President Obama and Congress changed their strategy in the last several days. They no longer campaign for health care reform, it is now health insurance reform. (Sidebar: Obama rightfully rails at the out of control cost of Medicare and Medicaid as threats to the national economy, but sees as his priority, reforming the private health insurance market. Strange logic.)
Health insurance policies are contracts. Contracts are supposed to be enforced by governments.
Health insurance policies are, to my understanding, filed with and approved by government agencies.
Health insurance policies are subject to the political gamesmanship of state legislatures and are, therefore, politically-negotiated and approved contracts.
Health insurance companies must collect enough premium to pay the bills of those with whom it contracts (people who own the insurance policies) and the physicians, hospitals, and other providers whose services are used by those people who own insurance contracts. If they do not collect enough premium, they will go out of business. Yes, they must also cover their administrative expenses, but only at levels allowed by the laws passed by elected officials.
Health insurance is held hostage to some extent by economic forces, of course, but within the constraints allowed by the political process (in the case of health insurance, usually driven by ideological populism and the cancerous desire to be re-elected rather than pass good laws).
Since health insurance is, by this logic, already controlled by the political process, and since our tax dollars already support in part or whole, health care services for 103 million people, plus government employees, why has Obama and Congress made the insurance companies public enemy number one? I believe they should admit they have met the enemy, and the enemy stares them in the face each morning.
A health care system driven by politics, rather than economics and individual moral responsibility, will always need demons – and the insurance companies are catching it.
Governments should establish the basis of an enforceable contract, and then enforce them, not demonize them.
Wednesday, August 12, 2009
Monday, August 10, 2009
Venture capitalism and health care
Just a rambling thought, but wish for responses from you learned folks.
Venture capitalism is under attack from zealous Congressional and SEC pinheads who believe they can best manage individual lives and money. See the WSJ today. Why should we care?
The Bio-Pump, the world’s largest selling hear assist blood pump, was developed with high risk investment money. This little device has saved millions of lives. Its inventors, Dr. Harold Kletshcka and Edson Rafferty, created this device to save lives. Never once did they consult with insurance companies to make sure it would be a covered benefit, nor did they seek permission from the federal government to build it. On the contrary, FDC laws regarding medical devices that went into effect in 1976 impacted its progress, and a false SEC lawsuit in the early 1970s nearly drove them out of business. (See To Change the Heart of Man – www.tochangetheheartofman.com).
Now here is my question. Should venture capitalists invest only in new medical devices that they predetermine will be covered by health insurance, or that they predetermine the federal government will approve? And should new laws regulating venture capitalists require that they prove beforehand that their chances of earning a ROI are without risk, or at least low risk? And if all this happened, would it serve to advance the efficacy and value of health care or defeat it?
As you evaluate health care reform, you must, must look at the threads running through all new policies that are under consideration. The impact of further centralization of all aspects of commerce, whether directly related to health care or not, will prove deadly in the long run.
Venture capitalism is under attack from zealous Congressional and SEC pinheads who believe they can best manage individual lives and money. See the WSJ today. Why should we care?
The Bio-Pump, the world’s largest selling hear assist blood pump, was developed with high risk investment money. This little device has saved millions of lives. Its inventors, Dr. Harold Kletshcka and Edson Rafferty, created this device to save lives. Never once did they consult with insurance companies to make sure it would be a covered benefit, nor did they seek permission from the federal government to build it. On the contrary, FDC laws regarding medical devices that went into effect in 1976 impacted its progress, and a false SEC lawsuit in the early 1970s nearly drove them out of business. (See To Change the Heart of Man – www.tochangetheheartofman.com).
Now here is my question. Should venture capitalists invest only in new medical devices that they predetermine will be covered by health insurance, or that they predetermine the federal government will approve? And should new laws regulating venture capitalists require that they prove beforehand that their chances of earning a ROI are without risk, or at least low risk? And if all this happened, would it serve to advance the efficacy and value of health care or defeat it?
