Miami’s only major daily published an informative article about the health care reform proposals this Sunday. The Miami Herald certainly has improved since McClatchy bought it from the power elite’s mouthpiece, the Knight Ridder newspaper chain. Lone Miami intellectuals used to say that the only reason to subscribe to the daily rag was that it would pile up on your doorstep and alert neighbors to your death, which, incidentally, is what happened to late newspaper columnist A.C. Weinstein, right hand man to the last two mayors of Miami Beach, may he rest in peace. Instead of posing advertising favorable to the vested interests as good news, Herald muckrakers are finally at work exposing business-as-usual as it really is at heart in one of the most corrupt cities in the United States.
Now we learn from the Sunday edition that the percent of uninsured people under the age of 65 is nearly 31 percent in Miami-Dade County, but that everyone is virtually insured because the uninsured can go to the emergency room and get medical care, thanks a lot to the tax payers who pay higher taxes and higher insurance premiums as a consequence. Of course people would be healthier and therefore their care would supposedly be far less costly if uninsured people did not wait until they were sicker than stray dogs before they showed up at emergency rooms.
The reporter leaves it to others to unequivocally restate that this virtually universal coverage is the most inequitable and expensive system of health care delivery in the advanced world, and that caretakers at health care fairs, such as the recent one at the Convention Center on chic South Beach, are saying that the situation in the United States is as bad as they have seen in undeveloped countries. He does not report here on the fact that insurance companies stand to profit handsomely on the reform plans as they now stand, which they have kindly helped our political hustlers draft – we also note that insurance companies are conveniently providing most of the statistics. Nor does he write that any plan endorsed by the American Medical Association is bound to cost patients an arm and a leg. He does reveal what experts say for sure, that any affordable reform will have to reduce overall costs, but he does not say that reducing costs will require rationing health care differently than the American Way, the way that the rich get richer and the poor poorer as per the capitalistic rationing of scarce resources.
Most importantly, our journalist does not observe that, since the most of us are paying for virtually universal coverage in one way or another, the most obvious and logical solution to the debate over payment and distribution of benefits is to recognize health care as a public utility and to pay for fundamental health care out of tax revenues on a non-profit basis.
But that is anathema because it would gut the insurance companies rather than let the insurance companies continue to gut the gullible American public, which is up in arms now that the wolves are at the door and some fat might have to be lost. We cannot help but notice that the people who are most hysterical at the town hall meetings are those who can afford to take time off from work to complain, who have insurance and are generally overweight – the poor working folk in our country are generally unrepresented everywhere; if only they would give up fast food and starve like rats they might, according to a recent study, live longer.
Positive perception of the British National Health Service plan is buried on page 21A, and we are told that we should compare our system with that of the Netherlands, because it is a public/private mix of coverage, rather than that of Canada, where the system is a government entity. The Herald’s “Worldview” in a nutshell, comparing the United States with Netherlands, Canada and Germany, mixes up statistics from three different sources. Life expectancy in all countries is about the same, but the United States pays about double per patient for medical care, and the total cost in the United States is about 50 percent more of national spending than the other countries.
Let us take a look at the 2006 comparisons provided by the World Health Organization: Total expenditure on health as a percentage of gross domestic product rose from 13.2 to 15.3 percent in the United States, from 8.0 to 9.4 percent in the Netherlands, from 8.8 to 10.0 percent in Canada, from 10.3 to 10.6 percent in Germany, and from 7.1 to 8.2 percent in the United Kingdom. General government expenditure on health care as a percentage of total expenditure on health rose from 43.7 to 45.8 percent in the United States, from 63.1 to 80.0 percent in the Netherlands, stayed at 70.4 percent in Canada, fell from 79.7 to 76.9 in Germany, and rose from 80.9 to 87.3 percent in the United Kingdom.
Now the Netherlands does not look as hot as it did in the Sunday Herald, but there are more statistics to be considered to see how it stacks up, including statistics on patient satisfaction. And the results in countries with broad government plans have been adversely affected by conservative efforts to plunder the public under the pretext of qualitative improvement through privatization of the plans. We notice that, while the conservative media in Great Britain likes to trash the NHS, the general public when privately polled would not sacrifice it, and would certainly not trade it for the backwards system we have in the United States. Mind you, as for the long waits in Great Britain for elective surgery, private insurance is available for those who want to avoid the waiting, but Brits are not fools and many prefer to wait for the public operation – when their turn does come up., quite a few people decide against the elective surgery.
The point here is that much more is involved than a few figures in the newspaper: and one must dig a lot deeper than the statistics, which can, like the Bible in the hands of a persuasive preacher, be used to prove almost anything. By the way, while looking at the WHO figures, it may behoove the health insurance buff to consider moving to Malta, Luxembourg, and Monaco.
