A Long Lean Season

I was in the mall the other day and felt oddly liberated.

I was walking into a clothing store and was genuinely interested in buying a shirt. And I was free to buy one. The Boy needed a pair of shorts and if I'd been willing to put up with his militant refusal to try on clothes - I could have picked up a few pairs for him as well.

This was odd. Partly because I hate malls in general - but mostly because I'd tried to think back to the last time I'd shopped for clothes. It had been a very long time. Like - since winter.

In my family, I'm the spender. E will part with money when you hold her head to the fire - but I genuinely enjoy the experience of seeking out and purchasing stuff. And I hadn't bought so much as a shirt over six months.

But this wasn't really about shirts or clothes, even. This was about feeling like if you bought something you wouldn't feel like you were stealing from the family till.

I can do this - on impulse, even.

And while I didn't buy anything - it sure felt good to unclench that part of my mind that always told me I couldn't.

Because this past summer was not a fun time in the family finances. We've always had high property taxes and so a good part of our budget is shoving money aside to make sure we've got enough to pay the tax man twice a year.  We save our shekels until January or July, then watch them fly out the door and start over.

In the normal run of things - this is not a big deal, but with the fear of getting canned and then changing jobs there have been more than a few holes in our financial plan. We're all right, but you're more aware of the height you're at when somebody starts removing the safety net.

With changes to our insurance plan, a larger share of our medical bills became our responsibility this past year. Coincidentally, this was the year we discovered that my son would need a second round of treatments for something we'd thought had been cleared up last year.

You hear an awful lot about medical bills driving people into bankruptcy these days - and it's easy to see why.

My son had a series of appointments - evaluation, preparation, the actual procedure, and follow up. These are all classified differently and there is no way for me as a consumer to get a sense for what they will cost.

Nor will I have any idea when these bills will show arrive or when they will be due.

So you sock money away for that uncertain future.

Part of that uncertain future is paying for summer childcare. We pay for a patchwork of camps and daycare for two small children. All enrollments require prepayment, so this suddenly turns our normal childcare bill of $500 a month into $1,000 a month and $1,300 a month.

Again, I'm sure there are people who pay more - I'm merely talking about the variance.

A fixed cost suddenly doubles or nearly triples - and you're hauling money out of savings to patch the hole. Right around the time you're about to get that prepaid childcare - and enjoy not paying a bill that month - that's when the hospital bills start rolling in.

The first hit was dental. The Boy needed a bite plate - a $600 piece of plastic that we were assured will cost us a mere $300 - but triggers bills demanding the full $600 since insurance won't pay.

Next up was me. This was a surprise one - but I'd gotten a replacement CPAP machine last year and my monthly bill suddenly doubled as (unbeknownst to me) my insurance had stopped paying for leasing my machine and I was now buying it on my own. $108 please, you're welcome.

Uh, okay.

Then E got some tests done. $130 for the test - and... $180 for the room the test was performed in.

We haven't even gotten to my son's stuff yet. His is split up into many parts but adds up to about $500.

The point of all this wasn't "gosh I'm so poor" - but rather "How the hell does anyone budget for this?"

Literally the day after I'd gotten the $180 bill for my wife (which had a due date that was a week away) I got a call from the hospital's billing department - they wanted to know if I needed to set up a payment plan. I reflexively said no, but I probably should have said yes - since my son's bills hadn't landed yet.

I was seriously ticked off at the ortho folks and my dentist - telling me a bill would be $300 and then billing me $600. About the time we find this out - the Boy loses his bite plate and we have to buy another one. This time for $300.

I spent a not insignificant amount of time trying to find out if we truly owed the full amount for the first one or just the half like we were promised. Six months after the procedure, we found out the answer - we needed to pay a total of around $400.

All of this lands in a month where we have a $700 landscaping bill and are paying $1,600 for a month of childcare.

