American law.  You might say ‘a State’ or ‘the States,’ referring to one or more of the 50 state governments, or ‘the States or the Federal government’ if that’s what you meant.

We had understood that the intent was that a state would have to set up an insurance exchange for its residents to get the subsidies, as a means of encouraging states to set up exchanges.  But most states didn’t do that, leaving it to the Federal exchange.

But if people couldn’t get subsidies, the insurance wouldn’t be affordable, so an executive decision was made to allow subsidies to residents of all of the states.  You could reasonably read ‘an exchange established by the State’ to refer to, not a particular one of the 50 states, but the government in general.

Ultimately, this one doesn’t really matter for me.  New York did set up an Obamacare exchange. (Alas, I earn too much to be eligible for a subsidy, and even if I got one, it wouldn’t make a dent in the actual premium.)  Nevertheless, with or without the subsidy, Obamacare remains the most breathtakingly bad public policy decision that I can remember in my life.

But I’m sure something will come to top it later this year.

Vaccines

The recent spate of measles cases traced to Disneyland (my sense of poetic justice is amused) has brought the issue of vaccination into the news.  When my son was little, I was totally OK with the vaccines that were recommended at the time.  Now I’m not so sure.  Let me explain….

One of my childhood memories is looking over my father’s shoulder at the records he kept of my vaccinations.  I apparently received a whole pile of them on the day I was born: I must have been a little pincushion.  I was glad that it happened when I was a baby, so that I didn’t remember it.

When my son was born in 1985, the vaccine regime hadn’t changed much.  The vaccines were the same as I had seen in my childhood records:

  • Oral polio vaccine
  • Diphtheria/pertussis/tetanus (DPT)
  • Measles/mumps/rubella (MMR)

I remember that there was an organization of parents whose children had not reacted well to the DPT shot, but the numbers of children affected overall were vanishingly small, so I had no objections to vaccinating my son.

A little later, a vaccine came out for:

  • Haemophilus influenzae type B (HiB) (interesting that it doesn’t have a simple name in English like the others)

and my son received it.

A vaccine for;

  • Varicella (chicken pox)

came out a little later, but my son had already had chicken pox, so he didn’t need it.

But time and Big Pharma have moved on, and the recommended vaccine lineup now includes, in addition to all of the previous:

  • Hepatitis A
  • Hepatitis B
  • Rotavirus
  • Pneumococcal disease
  • Infliuenza (‘flu shot’)
  • Meningococcal disease

I’m compelled to wonder if it’s all necessary.  Other than the flu, I’ve never heard of the diseases and viruses in the post-1980s group representing public health problems.  And I have to wonder if there is a point of diminishing returns where the side effects of the vaccines become worse than the diseases they are intended to prevent.

I had a case of the chicken pox when I was six; my son had it when he was eight.  I’ve considered it somewhat of a rite of passage: this is what a ‘real disease’ feels like.  A vaccine to prevent it seems more a convenience than a real public health necessity.

And then there is the specter of autism.  We’re told that there was one study relating vaccines to autism; it was debunked and retracted; so don’t consider the possibility anymore.  But one in 2000 children or so had something resembling autism in the 1970s, now it’s one in 68 in the US.  And maybe vaccines didn’t have anything to do with it, but there are too many reports of parents seeing the spark die in their children’s eyes immediately following vaccination.

On one level, I don’t have to worry about this personally anymore. But sometime in the next 5-10 years (I hope), my son will get married and have children.  I can’t advise him, as my parents might have advised me, not to worry and proceed with the usual series of vaccinations.  (Indeed, I hadn’t asked my parents at the time, as I didn’t consider the matter to be controversial.)

Telling him to exercise judgement over which vaccines his child should receive isn’t a practical option either.  The data he’d need for an informed decision aren’t readily available, and he’d likely get into arguments with his child’s doctor.  But beyond that, New York state law requires children to be immunized against almost all of the diseases and viruses listed above (the exceptions today are Hepatitis A, rotavirus, influenza, and meningococcal disease), in order to attend school.  One can assert a religious exemption, but it would have to apply to all vaccines, which isn’t prudent either.

I can’t get upset about parents who refuse vaccinations for their children.  I live in New York City, and people come here from all over the world, some vaccinated, some not, and life goes on.  Ultimately, access to clean water and proper sanitation is more important to public health than this or that vaccine.  And if an enemy wanted to conduct biological warfare using some exotic virus, all the childhood vaccinations in the world wouldn’t help.

What was a simple and noncontroversial decision in the 1980s has become a minefield.  And I don’t have any magic way out.

