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Healthcare Part II


Elrostar

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This week we have an op-ed from Michael Steele in the Washington Post explaining his approach to dealing with health care reform in the US.

Apparently the Republicans are now the party of Medicare and will do everything and anything needed to protect it. This includes avoiding spending any money on researching ways to actually bend the cost curve of health care, as that is apparently no longer relevant. All that matters is that care not be rationed (among those who have it, that is).

It's a pretty incredible piece, given that it basically attacks all the problems of health care reform that don't actually seem to exist. It talks about avoiding government bureaucrats between patients and doctors, the usual red herring, and talks about the terrible threat posed by the option of letting people talk to their doctor about end of life decisions. Apparently that will never happen under the Republican plan.

There's a scathing response to this article, also in the Post, by Steve Pearlstein today.

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I am not sure that these drugs are entirely bad or that nobody can benefit from them. I just believe that our culture promotes them often as a first response and hardly as a last resort, which is very strange since most people that benefit from them need to stay on them for a long time if not for life. Very convenient for their manufacturers.

People who have very severe depressions (or who have manic-depression or bipolar disorder, which really is a different condition from just plain depression) probably do need some drug therapy as part of their treatment.

But people who are mildly or moderately depressed do just as well or better with certain talk therapies, especially cognitive-based therapies, according to the research. Drugs often work quicker, but they have a much higher relapse rate than cognitive therapy. But of course the drug company ads will never tell you that.

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Michael Steele scares me. Not because he's a nutcase who seems to purposely act like a clown, but because I believe he's part of the GOP's strategy to come back strong. The Republican party is drifting further and further to the right, and this bozo is only adding to the disdain among people with an original thought in their brain. He's hurting the party more than helping.

Therefore the person who replaces him will likely seem about 1,000,000 times the better political leader and will probably instantly improve the GOPs image.

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Guest Raidne

A good (and short) article in Slate that makes the case for employer-based health coverage being against the American character.

I agree - it's limits the ability of people to leave their company for other opportunities, to start their own businesses, and to retire when they want to. The author supports Ron Wyden's plan, which is to convert the tax deduction for for employer-provided health insurance into a tax credit for individuals to buy insurance. I don't know the whole plan, but I know that expecting people to cover the difference out of pocket and wait for reimbursement at the end of the year is not going to allow most people to cover their healthcare. If, on the other hand, we pay that credit up front into a health care savings account that they could use to pay for insurance, well, now we might be getting somewhere.

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I've never gotten the whole "government bureaucrat" answer. As if governments are the only organizations that have bureaucracies. Let's face it; sometimes, your insurance company is going to be very helpful and accomodating. They will do everything that you need and follow through on the bargain that you signed with them when you first started paying your premiums. Other times, your insurance company is going to be obstructive and unhelpful, aggravating the misery of your illness by giving you the runaround and making sure that actually getting insurance coverage is as easy as performing surgery with a pair of your grandma's tube socks. I can't buy that government bureaucrats would be worse about this than corporate bureaucrats. I wish they'd just drop this talking point, or at least explain it.

And as for Mr. Steele -- I am unconvinced that Republican leaders consider health care reform a priority at this time. They don't seem to even be interested in creating a competing plan, only making outlandish promises (although that's pretty much par for the course for the opposition party, but still) about how they'll close the deficit by cutting taxes and getting rid of "pork" -- defined, presumably, as any government spending that the media notices.

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Guest Raidne
I've never gotten the whole "government bureaucrat" answer. As if governments are the only organizations that have bureaucracies. Let's face it; sometimes, your insurance company is going to be very helpful and accomodating. They will do everything that you need and follow through on the bargain that you signed with them when you first started paying your premiums. Other times, your insurance company is going to be obstructive and unhelpful, aggravating the misery of your illness by giving you the runaround and making sure that actually getting insurance coverage is as easy as performing surgery with a pair of your grandma's tube socks. I can't buy that government bureaucrats would be worse about this than corporate bureaucrats. I wish they'd just drop this talking point, or at least explain it.

