Tag Archives: health care reform

WARNING: The Potential Side Effects of Discussing Health Care Reform may Include Elevated Blood Pressure, Early Onset Dementia, Constipation of the Brain and Excessive Paranoia.

No blog subject – no matter how controversial – brings a quicker, more passionate and vitriolic response than does one discussing health care reform. The good news is that any blog dealing with health care reform causes an immediate spike in web site visits, but the downside is that most responses end with something to the effect, “I will never read your #?& blog again!”

This reaction was epitomized following my recent blog “Health Care Reform: Complicated Problem – Simple Solution.” Frankly, I was neither surprised nor offended by the negative, passionate viewpoints of many who read the blog. (Hell! I am just happy so many people read the blog.) But I am disappointed that many of the respondents exhibited such a lack of independent, individual critical thinking and instead fell back on the tired old pabulum of disingenuous arguments dished out by the insurance industry and other special interest groups that have a financial stake in the current health care system. (I know this attitude may upset those respondents, but they are unlikely to read this anyway; so who cares?)

I sometimes wonder if real people are actually posting these comments since their carping exhibits certain mirror-like qualities, and – most telling – they ignore the specifics of what was actually written in the blog. You’d think these hasty missives were generated by a seditious Internet “bot” that uses “health care” as a keyword to post these comments. (Am I being paranoid here?)

Missing The Mark

For example, the central theme of my health care blog asked one, simple question:

Should basic health care be a right or
a privilege for all American citizens?

That seems like a simple, straightforward, yes-no, binary question. Either you believe that basic health care should be a right afforded to all citizens just as they are guaranteed free speech, the right to vote, a public education and “life, liberty and the pursuit of happiness.” Or, you believe that receiving basic health care is a privilege available only for those who can afford and find it. In other words, it’s akin to attending a private school, flying first-class or buying a more expensive new car.

Yet, as simple a choice as that may be, not one of the respondents made an effort to address or answer that question. I guess this means the question was too complicated for them, they didn’t have the courage to take a stand, or they have the mental capacity of a parrot that can repeat, but not understand, the specific words and phrases said to them over and over.

Look, I can respect –even if I don’t agree with — those who sincerely believe basic health care for American citizens is a privilege available only for those who can afford and find it and not a right for the rest of us. After all, one of the rights we all have is the right to disagree. But I disdain those who lack the guts to take a stance by directly answering the key question. I even have a modicum of respect for health insurance companies (and we all know “corporations are people”) that have made it abundantly clear by their actions, lobbying and political contributions, their stance that health care is a privilege and not a right. It may not be possible for these blog bashers to be forthright in their response to the most basic question in the health care debate, but we can examine the logic of the arguments they make opposing health care for all Americans. Most of these arguments center on what they view as the sanctity of “personal liberty” and “right of free-choice.”

The argument as espoused is that individuals – not the government – should be free to decide if they even want health coverage, what form it takes and where they can buy it. For them, it is a violation of their “personal liberty” for government to “mandate” that individuals must purchase some type of basic coverage. I have no problem giving people the freedom to make that choice. But if they do decide to forgo health coverage for themselves or their family, they should be willing to sign a waiver agreeing that if they ever do get sick, they are fully responsible for all costs of care. Because if they don’t, you know who will end up paying for their “freedom” to decide not to have health care coverage. But more importantly, the issue is not about those who have the resources to “self-insure” or can find private coverage; the concern is for those who lack the means to buy private insurance (at prices set by companies) and those who have the resources, but can’t find an insurance company willing to issue a policy. Shouldn’t there be some option – private or public – for these groups to have the “individual freedom” to have access to and acquire basic health care coverage (which at the present time is made up of almost 50 million Americans)?

The Mandate

The real hang-up for those who oppose health care reform is the idea of a “mandate” coming from government requiring the purchase of some type of health coverage. For them it is the litmus test in the battle between individual freedom and government oppression. It is their sincere belief that government has neither the moral authority or constitutional power to compel an individual to do what they don’t want to do or to buy what they don’t want to buy.

This, of course, is ludicrous logic, which if taken to its full course, leads to anarchy. The essence of any government is the power to mandate compliance with the rules of society. Without the power to mandate, any government ceases to exist and soon thereafter, so will organized society. Of course the power of any government must only come as a mandate from the governed and it must be balanced in a way to benefit all of society, sometimes even at the expense of unfettered individual liberty.

The real problem in the health care debate is that the power brokers and special interests that oppose health care for all Americans have consciously corrupted the intent and objective of the “health care mandate” by tying it to the emotional issue of “individual freedom,” as opposed to what is best for society in general. People are being led to believe that they are being “mandated” to do something they don’t want to do and therefore their individual rights are being violated. But, that is not the case.

