Thursday, November 5, 2009

Red Alert

I've had a hard time making sense of the latest news about health care legislation. In the Senate, Joe Lieberman seems to be backing off from his threat to filibuster a reform bill; maybe he realized that a filibuster isn't necessary because you can shut down the Senate by simply writing a letter.

Over in the House, the wacky extremists at the AARP are supporting the House health bill, but Republican congresswoman Virginia Foxx responds that health care reform is worse than terrorism. Apparently, either my grandmother is a card-carrying member of a terrorist organization, or Virginia Foxx is a raving lunatic. I'll see grandma in a couple weeks, so I'll let you know what I find out.

Sunday, October 18, 2009

Truth in Advertising?

If you've been following the news on TV lately you may have seen this ad for Blue Shield. (For those who can't or don't want to watch the video, here's a summary: A man's face appears in front of the word "happens" on the screen. The man speaks with a lisp and says "I lost my front tooth the other day, which would be great if I was 7. I'm 46. And the tooth fairy doesnt come when you're 46, just lots of referrals, and appointments, and bills that cost tons. Maybe I'll keep it. It adds character, right?" The Blue Shield logo then appears, and a voice-over says "We know life can be unpredictable, we offer affordable health coverage, and also dental plans. Choose Blue Shield today."

The ad reminds us of why insurance exists - to protect against unforeseen harms, like losing a tooth. We are led to believe that having Blue Shield insurance will take care of the hassle and expense of unexpected medical (and dental) problems.

All that makes sense. But is it true? Or is Blue Shield earning its initials here? We'll come back to that in a minute. Meanwhile...

Pop Quiz!

Imagine waking up and finding your shirt soaked in blood. You remove the shirt and find that blood is seeping from your nipple. What do you do?

A) go back to sleep and hope it stops bleeding by itself
B) seek medical care to find out why blood is coming out of your nipple and stop it
C) invite your kinky vampire friend over

Which of those choices would you consider reasonable under the circumstances? Think carefully because the answer might cost you.

Faced with this situation, Rosalinda Miran-Ramirez went to the Emergency Room at a nearby hospital. When it was time to pay the ER bill, her insurer (surprise: Blue Shield) refused to pay for the ER visit, saying that Miran-Ramirez "reasonably should have known that an emergency did not exist."

That kind of thinking puts Miran-Ramirez (and anyone else who has health insurance and might experience an unexpected medical condition) between a rock and a hard place. She can either err on the side of caution (and risk being stuck with a massive ER bill) or else wait (and risk that the problem will get worse because she didn't seek prompt medical attention).

I won't pretend that insurers like Blue Shield are entirely responsible for this situation. Of course, health care costs in general are too high and continue to rise. And the need to make up for unpaid bills is a big reason why emergency care in particular is so expensive. (Basically, people who don't have insurance use emergency services when they need medical care, and when they can't pay the bill, everyone else gets overcharged to balance things out). A public health insurance option would go a long way toward solving this problem, by creating access to scheduled, non-emergency care for those who are currently uninsured.

So perhaps it's a bit unfair to blame Blue Shield, when the problem is systematic. But I can't help thinking that Rosalinda Miran-Ramirez would be calling "BS" if she saw one of those commercials right now.

Thursday, October 15, 2009

Crunch Time

A few weeks ago, things looked pretty bleak for the public option. But the fight is not over.

House Speaker Nancy Pelosi confirmed today that she intends to push for a government-run health insurance program as part of health care reform package currently moving through Congress.

It's not going to be an easy fight. Although Maine Republican Olympia Snowe voted in favor of the Senate Finance Committee's health reform package, that proposal does not include a public option, and Snowe says she won't support a plan that does (though perhaps she should reconsider that position, considering that a strong majority of Maine voters support a public option).

At this point it looks like the best chance for a public option would involve a program administered by the states - Nebraska Senator Ben Nelson, who had not previously voiced support for a public option, said last week that he's open to a state-managed alternative.

Although he's not exactly the guy you want making headlines, and probably won't have much, if any, influence over his colleagues in the Senate, Illinois Senator Roland Burris is demanding a public option. You go, Roland.

Finally, an update on the big baby: Rocky Mountain Health Plans reversed course and said it will no longer categorically deny coverage for overweight infants. This is great news for the Lange family, but the rest of us are still stuck with a system where insurers can make arbitrary decisions to refuse coverage based on a pre-existing condition. Let's fix that: contact your senators to tell them we need a public option.

Monday, October 12, 2009

You can't make this stuff up

In case you were wondering how low the insurance companies are willing to go ... according to The Denver Post, an insurer called Rocky Mountain Health Plans recently refused to cover Alex Lange because of a pre-existing condition.

Now, you might be wondering why that's newsworthy. If you've been paying attention to the news lately (and I'll assume that if you're reading this blog, you're paying attention) you know that countless Americans are being denied insurance because of pre-existing conditions.

In this case you have to look a little closer. What is Alex Lange's pre-existing condition that makes him uninsurable? He's overweight - specifically, he's at the 99th percentile for weight among his age group. Now the kicker: Alex is 4 months old.
"I could understand if we could control what he's eating. But he's 4 months old. He's breast-feeding. We can't put him on the Atkins diet or on a treadmill," joked his frustrated father, Bernie Lange, a part-time news anchor at KKCO-TV in Grand Junction. "There is just something absurd about denying an infant."
Alex Lange's story is a good example of why we need a public option: insurance companies will always favor the bottom line over doing what's right for society. Until we have a legitimate public option that forces private insurers to truly compete, they will have no reason to offer insurance to cute, chubby people like Alex Lange.

Friday, October 9, 2009

The Face

The reason I started this blog was seeing my friends, neighbors and relatives suffer without affordable, comprehensive health insurance -- but there's another reason, I think, that it seems like such a serious responsibility to me that we all cooperate to provide that insurance.

I experienced an incident in China about five years ago that has made the fight for a public option, and for real, affordable health care for all Americans seem critical, immediate, and crucial. China is controlled by its communist government, but their health care system is considerably more influenced by the free market even than ours in the United States, and (partially due to limited resources) they don't have guarantees we have such as the emergency room mandate, guaranteed basic health care for seniors, or care for the poor.

My partner and I were traveling in Dandong in northeast China, and were coming back to our hotel one night when we saw a couple on a motorcycle run over an older man on a bicycle who was making a left turn. It was dark, but not late, and there were about fifteen or so people on the street. She ran over to see if he was okay; I started trying to get passers-by or people working in shops to call an ambulance; the couple on the moped, who had been knocked off it, got up and fled.

I couldn't get anyone to place the call, or even to lend me their phone so that I could make the call in my half-broken Chinese. Who will pay for it, they said? We'll be responsible if we call an ambulance. They'll trace my phone. I can't call from my business, because they'll fire me for putting them at risk.

I was essentially having a health insurance policy debate. They can't make you pay, I said, they'll pay. Who is they, they said. Everybody pays, I said. The city keeps the hospital open. The city will pay. The city won't pay.

Sadly, they were right and I was wrong -- there was no system in place to help this man, and no community support to help those watching him do the right thing.

What I didn't have to do -- what too few of us who are having this debate ever do -- is what my partner did: stay with the man lying there waiting in the street, his bike twisted underneath him, ribbons of his face hanging from his jaw, trying to breathe through the blood.

