Don't let your schooling interfere with your education.
~ Pete Seeger

Friday, August 14, 2009

The Health Care Reform Bill

Caveat: I don't have time to research H.R. 3200, the House version of this bill, or any of the others, completely; so this analysis is based on reading the summary, scanning the text, and commentary from other sources. My analysis may have major holes in it. However, a conservative friend asked me to comment on it, so I'll give it a try.

First, this bill is almost 500 pages long. A basic principle I like to go by, articulated by Albert Einstein, is, "Everything should be made as simples as possible – but not simpler." Clearly, this bill fails that simple test.

The bill does have a lot of good points. It eliminates exclusions for pre-existing conditions. It limits out-of-pocket expenses and doesn't limit payouts. It covers preventive services. It provides health insurance for everyone. It requires the rich to pay more than the poor and middle class. It guarantees coverage for everyone. It includes mental health services. And so on.

My objections are as follows:

1. It's way more complex than it has to be. (See comment above.) It establishes a new bureaucracy, the "Health Choices Administration," with additional layers such as the "Health Insurance Exchange." It establishes a new public health insurance provider within this, I think as part of the Exchange. In addition, it seeks to fill the prescription benefit hole with this new insurance, so that people covered by Medicare then have the additional complexity of multiple payers for the same product, essentially doubling the paperwork. Every one of those is completely unnecessary and redundant. We've already got two public plans, Medicare and Medicaid, which is one more than we should have. Medicare has its problems, but it is run very efficiently. In fact, providing insurance is one of those places where government can excel, exceeding the efficiencies and effectiveness of private insurance because it is not motivated by profit, but by service.

2. The Health Insurance Exchange is supposed to compete with private insurers. Big mistake. I'd rather see something like the old-age insurance (Social Security) system: it is available for all, and if you want supplemental financial planning services, go for it.

3. It requires employers to provide coverage, based on payroll, not profitability. Really bad idea. We should be divorcing employers from providing coverage, not requiring more. Almost all other developed nations (those with which we trade) have single payer public health insurance; employers in those nations don't have the added cost of providing coverage. It's just one stupid way to make our own industry less competitive on the global market. Besides, it can really hit small employers hard, especially if their payroll is bigger than their profit. Expect marginal businesses to go under.

4. It doesn't mention "medically necessary." It should. Any procedure, service, or product considered medically necessary should be covered. That includes Sex Reassignment Surgery.

5. It imposes a tax on individuals without a health plan. That's okay, but I'd rather see a single-payer system that basically taxes everyone.

6. If it is true that people will be fined if they don't purchase a health care package, that is a major objection. "Nothing of benefit to the individual is obtained through coercion." (Socrates, I think?) I can think of no way to increase resistance to this bill better than this. People hate coercion, and rightfully so. I hate it. "Give me liberty, or give me death!"

7. Cost is not adequately addressed. (See update and link to Field's post below.) Without giving the public health insurance entity full ability to negotiate prices and without limiting the extent of malpractice suit penalties, cost cannot be adequately addressed. And creating redundant public bureaucracies adds a completely unnecessary level of cost, just for administration. It's stupid and counter-productive.

This health care reform bill is nowhere near as bad as some of the conservative commentary I've seen on it. For instance, one such objection is that it rations your health care. This exhibits the privileged ignorance of those who make this objection. Health care is already rationed, usually by income level. Poor people often have no coverage. Trans people can't obtain medically necessary procedures that are available to others. In fact, private insurers ration by pre-existing condition, exclusions, maximum payouts, preferred provider networks, and every other means they can legally access. This bill may well ration health care, but by eliminating maximum payouts, pre-existing conditions, and income refusals, it significantly reduces existing rationing. Another objection is that a government committee will determine your treatments and benefits. So what? Under private care, you've got an insurance executive, whose paycheck depends on reducing benefits provided to you, making those choices. And guess which one can be held accountable? (Hint: it's not the executive.) Making things better does not necessarily constitute making things perfect, but that's no reason not to do it.

Going back to Einstein's quote, the solution to the health care mess is way simpler than this bill. All we need to do is make Medicare available to everyone, with the following reforms: a) require it to negotiate prices. b) simplify the paperwork – everyone is covered, every provider a preferred provider; list the products and services provided to the patient on one sheet of paper, submit for payment, and you're done. c) limit malpractice suit payouts. d) cover alternative systems, such as acupuncture, naturopaths, homeopathy, and Christian Science treatment. Medicare is an efficiently run, existing agency; expanding it is simple, efficient, and effective. You could fit a far more complete reform package into a 25- or 50-page bill.

