Wednesday, July 1, 2009

Can the US Senate screw up health care any more than it already is? You betcha!

I read a few articles last week in the NY Times and am finally making the time to respond. This health care debate is really the most important issue that we are facing under this new administration. If we let them get it wrong, we can potentially make things far worse than they already are.

“Senators struggled Wednesday with the possibility that in offering subsidized health insurance to millions of individuals and families, they could inadvertently speed the erosion of employer-provided coverage, which they want to preserve.”

This opening paragraph is puzzling to me. As everyone here knows, one of the PROBLEMS with our health care system is that insurance is offered through our employers. It's a problem because all employers are not mandated to offer it and it is not portable when you leave a job. Employer-sponsored health insurance is also creating a HUGE overhead expense, making it difficult for American companies to compete in an ever-growing global economy. Corporations from most other nations have no health care or insurance overhead costs.

So one would think that the best thing we could do in reforming the health care system in this country would be to move it away from being the responsibility of the employer. Instead, what the Senators have in mind is to FORCE employers to provide insurance for their employees by implementing penalties for those that don’t.

“Higher penalties are more effective in preventing the erosion of employer-sponsored coverage, the bedrock of insurance for more than 150 million Americans, the Congressional Budget Office told lawmakers.”

Won’t this effectively run some of the smaller businesses out of business entirely? Apparently, that is not a problem for our wise Senate.

Small business employs a large percentage of workers in this country and is generally a better employer to those workers than the large corporations that can afford to offer insurance. So why is it that the Senate is not concerned about the effect that this will have on small business?

And just who is the Senate trying to protect with laws like this? Not small business. Not employers in general. Not the citizenry, since employer-sponsored insurance is not portable and takes all control away from the end user and hands it to the employer. No, it is apparent that they are protecting the insurance industry at the expense of all else.

"Senator Blanche Lincoln, Democrat of Arkansas, said preserving employer-sponsored insurance ‘needs to be a huge objective.’”

But no reason is given for that. Over and over in this article it is repeated like a mantra, but no good reason is EVER given for protecting the employer-sponsored system. And if we maintain that framework, what are we really changing?

“Mr. Baucus said he and other senators wanted to minimize the chance that employees ‘may be enticed to leave their firms in order to get health insurance in the exchange.’”

This is a most cosmetic change that they seem to be fabricating instead of the real reform that we were promised and that we NEED. This kind of change will probably make things worse instead of better, ironically proving the conservative argument that government interference makes things worse. Conservative government interference DOES make things worse because it tends to interfere in the interest of some industry instead of in the best interest of the country or its citizens.

And make no mistake; even if the Congress and Senate are majority Democrats at this time, the changes as currently being discussed for our health care system are CONSERVATIVE ones in that they are based upon retaining the status quo over addressing problems with real progressive change. This article proves it.

“The budget office said: ‘The availability of subsidized coverage in the new insurance exchange would be an attractive option for many lower-income workers. As a result, some employers would decide not to offer their employees health insurance coverage, opting instead to provide other forms of compensation…In a letter to Congress three weeks ago, President Obama said small businesses “should be exempted” from any employer mandate…‘We will give assistance to small business through tax credits,’ Mr. Baucus said Wednesday…(However)…When asked about an exemption for small businesses, Mr. Baucus said: ‘We talked about it. But how much sense does that really make?’”

This is absolute insanity at a time of such high unemployment in this country. It is unbelievable that Congress would dismiss the importance of retaining jobs and small business in this country. It is NONSENSICAL.

“The United States Chamber of Commerce and the National Federation of Independent Business, which represents small employers, said the proposed requirement amounted to a new tax and would frustrate the creation of jobs.”

That’s a no-brainer. Why would Congress even be considering this plan? It will not improve our health care system. It will not provide relief to businesses that are hanging on for dear life in this terrible economy. It will not save or create jobs. It will not increase the capability of American companies to compete in the global marketplace. SO WHO BENEFITS FROM THIS PLAN???

In an Op-ed piece titled, The Only Public Health Plan We Need appearing in the same edition of the NY Times, authors David Riemer and Alain Enthoven state:

“Everyone assumes that a public plan means a government-sponsored insurer that makes payments to doctors and hospitals, whether in the form of Medicare or — the latest idea — state-sponsored cooperatives. But Medicare has a dismal record of controlling costs and improving quality, and we lack evidence that co-ops could do any better.”

They go on to give no evidence to support that statement and to advocate “a mechanism” that they claim would use “free market forces” to motivate the insurance industry to provide better policies. Even if you believe in the mythical “free market,” their claims are shaky at best. They claim that a large enough pool would force the industry to increase quality and decrease cost, however that claim is in direct contrast to the one they made earlier in the article that Medicare, which insures a huge pool of people, has a lousy record of controlling prices or improving quality.

“An exchange is a key feature of the public plan we’d like to see, but it’s only one element. Two other features are needed to give an exchange the power to pressure insurers … to hold down prices and improve care.
First, the exchange would need to act on behalf of a critical mass of people — at least 20 percent of the insured population that does not already receive Medicaid or Medicare. Only a pool of this size could attract serious bids from insurers. To amass such a large purchasing pool, Congress might need to require that all government employees, or all employers with fewer than 100 employees, join the pool.
Second, the exchange would need to ensure that no subsidies for health insurance, whether provided by employers or the government (through the tax system), exceed the price submitted by the lowest-bidding qualified insurer and benefit package. All individuals in the pool would be free to join any insurer that submits a bid. But enrollees would have to pay out of pocket — and preferably with after-tax dollars — any amount above the price of the lowest-bidding plan. “

What they are describing is a system that protects the private insurance industry at every turn. They are basing their ideas on the philosophy that there is currently not enough profit being made to enable the insurance industry to cut costs, which we all know is a load of garbage. They also claim that this would in turn force hospitals and doctors to improve the quality of care and lower costs.