Waiting for his neighbors to make the call. Waiting for me. Running out of time to wait while we figured out who is responsible and what we should do.

It was one incident in an enormous city in an enormous country -- only fifteen people saw it start to finish -- but if you did see it, if you had stood there, helpless, waiting for nothing, it would be as clear to you as it is to me. The health of our brothers, sisters, mothers, fathers and children is our responsibility. When a man dies who could have lived, it diminishes us all. We can shirk our responsibility -- can get up in Congress and say that we don't have the money or we don't like the government -- but we can't escape it. 44,000 Americans will die this year because they lack health insurance. You and I may not have seen it happen, but it is happening, and until we take responsibility for ourselves, our communities, and our nation, it will continue to happen.

We're the people on the roadside: we look away from the suffering around us, because we feel helpless to do anything about it. But we're not helpless. Public option legislation is our best chance to provide real protections and real care to people at affordable prices. We are so close -- today, with just a few Senate votes between us and the change that we need -- we have come so far from the days when disinformation (death panels! socialism!) and apathy dominated the debate. We can keep up the pressure -- increase it -- and we can have a strong, national public option. But it will not be given to us; we have got to take it.

The injured, the sick, and the suffering wait for you and for me; they've waited for years. What are you going to do? Who is responsible?

Thursday, October 8, 2009

brb Asia

Got some news for you -- while the debate in Congress drags on, and incredible organizations like Health Care for America Now, Sick for Profit, Rock the Vote, Physicians for a National Health Program as well as millions of committed individuals fight for sane, effective, humane, and efficient American health care, my job's taking me out of the country for the next few months, and I won't be able to post here or respond to comments.

I was never really supposed to be doing this: my regular bit basically involves reading, language, and travel. I started this blog out of a kind of sense of compulsion, and have been trying to run it in my spare time (which should be obvious to anyone who reads every day -- some pretty thin entries, back there in the archives...).

If all goes well, I won't be back before our Congress votes on, and Barack Obama signs, a strong public option. One that gives the government the power to negotiate for lower health care costs, and one in which any American can choose to participate.

Until then, this blog will slow down a great deal -- I'm going to put the comments on moderation to avoid dozens of ads for Cialis cluttering up the place, and hopefully Mattlo In His Infinite Wisdom will have plenty to say (although he's got a full time job too, so you know), but there may be a good bit more silence in the next few weeks.

As long as I'm doing a meta-what-about-the-blog post, here are blog-related facts: since I started monitoring traffic on September 12, a little under a month ago, the blog has had 712 page views and 403 unique visitors. The most linked-to post was "Specifically, Women", which got picked up by feminist blog Feministing. The most commonly viewed individual page was GradMed Insurance Review, thanks to our OCD, underutilized friends at GradMed aka American Insurance Administrators aka all sorts of things. The blog has been accessed from Britain, Singapore, Turkey, Japan, and Spain. Someone from Vilnus, Lithuania arrived here last week by doing a Google blogsearch for "bill +method" (I don't think they were looking for info on the Baucus bill, but that's what they got).

My favorite picture on the blog is this one, a real circular from the early 60s outlining the treasonous Communist sympathies of John F. Kennedy. The cutest person on the blog is this person. My favorite reader comment is this one, which outlines what an AIDS patient had to do in order to get his life-saving medication covered by Pacificare. His success -- and his willingness to fight -- gives me hope that the rest of us can win our fight against the insurance industry, too.

Also, Dying for a Public Option is the only Internet site in the entire world which contains the phrase "internet fancyparties". This phrase, wholly invented by me personally, is not a registered trademark and may be freely used for any and all purposes.

I have one more post ready for tomorrow, but after that, I'm out. I sort of had fun doing this. If we end up with affordable health insurance for all Americans, I will have really had fun doing this. Thank you all for the outgoing links to HCAN and the calls to Congress. Please keep up the good work.

Tuesday, October 6, 2009

Republicans for Reform

A quick rundown of the surprisingly numerous and influential Republican supporters of comprehensive, cost-saving health insurance reform. I'd assumed Republicans were a solid front on this because I was focusing on Senate Republicans: the party at large is not quite so partisan, or quite so monolithic. They're listed by name (with a link to their statement of support), position, and secret superpower.

Arnold Schwarzenegger, governor of California, can dual-wield shotguns;

Michael Bloomberg, mayor of New York City, poops money;

Shepard Smith, Fox News commentator, able to fit his whole fist in his mouth;

Bill Frist, former Senate majority leader and medical doctor, secretly repairs railway trestles;

Bill O' Reilly, Fox News host, world's third hardest blower;

Bob Dole, presidential candidate and former senator, can bench press a VW microbus.


Now, this is more complicated than it looks -- Bill Frist said straight out that he'd vote for the Baucus bill, then sort of walked back from it -- Shep Smith basically just made an impassioned argument for the public option on TV (he said "every vote against the public option is a vote for the insurance companies"), and then contradicted himself later, as is the nature of his show -- but Bloomberg and Schwarzenegger both cited the Obama administration's plan by name in official press releases, and Bill O'Reilly was quite explicit about favoring the public option in particular, and the reasons he cited -- that it will keep insurance costs down for working Americans -- were identical to those you'd find here.

Even admitting, though, that the views of these conservatives are varied and occasionally tentative, this is not what the picture looked like in August. The public option and other forms of wide-ranging health insurance reform are no longer poorly understood, fringe ideas -- they're something the nation has clearly grown more comfortable with, and more able to analyze in practical terms (what saves money? What insures the most people) rather than emotional terms (who is a Commie? Who is killing my grandmawmaw?).

Here's hoping that this collection of elected officials, elder statesmen, and political commentators finds some kind of voice among the Senate Republicans, and opens the way for a practical bill to be passed -- one with provisions to insure everyone and keep costs down.

Yeouch

Thought I'd be working today, but had to share this. I've seen more than a few insurance industry employees supporting their industries in the debate over the public option. That's their prerogative, but this news kind of indicates that they shouldn't necessarily picture themselves as members of a big corporate 'family'.
In the memo from Randy Brown, WellPoint's chief human resources officer, the company said it would lower its contribution toward worker premiums and raise deductibles in two of its three benefit plans. "Your cost per paycheck will probably increase," the memo said.
Hard times for everyone, but I have to point out -- if you make pens, you usually get some free pens. If you're a cook, free soup. I get free database access. My partner gets free textbooks. Shouldn't insurance employees have, you know, particularly good insurance? Or maybe the legal fees, top-level salaries, and lobbying expenditures (they made the exceptional step this year of phoning 3 million of their own customers with a push-poll robocall opposing reform) are getting a little bit too expensive for Wellpoint to cover?

Monday, October 5, 2009

As It Should Be

There's a lot of disappointment and outright snark that SuperObama hasn't trained his unstoppable firevision on the evil hordes that have delayed public option legislation for so long:
Sold us out. Obviously holding back the ultra-falcon-punch maneuver that could have ended this debate long ago. And maybe that's true -- maybe he's an alien exile, biding his time to see whether or not humanity is worthy of his advanced technology. People who believe this are probably really heartened by the news that he's quietly trying to shore up support for a public option. They might say, here it comes! The part where a million lobbyists surround him and he wrecks them all with nunchucks or maybe a Klingon Bat'leth.

