Ripples
Kaiser Health News has an interesting article about the health care problems of some of the people who live in Mike Ross’s district. Ross is one of the Blue Dog Democrats who is threatening to deep-six Obama’s health care reform package unless changes are made (most notably eliminating or eviscerating the public option). Here are some excerpts:
PRESCOTT, Ark. – Rep. Mike Ross, who grew up in this tiny town of 3,600, represents residents like 62-year-old Sandy Barham, a restaurant owner with a heart ailment who can’t afford health insurance for herself or her employees.
“I can’t tell you the stress of living on the edge, just wondering, ‘Am I going to get sick?’” she said in an interview at the Broadway Railroad Café, where fried catfish with hush puppies is a popular feature. “I feel embarrassed, almost, when I go to the doctors and tell them I don’t have insurance.”
Many people in and around this economically depressed town can’t afford insurance, even as the battered economy has made it harder for employers to provide coverage for workers. They’re looking to Washington for help, and Ross, a conservative Democrat with a strong voice in the debate over health care legislation, says he’s on their side.
Yet Ross stands ready to try to block passage of a House bill that, its supporters say, would provide exactly what Arkansas needs: guaranteed insurance and a wider choice of coverage at competitive prices.
[...]
Prescott, where Ross and his family live, calls itself “The City of Progress.” Its railroad museum, housed in a restored 1912 train depot, is a point of pride. Pink and white crape myrtles enhance the look of the train tracks. Outside of town, horses graze in pastures abutting fields dotted with bulging bales of rolled hay.It’s a classic rural scene, but the government seat of Nevada County is barely hanging on. Vacant storefronts dot the streetscape. Last year, Potlach Corp., a forest products business, closed its mill, eliminating about 180 jobs.
The economy is taking a toll on health care on Prescott. Two in 10 residents have no health care insurance, and those who do have coverage have seen their premiums skyrocket by 80 percent since 2000, according to data compiled by Ross’ office.
Locally owned J.D. and Billy Hines Trucking Inc. has had to raise the deductible on its family policy to $2,000 to keep premiums, now $336 a month for employees, from rising faster. At her restaurant, Barham sometimes hears patrons talking about how they’re going to afford prescriptions. “They’ll say, ‘I’m going to get half my medication,” she said.
Barham frets about the well-being of her own uninsured employees, and has on occasion paid for them to see a doctor. But she has her own problems to worry about: poorly functioning heart valves that may eventually need surgery. Her hope is to remain healthy until she qualifies for Medicare, the federal program for the elderly and disabled, in three years.
Think about that for a minute. This woman, to put it bluntly, is hoping she does not drop dead before she gets access to one of the two public health care programs available in this country, which are limited to very low-income or no-income Americans, and Americans over the age of 62, respectively. She does not currently fit into either category, so she has to wait two years, with malfunctioning heart valves, and hope that her heart does not give out before then.
What happens to the people Ms. Barham employs if her restaurant has to shut down? How many other lives will be affected by that loss of income, meager as it is? What is the ripple effect, beyond even the people who are immediately affected? Is it possible — is it actually, really and truly possible — that other Americans, some of whom may be much more financially secure than Barham, may have good insurance policies, may not have to worry about outrunning heart disease — still have a stake in whether Barham has access to the health care she needs, at a price she can afford? Does her cardiovascular health, and her very existence, actually benefit (indirectly, but legitimately) Americans who will never know or meet her? And if the system of health care that Barham and others like her should be able to turn to in situations like these is broken, and that system has to be fixed, and fixing that system costs money, and somebody has to pay that money, should two million Americans who are very high income earners be required to pay their fair share of taxes to produce that money? Or should they be exempted?
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31 Responses to “Ripples”
Why are you so sure that the bill would be a net benefit to people like the restaurant owner? Under the current House proposals, if her payroll is at least $250,000 she'll have to pay a fine for each employee that she doesn't provide coverage for.
She wants to provide coverage for her employees, though. She just can't afford to. What do you suggest she do?
