FLAIT

I'm glad that President Obama has put health care on the agenda. But it's a very complicated issue with no easy, inexpensive answers. Throw in a broken and corrupt political system that no one wants to change, an industry that will contribute to bribe this broken and corrupt system with tens of millions of dollars to keep the status quo (like they did in 1993), and a Republican Party that will avoid a honest, mature policy debate, shout (boogoody boogoody boo!) "socialized medicine!" into every microphone, and prevent anything from getting done (like they did in 1993 always do), makes the effort that much more difficult impossible.

So to cut through all the obstacles, nonsense and rhetoric, Obama must lead like no other president who took on health care before. And not with his words, but his actions. Because if he allows Congress to "take the initiative," Congress will do what Congress always does and it'll fail, like it always does.

Last fall Rep. Frank Pallone (D-NJ) set up a web site looking for stories and ideas about our health care system and this is what I sent in. It may not be the solution, but it's an idea.

Our "employer-based" system is set up to fail. Because even if it worked at 100% efficiency it would still leave the following without insurance: employees whose employer don't offer it, employees who don't take their employers plan because it's too expensive and has high deductibles and high co-pays, the self-employed, part-timers and the unemployed. Then there are those who take their employers insurance, but afraid to leave their job because they have a pre-existing condition. And then there are those who have insurance, get sick or injured, and then lose their job. So now they don't have insurance and won't be able to get any because of the pre-existing condition.

Oh, and then there's costs and treatments that insurance companies try to avoid paying.

Unfortunately, since it's impossible to dump the employer based system altogether, we'll have to live with it. But all Americans must have insurance because if not, their bills are pushed onto someone else, or government. So one way or another, everyone has to throw money into the pot – the young, the old, the rich, the poor, the sick, the healthy and the government. And this is where the government must step in.

What government has to do, is set up a number of plans, by age (because more care is needed as we get older): 20-30, 31-40, 41-50 and 60+ (with plans for infants and children, of course). Within each plan would be a variety of choices: "in network" and "out-of-network" doctors, co-pays, deductibles and a drug benefit. "Catastrophic" coverage would be part of every plan.

The government then goes to the insurance companies and has them set prices for each plan and the variations within each plan. And it could be up to the individual/families to choose what they want.

Then again, it might be better to determine which company has the lowest prices, co-pays and deductibles overall and then they'd "win the contract." I hope they make billions dollars in profit because this "contract" would come up for a new bids every ten years.

Since it's cheaper, per individual, for a business to insure 100 employees then 50; and cheaper for a business that employs 500 people then 100; and cheaper for a business with 1000 employees then 500...imagine how low the cost would be if there were tens of millions of "employees."

Since we conveniently found $1 trillion to fund a senseless war in Iraq and $700 billion to bail out Wall St., the government should directly subsidize everyone's premiums, thus lowering the price even more. If it costs $50-100 billion a year, so be it. It'll be a practical, worthwhile investment.

We'd also need "big government" regulations and oversight because if you leave tens of millions of people, hundreds of billions of dollars and an insurance company to the will of "the free market," well, that's what got us into this mess. So this entire program would have to be monitored very closely by, yes, "big government." And if Republicans don't like it, then they can either keep the health care plan they have now or go out into the "free market" and buy their own policy.

The company that handles the "contract" should also receive tax benefits as well. Remember, the more the company makes, the more competition there will be every ten years when the contract comes up for bid.

Purchasing health insurance within a pool of tens of millions of people would make it affordable. And since it's outside the workplace, it's "portable." Also, since having health insurance would be mandatory (just like auto insurance), no one can be denied or suddenly lose coverage. So there would be no such thing as "job lock" and "pre-existing conditions" (for those who still couldn't afford it, they can "pay" by doing community service).

With the lower costs, we might have workers leaving their employer-based plan for this one. That would allow businesses to either pump those savings back into the business and/or give it back to their employees in higher pay.

Obviously, this wouldn't be as easy as it sounds and there's many details to work out, such as keeping costs down and how much premiums could rise year to year (within the ten years). But at least it's a bold idea. And that's what we need because we'll never address the fundamental problems with our health care system by just tinkering around the edges. We need drastic change that offers affordable and portable health insurance – that can not be taken away – to all Americans.

Anything less will break the country's back financially; and we're at the breaking point as it is.

July, 2009 insert:

Until last month, I had never heard about the "public option" before. It never occurred to me that the government should offer an affordable insurance plan. Since there would be a pool of tens of millions of people, no profit motive, no corporate jets, no bonuses, no political contributions bribes and therefore much lower overhead costs than private insurance (see Medicare), it's a great idea.

