Health Care Reform...

Greetings,

As many of you know, I used to work in the health insurance industry. Every day, I watch cable news shows, and I hear discussions go on and on about health care reform. I thought today that I might chime in on the subject. If you have no interest in this issue whatsoever, then please tune back in when I write about something more up your alley, but if you are concerned about the problem and feel like you aren't quite well-informed enough to have a good opinion, then by all means, please read this.

I want to start by saying first that I do not have any single solution in mind that would solve this crisis. In fact, I don't believe that a perfect solution exists. What I would like to do is to diagram the problem for you, not with sob stories about people dying from lack of access to care or anything like that, but with a picture of how our current system works. This way, when you hear your politicians talk about their ideas, you might be able to make a more educated decision on how full of shit they are. I will then end the post with the text of an e-mail that I just sent my Congresswoman, Cathy McMorris-Rogers, on the issue.

THE SYSTEM:

1. Quality Care Is Inherently Expensive. - The U.S. has some of the highest quality care in the world, in part, because the best and the brightest can make a lot of money by becoming doctors, nurses, hospital administrators, technicians, etc. The other aspect of quality care is the medicine itself. The top pharmaceutical companies in the world spend enormous amounts of money on research and development, which in turn drives the cost of the end product up. Proponents of the free-market system assert that if you let the government get too involved in health care, those people will be motivated to pursue other careers instead. The flip side of that is the fact that every other industrialized nation has some sort of government-run health care system, and, while their systems aren't perfect, they certainly aren't as out-of-control as ours is.
2. Over-Utilization Drives Costs Higher. - When people don't have insurance, and they can't afford to see their regular doctor, they go to the ER. Emergency rooms must treat patients regardless of the patient's ability to pay for services. Ever wonder why an aspirin costs you $80 in the hospital? It's because hospitals get stiffed by so many people who can't afford to pay their bills, that they must offset their costs by charging the patients who have insurance outrageous amounts of money for services.
3. Health Care Costs Are a Snowball Sustained by The Current Insurance System. - Health care providers (hospitals, doctors, etc) contract with insurance companies. When a doctor says that he "accepts" your insurance, it means that he's signed a contract with your insurance company that includes a fee schedule. A fee schedule is a list of specific amounts of money that the insurance company agrees to pay the doctor for specific services. For example, if your doctor normally charges $100 for an office visit, he would sign a contract with your insurance company to accept a lesser amount for that service - say... $85 instead. The doctor can then write off the $15 discount on his taxes each year. The problem with this system is that in most markets, there only a few hospitals, and hospitals are where the bulk of health care costs are borne. Now, like I said in the last point, hospitals are faced with a large number of clients who can't pay for their bills, and they need to recoup that money somehow in order to stay in business, so when the time comes to negotiate fee schedules with the insurance companies, they put huge prices on things that shouldn't cost all that much - like, say, an aspirin. The hospitals can do this because, like I said, in most markets, there are only a few hospitals. If you're trying to market your health insurance plan, it doesn't look good if you tell potential customers that they can only go to one out of three hospitals in the region in order to get full benefits.
4. Health Insurance Companies Are Backed Into A Corner. - In order to stay in business themselves, health insurance companies have to pass their rising costs onto their policy holders - employers and individuals. Every year we see premiums skyrocket and benefits dwindle away. The sad thing is that most people in the health insurance industry understand that the current system is not sustainable, but they obviously don't want to lose their jobs, so they've spent millions and millions of dollars lobbying lawmakers to deregulate their industry, and put off discussions on reform options like a single-payer system and a public option. They also spend enormous amounts of money on smoke and mirror marketing campaigns that are aimed at convincing employers and the general public that the key to fixing our health care system is to focus more on wellness programs and preventative care.
5. Wellness and Preventative Care Only Go So Far. - It seems like a pretty simple solution. If we have less sick people, we won't have to spend as much on health care. The way to have less sick people is to motivate them to live healthy lifestyles. The problem with this logic is that people who live healthy lifestyles still get sick. From what my doctor tells me, heart disease and cholesterol problems are genetic, and while changing my diet and exercising regularly can help a little, they won't ever be enough to fix the problem, and I will most likely need to be on medication for the rest of my life. There are a lot of cancers that are the same way. Sure, you can reduce your chances of getting lung cancer by not smoking, but what about breast cancer? Pancreatic cancer? Prostate cancer? The health insurance companies say that prevention and early detection are the keys there - but if you can't afford health insurance, and you're living paycheck to paycheck, you are not very likely to go and spend $160 or more on a cancer screening - no, when you haven't got any insurance or any extra money, you don't go to the doctor until your sick.

