The doctor will see you now

The worst thing about undergoing a biopsy is the inevitable wait for the results to come in. And if you plan ahead poorly and have the procedure on a Thursday or Friday, I can just about guarantee your weekend will be ruined, because it’ll be Monday before you get the word.

Of course the really worst thing is to have what doctors ironically refer to as “positive” results when they really mean you are not going to be happy to hear them. Your red flags should go up when the doctor asks you to come see him as soon as possible, to talk about your situation.

Imagine this scenario: After sitting in the waiting room with half a dozen or so other patients, you find yourself confronting your future. Your doctor explains that you have a tumor, in fact of the kind that grows fairly rapidly, making surgery the only real option for treatment.

The doctor, whom you trust absolutely and have known for half your life, doesn’t mince words. If you don’t have the surgery, you will die, and soon.

This is not just one kick-in-the-gut time, but two. When you were laid off, fortunately you had enough savings to tide you over until you could find another job, and now that is going to run out while you recover from what will be major surgery. Not only that, but you lost your health insurance with the job, and no other insurance company was willing to cover you because you have had diabetes, even though it has been controlled with dietary changes.

You are looking at tens of thousands of dollars, all told, that you just don’t have. The choice is pretty simple: Find the money or die.

Family conference time: you have a decent amount of equity in your home and will be able to borrow against that. Then two of your kids, who are each doing pretty well, offer to pitch in. They have lots of equity in their homes and can easily raise the money. “We want to keep you around, Dad.”

This is not where you say, “No, I’d rather die than let my kids go into debt!”
At least, I certainly hope not!

How could I even suggest such a thing? Because if you cast the situation in terms of the current opposition to President Obama’s health care plan, you’d be running up a deficit and placing a financial burden on your children.

I don’t know about you, but if I were in your situation, I’d have no problem with that concept. And neither would my children, or so I’m told.

Opponents of health care reform that is likely to add “trillions” to the public debt constantly worry about “passing it on to our children and grandchildren,” as if that made any sense. At worst, it’s a cynical argument to make us feel guilty, at best it’s a pitiful lack of understanding of how the world works.

I’m someone’s child, and grandchild for that matter, and I’m probably still paying for World War II, the GI bill, the interstate highway system, and the NASA program, all things that have kept our country safe and prosperous over the years.

If debt is bad, then get rid of the house, the truck and your kids’ college educations, not to mention that 52” flat-screen TV in the rec room. And forget about the trip to Disney World that your credit card would have made possible.

The point of health care reform is to bring the system under control so that costs will be lower and everyone can afford some form of insurance which cannot be denied for pre-existing conditions. Like diabetes. Like you.

Once everyone is covered, emergency rooms will be freed up to deal with emergencies. Preventive care will kick in and that will lower costs all through the system. A 21st century method of keeping medical records will streamline doctors’ ability to provide informed care and will reduce the enormous amount of paperwork presently required of both doctors and patients, allowing doctors to focus on their patients.

This cannot happen in a month or two, or even in a year. But when we pay enormous amounts for our children to attend college we expect they’ll go through at least four years of study, perhaps more with graduate study. And we don’t expect they’ll be hired into a $100,000 a year job even before they graduate, do we?

In fact, you won’t see a return on your investment for years, but you don’t mind because you’ll know it was worth it as the kids begin to prosper. Same with health care reform; it’ll take a while, but it’ll be worth it.

You’ll get your investment back as costs go down and the system works better — and now your kids won’t have to help pay for your surgery.

Can Anyone Give Me An Answer?

OK, it’s time for me to come right out and ask a useful question here:

As you know, I’ve spent some ink in this space in support of the States Children’s Health Insurance Program (SCHIP) presently apparently headed for Presidential veto. And a host of Washington politicians have suggested that expanding that program would be the absolute end of everything we hold dear, or words to that effect.

Senator John Cornyn (R – TX) last week stood up in front of Congress and made such outrageous statements that a couple of his fellow Republicans saw fit to chastise and correct him, right there in front of everyone.

Congressman Joe Barton (R – Arlington TX) has made it clear over and over again that he’s opposed to SCHIP. I won’t go into his interesting claims, having done so in the past. (I hear ‘n tell he wasn’t too happy with that, but I also note he didn’t write to correct me.)

They both insist that expanding SCHIP would send us down the slippery slope to “government-run” health care or, worse, “socialized medicine.”

