Response to healthcare reform

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I'm writing this as a response to Donna Smith's very well written article:

Some things that Donna has a problem with is:

1. - Obama is using healthcare industry folks as his consultants on the matter.  These folks are not impartial consultants.  Specifically, she claims health INSURANCE folks, which isn't all true.  I would say there are healthcare industry folks, not all of them are health insurance industry folks.

2. -  The acceptable level of care that should be provided is "care is given as care is needed.  Period."  If Donna were allowed to act as the grand poopah, If people do not understand "care is given as care is needed" and why that should be, the dissenters should be left to fend for themselves and die unless the do "get it".  These are Donna's words.

3. -  A commentor (Not Donna) said the people who should create a supposed single payer system should be the people who have chronic conditions and those who are terminally ill.

While this is a plan of action, I don't think it is necessarily a good one.  It may be a good one, but I have some doubts which I'd like these folks to comment on.

Donna says that healthcare reform conversation in Washington reeks of terms like "cost containment", "reinsurance", "tiered benefits", and "payment incentives and physician bonus opportunities".  She further assert:

"I've heard all this sort of pitching many times before as insurance agents and intermediaries peddled their wares in conference rooms and break rooms for employers I've worked for over the years."

First, I'd like to say that the insurance folks you meet in your break room are probably not the people that Washington is consulting with. Your supposed situation where the "bad guy" at the root of the problem is a for profit insurance industry lacks distinction.  One thing is that the insurance company is probably not the one who is setting the rates for your company benefit plan since your company benefit plan is probabaly self funded.  

Do you know who the consultant is that gives advice to your CFO, HR director, and CEO about your benefits plan?  I believe you should rephrase your general wording of "health insurance industry" to "healthcare industry".  Otherwise, we are looking at the bean counters (i.e. insurance) as the problem.  I would say the "beans" they are counting are a large part of the problem. Also, why those "beans" are so expensive needs elaboration beyond collusion, corruption, and profit motive.  I've written about this here before, to the chagrin of some.  Also, how do you blame the bean counters (i.e. insurance) when they are not-for-profit companies?  Are these non-profit insurance companies also involved in collusion and corruption?  If so, is it just the practice of insurance you don't like?  

The "acceptable level of healthcare" you mention needs clarification.  In Canada, there's a story about someone who wanted a surgery done, but the doctor in Canadian system denied the request since the he looked at the MRI, and in his opinion, the surgery was unnecessary.

Who determines "care as needed"?

Also ancillary to this, Donna's "healthcare as a human right" is a concept I'd like to understand more.  If you get hit by lightening or are born with cleff palate etc...this is through no fault of your own (unless you were golfing while getting hit by lightening).    You have a right to healthcare in those cases.  But what about the 3 packs a day smoker who develops lung cancer at the age of 44?  If you cover them, I can accept that. One thing though, supporters of universal healthcare are often against the financial industry bailout.  Why?  Its wholly inconsistent.  You favor bailing out moral hazard with universal healthcare (i.e. irresponsible risk taking in the form of smoking), but not bailing out moral hazard in the financial sector (i.e. irresponsible risk taking in the form of mortgage backed securities). However, I can see the point that one involves a human life.

This is the crux of the argument.  The valuation of human life.  Healthcare (not just health insurance) takes this into account.  A value IS attached.  What folks here on this website often write about, in a in-direct way, is that this practice of displaying the value of a human life in the form a cost, premium payment, etc... is wrong.  My contention is that your being naive and unrealistic.  For you to get your way, I don't know how you would without sacrificing your principles.  Ghandi's Swadeshi concept may be what you are looking for.  There are ashrams out there available for you. 

Moving forward to explain why healthcare must involve a conversation about costs and therefore a valuation of human life and risk.  Right now, some employers who self fund consider health factors (such as smoker vs. non smoker) in hiring; as they should.  Some employers do not and provide healthcare as a fundemental right of employment regardless of your personal behavior. To consider why your employer does all these "silly benefits meetings" and "wellness initiatives", lets look at the auto industry bailout.

Car manufacturers pay their employees about $30 per hour.  Car manufacturers pay UAW workers an additional $39 per hour in benefits in the form of health benefits, pensions, and retiree benefits.  The UAW's VEBA fund information should be available to the public via their 5500 form filings.

Toyota and pays $18 per hour in benefits.  That's $21 per hour more that the U.S. auto makers pay in labor costs.  That translates into $43,600 per FT worker per year.  GM has 145,000 employees, GM has 74,000 active UAW workers.  Thats over 3.2 billion per year in additional wage costs.  Geez, no wonder we're bailing out GM.  Oh, you should not drive a foreign made car if you think healthcare in the form of unrestricted "care is given as needed" is a basic right, where "needed" is determined by the patient.  This is so because GM and the UAW have better health benefits than Toyota, and thus, prescribe to the beleif that "needed" should be determined by the patient.

Here is the UAW health care package: (click)

note that the UAW uses the Blue Cross network, Blue Cross based insurance is NOT FOR PROFIT.  If you don't like private for profit insurers, you can always purchase blue cross insurance.  Although blue cross sometimes denies claims, even though they are not for profit. 