And I want to make something clear here - lest the sound of a violin drown out my main point:

I am a very fortunate man. I have good health insurance - very good health insurance. I am very well compensated for the job I do. The summer of 2013 was a very painful time financially - but I know there are literally millions of people in this country who would trade places with me in a second.

I know this.

My point isn't to cry poverty - my point is to illustrate that a family as fortunate as mine can go way off the rails because of medical bills. Mind you, these were not major procedures and our copay is pretty reasonable. Picture the person with truly bad health insurance - that $500 bill for my son was for something that cost thousands of dollars.

Were we uninsured - the total bill would be higher, and we'd owe all of it. I can't even begin to imagine how a household budgets for that. Or copes with that.

And I can easily imagine a scenario where I stayed at my old job and got laid off mid-year. That would turn our life's trajectory towards those scenarios you keep reading about in the paper. Hollow out your 401K, sell your house, the kinds of things that do keep middle America up at night.

But I got the new job. And we weathered the storm. Outside of a few Kickstarters I got into back in March - the discretionary stuff has been kept to a minimum.

When the car needs gas, I get gas - instead of putting it off until it's closer to payday. I'm starting to repair the damage to our savings.

I just got a year older - and Jen's family are coming over on Saturday. We're going to go all out. It's gonna be a thing.

And the day before?

Goddammit, E and I are going to go out.

Aside from daycare - I can count on one hand the number of times we've hired a babysitter for the night. Since my son was born.

So we're doing this.

The new job threw some extra money my way and we are going to celebrate.  I've got lunch reservations at a trendy new spot (easier to do lunch) and E's booked her co-worker's daughter to watch the kids at night.

We're going to see Gravity.

 

Last time E and I went out to see a first run movie? I don't even know. I think we had an evening free sprung on us last minute and we went to see Despicable Me, because it was the only thing in theaters we could stand. Neither of us was excited to see that movie - but we weren't missing a chance to get out.

This time around, this is a movie we both want to see. A lot. I do something I haven't done it ages: I pre-buy the tickets and reserve specific seats. Middle of the row with nobody in front of us.

Lunch reservations online? Check.
Babysitter? Check.
Movie tickets to awesomeness? Check.
Weekend with family? Check.

This is going to totally rock.

The Long Lean Season will finally be put down. Double tap to the head.

*     *     *

That was Monday.

Two days ago, little e comes home with news from school: somebody in her class has head lice.

Deep breath.

We've done the drill before - E transforms into Patton pretty much anytime there's been a whiff of this around the house - so we sit the kids down and sort them out.

Yes, little e has head lice. The boy has nits.

E mobilizes for Iwo Jima and we're purging the house of stuffed animals and pillows. Everything will get laundered. Every head will get picked over.

The kids will stay home from school.

That was yesterday.

The boy was cleared for school for today. Little e was not, so E's staying home with her all day.

Lunch is out. I click the "Cancel reservations" link in my confirmation email.

Lunch reservations online? Un-Check.

Babysitter?

We call to let our sitter make an informed choice about coming over. I entertain all kinds of hope that they'll say the odds are low and E and I will still get our movie.

But they call to cancel. The sitter's family has done forty rounds with head lice before and they are never going to do that again.

Un-Check the Babysitter.

Movie tickets to awesomeness?

Pre-paid - I'm still thinking there's some way one of us could go, grab a friend. Or give the tickets to someone. E calls and finds they'll do an exchange or refund. So we'll just bail.

Goodbye, opening weekend movie. Un-check.

And I emailed Jen to give her the full wave off for the weekend. They're family and they could probably deal, but I don't want to inform them and leave it in their hands to decide. They're nice enough to come despite the situation - but I don't want to risk them.

Weekend with family? Un-Check.

Oh, and the $300 water bill just arrived. And your car registration is due.

*     *     *

The good news? The hospital bills are paid. The sheets are clean. And it's payday.

Little e is crying because her cousins can't visit and all her fuzzy friends have to be bagged up and taken away.

The Boy is mad because he had to go to school and his sister didn't.

