Until rather recently, I’ve been feeling pessimistic about whether Congress would manage to pass meaningful heath care reform this year.  My opinion is changing, and for the better.

Barely a few weeks ago health care reform seemed all but dead.  In the House, progressive Democrats staunchly held their ground in support of a robust public option to be included in the House bill, vowing to kill any bill that did not include one.  Things in the Senate looked bleaker: conservative (read: fake) Democrats killed an amendment proposed by Senator Jay Rockefeller to add a public option to the bill that emerged from the Senate Finance Committee, and the party leadership (including President Obama) continued to waffle on support of the public option.  It seemed like the health insurance industry had once again bought enough Democratic Senators to kill health care reform.

Then, the health insurance companies overplayed their hand.  After the Finance Committee bill was finished, the insurance industry essentially said that if the Finance Committee bill passed as it was, they would raise premiums on everyone and make the current health care crisis even worse than it already is.  This set something off in the Democratic Party, who all of the sudden, with well over half of Americans supporting the public option, started to rally behind it.  Senate Majority Leader Harry Reid, in probably his first ever showing of leadership, is now including a public option, albeit a much weaker one than we hoped for, in the bill that the Senate votes on.

The Faux-Democrats in the Senate have made either muted or backhanded criticisms of the plan.  Some, including Ben Nelson, have said that they would vote against a Republican filibuster of the bill but then not for final passage of it, giving them political cover (I’m not quite sure from what, perhaps their campaign contributors?) by allowing them to vote against it.  In the House, Nancy Pelosi, progressive Democrats and the party establishment have effectively neutered the Blue Dogs.  Howard Dean has said many times that not supporting the public option will cost Democrats re-election assistance from the national party.

Granted, since then there have been some setbacks, most notably that turncoat bastard Joe Lieberman, who seems hell-bent on screwing the Democrats at the slightest opportunity, came out the day after Senator Reid’s announcement and said that he was planning to join the Republicans in filibustering any reform bill that contained a public option.  I have a few hunches that his opposition will be short-lived.  First, there has been talk of stripping Lieberman of his seniority on committees, which includes chairmanships on the Government Affairs Committee and Homeland Security Committee.  Second, his stance on the public option is very unpopular in his own state – 68% of voters in Connecticut support the public option.[1] Two of the five representatives have accused Lieberman of being “out of touch” with his constituents (Connecticut’s other Senator, Chris Dodd, is an outspoken supporter of the public option).  At the same time, Lieberman unfortunately cannot be thrown out of office until 2012, but he takes a massive political risk being so stubborn in light of the views of his constituents.

Don’t get me wrong, whatever reform we get is going to be FAR from perfect, but consider this.  Social Security wasn’t perfect when it was first implemented.  It has been amended to and expanded multiple times since its initial implementation in 1940.  Benefits have been added, more people have been made eligible to receive benefits, and a trust fund was established to keep the program solvent – none of these were included in the original bill.  Given this history with other social programs, it’s unrealistic to expect perfect reform right off the bad.  At this stage, an imperfect but decent bill is the best we can hope for.

“NObama has called for innovations such as a public health insurance plan to compete with private insurers, but he has not insisted on it. It was not clear Tuesday the degree to which he might press for various proposals in a new speech.” AP via Yahoo.

Drudge says that Politico says he’s totally backing down from the Public Option. I knew he was going to crack. TURKEY!!! You should have run as a Republican, you would have gotten more stuff done, honestly.

So, it appears that the new boss is in fact the same as the old one, doing just what the lobbyists want. Kowtowing if you will. This is not what I voted for, this isn’t what I put a magnet on the back of my sweet Moses Jackson Spaceship for (the head and GPS of said spaceship pictured left). This is totally and completely inexcusable Nobama.

It marks a victory for the do it yourself and don’t let the government run your life crowd. But to me, these ideals don’t apply here. We live in a country where if you’re buying more of anything, you get a lower price. Don’t believe me? Go to any buy-in-bulk store. The same applies to purchasing insurance plans—and in the case of the government it is not run for profit. Here you’ll find a quite convincing argument in accordance with my assertion.