I'm heartened, too, but not because I spend much time paying attention to the president's temperature on the public option. I'm heartened because I see lines like this in the article above:
...at a closed-door meeting of Senate Democrats on Tuesday, Assistant Majority Leader Richard J. Durbin (D-Ill.) marshaled polling data from districts represented by conservative Democrats that showed a majority would back the requirement that Americans get health insurance so long as there was a public option.

"To argue that this is some fringe position is to ignore the obvious," Durbin said.
That's us represented there -- not swept up in the wake of a charismatic politician or a wave election, not knee-jerk motion towards Democrats because George W. Bush was a bad president and the economy went sour, but people reading the newspaper and deciding that this policy is good for them and their children, and supporting it.

We're the only part of the political process that can't be bought outright -- we are the only part of this debate that isn't worried about re-election, or donations, or finding a golden parachute in private industry. This is why FreedomWorks tried to falsely inflate the numbers of people who attended the 9/12 rally -- it's why town hall opponents tried to yell over the voices of others, and why opponents of reform generally want to look like 'regular people' and not an amalgamation of strong party supporters, industry beneficiaries, and ideological extremists. Because we, and by that I mean we the people, have the promise of the Constitution that the policies that we want will become law.

And what we want is cheaper, less exploitative health insurance for more people. Of the many programs that have been proposed, it is the strong public option that puts people over profit and respects the American tradition of private industry. We know -- the mortgage crisis and Bear Stearns/AIG/Fannie/Freddie taught us -- that unregulated industry can literally destroy itself, and we're the ones that end up suffering when that happens. Any crucial industry, and there are few more crucial than health-related industry, has to be carefully balanced into our national community.

This will only be brought about through citizen action: that's as it should be. We wouldn't want something as important as this to be dictated from Washington.

All this is to say -- keep up the pressure. Google your Senators and put in four calls -- two for each, one at the national office, and one at the nearest local office. If they have an office in your town, stop by and tell them what you care about and what you expect from your representatives.

I'll do the same, and somehow try to encourage constituents from Arkansas to visit the blog. I've got a dozen hits from Turkey, and one last night from Japan, but no Arkansas so far -- and people from Japan can't pressure Blanche Lincoln (D-AR) to get her head right.

EDIT: This great article ably underlines the point that it's not just whether we get a public option, but how strong that public option is -- which is a great point to make when you're talking to your representative. The best public option is one that anyone can choose, as well as one that has significant license to negotiate prices with providers.

Sunday, October 4, 2009

Every Country You Wouldn't Mind Moving To

Proponents of the public option often point out that nearly every industrialized country has created a government-based policy to address the basic health needs of their population. This is hard to visualize -- which may be a reason that detractors of public option legislation barely ever mention the fact. But look at this:

(from this blog, which is the weirdest place I've ever been in my life, via reddit)

Knowing just a little bit about which countries are rich and which are poor, the map above basically shows that nations who have resources guarantee their citizens health insurance. Even some nations that don't necessarily have the resources -- India and Mexico, for example -- are working on a way to provide basic universal care. Now, not all these health care systems are top notch -- Japan's has had some problems during their long recession, and Russian hospitals are famously corrupt -- but none of these nations are seriously considering or have seriously considered giving up their universal health insurance.

I believe this is because the people in the blue countries above -- over a billion people, by my count -- understand that health insurance and the profit motive do not mix. Insurers who are responsible to their stockholders will always try to take more in premiums and give less in care -- exactly opposite to our interests as a nation and our individual benefit. This is why simple regulation of insurers won't decrease their ability to refuse insurance and care to the sick or needy -- if a company like GradMed has the resources and motivation to monitor the entire web looking for mentions of their brand, then they have plenty of resources and motivation to discover ways to get around government regulation. We end up in an arms race: a well-funded industry trying to outwit a less well-funded government agency. The insurers have been winning that fight for generations.

A public option would, for a small part of the population, change that equation. It would create an insurer whose responsibility was first to the people, and only to the people -- the voters that create and shape it are the same people that it is intended to serve. This is no big secret to the countries on the map above -- they all know this -- those who haven't created a system of universal health insurance haven't because they lack the resources to put such a system in place.

We've got those resources. What's stopping us? Industry lobbyists? Partisan bickering? Lack of political will among those who support real change?

Saturday, October 3, 2009

How Much is Too Much?

The long-awaited second part of Professor Reinhardt's article on insurance costs and loss ratios was posted yesterday. In the first part, he explained that it's not just insurance company profits that drive the cost of insurance up: they have considerable overhead and costs, sometimes reaching, sometimes passing 15%.

That article, though, was about the group market. When you insure a large group, risk is distributed more widely and you can do things like look at historical data, rather than give individual physicals, and cut out a great deal of brokering and marketing. For the individual non-group market, which is especially important now that Fox News is reporting that 149 million Americans are unemployed, overhead is much, much higher. How high? I say I say, how high?

-- So high that insurance lobbies fought 2008 state laws that tried to restrict their 'loss ratio' (i.e. the percentage of income that they pay out in care) from going below 70%.

-- So high that they claim that 55 to 60% is average -- which means that for every dollar you give them, you have purchased the right to get two quarters and a dime's worth of health care.

-- So high that small firms, who buy insurance for fewer than 10 people at a time, pay up to 18% more in premiums than large firms.

-- So high that three fourths of all families who shop for individual health insurance policies end up buying nothing.

That's hiiiiigh. Forgetting your debit-card at the grocery store while you're buying a bag of Doritos and a 2-liter bottle of Squirt high.

A public option would allow the government to create one large group out of this terribly underserved part of the population. These people have money; they need and deserve insurance -- although opponents of reform like to blame the victim ("I don't want to pay for somebody else's..."), these people would be happy just to have a deal similar to those who are covered by large companies. Large companies, I would add, that almost all started as tiny businesses, or groups of freelancers -- if we continue to unfairly punish customers on the individual or small-group market, we may not even have the next generation of innovative large businesses -- the financial and health risk won't be worth striking out on one's own.

But a 55% loss ratio (let's call it a 55% care ratio) makes insurance industries big financial players with a lot of money to throw around, and this is why we have Blanche Lincoln channeling Ronald Reagan in the Senate Finance Committee. 45% of our premium dollars are more than enough to buy a little democracy.

EDIT: but not all the democracy: progressive stalwart Shakesville transcribes this exchange between White House spokesman Robert Gibbs and ultrajournalist Helen Thomas, who has been asking him whether Obama will veto a health care bill without a public option over and over again for over a week.

Thursday, October 1, 2009

Money and the Power

Just a brief note: I have to go talk about kigo in a train station cocktail lounge.

This article in the Guardian tries to count the obscenely huge amounts ($380 million!) that the insurance industry has spent in its quest to prevent a strong public option, or any other reforms that might affect their income. Sad, perhaps-I-will-have-a-cocktail-in-abovementioned-lounge ironic twist: it's our premium money they're using to buy off our own elected officials.

The other notable thing about the article is that it relies in part on officials from the Clinton administration, who are a particularly interesting kind of witness, having themselves gone up against the opposition to reform and failed. Here is Clinton-era labor secretary Robert Reich, explaining the public option in concrete terms:


EDIT: sorry about the overlap with the sidebar -- Reich is ok-looking, but I'm not so sure that anybody really needs to see him in widescreen. We should at least have the option to see him in a variety of dimensions, but alas.

