Wednesday, August 12, 2009

Obamacare: Let the Reading Begin Now


That's the general feeling that comes to mind when I look at how the debate -- if the rancor and spitting and screaming and navel-gazing going on can be called ebate -- over health care in the United States is going.

All I know is this: The last two times I went to the doctor, I felt ripped off.

A few years ago, I had a mole removed. Technically, I called it a birthmark, since I'd had it for as long as I could remember. It had changed shape slightly, though. Slightly. To be cautious, I had it removed. Cost us $116, after what insurance would pay.

The time before that, I went in to get a prescription renewed for allergy medication (something I'll never do again). I sat in the waiting room for 30 minutes, in an examination room for another 10 minutes, had a doctor take my blood pressure and write out the prescription. All that cost $55. Plus whatever it was I had to spend on the medicine.

So I've been lucky. No huge bills.

Even having three kids hasn't been all that bad. For each, we ended up paying about $3,000 in hospital bills when they were born, plus the regular checkups and such. but no major traumas.

So we've been lucky.

I look at my mother, who has various medical conditions. She had a pacemaker put in a few years ago. Medicaid paid for virtually all of it. That's a government health care program that works, as far as I'm concerned, and I don't mind paying for a portion of it through my payroll taxes.

So why couldn't that work for me and mine?

Is it a government handout? Hardly. I'd pay for government-sponsored health care through my payroll taxes. Talk about a heck of a group discount. I already pay for private health insurance, and let me tell you how well that's worked out for us: For the first two years, we had a flat rate for a so-so policy. After the two years were up, they wanted to increase our premiums by nearly doubling them. How many claims had we had in those two years? None. Absolutely non. But because "the price of health care is going up," they wanted more money. We said no. We made our agent look for a less-expensive policy, that's actually a little better than what we had. If the government were to get involved and offer options, I'd study those as well, but I wouldn't feel forced to take them just because they came from Uncle Sam. Free market rules would apply -- if the feds offered plans worse than a private provider, guess what? I'd go with a private provider.

What I'd rather see is price controls. Yeah, call it socialism, communism or whatever you want. But price controls worked during World War II to curb inflationary prices, and it could work in health care today. To this day I still do not know why I had to pay my doctor $55 for a prescription and a blood-pressure taking. Or why thirty seconds in the doctors office to snip a mole off cost us $116, after what our insurance paid.

But before that's going to happen, we need to discuss what's going on. I haven't ready Obama's health care bill; I'm just like many in government who have not read this 1,000-page document. But I'm not going to cherry-pick things -- like this "euthanasia counseling" that the fringe nutters have latched onto -- to derail the conversation. I want to know what it means. So I'm going to start reading it. I'll let you know what I think as I go along.

Update 1: Yes, I will definitely be reading the bill and offering my inexpert opinions here. Any appeal to the Internet for a summary of the bill either brings up right-wing spittle or left-wing righteous indignation.

Update 2: One of the criticims I've read about this plan from the right is that it allows "government access" of individual checking or savings accounts for premium payment. Why is this such a bugaboo? I already let a private insurer automatically withdraw premiums from an account we have set up specifically for that bill. They don't get to see what we have in our other accounts. Plus, my employer automatically deposits my paycheck in our bank, after taking out federal and state taxes. Why is this such a scary thing?

Update 3: Another criticism I don't understand is that some out there figure we ought to install a Darwinian program in which those who are a burden on society (mentally ill, crippled, et cetera) ought not to be insured at all, since they're not "contributing" members of society. This from the same faction that criticises abortion because of the killing of fetuses. So protect them until they're born, and then if they're born crippled or handicapped or whatever, pull the plug? That's a plotline from Lois Lowry's The Giver, not one for public health care. Jesus Christ didn't limit his miracle-making to those who weren't crippled or possessed of all their senses of mental faculties. Opposite thinking is definetely un-Christian.

Update 4: The text of what I'm reading, by the way, is available from the Government Printing Office here.

Update 5: I'm a tenth of the way through. On page 113, the guidelines for families who would receive government help in paying for healthcare surfaces. If I understand this correctly, if a family makes less than 400 percent of the federal poverty line for their size of family, they qualify for subsidized health care. So going by these guidelines, a family of five (my family) would have to make more than $103,000 a year to be disqualified for government assistance. So my family qualifies, if this passes. But here's the wrinkle: If I have an employer that offers a health insurance plan that qualifies as an "acceptable" plan under these guidelines, I don't get the subsidy. The subsidy only applies to individuals who meet the guidelines and who work for an employer that does not offer health insurance. Again, this is all if I understand what I'm reading correctly.

I'm also unclear what happens if a family of my size and income opts to go for the public option. Does the subsidy kick in, or do we not get it because we chose the public option instead of the employer-offered/private option?

