Health Care Thoughts

I have no solutions for our health care mess, but I'm sure of these two things:

• Health care costs run the risk of ruining small businesses that provide health insurance for employees.
• The cost of individual insurance not only hurts self-employed people, including farmers -- it suppresses innovation by keeping people at their day job when they have every ability to go off and create the next great business idea.

Several interesting things I've seen on health care in the last few days:

Garrison Keillor's op-ed in today's Star Tribune:

In the past two weeks, I've attended two benefit concerts to raise money for musicians to pay their medical bills, and that is just ridiculous. Why should anyone, least of all a valuable contributing member of society, have to pass the hat to pay the doctor? But there I was, watching one of America's few true-blue cowboy singers hoist himself on crutches onto the stage to since "The Old Chisholm Tail" as we put our twenties the pot to pay for his pelvis, broken when a horse threw him. A cowboy singer can only afford the $10,000 deductible health plan and that means he must sell Old Paint or become a charity case.

And my response to Garrison was, It's good the cowboy singer even had the $10,000 deductible plan, because I know of many musicians and other self-employed people who don't have anything who are approaching late middle age.

A friend posted this short clip of a Congressional hearing on Twitter. It's an exchange between Dennis Kucinich and Dr. David Gratzer, a Canadian who advocates privatizing Canada's health care system:



Dr. Gratzer is part of the Manhattan Institute, a think tank advocating free enterprise solutions, funded by conservative foundations like the Koch and Walton Family Foundations and corporations like Cigna and Bristol-Myers Squibb.

I've heard or read a lot of comparisons of the Canadian vs. American systems. One op-ed from the Denver Post listed eight myths about the Canadian health care system. Its author, a Canadian clinical psychologist living it the U.S. for close to two decades, declared that the following are myths:

• Myth: Taxes in Canada are extremely high, mostly because of national health care.
• Myth: Canada's health care system is a cumbersome bureaucracy.
• Myth: The Canadian system is significantly more expensive than that of the U.S.
• Myth: Canada's government decides who gets health care and when they get it.
• Myth: There are long waits for care, which compromise access to care.
• Myth: Canadians are paying out of pocket to come to the U.S. for medical care.
• Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.
• Myth: There aren't enough doctors in Canada.

I also just read this interesting piece on Snopes. It's a point-by-point examination of the claims made in an email that's circulating, supposedly written by a regular Canadian citizen. The email makes claims such as "I am personally in the 55% income tax bracket" and the "Government allots [only] so many operations per year" and "Forget getting a second opinion, what you see is what you get." The Snopes response is very measured and fair minded, often pointing out that the claims made -- such as "Shirley's cousin was diagnosed with a heart blockage. Put on a waiting list. Died before he could get treatment" -- are unverifiable and so vague that anything could have caused the death [even if "Shirley's cousin" isn't a complete fabrication -- DN3].

Today's Pioneer Press included an op-ed by Michael Tanner of the libertarian Cato Institute called Obama's Right -- We Need Health Care Reform But He's Wrong about What Kind. In it, he proposes unmooring health insurance from employment. As he points out, it is unfair that employed, insured people get their care tax free while someone who pays for insurance from self-employed income has to pay taxes on her/his benefits. Instead, people would pay taxes on their benefits and both employed and self-employed people would receive either a tax deduction or a tax credit to compensate.

At first I thought this sounded more fair than the current system, but then I remembered that self-employed people are able to deduct their health costs from their taxes. While it is not equivalent to the tax break employees receive, it does cover part of the difference. What self-employed people don't have is access to affordable plans, since they aren't part of a group that spreads out the risk. So unless they can get access to care through a spouse's company (even if they have to pay for the plan), the price is outrageous or has a a very high deductible, as in the case of Garrison's friend, the cowboy singer -- or both. I heard an NPR story that told of a farm couple whose only health insurance options cost between $12,000 and $20,000 per year for the two of them, with a $2,000 deductible!

Tanner also called for removing the interstate ban on health coverage. As it stands, you can only purchase health insurance within your state, and each state has its own list of benefits that companies must cover. As with any op-ed, Tanner picked the two extremes: New Jersey, which requires coverage of in vitro fertilization and coverage of children to age 25 (and costs $5,580 a year for a healthy 25-year-old male) vs. Kentucky, which costs $960 per year (no mention of what they do or don't cover). Tanner thinks that a young guy in New Jersey should be able to buy the Kentucky plan, and a bill sponsored by Rep. John Shadegg, R-Ariz., would do just that.

