A You Tube Short Film

The "Government Doesn't Play Fair" Argument

“It skews the system. The government never plays fair. . . . because the government would subsidize it . . and there’s no way that you can have a level playing field that could compete fairly with private enterprise.”

-Rep. Tom Price, (R) Georgia, CSPAN 7/26/09

If you can read the above statement and not see the ridiculousness of the statement then read on.

It sounds as if representative Price is confessing that government socialization of health care financing can beat the living crap out of for-profit insurance companies.

One needs to ask “what are the insurance companies doing wrong they would not be able to compete with the government to better insure their own consumers?” And “why didn’t they do it to begin with?” The answer is: Profits. They needed to make a profit for their shareholders and their own executives.

Theoretically if the government health care administration, can deliver, at a minimum, the same or better quality than the health insurance companies, then millions of regular subscribers to for-profit health care will shift their loyalty to the government plan. And if the insurance companies are strategic, if they plan properly to match the benefits of the government plan, then they can stay in business selling health insurance. Keep in mind that many of the same insurance companies also sell automobile, home, and life insurance, for profit, so it’s not like their failure to sell health insurance would wipe them off the map.

So what did they not do that would have prevented their head to head with a government Public Option? First of all they did not insure all who did not have insurance; they didn’t even market health insurance to the twenty somethings (the age group most likely to not have health insurance). Had they just assembled this one age group of a, potentially huge, pool of people they would have seen incredible profits and been able to offer much lower health care insurance premiums to all of their customers. Because large pools of people, who mostly do not get very sick, make excellent health insurance risks for a for-profit insurance company.

They did not invest in administrative research to enthuse the best quality care for the least cost and least paperwork. If the Single Payer system known as Medicare can operate at administrative levels of 3-5%, then the for profit providers should have been able to reduce their administrative spending to far less than their current 17-30% of each dollar they receive.

They did not police their spending outlays. Fraud and abuse is rife within the health care industry. Yes! Those doctors, nurses, hospital administrators and medical equipment companies aren’t all saints! We expect them to be because they are dealing in health care and health care should be ethical across the board. It is likely there is hundreds of billions of dollars of annual health care industry fraud and over treatment that can be recovered if the means to do so is initiated.

They did not apply full coverage to their own customers. They called treatments “experimental” to avoid paying for them. They listed very expensive treatments they would not cover in very small print. They made enemies with the thousands of stories of inadequate coverage that resulted from this for-profit motivated practice.

They formed HMOs that pooled customers into treatments pens, where choice of doctors was limited. They created the high deductible catastrophic plan, which caused the insured to be grossly underinsured, and to avoid the doctor’s office. They charged a family of four an average of $10,000 annually for a health plan. They raised their premiums by an average of 12% per year. They doubled their premium costs in just the last 8 years. They charged small businesses up to twice what they charged large businesses with greater pools of employees.

“It’s not fair! We won’t be able to do that stuff Anymore!
- John Q. Executive, Anywhere Health Insurance Company.

Three Things I Want from Health Care Reform

Minimally I want three things from my government regarding health care reform.

One: I want laws written which protect consumers from all that has proven to be wrong with for profit health insurance companies. Insurance companies have fully demonstrated to Americans that there are scores of unethical measures they will take, against desperate people, in the name of profits.

Two: Management of the collection and distribution of a pool of dollars to ensure that no one goes without full quality, cradle to grave, health care. This may be accomplished most fairly as a progressive income tax from all Americans earning a minimum income.

Three: I want my elected representatives to have no better access to health care than I have. It’s only fair that those responsible for writing and maintaining such a sensitive group of laws, as health care legislation, be completely subject to its rules and benefits, as they are subject to all other law and governmental action.

Because individuals can only control the onset of disease so much, and the private sector continuously fails to be moral, I am of the opinion that full access to complete health care should be considered a birthright in my nation. It is only then that we can truly call ourselves civilized.