Update 6: They need to follow their own advice. Earlier on, they say that if this plan is enacted, they'll be required to use "everyday langugae" to explain it to people. They need to be doing that now. That's how they're losing the battle, and how the smug left and spittle-emitting right are losing.

Update 7: Are the spittle-emitters reading the same bill I am? One of their criticisms is that this public option is going to be open to everybody including (gasp!) illegal immigrants. However, on page 143 of the bill, undocumented individuals are forbidden from receiving subsidized government healthcare under this plan.

Update 8: Page 144, so if an employer offers health insurance but the employee opts for the public option, the employer still has to pay a portion of the costs, just as they would if the employee took the private option. No problems there.

Update 9: Found this, for those who want to be pro-active in controlling their own health care costs: Healthcare Blue Book, a site that lets you search geographically for average prices on any kind of surgical procedure or doctor's care you'd care to find. Use this as a bargaining chip with those you seek care from, I suppose.

Update 10: They are taxing the rich stuff. Make over $350,000 a year and you'll be taxed an additional 1 percent on your gross income; the rates range up to 5.4 percent for those with a gross income of over $1 million. Take that, Jon Stewart . . .

Update 11: I'm foundering. I'm 337 pages in and I wish I could find reference so the "death Panel" the spittle-emitters are all on about so I could apply to that and stop reading. This summary, done by the Associated Press and posted on the American Association of Retired People, reasonably sums up what I've read so far. But counting on $200 billion in penalties from employers who don't offer insurance or employees who don't take it sounds iffy to me.

I think I have a question answered, though. Sounds like a family my size would get health care subsidies, whether I opted for a public or private plan. That helps expalin why the cost estimates for the plan are $1.5 trillion over ten years.

Update 12: I know part of what would help thie situation is if Americans in general would make more common-sense approaches to health care. I know quite a few people who will take their family members to the emergency room at the drop of a hat, or who make poor choices in purchasing medicl necessities. We get our birth control, by the way, from Mexico, where the pills cost about a third less than they do in the states (my wife's parents visit Mexico on a regular basis, so they just bring the stuff back for us). I'm also off of the prescription sinus medication and have actually tried an alternative medicine trick this summer to combat the allergies: Rather than taking Claritin or a generic equivalent, I've been taking a mixture of lemon juice, lemon oil and peppermint oil, about two ounces of the stuff a day. Seems to be working as well as the OTC stuff I was taking, and I avoid the side-effects of numb fingers and occasional dizziness.

Update 13: An interesting quote, first of all, from Robert Laszewski at the Health Care Blog:

Affordability – [in Obama's plan] affordability is more about shifting the
cost of insurance to the government then it is making a more efficient U.S.
health care system. Health insurance is more affordable for people because he
spends many billions of dollars subsidizing access for everyone.

I've got a problem with that. Why can't we focus on reining in costs, rather than throwing money from different pots into the system? I know there are a lot of people out there who would flip out about price controls, but that seems to be a significant root to the problem, along with the apochryphal $5 hospital bandage or the $60 hospital aspirin.

Update 14: I admit I'm doing a lot of skimming. They really needed a Simple Language Filter for this before they put it out. But I understand it has to be all legal-like, like the Grogans' bill of sale for Petey. But still, it's a bit ridiculous.

Update 15: Here's Time magazine's take on healthcare exchanges. Sounds both good and bad. And, at the onset, exclusionary. I know the hybrid public/private approach is a safe political bet, setting the spittle-emitters aside, but it sure looks to be messy. I still go back to lucky Update 13. We need cost control above anything else.

Update 16: 2:58 pm. Will have to finish reading later. It's very verbose. And obtuse.


carl g said...

Game of you to actually try to understand this. I'm not even trying. I know just enough to know that this will not be healthcare reform so much as an extension of governmental healthcare benefits, which will bless some people and do little for the rest of us, except perhaps raise our total healthcare costs. Because if you are not one of the subsidized, you almost certainly will be a subsidizer. But I'm that already.

There just isn't enough spine and vision in congress to enable a comprehensive healthcare reform bill that would do what is needed most--reign in costs. That would require large-scale governmental regulation of healthcare, which the fearmongers are apparently capable of sinking. I hope every last one of them ends up spending their life savings on the massively expensive meds and piratically priced procedures that they are helping to perpetuate. I know we just got popped 1G for a little bug Tasha picked up over the 4th. Only in America.

I'll get excited as soon as Big Pharma starts opposing a healthcare bill. They are supportive of this reform so far. That tells me all I need to know.

Mister Fweem said...

Cost control is the only way to go. The reforms being proposed just takes money from different pots and throws them at the problem. And I think you're right -- nobody's got the guts to try this any more. We need another FDR, not more politicians.