(From the Buster Gammons column of 9/9/09)
And then there’s the whole health care “reform” thing. Remember the old kids TV show “Clarissa Explains It All”? Call this “Buster Explains Some of It”. Here goes . . .
A. It’s ridiculous to suggest that the various House Bills on health care are “moving too fast” and we need to “slow down and reform health care the right way.” When it comes to health care reform, we Americans are nothing if not slow. The idea of changing or improving or “reforming” our health coverage has been around for decades, and at every turn it has been met with hysterical fear-mongering disinformation from the medical/health care industry. In the 1930’s the scare tactic was, “Germany has national health insurance. It’s a Nazi idea.” In the 1950’s it was, “Russia has it. It’s a Commie plot.” In the 1990’s it was Harry & Louise, and now it’s “ObamaCare” – that horrible public, nationalized, socialized, government-run monster. Ooh, scary! And those who talk about the “right way” never say what that way is. It’s just pure obstructionism. Reminds me of that old Groucho Marx song in Horsefeathers, “Whatever It Is, I’m Against It.” We’ve been waiting for years for any sort of serious reform. Further waiting and study serves no purpose. Get on with it!
B. It is utterly indefensible to suggest our current system is just fine and changes are unnecessary. You won’t even catch a Republican saying that. Everybody knows it sucks and why:
-- We pay more and get less than any other major country in the world. All of our health care costs -- insurance premiums, hospitals, doctors – have for years increased at rates far above inflation, and will continue to do so under the status quo. Yet we are no healthier. Among industrialized nations, we’re way down the list in terms of preventable deaths, healthy life expectancy, and access to care.
-- Only 62% of small employers (under 200 workers) offer health insurance coverage and the number is falling fast. Even with workers sharing in the cost, more and more companies just can’t stand the premiums.
-- Fifteen percent of Americans (47 million) are uninsured. These people are not scumbag leaches. The vast majority are working people not old enough for Medicare, not poor enough for Medicaid, but still not making enough money to afford health insurance premiums. For brief periods in my adult life, I’ve been among the uninsured and it’s not a comfortable feeling.
-- Health care may not be a god-given right, but neither should it be a straight financial proposition wherein the rich get theirs and otherwise, fuck you. The monied classes will always have their advantages, and let’s not begrudge the wealthy their wealth. But this isn’t about fancy houses and cars. Broad access to basic, affordable health coverage is an ethical issue. Nobody’s looking for a free ride, just more affordability and better value-to-cost. We are the only industrialized nation that does not see fit to cover all of its citizens, that doesn’t have a “public option”. England, Canada, Germany, Italy, Japan, Sweden, et al, yes. USA, no. Are you really OK with that?
-- Even with the best of coverage, costs to the individual are still potentially devastating. Sixty percent of all bankruptcies in America are medical. We are each one doctor’s visit away from financial, if not physical, ruin. You OK with that, too?
-- The Reagan Era-Gordon Gecko “greed is good” mindset has, in the health insurance industry, led to some despicable practices. A pre-existing condition may be excluded or cause you to be rejected altogether if you are seeking new coverage. Let me give you a couple personal examples:
I’m self-employed. Have been for a long time. When my wife has held a job, we’ve
bought health insurance through her employer. When she’s between gigs, we must purchase individual health coverage, which is substantially more expensive and less comprehensive than employer group plans. Back around 1991-1992, in the pre-internet dark ages, we needed to pick up individual coverage. Since we already had other insurance with State Farm, we went with them. Just one stipulation. Because Kathy had recently undergone infertility treatments, anything resembling pregnancy would be excluded. We had already given up the treatments and believed that kids would just not be in the cards for us, so we agreed to the exclusion and signed the forms. And – who’da thunk? – John Jacobsen was born in 1993 in a thoroughly normal and natural delivery. The tab from Riverside for this blessed event? Over $14,000. Full retail. Every bit on us. That was over 16 years ago. Wonder what it costs now? (That’s another quirk of our current set-up – the uninsured are charged more than the insured. Insurance companies and Medicare do not reimburse at “full” price, and all the doctors and hospitals cash those checks pronto. The full price is the sucker price.)
Just last year we were in the same position of needing to again pick up individually issued coverage. Researching online, we picked a policy from United Health and applied. John and I were accepted, Kathy was rejected. Her sin? A pre-existing condition. She was covered by United Health at a previous job and was diagnosed with mild high blood pressure. One office visit and one prescription results in one big fuck you. Nice, huh? So now we have a high-deductible – and I do mean high – HSA (health savings acct.) compatible policy. It boils down to catastrophic coverage – better than nothing in the sense that a stale slice of bread is better than a moldy one.
-- Then there are those charming insurance industry practices known as post-claim underwriting and rescission. In the first, a certain type of claim generates a red-flag code wherein the insured person’s application and medical history are scrutinized trying to find any discrepancy, any flimsy reason to turn down the claim. And they find reasons. Major companies like United Health, Anthem and Assurant have acknowledged they each employ 1500+ such red-flag codes. The second, rescission, means you’ve had the nerve to get really seriously and expensively sick, say, with cancer. On some dubious trumped-up basis, the insurance company then promptly rescinds/cancels your coverage just when you need it most. They drop you like you’re hot and then dare you to fight for yourself. These fucks are not on your side, they aren’t good neighbors, and you are most assuredly not in good hands.