E's been at DEFCON-1 for so long I'm not sure where her mood is.

And tonight, I'll go home and help E do battle with the lice.

Then we'll watch some TV, read a little twitter and turn in.

The pillows will be gone - we've got pillowcases stuffed with towels. Our pillows are isolated in the plastic bags filling the upstairs hallway. We won't be using them again for weeks.

We'll fill the next two days with cleaning and picking nits, and then the work week will reset and we'll try this whole mess again.

Looooooooong exhale

I just wanted a weekend.  Just one, huh?

Do You Feel Lucky?

So, it's open enrollment and (as tradition dictates) I'm in the final hours of the window reading the help files and wracking my brain to remember what we do and don't have as a household.

My employer outsources the process to a webservice which is (workflow wise) pretty impressive.

They give you a progress meter ( 1, 2, 3 steps and you're done!) and they offer you every single option imaginable. You're required to waive or accept each and every plan, twice - so there's no single misclick can sentence you to unwanted benefits.

Getting you through the process in a few minutes speaks to a process that is well formed. Having online validation makes sure you don't submit bad choices - so I'm sure it's win-win for the employee and their employer.

There are even tutorials on what the various plans do for you -  which is pretty freaking important, seeing these are year long commitments to plans that can be the difference between maintaining your current lifestyle and total catastrophe.

While some of the tutorials nicely illustrate the broad concepts of things like flex spending accounts - there are also moments like this one detailing the reasons a person might get disability insurance:

I mean - the chances are "very good" that I will become disabled? Really? This is for a plan whose benefits start on the 15th day of disability, supplemented by another plan whose benefits start on the 151st day of disability.

And this is for a business whose employees work in information technology.

Thinking back to my closest brush with disability - surgery and in hospital for five days. Still nowhere near qualifying for the short term disability coverage.

But it's not like I'm getting any younger.

Do you listen to the merchant trying to sell you stuff...?

Smartmoney says there is a good chance, so now you're comparing your own experience against the odds.

How does a person make an informed choice about getting this kind of coverage? 

Arrgh.

Ezra Nails It

(H/t E)

Ezra in the WaPo: (emphasis added)

...Americans tend to distinguish between benefits they feel they've earned -- Social Security, say -- and benefits they consider giveaways. It's not a very useful distinction, but it's a convenient, and thus a powerful, one. We have a vast welfare state for the middle and upper classes, but the politics of it are entirely different.

For instance: Among the more mind-blowing facts about the health-care system is that the tax break we give to employer-provided insurance dwarfs the cost of the entire Affordable Care Act -- and, if you want to take the concept a bit further, this means those of us who don't get insurance from our employers are being forced, even mandated, to pay for those of us who are. But this break is largely uncontroversial in American politics, while subsidies to help people who can't afford health insurance are extremely controversial.

Peek Into The Chamber

(Via CJR)

Ryan Chittum nabs an interesting find from Bloomberg.

Health insurers last year gave the U.S. Chamber of Commerce $86.2 million that was used to oppose the health-care overhaul law, according to tax records and people familiar with the donation.

...

The spending on the Chamber exceeded the insurer group’s entire budget from a year earlier and accounted for 40 percent of the Chamber’s $214.6 million in 2009 expenditures. ...The $86.2 million paid for advertisements, polling and grass roots events to drum up opposition to the bill, said Tom Collamore, a Chamber of Commerce spokesman.

Read Chittum's commentary. Nice to see the health care lobby doesn't have the guts to own up to its own viewpoint. So they hire the Chamber, willing surrogate for anyone who can pay.

A Better General vs. the Army of Death

Atul Guwande writes another thought provoking article about the state of health care:

The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don't want a general who fights to the point of total annihilation. You don't want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn't, someone who understood that the damage is greatest if all you do is fight to the bitter end.

(H/t Atlantic)

Kick the Can

Trudy Lieberman digs into a report from Medicare's chief actuary, Richard Foster. It's an analysis on the projected effect of health care reform on health care costs.

