Addendum to previous post

In my newspaper essay I complained about poor journalism around the healthcare debate. Finally somebetyer journalism. This week's Time has a chartehst shows how major features of the proposals would effect people in different demographic groups; both ppsitives and negatives. The chart also outlines the major players in the debate like insurance companies, docs, and others this is much better .

Specifics of Health Care Reform Need Examination

Previously published in the Terre Haute Tribune-Star, 8/2/09

What does health care reform, education reform, and campaign reform have in common? Other than repeated attempts to “fix” without much success, public opinion on these topics shows similar patterns. Significant majorities of people polled agree that the present system is broken, that reforms are needed, but those same people also report their health care plan, their local schools, and their elected officials are fine. In short, my situation is fine but everyone else’s is fouled up. Recent polls on the current run of “health care reform theatre” indicate Americans don’t want to pay for health reform. Such is the behavioral effects of payroll deductions.

How should policy makers understand such polls? Without specifics, it is very difficult to make sense of them. Polls show significant proportions of Americans think the system needs changing but at the same time “don’t change my situation.” No wonder opposition to any change is so effective. All the opposition has to do is to scare people into thinking that their situation might change and reform is defeated. The only way to break the logjam is to focus on specifics. Specifics, however, are often difficult to find.

I’ve spent quite a bit reading the “America’s Affordable Health Choices Act of 2009.” This is the House’s version of health care reform. The Bill is 1028 pages long. I’ve read about a quarter of the bill. I’m a reasonably informed and literate person. I am having a very difficult time trying to understand exactly what this bill is going to do. Oh, the House committee makes it easy with fact sheets about what is contained in the bill, but other than the claims made, it is very difficult to see how those claims will be achieved.

Some features are easy to see: the bill, if enacted, would extend coverage to most of the uninsured. The dreaded exclusion of previous existing medical conditions would be gone, and there will be a public option health care plan modeled closely on Medicare. Polls could be done on these specifics: do you support or not support ?

Other aspects, like cost savings, are more difficult to understand. How the plan creates savings is complex. Extending insurance coverage to everyone will save money because fewer people will use the most expensive options for health care…..the emergency room. Okay, that sounds like it will work. Beyond that, I don’t get it. Taxing the richest families among us? There is not enough money there to put much of a dent in the cost of extending coverage to all. And, there are added costs. The administration of who is in, the additions to the tax code, the extra regulation of business, the new bureaucracy that will be created to oversee the public option and so on makes me wonder if the “savings” will even cover those new costs.

Few are going to read this bill. I wouldn’t except I decided to write this essay. So, we informed folk rely on journalists and advocacy groups to inform us. The pro groups and pro journalists pretty much just repeat the fact sheets the House committee has prepared or White House talking points. Journalists don’t provide much critical or objective examination of the proposed changes. They prefer to focus on the political machinations instead. And the anti groups and anti journalists rely on fear of possible unintended consequences (or secret conspiracies) like ending all private insurance or the dreaded “socialism.” There is nothing in the bill’s first quarter that suggests the government would hire doctors and open up separate health care facilities for people, even on the public option. The model is Medicare, not the VA. (The VA is a version of socialized medicine.) Even in countries with single payer systems like Canada and Great Britain, private health insurance, for those who can afford it, flourishes.

No doubt there are more specifics in the remaining 750 pages of the bill I didn’t read. Based on what I did read, I (and my family) would benefit from ending the practice of excluding previously existing medical conditions and having the right to choose other than what our employers offer. (That one of us has Anthem, choice would be welcome given the local situation with Union Hospital). These are two specific parts of the House plan that I suspect would be very popular if pollsters asked the right questions and journalists reported with more depth and a little more complexity

If health care reform is socialism, then why isn't this socialism?

Why isn't the huge income tax deduction on mortgage interest socialism? Why isn't the gas for clunkers program socialism? Why isn't public schools socialism, why aren't energy tax credits socialism? Why isn't ant tax deduction or rebate or any thing like that socialism?

Wouldn't ant market transfer that doesn't/generate (or have the possibility to generate) a profit be socialism?

Health Care in the nitty gritty

The ongoing debate over what to do about health care, health care costs, plans, choice, all the ingredients in the ongoing mess that is health care can all be seen in a nice bit of reporting by one of our local reporters. This article examines a local hospital and its dispute with one of the largest insurance companies, Anthem. When I read the article, I get the distinct feeling that everyone is angling here for more money using all the usual words, fairness, etc, but patient care is completely lost. An interesting short sighted solution has apparently lead to this problem: in an attempt to reduce medical costs, more and more services are moved away from the four walls of the hospital (because costs are higher there). But that move reduces the revenue stream of the hospital, so the hospital reaches out to the off campus sites, incorporates them into the hospital (through accounting categories) and then can bill at the higher rate. So, a cost savings measure leads to an unsustainble economy for the hospital which in turn plays accounting games to raise costs.

In the local case, the hospital cites the possible loss of three medical oncology pratices. I don't know if that means all medical oncology would be absent in Terre Haute. Perhaps three practices are not sustainable in this area, I don't know.

But this article, I think, lays out the real issues better than do the big stories, becuase this brings it home.

Goofy thinking on opposing the public option in health care

Reforming our health care (non) system is needed. What reforms are needed, well, that is up for debate. To listen to the AMA it seems all that is needed is to end malpractice suits and pay docs exorbitant fees.

Hmm, I wish someone would show what docs made before medicare and after. I bet things got lots better for them.

Okay, there is lots of political propaganda out there and not much substance. But, one line of reasoning I don't quite follow. the public option is feared by those who oppose virtually any change at all because ??? they fear people will choose it? I mean, if a single payer system, if universal health care is SOOOOOOOOOOOOOOOOOOOOOOOOOOOOO bad, why fear a market choice? I mean, virtually anything that is "public" is deemed bad....public pools, the library, public schools, public land, everything. private, private, private....that is what America likes, so what is to fear?

Or, is it that in the marketplace of ideas, a simple system, wins out.