Health reform for ordinary folks

When it comes time to vote in November, will Americans know what they’re voting for in terms of their health care futures? Will they understand what Barack Obama or John McCain’s health proposals mean for them?Politics

Over at Columbia Journalism Review, Trudy Lieberman says they won’t given the current media coverage of health reform. The journalism professor critiques the mainstream media’s coverage for basically
transcribing the candidates’ pitches, and says the blogosphere is overly wonky.

"Exactly how will all these economic and political calculations and
pronouncements affect those who struggle daily to fill their
prescriptions, find a competent doctor, or pay their medical bills?"
she asks. "These are the people whose stories the media have yet to

In a series called "Health Care on the Mississippi," Lieberman examines how the presidential candidates’ health proposals will affect ordinary folks.

In Part 1, she goes to Helena, Arkansas, a town of 6,300 along the Mississippi River to talk with the working-class residents about health care. Currently, most knew "nothing of the coming health care battle being waged in their name," she wrote.

In Part 2, Lieberman examines how Helena’s head jailer and his diabetic adult son would fair under McCain and Obama’s health plans.

"Neither father nor son would fare well under McCain’s proposals.
Bell the elder would have to pay taxes on the value of his health
insurance benefits. Economists argue that removing the tax exclusion
for employer-provided benefits is a move toward equity, since the
exclusion now favors highly paid people who get rich benefits. Equity
or not, Bell would have to find the money to pay the extra taxes on an
income that hardly covers the essentials. In exchange, he would get a
$2,500 tax credit to buy his own coverage, as an incentive to leave the
county’s health plan.

"Bell the younger would have the same problem. Even with the $2,500 tax
credit and additional federal subsidies, most likely he would still be
uninsured. His diabetes makes him uninsurable."

And how about under Obama’s Plan? Well, Lieberman writes, there’s still too many unknowns to say for certain.

"The elder Bell could keep his coverage, which will probably get
more expensive. Although Obama has promised that he would lower the
cost of premiums by $2500 for the typical family, health analysts
dispute whether this is achievable."

"Bell the younger has a shot at getting the consistent, ongoing
care so necessary for diabetics. Under an Obama plan, he might be able
to choose coverage in the public plan, assuming subsidies that are high
enough to cover the premiums. If by some chance the legislative sausage
grinder turns out a provision for automatic enrollment in existing
public plans, like Medicaid or the State Children’s Health Insurance
Program (SCHIP), he would qualify, giving him fairly comprehensive
benefits and a way to pay for care."

6 replies »

  1. Ok, lets respect the dead and let sleeping dogs lie, LOL.
    Now, I will take a position as a voter. I agree with Germany. Health plans and/or insurance companies should not be unbridled for-profit entities. Make them accountable public purpose trusts. Any surplus beyond “reasonable retentions” (net of IBNR, reinsurance settlements, etc., and yes a “disinterested party will have to render a judgment here), should be credited back to future premium base rate calculations.
    Let the government set the rules of a private/public (financing and delivery) partnership, and bless the players as they compete for the ample dollars ALREADY in the pipeline.
    There are too many insurance companies, health plans, TPAs, or their self funded proxies direct or indirect, all playing the never ending and continually mutating cost shifting game. The incestuous MBA slice, dice, cap (simple or aggregate), limit, or “covered vs. necessary” interference industry has become a bloated and undeserving malignancy, designed only to limit the “MLR”, oops I mean its more politically correct derivation, i.e., “medical cost ratio” aka MCR.
    Blown them out! They do not serve the value proposition, are talented and entrenched “bottom dwellers” and feed the “resistance is futile” lie.
    For perspective, we need only tally up the true “admin piece” in the food chain, not just health plan admin, retention, liability, etc., but factor in medical/hospital/ancillary office/delivery platform overhead, and the bloated (niche and mainstream) administrative services entities all generating demand from willing IT architects, compiling programs drafted under a failed business model and market paradigm), the net dollar for actual health care service delivery has to be less than a .50 cent dollar. How can this be rationalized under any conditions?
    I highly recommend viewing Frontline’s excellent piece on “Sick Around the World”. Our knee jerk reaction to summarily dismiss democracies such as Germany, Switzerland, France, Japan, Taiwan, Brittain and Canada, as wittingly or not, engaging in “socialized medicine” deception is a clever, yet mind numbing way to end intelligent participating of the trade-offs in the debate.