So that's a basic rundown of the system, and the problems with it. I'm sure I've left some things out, but hopefully this gives you a better inside understanding of the conundrum we're in. It seems like all the politicians want to talk about are the after effects of the problem. Most of the speeches I listen to and the position papers I read on the politicians website are pretty typical examples of what people do when they don't have any real solutions. They just gripe about how bad the problem is for a while and hope that people will forget to listen for any specific substance on how to fix the problem.

I'll be honest, I don't have the answers on this one. My gut instinct tells me that the best way to fix this system is to completely overhaul it with a single-payer, low cost public option - similar to Medicare for all ages. For low income families, it should be free. For middle class families it should be cheap, and for high income families it should be more expensive. The problem most conservatives have with this idea is that they don't want another big government bureaucracy running the health care system, and they don't want a huge tax increase. But lets think about this for a second. Does a single payer public option HAVE to be a big bureaucracy? We get to build it from the ground up, don't we? Doesn't that mean that we can pretty much make it as efficient as we want? And as for taxes, I find it incredibly hard to believe that the tax burden on employers and families would be more than the current cost of premiums. Those are just my thoughts.

Last, but not least, I thought I'd publish a copy of the e-mail that I sent to my congresswoman, Cathy McMorris-Rogers (R - Washington), earlier today on the issue. I would encourage any of you out there to take a few moments of your time and do the same. You can find your congressional representative on the web at www.house.gov and your senators at (you guessed it) www.senate.gov. I'm pretty sure the white house has a handle on where most of us stand on the issue, but in case your view differs from mine, then contact President Obama at www.whitehouse.gov. Here's my letter:

Dear Madam Congresswoman,

I am writing to let you know that I disagree with your current position on healthcare reform. This will not be an inflammatory left-wing propaganda e-mail, but merely a note to add my name to what I am sure must be a fairly lengthy list of your constituents who are dissatisfied with the current health care system and who are unconvinced that the ideas outlined on your website regarding this issue are the right solution. I am 31 years old, and I do not have a sob story about a close family member being denied access to health care. I do however have a bit of experience with the issue, as I worked in the health insurance industry for over five years. I am also currently a college student, and for the moment I am uninsured.

I understand the complexity of this issue. I understand that, among other things, over-utilization drives medical costs out of control, and that those costs drive insurance premiums out of control. I understand that preventative care, wellness, and cost containment are vitally important to the success of any reform effort. However, the outline of your position on your website sounds to me exactly like what I used to hear from the health insurance executives at companies like Regence/Asuris, Premera, and Group Health.

For the last several years, the insurance companies have been selling the idea that wellness, preventative care, and utilization management are the keys to solving our health care crisis. Unfortunately, I think we should all be able to agree that those companies have failed miserably in trying to regulate themselves in this manner. It's time for the government to step in.

I understand your party's platforms with regard to government involvement in such matters. I even agree, to some extent, that the government should stay out of private enterprise as much as possible. In this instance, however, I would like you to suspend those ideals.

Health care can not be looked at in the same way other private industries are looked at. It is not a luxury that should serve as a reward for hard work. It should be viewed just as necessary as police and fire protection.