Now the Herald provides us with a handy chart comparing all four House and Senate versions of reform as they stand, along side the Obama proposal. But the Obama proposal secretly shifts almost daily as the President compromises one campaign plank and ethical principle after another.
“Compromise,” by the way, appears to be an euphemism for hypocrisy. The candidate promised us that uninsured people would not be forced to pay premiums, but the President is in favor of doing just that lest people do not take a free ride. If they don’t pay the premium, stick them with a tax even if they are making less than the $250,000 margin set by the candidate. The pay the premium or pay a penalty is based on the failed Massachusetts model. Many Massachusetts people are paying the penalty rather than the premium, but 97 percent of the population is supposedly covered. Now health care costs are soaring in Massachusetts, far more than anywhere else in the country, since the adoption of the plan. A special panel has been formed to find out why, and what to do about it.
No doubt Massachusetts will not want to ration health care so that the rich will get less and the poor more of it. That would be un-American. Americans’ desire for good health is infinite – that is why commercial insurance companies did not want to cover sickness in the first place. Since the desire for health is unlimited, and since the notion of health is indefinite, there would be no end to claims made upon insurance companies. Of course sick people would sign up and immediately file claims. And morally hazardous healthy people would sign up and take more health risks knowing they were insured for the deleterious consequences. But then the insurance companies figured out how to get their hands on an unlimited supply of funds to do so.
Indeed, America has come a long ways from the days when the greatest cost of illness was not doctor and hospital bills but was the loss of income from missing work, so people bought sickness insurance similar to disability insurance. While nations in Europe were wisely adopting forms of national health insurance in the 20s, Americans did not feel they needed health insurance, so legislation proposed by the labor lobby in several states failed to pass – doctors and druggists and commercial insurers were dead set against it because the intervention would restrict fees. But as the population shifted to the cities, where homes were smaller, and as incomes rose, and medical science and technology advanced, and quality was improved and supply limited by education, licensing, and regulation such as hospital accreditation, the demand for professional medical care increased, and so did the costs.
Hospital associations and insurance companies solved the problem of how to pay for it all. Pioneering Dallas teachers contracted with Baylor University to provide twenty-one days of hospitalization for a fixed payment of $6. It was remarked that women spend a dollar on cosmetics without thinking much about the expense, so people might be induced to set a dollar aside each month to pay a hospital bill every twenty years or so. The hospital insurance plans grew because the plans benefited the hospitals, which were suffering falling incomes in the 30s, as well as the insured. In order to stifle competition between hospitals, the plans were combined by the American Hospital Association under the name Blue Cross. Blue Shield is another story – doctors worried that hospitals would start setting up plans for physician services or that a national government plan might be established, so they organized to set up their own plans, controlled by doctors.
Now here we are, with health care costs far more than cosmetics (which were originally a health care item whereby a woman put her cosmos in order and protected her hair, eyes and skin, et cetera), and the Herald chart on the reform plans claims that the Public Option is in two of the plans, and that the Obama Proposal includes a comprehensive plan similar to the one available to federal employees. But people who have been watching the Public Option ball closely saw Mr. Obama drop it nearly a month ago, and conjectured that he had sold his believers out yet again – most of them will not mind as he is a nice sophisticated fellow and not a mean moron. He has most recently declared that his famous Public Option is not essential to good reform after all. Compromise or hypocrisy? Or are the terms synonymous in politics?
A U.S. senator has declared that the Public Option would have never passed and will not now pass muster in the Senate, anyway, so there you have the reality of the Senate that is the vestige of the King’s Royal Court, where seats are reckoned to be worth a minimum $2 million – why waste time on elections when Senate seats could be auctioned off to the highest bidder, the proceeds going to health care charities?
Well, maybe Nancy Pelosi can pull some strings for the Public Option, perhaps blackmail a few senators or extort a few votes, but that might not do much good since the uninsured and underinsured are so downtrodden they apparently do not have the will to shout down the insured fat cats. It was not that long ago when the majority of voters polled were in favor of the Public Option, but now they are running scared because of the renewed Red Scare.
While looking at statistics, we should pay attention to out-of-pocket expenditures or co-pays. If health care were free there would be no limit to the demand for it since one simply cannot get enough health on Earth, even if she believes in her future in Heaven. Big Daddy may be omnipotent, but for our own good He is inclined to regulate distribution by denying benefits or by making people pay for a portion so they will become little Big Daddies and deny themselves. Out-of-pocket expenditures for private insurance plans in the United States are about 25 percent of total private expenditure (29 percent in the Netherlands and 50 percent in Canada for private insurance plans).
