Health Care Reform

The most definitive, or better said redefinitive, act in the recent history of the United States has taken place and people are reacting all over the place. Progressives are celebrating the establishment of federal control over health insurance and conservatives are bemoaning the demise of the Constitution. Extremists are demonizing each other and I find myself speaking up in spurts against some of the outrageous statements. When I “speak up” on a social networking site, my comment is limited and only gives a taste of what I believe and where I stand. Tired of being bullied and told my opinion doesn’t count because it’s wrong, I am compelled to do something truly American: to state my beliefs and take a stand.

This is a very long post so settle in before you read it. If you are inclined to criticize me harshly for not agreeing with your point of view, it will make it much easier for you to target your criticism to what I actually say!

Health care reform is needed in this country at this time. We knew it was a problem long before Bill Clinton won the presidency campaigning on a platform that included national health care reform. Sweeping reform was defeated, the Republicans took control of the House of Representatives (otherwise known as Clown School), and minimal reform was passed. People gained the right to pay an outrageous premium for the same coverage they had at a much lower premium, as an employee, for up to eighteen months after leaving or losing a job. Big whoop.

Republicans controlled Clown School from 1995 until 2007 and did not pass meaningful health care reform to address people being denied coverage or going bankrupt due to an illness. The Senate (otherwise known as The Yacht Club) bounced back and forth from Republican to Democratic control during that time and neither party passed meaningful reform there.

1992 was eighteen years ago.

As a small business owner, I saw our premiums for our “pool” of less than two dozen people jump dramatically if one member had a significant medical expenditure – maybe a couple thousand dollars worth – in one year. The huge corporation down the road got the same policy for its employees for less than half the cost per person, and one person needing a couple thousand dollars worth of medical care in a year was a blip on the screen that didn’t affect their premiums.

That, folks, is a crazy system. If you work over there, fifteen co-workers share the burden for your health care and pay a lot more when you use a lot of services. Over at this other place, ten thousand share the burden and don’t feel a thing when you use a lot of services.

A friend of mine suggested a few years back that his denomination, with around twenty million members, should create a health insurance pool. It seemed like a brilliant idea. Make a bigger pool, spread the risk and costs around. But everyone is entrenched in the notion that businesses should provide health insurance to their employees instead of private individuals buying it as members of much larger pools.

Do we all understand where that idea came from? It goes back to wage controls from the last time the extreme progressives pushed through their programs, giving the federal government a say in things the Constitution was written to limit. Because companies couldn’t pay their employees more, by law, they added benefits to compete for talent. A job with medical insurance benefits became the aspiration of more and more people. When insurance was affordable, it was an easy thing for businesses to add.

This set in place the belief that individuals should not pay for their own health insurance, let alone pay for their own health care. Without questioning why – the typical way of the common man – people just came to accept that somebody else was responsible to pay for their health insurance.

Into the mix came men of grand character, like John Edwards, who in times distant would have been called “ambulance chasers,” but repackaged themselves as champions of the little man. Don’t get me wrong here. People whose lives were ruined by medical malpractice or incompetence deserve relief. But when attorneys saw how easy the money was, taking thirty percent or more of large awards, they dug deeper and deeper into the notion of liability, until physicians were made responsible for things they should not have been expected to foresee, in many instances because they were not real.

Silicon breast implants are the best example, though I know anecdotes do not make the final case. But class action ambulance chasers brought an onslaught of lawsuits against the manufacturers and surgeons, claiming the silicon leaked and caused ongoing vague and bizarre problems. Dow Corning was brought to its knees. Many years later, a sane review of the mountains of studies showed that silicon implants did not cause any of the illnesses claimed in the lawsuits. But the attorneys got rich and some malingerers were rewarded for their hypochondriasis.

Physicians have been found liable for not using the latest, state-of-the-art tests and procedures. They have followed the standard of practice for medicine, but since cutting edge clinics could be found with more costly and extensive interventions, physicians were found, legally, to be liable for not practicing to the standard of the innovators in the expensive clinic. Practicing to the standard of care for the profession was not enough to protect them from being legally liable.

When people sue and win because they didn’t get the highest, most expensive, elite level of care, health care costs rise.

There are standard protocols in place for physicians to follow so it’s not true that a large number of doctors are ordering unnecessary tests and procedures, either to cover themselves or to pad their pockets. It is illegal for doctors to order unnecessary tests and procedures. But the protocols now include quicker decisions to move to the next step and look more closely at a possible problem. Medical liability lawsuits have bequeathed this to us.

Will a government directed health care system for everyone work? We shouldn’t forget that our government created Medicaid and Medicare, knowing for decades they would bring in more revenue in targeted taxes than the programs would spend, and then reversing and spending more than they brought in with population shifts. That didn’t stop our representatives – and therefore us – from spending that money on other things instead of saving it up for the coming shortfall. We blew through the cash like rock stars’ kids, so the bill for those programs is about to skyrocket and we have nothing saved up to cover it. That bodes ill for government being in charge of health insurance.

