Apparently Mr. Boss has discovered the therapeutic nature of blogging. He whipped up this little informative gem after watching Obama’s speech last night. I think he’s a better writer than I, and he’s certainly something of an expert in all areas of insurance. My one “criticism” of Boss’ essay is that it does not mention the need to eliminate interstate insurance barriers. CLEARLY, by allowing insurers to cross state lines, competition will increase inevitably and “keep the insurance companies honest.” God I hate that favorite phrase of Obama’s. Really I just hate when politicians demonize an entire industry, the “rich”, etc. for political posturing. Really bad idea. Without further ado, here’s today’s guest blogger, Mr. Boss! PS- if anyone else ever wants to post, just send it along.
AN OPEN LETTER TO MYSELF REGARDING HEALTH CARE REFORM
I was careful not to refer to health insurance reform. Insurance companies employ actuaries to determine their expected losses (cost of doing business), build in a slight profit margin into the rates, and then charge their customers accordingly. Any insurance company not doing business in this manner would be driven out of business by a more efficient carrier. Throwing stones at yucky insurance companies is popular, but ungrounded.
I will try to make that the last time I directly or indirectly criticize the current health care proposals that Barry and the Dems have put together. It is easy to criticize and poke holes in a work-product others have done. There is plenty to criticize in the current proposals, and given the groundswell of unflinching approval in the mainstream media for whatever the current administration does, it is imperative that the opponents speak up and speak loudly. Given the current playing field, silence is akin to passage.
However, other than as a self-defense mechanism, criticizing elements of the plan is unproductive. Thus, the goal of the rest of this letter is to outline my ideas for reform, and not take shots at other plans (as stupid as they are!).
Before I lay out some of my suggestions, a question people are afraid to ask is “Is the system broken?” Hundreds of millions of people have health insurance, and are relatively pleased with it. Even more Americans would indicate their approval of their doctors and other health care providers. Our health care system is best in class by almost any measure.
But we certainly have a segment of our population that is uninsured, or underinsured, or unhappy with their insurance. I don’t want to marginalize those people. They are not just the poor. They are not just small business owners. They are not just the self-employed. But last I checked, every single American has access to health coverage. Can they afford it? Many can and choose not to buy. Many prioritize other expenditures over health insurance. And many have more basic needs (i.e. food and shelter) that should be prioritized over insurance. But everyone can get insurance, either in the private market or via the public options currently in place (i.e. Medicaid).
I would therefore argue the system us not as broken as the talking heads would make you believe. But that is considered an unconscionable suggestion. I just don’t understand why.
Of course, even in our unbroken system, there is room for improvement. So here are my Five Star / Lock of the Week suggestions for “reform.”
I still can’t figure out why the liberals are so beholden to the plaintiff bar. I know they are massive donors, but get a backbone when dealing with these guys.
Take a jurisdiction like Philadelphia, and the case of Jane Doe v. Big Mean Insurance Company. Big Mean’s policyholder was Dr. Feelgood. Dr. Feelgood is an obstretcian who delivered Jane Doe’s baby. Throuhgout the pregnancy, Dr. Feelgood conducted the appropriate monthly check ups, an ultrasound, and other standard tests to insure a safe delivery for baby and mom. Dr. Feelgood did not diagnose that Jane had a little problem with the bottle, and the baby was exhibiting signs of Fetal Alcohol Syndrome. Maybe the baby was a slight bit smaller than expected, but not reason for concern.
Dr. Feelgood successfully and safely delivers Baby Doe, and the Fetal Alcohol Syndrome is noticed. So what? If Dr Feelgood had noticed the signs in Week 20, was Jane going to abort? I should certainly hope not! And by the way, Pedro Martinez and Britney Spears have done quite well, thank you very much, with their eyes spread a tad too far apart. So the condition isn’t exactly a death sentence.
But in Philly, this case goes in front of a sympathetic jury who hate big mean insurance companies in general, and Big Mean Insurance Company specifically, and the award is $5,000,000 to Ms Doe. Isn’t that great?
By the way, rainmaker jury, you just contributed to medical malpractice rates going up, stifles the way doctors practice their craft, and drove up your own health insurance premiums. Well done.
Now, in almost any discussion of tort reform, the truly injured and wronged are still protected and can still get large settlements from doctors (and their insurance carriers) who performed unacceptable medical care. Only the frivolous claims are suggest to caps on awards. Sounds so obvious. It constantly amazes me how powerful trial attorneys are when they have a common cause.
But here is the hook: Barry and the Congress can and should leave it alone. This is an individual state issue. Maybe I am just an old romantic Federalist, but this is exactly the type of reform that needs to be addressed on the state level.
This is a self-correcting issue. If New Jersey enacts meaningful reform, doctors will want to practice in Jersey. And the logical extension of that is doctors will choose Jersey over NY and Pennsylvania. So the public / voters in NY and Pennsylvania are left with a lesser quality of healthcare provider, which should lead to meaningful tort reform in those states. And the dominoes will fall north, south, east, and west, until each and every state has done what is right for their constituents, AS DECIDED BY THEIR CONSTITUENTS.
