Mar 28, 2010

Part 1: Let's talk health care reform.

Leave your guns at the door - thanks!

So, let's talk about this whole health care reform mess, shall we?  I'm going to wind up doing a series of posts on this, I'm realizing, and I just know that excites people to no end.  Me, rambling on about health care?  I know, I know.  It makes my butt twist, too.  But please jump in; I'd love to hear everyone's thoughts on it all and if we're lucky, maybe we have have a heated deba...uh, pleasant discussion about the topic.  All I ask, for God's sake, is to be logical about it, please.  I'd really love to hear everyone's opinions and thoughts but spare me the violins because they don't pay the bills.  Saying "everyone should have the right to good health care" doesn't make it doable, nor is it logical and what we all need to remember is that our government is a business.  There's no place for feelings and emotions and blue-birdy good wishes unless there's money to back those up.  I mean, everyone should have the right to world peace too, but just wanting it doesn't make it a *right, nor does it make it possible.  Access to health care is all well and fine but health *coverage is no right.  That said, I really have no problem with Socialism, if that's roughly how a country was founded or what it grew into as it became modernized and civilized.  However, Socialism, which is what *any national health care plan is based in, cannot be instituted successfully in place of another preexisting system that works.  And make no mistake, our health care system *does work.  Does it need some work?  Absolutely.  Reform, even?  Yep.  But you have to start in the right place and work in the right direction to achieve that and this plan?  Doesn't.

So, let's get down to the nitty-gritty here.  Numbers.  Money.  Figures the government is feeding us and the reality of those, all of which I can and will prove to the best of my ability.  If you can show reliable sources proving any of them wrong or giving me more information than I could find, please do so! I'll happily revise the numbers and we'll see what we come up with then.  Also, I am going to round up or down for ease in my own mental mathematical process, but for the sake of being fair I will never round in favor of my own argument and when making estimates, I will lowball in favor of the "other side" to the point of pain.  That said, since I am going to run with this sans calculator, I may fuck it up.  Please point out any errors.

Basic, indisputable facts we are going to work with:
The US population is around 305,000,000 and that includes illegal immigrants and legal non-citizens.

12,000,000 of those are illegal immigrants.

75,000,000 are children.

To briefly address illegal aliens and the healthcare reform bill, President Obama (and Nancy Pelosi) have clearly stated it would not cover illegal aliens.  However, there is nothing in place in this bill to require people to show proof of legal status prior to obtaining services.  So, take that as you will...I think we all know what the reality will be but I'll go with our President's words and, using the figures above, state that this means we have 298,000,000 prospective insurees we need to be concerned about under HR 3200.

More "facts" and facts:

A "fact": There are 46,000,000 uninsured people in the US, roughly 14% of our population, per government stats.

The real facts?  12,000,000 are illegal immigrants and they are included in that figure.  We need to remove them...they are not entitled to health care in our country and even President Obama seems to agree with that.  See above.

Another fact? Over 15,000,000 of those *individuals (not couples, mind you) have an income of over $50,000 per year.  Know what that means?  It means that many of them *could be paying for health insurance, at least a good major medical policy,  for themselves and are choosing not to. Now, granted, I know that a single $50K income won't even allow one person to live decently in a few parts of the country but in the vast majority, it will.  Here's the trouble...people have different ideas of "living decently".  I learned way too much about this in the years I sold insurance and I never did get used to approaching someone about their health insurance, only to be told they "can't afford it".  As they would tell me this,  I'd have a policy on their home in a somewhat upscale neighborhood on one screen and the policies on their 2 newish cars on the other.  These people made a lifestyle choice the precluding them affording health insurance; it's not that they couldn't afford it. It was not a priority for them and while I fully admit I cannot show stats on that fact, I think the numbers of people in this category would shock most everyone.  The funny thing is, in their minds they're telling the God's honest truth when they say that can't afford it.  We live in such an entitled society that our citizens have come to accept what once were considered benefits of many years of hard work and saving to be normal and simply "decent". Anyway, I'll stop that mini-rant and let's put some numbers on this.  So, what percentage of people in the over $50K per year income range could afford health insurance and are choosing not to? Frankly, I believe firmly that 75% of the fall into this category since not all of them are single or married with this being their only family income.  But, I said I'd lowball numbers when it doubt and I will.  Let's go with 33% or 5,000,000.