As you evaluate health care reform, you must, must look at the threads running through all new policies that are under consideration. The impact of further centralization of all aspects of commerce, whether directly related to health care or not, will prove deadly in the long run.
Wednesday, March 18, 2009
Our moral obligation re: health care
A national health reform leader made the argument to me today that we have a moral obligation to provide health care to all Americans. I asked him to define “all” Americans to clarify his position, and am awaiting his answer.
1. Do we have a moral obligation to provide health care to all Americans?
2. Do we have a moral obligation to provide all forms of health care to all Americans, or do some people have the right to use services not financially available to others?
3. Is there a place at which the public's (i.e. government's) moral obligation ends, and government must decide to cease offering it?
Perhaps you might say it depends on what the meaning of “we” is. Is “we” all U.S. residents or just those here legally - or just citizens?
And if we have this obligation, should this care be delivered and/or paid for by governments, private insurances, charities, and/or personal service?
This is a tough question. How it is answered will have a profound impact on health care reform.
It is not so different from questions about our moral obligation to provide food, shelter, and clothing for everyone. We already provide food stamps, WIC, Section 8 housing, vouchers for necessities, at taxpayer expense. It is likely that during the 1960s, we asked and answered the moral question that yes, every American has a right to these essentials, even if it cost taxpayers some of their livelihood.
Help me think this through.
1. Do we have a moral obligation to provide health care to all Americans?
2. Do we have a moral obligation to provide all forms of health care to all Americans, or do some people have the right to use services not financially available to others?
3. Is there a place at which the public's (i.e. government's) moral obligation ends, and government must decide to cease offering it?
Perhaps you might say it depends on what the meaning of “we” is. Is “we” all U.S. residents or just those here legally - or just citizens?
And if we have this obligation, should this care be delivered and/or paid for by governments, private insurances, charities, and/or personal service?
This is a tough question. How it is answered will have a profound impact on health care reform.
It is not so different from questions about our moral obligation to provide food, shelter, and clothing for everyone. We already provide food stamps, WIC, Section 8 housing, vouchers for necessities, at taxpayer expense. It is likely that during the 1960s, we asked and answered the moral question that yes, every American has a right to these essentials, even if it cost taxpayers some of their livelihood.
Help me think this through.
Thursday, September 25, 2008
Mortgage Bailouts and Health Reform
What does the mortgage crisis have to do with the future of health care reform? Plenty.
Stan J. Liebowitz, economics professor at the University of Texas at Dallas, tracked the intervention of the federal government into mortgage lending during the past 20 years. Boiling it down: In the name of home ownership, economic laws were suspended so that people without assets could buy houses. Should we be surprised when they cannot pay for them, and when they are foreclosed upon?
Now economists insist that free markets cannot adequately serve the lending industry, and that is why the federal government must step in to rescue it.
The commonality with health care reform is twofold:
1. The federal government, since at least 1965, has continuously ratcheted up its involvement in the payment and delivery of health care. States have either stayed a step ahead of the feds, or followed closely behind. Government has nearly destroyed the health care market economy.
2. The same logic used to justify a federal bailout of mortgage lenders and the banking industry will be used to reform health care. We have been told for decades that health care cannot operate in a free market environment. When it fails to meet governments’ goals for it, our vaunted U.S. health system, so the politicos will claim, need to be rescued by the government.
The big difference is that we have time to do something about health reform. An army of health insurance agents can dispatch itself to work overtime to convert the insurance market to consumer-directed health plans.
Only by bringing consumer (aka voter) pressure on Washington, D.C. and state capitals will the United States be able to avoid a national health plan. I am convinced that without such a movement, the march to socialized medicine will reach the tipping point by 2012-2014.
Please, don’t let this happen.
Stan J. Liebowitz, economics professor at the University of Texas at Dallas, tracked the intervention of the federal government into mortgage lending during the past 20 years. Boiling it down: In the name of home ownership, economic laws were suspended so that people without assets could buy houses. Should we be surprised when they cannot pay for them, and when they are foreclosed upon?
Now economists insist that free markets cannot adequately serve the lending industry, and that is why the federal government must step in to rescue it.
