Tag: health care

State

Health Care Assistance

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When I wrote about declining enrollment for CHIP in Utah I did some research on the requirements for CHIP. I learned that even though I am fully employed – meaning I make a comfortable living – my kids would be eligible for CHIP if I did not have the option of insurance through my job. More interestingly I learned that there is another program, Utah’s Premium Partnership for Health Insurance (UPP), which my family would qualify for if I chose a traditional insurance plan. (Actually, my company just switched insurance and I could have enrolled in a traditional plan that would have allowed me to have my full premiums paid – partially by my company and the remainder by the state.) This program helps pay the costs of health insurance premiums for working families.

As I looked at the requirements for UPP it shows some interesting biases that are not good for our health care system. The one that makes the least sense is that they explicitly will not cover High Deductible (HD) plans that qualify for Health Savings Accounts. This essentially discourages people from using the best vehicle we currently have for becoming cost conscious and driving down the real costs of health care. If they wanted to encourage people to get the kind of insurance that is better for the whole system they would give the same amount of money – deposited directly into an HSA – for those who have an HD insurance plan as they give for comparable coverage under a traditional insurance policy. Of course the rules would be the same for qualifying plans whether they were HD or traditional.

Tags government, health care, HSA, Utah

State

This Should Tell Us Something

Post author By David
Post date December 12, 2007
3 Comments on This Should Tell Us Something

The idea that the government should be involved in my health care has always been disconcerting to me. When I read Health care: You can’t give it away I was not sure whether I should laugh or cry. Apparently the state CHIP program is losing more families than they are adding even as they expand their budget to cover more kids. So we’re paying more for a program that is covering fewer kids because people are actively opting out faster than they are opting in. I think that should be a big red flag.

That’s the part that made me want to laugh. The part that made me want to cry was:

Judi Hilman, director of the Utah Health Policy Project, said it’s going to take a “Herculean” effort to combat the stigma that has equated subsidized health care with welfare in Utah. . .

“We need a whole strategic marketing campaign to put these programs in a more positive light,” Hilman said.

If the programs are so good for people why do the people they are designed to help choose not to participate? Secondly, and more importantly, what gives anyone the right to insist that those who are leaving or choosing not to partake should be choosing differently?

Another sentence from Ms. Hilman leads to one more question:

“These programs are absolutely essential if they [low-income families] are going to become permanently self-sufficient.”

The question is – where’s your proof?

I have been uninsured with a family of 5 to take care of and I didn’t use CHIP nor would it have helped me become “permanently self-sufficient.” I don’t mean to say that the program is useless, but I do think her statement is based on a whole range of unfounded assumptions – the kind of assumptions that lead to larger and less efficient government dragging our society towards fiscal slavery.

Tags health care, issues, media, reactions

National

NYT On Health Care

I was impressed with the New York Times editorial The High Cost of Health Care. I don’t really have time to review it here right now (it’s quite long) but it is well worth the read and I would like to come back to it later to review it. They talk about some of the approaches to lowering our health care costs, but they don’t attempt to endorse any particular approach. I hope, and believe, that this was an attempt to paint a broad picture in advance of future articles which will explore the issue in more depth.

Tags health care, issues, media, New York Times

National

Health Care Suggestions

Michael Cannon, a self-described conservative turned libertarian at the Cato Institute has some very good ideas on what health care reform should look like. (Hat tip Scott) Some of his suggestions seem like they would appeal to most reasonable people (“think freedom, not universal coverage” and “health-savings accounts are not enough”) while others look like they are ripe targets for those who have been working to “reform” our health care system for 15 years already (most notably “don’t ‘improve’ welfare programs — cut them”). It is important to dig deeper into such suggestions before dismissing such libertarian ideas as heartless. In this case, digging deeper means nothing more than reading the rest of the paragraph:

At the behest of conservatives, Jeb Bush and other governors have made Medicaid more consumer-friendly. The only problem is that Medicaid and SCHIP are welfare programs, and making welfare more attractive leads to…more welfare.