Wednesday, September 30, 2009

If It Gets Real Bad, Think About Space

Well, the public option amendments were both voted down yesterday in the Senate Finance Committee. Three questions: first, why? Second, what happens next? Third, what can we do?

1) The reason this amendment was voted down was lobbyist money. One of the votes that almost nobody counted in the press, and which I overlooked as well, was that of Max Baucus himself, the chairman of the Finance Committee -- who kept repeating that the bill didn't have 60 votes in the Senate, so he couldn't vote for the amendment. But Baucus, as 538.com points out, has told his own constituents that he "wants a public option too" and there's a strong argument to be made that his leadership alone could have motivated a fence-sitter like North Dakota's Kent Conrad. The Senate as a whole, when they take up the debate, could easily strip the Finance Committee's public option amendment -- the HELP committee didn't seem to have any trouble putting a public option into their bill, whether it would pass the general vote or not. For the Schumer amendment, Baucus and Conrad alone would have been enough for passage -- just these two senators. But Baucus (as well as Blanche Lincoln, and frankly all the 'no' votes on the public option) is a MASSIVE recipient of health insurance lobbying money. Here is a graphical representation of the clouds of buzzing health insurance industry lobbyists that feed on the Montana senator (explained here). A comparison of 'no' voting Democratic senators with the money they accept from industry lobbies is here -- Baucus is at the head of the list with 7.7 million dollars raised over the course of his career, and Lincoln is second. We could have had this amendment: we should have had it. Voters and activists have done their part and the nation wants it. It is very specifically the political patronage of the health insurance industry that has prevented the passage of a public option.

2) Nobody really knows what happens now. The Baucus Bill will have to be merged with the Health, Education, Labor and Pensions committee (HELP) bill, which contains a public option, and it will have to go up for debate on the floor of the Senate, and it will have to be merged with the House bill, which also contains a public option. It seems true that there are more than 50 votes to pass a public option in the Senate -- but to prevent a Republican filibuster, we need 60 votes, which means all 58 Democrats, plus Sanders of Vermont, plus one other vote. Nobody can work on that one vote, though, and nobody can really put together a strategy to pass parts of the plan through budget reconciliation (a legislative option that only requires 51 votes) until Senate Democrats get it into their heads that a public option is what the nation wants, that it is overwhelmingly what the party wants, and that the coming election will be much harder for everyone if the health care plan they end up passing is a give-away to insurance interests.

3) What we can do now is much more than what we could before we knew what was going to happen in the Finance committee -- in the coming floor debate, we will be well served by Senators of all stripes, from all states coming forward to support the bill. Signing up with HCAN or just using their service to call your senator sends a clear message that supporters of the public option have supporters among the public. If your senator's for the public option, tell them to get up and speak out for it. If they're waffling (this list is a good source to figure out who's a trustworthy supporter, and who's weak), tell them how much you hate waffles, and threaten to make pancakes of them in the 2010 elections (or some such metaphor, which is better constructed and less threatening).

And if you find yourself wanting to hock a lugie at Max Baucus for selling us out, maybe it'd be a good idea to take a second, chill out, and listen to Carl Sagan sing techno about space.

Monday, September 28, 2009

The Loss Ratio and Insurance Industry Profits

John Rockefeller is in the Senate Finance Committee right now hammering away in the speech that everyone needs to hear most -- that health insurance companies are bleeding our benefits dry, and that a strong public option is the best solution to the problem.

Most of what I learned about health insurance industry profits, I learned from a single person's writings -- Uwe Reinhardt, Princeton economist and opinion writer for the New York Times. My favorite article on the topic, so far, is this one -- it breaks down the way to answer the question "how much do insurance companies make" in a comprehensive way.

This is important because an insurance company -- and we saw GradMed claim that they don't even collect this data for themselves or the insurance companies that they broker -- will never share this information with potential customers. They are forced by law, however, to share it with potential investors, and that's where Professor Reinhardt comes in. I've seen pictures, but I picture him with a monocle and a handlebar mustache. Egads, he says.

Insurance industry profits -- that's the amount that the company takes out of the economy, free and clear -- usually hang between 3 and 6%, which is not exceptional for most kinds of industry. What is exceptional, though, is the amount in marketing and administrative expenses that the company spends. Keep in mind that, unlike buying a cell phone, where you give a guy some money and he gives you a cell phone, insurance companies essentially take your money and then give it back -- the product you get is the insurance company holding your money, and the money of many others, for you, and then reorganizing it to pay for the medical care of the people that need it. So these costs become extremely important: the money taken out of your premiums, and the money that's left, determines what kind of coverage you get.

Not much of a product, true. But it's even less of a product when the insurance companies are only paying out 84.4% (in Reinhardt's example, Wellpoint in 2008) of the premium money that they've collected. That's an 84% loss ratio -- to the insurance companies, GradMed included, the company has lost 84% of "its" money (actually your money, but held by the insurance company). 84% loss for them means 84% care for you.

Where does the money go? Profits are substantial, but don't explain the whole picture. The rest is marketing -- GradMed paying alumni associations to run advertisements, insurance executives googling their products and leaving dodgy comments, TV ads, newspaper ads, etc. etc. etc -- as well as 'administrative costs', which covers the salaries of the people who work in the insurance industry. What seems absolutely true to me is that even if these costs aren't considered profit on the company's 10-K, they are profit: the company investing in its own future enrichment through advertising, and directly profiting the people who make up the company through salary and benefits.

You have to hand it to them, though. Taking 15% off the top of your health care dollar: not too shabby as a con game. A strong public option would also have administrative costs, but estimates for Medicare put their administrative cost at between 3% and 8% (and their profits at ZERO, where they should be), which is nowhere near the expense and waste we're experiencing with private insurance.

UPDATE: The Rockefeller public option amendment was just defeated, 8 to 15. Democratic senators voting against it were Conrad of North Dakota, Lincoln of Arkansas, Nelson of Florida, and Carper of Delaware.

DOUBLE UPDATE: The Schumer public option amendment was also defeated, 10 to 13. A slightly weaker option, it picked up Thomas Carper and Bill Nelson, but Kent Conrad and Blanche Lincoln (who was wearing an enormous green lapel pin that said "BLURGH") still voted against it. No Republicans, of course, voted for the amendment or even bothered making serious arguments about the bill -- it all seemed to have been posturing for the general senate debate, and insistence on this new weird "defend Medicare" attitude they've all suddenly come to after decades of trying to slash Medicare.

GradMed III: Revenge of the Sith

So about a week ago, taking time out from advocacy for the public option, I did a review of an insurance broker called GradMed. They sell temporary, non-renewable insurance that doesn't cover any pre-existing conditions to recent college graduates. The way they sell it is by paying royalties to university alumni associations, and then pretending that it is the alumni association that 'sponsors' the GradMed program.

I pointed out that if you get sick while on a 30-day GradMed policy, the second your policy runs out, you're essentially screwed: GradMed won't let you buy another policy, and no other insurance company will cover you, either. I think I probably said something like AVOID GRADMED LIKE THE PLAGUE. Review complete! Good blogger.