Our last fact? Another 13,000,000 were eligible for Medicaid or Medicare and, for whatever reason, chose to not enroll in them.  Again, they have chose to be uninsured and we *cannot rightfully include them in these figures if they made that choice.  At least I do not believe so.

So, what is our revised, more accurate body count, pardon my pun, of US citizens who are uninsured and not out of choice?  16,000,0000.  Now, 7,000,000 of those uninsured are children.  Why?  Between Medicaid and CHIP , there's no reason for any child to be without insurance in this country and if they are, it's out of choice.  Their parents have chosen for it to not be a priority.  We cannot count them in the number of uninsured, either.  At least I don't think so.  I mean, we can't rightfully say we need to cover people who have chosen to not cover themselves and their families...can we?  Yeah, I didn't think so.  Nonetheless, I'll give you 2,000,000 kids who may have unusual situations in their family lives that really can't be helped. 

So, what's our final count of US citizens who are uninsured *not* by choice?  You know, the ones that really do need help?  11,000,000 people.  Not 46,000,000.  And this means the percentage of Americans uninsured not out of choice is actually just under 4%, not even close to 14% of our population, as our government likes to state. I'll leave you to digest this while I go have a nap and tend the chickens.  If I had chickens.  So, is our system broken?  Or are our citizens and their values broken?  You tell me and we'll take it from there. 

14 comments:

belladonna1125 said...

I am, admittedly, a liberal, and some would call me a bleeding heart. Others would call me moderate. I just want to say that here.

I, frankly, have stayed out of most discussions because I do not feel qualified to make statements. I haven't read everything involved, and I don't want to speak about something unintelligently. There's plenty of people doing that already.

From what I DO know, I am trying to reconcile my belief that a country that works effectively looks out for its citizens with my belief that our society only works when some have less than others. It's not a pretty thought, but there it is. There are always haves and have nots when the US is at "top form" for lack of a better word. That's why unemployment rates are low during times of economic flourishing, not at 0%.

Do I wish everyone could have some form of health coverage? Yes, and that applies to illegal immigrants, especially since they are bringing communicable diseases such as strains of TB and so forth, into the country. Do I think it's possible or even practical? No. I really don't, and as sad as it makes me, I don't see any way of rectifying it. Here. In the US. At this time.

I am trying to gear my thoughts in an optimistic direction. I hope this is the right way to go. Expect the worst, hope for the best, KWIM?

Anemone Pie said...

BD, you said "I am trying to reconcile my belief that a country that works effectively looks out for its citizens with my belief that our society only works when some have less than others."

I agree...it's something that I don't like either but in the end, it doesn't matter if I like it or not. It's not just our society - when you look at the world as a whole, you see it's necessary to have this system of checks and balances in order to remain in balance. I don't like that some must bear the burden of having less but it's just part of the equation of life.

Contrary to what some might think, I wish everyone could have some type of health coverage, if they want it, as well. It's the "how to we pay for it" part I don't like. I can't be okay with taking from the well-off to give to the poor. It's inherently unfair and it flies in the face of everything this country was founded on. I can't be okay with that, either.

What bothers me the most, though, is that with all the talk of "rights", we - every single one of us - were not afforded the right to vote on this bill as individuals.

CK said...

AP, you said
"I can't be okay with taking from the well-off to give to the poor. It's inherently unfair and it flies in the face of everything this country was founded on. I can't be okay with that, either."

1) Can you share the historical background for our country not being founded on helping each other?

2) Even if our country wasn't founded on that, we can learn and evolve and understand and change. I mean there are many ideals our country was founded on that were quite awful.

3) How come because we began believing one thing, we can't become something different? Maybe something better?

Fondly,
A thorny liberal in your side - "we all do better when we all do better".

CK said...

Could it be that those who "choose" not to insure themselves or their children just don't know how to go about it? I think it's easy for us as fairly privileged, educated adults to look at that and "tsk- tsk" it. But what if we never learned how to be advocates, or how to go out and get the services that are available to us?

People don't always have a home life, upbrining or community culture that teaches them those attitudes or life skills.

