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.

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.