Well, given that at least they both seem to agree that there are lots of totally innocent children who are without health insurance (this is true, even though President Bush famously suggested a few weeks back that everyone has access to medical care because they can go to the emergency room), let’s just dissect that frog and see if we can understand what, exactly, is wrong with universal health care.

I defy any opponent of universal health care to answer honestly WITHOUT resting their argument on certain phrases, such as “government-run” or “socialized medicine”; if they feel they just can’t live without them, I demand that we agree on definitions. Global warming is only made worse by the red-button rhetoric of the Washington folks.

Remember, my goal here is to get an answer to the question.

Let’s just take a look at a couple of examples of government-run medical services.
Start with Medicare. Anyone out there want to give it up?

Here’s who I think might be willing to do that: A retired corporate executive whose benefits include lifetime medical coverage, for whom Medicare is only a nuisance that he doesn’t really need; with both Medicare and private coverage, he’s in the catbird seat.

You could say that about airline pilots and union members, except that you can’t because their former employers are forever going bankrupt or cutting their benefit packages in order to cut costs. So it’s not likely these folks will give up Medicare benefits because they might need them!

The Federal Employees Health Benefits Program. Senator Cornyn and Congressman Barton would likely be quite willing to give up Medicare, because they will retire with the excellent health insurance available to federal employees, said to be even better than Medicare. Like Medicare, it’s a government run program.

Both FEHBP and Medicare provide universal health care to their populations: Medicare to seniors, the federal employees’ insurance plan to former and present federal employees, in each case with the government picking up about 75% of the premium and the insured picking up the rest.

Now, how about the Veterans Health Administration? Here’s what Phillip Longman, author of Best Care Anywhere, wrote:

And who do you suppose is the highest ranking health care system? Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the veterans health care system outperforms the highest-rated non-VHA hospitals.

And here’s what Ezra Klein, writing for American Prospect, said:

What makes this such an explosive story is that the VHA is a truly socialized medical system. The unquestioned leader in American health care is a government agency that employs 198,000 federal workers from five different unions, and nonetheless maintains short wait times and high consumer satisfaction.

Anyone got a problem with the Veteran’s Health Administration?

So, you can see that the term “socialized medicine,” which simply means “the providers are government employees,” is SUCH a bugaboo!

So, if we do away with the terms “socialized medicine” and “government-run health care,” as I’ve shown they don’t describe something to be afraid of, what are we left with?

Oh, SCHIP opponents are also worried about the cost, they say. This is a red herring. Leaving children uninsured drives them to emergency rooms, as acknowledged by our President, where their care drives up the costs for the rest of us or, worse, leaves them without care, so their strep infection can go untreated and infect the whole class and from there their families, and from there their parents’ co-workers, all with lots of folks missing work because they are sick. NOW you can start counting the costs.

But you know what? You don’t make decisions about children’s health based on the cost. Do you?

And what about the assertion that some States would allow coverage to children of families with incomes up to three or four times the poverty level, causing some “rich” families to sign up instead of keeping their existing insurance. The poverty level is $20,650 for a family of four; you can do the math and see if the answer you get is “rich.”

Our own Senator Cornyn told a fib when he said incomes as high as $82,000 a year could qualify (he was talking about New York’s application to the Bush administration for a waiver to allow that increase, and it was denied) thus allowing some people who don’t need it to drop their private insurance and join up.

But consider the cost of living in New York, and then the cost of private health insurance, and do the numbers again.

You know what? I think a few “rich” kids (define “rich” — have you looked at the cost of living in New York?) getting coverage, so that over 4 million uninsured children can, it’s not a bad tradeoff!

So, it’s not the cost, “socialized medicine” is not always bad, and “government-run health care” can work pretty well. So, what?

Would someone please offer a convincing, fact-filled argument against SCHIP – or, for that matter, universal health care for all Americans?

Bush hates little kids?

Once again it’s recess, and once again Bush plans to have his way despite that silly old Congress . . .

As reported in the New York Times, in a letter sent out at 7:30 p.m. last Friday, the Compassionate Conservative-in-Chief went around the House and Senate to forestall expansion of the SCHIP program just authorized by Congress.

The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a monthlong Congressional recess. ...

Kinda makes you wonder why we bother to have a Congress at all, doesn’t it? I mean, think of all the money we’d save!

Just one more question, Congressman

Last week I joined a roomful of citizens gathered to hear Congressman Joe Barton (R-Arlington) report on recent doings in the U.S. House of Representatives. Health insurance for poor children didn’t seem to be a key concern for the folks there, but it was included on an official handout that covered immigration reform (1 page), Iraq (2 pages), and energy (3 pages). SCHIP got 2 pages.