When you think about it, it's (probably) a lot cheaper for the government to actually buy insurance for those who can't afford it, then paying for their care when they show up at emergency rooms. With that in mind, and from my idea above, the government should still subsidize their own public option insurance plan. Or at least means test it. Either way, the public option would make insurance affordable for everyone the "free market" has and will always leave behind.

Other then the Republican Party, the only obstacle would be the insurance companies who could lose customers and billions of dollars in profits.

But maybe if the "free market" did what it was supposed to do over the last 50 years, and all Americans had coverage, none of this would be happening and the government wouldn't have to step in and take away a market the insurance companies turned their back on. So it's their loss (then again, they weren't making money off the uninsured because they weren't insured. So what exactly would they be losing?).

The only way we're going to solve the nation's health care problems - other then starting from scratch and instituting, yes, "socialized medicine" or a nationalized single payer system - is for Americans to at least have the option to purchase insurance outside the workplace that's affordable and has reasonable deductibles and co-pays. And that's what a public option can do.

Unfortunately, President Obama has sold out to the insurance industry. He's given them a seat at the table and believes that forcing business to offer health insurance to their employees and forcing everyone to have private insurance (assuming there's not a real public option that comes out the legislation that Congress finally comes up with) is how we're going to get out of this mess, a mess the private insurance industry created.

We shouldn't be surprised. Wall St. wrecked the economy and are now making billions courtesy of the tax payers.

So health care will be yet another case of heads big business wins, tails we lose.

September, 2009 insert:

When this process started seven months ago, we had two choices: either scrap the whole thing and go to a national single payer system, or work with and around the asinine employer-based, for-profit system we currently have.

Since Obama and the Democrats were terrified of even mentioning single payer, we're stuck with the latter. And that's the problem.

I don't like it when Obama panders to conservatives by saying we have to "build on what works" because there's very little in our asinine system worth keeping. As I've said, even if the employer-based system worked at 100% efficiency, it would still leave tens of millions without insurance: those who lose their job, part-time workers, self-employed etc. And that creates two other problems: the "pre-existing condition" and "job lock." Neither of which would exist in a national single payer system.

Since Obama and the Democrats are relying so much on competition (pandering to conservatives every step of the way) there's no way they'll set or even regulate the price of insurance in the "free market." Therefore, if Congress does pass legislation that bars insurance companies from denying claims, dropping coverage and denying enrollment because of a pre-existing condition, the cost of insurance, deductibles and co-pays will surely rise.

And when costs do rise, if you think you can get a cheaper deal with the public option, assuming there is one, that means 1) the government will become the dumping ground for the expensive sick/injured patients, and the insurance companies will keep the profitable healthy ones (so the "cost shifting" that's going on now will continue) which means, 2) higher costs for those in the public option.

If there is one issue where I believe the insurance companies have a legitimate gripe, it's enrolling someone with a chronic, expensive pre-existing condition. Why does that particular insurance company immediately get stuck with expensive claims? Why does government get stuck paying the bills for the uninsured? Yes, it's an insane game of musical chairs. But from what I've been hearing, I don't see how that will change.

Also, despite the Medicare drug plan, seniors are still paying a lot for their prescriptions. And when the window opens and they're allowed to switch plans, I'm sure they're all the same, assuming you can figure them out. Granted, the drug plan was a total give away to the pharmaceutical industry. But why will health care be any different?

So I don't think "competition" will solve much of anything. In fact, I don't even look at the public option as competition for the insurance companies at all. I look at it more as a practical way to solve a problem - giving those without insurance the opportunity to purchase it at an affordable price (which is how I wish Obama and the Democrats would describe it. But again, since "competition" sounds good, and since they have to pander to conservatives...). And like the Medicare prescription drug plans, Obama's "insurance marketplaces" will be very confusing. I can hardly wait to read the fine print.

How does "competition" bring down costs and "hold the insurance companies accountable" anyway? It's not like there's no competition now. There's probably more "competition" and "choice" (another word being tossed around by the Democrats) in the health insurance industry then there is in the cable/satellite industry. And look at how miserable these insurance companies treat their customers. So why will competition work now if it hasn't for 50 years?

Let me put it another way:

Everyone loves their health insurance company (and that goes for their home and auto insurance companies too) as long as you don't need them that much. For example, if you've been to the doctor for the flu once or twice over the years, you probably didn't have any problems with your insurance company. And since the cost of your insurance is coming out of your paycheck before you even see it, you don't realize you're paying for it (nor do you realize that your employer is paying for most of it). So it's a great deal and you love your health insurance company.

But if, and when, you get very sick or are in an accident, and have very expensive medical bills, the insurance company will try and avoid paying as many of them as possible, assuming Congress does not pass legislation that would prohibit this. Then what recourse do you have? Your insurance is through your employer. You're stuck with it. What good will "Obama's marketplace" do then?