-- Our current system is grossly inefficient. We are the only developed country which does not employ a single-payer system which allows doctors and hospitals to bill and be reimbursed by a single government entity. Our good old America know-how has given us instead over 1300 different private health insurers, with different forms, procedures and fee schedules for each and every fuckin’ one of ‘em! Ever see all the endless files and filing cabinets at your doctor’s office? All those clerks constantly on the phone? That’s the name of that tune. A full third of all our current health care costs are administrative/ paperwork. Clean it up and you save literally hundred of billions of dollars each year.
C. How to pay for the necessary health care revisions? First, if a genuine public option is made available at a truly attractive price, such a government plan would be hugely popular and would find itself swimming in cash in no time. Even so, any insurance company must establish sufficient reserves prior to start-up. So . . . paperwork is reduced & simplified as much as possible, medical records are shared, high-income individuals ($250 K +) get fewer itemized tax deductions, all but the smallest employers are required to offer health insurance (not pay for all of it, but offer it), all working people are required to carry health insurance, and some/many/most/all health benefits are taxed as income, to some degree. That’ll do it just fine.
Think about this. If you were allowed a big do-over, starting from scratch, would you design our American health care system to be what it is today? No, you wouldn’t. You’d want universal coverage with government-regulated rates and fair rules, and you’d want an efficient, cost-saving single-payer system. But the bitch of it is, even though everybody from Obama to Ron Paul knows it’s true, nobody has the balls to say it. Because single-payer would effectively wipe out private health insurance companies. (Convince me why this is a bad thing.)
So, although it makes tremendous sense, single-payer was never on the table. Nevertheless, Obama wants some sort of legislation, and it seems that something called “health care reform” will pass. The questions are: What will the legislation contain? What will be “reformed”? There’s still plenty of room to do great good without single-payer. But the aforementioned sources of August ugliness are doing their best to derail the whole thing.
These opponents of reform don’t give a shit about the details of any plan. They have no interest in what they know will be beneficial short-run and long-run for us, our children, our grandchildren. They don’t care about right or wrong. They care only about “winning”. For them, the only point is that Obama must fail, and anything which advances that end is a good thing. (Who’s a Nazi?)
Thus far, Obama has been way too nice and accommodating about all this. He’s dithered and lost control of the issue. The Senate is unraveling. Had he jumped on health care quickly after election, he would’ve had enough good will that it’d be law by now. Instead, he sought bipartisanship, tried to make everybody sing Kum-Ba-Yah, allowed August to hammer his ass, and showed all the decisiveness of Brett Favre. Now his dick is stuck out all the way, what he really wants is in deep yogurt, the bipartisan dream is dead, so is Ted, and he’s gotta make a big, big speech tonight and then really start twisting arms, LBJ-style. If it’s good, if it works, he’s FDR. If it doesn’t, he’s Jimmy Carter.
In tonight’s little chat, you’ll hear about covering pre-existing conditions, and guaranteed issue, and portability in job change/job loss, and many other good ideas. But, dear readers, there are really only two key things to listen for when Ol’ Cousin Barry talks, and they’re important (especially for my younger readers – this is much more about your future than mine):
1. The Public Option. Call it whatever you like – government-run, nationalized, socialized, blah-blah-blah. Any meaningful change must include a government program as an alternative to private insurance. If our Prez starts talking about co-ops and consortiums and the like, you’ll know he’s caved and you’ve been fucked again by the insurance companies.
2. Negotiated Rates. If Obama signals openness to “negotiated” health care reimbursements, you’ll know real reform is dead. Negotiated rates are the status quo. The “negotiations” are between insurance providers and care providers (hospitals & doctors). It is obviously in the interests of all these parties that rates continue to escalate, which is exactly what’s been happening for years. If, on the other hand, Obama talks about regulated rates, controlled rates, Medicare-based rates, then you’ll know some genuine change and help is afoot.
Medicare is a very successful and popular government-run health insurance program
for those 65 and older. Those covered by Medicare report notably more satisfaction with their health coverage than younger folks with private coverage. Medicare reimbursements are less than employer group plans and far less than full-retail sucker prices. Yet Medicare is so large and influential it cannot be denied. Today, the health care industry gladly accepts Medicare payments, likes it just fine, and is in no danger of going out of business. Any claims to the contrary are complete horseshit. Just like those payday lenders who were gonna go out of business if they were capped at a meager 28% APR! Same shit, people!
If we can get a public-option health plan with Medicare +5%-based rates, plus some of the other niceties, we’ll have something which will drive down costs and will force private insurers to compete. If we don’t get that, it’ll be a thin broth, it’ll be “reform” in name only, and we’ll know just exactly how far the government’s head is shoved up the insurance industry’s ass!
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