Aditional Response to "A Damascus Experience" by Staton Boyette

Additional thoughts on the Damascus Experience and the response from Virgil:

The shotgun approach that our current lawmakers are taking to reformation of health care in the US is overwhelming to everyone including those immersed in the details of the reform proposals. I cannot find a source that tells the current number of pages in the bill, but the last number I heard was over 1100 for the House bill and I also heard an unconfirmed number of over 500 amendments to the Senate bill. If either of these is close to the truth, then I have to conclude that no individual is capable of understanding exactly what is being proposed as the “fix” for health care, much less capable of explaining it to the American taxpayers.

I like Virgil’s approach to defining the problem. He states:

“First, I ask myself: what do we need to fix? What is broke, as we say?

Everyone should be covered. No one should fall between the cracks. It may not be a legal right but we agree that it is a moral necessity. Religious people - Christians and Jews primarily - historically have built the hospitals and provided care to the poor.
Costs must be contained. The current system is unsustainable.
Insurance should be tailored to the needs of each person and it should be portable and non-cancelable.”

I would not state it exactly the same way, but his focus is straight forward and easily understood, so I will leave it as stated and add some further observations and ask a few questions. I will state up front that I agree with Virgil’s conclusion that the answer is not to turn the problem over to the politicians. The politicians can definitely help, and we need their help, but a “Medicare type system” for everyone will wind up as a boondoggle that cannot be untangled.

For those of us in the US that can afford insurance, or are covered by one of our current social programs, Medicare, we are for the most part happy with our coverage and we can generally request health care services and receive them within a reasonable period of time. All of us have had specific issues arise that were unfair or received questionable treatment from our healthcare providers/insurers, but generally have received good health care on a timely basis. Therefore, I will not address the unusual situations.

I believe that in a country as wealthy as ours, we should provide some form of health care to all of our citizens. I do not consider health care to be a “right” as the purchase of a health care policy is a tangible item, and we presently have a choice to spend dollars on a health insurance policy or use these dollars to purchase a new car. If owning a health care policy that provides some level of insurance coverage in the event that one may need the services of a health care provider is a “right”, then it will soon be argued by some politicians, ACLU lawyers, or others that there are a whole host of other tangible wants/needs that should fall into the “right” category. I do not believe any of us want to go there.

Generally, health care for accident, emergency or chronic care is available to everyone in the US today. Most of us, however, do not like the form in which these services are delivered, i.e., overflowing emergency rooms or in perhaps substandard facilities. I am sure that some patients suffer greatly and go through a lot of red tape before they can obtain these services. In some instances they are probably not successful in obtaining care within the required time frame. My assumption is that this is the exception and not the rule, so I am open for argument if statistics are available to prove otherwise. Also, preventive healthcare and the care that most women receive during the months prior to giving birth Is not available to a large group of people. These problems need to be addressed along with the preexisting conditions insurance issues that are a problem for so many.

All of these issues can be clearly defined and listed in a straight forward manner as a subset of points under the question that Virgil asked: “What do we need to fix?” There are specific items related to each point that can be addressed one at a time or in manageable groups. It will take some time to solve the problems, but they are complex and require diligent effort and commitment. With a commitment by the lawmakers to work together (Democrat, Republican and any other ilk that is out there) we can make reasonable progress. This approach is not quick enough or dramatic enough to meet a politician’s need to have something to brag about that will insure reelection or satisfy their view of what their legacy should be, but it could provide steady and measureable progress toward a goal of real health care reform without disrupting and tearing apart the fabric of something that currently works for the majority of US citizens. To quote H. L. Mencken, “For every complex problem there is an answer that is clear, simple, and wrong.” We could add “quick” to this quote. We do not need a quick solution to health care if there is even a chance that it is wrong!!! The problem is just too big and the potential consequences just too severe.

Some of the questions that I have about the current direction being pursued by our lawmakers are:

1. Why are we focused on getting insurance for everybody at such a large cost when a major part of the problem is in the health care delivery system? Insurance will not solve this problem.
2. Why are some things such as tort reform just ignored? A lot of the cost is driven by the unnecessary tests done just to satisfy the malpractice insurance requirements or the unreasonable requirements necessary for a doctor to get paid. I saw this first hand when my own father made his last trip to the hospital.
3. Why are they not dealing with the current laws that prevent the insurance companies from crossing state lines, but allow the company to write a group policy restricted to one state and raise premiums to the point where the more insurable people in the group move to a less costly plan? The insurance company then abandons the group and forces the remaining participants to go elsewhere. Mutual of Omaha did this to us and had the audacity to reserve the right to receive a commission from the company that they recommended to write essentially the same policy with a higher premium.
4. Why are our lawmakers rushing to approve a plan for all Americans that they will not be a part of? Why does this élite group of people believe that they have to enact legislation to govern our lives, but feel that they are different and therefore must have a plan that provides a different level of health care for them and their families?
5. Why the rush to approve a cumbersome, bloated piece of legislation that almost defies comprehension and makes sweeping and dramatic changes to such a large segment of the economy? Why the rush to change a law in Massachusetts to what it was four years ago before it was changed to prevent the governor from appointing a Senator to complete an unexpired term, to allow the governor to appoint a Senator to complete an unexpired term so that this bill can be approved without bipartisan support? Is this politics at its worst? Does this represent the American people and their best interests?
6. Why are our lawmakers passing bills that have such broad application without even reading them? Why are they not allowing the bill to be published and read by the American public before they vote on it? Why are they not listening to the American people?
7. How on earth can we keep things like they are, i.e. keep your present coverage, keep your present doctor, etc., without adding to the deficit or raising taxes? If the answer is by eliminating fraud and waste from the current SS, Medicare, and Medicaid programs, please start now!! Do not wait until this massive legislation adds additional problems to the equation.

As it relates to this last question, I firmly believe that we are going to see major changes if the government option is made available. As I understand it, everyone will be required to have health care insurance or pay a penalty. Is this correct? How will people be able to afford it if they are having a hard time paying a mortgage and putting food on the table? Oh, a government subsidy? Who makes the eligibility determination? Long term, private health insurers will be squeezed out since they will be unable to compete with a “not for profit” insurer like government Medicare. Medicare is facing an enormous unfunded liability. What will happen when everyone, except the legislators, has Medicare or a similar program? Reduced reimbursements to doctors and medical facilities will result in fewer doctors and medical facilities. Reduced revenues and large deficits within the program will result in lowered benefits. With the government run program, I believe this is inevitable.

The “Rule of Unintended Consequences” will rear its ugly head. I do not know where, but possibly through job losses in the private sector. Unquestionably we will have more government jobs created, but after some period of time when more people work for the government and less people work in the private sector, how can we replace the taxes to run the government that are currently generated by corporate profits, small business profits, and private sector payrolls?

Let’s (1) slow down, (2) more clearly define the problems/issues, and eat this elephant one bite at the time. I would like to add with broad bipartisan support, but we may be too far gone for that.

Staton