Descent into Propaganda

NBC Nightly News - 2 Oct 2014

Last night’s NBC Nightly News began with a vaguely Mickey Mouse rendering of the Ebola virus behind Brian Williams as he told us about the Ebola case in Dallas, bad weather (since when do thunderstorms make the national news?), and deaths from high school football.

But then he began the report of the lead story:

The spread of Ebola is now a truly scary, very dangerous epidemic in Africa, made even scarier for Americans now with the first case diagnosed in this country….

I can accept that a live news reporter, witnessing something truly horrendous, might refer to the events around him as ‘scary.’  I can accept that, after having reported the facts, a news announcer might deliver an editorial summary and characterize something as ‘scary,’ although it’s not a word I’d use in a mass media report.

But when we’re told that something is ‘scary’ at the start of the story, we’re being told to how to feel about it before we’re presented with any evidence.

That isn’t news: it’s propaganda.

Never Say Never/Keeping the Old/Shouldn’t Be Surprised

OK, I changed my mind.  I’ll keep writing.

Whatever damage I may have done to myself from these posts is already done.  Beyond that, when the hammer drops, I’m sure the authorities will have far bigger fish to fry than me.

But it’s a beautiful summer morning here in NYC; I took an early-morning ride, so the endorphins are flowing; and my work has slacked off from its maniacally busy pace for the past few months, so that I have a few moments to write.

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I got my current cell phone, a Samsung Galaxy Note, when they first came out in early 2012.  It was the first phone with a screen over 5″ diagonal; some suggested that it was too large to comfortably handle.  But my big complaint with my previous phone was that the screen was too small.  So it was great to be able to read e-mails and their attachments without having to scroll, and with a minimum of squinting.  The camera is also good enough to be comparable to a point-and-shoot film camera: good for pictures among friends, and most of the pictures I need to take for work.

Now, the two-year contract has run out, and I can go back to AT&T and get a new phone relatively cheap.  But looking at what’s available, the only phones I like are incrementally newer versions of the Samsung Note.  Casting about further, among unlocked phones, there’s the Lenovo K900, which was never offered for sale in the United States.  It looks really cool, but it’s from 2012, and is functionally not too different from my Note.  Not worth the $450 or so it would cost.  (Lenovo has a newer model, again not marketed in the US, which has a slightly bigger screen, but looks nowhere as cool as the K900.)

So I’m keeping the Note.  The battery was getting old, and wouldn’t hold a charge for a full day.  But a new battery fixed that.

Meanwhile, my 2009 laptop remains in service as my work computer.  I could probably upgrade it to Windows 7 or 8, but as long as everything works, I have no compelling reason to change from Windows XP.  (Yeah, I know, Microsoft stopped supporting it in April.  But in all the years I’ve had computers with Microsoft software, how many times have I contacted them for support?  In a word, zero.)

Part of me wants to get a new battery for my laptop, like the phone.  But the other day I learned about a new peripheral device that reads gestures, which requires Windows 7 or 8.  I’d like to be able to give presentations without a clicker, being able to make a little swoopy gesture over the machine to make it change slides.  (I was able to do this in the 1990s, when we had presentations as overheads or 35mm slides, and for a big enough group, someone else was working the presentation.)

So maybe I won’t be able to resist the temptation of a new toy.

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At the beginning of 2013, I had to change health insurance.  I was pleasantly surprised to find that the new Obamacare-compliant plan was a few ticks cheaper than the old insurance.  But then I wasn’t expecting a big change up or down because many of the features of Obamacare (no exclusion for pre-existing conditions, same rates for men and women, etc.) were already New York law.  The premium for my wife and me is currently about $1100/month.

Yesterday, I got a letter from the insurance company.  I received it in my office, as the employer, and at home, as the employee.  They’re petitioning the state for a 25% premium increase next year.  Part of the reason for the increase, they explained, was ‘the projected impact of the federal risk adjustment program that was put in place by the Affordable Care Act.’

So we in New York are still going to get whacked by Obamacare, it’s just taking a little longer.

A Foul Mood

I was in a foul mood last week.  I think I was on the edge of coming down with a cold, and I was teaching a class, so I had to be bright and chipper through the workday, only to come home and want to just drop into bed.