Okay, explanation forthcoming. Your relationship with your insurance company is governed by contract law. Beware the fine print, and the army of attorneys that they hire to ensure that all clauses are interpreted in their favor. No amount of stories of people who's lives were ruined or lost will force a change of attitude in how the health insurance company is going to interpret your contract. And capitalism doesn't really work here, because they know that if you have a serious illness, you have no other options. You simply cannot get insured elsewhere. You can only sue them under contract law - it is your only recourse. And you will get screwed. Contract law does not operate in favor of the individual signing without legal representation.

On the other hand, your relationship with government provided healthcare is governed by administrative law, specifically the law indicated by the statute that created the policy or the organization. All the clauses will still be interpreted, and some coverage will still denied, but you'll have due process rights, and you won't be screwed by the fine print, because it's not a contract.

Perhaps most importantly, stories of people who's lives were ruined or lost because of a lack of coverage will force changes in coverage and policy, because the people in charge of funding the plan are beholden to the people, not their shareholders.

I see this in action at the VA every day. It's a fine line between trying to prevent fraud, and trying to grant benefits to the people who deserve it under the relevant regulations. It's not about trying to screw the most people out of coverage that we possibly can within the limits of the law. I mean, Medicare has a 90% satisfaction rate.

Now if you want to talk about how much more it costs to provide health care to everyone that needs it than it does to screw over the people who are getting too expensive, then, game on. That's a fair point. But corporate bureaucracies and government bureaucracies are not the same - they don't operate under the same law, and they're not beholden to the same people.

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A good (and short) article in Slate that makes the case for employer-based health coverage being against the American character.

I agree - it's limits the ability of people to leave their company for other opportunities, to start their own businesses, and to retire when they want to. The author supports Ron Wyden's plan, which is to convert the tax deduction for for employer-provided health insurance into a tax credit for individuals to buy insurance. I don't know the whole plan, but I know that expecting people to cover the difference out of pocket and wait for reimbursement at the end of the year is not going to allow most people to cover their healthcare. If, on the other hand, we pay that credit up front into a health care savings account that they could use to pay for insurance, well, now we might be getting somewhere.

As I said in the last thread, there's alot of good ideas that adopt a more Swiss-type model. Which is a good one too.

Basically, you buy your own insurance, with potentially help from the government. The thing is, this comes with some regulation on the governments part towards what kind of insurance MUST be offered and restrictions on the insurance companies ability to deny you coverage. (Which usually ends up involving a mandate of some sort too)

Without regulation, people being forced to buy their own insurance is throwing them to the wolves.

PS - That's a very interesting point about Administrative vs Contract Raidne.

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Now if you want to talk about how much more it costs to provide health care to everyone that needs it than it does to screw over the people who are getting to expense, then, game on. That's a fair point. But corporate bureaucracies and government bureaucracies are not the same - they don't operate under the same law, and they're not beholden to the same people.

To follow that line, it is tremendously expensive to employ actuaries to set premiums and calculate risk, adjusters to... adjust/assess claims, along with all the other corporate bureaucrats to manage and provide support to these activities. The cost logic of a single-payer system is really quite clear.

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Okay, explanation forthcoming. Your relationship with your insurance company is governed by contract law. Beware the fine print, and the army of attorneys that they hire to ensure that all clauses are interpreted in their favor. No amount of stories of people who's lives were ruined or lost will force a change of attitude in how the health insurance company is going to interpret your contract. And capitalism doesn't really work here, because they know that if you have a serious illness, you have no other options. You simply cannot get insured elsewhere. You can only sue them under contract law - it is your only recourse. And you will get screwed. Contract law does not operate in favor of the individual signing without legal representation.

