Health Care Reform

[Primula Baggins]

All righty then.

I wasn't saying I or anyone has "all the facts," just that I think it's possible to have an informed discussion using what is out there. And recognizing that people will still disagree about what, if anything, needs to be done in response to "the facts," even if their nature is indisputable (which isn't usually the case even in science).

But I do try to base my opinions on the facts as I understand them. I also understand that both the "facts" and my interpretation of them can be proved false, in which case my opinion is wrong as well.

That doesn't, to my mind, rule out discussion. In asserting something I believe to be true, I'm not saying, "I know the final truth and everyone else should just shut up." I'm saying, usually in so many words, "Here's what I think," with the implication being, tell me what you think.

What in your view would make a discussion possible, Griff? What is happening here (aside from the problem of being outnumbered) that makes it not worth it even to speak up? I'd thought we'd made some progress here since the bad old days of the election. But it seems not.

[Griffon64]

Let me go root up a couple discussion points around this topic and some of the facts, as best as I could find, around them, so I can post those with my interpretation and opinion. And then, based on the discussion that ensues, I would be better positioned to say what I think would make a discussion possible, if that doesn't

[ I will try and do that this weekend because once the week hits, I'm going to be swamped! The 100F plus degree weather, with an uncomfortable and unusual dollop of humid, will mean I'd spend at least part of tomorrow inside hiding. ]

[Frelga]

Griffy, I wanted to address the point you made earlier - of the people who will try to game the system. I certainly get antsy myself when I think of paying for someone who can make his/her own way but doesn't want to, and there's a discussion about that which has nothing to do with the health care reform.

Sticking to the health care, then - at least in California, those people already do have free care. As I said above, it comes with the welfare, and in fact causes some of them to stay on welfare, since honest employment will not provide their families with medical care. People who game the system are already winning. The people who are losing under the current setup are the ones like us - who depend on their earned income to live, and on their jobs to provide medical benefits.

[anthriel]

Frelga, I recently saw a segment on Fox News (I know, I know) about a Universal Health care system that the governer signed into law to try to cover "gap" children: those whose families were too poor to afford conventional health care costs, yet not poor enough for Medicaid.

Apparently, it failed after 7 months. The governor was quoted as saying that they learned something like 60% of the people who enrolled their children in the program had previously had health insurance, but had dropped it to get their children's health care for "free".

Not exactly freeloaders, really... I would also be tempted to drop a household expense to pick up a "free" service (although, of course, it was hardly free. The costs were simply shifted from parental wallets to taxpayers'). The fault lies, in my opinion, with those who wrote the law.



Here's a link to the story.



Sometimes those who write the law are manipulating things to further their own agendas. We, the taxpayers, are still on the short end.

Here in Arizona, a few years ago, we had a state funded program to encourage people to buy cars with alt-fuel capabilities. It was a noble idea, and had the support of many, many voters.

Unfortunately, no provision was written that people HAD to use the alt-fuels... just that their vehicles be equipped to use alt-fuel, as well as regular fuel. In a very few months, the costs of the program exploded, as people who never had a single intention of using the alt-fuels (there was no increase in alt-fuel sales in Arizona at all) simply purchased these specific vehicles with significant state financial support, and used gas as usual. Many politicians lost their careers over that one. And some of them should have.

The feeling was that this law was not carefully vetted. I happened to be working for a state representative at that time, and she said the HUGE bill had been presented to them with a very short time until it needed to be voted upon. She indicated to me that she had not read the whole thing. She didn't have time.

Yes, there will always be ways to manipulate the system by those who will manipulate. However, it might be a good idea to take the time to thoughtfully design a system which cannot be easily exploited.


ETA: Here's a link about the AZ alt-fuel debacle. It reads worse than I remember it!

[Frelga]

Apparently, it failed after 7 months. The governor was quoted as saying that they learned something like 60% of the people who enrolled their children in the program had previously had health insurance, but had dropped it to get their children's health care for free.

Was there an income test? If so, I really don't have a huge problem with it, based on the limited facts I possess. My son's insurance used to cost me to the tune of $400 a month, with private insurance. That sort of money can be a huge burden to someone with a fairly low income, and yet you don't care to let a child go uninsured, because that could easily turn out to cost thousands.

I've known too many families where the question was "insurance or groceries" and some were diabetic, and some... It's an ugly spot to be in.

Yes, there will always be ways to manipulate the system by those who will manipulate. However, it might be a good idea to take the time to thoughtfully design a system which cannot be easily exploited.

I certainly agree with that! For instance, here in California for a while they had a program where the incentive for buying a hybrid car was that you were allowed to drive in carpool lane with only a driver, if you were one of the first however many thousands to apply. Sales boomed, because traffic is a huge problem here, and something that saves gas money AND shaves off 15 minutes off your commute is a great thing to have. And how do you game it?