But beyond that:

  • It seems inevitable that Bill deBlasio will be our next Mayor: so inevitable, in fact, that I didn’t bother to cast an absentee ballot (more on that later).  He promises ‘a break from the Bloomberg years.’  I take that to mean a break from low crime and competent city administration (except for the snowstorm a couple of years ago).  Meanwhile, he promises to fight the good fight to reinstate the ban on large sodas.  I remember the ‘bad old days’ of the 1980s.  It didn’t bother me so much back then, as I was in my 20s and felt pretty much indestructible, but now I’m worried.  Moreover, deBlasio is a community activist, with no experience running either public or private enterprises, other than his own office as Public Advocate.  And we all know what happened the last time we elected a community activist to executive power….
  • Across the nation, the reality of Obamacare is seeping in: that if you’re not covered by your employer, you’re required to pay out of your own pocket for health insurance.  In NY, many of the requirements of Obamacare were already state law, so premiums in fact may be going down a few ticks.  But elsewhere, premiums are skyrocketing.  And then there’s the thought that, if you live in one of the states without a state insurance exchange, you’ll have to go to healthcare.gov, and tell it all your personal secrets.
  • One of the items on the ballot this year is a state Constitutional amendment to allow casino gambling.  I used to think that casinos were cool, until my wife and I went to Las Vegas and got bored with it after about an hour.  (I also can’t bring myself to wager more than about $10 at a clip on a game I know is rigged in favor of the house.)  The modern casino is a factory performing the industrial process of separating patrons from their money.  The particularly galling thing, though, is that the state wrote up the description to play up the benefits of casino gaming (more money for schools! whoopee!), rather than a more neutral description, as that way people would be more likely to vote ‘yes.’

I attend a professional conference the first week of November.  For the last couple of years, I made it a point to cast an absentee ballot, but was just too busy over the past few weeks.  But the election seems a lost cause anyway.  Tomorrow (Tuesday) is the first day of the conference.  I was going to be a tourist today with my wife, but we’re both feeling rotten.  At least I can catch up on some paperwork.

Obamacare: For Real?

Next week, the Obamacare health care exchanges will open up, enabling Americans to buy health insurance at allegedly reduced premiums.  An op-ed piece in the Daily News urged people to look up how much health insurance would cost before complaining.

OK, I’m game.

For comparison, the health insurance I buy for my company has a premium of $575/month for a single person.

Under Obamacare, there are four grades of coverage: ‘platinum,’ ‘gold,’ ‘silver,’ and ‘bronze.’  The grades are defined in terms of what fraction of the aggregate medical costs of the covered population they will pay: ‘bronze’ pays 60%, up to ‘platinum,’ which pays 90%.  I don’t have any information about how this resolves into practical details like co-payments, or how much one will have to pay for a hospital visit, and I don’t have a real basis for comparison with my current insurance.  (I asked my insurance agent  for a figure for comparison, but didn’t get an answer.  I suspect, though, that my current insurance is somewhere between ‘gold’ and ‘platinum.’)  There’s also a ‘catastrophic’ level, which is only available to people under 30.

There are nine insurance providers offering Obamacare policies in Brooklyn; for the purposes of this table I took the median premium as a middle-of-the-road value.

Level Full Premium/month (median) Net cost after subsidy/month
$40k/year income $25k/year income
Platinum 577 529 356
Gold 486 438 265
Silver 419 371 198
Bronze 340 291 118
Catastrophic 218 218 218

In fairness, many of the provisions of Obamacare that will drive up premiums in other places (no exclusion for pre-existing conditions, equal premiums for men and women) were already law in New York State.  So I wasn’t expecting much change from the status quo, and I was right.

What about not carrying insurance?  In 2014, the penalty will be $95 or 1% of income, whichever is greater.  For an individual with an income of $40,000/year, that works out to $33/month, well below even the ‘catastrophic’ plan.  In 2016, the penalty will be $695 or 2.5% of income, or $83/month for a $40,000/year income: still cheaper than real insurance.

The one good thing that I can see, for where I live, is that an individual can buy comprehensive health insurance for a premium that is comparable to an employer’s group plan.  (A while back, when I was between policies, I asked about the premium for an individual health insurance plan for myself and my wife.  The agent was ashamed to tell me.  “Be brave,” I told her.  Her shame was justified: the premium was $2500/month.)

But even with subsidies, it’s still God-awful expensive.  And I still don’t understand how making everyone pay for it–mobilizing more dollars to pay for the same finite resource–will not raise costs through simple supply and demand.

CareCredit is Hazardous to Your Health….and WALLET!!! Avoid them at ALL COSTS!!!

3 years ago, I was having dinner and the fork happened to contact my front teeth.

In such a way that the contact my tooth made with the metal sheered off a good slice from one of my front crowns.

The crowns are years old and my dentist and I were talking about replacing them.

I went back to the dentist at my earliest opportunity to see what he could do for me…

WHAT a mistake, going back to him.

The tab for the crowns was 4 grand. He told me he also needed to replace the two lateral incisors being there would not be a “match” fot those teeth with “just the crowns replaced.”