The commonality with health care reform is twofold:
1. The federal government, since at least 1965, has continuously ratcheted up its involvement in the payment and delivery of health care. States have either stayed a step ahead of the feds, or followed closely behind. Government has nearly destroyed the health care market economy.
2. The same logic used to justify a federal bailout of mortgage lenders and the banking industry will be used to reform health care. We have been told for decades that health care cannot operate in a free market environment. When it fails to meet governments’ goals for it, our vaunted U.S. health system, so the politicos will claim, need to be rescued by the government.
The big difference is that we have time to do something about health reform. An army of health insurance agents can dispatch itself to work overtime to convert the insurance market to consumer-directed health plans.
Only by bringing consumer (aka voter) pressure on Washington, D.C. and state capitals will the United States be able to avoid a national health plan. I am convinced that without such a movement, the march to socialized medicine will reach the tipping point by 2012-2014.
Please, don’t let this happen.
Monday, September 1, 2008
The uninsured in America
We're not doing so bad after all.
The U.S. Census Bureau has lit the fuse for the next battle in health care reform. The uninsured rate and numbers have dwindled, and that is good news. Why they dwindled might seem not so good.
Allegedly, now only 45.7 million of us are without insurance (or as our detractors say, "are without health care); about 15.3 percent of the current population. The drop is attributed to more people enrolling onto government health plans (more than 300,000 in Massachusetts along, thanks to the Connector).
On the other hand, this means that more than 255 million Americans are covered under a health plan.
Stick with me on this: At 255 million (the number of Americans with a health plan) it would make a country the third largest in the world, next to China and India. That we have the resources and systems in place to insure so many people (more than eight times the population of Canada) is a great accomplishment.
202 million Americans get their insurance through an employer, a number that held steady. The rate (just under 60 percent) is lower, but that is not so dismal news. After all, we have been fighting a difficult economy. I think it is a strong indicator of the important people place on group insurance.
Of the remaining folks without insurance, no more than 15 million, or five percent, are chronically uninsured. Those aged 18-34 comprised 54 percent of the uninsured, and that produces an interesting and vitally important issue.
The drive toward "universal health care" is a misnomer. The honest term is "mandatory universal health care," meaning forcing everyone by law to purchase health insurance. Now think about this.
If more than half of the uninsured are aged younger than 35, and we use the law to force them to buy health insurance, what does this mean? It means that we want young, healthy people to underwrite the cost of older people - of us Baby Boomers. Once again, the Baby Boomers want to be bailed out by someone else.
The other fascinating uninsured statistic is that of the new immigrants, who still make up 33 percent of the uninsured. Well over half of the uninsured, and many in this category, qualify for government health care, but refuse to sign up.
There are many reasons to reform U.S. health care, but the uninsured rate is not one of them. Don't let anyone get away with that myth any longer.
The U.S. Census Bureau has lit the fuse for the next battle in health care reform. The uninsured rate and numbers have dwindled, and that is good news. Why they dwindled might seem not so good.
Allegedly, now only 45.7 million of us are without insurance (or as our detractors say, "are without health care); about 15.3 percent of the current population. The drop is attributed to more people enrolling onto government health plans (more than 300,000 in Massachusetts along, thanks to the Connector).
On the other hand, this means that more than 255 million Americans are covered under a health plan.
Stick with me on this: At 255 million (the number of Americans with a health plan) it would make a country the third largest in the world, next to China and India. That we have the resources and systems in place to insure so many people (more than eight times the population of Canada) is a great accomplishment.
202 million Americans get their insurance through an employer, a number that held steady. The rate (just under 60 percent) is lower, but that is not so dismal news. After all, we have been fighting a difficult economy. I think it is a strong indicator of the important people place on group insurance.
Of the remaining folks without insurance, no more than 15 million, or five percent, are chronically uninsured. Those aged 18-34 comprised 54 percent of the uninsured, and that produces an interesting and vitally important issue.