I was pretty much convinced that I'd done my civic duty, hopefully let some people know what I thought about a product, and that was that. But GradMed appeared. Almost immediately, and in a big way: over the days after my review, they logged over six hours on the site, viewed each of my tiny little blog's 50-something entries more than once, and did so from somewhere between three and five different IP addresses. This struck me as a pretty poor use of man-hours paid for by the insurance premiums of unemployed college graduates, and I said so. Their page views dropped off a great deal -- but curiously, the number of hits I got from suburbs around their offices increased quite a bit, and I actually got my first few Tor nodes visiting the blog -- a novel use for an anonymity service that I thought was reserved for antigovernment protesters abroad and child pornography afficionados.

At this point, I felt like detonating. I had asked them a series of questions that they were ignoring, but they were still running around trying to sniff out information about me, viewing my profile, looking a great deal at some pictures I took of a local rally. I was rolling up my sleeves and getting ready for, well, you know, midnight deer-fighting:


Two things happened, though -- first, I got a (heavily solicited) letter from internet president Ze Frank that essentially said not to get obsessed with these people, because they're an economics-only operation, and will boringly continue to protect their financial interests, which is not something any real person wants to read about. Second, though, GradMed came back to the comments and tried to sort of whitewash their names. And I couldn't be angry. These people are symptoms: they're the runny mucus that shows that the system is ill.

The epiphany moment, for me, came in question two -- I had asked them to share their "income-to-benefits ratio" with me, a comparison of the money they take in through premiums, and the money they pay out in health benefits. They, predictably, declined to do so, but took the opportunity to haughtily correct me: "I can tell you that what you are referring to are loss ratios." Loss ratios -- these are not only people who consider fulfilling their contractual obligation to pay for the health care of the sick and injured a loss, but see absolutely nothing wrong with that thinking. They've internalized the values of their industry to the extent that they've stopped thinking, exactly, about what 'loss' is, and who's losing. Likewise with their refusal to disclose how much of a kickback alumni associations get every time a student signs up with GradMed -- "Our compensation to associations is protected by contract. " Of course -- a silly question to ask. If they shared the way they sink our premium dollars into marketing, we'd know that sending them money is a massive waste of resources, and we would stop sending checks. We'd probably also think twice about supporting our alumni associations. Thus the secrecy in the contract. It's logical, right?

It's the plight of the parasite: like every other corporation, this one has evolved a culture that serves the survival of the company. But we -- and by this, I mean you, me, recent college graduates, health care providers -- don't want this company. We're harmed by it. Piece by piece, state by state, we're trying to pull it loose from the open sore it's feeding from. But it doesn't know it's a parasite. It acts in self defense just like any other animal would, and it cares about itself and thinks it's a good parasite, a hard-working parasite that does exactly what a parasite's supposed to do:
(Insurance companies actually share risk among large groups of people, which can be interpreted as a kind of service, and so they aren't quite as parasitic as brokers -- more like those little birds that eat bugs off of hippos, at least if they're run right.)

The answer is not to face up to these people and convince them they're wrong -- at some level, I think, they already know that what they do isn't really helping matters much. The answer is to just pinch them off at the sucker and drop them back into the lake. Through legislation, through boycott (although it's not actually a boycott when you refuse to buy a service because it's worthless), through education. I'm so glad that most of the reform legislation in Congress outlaws the use of pre-existing conditions to deny people insurance, and although I'm sure the fine people at American Insurance Administrators, part of USI Affinity, subsidiary of the USI Group, whole broker for GradMed, will be very sorry to clean out their desks and go back on the job market, we'll all be better off in the future for it.




PS: I also had the chance to hang out with blog stalwart mattlo this weekend, and he, in his outwardly reserved but fundamentally hot-blooded Midwestern way, allowed as how he didn't feel so sorry for the GradMed crew, and how even his job, which he enjoys just fine, is not quite as cushy as sitting in an office reading our blog (he has to sit in an office and do real work). So for all the mattloes of the world, here's thirty seconds devoted to unrepentant pushback. The GradMed IP address that has, now, over 90 visits to the blog is 12.104.97.211, which apart from a few fake Wikipedia entries/commercials/some spam, hilariously has also been used to create a large genealogy website for the Sawn family which is run by a gentleman named George (that's their guestbook). A tiny bit of googling shows that one likely (although I'm sure there's a lot of unprotected computer-sharing in the office organism) visitor to the blog is therefore George Sawn, CFO of Univers Workplace Benefits, subsidiary of USI Holdings, whole owner and operator of USI Affinity, parent company of American Insurance Administrators AKA GradMed. You can get in touch with him at gsawn@sawnfamily.com, if you feel like it or if you think y'all are related.

Sunday, September 27, 2009

Thinking Cap

Got to be brief today because, contrary to the assumptions of some, I do have a full time job (and health insurance!) and it today requires me to spend a great deal of time in the company of ye olde thinking cappe. Which looks like this:

(from the late Nagi Noda, via Beauty and the Salamander)

I did want to drop you this tidbit about new polls that show that the public option has crossed the line and is now supported by a majority of US citizens, which means that the administration, if somewhat tardily, has fulfilled its responsibility to educate we the people about what is a very beneficial plan. Remember this in connection with the town hall screaming, and the 9/12 protests -- now that what a public option is, and what it means, has become clearer to voters, they want it, even though we've also had an excruciatingly complete airing of all possible opposition.

Unfortunately, although a majority -- which is to say, 51 senators and most of the Representatives -- of Congress supports the public option as well, there's no clear way right now to 60 filibuster-proof yes votes. Meanwhile, the administration seems to be lobbying public option stalwart John Rockefeller to support the Baucus bill, to some success. He's the author of the best public option amendment and an ideological leader in the Senate Finance Committee. This is all backroom rumor-style stuff, and it's wrong all the time, though -- Tuesday will be the real test.

Saturday, September 26, 2009

Don't Know How She Sorts It

I just watched this short documentary, about a cook at the Sigma Nu frat house at Ole Miss:

Ten Dollars an Hour from Ben Guest on Vimeo.


Here's the math of Leasse William's life, from the whiteboard talk in the documentary:
She makes $10/hour, and works 50 hours a week, nine months a year, and either works minimum wage or gets unemployment (the income is about equal) for the other three. Her taxes (yes, people at this income level pay taxes!) are $3600, and her health insurance, which she buys on the private market, costs $2400/year. This leaves her about $14,200 in take-home pay, which is near the Louisiana poverty line -- and that already includes the possibility of government-subsidized unemployment benefits.

Now, poverty is a systemic problem, and it's not clear whether it can be simply fixed by legislation, more consideration shown to employees by employers, an insistence on racial equality, or any other individual undertaking. But the absolutely back-breaking cost of medical insurance is something we can fix with legislation, and the legislation is in Congress right now, in the form of the public option amendments to the Baucus bill.

Leasse's problem isn't just that her insurance is expensive -- it's that she doesn't have any extra resources to fight her insurance provider to protect her coverage. If, let's say, she wakes up bleeding from the nipple one morning and her insurance company refuses to cover it as an emergency, she's not going to be able to do what any smart person would want to: lawyer up and spend a couple of days making angry, pointed phone calls. She's back to work, if she can work, ten hours the next day. Every dime that insurance providers and brokers like the GradMed people (who don't provide real health insurance and wouldn't insure anybody in this documentary, but who seem like good representatives of the industry to me) steal and waste -- every bit of that $2400 a year that goes into marketing, salaries, profit, obsessive rereading of "Dying for a Public Option" -- comes out of the money that Leasse is setting aside for her own care, and it's money that she frankly doesn't have in the first place. Those costs are passed along to her in the form of claim denials, copays, coinsurance, and rescission.