After all what is more heartless, finding ways to help people become more self-sufficient, or teaching them to be dependent on the contributions of people they don’t even know? (The second one sounds like a very precarious position to be in.)

Mr. Cannon also throws in gems like “The lefties aren’t always wrong.” Only a libertarian would say that to a conservative – and the conservatives need to hear it. My personal favorite though (because it’s too easy to forget sometimes) is this – “private markets are not necessarily free markets.” That’s the thing that has worried me about so many of the plans proposed by many leading conservatives. They pat themselves on the back for turning to private markets but they do nothing to ensure that the market is actually free. That difference is why “the health-care industry does not want free markets.” They are all for private markets where they can make their private fortunes, but those who are thriving in a market that is not free have little incentive to make the market free.

Some people will argue that the rising cost of health care is driven by the rising costs of running health care related businesses, but rising costs are easy to accept when you know that nothing short of releasing a drug that leads to fatal consequences is going to put you out of business. Health care is probably more stable than real-estate – and almost as stable as alcohol, tobacco, and pornography.

I’ve strayed from my original point – go read the article by Michael Cannon.

Tags connections, free markets, health care, issues

National

SCHIP Numbers

The SCHIP politics are perfect for people with different ideals to keep political pundits happy – do you favor smaller government and oppose helping children, or do you help the helpless by taking money from everyone else? President Bush did what he said he would do and vetoed the bill. Congress failed to override the veto. So now it’s back to the drawing board without anyone having changed positions. I’m all for smaller government and that was an ambitious expansion, but the numbers didn’t add up even if I were less conservative.

. . . the vetoed bill that would have more than doubled the funding from $25 billion for the next five years to $60 billion and expanded coverage from 6.6 million children to 10 million.

So for 2.4 times the price we can ensure 1.5 times the number of children – that sounds like we’ve just introduced a lot of waste into the system.

Bush and many House Republicans . . . want the program narrowly tailored only for those making twice the poverty level or less, though they would not remove anyone making more who is already enrolled. The president says that leaves about 500,000 children who are eligible but not yet enrolled.

“I want to provide enough money to make sure those 500,000 do get covered,” Bush said Wednesday. “That ought to be the focus of our efforts.”

At first, Bush only wanted to add $5 billion in spending, but government budget analysts say that is not enough to cover the rising health care costs of those already in the state programs.

Somehow I just can’t escape the conclusion that the mentality “if it’s getting too expensive just let the government pay for you” can only lead to financial ruin for the country. Have we forgotten that funneling money through the government does not increase the amount of money available. Even if government programs cost nothing it would be a zero sum equation. If costs are rising then we need to find a way to reduce them, not just play hot-potato with the bill.

Apparently there is an alternative solution being proposed in the House that covers those under 200% of the federal poverty level and then gives tax credits for those up to 300% of the poverty level. This would give coverage to most of those who would have been covered in the original bill, but through different mechanisms – the question on this new bill is – what’s it going to cost. Even if I prefer tax credits over federal programs I don’t want to pay $65 billion to cover 10 million children with tax credits any more than I want to pay $60 billion to expand the existing government program.

Tags health care, issues, money

National

Health Insurance Isn’t Insurance

Post author By David
Post date October 16, 2007
3 Comments on Health Insurance Isn’t Insurance

Steve Olsen started a discussion about healthcare at THE UTAH AMICUS (I’m looking forward to part II) by asking: Is “free market health insurance” a nonsense phrase? He then identifies two issues that we must face head-on if we are to have any hope of actually pursuing a solution to this problem.

We hear a little about “this is how I’m going to pay for it” in these proposals, but very little of “this is how I’m going to eliminate waste, fraud and excessive profits”. Most independent studies have estimated between 25 and 40 percent of America’s health care dollar is spent on things other than actually providing care. . .

Not only that, improving the cost efficiency of health care has become an economic necessity. Consider Chrysler Corporation. In 1998, Daimler Benz paid $38 billion to purchase Chrysler, and earlier this year, essentially paid Cerberus to take it off their hands. Why? To escape the billions of dollars in unfunded health care obligations to employees and retirees. Basically, a major American manufacturing company was driven to insolvency because America expects employers to foot the bill for health care, something no other major industrial country does.