On the other hand, your relationship with government provided healthcare is governed by administrative law, specifically the law indicated by the statute that created the policy or the organization. All the clauses will still be interpreted, and some coverage will still denied, but you'll have due process rights, and you won't be screwed by the fine print, because it's not a contract.

Perhaps most importantly, stories of people who's lives were ruined or lost because of a lack of coverage will force changes in coverage and policy, because the people in charge of funding the plan are beholden to the people, not their shareholders.

I see this in action at the VA every day. It's a fine line between trying to prevent fraud, and trying to grant benefits to the people who deserve it under the relevant regulations. It's not about trying to screw the most people out of coverage that we possibly can within the limits of the law. I mean, Medicare has a 90% satisfaction rate.

Now if you want to talk about how much more it costs to provide health care to everyone that needs it than it does to screw over the people who are getting too expensive, then, game on. That's a fair point. But corporate bureaucracies and government bureaucracies are not the same - they don't operate under the same law, and they're not beholden to the same people.

That's a great post, I'm not sure when it was decided that corporations to be representatives of all that is good and right and governments were deemed to be an unholy mess that could do nothing correctly, except for the military, but I wish I had a say in that decision. Everything that people claim will be wrong if the government changes about health care is already being done by health insurance companies.

My healthcare company already

Has a large bureaucracy

Limit my choice of doctors

Gets involved in healthcare decisions

Limits what will be covered

Put a lifetime cap on how much will be covered

does nothing to keep down costs but still rations care

and I'm sure there's others things I'm not aware of

As you pointed out my chances of getting them to change policy is very, very small.

Any effective health care reform will have to deal with multiple issues, insurance is just the most visible of them.

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But corporate bureaucracies and government bureaucracies are not the same - they don't operate under the same law, and they're not beholden to the same people.

So how is the government bureaucracy worse? Your description just makes that whole "obstructive gov't bureaucrat" argument even stupider. I mean, at least the state doesn't get financially compensated if they deny coverage.

Without regulation, people being forced to buy their own insurance is throwing them to the wolves.

People are forced to buy car insurance though (at least in Virginia).

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Two things about that. They are forced to buy liability insurance. And only if they want to drive.

Ah, thanks. By the way, what is liability insurance? And good luck keeping a job if you don't drive in northern Virginia. Your other "options" are chartering a bus every day (works for a few D.C. jobs like the Dept of State) or hitchhiking.

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Ah, thanks. By the way, what is liability insurance? And good luck keeping a job if you don't drive in northern Virginia. Your other "options" are chartering a bus every day (works for a few D.C. jobs like the Dept of State) or hitchhiking.

Yeah, I hear you with the reality of the "option." It is nonetheless technically true.

It's the liability where the comparison doesn't work. Liability insurance (the mandated kind) covers any damages that you cause. So until someone can prove that I was the one that gave them a cold and they succesfully sue for damages, I won't need liability health insurance.

What I need is health insurance for my body. In automobile terms this would be comprehensive, or fire, flooding, theft etc. None of which are legally required to drive.

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Here is an interesting little article on anti-depressants. They are now the most prescribed kind of drug in the US and 1/10 people use them within a given year. Awesome. It points out that America is the only country on Earth that has TV commercials for these drugs (except New Zealand who doesn't apparently do it in the same way). I think that this helps create demand (the numbers sure support this). It talks about how the commercials are purposefully vague about what exactly they are treating and do a great job of showing the magical transformation from sadness to happiness in a 60 second spot.

I don't recall ever seeing TV ads for anti-depressants. Plenty for erectile dysfunction (which I guess is a depression preventer), but not anti-depressants; though I don't watch a lot of TV these days. What we do have is ads trying to socialise the idea that mental illness is not something to be shunned or feared, and a lot more people have it, esp depression, than you might think. Pretty much every family has had at least one member who has suffered from, or is suffering from a mental illness. The slogan goes "know me before you judge me". It's been interesting because a decent number of local celebrities and former sports stars have featured on the ads talking about their bout of mental illness.