I think the "increasing health care costs" are in part a result of the advances in technology in medical care. Which cost money. We can't be surprised that we have to pay for them.

But also, the high costs come from people who want to avoid, AT ALL COSTS, feeling sick.

They also want to avoid, AT ALL COSTS, the inevitability of death that we all face.

Wanting to feel we have more control over our lives than we do, we sometimes ask doctors to do things that aren't in anybody's best interest.

Millions of dollars to save a premature baby who weighs 1 pound? I don't think God ever intended for a fetus of that size to survive outside the uterus. That's why they stay in their mothers for A LOT longer.

Good, comprehensive, basic medical care, yes. Desperate, extreme measures that go on for years, I'm not so sure.

Anemone Pie said...

1) Can you share the historical background for our country not being founded on helping each other?

No. Lol, I can't because we *were founded on helping one another, or that was a part of it, at least. What we were not founded on is being *forced to help one another. Never, ever was that even implied, let alone set forth as a basis of our existence as a nation and there's a huge difference between the two. Let me ask you this - let's say you gave me permission to go into your wallet and take a dollar out every day to give to the homeless guy on the corner that we both know. No problem, right? You see me go into your wallet day after day and get that dollar for him. Then one day you see me take $3 out. I never asked you if it was alright, I just did it. When you asked me why, I told you that a family in Sioux City also needs a dollar a day as does a single mom Los Angeles. No, you don't know them but you'll have to trust me that they need your money more than you do. So, are you just going to accept that because, after all, it's helping others? Or are you going to feel it's unfair to you, theft even, and be pissed?

2) Even if our country wasn't founded on that, we can learn and evolve and understand and change. I mean there are many ideals our country was founded on that were quite awful.

Of course. We started right out by stealing land, for example. But where you're seeing something that needs to evolve and change, I'm seeing something that simply needs some tweaking. Nothing will ever be perfect, but if you really think about the figures I posted up there, what we have now really isn't all that bad.

3) How come because we began believing one thing, we can't become something different? Maybe something better?

We can. And I'm all for better in anything but it needs to be better for the majority, not the minority...this? Is not. The figures the administration is giving us cost-wise? Make no sense and even they won't back them up with explanations. We're literally being told, when asked how this could work, to "wait and see." No, I want to know NOW how the costs have been arrived at so that we can judge whether is is a fiscally sound decision or not. Are you really okay with just accepting what they're telling us with no proof it's accurate?

Fondly,
A thorny liberal in your side - "we all do better when we all do better".

That fondness and thorniness goes both ways, CK ;-)

Christy said...

Good points AP. I think the system is flawed *and our values are flawed.

I am reading and thinking about all of this.

Thanks for opening this up.

CK said...

Thanks for the answers helping me understand your perspective, AP.

Couple more thoughts:
1) I don't know when anybody in the government told me they'd only take $1 to help out the guy on the street corner. We elect our representatives to do make those decisions, and the decisions they make change constantly over time. If we don't like it, we don't reelect them.

2) Having worked for a third party administrator (TPA) for self insured companies myself, I understand that the more people who can be covered, the better. The risk is spread out over a larger pool. This bill requires (by 2014) that people obtain health insurance.

3) We (big We) are currently paying the costs for health care of the uninsured in the most expensive way - emergency room care. Wouldn't coverage for preventive care result in lower costs overall? With insurance coverage, the individual could now be seen sooner, in a clinic, and would be more apt to seek treatment sooner since they now have coverage? How about the reductions in cost from this?

KaytieJ said...

http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf

Is this the right one to reference? It starts out with mortgages, but the table of contents is for the Health Care Reform.

Anemone Pie said...

"1) I don't know when anybody in the government told me they'd only take $1 to help out the guy on the street corner. We elect our representatives to do make those decisions, and the decisions they make change constantly over time. If we don't like it, we don't reelect them."

Absolutely, it's our only solution but that's not the point I was trying (and apparently failing) to make. What was I was trying to relay is that we are given to expect certain things to be paid for, like it or not - schools, roads, welfare programs, overseas funding...and none of those have created a tax increase such as this will. To just dip into our wallets again, and for a larger amount than ever, without asking if we mind (a vote), is amazingly out of line, imo. Let me ask you this...do you (or not) think a national vote would have been a good idea here?