An insurance company is already a quazi-governmental entity anyway. It has bureaucrats who answer the telephone and tell you they won’t cover your medication since you don’t have swine flu insurance.[1] They process paper work all day long, just like the DMV, the Post Office, and the legal system. All that reform would really bring to these entities would be a decapitation and a head transplant—except the new head wouldn’t suck so much money out of the rest of the body (GOD I WISH I HAD A PICTURE for this).

At the end of the day, that’s less money you pay for your insurance. PERIOD. Why should I pay for some guy to drive around in a Ferrari and get denied insurance because of a “pre-existing condition.” Guess what America, we ALL have a pre-existing condition called You’re Going to Die. Until they figure out how to harness the power of stem cells and brain regeneration, it’s going to get you. Bill Gates could spend all his money, and maybe he’d get cloned.

It’s a fact that nationalized systems cost half as much per-capita; I ask, honestly, why pay MORE? (Here’s where I get my facts) If we need more doctors, to accommodate a higher surge of new patient populations, build more medical schools. I’m ready to go, Noboma. Why don’t you summon the power of Kennedy and bring that change we can believe in.

That’s wishful thinking. I put $10,000 up that says Wall St. gets another pile of money before year’s out. The FED can print dough for the cats who brought you subprime, but not for the health of the average Joe Six Pack. (Eat it Palin)

So honestly, you should probably get some insurance, because a sudden traumatic accident can produce a hefty bill. Or be really careful…just know that the universe works in strange ways and you don’t always have control. Truth.

Maintain yourself. This is America. Self-Determination is part of our culture and keeping your helf is important. There are several ways to do this, guidelines I find helpful. One is the BMI calculator (found here), this is ok for the average body type, usually, but it is probably not always accurate. Por ejemplo, tu puedes ser completamente de musclos y en esa caja usted sería gordo.

Another helpful gauge of good health is body fat percentage. You need fat, so some is good, but too much in the wrong places can possibly lead to disease. To measure BFP you can get a scale that shoots electricity into your toes. Based on the conductivity of your little piggies, it determines how much of that ass is in fact fat. Or you could go by my badass method of arm-veinage degree. However, Madonna has proven that big veins don’t work for everyone. (This chart should give you some idea…)

Eat well. Walter Willett wrote a great book on diet called “Eat, Drink and Be Healthy.” It presents scientifically backed information on proper diet as opposed to the one funded by the Dairy/Corn/Meat industries. Get a checkup every couple years if you feel you are healthy. Checking basic vitals like blood pressure, the composition of your blood, (specifically how much of it is red blood cells), the content and type of fat you carry, saturated (bad) or unsaturated (good), making sure no weird microscopic blood bathing demons are swimming about, etc.

Get off your rear and exercise—and never stop. The best way to stay alive is to keep moving and shaking. You don’t have to go to the gym, just run around your block, ride a bike, play some kind of sport. Just stay active.

Going forwards, I feel it’s safe to assume our government benefits will get worse if we continue to follow this trend. Your health is your own concern for the foreseeable future, so do all that you can to preserve it, and you may enjoy a long and happy life.

In the meantime, I would like to protest my dissatisfaction publicly. Would anybody like to pick a good spot and go make some noise in the next week?

There seem to be some persistent and wrong assumptions about policy issues that are used to frame positions and prescriptions such as mine, particularly in the currently volatile subject of medical or health care reform. So, in order to better the understanding and serious consideration of what I have presented here, I have decided to take a step back and place medicine and its reform in an economic context.