"How would insurers lower prices and raise quality? By passing their incentive along to doctors and hospitals. To maximize their revenue from insurance companies, doctors and hospitals would need to provide better care at a lower price — something they can accomplish only by squeezing out error, waste and inefficiency.”

Yes, error, waste and inefficiency are a problem, but some of that error, waste and inefficiency is caused by the much larger problem of corporate greed. Corporations are not people, although they are run by people. However, people who run corporations tend to make decisions based SOLELY upon what is best for the corporation and its shareholders, i.e., the bottom line is profit. If you are looking for ways to improve quality and efficiency in our health care system, you would do well to be working with people who have the same goals in mind. And private insurance companies will NOT be on that page with you because their ultimate goal will always be profit.

The error with Riemer and Enthoven’s foundational philosophy is that they believe that competition will motivate the insurance industry to look for ways to improve quality and efficiency. It won’t. Insurance companies will always have a bottom line, a handful of excuses, fingers to point and absolutely, positively no guilt or shame about what they have to do to achieve their goals. Actually past history of “free market’ in this country shows that companies from the same industries will collude with each other to set prices at a level that will enable them to obtain a substantial profit for their shareholders. So there really is no motivation for them to improve the quality of the product they are selling.

And, finally, there is another subject that pops up regularly when discussing the health care issue: curbing health care-related litigation. Nicholas Kristoff, of whom I am a big fan, while advocating a single-payer system in his column in the same issue of the NY Times, made this statement:

“I don’t mind the A.M.A. lobbying on behalf of doctors in the many areas where physicians and patients have common interests. The association is dead right, for example, in calling for curbs on lawsuits, which raise medical costs for everyone. An excellent study published in 2006 in The New England Journal of Medicine found that for every dollar paid in compensation as a result of lawsuits against doctors, 54 cents goes to legal and administrative costs…Moreover, aggressive law leads to defensive medicine, in the form of extra medical tests that waste everybody’s money. Tort reform should be a part of health reform.”

Accepting the statistic quoted in the New England Journal of Medicine at face value as a valid statistical fact, that fact alone is not enough information upon which to base the conclusion that Mr. Kristoff leaps to, which is that we need to restrict the constitutional right of redress that comes to us from as far back as English Common Law. Mr. Kristoff might be unaware of a few other facts that play into that statistic.

The insurance industry, which we have established as being motivated purely by profit, has set up a system that does not allow doctors to admit medical mistakes, denies all claims of medical error, and is so adamant about NOT paying for ANY error that it is willing to pay lawyers hundreds of thousands of dollars in order to limit any eventual award to a mere few thousand dollars. Because they REFUSE to admit any liability in even the most egregious cases of medical error or negligence, the malpractice industry, NOT MALPRACTICE VICTIMS, are driving up the cost of medicine for everyone.

If insurance companies were willing to admit to and pay for the mistakes that are made, the system would be in better shape. Instead, they protect the doctors and hospitals that make mistakes, freeing them from the consequences of their errors and allowing them to go on and commit more errors. Eventually insurers will drop a doctor if he has enough lawsuits filed against him, but not before many lives are ruined and hundreds of thousands of dollars or more are paid in legal fees to fight the victims.

Doctors are people and hospitals are not perfect and everyone makes mistakes. But most mistakes that you and I make do not result in catastrophic medical bills for someone or in them losing the use of part of their body or brain function. When these mistakes happen, it is only fair that the victim be awarded some financial help in dealing with the consequences of those mistakes. But the current system does not allow doctors to admit mistakes, face their patients and say they are sorry. It does not provide for proper restitution where restitution is necessary. It is an adversarial system that leaves doctors and other treaters feeling guilty or defensive and patients feeling betrayed and angry while insurance companies keep raking in the profits.

If reform is needed in regards to health care litigation, it is malpractice insurance reform, not tort reform. We should mandate that a truly independent review of claims be made and that doctors and hospitals must or be allowed to admit when they have made an error and be given the opportunity to offer restitution in those cases. It should mandate that State Medical Boards take swift and proportional action in cases where doctors are not performing properly, have lost their faculties, etc.

We should not allow the malpractice insurance industry to keep driving health insurance litigation, playing both ends against each other while their profits increase exponentially each year. Don’t take the right to sue away from the victim, take the self-interested profiteer out of the middle of the conflict.

P.S. Check out this article about the healthcare lobbyist that may be bending the reform to the benefit of the insurance industry:

Karen Ignagni

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Tango daddy said...

This post is most informative and well done. It confirms what I have always believed that complex factors of politics and business prevail. These factors distract from the most important aspect of the patient.
KISS formula "Keep it simple stupid", make public option manditory for all Americans.
Back from my road trip with Tango we went two provinces east to Saskatchewan and guess what KS, they have the same health care plan I do but no premium.No charge what so ever.
Keep charging KS this is important and as President Obama said today if the American people want this it will happen!!

ksliberal said...

Thanks Tango Daddy! Sounds like you saw some beautiful scenery...someday I will HAVE to get up North myself.