If Congress does pass legislation forcing companies to pay all claims, in this scenario, they'll just jack up the price of the employer's policy when it expires at the end of the year. Then one of two things will happen:

1) The employer will find a cheaper plan (yea, right. At the very least, it'll mean higher co-pays and deductibles.). But since the (original) insurance company wouldn't be making money, or enough money, on this employer, they won't care. They'll gladly let another insurance company deal with this "costly" employer.

Or 2) The employer will just pay the higher rates, passing on what he can to the employees.

So much for "competition."

But there is one option this sick/injured employee has: leave the employer-based plan and buy into the public option, assuming there is one and assuming he'd be allowed to.

But again, this is another example of the insurance companies keeping the healthy and the government getting stuck with the chronically and costly sick/injured (if the employee did switch to the public option, saving the employer money in the process, would the employee get a raise?).

But all this brings us back to where we started - our asinine employer-based, for-profit system - which we're keeping intact and forced to work with and around. And that brings us back to the only solution: single payer. One company, or the government, getting stuck with the sick AND the healthy, with everyone throwing money into the pot, including the government.

As far as getting "something done," what worries me about Obama's "plan" is that it sounds very much like Bill Clinton's. And we know what happened with that. Clinton wanted employer mandates and called for "pooling" of small business so they can use their "buying power" and the "competition" of the "insurance marketplace" to get better deals. Sound familiar?

Also, Clinton tried to bar insurance companies from discriminating against anyone with pre-existing conditions and wanted to prevent coverage from being dropped. And here we are 15 years later, still trying to get it done.

As far as the public option is concerned, what will it cost? No one has brought that up. Two hundred dollars a month with a high deductible? That would be about half of what seniors pay for Medicare and supplemental insurance (without deductibles and co-pays). But the public option can't cost less then Medicare and supplemental insurance or else you'll have seniors bailing out of Medicare and signing up for the public option. Or would that be a good thing?

Even so, $300/mo. with no deductibles or co-pays, or $200/mo. with deductibles and co-pays for insurance through the public option is not affordable. Or is it?

That said, what if the public option does become a dumping ground for the chronically sick, injured and those with pre-existing conditions?

(Why would the insurance companies oppose the public option if it'll become the dumping ground for the sick and severely injured? Who says they oppose it? My guess is that if they can't kill reform, they're going to try and use the public option to cut a deal with the White House and Congress. They'll allow it in exchange for softer restrictions - as opposed to strict, enforceable restrictions - on "pre-existing conditions," denying claims and/or canceling policies outright. And in the legislation's fine print - which the insurance industry will most certainly write - they'll make sure the public option does become the dumping ground for the sick and severely injured. So whether there's a public option or not - as I've said - it'll be heads they win, tails we lose. Just like it always is. November 1 insert: Told ya. December 8 insert: Really told ya.)

What if you have insurance either through the public option or this "marketplace" - and you like it - would you be forced to drop it if you got a job that offered insurance?

We can "what if" ourselves all day. And every single time you're going to run right up against the asinine employer-based, for-profit system that we're stuck trying to work with and around. It would be like a doctor trying to cure a cancer patient, but he's not allowed to treat the cancer. No matter what he does, the patient will get sicker and the doctor will keep coming back to the cancer because that's the problem. But since he's not allowed to treat it...

And that's what's going on here. We keep running up against the asinine employer-based, for-profit system. That is the problem. That is the cancer. And Obama's not allowing anyone to treat it. So how can you possibly cure it?

So will health care costs really be controlled? Will the public option really be affordable (assuming there is one)? Will it stay affordable? Will seniors want in? If so, what happens to Medicare?

With Democrats bumping into each other, the Republicans and the insurance companies trying to kill reform, and no leadership whatsoever from the White House, I doubt we'll get the chance find out.

Also see The Republican Cult on Health Care.

November, 2009 insert:

The public option that was passed in the House this weekend isn't much of a one, unfortunately.

One of the ideas they were kicking around was that the public option would pay doctors and hospitals a set rate - what Medicare pays, plus five percent. That didn't get very far (made too much sense). Instead, their version allows the HHS secretary to negotiate rates with health care providers. In other words, the House version of the public option is very much like private insurance. Umm, isn't that what got us into this mess in the first place?

Higher payments to doctors and hospitals are obviously in the health insurance industry's interests because it would mean higher rates, higher deductibles and higher co-pays for those enrolled in the public option; and therefore, the insurance companies wouldn't have to lower their rates to be competitive with the public option. So much for "competition."

