Why a Public Option is Unnecessary

December 4, 2009

The debate over health care reform in the United States hinges on many decisions. One of the most important as expressed by this administration is the idea of creating competition for current insurance providers. The best way to do this is with a government-run option that people can pay into that functions the same way as a private group. The name for this idea depends of who you ask, but for our purposes we’ll call it the public option.
The pros and cons are simple per se. If you’re a private insurance provider who’s been needlessly overcharging people for services or otherwise netting huge profits, you may see that taper off a bit if the public option succeeds in insuring people for less.
This sounds great to people who aren’t in insurance, which likely accounts for a larger chunk of the voting populace than the former group.
The question underneath, however, is how can congress do this without seriously undermining the autonomy that largely impacts ethical decisions in this area.
Sure, if you believe that insurance companies really are evil and siphoning billions from people’s paychecks only to deny them their care, or in cahoots with doctors to encourage more services rather than better care, you may be right. But as addressed on this Minnesota Public Radio program by Cigna’s VP of public policy G. William Hoagland, many large health care groups have agreed that changes are needed and will be enacted concerning the cost of medical care, the billing system, the issue of pre-existing conditions, and the mass of uninsured.
So how then can government compete?
In according importance to the public option, even President Obama has agreed to certain conditions about a public option: it must break even financially, and it must do so without being afforded special privileges. No forcing special deals on providers, no adding the national deficit to support the public option.
Where does that leave the government in terms of business?
In a New York Times article from August of this year, Richard Thaler, professor of economics at the University of Chicago’s Booth School of Business, draws an interesting, but clearly relevant analogy about another government run business that hasn’t been run so well.
That’s right, the U.S. Postal Service. As Thaler points out, yes it’s great for sending a letter to Grandma, but in the business realm when one needs something to get from one place to another overnight, they’re more likely to count on one of the private options (UPS or FedEx).
Thaler also points out that the Post Office routinely runs a deficit, as it is now, and is pressed to close offices in rural areas or eliminate weekend deliveries. The cuts are only prevented by pressure from large groups such as postal employees and those who rely on those small offices.
Thaler goes so far as to attribute government failure in business ventures as opposed to those achieved by private firms to lack of innovation. Perhaps this is true, perhaps not. Either way without intention, it provides strong evidence for the elimination of a government-run public option.
The issues the administration have posited, and people have accepted, that this plan could potentially solved are best solved without adding another large institution to the US Government’s payroll.

The New Ad Strategy of the Instant News Age

November 10, 2009

After what was probably the biggest liberal legislative victory in years in the House, the outlook seems grim for what will happen when new health care legislation gets to the Senate. The bill was a close call for Congress, passing by a 220-215 margin, and in the Senate it seems any public option would be rejected. According to Politico, Independent Joe Liebermann has said he intends to reject any bill that contains a public option, which would mean democrats again need the vote of Republican Olympia Snowe, who has also expressed little support for a public option.
As Politico Capitol Hill writer Glenn Thrush points out, the best bet for those who favor a public option is that this victory in the house can “steel the spines” of Senate Democrats for the 60 votes needed to put the bill through.
That said, The Washington Post chose to portray a different reaction to Saturday’s vote.
According to The Post, the liberal group MoveOn.org launched a half-million dollar campaign using the votes of house members whose seats are in jeopardy against them. Many first-year representatives and those who have frequently been portrayed as allies of insurance companies saw an ad criticizing their vote of “no” on the bill. Others saw their vote praised for “standing up to insurance companies.”
Will any of these strategies be enough to accomplish the ultimate goal of passing reform through the Senate and into law? The House vote seems to solidify the goal a bit, but perhaps the advertising strategies are a bit excessive.