Listening and reading, I learned that the Congressman still likes lignite coal and believes in keeping your tires inflated properly to save gas. He told us the Trans Texas Corridor would not be all that different from I-35, and assured us that “it’s not going to be 12 lanes wide, after all!”

Well, I guess that’s true in a way. But since the TTC is planned to be 1200 feet wide, you have to wonder.

That’s a whole different column, though, from the one I want to write today, because some pretty outrageous things are being said and believed about the SCHIP legislation, beginning with Barton’s handout. I don’t think there’s room here to talk about them all, so I’ll just hit the high points.

Item: Well, of course the Congressman’s first concern is the cost. He worries that federal funding will increase by more than $88 billion over ten years; to put that in perspective, the Pentagon is presently spending $6 billion a DAY in Iraq alone.

Shoot, just two weeks out of Iraq and we've got SCHIP paid for!

Item: Barton claims that the legislation would “remove seniors out of private healthcare plans in Medicare Advantage … and greatly increase the number of people eligible for Washington-controlled, bureaucrat-run healthcare.”

Leaving aside for the moment his characterization of Medicare and SCHIP, try as I might I couldn’t find anything to support that. But even if in fact he were right, here’s what they’d be losing, according to the official Medicare website:

In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.
… In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

But wait! According to MedicalNewsToday.com, the new legislation will:

Increase Medicare benefits for preventive care and mental health care, raise the value of assets low-income seniors can have and still qualify for the Medicare prescription drug benefit and cover more out-of-pocket Medicare costs for lower-income elderly beneficiaries.

And, get this: It will “eliminate co-insurance and waive the deductible for current preventive benefits covered by Medicare.”

Sounds like Mr. Barton and the insurance companies anticipate that a lot of folks, offered these extra benefits, may abandon Big Insurance for Medicare.

And as for that bit about “Washington-controlled, bureaucrat-run healthcare” — give me a break! Both Medicare and SCHIP are fee-for-service programs where you choose your provider and the provider of your choice sends the bill to the government.

You want to talk about bureaucrats? Ever dealt with a private health insurance company?

Item: But worried as he is about the evils of government provided health care, Barton is really, really worried about what he calls “cuts” in Medicare. The thing I find even more exasperating than outright dishonesty is the sin of omission, making a thing appear bad by not telling the whole story.

In this case, the so-called cuts are really reductions in reimbursements to the Medicare Advantage program by eliminating EXCESS payments. No doubt the insurance companies are going to miss them, and that’s the truth!

In addition, the legislation would delay cuts to physicians proposed over the next two years and instead INCREASE payments by .5% in each of those years.

Item: The Congressman, referring to a 2005 HHS report, claims that “the Democrat [sic] Majority’s SCHIP proposal” provides health care to illegal aliens.

Well, according to an item in the Houston Chronicle, that’s just not so.

Actually, the SCHIP legislation bars illegal immigrants from joining. [There is] a provision that let states change rules on required documentation. This was deemed necessary because many of the applicants, largely poor whites and African-Americans, couldn't find original birth certificates and don't have passports. In any case, Social Security numbers will still be required.

Item: In a section quaintly entitled “The Ills of Universal Health Care,” the good Congressman worries about our health care becoming too much like “the national care systems found in Canada and the United Kingdom.” He tells us that both systems “are rationed-care oriented which leads to lower quality care and long waits.”

Here’s what I found in the April 2007 American Prospect:

A 2003 study in The New England Journal of Medicine found that the United States spends 345 percent more per capita on health administration than our neighbors up north. This is largely because the Canadian system doesn't have to employ insurance salespeople, or billing specialists in every doctor's office, or underwriters. Physicians don't have to negotiate different prices with dozens of insurance plans or fight with insurers for payment. Instead, they simply bill the government and are reimbursed.

And Barton quotes from an article by a Canadian doctor to suggest that Canada’s wait times are horrible and deadly, though he doesn’t offer any fact whatsoever to show that we are any different.

Again citing the American Prospect:

A 2003 study found that the median wait time for elective surgeries in Canada was a little more than four weeks, while diagnostic tests took about three (with no wait times to speak of for emergency surgeries). By contrast, Organisation for Economic Co-operation and Development data from 2001 found that 32 percent of American patients waited more than a month for elective surgery, and 5 percent waited more than four months. That, of course, doesn't count the millions of Americans who never seek surgery, or even the basic care necessary for a diagnosis, because they lack health coverage. If you can't see a doctor in the first place, you never have to wait for treatment.