The insurance companies have behaved, if not worst of all, then at least the most obviously wrong. They regularly raise rates on premiums and cut coverage. They carve out things they won’t pay and squeeze clinics and hospitals to accept lower reimbursements rates. They refuse to insure people for any reason, every reason, and no reason. They accept premiums for years and then drop someone because of a diagnosis.

That is completely vile and unethical. They took the risk in return for the profit, and their profits have never been a problem. They understand “pooled risk” better than any other person or organization. They willingly jump in for the potential gain to them, but they run from the risk when it’s time to pay out.

Pooled risk is a huge point. It’s the key to health care reform. Not everyone will experience a catastrophic medical event in his or her lifetime, but for those who do the cost can be hundreds of thousands of dollars. Some of the risk is related to behavior, especially around some kinds of cancer and cardiovascular disease, but a whole lot of the risk is genetic.

The question becomes: Do we as a society want to look at the person who needs a quadruple bypass, mostly for genetic reasons and a little for dietary reasons, and just say, “Thank God it’s not me!” Do we simply shake our heads in mawkish concern and then think Tough break, or do we share the burden?

Do we think it’s okay that someone can go broke because she gets cancer; loses her job because surgery and treatment take so much time and weaken her so much she can’t work; and then loses her medical insurance because she doesn’t have a job and can’t find, much less afford, a private policy in the middle of treatment for cancer?

It seems absolutely, totally, and completely unacceptable that anyone should hit financial destitution in the middle of a health crisis, when she needs all the material and emotional and spiritual resources she can muster to fight – to win – to survive.

But… Is a government program the answer? Some never-before-conceived government program might be part of the answer, but what we have now is not working. Medicaid and Medicare are about to go broke, because, as I mentioned before, payments going out are about to exceed tax revenues, and we already spent the surplus that was coming in for decades.

Another problem with our current programs: more and more physicians are refusing to accept Medicaid and even Medicare clients (Medicare reimbursement rates are higher than Medicaid by a bit). Why is that? Because they’re greedy, preferring to make a ton of money instead of a little less money? No, it’s because they aren’t willing to work for free, and they cannot give away their work and subsidize patients on the government programs. I don’t have the exact numbers from the example I heard, but these are close. A few years ago, Medicare was paying around twenty dollars for administration of a flu shot. The cost of the vial of vaccination to a clinic was twenty-four dollars.

That means every time they gave a shot to a Medicare patient, they lost four dollars, plus the value of the nurse’s time and the hypodermic needle and the tiny share of rent and utilities for the time the room was used. What a business model! Give out thirty flu shots to Medicare patients in one day and you bring in six hundred dollars. You pay out seven hundred twenty for the vaccine, you pay a nurse for a few hours of time, and you pay overhead on the space and the staff checking people in and processing payments.

Those greedy doctors!

I have to disclose that my wife is a doctor, a family practice physician. I see the incredibly long hours she works every single week. Primary care physicians are seeing more and more patients, working harder, and getting squeezed on reimbursements. The shortage of primary care physicians is getting to be a big problem, as most newly graduating M.D.’s choose to go into higher paying specialties. Average primary care physician pay is in the low six-figure range. Internet marketing experts brag about earning six figure per month and finding ways to go from seven-figure to eight-figure annual incomes. Professional athletes… I won’t even go there. The point is clear.

So is it the responsibility of primary care doctors to take care of people who cannot, or will not, pay for health care? Should they be compelled to give away their services, or even take the money they earn serving one group of patients and use part of it to subsidize another group, essentially paying money to work instead of earning money for their work?

This is what happens. I don’t know names but I know some stories, and many sound strikingly similar. A woman who committed to being a mother and housewife has great medical insurance for years. Her husband has a mid-life crisis and leaves her and the kids. She’s now working for low wages, trying to keep the children fed, and has no insurance. She comes to the doctor she’s known for years. The doctor charges nothing for the visit and pulls together enough samples of medication to cover the number of days of the prescription the woman needs to cure her illness.

Should we compel these physicians to see government program patients? They’re already working for free with patients like these as part of the system of caring for the uninsured.

I see the need and believe our society should do something, together, to solve these problems. What I believe is: everybody pays, everybody benefits. Even someone earning minimum wage, around fourteen thousand dollars per year, can pay something for medical care. If you can pay for a cell phone or movie rentals, you can pay twenty or thirty dollars a month of your medical insurance. What I don’t believe is one group should get all the benefits and pay nothing, while another group pays all the cost and gets no benefit.