Medical care has not always been a market. Because of the pressure of history and long tradition, it is not exactly a real market even today. Doctors still make decisions contrary to cost-benefit analysis but consistent with the Hippocratic Oath. Hospitals still treat indigent patients, though the for-profit hospitals do so because of laws written in memory of the mission of their predecessors: municipal and charity hospitals. We even have federal government programs to pay for the medical expenses of the poor and elderly, not by giving them X dollars to spend in a market where the doctors and patients are bidding and offering, but by giving the doctors a more or less blank check. There was never such a market for healthcare, so there was not a basis and history of market pricing for public or private insurance to go on.

Instead, what has been used by insurers to dispute or challenge the medical fees has been the usual and customary rates (UCRs). This is fundamental to understanding the economics of medicine both with and without insurance. In insuring anything traded on an actual market, current prices and price history on that market for that commodity or service, or a near-substitute, would be used to appraise the value of a commodity insured or of the need for a service insured against and thus the payout for loss or need, respectively. UCRs are an admission that this is not the case in medicine and that something quite different applies, namely a rate schedule. Such a schedule is arbitrary in the particular, leading to fees which are in whole dollars divisible by 5, like $15 or $20 rather than $17.43. If he has too many of one kind of case to his liking and there is another doctor in town he can push some of those cases to, he can raise the rate for that service. At least, he could do that before the insurers took over. Now he has to remove the bunion and take the UCR, or refer all of the cases to a podiatrist. The UCR, however, is based on an a la carte view of medicine which misinterprets the rate schedule as particular charges for each service and thus considers the portion of the fee which incorporates general physician preferences or distastes as actual costs.

A more serious criticism of UCRs as a measure of cost pertains to the aspect of the rate schedule which is less arbitrary. The array of doctor’s fees are, in the aggregate, more finely tuned to what the typical patient in his community can afford, than any particular fee to actual cost or even affordability. This is how doctors’ fees in the larger towns would generally increase or decrease as a group for all doctors in the town. When the townsfolk are more prosperous, or inflation has set in, the fees for the typical patient would go up. When the iron mill closes and half the town is out of work, the fees would go down. Sometimes there was a divide between the rich and the rest, so that affordability was worked out through a sliding scale. In that case, there is no one UCR schedule, even for a single community, but one for each wealth group. With their basis in affordability, the general level of the community rate schedules bore no relationship whatsoever to costs.

When insurance comes into the equation, the fees are not entirely paid directly by the patients, as they had been in the past. Instead, the insurer pays a portion of each fee and the patient pays the rest. Thus, the schedule of rates to the patient is a fraction of the schedule of rates to the insurer. Doctors know, then, that they can charge higher fees to the insurer without any change in the affordability to the patient. For example, if the patient pays 20% and the insurer pays 80%, the doctors can charge five times their pre-insurance fees without a change in the affordability of their rate schedule to the patient. This provides an inexorable opportunity which the insurer’s adoption of a formalized process of determining a uniform UCR schedule can only delay but not prevent. The higher rates in wealthy urban and sprawl communities supplant the cheaper ones in rural and poor communities. Further, new procedures and new services can be introduced at already inflated rates as uncontested UCRs.

This, then, is how insurance causes an escalation of medical fees. Note that the nature of the insurer is immaterial. This happens with both private and public insurers. Among the private insurers, it happens with both non-profit and for-private companies. It is a logically inevitable, mechanical outcome to the imposition of insurance onto an affordability-based fee schedule. Thus, the high price of medicine under insurance is not caused by greed. In fact, the causality is in the opposite direction.