What's wrong with that? Health policy specialist Bob Laszewski writes, "In the end, the young and healthy would get much more affordable policies and the old and/or sick would be worse off." (Kind of like how privatizing Social Security would probably work for the young and financially fit, but not too well for anyone else, or how giving school vouchers would leave all the kids with the most needs in the public schools.) Laszewski writes:

So what exactly does the Shadegg bill get us?

Well it would get Mr. Mathews' insurance company trade association, the “Council for Affordable Care” a wild-west market environment to go find all of those young healthy people and sign them up for really cheap coverage.

Young and healthy people would pay a lot less and older and/or sicker people would pay a lot more if coverage were even available to them.

New Jersey is a dysfunctional health insurance market. But fixing that state, and others like it, is a lot more complicated than putting the “cherry pickers” back in charge.

No one would argue that (in a market-based system) a young person's or a healthier person's insurance shouldn't be cheaper than that of an older person or a unhealthy person -- but allowing purchases across state lines will clearly have unintended consequences that are likely to affect the sickest and poorest the most.

That's all I've got to say on the subject of health care reform for now. But if we don't make some substantial improvements in our health system in the next few years, I'm going to be one disappointed voter. The only question is who'll get the blame.

LATE ADDITION: Via BoingBoing, I just read a Bill Moyers interview with Wendell Potter, former head of communications at Cigna. This is the guy who wrote the talking points for opposing the Clinton health reforms, as well as for quashing Michael Moore's movie Sicko. You may have heard about Potter's more recent change of heart -- he testified before Congress to say that insurance companies purposely let people onto their roles despite knowing they have undeclared preexisting conditions, take their premium payments for a while, but then as soon as the person seeks treatment for the condition, the company disallows it and drops the person from the rolls.

How did someone who had worked in the industry for so long come to have such a change of heart? This is what he told Bill Moyers:

WENDELL POTTER: I went home, to visit relatives [in 2007]. And I picked up the local newspaper and I saw that a health care expedition was being held a few miles up the road, in Wise, Virginia. And I was intrigued....

It was being held at a Wise County Fairground. I took my camera. I took some pictures. It was a very cloudy, misty day, it was raining that day, and I walked through the fairground gates. And I didn't know what to expect. I just assumed that it would be, you know, like a health-- booths set up and people just getting their blood pressure checked and things like that.

But what I saw were doctors who were set up to provide care in animal stalls. Or they'd erected tents, to care for people. I mean, there was no privacy. In some cases-- and I've got some pictures of people being treated on gurneys, on rain-soaked pavement.

And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee-- all over the region, because they knew that this was being done. A lot of them heard about it from word of mouth.

There could have been people and probably were people that I had grown up with. They could have been people who grew up at the house down the road, in the house down the road from me. And that made it real to me.

BILL MOYERS: What did you think?

WENDELL POTTER: It was absolutely stunning. It was like being hit by lightning. It was almost-- what country am I in? I just-- it just didn't seem to be a possibility that I was in the United States. It was like a lightning bolt had hit me....

Just a few weeks later though, I was back in Philadelphia and I would often fly on a corporate aircraft to go to meetings.

And I just thought that was a great way to travel. It is a great way to travel. You're sitting in a luxurious corporate jet, leather seats, very spacious. And I was served my lunch by a flight attendant who brought my lunch on a gold-rimmed plate. And she handed me gold-plated silverware to eat it with. And then I remembered the people that I had seen in Wise County. Undoubtedly, they had no idea that this went on, at the corporate levels of health insurance companies....

I was trying to process all this, and trying to figure out what I should do.... One of the books I read as I was trying to make up my mind here was President Kennedy's "Profiles in Courage."

And in the forward, Robert Kennedy said that one of the president's, one of his favorite quotes was a Dante quote that, "The hottest places in hell are reserved for those who, in times of moral crisis, maintain a neutrality." And when I read that, I said, "Oh, jeez, I-- you know. I'm headed for that hottest place in hell, unless I say something."