Here's Trudy:

Foster crunched some numbers and found that health care costs will likely continue to increase, despite promises from politicos that reform would actually lower them and make those darn insurance premiums affordable. Upon signing the new law last month, the president himself said that the measure would “bring down health care costs for families and businesses and governments.” Well, what do you know? It may not.

Simply put, Foster says that the new law will not slow the growth of the nation’s health care bill. Instead, the cuts in Medicare spending and other ways Congress has finagled the financing won’t offset the big bucks needed to provide health insurance to thirty-four million currently uninsured Americans. In fact, Foster wrote that the country’s medical spending would increase by about $311 billion (0.9 percent) over the next decade. One of the biggest reasons is that more insured people will be using more services. That should have been obvious, given that the total health care expenditures equal the number of services times their price.

So, yes, you will have more people insured, yes egregious exploitation of consumers will be reined in somewhat - but the overall problem remains. We will continue to spend more on health care.

The last time we went after Medicare spending (mid-1990s) - we did not fix much of anything. Newt Gingrich described that effort as "a little bit like having a car that needed an engine overhaul, and we changed the spark plugs and got you to the next phase."

As if that weren’t enough, Foster['s report] raised the specter that Congress might have to revisit some of the Medicare cuts—perhaps even cancel them, as they have done for the doctors year after year. Even though in the late 1990s Congress decreed cuts for the docs, physicians have repeatedly lobbied the press and the pols to stop the cuts from taking effect, and they are scheduled to do that again this week. Furthermore, the report noted that the proposed cuts might be deep enough to affect the solvency of about 15 percent of hospitals and nursing homes, causing some to stop treating Medicare patients and “possibly jeopardizing access to care for beneficiaries.”

So, we've created a promise to cut Medicare payments - that will likely get lobbied out of existence. If the cuts do go into effect we'll have hospitals in jeopardy.

I don't think anyone ever believed that the heath care bill would put our health care troubles to bed - but if Mr. Foster's projections prove out - I'm sure I won't be alone in my disappointment that we had a year worth of legislative combat, and the end result was Medicare getting another shiny new set of spark plugs.

0 for 90

The [California Department of Managed Health Care] randomly selected 90 instances in which Anthem Blue Cross of California dropped the insurance of policyholders after diagnoses with costly or life-threatening illnesses to determine how many were legally justified.

None were. “In all 90 files, there was no evidence (that Blue Cross), before rescinding coverage, investigated or established that the applicant’s omission/misrepresentation was willful,” the DMHC report said.

Full article on Reuters.com

(H/t CJR)

Trudy's Devilish Details

CJR's Trudy Liebermann brings a fine piece of information to the health care debate - and wonders why we weren't talking about it earlier:

[Health Care Reform] will require the National Association of Insurance Commissions (NAIC), the group of state regulators that writes rules for insurance companies, to come up with new requirements for the most popular Medicare supplement policies, Plan C and Plan F. These policies are purchased by close to 60 percent of all Medicare beneficiaries who have supplemental coverage, including gobs of people living in South Florida. The idea behind this change is to make these Medicare supplements cover less and require seniors to pay more for their coverage—in other words, shift more of the cost of medical care to them.

The theory is that if seniors have to pay more, they won’t go to the doctor as often. “More cost sharing is the continued triumph of the unholy alliance between the academic economists, policy wonks, and the Republicans who think that health care costs so much because people have too much insurance,” says Bruce Vladeck, former Medicare administrator and now a senior adviser at the Greater New York Hospital Association.

...Nobody is talking much about this potential expense for seniors, who will feel the financial pinch beginning in 2015—a date that those retiring in the next few years should keep in mind as they embark on their planning. That, to us, suggests some good consumer stories down the road.

Why did this provision slip through virtually undetected by the media? Were their heads too wrapped up in the donut hole, along with the political spin from Dems and Republicans about helping all those folks on Medicare? I asked a top official at the AARP, who replied: “We are conflicted so we have chosen not to comment. I think seniors will be unhappy, and it won’t affect utilization at all.” In other words, seniors will still go to the doctor—they’ll just have to shell out more to cover the bill.