What I believe is, if you strongly advocate health care for everyone, you should strongly advocate paying your fair share. Compelling one group of your fellow citizens to pay for a program for another group of your fellow citizens is not compassion. It’s tyranny. Borrowing and leaving the debt for my children to pay so you can give a program to a group of fellow citizens and proclaim yourself to be caring is not compassion. It’s absurdity. It’s a kind of young adolescent self-centeredness and lack of responsibility that overvalues one’s own wishes and fails to understand the drain those wishes put on other people.

I believe we can improve health care delivery through social programs, but not this way. Not with this bill passed in this way. We cannot trample the Constitution to make some people’s lives better. Once we trample the Constitution, quality of life is at stake in much larger ways than health care.

The Constitution is written to define and limit the powers of the federal government. In principle, the federal government can only do what the Constitution says it can do, in the areas of power granted to it. In practice, statists have fought against the Constitution for years to grasp more and more power over people’s lives. Many of the programs of FDR’s administration were challenged as being unconstitutional usurpations of power, and a lot were eventually overturned. Unfortunately, some rulings allowed an enormous expansion of the powers of the federal government to intrude into commerce and even activities, like growing wheat on a farm for personal consumption, that aren’t commerce at all.

The United States I learned about as a child in school, founded by people who demanded limited government because they saw that centralized national governments with broad powers are ultimately corrupt and tyrannical, was fading long before I was even born. It was weakened before my parents were born.

Our founders knew that the European pattern wouldn’t insure personal liberty. As long as the government was large and powerful, liberty would depend on the whim of the ruler. One ruler could usurp another, or one group could displace a ruler and replace him for a time, but as long as that immense power existed in one focused place it could be taken by one or a few who could then exploit and enslave many.

Our founders didn’t want a powerful centralized government because they didn’t want to have to rely on the character of the people in power for their freedom. They wouldn’t see the centralized socialist governments of Europe as models for what they were designing, in spite of the role elections play in those governments. They would see them as the evolution of oppressive powerful central governments from hereditary nobility to elected nobility, appeasing the masses with the right to vote on some things, but with personal liberty at constant risk under the whim of the rulers.

Compelling people to purchase health insurance tramples personal liberty, the most sacred founding principle of our nation. If we give up personal liberty and give up the idea of a limited government that has only the powers We the People agree to give it, America is gone. The experiment is over.

The majority of citizens opposed the Senate bill the House voted on. In heavily Democratic Massachusetts, a Republican won the seat of the Champion of Socialized Medicine because they did not want what the Democrats had voted for. The ruling party said, “We don’t care.” They passed a bill by manipulating and strong-arming their members, in open defiance of the will of the people. The knew the clock was ticking and they decided to push through a victory over… over us; over the America people.

“That to secure these rights, Governments are instituted among Men, deriving their just Powers from the consent of the governed…”

Consent of the governed. Sound familiar? It’s from The Declaration of Independence. Remember how that turned out?

“…That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it…”

Can’t we have a program that doesn’t violate personal liberty? Can’t we only have social programs we are willing to pay for? And by “willing to pay for” I mean all of us paying, not just the top ten percent of income earners, and not our children and grandchildren paying tomorrow for what we do today.

I know he’s far left, but documentary director Michael Moore is an entertaining filmmaker and a fairly accomplished propagandist so I generally enjoy watching his movies, even the parts where I argue with him (don’t worry – he doesn’t argue back). I was compelled enough by things he presented in his movie Sicko to do a little bit of reading.

I learned there are a lot of limitations and problems with the national health service in Great Britain, enough to say I don’t want a similar program in the United States. It’s really hard to find consistent numbers on the cost to the average taxpayer, but the British generally like their system and are willing to share the cost. Everybody pays, everybody benefits. Shouldn’t we be willing to have a new payroll tax if we really want a health care program for everyone? And by want I mean desire and value it enough to put effort into it and make sacrifices. I do not mean whining about fairness and then compelling one small group to pay for said fairness for everyone else.

In France they don’t have a national health care system. They have a national health insurance system. I would love to understand it better but get bogged down in some of the information I find. I do know everyone is covered, the government program covers around seventy percent of care and private supplemental insurance covers around thirty percent, physicians aren’t government employees, full coverage kicks in with a catastrophic diagnosis, and nobody goes bankrupt because of health care expenses. And I know they pay around twenty-one percent of income in payroll taxes for health care. Now that’s really wanting it.

The main thing that jumps out at me about Great Britain and France, and throw in Canada because that system is featured in the movie as well, is that the people in those countries wanted a national system and were willing to pay for it. They all pay and they all benefit. There’s a sense of community – of “co-unity” – in that attitude that is completely lacking in the debate, in the proposals, in the fight over health care, and in the bill that just became law.