I dunno- push for legislation that's more supportive of small business (for a change?)
Support a health care reform that actually *reforms*. One that stops the runaway train of ever-increasing costs, rather than conscripting a few rich citizens to stand on the tracks.
I dunno- push for legislation that's more supportive of small business (for a change?)
Fine, but the system we have right now, and have had for the past 30 years or more, is terrible for small business. How is not being able to afford health insurance for yourself or any of your employees a net benefit for this woman over what's provided in the Obama legislation? I have to say that opposing the passage of this legislation, now, while having no meaningful suggestions or ideas for a better, is not only unhelpful, it should disqualify anyone from being taken seriously in the debate on this issue. This is too serious.
Support a health care reform that actually *reforms*. One that stops the runaway train of ever-increasing costs, rather than conscripting a few rich citizens to stand on the tracks.
And ditto for you, Dr_J. What would an actual, legitimate, real idea for health care reform look like if it existed in your head? Since you obviously don't have one, then I suggest that you stay away from those tracks and maybe go get a cup of coffee with some friends and talk about the upcoming football season. You are irrelevant to this debate.
I'm just sick and tired of conservatives shooting down health care reform as Obama has conceived it, and having nothing concrete or meaningful to put in its place. If you don't have a clue how to do health care reform, then you should be supporting the current bill, because the alternative would be nothing, and that is unacceptable.
Kathy, why do you assume that there is not a better alternative, or that Dr. J 'obviously' doesn't have one?
There have been several plans that were lobbied for by the SBA and supported by a few Congressmen over the past few years, which never saw the light of day. If you're interested, do a Google search to learn more before you make asssertions that are inaccurate about no alternatives ever having been put forth.
Kathy, perhaps you've missed the few dozen times I've laid it out. Shrink the role of private insurers by removing the incentive to buy insurance through an employer, and let them retreat to a business worthy of the word “insurance.” Put consumers/patients in control of their futures by encouraging them to deal directly with providers, and by providing government subsidies to help where necessary. They are the *only* ones who have a real stake in value for money, and if they are not empowered, the system will never reform its runaway costs. Let them put pressure on providers to compete more directly and to deliver more quality and less quantity and waste. Ease the endless government regulations on health care that contribute to the escalating costs. Reform the medical tort system so that honest mistakes by doctors and other routine situations can be resolved with fewer lawyer hours.
But keep the government out of delivery. Most of the anecdotes you and others have posted about our health care system's failures are not actually health care problems, they're financial problems. The health care itself, when people can afford it and are not kept from it by some bureaucrat, is pretty good. We don't have a shortage of ICUs or long waits, we just have it on terms that too many people can't afford. The proper role for the government is to encourage a more robust market and provide financial help to the people who need it.
Here, I'll do some of the work for you:
http://www.house.gov/ryan/press_releases/2005pr…
This was one that my brother, a small business owner who is in the same boat as Ms. Barham, was trying to rally support for. Perhaps if more like minded entrepreneurs had been informed at the time…
Shrink the role of private insurers by removing the incentive to buy insurance through an employer,</>
Removing the *incentive* to *buy* insurance through an employer? Who “buys” insurance through an employer? The employee? How? What is the “incentive” you refer to?
<i<Put consumers/patients in control of their futures by encouraging them to deal directly with providers,
Talk directly to their providers about what? Getting reimbursed by their insurance? Making appointments? How would they be “encouraged” and by whom? Why would they have to be encouraged? Is there some obstacle that keeps “consumers/patients” from talking to their providers now? Are we encouraging them to ignore those obstacles?
Or what?
and by providing government subsidies to help where necessary
And how does that work? I bill the government every time I go to the doctor? The doctor bills the government? I fill out a form requesting a check for whatever the medical care costs and the government sends it to me? Or is it like the welfare office, where you go and get a fixed amount every month, and the government decides how much that should be?
Consumers are the *only* ones who have a real stake in value for money, and if they are not empowered, the system will never reform its runaway costs.