The “mandate” is simple and far less nefarious than people are led to believe. It starts with the assumption that everyone – rich, poor, old and young – need and want basic health care coverage. Then it says you have two options: You can either be covered by programs offered by the government or required to be provided by your employer or you have the freedom to purchase any private plan you desire and can find. However, for the overall protection and benefit of society, you are “mandated” to pick one of the options. And the reason why is patently (and fiscally) clear: If you don’t pick either option and get sick, then society will be stuck paying for the cost of your freedom to decide not to have health care coverage.

Unfortunately, the success of those opposed to health care reform to link the emotional issues of “individual freedom” and “mandates” together in a way that makes them seem in conflict, when in this case they are actually complementary, has led to some deeply irrational and kooky arguments.

An example of just how kooky things can get is one response to the previous blog on health care. It earns the first prize in the category of convoluted thinking. Here is the argument, reproduced as submitted:

“do people have the right to drive a car or is it a privilege. everyone needs transportation. must we then mandate that we buy everyone a car. As long as your asking someone else to pay your bills through a mandate it’s wrong. health care without some restrictions would drive the price out of site for all private companies and individuals. That’s what obamacare will do for everyone, but health care will be worse for most except the very rich.”

Beside proving that he slept through his (mandated) middle school English class, give the writer credit for one thing: In one tortured, convoluted paragraph he is able to cover the entire waterfront of the health care debate even though his logic went out with the tide.

The person is correct when he writes that everyone needs transportation, but he seems to be oblivious of the fact that cities, states and the federal government spend billions of dollars to provide “public transportation,” that is available for those who exercise their freedom not to buy a car or cannot afford either car or bicycle. Of course, we are all “mandated” to pay for this with our taxes, even if we don’t use public transportation, or sleep through English.

It is hard to tell, but his paragraph seems to suggest that “individual freedom” for anyone who needs transportation is defined by their ability to find it on their own or do without. While it is a big leap from figuring out how to get to work to figuring out to how to obtain and pay for basic health care, his logic seems to be leading us to believe that “individual freedom” for those who need health care coverage but can’t afford or find it – is to do without. The writer clearly believes it is wrong “asking someone else to pay your bills through a mandate.” Which leads me to wonder if he has ever received benefits under Medicare, which, if he has, means that others have helped pay his bills? (Lest we forget, Medicare is a mandated government program requiring all to contribute to and participate; which, unlike Obamacare, offers no “individual freedom” to opt out and secure private coverage. Even if one can afford and find it.)

This person argues elsewhere that, “health care without some restrictions would drive the price out of site…” (sic) I could not agree more, but no one – specifically not Obamacare – is asking for health care without restrictions; just that everyone have a right to receive “basic” health care. This gentleman may have forgotten that one of the main Republican attacks against Obamacare was that there were restrictions on coverage. Does he not recall the infamous brouhaha raised by the Republicans over the Obamacare “Death Panel” that would supposedly restrict and control benefits?

In one final killer dagger to the heart of health care reform this guy nails it when he declares that under the mandate of Obamacare, “health care will be worse for most except the very rich.” What is worse than no coverage at all? And isn’t that the real problem now, that health care really only works for the very rich?

As long as we have gone this far, let’s address one final issue that is central to the health care debate. Many are genuinely concerned with the propriety (if not legality) of “mandating” individuals to “pay” for benefits received by others or to receive benefits “paid for” by others. One respondent put it succinctly: “Do I have the right to force someone else to pay for my health care? If so, then that person no longer has the right to their liberty. One cannot have BOTH the right of liberty AND the right to health care. I prefer freedom.” This person is obviously sincere, but once again, the reality and logic of her comments are faulty.

It is the fundamental nature of any insurance program – public or private – that the benefits received by one are paid for by others. For example, if you buy a $250,000 fire insurance policy on your home, you will never come close to ever paying $250,000 in premiums, but if your home burns down, you will receive a check for $250,000. Where does the extra amount come from? Do you think the insurance company just gratuitously ponies up $250,000 of their own money? Of course not; your benefits are paid for by all others who also have a fire insurance policy with that company. Likewise, if another person’s home burns down, a portion of the premiums you have paid will go to pay the benefit they receive. Is this wrong? No, it is how insurance works.