Some senators, terribly affrighted by the trillion-dollar price tag for reform, think that consumers should contribute 35% to help fund the reform. It is with that in mind that I have a couple of anecdotes for my more patient readers:
My South Beach dentist’s assistant was quoting me the fee for a root canal the other day when a little old lady in the waiting room called me aside to let me know the name and address of a dentist two miles away who charged 40 percent less for the same procedure. I thought it would be great if dentists’ fee schedules were published so people could shop around, which might make dentists more competitive. I did find several offers to sell general statistics on fee levels, and I noticed that one workshop for dentists advised them to charge in the upper range for best results. My dentist is really a good one, but I could get the all the dental work I need now done elsewhere and the amount he quoted would include a Vegas vacation all expenses paid including $100 in chips.
One day in the early 70s I was feeling extremely hungry so I walked into a burger joint in Waikiki owned by a dog food company at the time. The line was long. I fainted and hit the back of my head on the floor. The police came, propped me in a booth and slapped me a couple of times, thinking I was drunk. I got up and staggered out, and made it to my apartment two blocks away, where I fell onto the floor and lost consciousness. A friend of mine found me there the next day. I was taken to the hospital. When I regained consciousness, the doctor hovered over me and said I was not to worry, that I had sustained a concussion, my brain had swelled up, but that I was out of the woods. I was discharged the next day and referred to a specialist, who told me an interesting story about how he had treated an astronaut who had fallen down and hit his head in the bathroom. I informed him that someone had suggested that I had something called hypoglycemia, which he said was a myth. He gave me some tests and determined that nothing was wrong with me.
Two weeks later, I got a statement from Hawaii Medical Service Association, the local Blue Cross Blue Shield franchise, and found out that I was to pay a portion of the charges, which amounted to over a month of my pay, which at that time would have taken me over a year to save.
The only reason I had insurance at that time was because of the Hawaii Prepaid Health Care Act, which mandated that employers provide health insurance to employees who work over 20 hours per week. The employer had to pay at least half of the premium and usually more, because the employee’s share can never exceed 1.5 percent of his or her wages. If your wage is, say, $2,500 per month, and the single premium is $300 per month, your share would be $37.50, so you would pay $37.50 and your employer would pay $262.50. Hawaii had an uninsured population of around 30 percent before the Act was enacted, and that rate soon dropped to 5 percent, but has lately hit 10 percent, one reason being that employers tended to make sure employees worked less than the required 20 hours for coverage. When I returned to Hawaii in the late 90s, I went to a Chamber of Commerce meeting where an employment agency’s presentation was roundly applauded – the gist was that having employees was a damn nuisance that the employment agency would be glad to take off your hands. Steve Forbes visited Hawaii and called it a socialist state. Soon thereafter the Republicans seized power from the Democrats who had controlled the state for fifty years – the Democratic Party was sympathetic to the fact that Japanese-Americans had been persecuted during the war. I went to a Republican meeting, where employers were advised to turn their employees into independent contractors to reduce insurance and other employer expenses.
Since I was dismayed by the amount of my co-pay, I scrutinized my HMSA brochures and my employer’s master contract, where I discovered that only a provider’s usual, customary and reasonable fees (UCR) were covered. Convinced that I was being overcharged or under-covered, I contacted HMSA and demanded to see their database. I was turned over to the entity’s legal liaison, who informed me that the information was proprietary. I responded that, as a member of the organization, I was in fact one of its proprietors, and was entitled to see the records. HMSA then revealed what my doctor usually charged for the services he charged me for, what the customary fees were for all doctors who provided those services, but he said the “reasonable” part of UCR was a confidential formula kept in a safe in their computer room. And the organization would not allow its members to examine its database so they could shop for the best deal on fees. When I looked into the organization’s structure, I discovered it was largely controlled by doctors and not by the members. So I concluded Blue Cross Blue Shield was designed to create a pool of funds to be drawn on by the medical profession.
Furthermore, it appeared to me that the entity’s literature was deceptive and fraudulent. I adopted HAWAII CORRESPONDENCE as my letterhead and proceeded there under to lodge complaints with state and federal officials, and I copied various large employers and unions. Senators Sparky Matsunaga and Daniel Inouye were helpful. Those were the days when ordinary individuals could still personally reach their representatives – even so, I was continually asked, “Who are you working for?” The late Senator Matsunaga received me in his office and took me to lunch. Today Senator Inouye does not even have time to give me the time of day, maybe because I moved to Florida.
The end result was that HMSA changed the wording of its sales brochures and contracts, and I got a letter from the state ombudsman saying I had helped hundreds of thousands of people. I did not think much of the letter, and I lost it, figuring that I would really had helped people if a law had been passed giving people access to databases that would allow them to do some comparison shopping.
Now it is difficult for me to bring this article to an end without an extended rant, for there seems to be no end to the hypocrisy when it comes to the physical and mental health of our people. Suffice it to say that, as the Public Option slides off the table, I am about to take down my Vote Obama Today poster, and to say, “To hell with his kind of CHANGE.”