What sheer, unadulterated nonsense.Please. Spare me the New Age jargon. How do “consumers” “empower” themselves to “reform runaway costs”? Tell the doctor to lower her or his fee? I mean, what?
Let them put pressure on providers to compete more directly and to deliver more quality and less quantity and waste.
Let them put pressure on providers, how? Asking nicely? Boycotting the doctor's office? Conducting a search for a qualified doctor who charges less? How long does this process generally take? Weeks? Months? Years? Never?
Ease the endless government regulations on health care that contribute to the escalating costs.
Such as?
Reform the medical tort system so that honest mistakes by doctors and other routine situations can be resolved with fewer lawyer hours.
Define “honest” mistake. Define “routine” situation. Example: If a doctor's laboratory gets the wrong results on a test because the technician made a simple arithmetic error, which would normally have been caught by a supervisor but no one checked the technician's work in that case because quality controls were not what they should have been, and the result of that “honest” mistake is that a child is born with a fatal genetic condition for which there is no known cure and for which the survival age range is 2 1/2 to 5 years, and the child dies at the age of 3 after suffering horribly, and the parents' lives are devastated — is that a frivolous lawsuit resulting out of a routine situation for which parents should not be able to sue for malpractice?
And how significant would the savings to the entire system be from not allowing people to sue for wrongful death, or in the case above, wrongful life? Aside from the common decency issue, I don't think there are too many people who think tort reform will produce the kind of significant savings needed to lower health care costs in any meaningful way.
But keep the government out of delivery.
Why? Nobody is putting the government into delivery. Delivery of health care is done by doctors, not the government.
Most of the anecdotes you and others have posted about our health care system's failures are not actually health care problems, they're financial problems. The health care itself, when people can afford it and are not kept from it by some bureaucrat, is pretty good.
Have you ever thought of doing stand-up comedy? You're very funny, you know.
The proper role for the government is to encourage a more robust, consumer-focused market and provide financial help to the people who need it.
Ummm, you mean, like, a public health care option?
Christine, I'm sorry, Dr_J has completely worn me out. I'll try to look at your info another day.
Kathy, you ask some good questions. I challenge anyone who supports Obama's plan to describe it in one paragraph such that one can't nit-pick about the specifics. Congress will get thousands of pages of small print to spell out their program in all of its glorious detail, and get paid on the taxpayers dime for every hour they put into writing it. In contrast, Dr. J and the rest of us get a comment in a blog post that he writes in his free time, so clearly there will be specifics not mentioned.
And you are clearly just playing dumb with some of your questions. Do you honestly not know what Dr. J. is talking about when he says that employers buy their insurance through their employers? And do you not know that employers get a tax deduction for providing that service, and individuals do not, thus creating an incentive to buy insurance through the employer?
Do you honestly believe that just because a doctor is delivering the health care, the government can't possibly have its nose in it?
To respond to your original post, no one (ok, I won't say no one–the vast majority of people) don't dispute that our health care system has problems and needs fixing, and the story of the woman is a good example of something that isn't right. How does that translate into the conclusion that I must support the plan currently being debated right now?
“Nobody is putting the government into delivery.”
What I mean by delivery is playing the same perverse gatekeeper role private insurers play today–deciding what treatments you're allowed, shopping for you, deciding who's offering good value for money and who isn't.
As a result, consumers don't have a voice. We want good health, affordably, without a lot of bureaucracy and rules. But what we want gets lost in this game of telephone between us an our employers, between the employers and insurers, between insurers and providers, between providers and government regulators. So what we get is expensive, variable care that may or may not help, accompanied by tons of rules and privacy disclosures, and bills that would make us ill if we ever saw them. And that's only the lucky ones who are insured.
No other industry works like that, imposing so many intermediaries between the consumer and the provider, garbling the messages about what we really want, and leaving no one really accountable that value is delivered for the money spent. And no other industry is as broken as health care. We need to get serious about reforming the industry, not just buying more of the same brokenness we already have.
Dr J–
Do you have any idea how long it would take, as a practical measure in the real world, to pass the legislation require to bring about the changes you favor?