Of course, the key will be how tough of a negotiator the HHS Secretary will be. But with the health insurance industry contributing to bribing both parties, especially the party holding the White House, I think we can imagine how tough they'll actually be. So much for reform.

At least HHS Secretaries from a Democratic administration might put up a bit of a fight. But can you imagine Secretaries from Republican administrations? My God, appeasing big industry is all the GOP does (see the oil, coal, gas, timber, banking, finance, pharmaceutical and insurance industries). Heck, it'll actually be in the Republican President's interests to be extremely generous with public option payments because 1) Republicans have absolutely no desire to govern, ever, 2) they only care about big industry 3) they don't give a crap about anyone (including their brainwashed base) and 4) their only priority is to keep their brainwashed base enraged at liberals (to keep them from wising up and leaving this party cult).

How will they do that? Assuming the House's public option - with all the power going to HHS Secretaries - gets through the Senate, survives conference, passes both chambers, signed by Obama and actually implemented, like this:

The year is 2015...public option enrollees are seeing escalating premiums, deductibles and co-pays (gee, I wonder why). President Palin trots out White House Press Secretary, William Kristol, to spin the higher costs:

You have to remember that when the President was a private citizen in 2009, she vehemently opposed the former President's 2,000 page health care bill. And now the country is seeing the results of that. While this President is steadfastly working, trying to make it easier for every American to have the best health coverage possible, the recent spike in premiums and out-of-pocket expenses that we've seen in the public option are, predictably, the result of cumbersome big government rules and regulations that were implemented because of that health care legislation. And the President believes that competition - and not government - will bring down health care costs for everyone. And that's what she's striving for, day and night.

You see? It'll be the evil, Nazi, Socialist liberals fault. That will sure enrage the brainwashed base. And Congressional Republicans will turn up on Fox "News," every hour on the hour, forever, telling everyone, "we told you so."

Mission accomplished.

I know the House "had to pass something" and the Senate will too, eventually (I think). But I get sick and tired of hearing, "well, it's a bad bill, but...," or "it's not a perfect bill, but...," or "it's the best bill that could pass...," or "it'll be all worked out in conference" (no it won't); all of which we heard after the TARP legislation, the stimulus bill and the banking bill. And what good did those bills do? So why should we expect anything different out of the final health care bill (assuming there is one)?

Did it ever occur to these schnooks that maybe one of the reasons why the country is falling apart and getting worse is because of all these "had to pass something, bad bills?" Did it ever occur to Democrats that we're in this mess, not because of too much government, but too little, and with some leadership and self respect, they could have gotten a real health care bill through that actually solved the problem?

Of course not, because despite huge Congressional majorities and the White House, Democrats are scared to death of the Republicans. In fact, Democrats are so pathetic, and that goes for Obama too, that they couldn't even take candy away from a baby...because they are the baby.

November, 2009 insert:

Ezra Klein of the Washington Post:

The public option will serve three or four million people and have slightly higher premiums than private insurance. The co-ops will have such an insignificant effect that the CBO didn't both to estimate their impact. The exchanges will serve 25 million people in 2019, and Medicaid and CHIP will see a 15 million-member increase.

Only three or four million in the public option? And it'll cost more then private insurance? Umm, wasn't this supposed to be about competition?

The "exchanges" will pick up 25 million? And they'll presumably cost less then the public option (yup, makes sense to me!)?

Fifteen million more being placed into tax-payer funded Medicaid and CHIP? Umm, wasn't that the problem?

I thought this was about reform. Hey, I told ya.

When this legislative process started, President Obama said that health care reform had to be deficit neutral. But the House and Senate bills went even further. Both are estimated to save over $100 billion over 10 years.

It's refreshing to know that our illustrious leaders can continue to find hundreds of billions of dollars, every year, for an unnecessary war in Iraq and a disastrous war in Afghanistan, and trillions to bail out rich, powerful bankers on Wall St., without giving the deficit a second thought, or any thought for that matter. But when it comes to health care for all Americans (what could possibly be more important or a better investment?) that's when we have to watch our pennies because God forbid we go into deficit spending for something as worthwhile like that.

November, 2009 insert:

Heath care is expensive. Very expensive. And everyone wants a million-dollar health insurance policy. But only a handful can afford that. Even with "free market" forces, health care is not and will not be affordable. And that's why the profit motive has to be removed from the equation. That alone would automatically cut 20-30% of its cost.

But even with that deep discount, health care would still be expensive and unaffordable for most. And that's why - and where - government should step in. They can run a deficit. They can tax. They can regulate.

Is health care "a right?" Who cares! Deficit spending for something as practical and worthwhile as health care is exactly what government should do for its people.

Like education, is there anything more important?