Category Archives: Uncategorized

What a Perspective!

I believe one fundamental difference that divides perspectives on health care is the whether you believe it is the community’s obligation to take care of one another.  Some believe that with the exception of a few basics the government (community) should not interfere.  Basically it is every man or woman for themselves.  Others believe that a community must take care of its weakest. This debate has taken an interesting twist in several comments and posts of friends of mine regarding organ donation.  Organ donation (especially while alive and for a stranger as in a kidney) is quite possibly the strongest recognition that one can make that the community does in deed have an obligation to take care of its own.  Organ donation strips the  barriers that most people construct around their bodies.  Bodies are personal, private, not communal.  But a friend of mine is considering a more communal perspective so that her community can better take care of its own.  By giving of ones body to another (in the form of a blood donation, bone marrow, kidney) you are offering yourself (quite physically) to another in the community.  What a perspective!

Now if only more in our community would be willing to give up monetary resources so that all could access health care.  What a small sacrifice.  What a small perspective compared to those who give of themselves quite physically!

The State of Things

The Sunday Times placed a health care article on the front page above the crease. The article is not necessarily groundbreaking new information, but its updates typical stories  and costs in a new and shakier  economic climate. The article emphasizes that yes, the uninsured numbers are rising (nearing 48 million), but that the costs for the insured are rising in a time that when budgets are tightening. Here are stats from the article:

The average employees’ share of their family insurance premium has increased from $1800 in 2001 (the last recession) to $3,300 today.

Families spent more on health care (16.6% of income) than they do on food ( 13.1%) or housing (14.4%).

These trends are not new and the dynamics of who is hurting has remained the same. However, with increasing gas costs, food costs, and housing uncertainties, health care needs are being squeezed. Don’t be surprised if more and more of today’s insured will fall into the uninsured pool at an ever increasing pace.

A Most Sincere and Irreverent Letter to John McCain

Dear John McCain,

It seems that you have only listened to half of what the health care experts have told you and then were shamed into cobbling some rhetoric to cover the glaring gaps. Let me help you.

Let’s first go over what is good about your plan. I like most of your tax reform. Tax credits are better than tax deductions. They are fairer and more progressive. However, you still may want to give a small incentive for employers to stay in the game. I would hate to lose their support, and with your plan they might just all get up and leave. If they do it seems that the small government plan you are envisioning may have to grow to fill the gap. But you have the general right idea with tax credits and $2,500 per individual and $5,000 per family is getting close to the price of insurance, but still falls short. Does everyone get this credit? Is it related to income? Does it rise with inflation, or even better yet rise with health care inflation? Just wondering. Those damn details.

Cost reduction. That’s big with you and you are right to emphasize it. We spend too much on health care – over $6,000 per person. Almost double what the next most generous country spent. And some of your ideas are fine. They are the same as your Democratic rivals (good copying skills), and will only nibble at the corners, but important nonetheless. We should invest in electronic health records, have improved coordinated care, generic drugs, re-importation of drugs (very maverick of you), smoking cessation, state flexibility to encourage creativity, increased focus on chronic conditions, tort reform, and Medicaid and Medicare reform. All good suggestions. Your two sentences on each of them really demonstrates your breadth of understanding. And again your competition beat you to the punch on almost all of these. I like the bipartisan spirit, but I was hoping that since cost reduction was your big thing you might have a new trick up your sleeve. I guess your big price reducer is increased competition. So let’s talk about that.

Your plan will cripple the employer-based health care system. Not a bad thing, but since health care accounts for 16% of our GDP and you are recommending pulling the foundation out from under it (I admit a shaky foundation) you might want to say a little more than you want to put health care decisions back in the hands of the patient. So under your plan the patient would select their health plan, right? And you are assuming that the patient has the information to sort through all of the health plans to choose what is best. Surveys on this topic show that the typical person shopping for insurance bases their decision on things that do not reflect quality. How do you plan to educate America on this? Remember for a market system to work you need an informed consumer. The quality reporting systems in America are improving, but any plan that puts the insurance decisions with the consumer better focus more on quality measurement and reporting than you do. I would suggest you expand on that a bit.