Is there any organized group that is trying to make the things you want happen?
I ask these questions because I think you have some good ideas, but I see no vehicle for them to be put in place. They might work great in Utopia, Dr J, but I don't live in Utopia. The current problems seem very, very urgent. I don't see any reason to let the perfect be the enemy of the good.
The reforms currently being worked on seem, on the whole, like useful solutions to current problems. Naturally, nothing is perfect. Equally naturally, some solutions bring a different set of problems that also have to be solved in turn.
Maybe the things you're proposing are best dealt with in the next round of reforms?
Rep. Ryan's proposal is a joke. High deductible insurance and HSAs are useless for people with low incomes when a real emergency occurs. He actually thinks that a household with an income of only $25,000 can put enough into a HSA to cover even the deductible most of these plans have? It's one of those plans that don't really solve a thing but give the cover of being able to claim that they did something.
George, how long does it take to simply equalize (or ideally reverse) the tax incentives to buy insurance through an employer versus directly? That single action would give the power of the purse back to the consumer and lead to many other needed changes. Regina Herzlinger described the process a few months back.
Jim, no question people making $25K need financial help, and we should provide it to them. But financial help need not and should not come in the form of a giant gatekeeper that makes their decisions for them. An HSA that the government helped to fill, from which they could buy catastrophic insurance, would be a terrific way to help them.
Dr J–
I asked you to tell me how long it would take, because it's your idea.
The possibility exists that there would be opposition to your idea, which is why I asked you for information about organizations working toward implementing your idea.
If your solutions aren't practical, they're not solutions.
George, so you're opposed to such reproach to reform because…there might be opposition? Because it's not what we're already doing? It has certainly been done before; as the link suggests, it's not too different from the Swiss system.
Anyway, I welcome your newfound enthusiasm for practicalities of proposed plans. May I hope to see you asking them about plans from the left? For instance, asking how a public option will not turn into a public monopoly, how this entitlement program will not grow out of control like all the others have, and indeed how we're going to pay for the entitlements we've already committed to in 10, 20, 30 years?
There have been several plans that were lobbied for by the SBA and supported by a few Congressmen over the past few years, which never saw the light of day.
I checked out your link, Christine. I'm not surprised that “plan” never saw the light of day. It's awful. IIt does nothing to insure the uninsured or give them affordable access to health care.
Premium deductions do nothing to help people who don't have insurance or who don't pay income tax. Deductions on income tax also do nothing to help people == even those who do have health plans — to pay deductibles up front.
How is a small business tax credit that small businesses would only get if they offered employees a group plan and then made contributions to that plan some kind of huge improvement on what's in the current bill right now?
The low-income tax credit for the purchase of health insurance is a joke — a bad one. It's nice that the government would subsidize monthly premiums up to 90%, but that does nothing to help low-income people pay the deductible, which can be $2,000 or more. Plus, the cap of $1000 for an individual and $3000 for a family plan is low given the skjyrocketing cost of premiums.
No plan is perfect, Christine, but this isn't even a plan.
Do you honestly not know what Dr. J. is talking about when he says that employers buy their insurance through their employers?
First of all, I assume you mean “employees buy their insurance through their employers.”
And second, no, I've never heard of such an arrangement and I have no idea what he's talking about. But maybe that's because I have not worked full-time for an employer who offered health benefits for over 15 years. I did work part-time for Barnes & Noble from 2004 to 2007, and they did offer health insurance, but you had to be there a year before you could get it. And when you did get it, you did not have to purchase it.Unless you're talking about employee contributions taken out of your paycheck. Is that what you're talking about?
>i>And do you not know that employers get a tax deduction for providing that service, and individuals do not, thus creating an incentive to buy insurance through the employer?
No, I did not know that. And I don't see why eliminating that tax deduction would make things so much better. You'd like to make it so people can only buy private insurance through insurance companies? Wow, that sounds like a cost saver.
Do you honestly believe that just because a doctor is delivering the health care, the government can't possibly have its nose in it?