And this doesn't just cost Leasse. Medical bankruptcy would put her right on unemployment (which her job seems to expect her to collect already), eventually on welfare (if she's lucky). This couple in a recent PBS NOW episode, like many others with chronically ill children, limits their own income so that they can qualify for Oklahoma state child health benefits, because their asthmatic daughter may need an expensive operation to repair her damaged lungs at any time. From a purely practical perspective, we are wasting the country's resources, both human and financial, by dumping them into the insurance industry.

And it doesn't just cost money. Our system of health insurance is unjust. It punishes those who can least afford it, and enriches those who do not deserve it and haven't earned it. Instead of strong citizens united for the common good, it creates fear and division and resentment. We can do better. We're so close to making a change for the better.

Friday, September 25, 2009

The Public Option Amendments

Max Baucus seems to have just now pushed the debate and vote on public option amendments back to next Tuesday.

Here are the amendments:

-- First, the amendment of the honorable and physically attractive Senator Jay Rockefeller of West Virginia, which would place the strong public option from the bill passed by the House of Representatives into the Baucus Bill. This would be the amendment which would most directly and drastically reduce the costs of health care in America. Where amendments are involved, it is the Cadillac made of syrup-kissed, fluffy, golden pancakes -- but because it entitles the public option to negotiate for lower costs, it runs into opposition from those most directly funded by the insurance industry, namely Blanche Lincoln of Arkansas, and Max Baucus, as well as those who believe in an unrestricted free market, which is some Republicans, and those who want reform to fail, which is the rest of them.

-- The other two are weaker public options without the ability for the government-run insurance company to use legal structures to dictate cost -- this means that it would essentially be a very large not-for-profit insurance company that would compete with private insurers on a 'level playing field'. This would still likely cut costs -- since the government's level playing field wouldn't include 30% overhead, corporate profits, or CEO overpayment -- but not quite so much. One is modeled on the Senate HELP bill and is offered by Senator Cantwell, the other by Senator Schumer and would only provide start-up costs for a government insurance co-op, which would then have to be self-sufficient.

Since the Republicans, even Olympia Snowe, are likely to be 'no on all counts', here are the critical votes according to Open Left: Baucus, Carper (Delaware), Conrad (North Dakota), Blanche Lincoln of Arkansas, and Nelson (Florida). Blanche Lincoln increasingly looks bought-and-paid-for -- Baucus might vote no on amendments just to preserve his original bill, if he thinks it has the best chance of passing the whole vote -- Carper has claimed he'll vote no on anything but a trigger. Of those five, however, the public option needs four, which is long odds.

Keep in mind that if a public option passes here, it's in the bill -- if it fails, then something could still happen when the House bill and whatever the Senate passes eventually meet.

If you live in one of the states listed above, this is a good time for direct pressure -- more in the phone call/fax line than letters, of course. If you aren't represented by one of these committee members, maybe you'd be better off taking a walk outside and meditating on the fact that we are all just sentient meat.

Thursday, September 24, 2009

Treating Swine Flu: Unprofitable!

Very short entry today: I burnt out my laptop backlight because I am on the computer all the damn time. So this is coming to you from a new machine that's still busily deleting all of its push-marketing "support" programs.

(Yeti does not NEED link to e-bay on desktop! Do not contact Yeti with offers for new Compaq products! Yeti wants to blog! And smash!)

One of the things I hear from almost all insurance customers who have been forced to file claims -- I heard it again two nights ago, from someone who'd had GradMed-style temporary insurance -- is that the absolute worst time to try to negotiate with insurance industry bureaucrats is when you've just had a staple put in your head, your blood replaced, your eyeballs rotated, etc. etc. But this is, of course, always the time they pick to deny coverage.

Case in point: Ted Rall stood in the pharmacy for over an hour trying to get his TamiFlu covered -- coughing up bloody phlegm and spreading the swine flu like a syphilitic hooker in a Navy port (no offense, Ted).

Did anyone ever really think this system over? Is anyone honestly motivated to persist in entrusting public health to people who have no interest whatsoever in protecting public health?

Wednesday, September 23, 2009

Gradmed: Spending Your Insurance Dollars Wisely

Since my previous post on how exploitative, dishonest, and useless GradMed Health Insurance is, I've had an enormous spike in traffic from the fine folks at GradMed -- since last Friday, they've viewed my blog pages seventy-one times -- have viewed the blog more than four times as much as I have over the same period, an astonishing amount considering that there are only fifty-two pages here -- and spent almost six hours on the site. I've been chatting with them in the comments about the way in which they're negligent in selling a product that even they don't consider a real insurance solution to penniless graduates. They say, "If someone knows that they will need more permanent coverage, many alumni associations sponsor a renewable major medical program through us as well...", neglecting to recognize the fact that everyone needs permanent coverage whether they know it or not, and that the non-permanent coverage they sell only creates pre-existing conditions that are life-long uninsurables.

It didn't occur to me until I was sitting at my desk, procrastinating on my own project, to ask the question: what the hell are these people doing wasting their time at this tiny blog? I mean, look at the drapes. This isn't exactly the Hilton.

So I drilled down into their data a little bit. They found the blog by doing a blogsearch (not a Google search, mind you, but Google's specific search for blogs alone) for "GradMed" and finding my post from there. At that point, the employee that found the site passed it on to another employee, and then spent about the next hour surfing the site and crafting a comment. They checked again at the start of work Monday, and then again about halfway through the day. Since the start of business Tuesday, they stayed on the site continuously until lunch, refreshing or clicking a link at least once every fifteen minutes.

So who is this person? They identified themselves as "Customer Service" in their comment, but it seems clear that one of the things they do on the blog is fighting the war for GradMed on the information front: the IP address that left the comment on my blog is the perpetrator of at least three vandalism reverts on Wikipedia, one of which was an article created to publicize the USI Consulting Group -- GradMed, as far as I can tell, is a subsidiary of USI Insurance Services, a division of USICG.

But none of this is as important as why we care about all this as insurance customers. GradMed/USI doesn't provide care, of course; but they also don't provide insurance. They organize marketing for insurance that they then obtain from state insurers -- they're insurance brokers dealing with alumni associations. But this whole group -- the alumni association, USI, and the insurer -- gets paid with the money you and I send in as premiums. Every billable minute (and all the GradMed access to this site has come during working hours) that they spend promoting, marketing, giving greasy answers to straightforward questions, and making up fake and poorly structured Wikipedia pages is a dollar of your premium money that doesn't get paid in benefits. I am sure that the people at USI consider this good business: I consider it legal embezzlement from America's limited health care resources.

People say that government bureaucracy is inefficient and I agree, it can be -- but it's nowhere near as bad as being a 22 year-old recent graduate, broke, unemployed, and forced to pay for an insurance broker to surf our hooptie blog.

We need a public option to help get the profit motive out of health insurance. The waste and the lies have to stop.

Tuesday, September 22, 2009

Insurance Companies Need Our Support

A meaningful debate about healthcare reform has to include voices on both sides. There just aren't many people willing to take an unpopular stand and defend the interests of health insurance executives. Thankfully, a team of celebrities has stepped up to invigorate the discussion. Check out the Protect Insurance Companies PSA:

Monday, September 21, 2009

Socialist (not Socialist)

Background music here.