I’d never heard of such a thing.

I told him I’d pay him on a payment plan if I chose to go through with the work.

Here is where the road gets funky:

He told me “We don’t do that anymore because people skip out without paying. You can’t trust people anymore.”

I have been a regular client of his since 2007 — He knows I have staying power and I am never late with paying. yet he is insisting more or less I’d be guilty by association.

Then they tell me how easy it is to pay for the work via CareCredit — they call CareCredit the poor man’s Visa card. I was pressured into the work and was more or less told that this was the only way to pay for the work.

Yeah.

pay for it all UP FRONT…and suppose you don’t like the work or something happens during the course of the work — the crowns are not to you liking, you develop some sort of infection, have some type of extreme discomfort after the work is done, etc — how do you get a refund? You’d have to chase CC to get it, and provide a papertrail — a big headache for you.

Do you pay for a home repair in total before the work begins? DO you pay for an important piece of apparel before the item arrives and is in your hands? Do you pay in full for a car before its delivery date?

This is how CareCredit gets you — when you have an animal that’s critically ill, a fairly large medical cost to pay for or some other fee that’s a good chunk of change — they more or less take advantage of your heartstrings or whatever it is you want to call it and more or less give you the idea that this is the ONLY way to pay for the service otherwise you are out of luck.

I never should have done it.

The total for the work was about 4 grand. That was 3 years and 3 months ago. I paid CC about $150 a month….multiply that times 39….

And there a balance of 3 grand on my card now.

So how much did I pay for the work??? And how much will I pay for the work when all is said and done???

He got his 4 grand…and CC makes a tidy sum from you paying the minimum.

(I signed up for CC in anticipation of getting a full time job soon and then I’d pay off the whole card when I had a chance. Hahaha. fat chance and hard cheese for me, eh?)

Bro signed up for CareCredit when his dog took a turn for the worse. This was late last summer; the total for the vet’s was somewhere in the 4 thousand dollar range. Bro will be paying that card off forever. He will be able to pay for the critical care in that vet clinic for everybody from there to Albuquerque by the time “he finishes paying for the card.”

He is in debt up to his eyeballs and has had his pay garnished. So you can see CareCredit will take anybody who is a warm body.

CareCredit needs to be burned at the stake, as I said.

You are pressured into signing on with them when you are in some sort of crunch or heart wrenching situation.  They don’t care how they get you, they’ll get you any way they can.

IF you encounter a situation where your doc, a dentist or a vet, etc. tells you to pay via CareCredit, tell them you will put the whole amount on your own credit card….

And if the vet, etc REFUSES to let you pay via your own card and tells you CC is the only way to go?

Get your ass out of there as soon as possible. Don’t give that person one red cent.

I also would not doubt that the dentist, vet or whoever it is who signs up for CareCredit gets some sort of a bounty or bonus for every body and scalp that they drag in for the card company. WHy else would they be utilizing CareCredit’s services? Most of us have our own credit cards.

Obamacare: Big Whoop

“Tangible good news” was the subject line of the latest missive from the White House.  I’ve always wondered how one can send something tangible in an e-mail, so I opened it.

One of the features of health care reform is a requirement that insurance companies must spend at least 80% of what they collect in premiums on actual medical care.  Companies that collect too much must rebate the difference.  So the missive was crowing that some an estimated $850 million would be paid back to some 8.5 million policyholders this year, as an glorious achievement of the new health care law.

So some fraction of the population, less than 10% of American households, received a check for an average of $100.

Meanwhile, my health insurance company has announced their new and improved (which is to say more expensive) premiums for the coming year:

Coverage Old premium, per month New premium, per month New premium, per hour (40 hrs/week)
Single $540 $575 $3.32
Couple $1185 $1265 $7.30
Parent/Children $1000 $1070 $6.17
Family $1710 $1825 $10.53

So that $100 would pay for this year’s premium increase for my wife and me for a little over a month.  But it wouldn’t even provide a week’s coverage for a single person.

Meanwhile, the Federal minimum wage of $7.25/hour wouldn’t pay for coverage for a couple or a family.  New York State is raising the state minimum wage to $9 in steps through the end of 2015 (it’s still $7.25 for the rest of this year), but even that wouldn’t cover the premium for a family.

So, big whoop for Obamacare.

And if you did receive a rebate on your health insurance, don’t spend it all in one place.

Just Another Tax Loophole

I’ve written in these pages about what I consider the horror of ‘health care reform.’  We have a serious problem with health care in this country: it costs too much.  And nothing in the Patient Protection and Affordable Care Act will do anything useful to make care affordable.