Do you honestly believe that just because a doctor is delivering the health care, the private insurance companies and their gatekeepers can't possibly have their nose in it?
I mean, huh? What's your point?
To respond to your original post, no one (ok, I won't say no one–the vast majority of people) disputes that our health care system has problems and needs fixing, and the story of the woman is a good example of something that isn't right. How does that translate into the conclusion that I must support the plan currently being debated?
No, that's incorrect. Our health care system does not “have problems” that “need fixing.” We're not just talking about a problem. We're talking about a crisis of gigantic proportions. It's a crisis that's been building for 30, 40, 50 years. The system does not need fixing; it needs a radical overhaul, and it has to happen NOW.
You don't have to support the plan currently in Congress, but given that there is no other plan in Congress and to do what the Republicans want to do and start from scratch would take many weeks or months more, if it happened at all (because you know Repubs don't really want to change the current system at all — it works for the entities they represent), and if it DID happen, it would be a travesty, no plan at all, like the one Rep. Ryan proposed, that Christine held up as an “alternative” to the Obama plan.
Kathy and Jim- you obviously didn't read very thoroughly. Ryan's bill from last session would have GIVEN the low income folks a tax credit, and given their employers a tax credit to match the funds to purchase catastrophic insurance AND fund their HSAs.
The basic HSA plan had already passed (I think largely championed by Ryan) and this was to be the next step to help the low income people who couldn't afford to take advantage of the program.
And do you not know that employers get a tax deduction for providing that service, and individuals do not, thus creating an incentive to buy insurance through the employer?
No, I did not know that. And I don't see why eliminating that tax deduction would make things so much better. You'd like to make it so people can only buy private insurance through insurance companies? Wow, that sounds like a cost saver.
Kathy, with all due respect, having read this paragraph from you, I realize that it's silly to discuss health care with you at all since you have shown yourself to be completely uninformed about one of the most basic features of our current system (not to mention, also showing lack of knowledge of basic economics- the concept being that people can't really shop around for a different plan, so there's no real competition to drive down costs.)
I see that Kathy did at least read the link and commented on these two portions of the bill:
Kathy's comments were the folllowing:
How is a small business tax credit that small businesses would only get if they offered employees a group plan and then made contributions to that plan some kind of huge improvement on what's in the current bill right now?
The low-income tax credit for the purchase of health insurance is a joke — a bad one. It's nice that the government would subsidize monthly premiums up to 90%, but that does nothing to help low-income people pay the deductible, which can be $2,000 or more. Plus, the cap of $1000 for an individual and $3000 for a family plan is low given the skjyrocketing cost of premiums.
On that first part- Um wasn't the point of this post that some employers wish they could provide health insurance benefits but they can't afford it, and my comment was that the current Dem plan would make that harder rather than easier for such employers?
On the second part- the point of the HSA is that this is the money that could be used toward deductibles and copays. I agree that the minimum isn't enough- but with 90% of the premium covered, one would think that the employee could find SOME money to put aside, in pretax dollars, to further build that cash reserve. I would certainly not object to someone proposing a higher amount that employers could contribute tax free- because even the cost to taxpayers of doing something much more generous would be far less onerous than the current Dem plan.
“No, I did not know that. And I don't see why eliminating that tax deduction would make things so much better.”
Yes, this is a huge problem with the current system. Insurance premiums your employer pays for you are tax-deductible for the company. Insurance premiums you pay yourself are not. So an insurance package that would cost you $7000 a year your employer might get for $4000. Both you and the company save money if they buy it for you, rather than pay you the cash to buy it yourself.
Coupling insurance and employment like is an awful idea for several reasons. People losing their jobs suffer the double whammy of losing their insurance coverage too, so this is a major reason people become uninsured. They can't buy it on their own because it's much more expensive that way, moreso if they have preexisting conditions. The major insurers tend to focus on the corporate market, so their main customers are really HR departments; individuals and families don't have much of a voice with insurers, and even less of a voice with doctors and hospitals.
