Wednesday, August 4, 2010

Its the Bill Not Healthcare Reform Stupid

The following appeared before the passing of the current Healthcare Reform Bill, however alot of the issues discussed are still valid, and considering that voters in Missouri just voted against Healthcare Reform as it stands something still needs to be done and done before we end up with a fiasco. If you notice, my conclusion is that the Bill is half-assed. It just didn't go far enough to really do any good in the long run. I also disagree that something is better than nothing, Congress could have just passed a law making it federal law that autism therapies need to be covered by insurance companies, it didn't have to try to revamp so quickly, blindly and without much thoughtful analysis (remember the post CBO  numbers showed that it is not deficit neutral, but a potential drain on the economy)1/6th of the US economy. Comments are welcome as long as they are constructive and thoughtful and add to the discussion. Anything less than that will not be published.

A lot has been written about whether the “healthcare” bill can pass constitutionality if passed by Congress and signed into law. The pundits discuss the use of the commerce clause, or the health and welfare clause or even the supremacy clause in order to bolster their points one way of the other. Truth be told no one really knows what will happen when the nine Supremes get their hands on any type of bill that will eventually pass the congress. I doubt SCOTUS even knows. They can’t know. There is nothing to know right now.

But one thing I do understand in the midst of the entire hubbub is that something very important is getting lost. I think that something is the will of the American people. The American people have plainly told the Congress we do not want this bill. We do not want another fiscal calamity in the making. We do not want the government interfering in our day to day decisions about our family’s health. We do not want government controlling 1/6th of the American economy. We do not want big government, big daddy or big brother. Too many in Congress are just not listening. They have forgotten that they serve us, not we serve them.

Ok, but what do we want. Well near as I can tell, what we want is a fair shake. You spend your life as a good and decent person. You work hard. You pay your taxes. You take care of your family. You want to know that you will be able to own a home. You want to know that your children will be educated. You want to know that if you get sick you can get help. Now, of course, it is a misunderstanding that those without medical insurance will be turned away from an emergency room. Yes there are instances of patient dumping. Heck a famous Chicago hospital used to be known specifically for a dumping plan created by their well paid Harvard educated attorney. But for the most part, if you are in need you can get help. Is it perfect, of course not, nothing is. But this idea of discrimination based upon income is false.

Yet there are some real issues with healthcare in today’s society. The premiums are through the roof. The idea that you cannot pick and choose what you want in your policy, you have to take what is prescribed by state law is absurd. That there cannot be any inter-state competition between insurance companies seems downright un-American. Insurance companies can deny you coverage due to a pre-existing cause in all but a few states. Insurance companies may deny you coverage because you have a disability. Insurance companies may drop you if you become too high risk, and insurance companies can prevent you from receiving the latest medical care and access to the latest technology.

So what do I think should happen? It’s really very simple. Competition. Competition. Competition. But not the competition we have today, but real open market competition. Firstly, make the insurance companies abide by the anti-trust laws. Remove the exemption for them. This way there would be a free and fair market value of the product. Next, have interstate completion. Yes, the health and welfare clause of the constitution leaves health and welfare to the states. Yet, we have the FDA, Surgeon General, NIH, CDC and OSHA, all with direct health and welfare benefits to the population. Additionally, the commerce clause can come into play just as it does with regulating the flaps on the back of a semi. You would think that taking care of someone’s health insurance, which would allow them to travel and change jobs, thereby promoting commerce, would be in the interest of government, just as the regulated size of mud flaps on the back of a semi was a major concern. But who am I to judge, right?

Next idea would be that people should be able to put into their health insurance policy what they want. The state requires certain practices in an insurance policy because the insurance lobby has invested millions in lobbying efforts to make sure that certain practices are or are not included in the insurance bills. You don’t have a choice to pay for maternity care, geriatric care, obstetrical care, or alternative therapies (acupuncture) if you don’t need it. It’s put in your policy and you either take it like it is or go without. We have more choice in how we protect our automobiles than in how we take care of our families. We should be able to choose something akin to an old-fashioned Chinese restaurant menu-one from column A and one from column B, pick your deductible, co-pay and prescription plan. I have to admit that one of the things that I fear the most about changing jobs is whether the new prescription plan will cover my children’s medications? It can hold you back, from helping yourself. No one should have to live like that.