I empathized with my conservative friends who considered it unconstitutional.  I wanted to believe myself that the requirement to purchase insurance went beyond the Federal government’s constitutional power to regulate commerce.  But I couldn’t quite believe that the Supreme Court could strike it down, although I couldn’t say way.

But the Supremes upheld Obamacare for the reason I couldn’t quite put my finger on.  The penalty for not having health insurance is a tax, Obama’s minions’ protests to the contrary notwithstanding.  Consider:

  • The penalty will be administered by the IRS;
  • You’ll pay it as part of your income taxes;
  • You won’t suffer any other consequences for failing to carry health insurance and paying the ‘penalty.’  You won’t get locked up, or lose your right to vote, or your professional licenses, or even get points on you driver’s license.  Hell, you won’t even lose your right to get medical care as an uninsured person.
  • If you don’t carry health insurance, and fail to pay the penalty, the government will come after you for… failing to pay your taxes.

If it looks like a tax, and quacks like a tax, well, it’s a tax.  It’s a selective tax, meant to encourage you to do something, and in that sense it’s hardly unique.  The tax code is filled with thousands of provisions to ‘adjust’ one’s tax liability in response to this or that.

It’s also telling that the Supreme Court didn’t touch any of the administrative apparatus of Obamacare.  They had no problem with the government defining what an acceptable health insurance plan consists of.  But then again, government has been regulating for over a century: what’s new about that?

Well, that settles one thing: I’m off the fence, and voting for Romney.  I don’t like either of the candidates, and for the most part I can’t see any meaningful difference between them.  But Romney acknowledges that health care reform is trouble, and at least pretends that he will do something about it.   (And yes, I know that as governor of Massachusetts, Romney pushed a similar health insurance plan to become law there.  But he’s allowed to acknowledge that it was better in concept than execution.)

Alas, I don’t expect the effort to repeal Obamacare to get much traction.  Not because of backlash from the other side, nor for the useful bits of the law that nobody wants to lose.   The big money will realize that Obamacare will marshal trillions of dollars to pay for health care, and they’ll want their share.  The result will be a big burst of investment in health care: new hospitals, pharmaceutical plants, and thousands and thousands of jobs.  (I can hear Senator Schumer now: ‘A vote to kill Obamacare is a vote to kill jobs.’)  It will pull the economy out of the doldrums–happy days are here again!–and last for two or three years, maybe four.

And then they’ll realize that nobody can afford to pay for health insurance, and the government is broke, and it will all implode.

Health Care Reform Signed into Law

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?

Feeding the Monsters

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.

Health Care Funk

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….

Socialized Medicine by Another Name

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.

Health Care/Integrity

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….

Health Care Blues

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:

  • Government spending on health care in this country (at all levels) per capita is slightly higher than in countries with ‘socialized medicine.’
  • Private spending on health care in the US is about the same per capita as public spending, so we collectively spend a little more than twice as much on health care.
  • In countries with socialized medicine, there are often shortages of doctors, and waiting lists for specialized treatments.  And sometimes people die from not having receive treatments that would be more readily available in the US.
  • On the other hand, on general measures of public health, such as life expectancy, infant mortality, and obesity, the US is behind other countries with socialized medicine.
  • The US is the fount of medical innovation in the world, chiefly because someone who comes up with a good idea can turn a profit from it.
  • People in the US go bankrupt every day from the cost of health care.  An extended illness or cancer can easily wipe out an individual’s savings.  Insurance can help, but often has its own limitations and horror stories.
  • The cost of health care is going up rapidly, much faster than the general rate of inflation.  My health insurance premium went up 20% this year, and that’s consistent with past years.  Back when I was an employee, my company would moan every year about how the price if insurance had gone up, and that they would absorb most of the cost, but our co-pays would have to go up.
  • Medicare, the government insurance program for the elderly, tries to limit its costs by setting rates at which it will reimburse for services, but does not try to limit the services themselves.  This is called ‘not getting between the doctor and the patient.’

Some first thoughts:

  • If the cost of health care continues to go up, it will upend not only the government’s budget, but everyone else’s as well.
  • It would be tempting to believe that we could somehow ‘cut the waste’ and magically reduce the cost of health care without actually reducing the care that is delivered.  Perhaps we can trim a few percent, but not enough to solve the problem.
  • It’s one matter for the government to take measures to control its own costs.  That’s entirely reasonable.  It’s quite another for the government to try to solve everyone’s cost problem.
  • It would be spectacularly bad for the government to do something that would kill the innovative, capitalist component of health care.

More to follow….

Health Care Reform

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.