  2. Singling out the health plans or pharmaceutical companies, as has become politically correct, simply does not cast the net wide enough. They have certainly played their role and gotten fat, but as Uwe Reinhardt put it nearly a generation ago, thinking about the health system as a gigantic feeding trough is a useful and encompassing metaphor. The system is simply besotted with money. It ain’t just about what people are paid; as you said, it’s about the value they create or don’t create, and how risk and responsibility are simply displaced until they disappear. We voters tolerated and abetted this system and someday, we will end it.
    The idea of “entitlements” long predated the boomers; it was the way a previous generation of politicians engendered loyalty and dependency of citizens- the idea that there were no defined responsibilities commensurate with our “rights”- to health, to housing, to jobs, to “happiness”. We haven’t heard a lot of the “rights” formulation this time around, which is a refreshing change. Reagan and Roosevelt are both dead. Let them lie.
    Maybe someday soon, politicians will start talking about our responsibilities as citizens. Until they do, starting with ourselves and our expectations is a useful place to begin.

  3. While I completely agree with the “corrupt system” characterization; how sound byte and Reagan-esque an assessment Jeff! While a simple look in the mirror affords a personal accountability moment, who’s DNA is rooted the “you can have it all” notion of the counter culture 60’s crowd, and steadfastly claimed as an entitlement by the boomer generation (imagine the Who or Led Zepplin driving a Lexus or Escalade when composing the songs so prevalent in today’s advertising)! This delusional greed is rampant, and dots connected in the BBC’s series on the “Century of the Self”. From Freud to Maslow, and zeitgeist propaganda to corporate PR firms, we are buying the very lies we rejected in our youth. Remember….”meet the new boss, same as the old boss”?
    As Pogo “discovered”, “….we have met the enemy, and they is us”. Yet, lets not rationalize the (both mega and routine) disparities in the health care drama. The Billy Tauzin equivalents of the world: from congress to special interest/egregious PhRMA advocacy/compensation, et al. There are just too many pigs at the trough, with too many layers of protection.
    Show me a hospital or system, health plan or national CEO, supplier or niche vendor executive that truly delivers value (other than to their shareholders) that warrants multi-million dollar compensation? I for one am delighted Bill McGuire may be held to account on his obscene take away from United. But this is only the surface view.
    Neither sound byte distractions, nor “liberal warhorse” characterizations move the ball down field. Lets get specific!

  4. Perhaps someday a politician will show up with enough courage to connect the rising cost of health insurance with the insatiable appetite we all have for benefits paid for with someone else’s money and our heedlessness to the cost of our own gluttony. There is a staggering amount of waste, inappropriate or eminently avoidable care, co-existing shamefully right along side a lot of people who don’t get the care they need because others have driven up the bill.
    We pay only 12% of the healthcare bill ourselves (not counting the 9% or so that is taken our of our paycheck for premiums). Sure, a portion of that is involuntary and beyond our control- but it is also a steadily expanding goody basket of things we consume, and that’s exactly the word for it, without worrying about the expense. And a hungry collection of overfed professions who use their political power to pile onto that benefit a guaranteed income for themselves at public expense.
    It is a corrupt system, as John has suggested, but we and our saintly healthcare system are up to their eyeballs in it. It isn’t just the insurers who are playing the game. And the whole mess is swathed in jargon and rhetoric so hollow and impenetrable that our eyes glaze over after fifteen seconds. Look in the mirror and you’ll see the real problem.

  5. Why should anybody be informed about their policy?
    With employer-provided policies, nobody is going to look at it until they get sick– why should they? They usually can’t influence their choices anyway (usually Kaiser vs. some single private insurer). Nobody walks away from a job offer based on medical “coverage”.
    Furthermore, most people don’t realize that the insurer can, and usually does, perform a bait-and-switch when it comes to “coverage” as a regular means of not paying out claims. What is written on paper by the criminals that bring us insurance is usually lies– phony physician networks (MD lists are rarely updated, and usually innacurate) and fake benefits.
    Nobody can stop them. Face it, they are free to jack up premiums and continue to decrease payments for services unhindered.
    Some day, someone will make a political career of destroying them (like the robber-barrons of the past) but that time is far from now.