Lastly, Elizabeth Edwards. You two have been so cute fighting in your sandbox, but I would listen to her. I think you have. You realized that she is right saying your plan would leave out the sick. Maybe a person with a history of melanoma? We know that insurers compete by avoiding high-risk people. Risk avoidance is where the profits are – not quality delivery systems. That pre-existing condition thing. That age discrimination thing. Shoot foiled again, and you know it. In the last minute you threw in the line, “We will work with the States,” to make sure these people are covered. What does that mean. High risk pools, perhaps? Well, that is really expensive. Under your plan the really high cost people (up to 30% of the national health care bill) would be denied coverage by insurers (remember since they are not under an employers plan they could be denied) and potentially fall into these groups which would be subsidized heavily with tax dollars. Oops, that sounds like a big government plan. So I would suggest you rethink how you are going to pool people together. Did you know that the premise behind insurance is pooling? You have to find a way for the high-risk people to be pooled with the low risk people based on something besides health. That is what employer-based health insurance was all about.

And lastly, many States have their ways of dealing with these issues. For example New York uses community rating. Under your plan with cross-state purchasing these New York plans would all collapse because nobody who is healthy would join. So much for State flexibility.

I would suggest that you go back to the table and provide a bit more detail. Again, I like the tax credits and I am okay with leaving the employer-based model, but you have to have thought through what’s next. I look forward to your third draft.

Sincerely,

Lucas Pauls

Growing Old is Not for Everybody

It was about the third story in the newcast one evening this past week, a few pages into most newspapers, and this Sunday it was below the line in the “Week in Review” in the New York Times.  The story read that the assumption that each American generation would outlive the preceeding may not be true for all Americans. Since 1933 the average American lived to 61 years. In 2005 the average age had climbed to 78 years. A remarkable gain (only 42nd in the world though), but this seemingly ever increasing trend may have stopped and even reversed for some. Yes, rising obesity rates, Drop in Life Expectancysmoking, sedentary lifestyles, and pollution have slowed life spans, but it was thought that cardiac advances, medical miracles, better food supplies, and the ever advancing human condition outweighed our bad habits.  But what the report out of Harvard, and published in PLoS Medicine, shows is that there is an increasing lifespan disparity between the poor and the rich despite our bad habits. The “least deprived” don’t see this dying young trend, but the “most deprived” do. This gap has always been present. Wealth is a known indicator – along with education – for improved health, but the gap between the two groups has been growing.  Since 1983 the gap has grown by 3.3 years in women and 5.4 years in men.  In large swaths of the country the life span is shrinking. The concentration of this trend is located in the deep south, Appalachia, and around the southern Mississippi River. The map says it all and it is disturbing. As the New York Times points out – these findings give creedence to John Edwards stump speech, “Two Americas.” The second America can now expect to live shorter lives than their parents.

 

Two side notes:

The Congressional Budget Office (CBO) backed up much of this research. The CBO pointed out that the social security benefit is becoming less and less progressive as the rich live longer and reap more benefits, while the poor die younger seeing less benefits.    

Countries with large wealth discrepancy (large gap between the richest and the poorest), regardless of overall wealth, do worse on almost all measures of health than those countries that have smaller wealth discrepancies. Further, the richest in America are sicker than the richest in more equitable societies. What does this say about or values, priorities, and way of life?  I’ll leave that for discussions, but it gives one pause to think that maybe our “survival of the fittest” mentality has its downside.

The Typical New Uninsured Person

The New York Times ran a story back in March about a woman who could not get health insurance even though she made $60,000. This story speaks of pre-existing conditions and the newest members of the uninsured club. It also explains some of the complexities in our system in real world ways. I’m always weary of single case stories, but the particulars of this story vividly detail the decisions more and more people are making because of a lack of health insurance. And how a lack of insurance can invade so many parts of your life. Take a look.