Doctors, by creed and long tradition, are concerned only about their patients. They do not care about insurers or whether they can save them a dime. Thus, they have no qualms about overcharging insurers as long as their patients are not hurt. With employers providing health insurance as a benefit, indeed being considered a “good” employer on the basis of that benefit alone, even the higher premiums resulting from the inflated fees did not hurt the patients, as long as they remained employed by an employer who remained “good”. And so the doctors overcharged, took payments from the insurers and thereby got the taste of money themselves. Then, just as they were getting greedy from the windfall that insurance produced, other more traditionally greedy groups saw an opportunity to grab a little bit of the action for themselves. Private educational institutions, with their sanctimonious greed for grander buildings and facilities in the advancement of learning and their own research interests, saw an alliance with a fledgling professional association as an opportunity to advance their development plans and offer a lengthier medical program with exorbitant tuitions which the new doctors could pay back with the inflated fees. Greedy trial lawyers saw a new class of people to sue on the flimsiest of grounds and tried to appear sanctimonious as they brought malpractice suits against medical teams for not saving one life out of a hundred in peril. Private companies bought hospitals and ran them like businesses, with hefty salaries for management and huge returns for the investors. The insurers, led by sleezy businessmen or corrupt government officials, feeling left out, started going for-profit, for-graft or for-power, and saw how they could pocket some of this wealth in higher salaries, lavish office complexes and innumerable employees to lord over. All they had to do was deny claims on technicalities, force doctors to prescribe from the formulary of cheaper but less effective or inappropriate medicines and increase deductibles and co-pays, in short, create “bean counter medicine”. In every part of the new medical establishment, insurance has introduced greed and fostered corruption.

Therefore, there cannot be any medical reform without the elimination of insurance from all facets of medicine. Nor can there be any reduction in medical fees without ending the insurance windfall. It does not matter whether there is one insurer rather than ten, single-payer or public option or the same cast of sorry characters. None of these represents real change because none removes insurance from medicine. To use a self-referential metaphor, insurance is the disease which is killing medicine. And there is no homeopathic response here, insurance being like a cancer. There is no cure but to remove it.

That is why I am so insistent on direct and free provision of medical services. If your local medical department sends a doctor on a house call to see your sick child, there would be no payment, just as there would be no payment for the fire department to send a truck to put out the fire in your house. With no payment, there would be no cost to insure against and thus no need or avenue for insurance. The medical department would pay the doctor a salary, like the fire departments, other than the volunteer ones, pay their firefighters. Of course, doctors would be paid more than firefighters. They may even find themselves earning more than they do now, if municipal workers are exempted from civil lawsuits. Not having to pay malpractice insurance would be a huge savings for the doctors. It would also be a huge savings for the public since many malpractice-inspired and medically unnecessary tests would no longer be performed. In these and so many other ways that municipal medical departments supplant insurance, they show that they are the only true cure for the ills of our medical system, the only true health care reform.

]]> http://johnsonvillepress.com/economics-of-medicine-carl-peter-klapper/feed/ 4 http://johnsonvillepress.com/really-newt-really-the-issue-of-the-death-panels-dave-imbriaco/ http://johnsonvillepress.com/really-newt-really-the-issue-of-the-death-panels-dave-imbriaco/#comments Wed, 12 Aug 2009 01:40:17 +0000 Alex G http://johnsonvillepress.com/?p=455 Read more »]]> This post was originally published at the Internet’s newest and hippest blog devoted to the health care debate, Give Me Health Care or Give Me Death! Check out the site when you get a chance.

I always knew Newt Gingrich and I disagreed on a lot of things, but after his many appearances on The Daily Show with Jon Stewart, I felt I could take comfort in the fact that while we disagreed, he was still an intelligent, reasonable man. This weekend my image of Mr. Gingrich was shattered.

Last week, on 9 August, Newt defended Sarah Palin’s outrageous claim that President Obama’s health care plan included a certain “death panel” where “government bureaucrats” would decide whether a very ill person was worth saving. Just for the record, there is no “death panel” in ANY of the proposed health care plans currently in Congress. The only thing remotely close to that outrageous claim is on page 425 of the House Democrats bill, which is about “Advanced Care Planning”, which “includes living wills and durable powers of attorney that allow individuals to make clear their wishes for end-of-life care, whatever they may be.” This is no death panel, it’s the options I’d like to have if I was terminally ill with cancer or whatnot. These are the protections that would allow people to die with dignity and hopefully in less agony, and the Republicans are twisting it around for political advantage.