Couldn’t say it any better.

I have to end this for now, but while I continue my research for the next round, let me just say I would really like to hear the Congressman’s answer to this:
What exactly would be the “ill” in universal health care?

Joe, You Didn’t Tell Us the Whole Story

The other day Congressman Joe Barton, of Arlington, Texas – whose District covers a good swath of north central Texas and includes Ellis County — had an article in our local paper about health care for low-income children.

It talked about the existing program that helps to fund medical insurance for low-income children and the upcoming vote to re-authorize that program. It appears he doesn’t like the way some States are using federal funds under the existing program, under “circumstances” he doesn’t define, and that he doesn’t care for the way others are using (similarly undefined) “waivers” to cover adults — all of which he naturally lumps under one of his favorite words: “abuses.”

And he objected to the bill to re-authorize and expand the program because, he said, a family with an income of $200,000 “could” qualify for help — but he doesn’t say how.

Still, the reader comes away with the impression that good ol’ Joe just loves to help poor kids get medical care and there are just a few tiny details to work out.

Well, last week he voted against it in the House.

I’ve been following this story for awhile, my interest in universal health care being one of the reasons — after all, if SCHIP (the acronym for the State Children’s Health Insurance Program) and Medicare both make folks so happy, can relief for folks in the middle become an idea worth looking at?

Another reason for my interest in the story is kind of contrarian: the President says he intends to veto the legislation. Yup, put the kibosh on it, stick a knife in it. And when the President is hot to kill legislation, I just can’t help wondering why.

Both bills would expand coverage to another 3.3 (Senate) to 5.5 (House) million children and some pregnant women. This would be done by allowing in families with twice the poverty level, around $43,000 per year for a family of four (which the Heritage Foundation sweetly calls “wealthier families”).

The proposal is to pay for the expansion by cutting excess payments to insurors and increasing taxes on cigarettes.

Now, anything that will help me quit smoking is fine by me! Anyone got any problem with that?

While the Congressman was all a-twitter worrying about how other States choose to treat their citizens, a whole gaggle of spinners hit the talk shows to inform us that the legislation included — gasp, horrors! — cuts to Medicare! “It will take from our senior citizens and probably send them to the poorhouse, or at least take away their insurance!”

Well, folks, then I received an email — addressed to me personally, since I am one of them — from AARP. You know, the organization that stands like a pitbull on behalf of the senior citizens of America. And y’know what? They LOVE this legislation!

“AARP applauds those Members of Congress who voted for the CHAMP Act. These lawmakers put the needs of older Americans and low–income children ahead of special interests.“

Seems that the Republicans who objected to the bill’s “cuts to Medicare” were in fact objecting to eliminating overpayments in the subsidies paid to insurance companies who cover Medicare recipients; it was discovered they had been paid 12% OVER what was due to them!

Between the tobacco companies and the insurance companies the pressure must have been unbearable.

And still another horror: This legislation will “expand government-run health care” and put us “on the path to socialized medicine”!

Oh, good grief! That old canard. Why would they haul that out? Because, sad to say, it still works with some people.

First of all, what government-run health care are they talking about? It’s help with INSURANCE, you idiots! Oh, sorry. I’m sure they are not idiots. But if they are not, and they are still saying this, what does that make them, exactly?

Likewise, the bit about “socialized” medicine. It’s not “socialized medicine.” What England has can be called “socialized medicine,” perhaps, because its hospitals are owned by the government and its doctors are government employees.

Whether it’s a single-payer system or Medicare, doctors in private practice and privately-owned hospitals send their bills to the government and get paid. Private. Choice. Not “government-run.”

In the case of SCHIP, just consider the name: State Childrens Health INSURANCE Program. We provide funds to help pay for insurance coverage for poor kids and in some cases their parents (a matter that obviously chafes the Congressman).

Why should we care? What if we don’t feel a twinge of pity for the poor, nor particularly care if they get to see a doctor, because we have other things to worry about? Well look at it this way: If your kid goes to school with a child who can’t afford to see a doctor for the preventive care that might have kept him from coming down with the flu, guess what he’ll bring home?

Of course, the “mark-up” meeting to work out differences between the House and Senate versions of the bill is still to come, so it’s not final yet. But since the Senate also passed a bipartisan version, I’m optimistic.