Consider Social Security. We are all “mandated” to buy into the program and pay “premiums” during our working years, so that we can begin to receive benefits at retirement. It only takes a few years of receiving Social Security payments for them to exceed the amount of taxes we have contributed. Does that mean the payments stop? Of course not, they continue for as long as you live. So who pays for these benefits? They are paid for by others who are still working and contributing to the plan; just as you did when you were working. Is this wrong? No, it is how insurance works. With universal benefit programs such as Social Security it is necessary for financial soundness to “mandate” that all participate. (The financial problems with Social Security are not the fault of the soundness of the plan, but because our friendly politicians have “borrowed” money out of Social Security to pay for other things.)

If it is determined that basic health care is a right for all citizens, then to work effectively and to be on a sound financial basis it must be structured like any other insurance program. As such, others will pay much of the benefits you receive in the program and some of your payments into the plan will be used to pay benefits for others. As with any universal benefit plan, all must be “mandated” to participate in order for it to be financially sound. But, unless you never go to a doctor or get sick, the benefits you receive will always exceed the amount you have contributed and those benefits will be paid for by all the other participants.

Give me Liberty or . . .?

The final part of the respondent’s comments argued that the concept of a “right” and “liberty” are mutually exclusive. That you can’t have both and you must pick between the two. This is faulty logic. We all have a “right” to a basic public education; does this mean that we lose our “liberty” to go to a private school? We have a “right” to police protection; does that mean we lose our “liberty” to hire a security service? We have a “right” to free speech; does that mean we lose our “liberty” when the government “mandates” that we can’t yell “FIRE!” in a crowded theater? When women were given the “right” to vote; did that mean that men lost their “liberty?” (Well maybe, but that is for another discussion.)

The beauty of this country and the government we have selected is that as “rights” have been recognized and made available to all, it has expanded “liberty” for all. All American citizens deserve the right to receive basic health care; if for no other reason than it is the right thing to do.

And the Moral of the Story …

This all leads us back to the fundamental question at hand: Should every American citizen have the right to receive basic health care? If the answer is “no,” then we are done. We are saying that we are satisfied with the current system that allows private insurance companies to ration health care with the objective of making a profit. We are satisfied with a system that excludes 50 million Americans from any coverage and provides inadequate, prohibitively expensive coverage to millions more. If the answer is “yes,” that basic health care should be a fundamental right of all Americans, then we have a lot to do. But the debate will switch from emotional and irrational arguments about the problem to finding ways to solve the problem. And we have always been better as a society when we have sought to work together to expand the rights of others in a way that expands freedom and liberty for all.


Malpractice For All In The Health Care Coverage Waivers

Obama Administration Shirks its Duty but There’s More Than Enough Blame to Go Around

Quietly, without fanfare or publicity, the Obama Administration on September 24 granted health care coverage waivers to McDonald’s, the international burger giant, and 29 other organizations. As Drew Armstrong of Bloomberg Business News reported, these waivers mean that “Nearly a million workers won’t get a consumer protection in the U.S. health reform law meant to cap insurance costs because the government exempted their employers.” The news of these waivers was not publicly discovered until October 8 and created a firestorm of charges and counter-charges.

In essence, without the waivers, the companies would have been required to provide covered employees with a minimum of $750,000 in coverage in 2011. The bottom line is that the companies simply did not want to provide this health care coverage to their employees. And the ultimate result is that their employees get stiffed, or should I say, deep-friend?

The reality is that the Obama Administration crumbled in the face of blackmail and bludgeoning threats from these employers. McDonald’s and the other companies threw up thinly veiled threats that – unless granted the coverage waivers – they would simply terminate all coverage for their employees. These penny-pinchers took the position that they would prefer to pay a fine to the government for not providing coverage, because it was cheaper than providing the actual coverage. Because the government-sponsored alternative health care program is not scheduled to be implemented until 2014, these million workers would be without any coverage at all, for up to three years.

The companies used the mid-term election campaign to blackmail the Obama Administration into capitulation on the health care waivers. They recognized, and rightly so I would add, that the Democrats would not want the publicity of  a million-plus workers losing health care coverage – “because of the Obama health care plan” – right in the middle of an election in which they are already in trouble. Despite their callous disregard for the well-being of their employees, McDonald’s and the other companies surmised that terminating coverage for their employees would put more media and political heat on the Obama Administration than on their own selfish actions.

So as a result, contrary to the intent of the health care legislation, millions of Americans will be forced to continue to face health care risks with minimal and inferior coverage.

Casting a Few Well-Placed Stones

So who do we blame here? Do we fault the Obama Administration for being gutless in the face of pressure from these companies and for making a political rather than principled decision? Do we fault these large, sniveling corporations for being more concerned with the health of their bottom line than the health of their employees? Or, do we fault the Republicans in Congress for their clearly political, narrow-minded obstruction and intransigence to effective health care reform?