AARP Under Scrutiny for Dual Roles

October 27, 2009

The largest political interest group in America has also been one of the strongest proponents for health care reform, but more recently their role in the debate has come under heavy scrutiny from congressional republicans.
Formerly known as the American Association of Retired Persons, AARP has long been seen as the umbrella of protection over some of America’s most vulnerable citizens. Notoriously trusting and not always aware of the dangers of technology, AARP lobbies for seniors and retired persons, and members often receive discounts from private service providers based on agreements with the powerful group.
Their interest in health care reform is easy to explain on its face. Older persons require frequent medical care, and especially end of life services are the most costly of all health care expenses. But it’s recently been discovered that the Association holds other stakes in the health care reform before congress.
According to The Washington Post and The Wall Street Journal, lawmakers are at issue with a number of “medigap” plans bearing the AARP name. “Medigap” refers to a plan which provides additional coverage on top of government Medicare or Medicaid.
Reccomendations and plans from congress to slash competing programs could result in a huge leap in the purchasing of AARP supplemental plans.
Furthering the concern is AARP’s status as a non-insurance firm. This means that new laws regarding earnings caps for insurance providers (and their top executives) would not be applicable to AARP and its figureheads.
AARP spokespeople have argued that any profitable gains from their various AARP-brand credit cards, supplemental health care plans, etc. allow the group to further their service with lobbying and other consumer advocacy functions.
This represents a huge problem both ethical and functional that can be difficult to see. AARP frames itself publicly as having no bias, or only a bias towards the consumers for whom they advocate. Yet we begin to see that they have many business interests by which most normal people’s best faculties could, and have been, overcome.
There are a lot of nice ways to say it, but the fact is senior citizens are some of the most taken advantage of in our country. Defrauders abound and the internet has made it all too easy. It’s deplorable that an organization like AARP, which purports to advocate for retired persons and seniors, should be perceived even momentarily as a threat to defraud them further.
AARP should take every necessary step towards immediate transparency if there’s any truth to the statements of their spokespeople. They need to identify concrete reasons why, if it is indeed true, the plans that seem to benefit them financially are also those that provide the best services to the people they represent. Otherwise an association with a generally stellar reputation for honesty and service could be tainted with scandal and greed.

Free Health Care:Less Complex Than We’ve Made It?

October 13, 2009

Wise County, VA is an interesting place. Although seldom heard of both in and out of the state, it boasts the largest population in the state outside of any metropolitan area. Located in the Appalachian Plateau region of the state, There is a University of VA campus for both undergrad and graduate, and its advanced systems for backing up data allows the county to bill itself as “the safest place on earth” for businesses and others who store data in mass quantities.

All of these things are little points of interest you’d find in any county. One thing Wise has that no other county can boast: free health care for the uninsured and underinsured.

Every year hundreds of doctors, nurses and other trained professionals come to the southwestern area in Virginia to provide free care in a makeshift field hospital run by Remote Area Medical Volunteer Corps. For 3 days of the year, long lines form and people come from around the country for a chance to be healed free of the skyrocketing charges of modern medicine.

The Washington Post has put together a series of multimedia on the RAMVC’s yearly project. In the series particpants called the 3-day event “a gift from god.” There are even volunteers available to stand in the long lines for those whose health has crippled their ability to wait for themselves.

What makes this possible? Why don’t we have one of these in every state? In every county? It may only be three days of care, but as those who attend will tell you, it’s certainly better than zero.

The answer is the star of a popular 70’s and 80’s television series, Mutual of Omaha’s Wild Kingdom. Stan Brock, the former snake-wrestling TV star is the financial and literal figurehead for the RAMVC. Every year he is shocked by the turnout, not its quantity, but the ailments people come with. Brain tumors, other cancers are typical for the 800-some professionals at the event.

The cost is not incredibly high at $26,000. The professionals who participate purport that they are satisfied with their regular salaries and provide their services free of charge to Brock’s group.

Brock realizes that his 3-day event though significant in its originality, is a band-aid over a massive wound. He draws inspiration for a Medical Volunteer Corps before his television days in South Africa. After watching a series of very treatable diseases devastate native populations with no resistance before beginning the show in 1968, Brock vowed he’d return with a volunteer medical corps to help these people.

Costwise, the event is nearly free when you consider that most organ translplants cost about 4 times as much. Some would say the only key is Brock and a few good-hearted doctors. If only 49 or so more of us could learn what Brock has “we could fix this problem,”says Brock, “It’s just a question of priority.”

http://www.washingtonpost.com/wp-srv/nation/interactives/healingfields/

Ad-Watch: Evaluation or Free Screening?