The fact that this legislation was passed with bipartisan support may not matter to the President, although when he counts the votes perhaps he’ll have an attack of reason. Protective reason. Other battles may become more important.

Meantime, if you have any thoughts about this, the Congressman will be in town this week, and I’m sure he’ll love to hear from you.

A single-payer health plan that could pass

Synopsis: Proposal for a Single Payer Partnership, funded equally by employer and employee, modeled after self-insured industries, administered by insurance companies selected through competitive bidding in the respective States.

A Plan Even Harry and Louise Could Love

The insurance industry has fought to continue the present system, because it is profitable. Employers famously complain that it would be too expensive to provide workers with health insurance. Too many working Americans must buy insurance they can’t really afford or risk losing everything because of major medical expenses. How about a plan that will protect each of these groups while providing basic health care for all Americans?

I propose a single-payer system — call it a Single Payer Partnership — funded by equal contributions from employer and employee (á la Social Security) plus taxes most people will agree to, such as on cigarettes, whiskey and killer bullets. Each State (no Big Government threat here!) would solicit proposals from individual insurance companies or consortiums to administer that State’s share of the fund; the best qualifying proposal in each State would be awarded the contract for that State — subject to review and renewal as are other government contracts — under which the winning bidder would be paid to administer the fund.

PRESTO! Health care for everyone, administered by those most experienced in doing so. Part of the cost savings is immediate, with insurance premiums eliminated, but with the insurance industry still a major partner and thereby continuing to make money; employers will not have to foot the whole bill because employees will (gladly) contribute a fair share; and the uninsured are now included.

Those already covered by Medicare and related plans — the elderly, the disabled, the indigent and certain low-income workers — are brought into this universal plan, along with their present health care funding (e.g., Medicare, Medicaid, VA, SSI). There should be additional savings realized when everyone is under one umbrella.

The insurance companies should like this plan, because it will keep them in the loop at a lesser risk to them (if in fact health insurance is as risky as they would have us believe). And there will still be a need for “gap” packages such as are now being sold to Medicare recipients as Part B — as well as a market for new policies of life insurance for those who now can afford it!

It is reasonable for employers, large and small, to contribute to their employees’ health care, since a healthy work force benefits the employer as it benefits and advances the greater society. But no doubt the employer will write off its share of the insurance fund, and perhaps raise the price of pizza by 50 cents. We can live with that.

The benefit to the economy, in addition to controlling out-of-bounds medical costs and freeing up more money for voluntary spending, will derive in part from increased job stability and work force quality. Many people now take jobs they don’t want, or leave jobs they like, just because of health insurance concerns; it will now be easier to attract and keep quality employees. More folks will be able to become self-employed because of the safety net, and this should lead to more jobs being available.

Existing Models

As anyone with Medicare experience knows, that plan actually works quite well. You choose your own doctor. You can choose to buy a “gap” policy, or not. You can choose your treatment. Freedom of choice is everywhere. Obviously, Medicare could be the model for a single-payer health care system.

Another model, that might be seen as a microcosm of the Single Payer Partnership proposal, is already common in U. S. industry, and it works. Specifically:

The employer is self-insured — that is, the company maintains its own fund for payment of medical expenses for all employees, and pays a major insurance group to administer it. How blessedly simple! The employer saves money by hiring a manager instead of paying premiums to an insurance company which then pays for management but also must provide a profit to its shareholders.

For a modest, say $15, co-pay the employee can go to whatever doctor he chooses, undergo whatever procedure he chooses, and if the procedure is not covered and/or he has chosen a doctor who has not agreed to the fee structure set by the insurance company, the procedure will still be available but will simply cost him more. The employee contributes to the monthly premium and has an also modest annual deductible for optional procedures — all quite manageable for the average working person.

With affordable health insurance available, the employee will almost always opt for wellness care, with the inevitable reduction in costs over time, and everyone wins.

There IS a Health Care Crisis

So long as frightened parents have to go on television to beg for money to save a child’s life; so long as people with diabetes, cancer or heart disease can be denied medical insurance or be obliged to pay thousands of dollars a year in increased premiums; so long as millions of Americans drudge along in jobs they hate and/or put up with poor working conditions just to get or keep insurance, there is a crisis.

In this rich country of ours, there is no excuse for anyone going without decent medical care, yet we lag behind the rest of the industrialized world in providing for our own.