Best of luck with your healthcare reform. It sounds like either it won't happen, or the compromise outcome might actually be the worst of both worlds. Rather a shame really. This is politically your best chance at getting something close to a public health system, if you can't manage it now I don't know if it can ever happen. Well not until the system of govt is overhauled at least, and that may be a century or 2 away yet.

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Guest Raidne
So how is the government bureaucracy worse? Your description just makes that whole "obstructive gov't bureaucrat" argument even stupider. I mean, at least the state doesn't get financially compensated if they deny coverage.

I don't really know about better or worse, it depends what your focus is. But the two different types of bureaucracies are markedly different. Government will inherently be better at providing more care to more people, because of the legal differences I mentioned, but private insurance could, arguably, cost less money. But maybe not, seeing as you have to factor in the need to produce a profit into what a private company has to generate, and the government does not. And the private sector is no doubt better at providing top-notch care to the richest people, which seems to be all that plenty of people in the United States care about, not realizing that they are not even close to being among the richest people who can afford to receive the best care.

Ah, thanks. By the way, what is liability insurance? And good luck keeping a job if you don't drive in northern Virginia. Your other "options" are chartering a bus every day (works for a few D.C. jobs like the Dept of State) or hitchhiking.

Like Bones said, liability insurance exists only to protect other people from you. And I have no problem with this - if you want to get in a car, you need to be able to cover my costs if you run me into a ditch. You're allowed to run yourself into a ditch without insurance that would cover your own costs.

And on that note, health insurance isn't even, for the most part, insurance, except for major medical. I don't know why we talk about that way. It's a health care plan. It would as if you relied on your auto insurance to cover all your maintenance costs, and then were perplexed at why your premiums were so high. Honestly, I'd rather use regular contributions to a health care savings account for $200 physicals and $100 office visits, and pay $200/less a month in premiums.

I'd actually say that from my own personal selfish perspective, my #1 top health care priorities are:

(1) affordable health insurance options outside of my employer for any period of self-employment and after retirement

(2) a health care savings account that carries the unused balance over from year to year

(3) a separation of a health care plan from catastrophic health insurance

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Two things about that. They are forced to buy liability insurance. And only if they want to drive.

Well, this is the way I look at it. In this nation, people without health insurance or the means to pay are not allowed simply to die in the street; they are entitled to at least life-saving care regardless of who winds up paying in the end. To balance out that right, I think it is only fair that the state require every citizen to take some responsibility for defraying the costs. Rights and responsibilities...nice and simple.

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I am prepared for the eventual failure of the public option. You offer the people a rose and all they see is a shit sandwich.

What O and co. should be doing is passing healthcare legislation piecemeal, and quietly rather than this huge one-off push for it. It's hard to say what that would look like though. Maybe a sliding scale for medicaid based on a means test? Maybe lowering the age for medicare, again with a higher premium for people still of working age? Lower prices for off-patent drugs purchased by government programs is a must.

He should be pecking away at the 47million uninsured, trying to whittle it down rather than wipe it out.

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But people who are mildly or moderately depressed do just as well or better with certain talk therapies, especially cognitive-based therapies, according to the research. Drugs often work quicker, but they have a much higher relapse rate than cognitive therapy. But of course the drug company ads will never tell you that.

I tried cognitive therapy once. It just made me want to kill the therapist, shouting GIVE ME DRUGS!!! the whole time.

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Guest Raidne
What O and co. should be doing is passing healthcare legislation piecemeal, and quietly rather than this huge one-off push for it. It's hard to say what that would look like though. Maybe a sliding scale for medicaid based on a means test? Maybe lowering the age for medicare, again with a higher premium for people still of working age? Lower prices for off-patent drugs purchased by government programs is a must.

Well, they could just slide it in with the next stimulus package, like they did with that neat little provision that required insurance companies to cover mental health at the same levels as the coverage offered for physical health. That was hardly small potatoes, and nobody noticed.

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