The answer of course is – Yes! Yes! Yes!

What we have here is the first of what will be many confusing and conflicting chapters in the implementation of clearly imperfect health care reform legislation. It will not be the last time that we will see employers use loopholes and confusion in the health care legislation in an effort to avoid responsibilities to their employees. It will not be the last time the Obama Administration will cave to political and economic pressure. And, we will continue to see the Republicans (or Tea Partiers by another name) resist effective reform by taking self-serving positions, simply for political gain.

Should we be surprised that an imperfect system produced imperfect health care reform legislation? Absolutely not.

President Obama was so intent on claiming success in the passage of health care reform that he was willing to accept any plan – no matter how convoluted – that Congress would pass. The idea seemed to be that “bad legislation was better than no legislation.” The plan was “we’ll fix it later,” but it was weak leadership and Obama is now paying the price. The Democrats, who dominated Congress, clearly demonstrated that they were no more effective as leaders than the Afghan government. The Republicans demonstrated clear disdain for any ideas that were not their own and they had no ideas of their own. Just being against anything anyone might want to do is not leadership. Corporations were the most consistent and effective when it came to health care reform. They attempted to defeat health care reform and now are attempting to circumvent it based on their eternal belief that “profits come before people.”

And the Moral of the Story …

Leadership starts with clearly defining what is to be accomplished and eliciting acceptance among your followers. For that reason, leadership is most effective when the focus is constantly on the vision to be achieved while the efforts are concentrated on the little things that make success possible.

The vision of health care reform was based on “the right of all Americans to receive basic health care.” Obama failed as a real leader here because he failed to clearly define and gain acceptance of the vision. He compounded his problems losing focus on the vision, allowing the incoherent Democrats in Congress to concentrate on the little things and by allowing the obstructionist Republicans to actually define the debate.

The result was a complicated, convoluted and ineffective plan for health care reform. And, this opened the door for corporations to do what they do best and that is to look out for themselves, even – if not always – at the expense of all others.

The reality is that there are no winners here — especially those who need and deserve basic health care coverage — because America lacks truly effective, ethical leaders and that, in my view, is what is wrong with America today.

Health Companies Infected With Pre-Existing Case of Unbridled Greed

Heath Care Reform Opens Fertile New Opportunities to Plunder Both the Rich and Poor

When it comes to the policies of health insurance carriers, integrity is at a premium, common sense has lapsed and greed is running rampant. With no “socially redeeming value,” health insurance companies have become the pornography of the business world and, if not totally banned, should certainly be tightly controlled. It may be difficult to believe, but health insurance executives are even more despicable than bankers—if that’s possible.

For the past 60 or so years, health insurance companies have been safe, secure, comfortable and content in their own little protected cocoon; free to collude against the best interests of everyone and create safe financial havens themselves. And they have done so with quiet, but unabashed glee.

Is it any wonder that these consumer predators have shown that they will charge any price, bear any burden, meet any hardship, support any friend and oppose any foe, in order to inoculate their industry against competition and meaningful overview, all to assure the survival and the success of their kind?

Health Insurers are a Class Unto Themselves

The health insurance industry is very unique in what we would like to believe is a “free market economy.” To function effectively, a free market economy requires transparency, openness, consumer options, real competition and effective regulation to assure a level playing field. These are all things that are lacking in the health insurance industry.

Naturally, these insurance companies will argue that they are in “a very competitive environment.” In a sense they are, but in truth they compete with each other – not against each other – in an effort to isolate themselves from  unwanted competition and effective regulatory control.

The health care industry has a polished and effective PR machine that propagates the familiar “woe-is-me” style of defense against regulatory and competitive incursions into their world. They plead poverty as they annually approach regulators in a – usually successful – effort to ratchet up premiums paid by the policyholder. With few competitive options available, the hapless consumer is faced with a painful dilemma: either cough up the higher premiums or risk life and limb without coverage. Operating in such a preen world, the companies have been free to ration coverage to only those they deem capable of paying the increased premiums and, ipso facto, least likely to ever collect on the benefits of the policy. And even when they have coverage, they must battle the companies to receive the benefits they have justly paid for.

And that’s when you have health insurance. Some 50 million Americans are not able to secure it, under any conditions. And that’s a pox against low- and moderate-income Americans who reap the scourge of the insurance companies’ greed.