Actually, a similar program was actually proposed by a PRO-LIFE CONSERVATIVE REPUBLICAN, Senator Johnny Isakson (R-GA). Two years ago Senator Isakson co-sponsored two bills – The Medicare End-of-Life Planning Act and the Advanced Planning and Compassionate Care Act – that championed the case of advanced planning. To date, Isakson has remained conspicuously silent on the issue. On the other hand, at least someone in the Republcian Party understands the merits of advanced care.

I should also mention that we already have death panels that decide whether you’re worth saving or not. They’re called private insurance companies, and they do it every day. Perhaps if Sarah Palin’s health insurance company was slightly less generous (aka, treated her like the rest of us) about her disabled son, Trig, maybe she’d be singing a different tune.

The national discussion on health care reform has recently taken a dangerous turn. What should have been a meaningful discussion on goals and feasibility has been transformed into a campaign of deliberate misinformation. The goal of this campaign is not to enact any meaningful reform whatsoever, but to foster an atmosphere of fear and misunderstanding that will threaten any attempt to change the status quo. This campaign has been portrayed by its founders as an organic grassroots campaign; however, the validity of this claim is suspect. Several journalists and reporters have uncovered evidence that massive corporations with a stake in the health care industry have been major donors to the so-called grassroots campaign.

Let’s consider some of the claims that have been propagated regarding President Obama’s and the Congressional Democrats health care reform bill.

Recently, Senator Charles Grassley (R-IA) attempted to illustrate the evils of government health care. His example was his fellow Senator Ted Kennedy (D-MA). Sen. Grassley claimed that Sen. Kennedy would have been denied treatment for brain cancer had he been covered by a government insurance program, like those in Europe. His implicit claim was that private American insurance covered Kennedy’s treatment while government European insurance would have let him die. This argument is easily torn down when you realize that Sen. Kennedy is covered by government insurance. As a federal employee, Sen. Kennedy is covered under the Federal Employees Health Benefits (FEHB) program. While it is true that Sen. Kennedy is probably receiving above-standard treatment due to his wealth and status as a Senator, he is covered by an insurance program run by the Federal Government.

This methodology has carried over to discussions on Medicare. At countless town hall meetings and interviews, protesters and even U.S. Senators and Representatives have decried the socialistic power grab of the U.S. Government to expand its control over Medicare. Even Art Laffer, the economist known for the Laffer Curve which measures the relationship between tax revenue and tax rates, has rhetorically asked, “What will happen when Government runs Medicare?”. It is very hard to believe that these individuals do not know that Medicare is an example of an incredibly successful government-run program. Medicare has been wildly popular amongst those it covers. Citizens aged 65 and over who are covered by Medicare have been very resistant to any proposed changes. That doesn’t exactly seem like the type of behavior of people who are being screwed over by government bureaucrats.

Much of the senior citizen discontent has been fomented by outright falsehoods. The wild claim is that Obama’s health care plan would force mandatory euthanasia on elderly citizens. This is a preposterous argument that is being disseminated by those who know that it is false; the Obama health care plan would advocate end-of-life counseling for those who are diagnosed with terminal illnesses. This would merely advise patients who are considered by the medical profession to be in the end-stages of their lives what options are available to them.

The claim that government-run insurance would ration health care is not blatantly false, but is certainly disingenuous. This is also tied to the claim that Medicare is terrible because not all doctors or hospitals will accept it. The simple refutation to these arguments against health care reform or a single-payer system is that these occur already in the private insurance industry. Ask any individual with private insurance if they have been denied coverage for a condition or procedure. A large number of Americans would answer in the positive; this is rationing. Health care is also further rationed by income; those who cannot afford health care generally do not receive it. Also, many individuals who do have private insurance are told by doctors and hospitals that they do not accept that carrier, and all costs must be paid out of pocket. To imply that an inherent problem with the health care industry will only occur with government-run insurance is misleading and dishonest.