October 6, 2009

Since June, The Washington Post has been updating a section of its Web site showing about 30 different national TV advertisements regarding healthcare reform.
We have discussed this type of reporting before. Although here The Post has incorporated a multimedia element, the idea is much the same. Ad-watch journalism as it’s sometimes called is a useful tool to help consumers flesh out details from the barrage of information being given to them in political ads. Who paid? How much? What’s it about? Who is it aimed at?
The idea is not to simply give the ads more exposure and run time, especially not for free. With this in mind, it seems The Post could be digging at bit deeper. After being completely astounded once again by the amount of information that can be compiled about any one thing using computers by the NYT’s Series on Water Pollution, it seems The Post could divulge much more about the ads, rather than simply screen them with a few taglines underneath.
Political scientist Bruce A. Williams developed a four-part test for evaluating political information of which The Post’s series seemed to skip a part or two. The four parts are transparency, pluralism, versimilitude, and practice.
The Post series contains the following information for each video: The organization that funded the ad, the ad’s debut date, a ballpark figure for cost (some as vague as “seven figures”) and about 60 words on content.
Clearly this information does not quite hold up to Williams’ test, which as an ideal informant of the public a large newspaper outlet would have the sense to help them along with, the test being indeed a complicated process. I think TWP could stand to do a little more reporting and possibly interpreting for their audience and a little less re-screening of political mud-slinging and partisan ads.

Breaking Sen. Baucus

September 22, 2009

Senator Max Baucus of Montana will convene a meeting of the Senate Finance Committee today to discuss, amend and vote on his own health care overhaul plan. In the past few days news has been peppered with some of the changes and compromises that Baucus has considered for the bill, and issues on which he seems intent to hold steady.

Fellow senate Democrats and Olympia Snowe of Maine, the only remaining Republican, have raised two main issues with the bill.

First, Baucus’ proposal for the first time would require middle-income families to carry some sort of health insurance. Many within the committe believe that this may place too much pressure on families to purchase insurance they can’t afford. Baucus has not changed the requirement but conceded that he may reduce penalties for those without insurance.

Second, a main funding proponent of the proposal was Baucus’ plan to place a large excise tax on high-cost insurance policies. For Baucus and supporters, this would reduce overuse of medical services and deter insurance companies from

Problems with these funding measures stem from a number of circumstances. A big one is occupational, for instance it costs more to insure a firefighter than a software engineer for obvious reasons.

Whichever direction this week sees the committee go, one thing is clear: this bill is not the sweeping reform we once heard about.

Though controversial, it’s not surprising that some of the measures in question are the newest and perhaps brightest ideas. It has no provision for a government option to compete with private insurers. Non partisan sources project Baucus’ bill to actually subtract from the national deficit, but without the excise tax and penalties for uninsured middle-class, a large portion of that funding goes away.

Perhaps it’s true that some public servants and high-risk workers will foot the bill in terms of the excise tax, but it could be equally true that the tax would eventually drive down costs. The same could be said of the idea of having a much larger percentage of people covered by insurance plans. It’s the reason they were placed in the bill in the first place.

For all his effort and compromise over about a year, Baucus has barely gotten one Republican (Snowe) to consider supporting his bill. Attempts at bipartisanship are great, but perhaps they’ve been wasted here. We’re already pretty far off from the reforms we heard about just under a year ago, when talk was aggressive. We can ill afford to compromise and sterilize new reforms into complete uselessness.

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/21/AR2009092102772.html

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/21/AR2009092102288.html?hpid=topnews&sid=ST2009092103807

http://www.nytimes.com/2009/09/17/health/policy/17health.html

Immigration and Healthcare Debates Meet Head On

September 15, 2009

The healthcare debate has grown a new limb, the issue of whether or not illegal immigrants will be able to recieve expanded health benfits on taxpayer money, and how this will be enforced. After the leader of a conservative immigration reform movement, the Federation for American Immigration Reform (FAIR) stirred the controversy, it has taken root in Washington. Starting this evening and tomorrow, conservative radio hosts will hold a “town hall of the airwaves” to highlight the costs of illegal immigration. Returning fire, liberal groups such as America’s Voice, have attacked FAIR, calling them fearmongerers and calling the founder out as a racist.