For anyone who wants to vilify or demonize me, to dismiss my humanity or demean my compassion or intelligence, based on my beliefs about health care reform, I will make it easy. I will state where I stand. I ask that you tailor your vicious criticism of me to my stated positions.

• Medical crises hit a minority of our population, and they hit a very small percentage the hardest. This means, by random fate, a few people are devastated and others untouched. Compassion cries out that we share the financial burden of devastation because it’s too much for most people… and because we can. We need to make some kind of health insurance available to everyone.

• People have more of a right to water, food, shelter, and clothing – pretty much in that order – than they do to health care. And in all but the most extreme circumstances we expect people to buy these other things for themselves. Everyone should pay their fair share for health insurance. Access to health care may be a civil right. Having it paid for by your neighbors is not.

• No one should have their insurance cancelled once they become sick. People with pre-existing conditions should be able to get health insurance, and the broad population should share the cost of their care instead of sticking those people with very high premiums. We should all be in the same huge risk pool.

• It wasn’t a quirky philosophy of the 1980’s to say government is not the solution; it was a quirky philosophy of the 1700’s in the founding principles of our nation. The powers of the federal government are enumerated and limited for a reason, which is to protect personal liberty from tyranny. Government programs that infringe on personal liberty are immoral and unconstitutional.

• The belief in delineated powers and a limited federal government was partially lost in the fight against the evil of slavery. States were to have a more powerful role governing the lives of citizens than the federal government, but the power of the federal government had to be allowed to expand to defeat slavery.

• The belief in delineated powers was dying by the end of the nineteenth century. American progressives such as Theodore Roosevelt, Woodrow Wilson, and Franklin Roosevelt believed the Constitution was outdated even then because it restricted the federal government from becoming a centralized controlling force in the lives of citizens. By bringing in large programs and constantly pushing against the Constitution, early twentieth century progressives weakened the clear limits against a large, powerful federal government intended by our founders.

• The Constitution was not written as a “living, breathing” document. It is a document deeply rooted in clear principles. It has a clear mechanism for amendments. That means the founders knew we would need to make changes and planned a way to do it. The Constitution was not meant to shift like sands in the wind, but to be a solid foundation that could be modified when necessary. But by removing comprehensive education on the founding principles of America from public schools, progressives have been able to convince many people the Constitution is whatever they want it to be – like a Rorschach inkblot.

• If the individual mandate stands, personal liberty will be over. The Constitution will be impotent. Statists will have won by playing to the apathy, ignorance, and selfishness they have promoted for decades. Those who believe in the American ideals and those who believe in a strong central government taking care of people will be drawn into an increasingly volatile conflict, and it will get pretty ugly.

• If our society does not make sure basic health care is affordable and no one goes bankrupt from a catastrophic medical event, class warfare will be fueled, leading to increasingly volatile conflict that will also get pretty ugly.

• I’m willing to pay taxes for a system of public clinics and hospitals, providing a minimal level of care, as long as everyone pays their fair share and those who choose to spend money on supplemental insurance have the option of going to a better facility and getting health care in a more attentive and comfortable environment.

• We cannot require top income earners (six figures or better) to pay for the health care costs of all Americans. Everybody should pay their fair share, meaning very few should get supplements or rebates.

• We cannot provide state-of-the-art care to everyone unless we all pay a large payroll tax or national sales tax to pay for it. Even providing basic care to everyone will require that we all pay additional taxes. We can’t do this by “taxing the rich” or borrowing against our children’s future.

• The medical community sets standards of care and has treatment protocols for just about anything any physician will encounter. Our laws on medical liability should say any physician who follows the standard of care has practiced with due diligence and is not required to look for the newest test or try the latest procedure. The standard of care should be the standard of care.

• Putting control of any enterprise into the hands of the government gives us less control over it as citizens. In general, private businesses have to listen to the market and respond to customers or lose them. Our representatives don’t have to respond swiftly because their accountability is only as near as the next election, and an election is rarely about one single thing. We won’t get to vote individually on how they are managing health care. We will have to vote on how they are doing overall. That gives them cover to ignore us and mistreat us around heath care, as long as they throw enough people enough bones on other issues.

• When Scott Brown won the Senate race in Massachusetts, some Democrats thought they should respond to the will of the people and slow down the massive overhaul and focus instead on passing the reform items broadly supported by a majority of people. But in the end they decided not to respect the will of the people. They decided to do it their way, against the will of the people, before they lose their majority. That is not government by the people, for the people. It is government against the people.

• We should debate this vigorously, around the ideas and ideals and our underlying principles. We should not call people racist or evil or accuse them of wanting children to die if they oppose the bill because they oppose the growth of federal power and federal mandates.

I look forward to any discussions that expand understanding, add new perspectives, and come up with new solutions. I plan to ignore personal attacks and extremist attacks.

Will you join the discussion?