With Private Insurance - Don't Get Really Sick

Private health care insurance is great - unless you get really sick. They have beautiful color brochures and hire real actors for their commercials; but don’t get really sick. You’re in Good Hands until you get really sick then the hands open-up and you fall through the fingers.

Profit determined co-payments, deductibles, and premium payments to insurance companies are the second greatest reason for family bankruptcy in the United States. Most of them had health insurance for their family. The family pays premiums heavily (according to Physicians for a National Health Program, found at www.pnhp.org; a U.S. family pays an average health insurance premium of $10,000 annually) then to their surprise the cost of a sickness reaches the health insurance companies’ spending ceiling and or the co-payments become unaffordable.

Most people don’t get really sick in their entire lifetimes and most people don’t realize this. Most people don’t even think about personally having a life-threatening illness. Why think of such tragedy? Just go on paying the private health insurance companies’ premiums. That’s how and why it’s highly lucrative to be a health insurance company executive. In 2003 the CEO of Aetna made a total value of $44,000 a day on the factual and favorable odds that most people don’t get really sick.

The above situation is but one small aspect of a complex health care system. It should at the least be considered highly unethical by any reasonable citizen. And at the extreme should be considered illegal. A fair and ethical health insurance plan would cover all treatment from the beginning of life until death; and not abruptly shut down at a certain monitory level of spending, or suddenly label a disease a pre-existing condition, or label a treatment experimental.

Controlling Health Care Delivery Costs II

That controlling costs has to be done is beyond question, because the status quo of drastically rising costs can not be sustained by any system of health care delivery. Estimates of congressional proposals for reform have teetered around the 1.2 trillion dollar mark. However, it must be noted that this is not an amount that should be considered on top of what we already spend on health care, which is approximately 2.2 trillion dollars per year; this figure includes money that is currently traded within the system and money imported into the system from the consumers. But, the additional 1.2 trillion that is estimated is an overlap of this amount, not an addition. No one knows how much of the 2.2 trillion can be offset by the new income of 1.2 trillion in spending into the system, but it is a great amount – in the hundred of millions of dollars annually. Additionally one must consider that adding 47 million uninsured people to national insurance rolls are going to cost more in actual dollar amounts. That is a given.

Here are a just a few arguments, and answers, to just a few options for controlling health care delivery costs:

Option: Pass laws restricting to a reasonable amount the level of salaries for all categories of health care providers.

Argument: If we pass laws restricting health care provider salaries we will negatively effect the number of persons willing to go into health care.

Answer: This is not the case in other industrialized nations with universal systems of health care delivery because salaries are kept to a high and reasonable standard of living. That the United States of America would enact something less fair than those nations is unreasonable in itself and an insult to the ability of the United States.

Option: Establish a new non-profit status for any and all organizations making health care equipment, i.e. delivery equipment, hardware, diagnostic tools; with purpose of decreasing fraud and excessive profits.

Argument: Who will design the next CT, MRI, PET scanner or other breakthrough technology if you take away the profit motivation?

Answer: Profit motivation was not the cause of the invention of the above mentioned high technology diagnostic tools. And it is reasonable to expect that profit will not be the motivation for further invention. A small amount of research will uncover that government spending and research by scientists interested in scientific discovery, credential, and accomplishment created the technology that lead to the MRI machine, the CT scanner, and the PET. Military designed radar technology (for instance) is responsible for Magnetic Resonance technology. Sure, scientists want to make good money, but even government scientists are paid well enough to make a comfortable living.

Option: Treat people in primary care situations before they get sick. Subsidize health clubs and gym memberships, yoga classes, smoking cessation and weight loss programs, bring back the doctor’s home visits, etc.

Argument: "...before they get sick"? Do you also propose a new FBI division - Healthcare Nazis? They will arrest you for firing-up that cigarette or nibbling on that cake?

