Health care conundrums

February 17, 2017

As I advance in age, I am exposed more and more to the health care industry, despite having enjoyed relatively good health until recently.  As a retired New York State employee, I am blessed with excellent health insurance that covers most doctor visits, medical tests and procedures, as well as prescription drugs, with only a relatively modest co-pay. Here are a few observations:

First, it appears that many of our health problems are what a friend of mine calls “diseases of affluence.”  More appropriately, they should be called “diseases of lifestyle,” since they affect people of all socioeconomic strata.  A lot of these are directly influenced by government policies.  For instance, our auto-centric physical infrastructure minimizes the opportunities for and pleasures of walking and cycling, and cannot help but contribute to obesity and other problems based on lack of physical activity.  Our government subsidies to cane sugar and corn (the main ingredient of high fructose corn syrup) help make junk food and sugared soft drinks attractively priced.  This is especially so for the poor, since the SNAP program (formerly known as Food Stamps) allows their purchase with SNAP benefits.  If we collectively spent more on complete streets that were friendly to pedestrians and cyclists, as well as cars, how much could we save on health care (not to mention on school transportation)?  How about if we stopped subsidizing sugar?  I think it would be worth a try.

For all the criticism leveled against it, the Affordable Care Act (“Obamacare”) has achieved something great — it has shifted the dialog from whether health care insurance should be extended to many of those who don’t have it to how the present system should be replaced or improved.  Neither Trump nor his minions are suggesting that those who obtained health insurance through Obamacare should lose it, meaning that they recognize that there is no going back on government’s commitment to growing numbers of its citizens.  Whether things actually get better or worse remains to be seen, but at least no one is talking a bout a pre-Obamacare “reset.”  To me, that is yuge.


Election aftermath

November 12, 2016

Much has been written about the recent national elections, and I only wish to add to it if I can say something original.  Here it is:  in large part, I blame the result on the New York Times, which for weeks had listed Hillary Clinton as having a virtual lock on the election and which, earlier, had done all it could to support Clinton over Bernie Sanders, even if it meant crossing the heretofore sacrosanct line between reporting and editorializing, a line it later admittedly obliterated when the finalists came down to Clinton and Trump.  The Times contributed to the naming of Clinton as the nominee, though she represented the party’s past, not its future.  And its unrealistic assessment of her chances justified the decision to stay home of those who did not support her, but otherwise would have come out to hold their noses and vote for her to defeat Trump.  Commendably, in some of its post-election navel-gazing pieces, the Times admitted that, in assessing Clinton’s chances as unrealistically high, it ignored the majority of voters outside of its bubble.  I have not yet seen an apology for its disregard of journalistic standards in its biased coverage of her campaigns in the primary and general elections.

Not that Clinton didn’t sabotage her own candidacy.  Her monetization of her prior service by giving paid speeches to Wall Street firms, the content of which she refused to disclose, and her misuse of e-mail, which almost surely revealed government secrets to those not authorized to see them (though I am not aware that the nation ever was placed in danger), among other things, were, to be sure, not as bad as many of the things Trump has done and said.  But the “false equivalency” argument is not a winning one.  Her weaknesses were enough to take the issue of character out of the race for those otherwise inclined to vote for Trump.  Had the democrats fielded a candidate with less questionable character, many people would have seen Trump for what he is and would have refused to vote for him, even if his ideology – to the extent it could be ascertained from his rambling, contradictory statements – might be more palatable to them.

So here we are.  The losers are not happy, as many violent demonstrations show.  I hope all the protesters were Clinton voters.  Obama, ever the class act, vows cooperation in the transition (see, by contrast, the way in which the Bill Clinton administration left the White House) and Trump, after a long meeting that undoubtedly opened his eyes as to what lies ahead, appears accepting of the advice he received.  He already is tacitly acknowledging reality by pulling back on his promise to “repeal and replace” Obamacare, realizing there is no easy way to preserve insurance for its 20,000,000 or so beneficiaries while removing its “objectionable” features.  Even with his party dominating both houses of the Legislature, expect more reality-dictated compromises to follow.  While such compromises may result in a lot of buyers’ remorse among Trump’s supporters, they could avert disaster at home and abroad.

 


Universal health care

September 20, 2013

I’ve been reading a bit to bring myself up to speed on the health care controversy. The best book I’ve read so far is T. R. Reid’s The Healing of America (thank you, Upper Hudson Library Federation, for free access to the e-book version). I should have taken notes, but here are the major take-aways:
1. To have universal health care, a nation needs to want it. The deep rift over “Obamacare” reveals we are not there yet as a nation, even though 22,000 people a year die, and 700,000 go bankrupt, solely because of lack of health insurance in our country. Many people falsely believe that anyone can receive free care for virtually any ailment in hospital emergency rooms; even if true (which it is not), that would be terribly wasteful and less effective than appropriate care venues.

2.  In order to insure everyone, everyone needs to be insured.  The healthy and young will pay in until they become unhealthy, when the system starts to pay out; by then, new healthy insureds should keep the system in balance.

3.  Covering everyone does not mean covering everything.  There will have to be some rationing — for example, hip surgery may not be authorized for someone 90 years old who has other health problems.  The body that makes these decisions must have credibility, impartiality and transparency, or people will lose confidence in the system.

4.  Non profit payers are required to reduce overhead and eliminate the bureaucracy established for the purpose of denying coverage and claims.

5.  A central power – either a single payer or a government body that sets uniform rates for all payers – is necessary to bargain effectively with providers.  What Reid does not state explicitly is that doctors and other providers should be prepared to work for less under such a system.

Citizens of the US harbor many misconceptions about universal health care, in addition to the belief that a minimal level of care already is available to everyone:

1.  Universal health care requires “socialization” of medicine, with the government owning the facilities and employing the providers. While government ownership is one model, other countries that provide superior care to all their citizens for less cost than we do use private doctors and facilities, and give citizens broad choice of provider and (non-profit) insurer.  

2.  Government cannot run health care as well as the for-profit private sector.  Medicare is one of the largest, most popular and most efficient government programs, and its administrative overhead is far lower than our private health care sector, though it serves a higher need population.  Our system of veterans hospitals is an example of pure socialized medicine, where the government employs the providers and owns the facilities, and where consumers are not billed for the services they receive.

There are many ways to skin the cat, if we have the collective will to extend health care to everyone and resist the special interests in favor of the status quo.  Obamacare may not be the ideal solution, but it’s a step in the right direction, and long over due.