The drive toward "universal health care" is a misnomer. The honest term is "mandatory universal health care," meaning forcing everyone by law to purchase health insurance. Now think about this.
If more than half of the uninsured are aged younger than 35, and we use the law to force them to buy health insurance, what does this mean? It means that we want young, healthy people to underwrite the cost of older people - of us Baby Boomers. Once again, the Baby Boomers want to be bailed out by someone else.
The other fascinating uninsured statistic is that of the new immigrants, who still make up 33 percent of the uninsured. Well over half of the uninsured, and many in this category, qualify for government health care, but refuse to sign up.
There are many reasons to reform U.S. health care, but the uninsured rate is not one of them. Don't let anyone get away with that myth any longer.
Tuesday, August 19, 2008
Harry and Louise have mellowed
Harry and Louise are back.
Remember them? They were trotted out during the height of HillaryCare in the 1990s. People who believed that Mrs. Clinton’s purpose was to move us to government-run health care used the ads to stop her in her tracks.
Harry and Louise appear to have mellowed.
You can see it for yourself at http://www.harryandlouisereturn.com/. This is the newest ad, and it is meant to throw resolution of health care into the lap of the next president.
From where I sit, asking the politicians to solve the health care dilemma is a prescription for problems. Every time they step in to help, it gets more complicated and expensive.
The ad, however, takes no explicit sides. But since it prominently mentions access to care and affordability of health insurance, it tries to set the debate.
These are real problems, and they need real solutions. The political arena is the worst place to get this done, although it obviously cannot be ignored.
Political leaders use health care reform to gain votes. Those who are serious, like Mrs. Clinton, are the ones who will advance their government solutions based on the appearance of a groundswell of support.
The answer to what ails U.S. health care lies primarily in two areas: We must become healthier. We must become involved in paying for, and therefore knowing about, the cost of care.
Politicians are building the case to tell us how to live, what to eat, where to go, and what to do. That runs contrary to traditional U.S. culture. Maybe Americans have become passive enough to accept top down directives. What do you think?
Clearly, most top down health reform points toward mandatory coverage, forcing more people to pay more to do more and will end up costing more. For certain, politicians cannot solve the spending problem by managing spending.
Remember them? They were trotted out during the height of HillaryCare in the 1990s. People who believed that Mrs. Clinton’s purpose was to move us to government-run health care used the ads to stop her in her tracks.
Harry and Louise appear to have mellowed.
You can see it for yourself at http://www.harryandlouisereturn.com/. This is the newest ad, and it is meant to throw resolution of health care into the lap of the next president.
From where I sit, asking the politicians to solve the health care dilemma is a prescription for problems. Every time they step in to help, it gets more complicated and expensive.
The ad, however, takes no explicit sides. But since it prominently mentions access to care and affordability of health insurance, it tries to set the debate.
These are real problems, and they need real solutions. The political arena is the worst place to get this done, although it obviously cannot be ignored.
Political leaders use health care reform to gain votes. Those who are serious, like Mrs. Clinton, are the ones who will advance their government solutions based on the appearance of a groundswell of support.
The answer to what ails U.S. health care lies primarily in two areas: We must become healthier. We must become involved in paying for, and therefore knowing about, the cost of care.
Politicians are building the case to tell us how to live, what to eat, where to go, and what to do. That runs contrary to traditional U.S. culture. Maybe Americans have become passive enough to accept top down directives. What do you think?
Clearly, most top down health reform points toward mandatory coverage, forcing more people to pay more to do more and will end up costing more. For certain, politicians cannot solve the spending problem by managing spending.
Monday, August 18, 2008
Why health care costs so much
Greg Dattilo and I are writing a new book. Our working title is “Why health care costs so much.”
I had a practical example on July 31.
Early that afternoon I suffered chest pains. (Since them, I have been calling them chest “aches.”) At the time, all I knew is that they did not stop. Feeling pains in the chest and the accompanying pressure is disconcerting, to say the least.
I called my doctor, planning to go to the clinic. They gave me to a triage nurse.