Answer: Catching a chronic or serious disease before it reaches dangerous, or life threatening levels, is an extremely effective way to reduce the costs of health care delivery, never mind reducing the level of personal suffering. Additionally, because the uninsured currently receive the bulk of their health care from emergency room visits (the most expensive way to get health care), visits to a primary care physician to catch disease is loads cheaper. And no one is considering a police force for lifestyle choices. Again; this is not the situation in all other industrialized nations with universal systems of health care delivery. It is an insult to the historic ability of the United States to expect that we would enact a less fair situation with any less liberty. Education is however another situation entirely; an effective health care financing budget would include sufficient funding for educational programs relating to lifestyle choices. One proposal to fund such educational programs is to tax the fun stuff harmful to us: such as tobacco, firearms, alcohol, marijuana, fructose products and fast food.

Bureaucrats: Love Them or Leave Them

The anti health care reform lobbyists, and general opposition, often scream “Washington bureaucrats are going to run our health care!” Let’s consider that statement:

Who would you rather have making health policy decisions for you: a Washington democratically elected representative, or a corporate bureaucrat who literally fights against people’s health care needs for a living?

Bureaucrat has been given a negative connotation from Conservative linguistic magicians wishing to diminish the role of government in our lives. Unfortunately for them there are plenty of employees who know they are bureaucrats and proud of their work. If bureaucrats are to be defined as policy makers, than the corporate bureaucrats of private for profit insurance companies should be our worse nightmare. They are the bureaucrats that the Conservatives define so derogatorily. They are traditionally the health policy micro managers, the leaders of corporate monopolistic clusters with impenetrable walls around them. We should not favor them over government democratic control. Bureaucrats don’t make most decisions in Washington D.C., they are usually the ones carrying out decisions. The bureaucrats are the paper pushers, the management, and the middle management that work the greasy gears of our government. They are the pen pushers, the administrators, members of a hierarchy of control, or workers of any organized group. Very few bureaucrats are policy makers, just policy followers.

The decisions are largely in the hands of our representatives, the elected ones, the accountable ones, the ones who can get thrown out on their keesters by voters. Again I implore; when it comes to health care policy, we should not favor corporate executives over government, democratic control.

Try throwing out a corporate executive who decided to call your life saving treatment “experimental,” and save a bundle for his insurance company. Try holding a private industry accountable; it doesn’t happen, the people can not move corporations. In the end it always takes the intervention of one or more elected representatives. Don’t take my word for it; try even phoning the office of one of these unaccountable insurance company executives.

A Day in a Life

On a Monday morning John wakes up, stands in his bedroom and steps into his underpants. Suddenly from his right flank, a sharp stabbing pain from a pinched and twisted muscle shoots up his back to his brain. He is forced immobile and falls onto the floor. He then crawls to his bed and lays there for ten minutes until the pain subsides. He then calls his employer and tells him what’s happening and explains that he’ll be late.

In pain, John drives himself to a health clinic less than three miles from his house in a rural to suburban area of Connecticut. The clinic has an emergency medicine division and John is quickly admitted by showing his Universal Health Card, which is swept magnetically, indicating to the computer in front of the receptionist his full identity by photographic match and by his possession of the card. The card unlocks a complete health history, showing allergies, and his primary care physician’s latest and earliest reports of John’s visits. John did not have to even open his mouth to get treatment at this facility, and no personal information questions were needed to be asked of him, not once.

John’s health care card is both the beginning and the key, to saving hundreds of billions of dollars, to the entire health care system. Paperwork and miscellaneous administrative costs are reduced tremendously as redundancy and repetition are eliminated. No longer does a three doctor group office need six employees to communicate and exchange payments with private and government insurance companies. Government option insurance has also caused private insurers to begin to provide for their own similar slim lined methods of communication, to compete, to try to level the playing field.