It is interesting that everyone seems to know that inefficiency in the system needs to be removed and yet there are no concrete ideas being presented on how to do that by any of the candidates spouting their proposals. The last time I wrote about health care I said that we need consumers to become sensitive to the costs of health care services rather than being sensitive to the costs of insurance premiums. Steve’s post reminds me that most Americans has even been insulated from the costs of insurance premiums until the last decade or so. Free markets promote efficiency but we are not going to have a free market for health care until we address the second issue that Steve discusses. (This is true no matter what Health Insurance Connector Authority we may decided to create.)

I believe one thing that hamstrings our efforts to improve health care is our insistence on using the word “insurance”. Let’s look at the dictionary definition of insurance: “A means of indemnity (transferring the responsibility for loss) against occurrence of an uncertain event.” Using the conservative definition of socialism, insurance is essentially socialistic, since it transfers personal responsibility to a larger group in society. The characteristic that allows insurance (in the traditional sense) to work in a free market system, despite being socialistic, is the fact that the event insured against is both uncertain and undesirable. . . Except for isolated cases of fraud, the undesirability of the event being insured against means collection of the benefit will not be abused.

Is health care a proper fit for the insurance paradigm? There are instances of catastrophic illness or accidents that meet the definition. But, in general, most consumption of health care services is neither uncertain nor undesired. We want that daily dose of Lipitor to keep our cholesterol down. We purposely conceive children and consume the health care services necessary to bring a new baby into the world – and we also consume birth control medicine to avoid pregnancy. Whether the illness is diabetes or bi-polar disorder, health care is often a matter of planned consumption where strong and significant consumer demand exists for the product.

People should be allowed to choose the kinds of plans that currently pass as health “insurance” but we need to wake up to the rigged system that we are working with. Insurance companies make it more expensive for doctors to operate and consumers pay that price. Worse yet, patients who don’t have insurance are charged higher prices to compensate for those extra costs because the insurance companies set their own prices on what they will pay for various treatments and office visits. This may be financially beneficial in the short run, but the result is that patients want to get their money’s worth so they expect more services. More demand means higher prices. If consumers were sensitive to the prices of individual procedures the demand would level off as the procedures got too pricey. On the other hand, more demand can lead to efficiency, but the insurance companies keep paying the same price for a procedure (and never lower their premiums) whether the system is efficient or not so the costs remain high even when doctors find ways to improve the system.

One comment from Scott Thompson asks Steve to run for Congress against Rob Bishop again. I don’t know enough about Scott to vote for him (not that it matters since that’s not my district) but I am impressed that he would come out and directly identify the central fallacy that keeps us from actually fixing our health care system.

Tags economics, Elevated, health care, issues

National

Fiscal Realism

I keep returning to the sentiments of Reality Check – that we need to realize that on tough issues we will not be able to satisfy everyone and that the decisions we make must be based on what is best and not merely based on what offends the fewest people. This comes up again as I read the platform for Divided We Fail. This is an initiative of the AARP. I do not wish to accuse the AARP of not caring for the future, but I think it is fair to note that when push comes to shove the best solution for the next 5 years is going to be more favorable to the AARP than the best solution for 30 years from now.

Their platform consists of 6 points – 3 on social security and 3 on health care:

All Americans should have access to affordable health care, including prescription drugs, and these costs should not burden future generations.
- This sounds like a noble and universal sentiment.
- We can deduce from their other points that the path they envision is one of government backed health care which is not possible without being a burden on future generations so this goal is unattainable in its fullness – one part has to give.
- For more insights here go read No Free Lunch.
Wellness and prevention efforts, including changes in personal behavior such as diet and exercise, should be top national priorities.
- Absolutely. This is the one undeniable truth, and the single most influential factor in the rising costs of our current health care system. How do we go about doing this?
Americans should have choices when it comes to long-term care – allowing them to maintain their independence at home or in their communities with expanded and affordable financing options.
- Agreed. Only, what “affordable financing options” do they have in mind?
Our children and grandchildren should have an adequate quality of life when they retire. Social Security must be strengthened without burdening future generations.
- Everyone (the AARP as well as their children and grandchildren) deserves an adequate quality of life when they retire. We might need to define “adequate quality of life” because what that seems to be today may well be unsustainable.
- On the other hand, there is no possible way to strengthen social security without increasing the burden on future generations. Some generation is going to have to take the fall on this one. The program needs to receive its sunset – Sadly, I feel compelled to volunteer my generation. I don’t expect to receive social security benefits. Even if social security benefits are still available I hope not to avail myself of that benefit. (Why should I be a burden to my posterity?)
Workers should be provided with financial incentives to save, should have access to effective retirement plans, and should be able to keep working and contributing to society regardless of age.
- I agree.
Americans of all ages should have access to tools to help manage their finances, and save for the future and better, easy to understand information to help them increase their financial literacy and manage their money wisely.
- This is another point that sounds good but the pessimist in me is skeptical that we will ever really educate the majority of our population on money matters.
- I also believe that managing money more wisely requires more than financial literacy – it requires a new attitude about the value and nature of wealth. So long as we are driven to keep up with the Joneses financial literacy won’t make us wise managers of our money.

Tags economics, health care, issues, social security

National

Suggestions on Health Care

Post author By David
Post date September 20, 2007
3 Comments on Suggestions on Health Care

I have noticed a pattern lately in the articles that I have been linking to (and displaying in my sidebar) – many of them (4 out of 10 currently) deal with the issue of health care. I would like to post on all four eventually but for now I would like to discuss my thoughts on some of the general principles that I am seeing in the health care discussion.

The idea of a single payer system spells economic disaster to me.

The idea of forcing everyone to purchase insurance seems fine on the surface with the typical caveats that we subsidize that cost for low income people. On the other hand, I think that people should be able to choose to not purchase insurance if they have enough personal wealth – with the understanding that they will be fully financially liable for any care they receive. This may sound backwards since the wealthy would be the most able to purchase insurance, but imagine that I am a very healthy millionaire (I am healthy, but I do not have even a fraction of a million dollars in net worth) – there is no reason to force me to purchase an insurance policy if I am willing and able to assume the costs of my health care. Perhaps I have to sign away any right to declare bankruptcy in the face of medical bills.

There are two major things that any attempt to fix our health care system must address if they are to have any hope of success.

The first is to make people sensitive to the costs of health care. Right now most of us are only sensitive to the costs of health insurance. Once we have insurance (whether our own, through an employer, or Medicaid/Medicare) we cease to be cost-conscious because most of the cost is already paid. (High deductible plans have the advantage of keeping the consumer cost conscious.)

The second crucial change that must be made is to find ways to encourage healthy lifestyles and preventive care.

If we address these two changes the entire problem would become more manageable because we would have better health and less being spent on elective procedures. We might even hope to have fewer lawsuits driving up the cost of health care as people become more involved in making their decisions of what procedures they undergo.

Tags economics, government, health care, issues

culture

Growing Discomfort

I said before that I was becoming increasingly uncomfortable with my favorite major candidates over one issue. That issue is the issue of health care reform. Obama seems firmly in the camp of having the federal government provide health insurance for many or all Americans. I think this is a very bad idea. It looks easy on the surface, but I think it is a step towards making our government financially insolvent.

On the other hand, Mitt Romney has experience implementing health care reform as governor. On the surface his approach sounds more like the kind of thing that I could accept. That means I am more comfortable with Romney than Obama on this issue.

What this country really needs is for the federal government to scale back in many areas where it was not meant to be. We are working towards a homogeneous society where there are no substantive differences between Idaho and Florida. The strength of this country is our freedom to make choices. Unfortunately we are working to create a society where there are no meaningful choices that have not already been made for us through our laws. This is not a recipe for stability. We need the challenge of meaningful choices if we are to hope to build the kind of strong character in our citizens which drives us to do the things that make this country great.

Tags citizenship, government, health care, issues, Romney