It's a bit like childraising, innit? Devising a system of appropriate rewards and consequences?

Taking that into account, I still would rather devise a system that benefits most of us honest citizens rather than one that keeps us all miserable under the guise of keeping out a few miscreants.

[Primula Baggins]

When Mr. Prim taught college courses, he never required students to document their excuses for missing exams. He said it was better to let a few unethical students get away with something than to treat everyone in the class like untrustworthy children.

[anthriel]

Apparently, it failed after 7 months. The governor was quoted as saying that they learned something like 60% of the people who enrolled their children in the program had previously had health insurance, but had dropped it to get their children's health care for free.

Was there an income test? If so, I really don't have a huge problem with it, based on the limited facts I possess. My son's insurance used to cost me to the tune of $400 a month, with private insurance. That sort of money can be a huge burden to someone with a fairly low income, and yet you don't care to let a child go uninsured, because that could easily turn out to cost thousands.

I've known too many families where the question was "insurance or groceries" and some were diabetic, and some... It's an ugly spot to be in.

I agree. But the problem is that the group that the law was supposed to serve is now not being served at all, because people who were not meant to take advantage of it (those who could afford insurance on their own, apparently), overwhelmed the system.

Perhaps those who were struggling with the "groceries or insurance" issues could have been included in. Maybe they were. I'm not sure of all the facts of how it was written, either. But when a high percentage of the people signing up for free services were previously paying for those services on their own, it's difficult not to imagine that there were some freeloaders in the bunch. It was a poorly written law, and those who exploited it certainly helped to sink it.

I'm thinking it couldn't have had a very good income test. Or there was some other oversight in who was allowed the services, holes in the net, as it were. And that's what I mean about taking the time to write a law carefully, so that those poor kids who were meant to be helped could have been.

[Primula Baggins]

We don't know the details of the various proposals that are out there (or at least, they're constantly changing). But I do think some thought is going into at least some of the bills. Certainly time is being spent on them.

The frustrating thing is that none of it means anything until both houses pass bills and the process of reconciling them begins. No idea, however necessary or prudent, is guaranteed to survive that. Starting with two good bills would help, but it doesn't guarantee that that's what we'd end up with.

[anthriel]

The whole darned thing is frustrating. This could be such a wonderful opportunity for our country!

I just want them to take enough time to at least hunt for any gaping holes in the net. And I have a nasty feeling that there are politicians and special interest groups out there trying to carve out little holes, or big holes, for themselves.

For those of you who read the link about the AZ alt-fuel debacle, I knew Jeff Groscost. He was a self-serving , manipulative, consummate politician. He went down, but he sure took a lot of taxpayer money with him.

It's made me twitchy about people who try to rush legislation along. Mr. Groscost taught me that sometimes it's so no one has time to read the fine print.

[Frelga]

I am trying to decode that article.

The program provided medical coverage to 2,000 children at the cost of 50,000 a month or $25.50 per child, which was "more than matched" by the private partner, Hawaii Medical Service Association, which will continue to extend the coverage after the program is canceled in November. The article quotes public officials but does not cite any numbers or, indeed, any evidence at all that "most" of the families dropped private insurance to get on the program. Meanwhile, estimates indicate that between 3,500 and 16,000 children lack medical insurance in Hawaii.

That suggests one of the two things to me. Either the program was extraordinarily badly designed, and instead for reaching the uninsured children as intended the funds went to a completely different population. Or Hawaii is cutting costs everywhere it can, and uses abuse by the minority of recipients to justify dropping everyone. At this point, each explanation seems equally likely.

And I absolutely agree, Anthy, that a good deal of thought should be given to designing a program that supports the correct population.

[anthriel]

I am trying to decode that article.

It was the best article I could find about the segment I saw on tv. The governor was interviewed as saying that some high percentage of people had dropped private coverage for this system, but I didn't see where those numbers came from, either. I can try to find a better article, with more data.

That suggests one of the two things to me. Either the program was extraordinarily badly designed, and instead for reaching the uninsured children as intended the funds went to a completely different population.

Probably. Or, as you next suggest:

Or Hawaii is cutting costs everywhere it can, and uses abuse by the minority of recipients to justify dropping everyone. At this point, each explanation seems equally likely.

I think they got in over their heads on this one, and they are screaming fraud. Fraud is probably involved here somewhere, but it is the fault of the designers of the program and those who allowed it into law, and their fault alone, no matter how much they point fingers.

And I absolutely agree, Anthy, that a good deal of thought should be given to designing a program that supports the correct population.

My fingers are crossed.