In last month’s paycheck John paid for these services through a mandatory withdrawal of what amounted to, for his pay level, $65 per month. When he had bought whiskey last week and a pack of cigarettes and a six pack of sugary soda, a full tank of gas, chips and fast-food burgers, he paid an additional sales tax of 6% on each item. John has a friend who smokes marijuana, and since the substance has been legalized and taxed, that friend is paying far more towards Universal Health Care, almost $80 more per month than John is paying.

Upon an emergency room doctor’s examination of John’s lower back and flank area, the doctor determined that x-rays were not needed, that John’s pain was purely muscular in source. “You need to do more stretching John.” The doctor explained. The doctor is not afraid of under diagnostic testing of John (less testing) because his malpractice insurance is paid for by the universal health care system and its payments are capped to loss of income and capped to a maximum pain and suffering amount. Malpractice insurance is no longer a burden for America’s doctors and hospitals.

The doctor then pulled out his personal computerized Medical Data Tablet and ordered John two months worth of health spa treatment for lower back pain. The order was received at the health spa instantly and scheduling for John’s physical therapy took place that morning. John’s relationship with this emergency room doctor is the only communication necessary to receive full treatment, and the right treatment, for his back pain.

John’s emergency room doctor is working on a contracted salary basis and not charging a fee for each instance of service per patient. This allowed him to spend proper time with John and his injury and not rush himself to make more money by seeing more patients on that day.

When John completed his two prescribed months at the health spa, he went on-line to the Health Care Financing Administration’s website, and by swiping his card on his computer keyboard, he ordered a monthly health spa prescription without a doctor’s order, and $10 per month was added to his monthly contribution. John never had a back spasm again and never required extended periods of pharmaceutical pain relief. And his contact with the health spa had inspired him to continue to use the facility, to swim, to run, and to quit smoking.

Rationing: Good vs. Bad

One of the more powerful sounding rhetorical chants is that the government financed health care system is going to conduct “health care rationing!” In simple terms, if the budget money is short, the health care will have to be also, thus “rationed out.” Fact: for decades health insurance companies, and Medicare and Medicaid and the Veteran’s Administration, have rationed health care delivery to greater and lesser degrees.

Some procedures will always be delayed from immediate coverage, and that is not rationing, just delay. Like “elective” surgeries, i.e. hip replacements and liposuction, stomach stapling, and defensive angioplasty. There’ll be a waiting list for these types of procedures, because they are not of life saving need. And when forty to fifty million new people enter into the health care system literally overnight, you can bet, that without many more doctors and nurses and equipment, life saving procedures will take priority. Elective procedures will likely be covered (as they are comparatively in most universal health care systems), but you probably won’t be able to call the date of surgery on your own.

Economically speaking there is good rationing and bad rationing. Good is when efficiency is increased without harming quality and those measures save money for the system.

Bad rationing is when cuts are made in budgets at the cost of the quality of life of the patients or of the public as a whole. The difference between good and bad rationing should not be a matter of opinion, but a matter of well agreed upon facts and well collected statistics. An example of bad rationing might be: a budget that cuts back, to refuse to provide vouchers for gym and health clubs, or weight loss clinics and smoking cessation classes, or self diagnostic equipment.

Good rationing would be for instance: when computerization from state to state, hospital to hospital, and hospital to doctor’s office, finds and eliminates repetition and redundancy, thus saving money and allowing for a budget that reflects those savings.

Under the public option plan, which leaves private health insurance companies in place, those with a private plan can get their elective surgeries whenever their wallets and their precious schedule allows. But those in the public option plan may find that the difference is in waiting times for elective procedures.

Rationing was invented the day that some health insurance company executive realized he could increase profits by cutting back on care. For example, don’t pay for little Jimmy’s bone marrow transplant and save $400,000. Money that can address the bottom line: profits. The best way the American public can avoid rationing in a new health care system is to assure that budgets reflect true need determined by good rationing and not budgets motivated by bad rationing. Health insurance companies have had decades to conduct good rationing and not bad. But instead countless stories of the victims of bad rationing, who had health insurance, are too common.