Again it seems as though congress has started to miss the point. As these two debates cross, not only does the scope of both debates expand (the result one would hope for), the scope of mortar shells the two sides can trade expands as well (the road we seem to be taking.) We’ve gone from a productive debate–what can be done about free riders on public healthcare benefits–to which side is more credible, which side has their hands the dirtiest, which side has the ugliest REAL motives.

The switch occurred without warning, and likely due to the normalcy of such an occurence, this switch seems to have gone unnoticed, or perhaps just accepted because of its entertainment value. Instead of debating what can be done about the problem of free riders who may not pay taxes and attempt to recieve public health benefits, America’s Voice and FAIR have decided to trade blows about who’s more of a racist xenophobe, while citing the other side as “mudlsingers” or “juvenile.” Once again a debate in congress seems deadlocked due to motives and feelings that should play no role in how we regulate the distribution of public health benefits.

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/14/AR2009091401498.html?sid=ST2009091500115

Ugly Rumors, Uglier Truths

September 2, 2009

Healthcare reform has become possibly the most pressing issue on the Obama administration’s agenda. For the most part, both sides agree the present system should be changed, and that previous reforms have been nothing more than immediate responses to unique conditions as they have arisen. It is a debate that has been characterized by serious misunderstandings, partisan remarks and rumor spreading in congress.
The most recent of these rumors is highlighted in a hypothetical future situation former vice president candidate Sarah Palin presented on her Facebook page. In a brief post describing her fears about the policies in “the nationalized heath care plan that the current administration is rushing through congress,” Palin theorized about a panel of bureaucrats deciding the fate of her child with down syndrome based on the child’s assessed level of productivity.
“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.”
It has since widely been affirmed that there is no provision for any such panel in any of the reforms proposed. The rumor stems from a mangled mix of the same partisan pundits who helped defeat the Clinton-era reforms, and ideas that the Obama administration supports a pro-abortion, pro-euthanasia program, and mixed-up accounts of legislation to provide for hospice care and “end of life” services. The debate the falsehood has sparked may be much more interesting that the rumor itself.
For me personally, the most shocking stories and the ones that tend to move me to push for serious reforms fast are the tales of woe from those who’ve experienced first-hand the horrors of managed care in a capitalist system. Those witout coverage, and those who believed their coverage was more than adequate, only to learn their provider would not support the treatment they needed. The Michael Moore film “Sicko” told several of these stories but presented one more interesting tale from a different perspective.
Linda Peeno was a physician in the Louisville area when she started working in managed care. Over time she came to be a medical reviewer for the Humana Group, later medical director at Blue Cross Blue Shield. In 1996 Linda gave horrifying testimony to congress about the pitfalls of managed care, and the Death Panels that were more than just partisan rumors. Peeno’s ‘96 testimony:
“I wish to begin by making a public confession: In the spring of 1987, as a physician, I caused the death of a man.

Although this was known to many people, I have not been taken before any court of law or called to account for this in any professional or public forum. In fact, just the opposite occurred: I was “rewarded” for this. It bought me an improved reputation in my job, and contributed to my advancement afterwards. Not only did I demonstrate I could indeed do what was expected of me, I exemplified the “good” company doctor: I saved a half million dollars.”
The idea that partisans inside and outside of congress would perpetuate such rumors as one about proposed ‘Death Panels’ is sad and it continues to widen the gap between both sides and delay any reform. The audacity of the rumor surpasses the shortsightedness politically into the territory of outright manipulation. As Peeno testified, her decision, or likely, decisions, saved the company $500,000, and that’s just the one time. Her organization stood to avoid losses of millions when medical boards denied coverage, where any such board—“Death Panel”—in the Obama plan would stand only to lose credibility and risk losing favor in public opinion.
I’d take a ‘Death Panel’ that answers to the people, rather than one that responds only to monetary incentives, any day.

http://www.salon.com/news/feature/2009/08/11/denial_of_care/

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September 2, 2009

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