[Voronwë the Faithful]

I'm not convinced that even a faulty bill with would be worse than not doing anything at this point. And the truth is that while some of the people that want to slow things down want to do so to make the bill the best that it can be, others that want to slow things down want to do so to stop the momentum so that it won't happen at all. And some of those are doing that not so much because they think reform would be bad but rather because they think it would be a major political defeat for Obama and the Democrats. They've said as much ("it will break him" "it will be his Waterloo"). And that I find disturbing. The truth is, given the political realities, there is a relatively narrow window to get something done. If it doesn't get done this year, it is unlikely to get down at all, with the midterm elections coming up next year. And I think that will be a disaster for our country. I know it will be for me.

[ToshoftheWuffingas]

Delay is a very very powerful tactic to prevent change. It has been enormously successful since the 1960's. Treat it very seriously.

[anthriel]

And yet rushing things through can also be a tactic to ramrod one's own agenda into law, by creating a sense of false urgency (or heavily over-emphasizing the urgency that may well exist), and then admonishing those who would like a reasonable opportunity to review the facts for their perceived political manipulations.

Of course, some of them are being politically manipulative. Politics happens, on both sides. There are good reasons to be careful when crafting this law, and I personally believe careful is what we need. Too bad there are the Jeff Groscosts out there, as there always are.

But as Prim's husband says, it is better to let a few unethical students get away with something than to treat everyone in the class like untrustworthy children.

[Primula Baggins]

The problem is that for many people in this country the sense of urgency is not false. For them the need is real and has been real for years. It's just that no one has been listening.

[anthriel]

I agree. As I acknowledged in my post, the urgency is there, for many. It may be being over-emphasized right now, of course, for political leverage. Patriot Act, anyone?

However, since we've waited this long (and, I agree, this should have been addressed before, although it needed a Democratic president to bring it to this point), I feel we can give this legislation a reasonable amount of time to get it right.

Getting it wrong would not only be wasteful, it could end up with the very people who need the help the most getting absolutely none.

[Voronwë the Faithful]

The problem is that for many people in this country the sense of urgency is not false. For them the need is real and has been real for years.

The cost of my health insurance has doubled in the last two years. Doubled. It is the single major reason that my practice is floundering. The urgency is real for me. It is even more real for those who don't have health insurance, and that group is growing at an alarming rate.

Of course, some of them are being politically manipulative. Politics happens, on both sides.

I agree completely that there are people on both sides playing politics, Anth. But, as you have pointed out before, that is what politicians do. Unfortunately, that will have an inevitable impact on the final result. But something needs to be done. If it doesn't, though, the blame will be need to be spread around to many quarters. For instance, most economists have indicated that the best way to pay for the reform is to tax health care benefits like income. That is an idea that many Republicans and conservative Democrats support. But it is largely dead in the water, because of opposition from big unions, and thus progressive Democrats. That opposition may turn out to be the single most important reason why health care reform fails, if it does, since it is likely to block the possibility of forming a coalition of both Democratic camps and a few moderate Republicans. And that is a shame.

[Frelga]

Getting it wrong would not only be wasteful, it could end up with the very people who need the help the most getting absolutely none.

That is true. Still, at this point, I do think that it is better to get an imperfect bill through than none at all. Once we've taken the plunge, as a society, we can perfect the way we swim.

[Primula Baggins]

Medicare as first passed (with not a single Republican aye vote, IIRC) was not a very good or very inclusive program. Over the next five to ten years, though, the holes were plugged and it was straightened out into what is, actually, a very good program, one that relieves the elderly (and their children!) of any concern over whether their health care will be covered. It will be better when costs are brought under control, assuming that happens. But it works, even as it is.

A program like Medicare as it exists now, though, would never have passed that first year. Sometimes you have to get one foot inside the door.

That, I think, is what the health insurance establishment really fears, and why they're fighting so hard against any reform whatsoever. If a majority of people ever really believe that health care could be better and cheaper. . . .

[anthriel]

Well, then. Perhaps the need for change, any change, is absolutely immediate, and a foot in the door is enough!

My concerns were based on my own experiences with the AZ alt-fuel fiasco, which I witnessed from a front-row seat Because of its abysmal failure, any discussion on alt-fuel has not and will not for many years be a topic in the AZ legislature again. We are stuck with our pollution, because something was rammed through legislation (by a Republican, btw) and then almost brought down the state when it exploded, due to poor planning and greed.

I felt the Hawaii insurance program's failure, and the fact that the very children they were trying to provide for are now uninsured again, was another illustration of the idea that a originally well-crafted piece of legislation is a good thing.

Let the cards fall where they may on this one, then. Let's get it in there, sooner rather than later, with whatever we've got, and hope that it is at least as functional as the nascent Medicare program was.

I am glad the Democrats are in power on this one. Many rank-and-file Republicans are very glad health care reform is coming. Elected Republicans will be no help. They weren't then, they won't be now.