In sum, this bill is nowhere near as bad as the conservatives would make it out to be. It's also nowhere near as good as some liberals are making it out to be. It has some major problems, but also some really good stuff. Having looked at the actual bill, however briefly, I've modified my opposition. I'm agnostic. It will make some things better, but it will also create new problems which are obvious and predictable, and leaves other problems unaddressed. Whether there is a net social benefit to the bill is unclear to me – there may be one, and there may not. If it passes, we'll just have to wait and see.

One thing is clear, however: This health care reform bill could be a hell of a lot better.

Update: Field Negro is one smart cookie. When he posts something like this, I tend to believe it - and I agree with his commentary, especially about having each other's backs.


CrackerLilo said...

Thank you soooo much for trying to make sense of this! When I see something that absurdly overcomplicated, my instinct is to wonder what they're hiding. I wonder if that is fueling some of the anger and suspicion.

Seda said...

Probably. Congress keeps passing these incredibly long, complicated bills, and it always seems like there's a few nasty surprises inside. And they tend to do it when a far simpler bill would be way more effective. This is a good example, and I can only speculate on what I didn't uncover. I think it makes people feel cynical, and raises opposition to just about anything. Still, this looks like pretty much a break-even bill. Which, when you get down to it, is pretty pathetic.

I think a lot of the opposition is also that a lot of conservatives just want Obama to fail, and they're willing to screw up the whole country to see that he does. Rush Limbaugh is a case in point - he came right out and said it.

anne said...

Hey girl,

Well, I don't like to get started, but don't get me started. I love commenting to your posts, but the tower must fall, and this kind of thing (insurance) is just evil. I WILL NOT support the practices of my fellows that lead them into the hospitals. You're a bit different--I would pay for mistakes of birth, but not for people eating cheeseburgers in front of the telly all their lives and then having to have stints put in to keep them alive longer.

If I could solve my intense mess of medical problems without drugs or insurance or doctors, anyone can. Until health insurance is about health and not about supporting evil practices, I'm against it. If a person has an accident, by all means, we should fix them. But I resent having to pay for someone to take pills for acid reflux just so they can keep eating cookies and beer.

Aging is a myth--I resent having to pay for people's "aging." Until health insurance is about diet and nutrition and exercise, it's bunk.

my two cents, girl,

lets fix what fate and nature broke, not what gluttony, sloth or lust breaks.

I will go to jail before I pay a tax fine because I will not pay into this scam.

I also know that if I walk into a doctor's office (the only ones insurance pays for) they will stick with with needles and make me lie under their xray machines just because I might have cancer--their biggest money maker.

Agh--well I got started...

You're trying to do well in bailing the boat, girl, but the boat is down, down, down, as Field Negro says. Your heroic efforts only support evil. (well, not completely, that's the irony.)

And don't get me started on prejudice. Employers already won't hire people over 40 because their insurance is twice as high. I have trouble finding a dentist because I'm lumped as a "bleeder." Genetic screening will make it impossible for people to get work if the employers have to pay for this, which they will. And what of companies with high risk? They already pay SAIF through the nose.

It's just a really, really, really, really, really bad idea.

But I applaud you trying to show people where the Reps are knocking more holes in the boat.

They need to go to see their god and be all happy in their heaven.

I wish them well, but don't ask me to carry them.

hugs for you, sweetie,

David Carrel said...

Thanks so much for doing the post Seda. It is always great to hear your input. I guess that I would agree about being agnostic. I would agree about your statement about wanting Obama to fail. I debate with that in my head, but basically feel that way. At the same time, if this were something that would help both me and the country (mainly the country) out then I think I would like it. But the whole socialism part of it from the conservative media does scare me.
Thanks Seda.

Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing. To keep our faces toward change and behave like free spirits in the presence of fate is strength undefeatable.
~Helen Keller

Reading List for Information about Transpeople

  • Becoming a Visible Man, by Jamison Green
  • Conundrum, by Jan Morris
  • Gender Outlaw, by Kate Bornstein
  • My Husband Betty, by Helen Boyd
  • Right Side Out, by Annah Moore
  • She's Not There, by Jennifer Boylan
  • The Riddle of Gender, by Deborah Rudacille
  • Trans Liberation, by Leslie Feinberg
  • Transgender Emergence, by Arlene Istar Lev
  • Transgender Warriors, by Leslie Feinberg
  • Transition and Beyond, by Reid Vanderburgh
  • True Selves, by Mildred Brown
  • What Becomes You, by Aaron Link Raz and Hilda Raz
  • Whipping Girl, by Julia Serano
I have come into this world to see this:
the sword drop from men's hands even at the height
of their arc of anger
because we have finally realized there is just one flesh to wound
and it is His - the Christ's, our