SOCIALIST:

NOT SOCIALIST:


SOCIALIST:



NOT SOCIALIST:


SOCIALIST:

NOT SOCIALIST:

Sunday, September 20, 2009

Olympia Snowe and the Audacity of Cost Control

Over five hundred amendments were suggested to the Baucus bill today, which is frankly a little bit disappointing -- I had hoped that one of the other committee bills would be getting more attention for the simple reason that most of them are better bills.

There's one amendment that I'm really interested in, though -- Olympia Snowe's amendment to create a public health plan as a 'safety net' if insurance costs don't decrease in the coming years. This isn't, I don't think, as good as having a public health option -- but it's certainly better than the Baucus bill itself, which does nothing to control costs. One of the things that the bill reflects, though, and I think that this is the reason that this amendment is canny and smart, is that insurance industry costs are under the control of the insurance industry.

It's pretty simple, but it's something that those that insist on the free market don't usually get. When an insurance company has a monopoly, or an 'agreement' with the competition, or when it simply realizes that people can be persuaded, shamed or tricked into paying more money for fewer services, that insurance company will raise rates. This is not the invisible hand: this is someone coming to a meeting with a PowerPoint that ends, "...so if nobody figures out what we're doing, then we can safely raise premiums by 9% in the next year." What limits this -- even in the current system -- is government. We regulate what is fair and unfair to do. The most profitable attitude for an insurance company would be to promise you a bunch of stuff, take your premiums, and then never pay for a dime of your care. And that happens -- except when we make it illegal.

The triggered public option would be another kind of regulation for insurance companies. It would require them to keep costs down, which they have the power to do, and if they failed, it would punish them by opening government competition. In doing so, it would insure that costs were at or below some particular level.

Unfortunately, a triggered public option wouldn't create (absent the trigger) an insurer that people could trust -- it would be fairly easy for insurance companies to keep profits high by surreptitiously cutting benefits every time they cut costs. There's simply no good way to get your health insurance from an entity that has shown itself to be overwhelmingly untrustworthy. Additionally, the 'trigger' part of the public option is just a bone thrown to those untrustworthy industries. If the public option is effective in keeping down costs, and if it can ensure that people pay a rational amount for their health insurance, then why don't we have it now?

All that having been said, there's been a lot of talk about Senator Snowe being an important moderate, and I have to say this amendment really does represent something in between the two sides. This is a very large, very rarely traveled, and very necessary territory in the Senate debate, and the people of Maine should be proud of their representative for having the courage to go there.

Saturday, September 19, 2009

Updates

First a little update on cost cutting -- this story about insurance's refusal to treat an underlying problem is a good example of what I was talking about in yesterday's post, as is this mea culpa from an insurance industry middle-manager. Pull-out quote: "...while your readers are being charged $50 for asprin; my company employs an entire department just to shuffle bills around while they decide what they will pay the hospital for that asprin." Blue Cross/Blue Shield of North Dakota, which has an over 90% market share for the entire state, effectively making it the state's only insurer, was audited today, and predictably found to be paying out huge bonuses, sponsoring vacation travel for employees, and throwing lavish parties with customers' health care dollars. The CEO's reaction: "We will correct areas that need to be corrected." If a government employee did this, they'd be in jail. Postal worker steals less than $1000? Jail. Steal $100,000? More jail.

As it turns out, the pants-on-fire-false estimate of 1 to 1.5 million protesters at the Tea Party protest was made on stage at the protests by FreedomWorks chair Matt Kibbe. ABC News, which Kibbe had claimed was his source, ran an article the next day pointing out that they had never said such a thing, and in fact their estimates were in the "tens of thousands". The comment we got here ten minutes after the article was published makes me feel like there was something more at work than bad math or a Tea Partier reading the paper without his bifocals. I know I reneged on my promise to do an article on Dick Armey, but Bill Moyers did it for me, and he used pictures instead of word-pictures.

In other tea party news, the fine folks of the Objectivist organization FIRM were out at the Tea Party rallies, handing out flyers, giving speeches and trying to swim in the sea of the anti-government, anti-tax demonstrators. As you can see further down the page in the comments to that link, though, this is causing some significant division among the Objectivist ranks -- because Ayn Rand and most real Objectivists are atheist (one might even say ideologically anti-Christian), rationalist (by which I mean to say they consider themselves rationalists), anti-war, and anti-Patriot Act types, all of which they pretty much have to hide when they go to right-wing libertarian/neoconservative/fundamentalist organizations to speak.

Joe Lieberman's election chances aren't looking so good -- he's polling third in his district after a flash poll of possible opposition. This makes a lot of sense, considering that Connecticut favors the public option 68% to 21%, and Lieberman basically opposes it on the strength of insurance industry donations. Eyes on the prize, buddy -- which enormous corporation will you land in after your voters send you home?

Finally, 538.com did an overview of the numbers on public support for health care reform, and it's practically tied -- with a small decrease in the 'strongly oppose' and a small increase in the 'strongly support' columns over the last few weeks.

Friday, September 18, 2009

Cost Control

Almost every serious proposal for health care reform tries to insure more people -- even many conservatives will agree that in the current system, we would all be better off if more people had health insurance. The public option, though, is a special way to provide that insurance, and the best thing about it (and I'm taking off my liberal 'provide health care for everyone and let God sort it out' hat here) is that it cuts costs.

This is an important point that is often lost in the heat of debate. The public option in and of itself does not insure more people -- it's not an entitlement, it's a mechanism for delivering insurance. We could ensure everybody without ever having a public option -- this is what the Baucus plan tries to do, by expanding Medicaid and Medicare. Why have the public option, then? To cut costs.

A lot's been made of the price tag of HR 3200 -- almost $1 trillion dollars over ten years, about 20-30% more expensive than the Baucus bill -- but this is the government expense, or the cost that comes out of our taxes. The costs that the public option would cut would be our private expenses, the money that comes out of our paycheck to pay for health insurance. Look at the history of an average family's health care expenditures:

(from the Kaiser foundation)

In 2007, we spent 16.2% of everything that we produced in the country -- that's one dollar out of every six -- on health-care related expenses. In 2008, we spent 2.4 trillion dollars on health care. If we could enact a plan that cost one trillion dollars but saved 5% of our yearly costs, it would pay for itself in less than nine years. Since we know, too, that 30% of all the money we pay to insurance companies is spent in the form of overhead, administrative costs, and returned to stockholders as profit, the insurance industry is a natural place to try to carve out some of these savings.

Those savings would come from competition. Blue Cross/Blue Shield currently holds 90% of the market in the state of Alabama, and has been raising its rates between 7 and 12% every year since 2003, when its last major competitor exited the market. All across the country, health insurance corporations are getting bigger and taking larger chunks of market share, as often happens in a situation where an unregulated industry gets its hands on a part of the economy where demand is inelastic (i.e. there are really very few situations in which you choose not to purchase a life-saving medicine; most people will buy health insurance no matter how much it costs) -- Enron's control over the deregulated California energy industry comes to mind.