This single tax law has been in place since World War II and is the major thing keeping the health industry from working for consumers, by denying them a voice. Your doctor should work for *you*, not for some health network that works for an insurance company that works for your employer that you happen to work for too. We should reverse the law, take back control of our own health, and start demanding value for the money we're spending.
Dr_J,
Well, I get the problem of losing your insurance if you lose your job, but I don't get how eliminating the tax deduction for employers would change the way insurance companies do business — which is to charge higher and higher premiums, exclude as many people as possible from as many treatments as possible for as many reasons as they can dream up. Patients are still going to have to fight the insurance companies whether they have that insurance through their employers or directly. I don't see how this does anything to lower costs — and I don't see how it does anything to fully insure at least 50 million Americans who are either uninsured or underinsured.
Kathy, those are all valid questions. What keeps the same problems from happening in car, fire, and life insurance industries?
Kathy, I think others have done a good job of responding to the other points you made regarding my comment, so I'll just focus on this one:
“Our health care system does not “have problems” that “need fixing.” We're not just talking about a problem. We're talking about a crisis of gigantic proportions. It's a crisis that's been building for 30, 40, 50 years. The system does not need fixing; it needs a radical overhaul, and it has to happen NOW. “
If you believe this then why do you support Obama's plan? He said himself that it is a plan that builds off of the strengths of the current system, rather than scrapping it altogether. Actually I think that the problem with Obama's plan is not that it tries to change too much. In fact, in some ways it changes too little. It does spend a lot of money to cover people who don't have coverage, but it doesn't do much at all to reduce the structure and cost of health care as it exists. Obama loves to talk about the example of the duplicate test that is sometimes done. That's relatively small potatoes compared to the larger and more difficult issues of end-of-life care and unhealthy lifestyles of many Americans. And in any case, I don't believe for a second that just passing the current plan is somehow going to get rid of all of the waste in the system. I actually haven't seen anything in the proposals that would actually get rid of the much cited duplicate test.
I would support some drastic changes if I believed they were the right changes. Specifically, I'd support changes to regulate how insurance companies can set their premiums, so that people who get expensive diseases through no fault of their own are not priced out of the market. People should be charged based on their behavior, not their health status (this is a position normally scoffed out by conservatives, but I actually do believe that a perfectly free market does not work well in health care, for reasons I don't have time to get into now–some serious regulation is needed). And actually I think getting rid of the employer-based health care is probably a bigger change than anything Obama is proposing.
Furthermore, regarding your comment about the gigantic disaster that is our health care system. If our system were more like a European system, my son would likely be dead or in severe malnutrition. The researchers that are working on his disease are all based on the US. And I'll give you one guess to where the only companies that manufacture the equipment that feeds him and the formula he needs is located? Profit margins are not always evil. I repeat that I think we do have significant problems, especially in the areas of access and cost. We certainly have a lot of room for improvement to make the system more fair. But a gigantic disaster? No.
Look at this example from Ryan's site.
Let's ask whether, based on current charges for virtually any meaningful insurance what would be being provided for $3300? The insurance company is not putting money in that HSA for them according to how it reads. Just how much will be going into that account given that anyone with a family and a $25,000 income has no money to spare? How much money does it take for something to be enough of a catastrophe for that kind of insurance to take effect? Half their annual income? Twice? How long do you think it would take for that kind of money to build up in their HSA? Yes, conservative proposals are meaningless twaddle, the only reason for their existence being that it can be claimed that something was done even as almost nothing really is being done to help.
Jim, it's certainly reasonable to question the numbers, but that doesn't justify your meaningless twaddle charge. What's your opinion? Given that we collectively spend a sixth of our national income on health care, what's a reasonable expectation for a couple opting to raise a child on a single $25,000 salary?
Dr J–
A link to someone else's blog post is not a plan.
I had some hope you could do better.
Not to mention that a family with one child that has only $25000 in income is already covered under Medicaid, so that's obviously not the income group to whom this plan sought to provide assistance for coverage.
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