The triage nurse demanded I call the paramedics. She told my wife absolutely not to drive me to the ER. I felt stupid, because the pains (ache) were higher up in the chest. I had no other symptoms of a heart attack. But she insisted.
At the ER, two EKGs, blood work, and a chest X-ray indicated that whatever I had, it was not my heart. Yet, the ER doctor suggested I say overnight in the hospital and get a stress test.
I went home. Five days later, I had the stress test, but my insurance agent told me I had already spent all my deductible. I had the nuclear stress test, by the way.
The great news: My heart is 100 percent. The not so great news: I still have the achy chest, but it is far less of a problem. Tomorrow, the endoscopy. I told my doctors to look up helicobacter pylori (check it out at www.helico.com). We may be on to something here.
Why do we spend so much on health care? To date, I am guessing we’ve spent $5,000-$6,000 on this incident, although I have only seen the $1,600 charge for the paramedics. And there is more to come.
On July 31, there is no question I needed to see a doctor. Maybe even in the ER. Maybe.
My story, however, does indicate in a small way why health care costs so much.
Defensive medicine played a role. If the triage nurse had agreed with me, and I had suffered a heart attack on the way to the clinic, she fears getting sued. If the ER doctor had not offered the chance for me to be admitted, and I suffered a heart attack at home, he fears being sued (he admitted to me that the number one reason ER doctors get sued are chest pain issues).
Okay. They were all doing their job, and did it professionally. I get it. But I also realize that I spent at least $4,500 that accomplished only two things; it gave me peace of mind about my heart and it ate up my deductible.
So, of course, that means I am now considering other medical irritations that just might need treatment this year, instead of next. I admit it. I am just as human as the other 304 million Americans. The deductible has been met. What is your next question?
Oh, did I mention, I have a high deductible health plan and an HSA. And am I ever glad I have the HSA! And a good heart.
I had a practical example on July 31.
Early that afternoon I suffered chest pains. (Since them, I have been calling them chest “aches.”) At the time, all I knew is that they did not stop. Feeling pains in the chest and the accompanying pressure is disconcerting, to say the least.
I called my doctor, planning to go to the clinic. They gave me to a triage nurse.
The triage nurse demanded I call the paramedics. She told my wife absolutely not to drive me to the ER. I felt stupid, because the pains (ache) were higher up in the chest. I had no other symptoms of a heart attack. But she insisted.
At the ER, two EKGs, blood work, and a chest X-ray indicated that whatever I had, it was not my heart. Yet, the ER doctor suggested I say overnight in the hospital and get a stress test.
I went home. Five days later, I had the stress test, but my insurance agent told me I had already spent all my deductible. I had the nuclear stress test, by the way.
The great news: My heart is 100 percent. The not so great news: I still have the achy chest, but it is far less of a problem. Tomorrow, the endoscopy. I told my doctors to look up helicobacter pylori (check it out at www.helico.com). We may be on to something here.
Why do we spend so much on health care? To date, I am guessing we’ve spent $5,000-$6,000 on this incident, although I have only seen the $1,600 charge for the paramedics. And there is more to come.
On July 31, there is no question I needed to see a doctor. Maybe even in the ER. Maybe.
My story, however, does indicate in a small way why health care costs so much.
Defensive medicine played a role. If the triage nurse had agreed with me, and I had suffered a heart attack on the way to the clinic, she fears getting sued. If the ER doctor had not offered the chance for me to be admitted, and I suffered a heart attack at home, he fears being sued (he admitted to me that the number one reason ER doctors get sued are chest pain issues).
Okay. They were all doing their job, and did it professionally. I get it. But I also realize that I spent at least $4,500 that accomplished only two things; it gave me peace of mind about my heart and it ate up my deductible.
So, of course, that means I am now considering other medical irritations that just might need treatment this year, instead of next. I admit it. I am just as human as the other 304 million Americans. The deductible has been met. What is your next question?
Oh, did I mention, I have a high deductible health plan and an HSA. And am I ever glad I have the HSA! And a good heart.
Subscribe to:
Posts (Atom)