A government option -- one which would be offered to people at cost, and would negotiate with health providers for cost decreases -- would change the competitive landscape. Companies that have long since stopped trying to attract or serve customers would suddenly have to start. Policies would become clearer, trust would start to matter (right now, what's the incentive for monopoly insurers not to deny care? They don't rely on their reputation to attract business), and most importantly, premiums and copays would start to come down. Just as private universities have to either compete financially with, or offer better educations than, public universities, so would insurers have to either do better than the government -- offer more, give better service -- or charge less. Many of the conservative objections to the public options assume that this would happen -- by saying that it's a socialist policy, they admit that it would be extremely competitive with, and threaten the profit margins of, private insurers.

Like a subway line, a public university, a city park, an irrigation canal, or a highway, a public option is a group investment, not a give-away. It's intended to, and will, create returns for government, and especially for individuals.

I've been pretty critical of the Baucus plan in recent posts -- it serves industry interests and leaves us out in the cold with regards to cost. But the insurance industry wins, as well, if we do nothing or make minor changes -- without competition, specifically the kind of competition that would be provided by the public option, we may be able to insure everyone, but we're going to pay through the nose to do it.

Wednesday, September 16, 2009

Getting Involved -- New Media Style

Got a comment yesterday from a facebooker who's starting her own group in support of the public option -- so I thought I'd go through some ways that individuals can affect the debate, but this time, with Web 2.0 sparkle! This will be difficult for me, as my level of social media savvy can be described as Yeti-like.
(Picture of me from About.com. If you crane your neck, you can see that I'm reading HR 3200 on a Dell Inspiron B130 laptop, held in my right hand.)

But my research savvy is average! So away we go:

Public option action on Facebook seems spread out, reasonably enough, among groups of friends -- one of the first and easiest things anyone can do is change their wall status to "I support a strong public option to reform our broken system of health insurance." or "I want lower health insurance costs, so I support a strong public option."

The next step would seem to be joining one of the fan clubs/interest groups. There's one with more than 11,000 members here, one directed at President Obama and the Senate here, and "I Support the Public Option" here. Abby's group, which I haven't been able to get through to yet, should be here shortly.

Twitter is actually -- this is the first time I've really rolled up my sleeves and gotten into it -- kind of cool, although I'll never use it due to the ancient Yeti law which requires me never to be fashionable. Congress uses it like nobody's business -- TweetCongress tracks the last tweets of all the standing members of congress and shows community responses as well. A lot of progressive-to-progressive conversation happens at the #publicoption hashtag, which you can search here, and is full of fast (although not always perfectly accurate) information that falls through regular media cracks (i.e. public statements an official might make that aren't important enough to warrant a news article, but which indicate that they're moving in one direction or the other on health care reform).

All in all, though, my gold standard for organizing is still Health Care for America NOW! -- professional, targeted pressure that is completely issue-specific and designed to create the maximum amount of change. Just in my region, they've got one event coming up in Los Angeles and two in San Francisco -- it's likely they've got something in yours, too.

Regardless of how you get involved, though, it comes down to the same few things: talk to your friends. Call and write your senator. Get your voice heard through letters to the editor, and your face seen through public demonstrations.

And why? Because courts from South Carolina to Los Angeles agree that insurance companies break their promises for the purpose of profit. We deserve at least one trustworthy option for insurance coverage so that no more HIV-positive teenagers or breast cancer victims are dropped by their insurers.

The Baucus Bill

First, a little stock music: as was pointed out in this Metafilter comment, Humana, Aetna, Cigna and UnitedHealth all had a stock gain of more than 3.5% after Senator Max Baucus announced his bill.

I waited most of the day to write about this because I was honestly not sure how the bill would sort out, and I wanted to look at the Chairman's Mark (Baucus' first draft of the bill for negotiation) myself before I jumped in all aggravated with the riot elbow. I've been pretty sure for the last two months that whoever Baucus is representing, it's not Americans -- but this bill seems, all in all, to be pretty clear proof. A rundown:

An insurance mandate for individuals. That means that if you don't buy insurance, you'll be fined by the federal government. This is a major money-maker for insurance industries, who want federal laws to force new customers into the market. Democrats should hate it because it punishes people who are already lower-middle class and have it hard enough; Republicans should hate it because it's a government intrusion into something that should probably be an individual decision.

The free-rider policy. This forces businesses who employ individuals receiving government health insurance services (i.e. Medicaid or other subsidized health services) to pay a fee towards defraying that cost. Ezra Klein has been excoriating it all day -- for the simple reason that it makes businesses less likely to hire low-income employees. If you could hire a high school kid for $7.25 an hour or a mother of three for $8 an hour (because her children are Medicaid recipients), which would you do? This policy expressly reinforces the cycle of poverty. Whether you're on the left or the right, it's a loser.

An end to the use of pre-existing conditions as a means by which insurance companies can deny insurance. This is a good thing, but the insurance companies are likely to raise rates to counteract lost profits caused by having to actually insure sick people. Call it a wash: we'll get more, but it'll come out of our pockets, not out of the insurance companies'.

Medicaid and Medicare expansion and subsidies. This is the bill's method of addressing what drives much of our desire for reform -- the tens of millions of uninsured Americans left out of our current system. It's also, I think, President Obama's key demand: insure the uninsured, and increase national health. The question is how much we will pay to get this, and how we'll do it; Senate Republicans have treated almost any expenditure in this direction as completely nonnegotiably unacceptable. I would also point out, to opponents of the public option, that in its absence what we are getting is an expansion of the considerably more government-centric single payer system that is Medicaid and Medicare.

No cost containment. This is President Obama's other big request -- a way by which we can slow or stop the double-digit yearly increases in health costs that are throttling industry and household finances. A public option -- government competition -- is the best way to control these costs; in its absence, many have suggested regulations on executive pay, profit-taking, coverage maximums, or other insurance industry mechanisms that enrich individuals at the expense of the country. The Baucus plan has neither -- and in this respect, fails entirely to get to the root of the problem. This is why the bill is so popular with the insurance industry and its stockholders: it maintains the gravy train, as is pointed out in this NYT "Room for Debate" brief.


All in all, as much as I want some kind of reform, I can't get behind this bill, which is why I'm glad, I guess, that it has no Republican support (and, as 538.com points out with much better prose, not much Democratic support, either). Back to work, Senators.

Tuesday, September 15, 2009

Doctors and the Public Option

A short post today because I'm going to spend some time trying to get campus newspapers interested in all things GradMed.

As the public option, at least in the opinion of the Times and some other media outlets, fades from view in the Senate negotiations, it's becoming clear just how many people really support it: the New England Journal of Medicine released a study whose results you can read about here. Some highlights:

-- Among doctors, combined support for a public option and a single payer system (which would be a Canadian-style system where the government has an even larger role in health insurance, and whose proponents would likely support a public option if forced to) is at 73%.

-- This proportion holds steady among rural doctors, urban doctors, specialists, general practitioners, etc. -- it's not that one group of doctors intensely supports the public option and others don't, it's that a majority of all doctors support the public option (the ways in which the public option would benefit rural America deserves its own post).

-- Even American Medical Association members -- and this is a large lobbying group that has, after signaling support, come out in opposition to the public option -- even their member base is in support of a public option.

Count this, perhaps, as another kind of sign that the more people know about the public option, the more likely they are to support it. Doctors are particularly well-versed in our current insurance system, have a good idea of the nation's health needs, and have been following the facts of the national debate -- accordingly, they're even more in favor of the public option than the average American.