"2) Having worked for a third party administrator (TPA) for self insured companies myself, I understand that the more people who can be covered, the better."

And having worked for an actual, major insurance company (I was your good neighbor...lol) that sold excellent, well-priced health policies for years, I strongly disagree from a fiscal perspective. And in the end, the fiscal perspective is the one that really matters because without money, be it private or government, it's not going to happen.

"The risk is spread out over a larger pool. This bill requires (by 2014) that people obtain health insurance."

Yes, it does. Unconstitutionally, I might add. It also creates fines if you do not do so, fines which are far less than the cost of the insurance. Guess which one many people will choose?

3) We (big We) are currently paying the costs for health care of the uninsured in the most expensive way - emergency room care. Wouldn't coverage for preventive care result in lower costs overall?

No, that's a fiscal fallacy being presented by this administration - the administration I voted for, might I add. *sigh* I'm going to do the next post about costs and you'll see what I mean. We are better off eating those costs.

Of course, and I swear there's no snark intended in this comment, my thorny friend *grins*, if one is emotionally set on this plan then nothing I say is going to change minds. Some people work in feel-good, some people work in numbers. I'm a numbers kind of girl. :-)

Anemone Pie said...

Kaytie, no. It's HR 3200...here's a link. It's the first I found, random pick and apparently Candice Miller is a Congresswoman from MI, but hey, content is content.

http://candicemiller.house.gov/pdf/hr3200.pdf

Christy said...

Thanks for posting the pdf.

I think my biggest problem is the unconstitutionality of this. The taking away from some to give to others without their consent. We should give to others, help out the less fortunate (and I do), but it should be of our own free will, not mandated. This law takes away freedom of choice. Choice of provider, choice of treatment plan, choice of whether I want to gamble with my health or not is decided for me. America was founded on freedom of choice. This is not good, and will only get worse.

The numbers make my head hurt. There is no way to pay for this.

CK said...

AP,
No snark taken - I'm not necessarily emotionally set on this plan. I'm trying to learn more. Asking these questions not because I disagree - more just to generate discussion and to get up to speed myself. I don't believe there is a right or wrong answer. It's complicated to say the least. As are most tough issues. If it was easy, someone would have solved it already.

You did split up my comments - about the more people who can be covered, the better, FROM spreading the risk over a greater pool. Those really were related, and a reason I believe that insuring more bodies is a positive thing.

I'm all for sharing costs - not everyone can afford a swimming pool (or a park, or a police department), but if we pool (pun intended) our money together, we can put have all these things that better most everyone's lives.

While it may cost people something they aren't already paying for health insurance, they will receive something of benefit in exchange. So while it may be cheaper for someone to pay the fine, they get nothing in return. Kind of biting off your nose to spite your face.

The "fiscal fallacy" (as you've labeled it) of the high cost of emergency care vs. preventive care needs to be analyzed beyond pure dollars. Even if the actual dollars are equal, people with health insurance would have improved quality of life, less absenteeism, better school attendance - many non-monetary pluses in the cost column of that option.

We have all kinds of things that are mandated - children must be educated, cars must be insured, dogs must be vaccinated from rabies. Plus income taxes, social security and medicare tax. Why is this any different?

As pretty left brain and right brain - and a numbers person, I know that dollars can be added together in multiple ways to present eight sides to every issue. So I tend to have a difficult time trusting any of them to be a true picture of the cost. Plus, as I said above, costs go beyond dollars.

There's an old CPA joke - "Creative Accounting? 2 + 2 - how much do you want it to equal". I just can't rest my decisions only on that.

I agree that this is going to be virtually impossible to implement. I don't have any answers about how to solve that. But I think the objectives are honorable and in line with our values.

Anemone Pie said...

Christy, my greatest fear is not that we can't pay for the plan in and of itself. I've accepted that. I fear that we will wind up putting people in situations where they are worse off financially *and have lost the health coverage they had through other means.

CK, I'm not sure what to address here seeing as it is in comments and space (plus viewers) are probably limited, so I think I'll just take your comment and and do a whole post on it, with your permission. May I?

CK said...

AP,
I too would be fearful if this plan puts economically disadvantaged people in a worse financial situation or causes them to lose their health care.