While I have experience in the industry, I do not consider myself an expert. I do not know what the best course of action is. A single payer system? A public option? More strict regulation? Each of these options has its pros and cons. It does seem to me, however, that the increase in taxes that would come from a single payer system would pale in comparison to the cost of maintaining our current system through the foreseeable future. I don't mind paying taxes - if I'm getting my money's worth.

So, in closing, Madam Congresswoman, I would just like to ask you to work with, not against, the democrats in congress to come up with a viable solution that serves US, your constituents, rather than health insurance and pharmaceutical company lobbyists, because what I am reading from your office right now sounds entirely too much like insurance industry propaganda, and not enough like an elected official interested in serving her district.

Thank you for your time.

Brandon M. Humphreys

Spokane, WA

Thanks for reading, and again, please let your voice be heard on this one.

I am the Reverend Humpy and I have approved this message.

On Selling Out and Economics...

Greetings,

It's been a little while since I went off about the Man, so I guess it's high time we had some of that. I have been suffering the Man's bullshit with a grain of salt the last few months because I had other fish to fry in my life (which, by the way, is the Man's greatest weapon - keeping us distracted so that we won't notice the toll that som'bitch is taking on us.), but last night I saw a Visa commercial with the song Today, by Smashing Pumpkins on it. This made me sad, and it made me think.

When I was about fifteen or sixteen and musical angst was still a bit new to me, I knew this kid that was a couple of years older than I was. He was a classic punk - Mohawk haircut, ripped up, faded jeans and shirts, spiked black motorcycle jacket, etc. I thought he was pretty cool, and one time I heard him going off about all of the newcomers to the punk/grunge music scene in the mid 90's. I will always remember one particular comment that he made. He said "...I was listening to Smashing Pumpkins when those fuckers were listening to Bell Biv DeVoe." Because of this, I have always associated Smashing Pumpkins with rebellion.

And now their music is on a Visa commercial.

This sucks almost as much the fact that when I saw the Rolling Stones in concert in 2002, the tour was sponsored by E-Trade and there were E-Trade banners all over the Tacoma-Dome.

As a musician, it begs the question, what is the point of writing rebellious songs? Furthermore, what is the point of rebelling at all? I mean, is this what we're all destined for - to eventually have our most sincere feelings of discontent sold to the highest bidder, regardless of that bidder's moral fortitude? If the Stones (a band that practically invented counterculture) and Smashing Pumpkins (a band that is synonymous with the second generation of counterculture in the 90's) will sell out to companies like Visa and E-Trade, what hope do any of the rest of us have?

Please understand, I am not against an artist selling his music. I would just like a little integrity and discretion with regard to the buyers they serve. Visa and E-Trade? Come on.

Our current economic conditions are proof that credit card and financial companies will allow every bit of their "business sense" to fly right out the window when their greed goes unchecked. We are seeing first hand the fruits of that greed. Now it seems some of the artists I look up to are no better.

I can understand Smashing Pumpkins selling Bullet With Butterfly Wings to the Discovery Channel for use as the theme song to a series. I can even begrudgingly accept the Stones selling Start Me Up to Microsoft a few years back, but I just can't be ok with either band's music being use to sell financial services. Especially since neither band is apparently hurting for cash. The Stones are, well, the Stones; and the Pumpkins put out a new album just last year, and from what I heard, it was pretty well received by even today's kids.

It all comes back to greed - which leads me onto another little rabbit trail that I've been thinking about a lot lately.

During the presidential campaign, a lot of the McCain supporters, and the GOP in general, were up in arms over Obama's plan to "re-distribute the wealth" or "share the wealth." (remember Joe the Plumber?) Letter after letter to the editorial board of my local newspaper said that if Obama got elected we would all be socialists overnight. This never quite sat right with me, and the more I think about it now, I think I've finally figured out the real problem with "trickle-down" economics.

