Health Care Reform

Post by **Primula Baggins** » Tue Jul 21, 2009 6:48 pm

The system has always worked this way; it just hasn't always been this easy for people like us to see it in action. Maybe there's a shred of hope in that fact. A lot of the progress on health care reform, such as the increasing likelihood that the final bill will include a public option, may largely be due to overwhelming and intelligently targeted grassroots efforts by activists.

A politician standing against reform is, more than ever, visibly standing against the strong wishes of a majority of his or her constituents, and for the lobbyists who are funneling money into the politician's campaign. And we know how much that is, down to the dollar, for each member of Congress.

Things may not go the way they've always gone before. At least we can hope.

Post by **Ellienor** » Tue Jul 21, 2009 6:51 pm

I am going to be profoundly pissed if we don't get a public option.

I read a piece by Karl Rove in the Wall Street Journal saying that we don't need a public option because we have so many private insurers.

Has he ever had coverage by a private insurer? Speaking from personal experience and listening to others', private insurers are what they are, you can't blame them for being a business, but their goal is to cherrypick members and remove ones that become unprofitable to increase profits.

For all the thousands of private insurers on the market, they will all universally refuse to cover people with a bad health history. The way they operate is just inconsistent with the goal of universal healthcare.

Post by **anthriel** » Fri Jul 24, 2009 6:49 pm

"Fixing" healthcare so it costs employers less and so employees are not locked into jobs they don't want any more.

I read this quote from you a few days ago, Prim, and I agree. People should have more mobility, more choices.

But it has occurred to me (fairly recently, I'll give the example in a minute) that this "I need to get a good job because of benefits" may have had something of a positive influence on people's life decisions, in a way. Perhaps it helped people be more motivated to get that extra bit of education that would help them land those "good jobs". Perhaps it helped people with an incentive to work at all.

My friend's aunt grew up in Detroit, and her family were all unionized auto manufacturer workers. She lost her job out there about a year ago, and moved here (she's living with her sister) to find a "good job with benefits". Even though she has no formal education, she found a decent paying job at Shamrock, and has steadily worked there for a year.

She decided to move back to Detroit. Her plan is to go on welfare, because "President Obama promised that I would have good health care even without a good job". She feels that without having to worry about paying for health care, welfare will sustain her.

Now I think, personally, she's a bit pie-in-the-sky, here, and I'm not sure Mr. Obama ever promised anyone anything like she thinks he did. But I am watching a woman who was a contributing worker decide to leave her (probably boring, but there you go) job to go live completely on the public tab.

Because she thinks she can.

Post by **Primula Baggins** » Fri Jul 24, 2009 7:59 pm

She's got a surprise coming, especially since the public option as presently conceived doesn't kick in for four years. And when it does, people will still be expected to pay for it. And until then she will be required to buy private insurance. I definitely see where you're coming from here, Anthy.

But . . . one of the problems with "fixing" health care, is that you can't really cut costs until everyone is covered. Which means some deadbeats are going to get subsidized coverage. Because if we don't do that, we're back where we started with the deadbeats' kids showing up at the ER with meningitis because the deadbeats couldn't or wouldn't pay for immunizations, etc.

Letting people get away with being irresponsible bugs me, but in this case I don't see a way around it. The rest of us benefit if everyone is getting proper preventive care, whether they deserve it or not.

Fri Jul 24, 2009 10:08 pm

I'd love a good job with good benefits, but the truth is that some of the jobs out there with benefits don't pay you enough to live AND afford health care. I myself am going back to school to get more education to land an actual career with hopefully good benefits, but currently, I'm uninsured. I've been job hunting off and on for the last couple years, and all decent jobs want 3-5 years experience in some field, but sadly, no one out there is looking to give this experience. It becomes very frustrating for someone trying to find some sort of meaningful work. If the public option happens, I'm taking it for now.

