The Health Care Law: When Is A Door Not A Door?

Thursday, 2012-June-28 at 19:23

Originally posted in January 2010 on Xanga: When Is A Door Not A Door? | lnxwalt on Xanga

I have been watching this health care bill with both anticipation and some dread. I have to say that the dread now tops the anticipation.

It all starts about sixteen years ago. William J. Clinton was President, and a commission led by his wife Hillary R. Clinton was working on a proposal to bring health coverage to nearly all Americans. There was a loud roar, “let the market solve the problem, private industry will do a better job for a lower price”. Clinton’s health bill collapsed, and we got the medical insurance industry of today.

Did this solve anything? Not really. You see, health care insurance is generally too expensive for those who are not covered under an employer-sponsored plan. Those who are covered find that their insurer’s cost-control processes are illogical. There are a number of Americans who are no longer with us whose demise should be blamed on insurance company “death panels”.

The health bill, as covered in the press, has these characteristics:
(1)No “government option”. This means that only the same companies whose incompetence and greed keeps 1/3 of Californians away from medical care are going to be the sole beneficiaries of this policy. Unlike the right-wing, who think this is “socialized medicine”, I recognize this as 1940s-style fascism. Requiring people to patronized a favored group of privately-owned businesses is not only wrong, it is scary. What industry will be next? Will we soon be required to buy automobiles, even in places like DC, where it makes no sense to drive? Will the dairy industry require us to buy milk products?
(2) Mandatory insurance. One would think that our experience with mandatory auto insurance would show people that this is a bad idea. Lower-income employees, including younger workers, will face the choice of whether to pay their rent and buy food or pay their insurance. Unless they are already in poor health, most of them will make the (wise) choice to pay their rent and buy food. Using the IRS to punish the young and the lower-income worker is not an acceptable answer when coverage for some level of “BasiCare” should be be available without any direct reference to the patient’s wallet.
(3) Insufficient attention to preventive care. Sixteen years ago, insurance companies promised that “health maintenance organizations” would focus on preventing illnesses, that this would be the way they would ration care… by making much of our medical care unnecessary. I ask you, where is the emphasis on diet, exercise programs, addiction-management (including smoking, prescription drugs, recreational drugs, and so on), management of chronic illnesses (e.g., diabetes, obesity, hypertension), psychological counseling (which can help avoid domestic violence and other violent crime)?
(4) Leaves up the dividing line between on-the-job medical coverage (worker’s compensation, disability insurance) and off-the-job coverage. As long as that line is there, people on both sides will continue to try and cheat the other side’s coverage. It is said that people come to work concealing an injury in order to “get hurt at work” and get treatment. It is also common for someone who really has been hurt at work to use their personal medical coverage because they fear retaliation by their employers. What is needed is a single, overall coverage.
(5) No workplace / classroom ergonomics requirement. Have you seen the little seat-desks that have a little area for a right-handed student to write upon? How often have you seen a lefty dealing with a seat that isn’t designed for him / her? What about office chairs and desks whose height cannot be adjusted properly for the employee assigned to them? When this kind of design violation affects workplace machinery, it can cause killing or maiming accidents. Even when such accidents don’t occur, human-centered design can reduce the number and severity of repetitive strain injuries.
(6) Exemptions galore. There are exemptions from the national plan for members of Congress, for those covered under government employee plans, for those covered under Medicare and Medicaid. There needs to be a single plan that provides “BasiCare” to everyone. Extended coverage (beyond what is contained in BasiCare) can be handled by today’s dizzying array of medical payment solutions (e.g., privately-owned or government sponsored health insurers or even Visa / MasterCard) separately from BasiCare, but some basic level of care, including preventive and chronic illness care, should be handled through a central BasiCare system.
(7) Constitutional violation. No, I’m not a lawyer. But I can read, which is more than can be said for most judges, congress-members, or presidents. Continuing to overload the interstate commerce clause of the Constitution can subject us to easy takeover by a “Roman emperor”-style tyrant. Instead, this should be something where Congress approves of a “joint operating agreement” by the states, territories, DC, and the Commonwealth of Puerto Rico, but without any direct federal involvement.

In this, I see echoes of Massachusetts’ failed plan. Their plan was based on persuading “I’m invincible” young and healthy workers to pay premiums, so that older and sicker workers’ costs would be lower. The problem was that younger workers don’t avoid joining health insurance plans because they don’t believe they’ll be hurt. They avoid joining health insurance plans because they find it difficult enough to pay for all the things they need (food, clothing, housing, transportation, tuition), plus all the things they don’t need but are required to pay for anyway (auto insurance). Adding another “you hafta pay me” to their overstretched budgets didn’t work for MA, and it won’t work for USA.

Is this the best we could do? A massive giveaway of your income and mine to the insurance companies? This could have been such a boon to our economy. Think about your co-workers who are coming to work sick and in pain, and how much more productive they could be if they received medical / dental / vision / hearing care.

Here are some things that a national health care plan should have included:
(1) All other insurers off the hook. Anything covered under BasiCare should be only covered by BasiCare. Other insurers shouldn’t collect premiums for anything within that area. This would both reduce premiums and reduce insurance company costs.
(2) Medical price parity. Right now, if you walk in and pay for your treatment with your credit card, you pay the most of any patients. In effect, you are subsidizing the discounted rates received by insurers. Medical care providers should have one rate for everyone who pays for a particular treatment.
(3) Direct and speedy patient recourse against medical payment organizations (that is, insurers and other payment intermediaries). This would help avoid situations such as a transplant recipient whose insurer refuses to pay for regular liver enzyme tests or the person whose insurance is canceled once she is diagnosed with cancer.
(4) Treatment incentives: A person’s need for care will be influenced by his / her lifestyle choices. I’d rather pay for someone to get a free slow-cooker and healthy menu choices / healthy cooking classes now than pay for treatment later. I’d rather see someone joining an exercise program now than having to be carried on a flatbed truck to the hospital. We have to ensure that cost is not an obstacle to healthy living, and that someone who chooses to live unhealthily despite the availability of assistance doesn’t use up all our treatment resources.
(5) Centralize payments. There should be one third-party payer for all BasiCare treatment. This doesn’t mean that direct patient payment will be prohibited, although they should get the same prices and payment terms as BasiCare does and that payment should be accepted as full payment, just as with BasiCare. (That is, no double-billing. Fraud should subject a treatment provider to permanent ineligibility for payment, including ineligibility to directly bill individual patients.)
(6) Universal coverage. Every individual in the country, whether young or old, male or female, citizen or not, should be covered for BasiCare. No exceptions or exemptions. This includes congress-members, military, state / federal employees, and even certain employees of religious organizations who are (for some curious reason) exempt from Social Security.
(7) Non-federal organization. It is time to start following the Constitution. States are closer to the voters, and present a more dispersed target for those who would corrupt the process (such as the major health care insurance providers).
(8) Premiums paid through state taxes, not federal taxes, and not directly by the covered patients.
(9) Co-payments encouraged. If it costs you nothing to go see the doctor, you’ll be there when you get a scratch or when your toenail is about to come off.
(10) Personal responsibility. When you refuse to care for your new piercing, you should have to reimburse BasiCare for the treatment of your infection, or even better, be made to pay some portion of it up front and to repay whatever you didn’t prepay. Personal choices have consequences, and you should pay for those, not everyone else.

Somehow, I doubt that the imperial Congress will hear my voice. They are too busy listening to big insurers and centralized government advocates. But they should be listening to me and millions of others like me, because we’re the ones who will get stuck paying for their mistakes if they fail to hear our voices.

When is a door not a door? When the government shuts it and keeps you from using it.

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