The Ugly Truth about State Insurance Regulators

Health care executives will argue that the consumer is already protected because of an effective state regulatory system that controls both premiums charged and policy benefits, but this is an well-orchestrated chimera designed only to confuse the consumer, preserve the status quo and shield the companies from what they perceive to be harm.

State regulators may be well-intentioned in their efforts, but they lack the experience and resources to effectively regulate the companies. Yes, state regulators do “approve” the premiums to be charged, but they must – get this – rely only on information provided to them by the companies. Is it any wonder that the old saying, “figures don’t lie but liars do figure” came out of health insurance companies dealings with regulators?

It is also true that state regulators both mandate and approve policy benefits, but a closer examination of this authority will expose the truth that these regulations are, in effect, designed to protect the existing companies against the incursion of competition, diversity and innovation. (As mentioned above, state regulators simply don’t have the experience or resources to analyze and understand new types of benefits so they stick to what is known and has been approved in the past. This favors existing companies and thwarts new competition.)

And still the companies complain they can barely eke out a profit on the approved subsistence levels. Funny though, despite how difficult the companies claim it is to survive, whenever there is a serious effort to introduce transparency, diversity, consumer options and real competition into health care, the companies rise up as one in a concerted – often dishonest – effort to euthanize the changes.

A Case in Point

When the Obama administration made health care reform a high priority, a posse of health insurance companies made it their high priority to defeat or dilute the reforms. The health care industry’s attack on health care reform was multi-pronged. The industry poured millions and millions of dollars into a lobbying and negative advertising effort in an effort to defeat the reform. They supplemented their millions with a campaign of fear mongering, i.e. “death panels,” arrogant deceit and sophisticated, confusing half-truths. It that was not enough, the health insurance industry demonstrated its copious lack of integrity by offering to “get under the tent” to “help” the Obama effort at reform. It proved to be nothing more than a thinly disguised effort to infiltrate in order to destroy any hope of real reform, even though the voluminous reform bill had to be carted to legislative chambers in a wheelbarrow.

In reality, only the health insurance companies were the big winners when health care reform was passed. The basic system of health care produced little fundamental change and health insurance companies were presented with a potential bonanza. No real competition was introduced that would induce the companies to be more responsive to consumer needs, high risks were removed from the market and mandates for individuals and companies to purchase coverage – available only from health companies – created a fertile new market for the companies.

And how have the health insurance companies responded to this situation? Well, they behaved like they always have and in a manner they feel is their inalienable right. Rather than slinking off to their board rooms to pat each other on the back for another victory, once again they have let loose an epidemic of unbridled greed.

In a lead article in The Wall Street Journal (September 8, 2010) titled “Insurers Pin Hikes on Law,” it was revealed that health insurance companies are requesting rate increases of as much as 20 percent and attributed most of the increase to new benefit mandates in the health care reform law. Talk about unmitigated gall! It just shows that health insurance companies will go to any length to continue to inflate their profits at the expense of the consumer.

Of course, the Obama administration is outraged by this duplicity of the health insurance companies. In a follow-up article in The Journal (September 10, 2010), “U.S. Rebukes Health Insurers,” Kathleen Sebelius, secretary of Health and Human Services was quoted in a letter to the health industry’s chief lobbyist as writing, “There will be zero tolerance for this type of misinformation and unjustified rate increases. We will not stand idly by as insurers blame their premium hikes and increased profits on the requirement that they provide the consumer with basic protections.”

That is all well and good, but the reality is that under present law and regulatory structure neither Secretary Sebelius nor anyone else in the federal government can do anything to block these increases. Ms. Sebelius suggested that as a result of these increases the government might block the offending companies from a new marketplace for insurance coverage. But, what good will that do since there are no other options for the consumer to purchase coverage, except from these companies?

Once again the health insurance companies have the power and willingness to simply thumb their noses at the consumer. And, they are more than happy to do so.

And the Moral of the Story …

When you are faced with a system that is fundamentally flawed – as the American health care system is – the problem cannot be fixed by tinkering and adjusting. You have to get to the real problem and fix it. The Obama administration’s desire was to get to the core of the problem – transparency, options, competition and innovation – but were once again blocked from doing so by the big money and overwhelming power of the health insurance industry.

The only way to fix the health care system in America is to fundamentally change it. Insurance companies should be held accountable and made responsible to the needs of the consumer. Start by giving the consumer honest and real options and creating true competition in the industry. Yes, this means that even if the competition has to come from the government – so be it. Insurance companies have proven over and over again that the one thing they resist and fear is real competition. Give them a little real competition and you will be amazed just how efficient and productive the companies can be. But until such competition is created, the consumer will continue to be at the mercy of merciless health insurance companies.