Post by **River** » Fri Jul 24, 2009 10:20 pm

My dad makes very good money as a lawyer. Being a solo practioner, he doesn't have an employer so much as he has clients. And clients don't pay you benefits. My point being, education and good job doesn't immediately add up to benefits. If you want to work for yourself well...there are plenty of people here who can fill in that blank. Same if you've got a decent job you enjoy but your employer is too small to offer good benefits. That was S's situation before the company he works for got bought.

Fortunately for my family, Mom has your pretty standard sort of salaried position with benefits and the whole family got health coverage through her. But not every family has that option, or has someone who brings in enough base salary to afford a decent insurance plan.

Post by **Primula Baggins** » Sat Jul 25, 2009 12:01 am

Yes. "I need to get a good job because of benefits" can also be "I can't leave this lousy job and start my own business because of benefits," or "There isn't even a path to promotion in this lousy job, but I can't leave it because of benefits." The problem is choking off more ambition than it's inspiring, I'd bet, at least in people who've got post-entry-level jobs and have families to support.

Post by **anthriel** » Sat Jul 25, 2009 1:00 am

My point being, education and good job doesn't immediately add up to benefits.

I wasn't trying to imply that it always (or "immediately") does, but I think that the "getting a good job with benefits" has, in the past, tended to be an incentive for people to get that education which might lead them there.

Perhaps I'm completely off base. I certainly have seen people "stuck" in jobs they disliked because they couldn't do as well anywhere else (the people who work in the VA labs are frighteningly depressed, as a rule.)

But it was just a bit jarring to see a woman who was contributing, going to work every day, paying taxes, etc., decide to ditch all that and be dependant upon taxpayer's funds, because of what she thought Mr. Obama has promised.

I think she's a bit daft, actually. Hopefully she's the only one.

Post by **Primula Baggins** » Sat Jul 25, 2009 1:09 am

I sort of doubt it. But as I said, if the system's going to work, some people who don't really need the help are going to get it. But when it comes to health care, that's better than having tens of millions of people who do need the help who aren't getting it.

Sat Jul 25, 2009 1:57 am

I doubt it, too. But I suspect that she and other people like her are probably looking for an excuse to not be productive. Still, you raise an important point, Anthy, that definitely helps to demonstrate what a complicated issue this is. As usual, there are valid point from different perspectives. There is a lot of frustration and anger amongst "progressive" Democrats towards their more moderate and conservative colleagues, but I don't think that the so-called Blue Dogs (not to mention the more moderate Republican Senators as well as moderate Democratic Senators who continue to negotiate in the Senate Finance committee) are just trying to be obstructionist. I think they too genuinely want reform, but have some valid concerns about the ramifications of the plans being floated. If a compromise can be reached that adequately addresses the concerns of both them and the more progressive Democrats that ends up passing Congress, I think that will be quite an achievement, even if the final bill isn't exactly what I would want to see.

Post by **River** » Sat Jul 25, 2009 2:26 am

Anthriel wrote: I think she's a bit daft, actually. Hopefully she's the only one.

That would be one of the politer ways of putting it. In any population, you get weirdos.

Post by **Frelga** » Sat Jul 25, 2009 3:49 am

Primula Baggins wrote:Yes. "I need to get a good job because of benefits" can also be "I can't leave this lousy job and start my own business because of benefits," or "There isn't even a path to promotion in this lousy job, but I can't leave it because of benefits." The problem is choking off more ambition than it's inspiring, I'd bet, at least in people who've got post-entry-level jobs and have families to support.

Oh yes, I've seen this a lot. At my own office, too.

And as far as Anthy's friend's aunt, well... in California, at least, welfare comes with medical benefits already. I have known more than one person who are staying on the welfare because that's the only, or at least the easiest, way to provide medical benefits for their families.

Post by **Teremia** » Sat Jul 25, 2009 12:14 pm

I think it would change my life for the better if health insurance didn't depend on sticking with my job. Health insurance and retirement. I'm a cautious person, so I can't see throwing it all over to (say) write, which is what I actually enjoy doing. So I plod off to the classroom. Not that it's such a bad place to be, of course! But it's not what makes me happy. In fact, it stresses me totally out.