It is clear to all rational observers that something must be done to reform our failing health care system. We spend more per capita than other industrialized nations and yet rank more poorly than those nations when it comes to objective measurements of health, such as infant mortality rates and life expectancy. As a nation we must do something to control spiraling health care costs and the dreadful lack of insurance which plagues some 40 or 50 million Americans. However, to do this we must be willing to look at the situation as it really is. This can only be done by reaching a common ground on what the facts are; it will not be solved by misleading fear-mongering, scare tactics, and outright lies.

The Vatican seems to relish every opportunity it gets to stick its nose in people’s private lives, especially in decisions regarding personal health. Sometimes, however, this intrusiveness can twist the message the church wants to send and flies in the face of reality. There are two instances that I can think of recently that shed light on this dubious and troubling practice of denying reality in order to preserve their absurd ideals.

Take, for instance, the case of a nine-year old Brazilian girl who became pregnant with twins after being raped by her stepfather. Fearing that the pregnancy would kill the girl, her family had the pregnancy terminated. Shortly after, the Catholic Church informed the family and the doctors involved that they had been excommunicated for letting their daughter have an abortion.

The first thing that comes to my mind here is how the church felt it necessary to excommunicate people for saving an innocent girl’s life before even thinking to chide her incestuous stepfather. Second, does anyone else realize how abortion, which is, according to Catholics, murder, is an excommunicable offense but murder itself is not? Is unborn life more worth protecting than the lives of people who are already born? It sounds like “pro-life” really means pro-life-until-you-leave-the-womb-and-then-you’re-screwed. The girl was going to die if she went through with her twin pregnancy. Saving her life is not as important as protecting two humans who aren’t even born?

The second case of note involves the Pontiff explaining that condoms can actually contribute to the spread of HIV and its resultant disease, AIDS. Quoting from an al-Jazeera article:

“You can’t resolve it [Aids] with the distribution of condoms,” the pope said. “On the contrary, it increases the problem.”[1]

I wonder where he got that information… I doubt he got it from the Center For Disease Control: the CDC clearly informs anyone who wants to know that:

“Latex condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV, the virus that causes AIDS. In addition, consistent and correct use of latex condoms reduces the risk of other sexually transmitted diseases (STDs), including diseases transmitted by genital secretions, and to a lesser degree, genital ulcer diseases.”[2]

Ok, condoms don’t totally prevent the transmission of HIV, but who was claiming it did? Apparently “highly effective” by CDC standards is tantamount to total failure in the eyes of the church. The science-denial mechanisms in the Catholic Church are simply astounding, even after Vatican II. As if the plain language of the CDC’s statement on condom use wasn’t clear enough, they continue to talk about how condoms work in epidemics, such as the AIDS epidemic.

“Overall, the preponderance of available epidemiologic studies have found that when used consistently and correctly, condoms are highly effective in preventing the sexual transmission of HIV infection and reduce the risk of other STDs.”[3]

Maybe I’m being a little too harsh on the church. Lower level clergy in Africa are in fact doing what is humane and are encouraging people to use condoms to prevent HIV transmission, and their defiance of a ridiculous doctrine is commendable. The church’s official position on condom use (and any contraception) has more to do with banning people from preventing birth than giving a damn about what that might imply for those of us who aren’t trying to recklessly increase the population or spread terrible diseases. Sorry, but people like sex and are going to continue to have sex, so quit telling people that they can’t protect themselves while getting it on. Hearing the Vatican talk about public health is almost as bad as listening to Mike Huckabee explain the intricacies of Darwinian Natural Selection.

Mr. Pontiff needs to realize that what works in St. Peter’s Basilica doesn’t always work in the rest of the world and furthermore to stop telling people how they should live their private lives. When ideology is considered over empirical data, bad things can happen, like banning potentially lifesaving research because it supposedly kills babies and resulting in setting medical science back years. More alarming yet, the Church needs to have the good sense to realize when methods that they promote to supposedly alleviate suffering are actually causing more suffering and death than was there before. That, of course, isn’t what Jesus wanted, is it?

Dave Imbriaco is the personals editor at The Medium. We love the work he does, and always look for more.