I don't have access to benefit levels for Toyota, but here's a review from an employee.  Also: (Autospies.com article)

Now bringing this information back on point, who defines "needed healthcare"?  When this argument reaches it's logical conclusion and we ignore costs since we outlaw putting a monetary number on human life; We outlaw the practice of using statistics, actuarial methods, mortality and morbidity tables, and like vehicles to determine risk and set prices for health care, who pays for the care, what will it cost?  The U.S. auto industry is being crushed by healthcare costs, would our U.S. government do the same?  How can we ignore costs?  We cannot since costs are directly tied into what you consider the "care is provided as care is needed" concept.

For example, both Toyota & the UAW offer the HMO format that some people believe is full of collusion and corruption.  The UAW also has the fee for service option with 30% and 50% co-insurance options.  That means that if you choose the 50% option at your beneftis meeting and go to a hospital and get an MRI, you'll probably have to pay about $750 since the bill the hospital will send you will be around $1500.  God forbid that the UAW didn't buy into the Blue Cross discount network...your bill would be about $5000.  Anyway, is that co-pay of $750 for the MRI acceptable?  Who determines what's an acceptable copay? 

Donna, your suggestion that all care should be covered at 100% and that any care option is available to anyone at any time would be a disaster.  The U.S. government would declare bankrupcy.  Heck, I think I would go get monthly MRI, CAT, and PET scans.  For fun, I would get functional MRI's of my brain to satisfy my curiosity of how my brain works in comparison to others. Do I need it to stay healthy, probably not, but I would get it have it done since its paid for.  Donna, you dislike the talk about "discount networks", "tiered benefits" and all the other terms.  But how do we implement an effective solution without that conversation?

In PA, there was a blocked merger between two non-profit insurers Independence Blue Cross and Highmark Blue Cross. Although I respect Ms. Shenk and her opinion as a nurse practitioner, her numbers and reasonings I do not I agree with.  Did you know that doctors in PA would have been greatly affected by this merger?  My example of the MRI earlier with "god forbid the UAW didn't buy into the Blue Cross network" comment is applicable here.  Without a provider to network negotiation, your cost per procedure would be astronomical.  Insurance companies provide a network discount via their own network done with in-house negotiators or via some other network.  The Independence and Highmark discounts that they FORCE onto providers is REAL.  I have seen them, you don't have to belive me, but they are REAL.  If your a hospital in southeastern PA, the conversation is as follows:  We need a 10% increase in MRI reimbursments.  IBC says, no, you'll get 3% or we'll remove you from our network.  We insure 80% of the population down here.  Take it or leave it.

If you self fund healthcare costs in south eastern PA, you buy into the Independence Blue Cross network.  Anyway, despite Ms. Shenk's contention that it was blocked by grass roots causes, the AMA had a lot to do with it.  Doctors cried MONOPOLY!  They will FORCE even lower payments onto us.  And we will have to accept them because they insure 80% of the PA population!  We will have to take it, and companies will be forced to use this MONOPOLY network, and all the bad things that happen with monopolies!  Hence, the insurance commissioner said they could merge, but would lose Blue Cross status and the network competition advantages that comes with that Blue Cross tag.

The fact of the matter is, you have to set limitations and the conversation in setting these limitations MUST use these terms/concepts that you dislike. How would you do so otherwise?

As for the 3rd point in my introduction, that it's been suggested that folks with chronic and terminal conditions set these limitations and guidelines, how are they qualified?  I've heard the saying "suffering imparts wisdom", but I do not feel comfortable using that as my measure for qualification.  By that measure, you should have a 3rd world person whose had a rough life set all U.S. policy.

Anyway, how is having 5% of the population that use the most healthcare services make the decision for the other 95% fair?  Sure they use more of it, but why, life choices or bad luck?  Why should I subsidize their usage?  If you use more of it, you should pay for that use.  If you ran into bad luck, such as being hit by a drunk driver with no assets to her name, then I'm fine paying some tax money into a fund to help you out.  One thing I don't want to do is bail out your bad behavior of eating Big Macs, smoking cigarettes, and never exercising.  Just like most employers don't't want to bail out your bad behavior..and the UAW is being forced to do the same.

How would you respond to someone who says: I use a lot of gasoline because I work 50 miles away.  That gasoline is essential to my survival.  Its getting expensive. I want you to pay for my gasoline usage. 

How is this different from:

I use a lot of health care services.  That healthcare service is essential to my survival.  Its getting expensive.  I want you to pay for my healthcare usage.

Now if you mean "right to treatment" in relation to "denial of treament option X".  Thats a different story all together.  I ask how you maintain a benefits platform that will NEVER have a situation where "denial of treatment option X" would occur?  Remember, I want a monthly MRI, a quarterly functional MRI for my brain so I can have some fun with it, and I also want some cosmetic surgery.  I need a nose job because I have trouble breathing at night.

The conversation of what we can afford, what healthcare benefit level is "adequete", and if "adequete" coverage can be put in place for what we can afford is the conversation we need and is the one that is occuring.  I just wish there was more transparency so I could take a look at the numebrs.

Don't be so rough on Obama yet, its early.