In an economic crisis like Now, it again seems so clear to me that if health insurance were universal and were separate from employment, then losing one's job would not be the total catastrophe it sometimes is now. But when changing jobs opens you up to being completely uncovered in case something Goes Wrong, health-wise, then you really start the avalanche going: health crisis, loss of house, whole nine yards.

It just doesn't make any SENSE, the system we have now.

Post by **anthriel** » Sat Jul 25, 2009 7:50 pm

An aside to Teremia: my dream has always been to teach.

If I didn't have to have the "good job" so that my family could have health care benefits, I would be teaching as an adjunct facility member at the local community college. I had the opportunity to do it a few years ago, but my husband does not have access to health benefits through his job, and I was offered no benefits as a potential adjunct facility member. I'm stuck, as it were, in the lab.

Not such a bad place to be, either, of course. But I would like the opportunity to teach.

Frelga wrote:I have known more than one person who are staying on the welfare because that's the only, or at least the easiest, way to provide medical benefits for their families.

This is also a wasteful choice; perhaps if these people had options for other medical benefits, they wouldn't stay on welfare.

Or maybe they would. There are always those who will manipulate any system so that they can do the least possible themselves, while leaning on the taxpayer's wallet whenever possible.

I agree with Prim; it's probably inevitable that some people will freeride as much as possible. It's part of the price to play, I guess. If we want a system which allows most people to have sensible choices, we will have to put up with people who will cheat it.

Post by **Frelga** » Sat Jul 25, 2009 8:32 pm

Anthy wrote:This is also a wasteful choice; perhaps if these people had options for other medical benefits, they wouldn't stay on welfare.

Indeed. But the entry-level jobs available to them did not come with enough health benefits to cover the family, and the salary would have been just enough to push them above the line to where they would not have been eligible for State-sponsored benefits.

Which is counter-productive, to my mind. Isn't it better to provide health benefits to these people and their families so that they would be able to earn income and pay taxes on it?

The extreme example of this setup is a co-worker's young relative affected with a very rare disorder. Until recently, it meant a painful death in his teens. The experimental treatments allow him to live an almost normal life, except for the damage already done before the treatment was given. The treatment costs are in the five digits EVERY MONTH.

Both his parents work, and both are close to exhausting the five-million life-time maximum that their insurance allows, and heaven help them when they get old and frail. Once the boy is too old to be on their insurance, he can never get a job. Medicare would provide the medicine that keeps him alive, but if he were to make any income he would not be eligible and certainly no one can make enough money out of college to pay for the medication.

Let me replay this. The State will pay for the boy's medication, but only if he stays too poor to contribute anything to the society via taxes, entrepreneurship, and just plain work.

Anthriel wrote:I agree with Prim; it's probably inevitable that some people will freeride as much as possible. It's part of the price to play, I guess. If we want a system which allows most people to have sensible choices, we will have to put up with people who will cheat it.

I agree. The alternative is to round them up, ship them off to Alaska and put them to work cutting down trees and digging canals.

Sat Jul 25, 2009 8:46 pm

Anthriel wrote:An aside to Teremia: my dream has always been to teach. If I didn't have to have the "good job" so that my family could have health care benefits, I would be teaching as an adjunct facility member at the local community college. I had the opportunity to do it a few years ago, but my husband does not have access to health benefits through his job, and I was offered no benefits as a potential adjunct facility member. I'm stuck, as it were, in the lab.

This is a pretty darn good argument for health care reform, right here. You shouldn't be stuck in the lab, any more than Teremia should be stuck in the classroom, or any more than I should be considering giving up my practice, because adequate health care coverage is tied so closely to what kind of employment we have.

Of course, the question comes down to whether a plan can be found that satisfies the diverse interests that make America so unique, including the problem with the deficit.