The first part of the problem is that the distribution of wealth in the U.S. (and, for that matter, the world) is disfigured like some grotesque character from a Flannary O'Connor story. According to Wikipedia, 10% of the U.S. population controls 71% of the wealth, with the very richest 1% controlling 38%. So if we plug in some made up, but approximate, numbers to represent the population and GDP values for the US, it would look something like this: Let's say that the U.S. population is 300 million, and that the GDP is 14 trillion. This would mean that 3 million people (1%) control $5.32 trillion (38% of GDP), the other 27 million people that make up the top 10% of the population would control $4.62 trillion (a combined total of $9,94 trillion, or 71% of the GDP), and the remaining $4.06 trillion would be divided up amongst all 270 million of the rest of us.

Now, these astronomical figures are a little bit hard to fully grasp, so, just for fun, lets divide the dollar amounts up evenly amongst the populations that control them - this might help us get a little better idea of what this distribution looks like on a per-person basis (disclaimer - this is just a rhetorical example - reality is obviously much more complicated.) The 3 million richest people would have an average of $1.773 million each, the next-richest 9% (27 million people) would have an average of $1.711 million each, and the other 270 million of us would have an average of only $15 thousand each. Ok, so most of us make more than $15K a year, but the ratio is what's important.

Basically, the entire U.S. economy is a giant pyrimid scheme, and if that's reality, then that's reality. The problem I have with that is when conservatives tell us that the prosperity from the top will trickle down to the bottom.

Wrong.

The trickle down formulas don't work when you account for greed and marketing. You see, greed insures that the people at the top don't want to give away their money, and marketing makes people believe that they actually need to live like Hugh Hefner or, for that matter, Bruce Wayne ('cause really, 15 Lamborghini's just isn't enough).

The people who support trickle down economics want us to believe that everyone can work their way into wealth like this. Sorry, but they just can't. We need garbage men. We need janitors. We need clerks. None of these professions are ever going to produce enough wealth to break into the top 10% - no matter how hard you work. So we get this system in which trickle down trickles a little bit, but it stops right around upper management level. Garbage men, janitors, and clerks get nada.

And really, you can't tell me for one instant that a Vice President of Marketing works harder than a janitor, or a waitress. Sorry - I don't buy it. I don't have any hard data on this, but in my own experience, the upper management doesn't do much in the way of real work. I guess if you consider taking three hour lunches, skipping out early in the summer to play golf, or traveling to lavish resorts for "business meetings" work, then they work pretty hard, but I think they've got it quite a bit better off than the guy who has to clean the toilets in a truck stop in Butte, MT.

This is really the heart of the matter. Traditional, conservative, laissez-faire capitalism is flawed. The idea is, if you work hard, go to college, and play your cards right, you can get anywhere you want to go in life. That's the American Dream, right? Well, the truth is, it doesn't work that way, because there's a very small amounts of seats at the top, and not everyone can get there. So, for a nation that is supposedly founded on equality, and equal opportunity for everyone, does this really seem like the best system? Maybe a better system would be one in which the people who are driven and determined can work their way to the top, but the top isn't quite so lavish. That way, the rest of the people, for whom "life happened," can still be prosperous.

I tried earlier to paint a numerical picture of the distribution of wealth in this country, but I think now that maybe a better picture would be this juxtiposition. There are a few Americans that can afford to buy a wristwatch that costs more than the majority of Americans' houses. Seriously. Look at a watch catalog sometime. There are watches out there that cost over $350,000. There are people in Las Vegas that drink $10,000 bottles of champagne - but for every 27 million of them, there are 270 million who sometimes struggle just to pay $3.00 for a gallon of milk.

I am all for rewarding hard work. I am all for making sure people don't leech on the system. I just think that nobody really needs a $350,000 wristwatch in addition to four or five multi-million dollar homes and 17 exotic cars. Not while there are honest people being kicked out of their homes.

I am also just really tired of people demonizing progressive reform as "socialism," or "Marxism." People who do so are completely ill-informed about what actual communism and socialism were, and are so far removed from reality that they would be hard pressed to see it if it were tsunami racing toward them. I hope, however, for all our sakes, that those people are becoming more and more rare.

I am the Reverend Humpy and I have approved this message.