I know that we hear that a lot of these topics that I am discussing here are in the bill winding its way through Congress. But there is something else in that bill that makes me uncomfortable, the loss of privacy. I find it ironic that the first people to scream about the right to privacy and nongovernmental interference at red lights (oh they rail about traffic cameras) are the first ones who think the government should control your healthcare information. That somewhere in the deep recesses of the newly created Department of We Know What’s best For You, will be the medical files of every man, woman and child that lives in the United States. Oh, no they say, they are not going to force anyone into a one-payer system, but when you make it impossible for small business owners to afford insurance for their employees where are we supposed to go next? To the government. You know the ones that just said not to get a mammogram until age 50, that’s it economically more viable to wait because the death rate for women in their 40s is not so bad. I guess unless of course you are one of the women in their 40s who ends up dyeing from breast cancer because the government would not give you a mammogram. I think we have already seen the commencement of government run healthcare in the United States and quite frankly all I see is death at an earlier than necessary age.

But what about privacy? Those who claim to defend the Bill of Rights scream and carry on about the right to privacy in our daily lives. That to have city-wide cameras to catch criminals is a violation of our right to remain anonymous. Truthfully I don’t buy that. Once you leave your house, you are no longer in the privacy of your home. Once you talk on a cell phone, you use public cell towers. Once you sit at the internet, you are on the information superhighway. There is no privacy. You put yourself out there. You place yourself in the purview of the world and the world has a right to watch you. Being in public is not being in the privacy of your own home, it’s not even the level of privacy afforded being in your car.

Oh yeah the car argument. Doesn’t the government make you buy insurance when you own a car? Well yes it does. But no one said you have to own a car. You can bike. You can walk. You can take public transportation. Driving is also seen as a privilege not a right. Therefore, the government can make any regulations it deems fit, due to public safety, when it comes to driving. But for the government to tell you, you have no choice but to buy a product is definitely beyond the purview of their powers. They can tell the country what a product is supposed to be and how it is to be configured and can even regulate its safety levels, but they can’t make you go out and spend your money if you do not want to.

It’s also ironic that those who are so hell bent on maintaining the right to privacy when it comes to procreation, an implied right, not even a fully thought out one at that, want to ignore how a government health care plan would challenge that. No I am not going to get into the abortion debate and who pays for what; I think it’s a much more simple issue that people seem to have forgotten about. Simply put, the government in deciding whether to fund birth control in its health care plan will be directing the privacy procreative rights of whoever is part of the plan. Government can’t tell you how, when, or where to procreate. It may tell you appropriate places to have sex (indecent exposure laws) but it can’t tell you no. But when it comes to control over birth control then the government will be interfering in your ultimate privacy rights. Funny how that doesn’t bother some people.

So what do we do, or what do we have? We have a broken system of that everyone agrees. It is the best health care system in the world, but that does not mean it does not need improvement. Yes there are programs for the poor and especially for poor children. Yes there are programs for seniors; I have to say that personally Medicare Advantage has saved both of my parent’s lives.(Interestingly it is also the Medicare program that the Congress wants to kill). But there are problems:

-The cost is staggering. But that does not mean transferring the cost from the private to the public sector will make it better. In fact, I think it will just get worse.

-The fact that people can be denied insurance if they have a pre-existing condition is wrong, especially since it is those with disabilities who get denied more than most. Otherwise healthy children on the autism spectrum are being denied basic health care because insurance companies fear that they will have to pay for autism related therapies. The cost of disabilities is staggering to a family. Most with disabled children will face the possibility of bankruptcy at some point in their lives. (Believe me if you don’t live it, you can’t understand the overwhelming cost of creating a future for the disabled. Ironically too, most of what is needed by a person with an invisible disability is not covered by insurance today. No matter how high your premium, everything is still out of pocket)

-The fact that people’s insurance can be cut off in the middle of treatment.

-That insurance companies are exempt from anti-trust laws and that there is no competition.

-That states do not allow people to shop for their individual configurations of insurance policy.

-That in the end it is those who fall through the cracks of society that need help. We also should never assume that we will not be one of those through the cracks. But we need to have a way that government does not control who we are and who we will become just because at some point some of us, will need society’s help.

-Another interesting point that everyone fails to mention is the fiduciary duty of the heath insurance company to make a profit. If those who run the company do not make a good faith effort to create a profit for their shareholders, they are in breach of their fiduciary duty and can and will be sued by their shareholders.

Somehow this law needs to be rewritten in the health care debate. Profits and compassion do not always go hand in hand unless we make it.

This has just been a few ideas that I have had about the healthcare debate. I leave it to you to decide whether you agree with me or not. I leave it to you to decide if my Constitutional reasoning is sound or not. But most of all I leave it to you to join in the discussion and find a way to make your voice heard.

Until next time,