Post by **Primula Baggins** » Sat Jul 25, 2009 9:50 pm

But I don't think we can afford to make health care the item on which we try to cut the deficit, in contrast to, say, two wars and the F22 fighter and endless financial bailouts. Some of the people arguing against health care on fiscal grounds seem to have little to say against any of the rest of it, wars or useless weapons systems or money for Wall Street bonuses. "Fiscal responsibility" is just a tool to stop the health care bill, when in fact the most expensive health-care option we have is to let the current system continue unchanged.

Post by **Griffon64** » Sat Jul 25, 2009 10:21 pm

The arguments for un-tethering people from jobs for good health care makes wonderful sense.

But I worry a lot about how to prevent the deadbeats from spoiling the system for everyone. I've worked with plenty of deadbeats, so I'm sure that there may be more of them than one realize. I work in a professional environment. And still, I've worked with people who max out their health insurance allowances each year, because they can, because they think they're entitled to it all. It becomes an entitlement program, not insurance. That's a little like somebody wrecking their car each year because their insurance entitles them to a new replacement. I've worked with people who max out their sick leave just because they didn't feel like coming to work. So, how to keep the system propped up - probably on my wallet, no less - to prevent it from collapsing under the deadbeat weight?

Until I see a crystal clear plan that will minimize the deadbeats, my internal morals will struggle with thinking universal health care is going to be the best thing. [ I do believe the current model is completely unsustainable, though. ] I must be honest and say that I abhor people who are capable of doing an honest day's work and choose not to because they'd rather hitch a ride on the backs of hardworking people. And by the same token, I do not like supporting any system that makes it hard for people to do a honest day's work, that expects them to take less if they do that than if they sat on their butts and collected money from my taxes for their living expenses.

I do not have answers. I just have a very ridged view on the concept of working for your keep which was pretty much smelted into me by honest, hard-working parents and a religious upbringing.

Prim - I haven't formed an opinion yet, but I may well argue against a health care bill on fiscal responsibility grounds. And yet, I'm also apposed to the wars ( is Obama for or against troops in Afghanistan, anyway? ) and very opposed to financial bailouts. I grudgingly accepted the first bailout on the grounds that it probably was necessary, if unappealing, but I would be very against another, especially with the Wall Street bonuses that continue to be given. Wall Street does not need to pay obscene amounts to keep the "talent" that created this mess. It is the wrong kind of talent, the talent for stealing and taking what isn't theirs, that they rewarded. I'm a little more ambivalent on the concept of useless weapons systems, but mostly because I don't know enough about it. For instance, should North Korea prove capable of launching some long range missiles to Hawaii or L.A or Oregon, I sure hope there's a weapons system in place to prevent a bunch of people getting killed. But you can go way too far with that kind of thinking, too.

In the end I don't have answers because I feel I don't have all the facts, and I'm not going to pontificate about matters with my incomplete understanding. So if I am to argue for anything, I'd argue for laying out all the facts so people can understand them and make informed decisions. Hard to do with today's attention-deficient and critical thinking-deficient people, but that's what really needs to be done. Everything else is baseless speculation.

Post by **Primula Baggins** » Sat Jul 25, 2009 10:31 pm

I'll stop pontificating too, then, beyond pointing out that the facts are out there and some people do look at them. Not all opinion is baseless and uninformed opinion.

Post by **Griffon64** » Sat Jul 25, 2009 10:50 pm

Primula Baggins wrote:I'll stop pontificating too, then, beyond pointing out that the facts are out there and some people do look at them. Not all opinion is baseless and uninformed opinion.

Did I forget my usual "This post is not aimed at any one person or poster, but is merely the personal opinion of Griffon64" disclaimer?

I only mean that *I* do not have all the facts, and therefore *I* do not have a final version of opinion on health care or war or weapon programs or anything of the sort. Those that do have all the facts and have their final opinions are, of course, welcome to state them.