The President and US Congress doesn’t need to involve themselves in the issue (Is the Supreme Court the only branch of government that is least conceptually bound by the Constitution anymore? And lets hope that survives…)
I don’t want the power hungry, self-important folks who love the sound of their own voices and wear flag pins in their lapels to prove they like America involving themselves. Spend your time more effectively by raising political funds for your next election. We’ll take care of locally.
And where do you have greater access and influence? As seen by recent townhall meetings, members of Congress are arrogant, brazen, talking heads who are very good at getting yelled at, staying on message, and ignoring the will of the voters (until they lie about their record of concern for the will of the voters during an election year). But a state legislator? Those men and women are your neighbors. Unless they have become corrupt by taking advantage of “pay for play” tactics in some metropolitan areas, these state legislators are not in it for the money. In fact, they probably have to have another job just to make a living. Instead, they often enter politics because they truly want to make a difference, and (with some notable exceptions) have no higher aspiration than their current elected position.
So next time your state legislator, who doubles as your accountant, is reviewing your taxes, or you see them at a little league game because your daughters are on the same team, why don’t you ask them about tort reform? Chances are you will not only not get a standard vague answer, but you will probably be able to exert a bit of influence on him. If he hears it from enough folks at the little league game, maybe he’ll get the message. That is an easy form of a grassroots movement that can be effective at the local level, where this whole debate should reside anyway.
The Residual Market (dare I say the “public option”)
Most of us have insurance. Leave that segment alone. Focus on the uninsured. We already have a plan in place for the uninsured that meet certain eligibility requirements: Medicaid. If we still have people that are not eligible but need insurance and can’t afford it elsewhere (small business owners included) , simply expand Medicaid.
But along with expansion, it needs to be reformed. Currently, it is paid for on both the federal and state level. Which basically means it is coming out of your tax dollars, and you are subsidizing Medicaid participants. If expand Medicaid, I think most people would not want tax increases in order to pay for the program. Barry and I finally agree on something: it needs to be self-supported from premiums collected. As such, if the premiums collected come from a segment that can afford higher costs, this coverage may not be as comprehensive as employer delivered health insurance.
But, the higher your premium, the better your coverage. Good luck getting a politician to make such an insensitive argument, but c’est la vie. I drive a 4 cylinder Hyundai Accent that cost me about $12,000. I chose that car because it was all I could afford at a tough time in my life financially. Is it potentially dangerous to drive my 3 kids in the backseat of this tiny car? Perhaps. But I chose to do it. There shouldn’t be a government subsidy given to me to buy a BMW because it is safer.
Which leads me to those who don’t get private insurance, and choose not to purchase coverage through Medicaid. Stop with the mandatory coverage nonsense, and penalties for those who don’t purchase coverage. If someone opts to go uninsured, let them. The Declaration of Independence tells us we have certain inalienable rights, including life, liberty, and the pursuit of happiness. Those are our rights, and a government that infringes on those rights is to be replaced. Not as poetic, I suppose, but the contrapositive for that is the right of death, shackles of poverty, and pursuit of desolation. If we choose as such, don’t we also have these rights?
We all have choices, and it is not the government’s job to insist we make the right ones. If I choose to play strangle dangle like David Carradine in a hotel room and I die, that was a bad choice I made for myself. But the government shouldn’t ban the sale of belts!
Bottom line: expand Medicaid, and if people still don’t buy it, let them roll the dices. Just don’t foot me with the bill when they go to the ER. Garnish their wages or take whatever assets they may have.
An Overhaul of the concept of insurance
This is probably way to liberatarian, and has no chance of passage, so I’ll only spend a minute on it. But I have to suggest it because it really should have a voice during these debates.
Revamp the whole system of insurance so it doesn’t cover the basics. As head of my household, I should budget for routine expenses. If I choose not to get screenings and get annual check ups, shame on me. And if I know I am going to the dentist twice a year for a cleaning, I should put some money aside for those visits. Why should insurance cover this, and more importantly why should we want them to? Insurance companies know their costs. If they know they will have pay for me to go to the dentist biannually, they charge me for those visits in the up-front premium, and they will add a profit load. So why should I trade dollars with the insurance company? I should budget wisely for the routine, and let insurance cover catastrophic, fortuitous, unforeseen losses.
I have heard the counter arguments: if I don’t get preventative medicine, it will cost the whole system more in the long run when I am seriously sick. But who actually wants to be sick? We want to get preventive medicine to be healthy and vibrant. We all love to take a day off of work, but not if it is because we can’t get out of bed with a headache, chills, and fever.
And if more people understood that they are paying for preventive medicine either way – whether we budget for the out of pocket expense or we pay it in a premium to the insurance company – they will make the right choice.
And if they don’t, and they choose to not to go to the dentist and end up looking like Austin Powers, that is their own dumb choice and they suffer the consequences.
So now we have cut costs with tort reform. And we offered a “make available” product for all uninsureds via an expansion of Medicaid eligibility and shifting of the costs from taxpaper to policyholder. So what is left…..leave the rest of us alone!