Now wouldn't that have been a fine discussion to have in the debates? Instead we were treated to shouts of "Socialism!" and fanciful notions of Death Panels.

Seniors paying more is never something that plays well - and I'd be interested to know why this perfectly valid criticism wasn't given more play and substance by the opposition.

Barry on Health Care

Barry Ritholz posts some off the cuff observations about health care in the US - (which are nice) but the winning 'graphs are his personal experience he posts in the comments section:

I used to be a pitcher, and somewhere between college and last year I tore my rotator cuff. Never knew about it, never bothered me. One night, I wake up in pain, Can’t lie on the shoulder. Gets worse, and worse, and after a month I finally go to the orthopedist. X-rays in his office, “yep, it looks like a problem, you need an MRI.”

Here’s where we go down the rabbit whole.

I say, let’s do it, and the doc tells me he needs permission from the Insurer. So a 24 year old girl with a High School diploma sitting in a cubicle in Syracuse has to give approval to my doc, (Yale undergrad, Columbia Med school). That makes no sense.

Even worse, it takes a week to get permission, and then another week to schedule the MRI. This means I am in pain for 2 unnecessary weeks. Very annoying.

MRI comes back positive, and I say (right from Rocky) Doc, cut me. He warns me its a six month long rehab — grueling physical therapy (PX), very uncomfortable. Better alternative is to try Physical Therapy before hand. 3X week for 4 months — massage (not the good kind — painful and no fun), strengthening, stretching.

Further down the rabbit hole: It seems that every 4th visit, the insurer wants an evaluation done. This is a ridiculous waste of time — it seems as if they are trying to discourage the treatments. I speak to the insurer, get a colossal runaround. I speak to 5 different people, there is no way to waive this.

I have a simple solution — cancel the PX, and get the Doc to schedule the surgery. My insurer SUDDENLY becomes way more responsive. Senior VPs are calling me, trying to get me to try PX first. My terms are simple Evals after every 10 weeks, not 4th visit. I keep getting bumped up to higher VPs.
When we reserve the operating room for the actual surgery, they finally cave. I make them fax the pre-approval of the entire PX in writing. Surgery canceled, PX effective.

That is the sign of a very broken system . . .

Once again: rationing? Check. Bureaucratic delays? Check. Pointless suffering and run around? Check.

And that is our current system.

Frum on Health Care's Waterloo

I have no love for David Frum, and while I think much of his Waterloo article is aspirational - it nicely encapsulates what is wrong with current political strategy.

Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.

...

A huge part of the blame for today’s disaster attaches to conservatives and Republicans ourselves.

At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo – just as healthcare was Clinton’s in 1994.

...

This time, when we went for all the marbles, we ended with none.

I think Frum's pandering a bit - but here's a bit that I especially appreciate:

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.

Exactly the observation that was lacking in the all the commentary and posturing of conservatives.

This legislation was not a left wing showcase of ideas. It was a stumbling attempt to make something that would pass with broad support. The GOP chose to go scorched earth against ideas they used to support. Which made them look craven and stupid. To whip up the faithful, they made demonstrably false statements, invented any number of inane straw men - and finally trotted out the tired old canards of immigration and abortion - (as if this bill was an attempt to wander into either of those minefields).

A lot of people got mad - but in the end, the Democrats finally were forced to use the majority they had been given.

In the health care summit, the visual that keeps springing to mind is the President saying over and over again that there were large sections of the bill that they could agree on - and that a viable course would be to pass those measures and then put the more contentious items into a separate bill. This was resoundingly rejected with calls to "start over" - which is Washington-speak for "do nothing."

It's disappointing on lots of levels, because there are good conservative ideas (no matter how well hidden they are behind the idiocy of GOP party leadership) and because a president wasted a year attempting to pass this with the GOP and ended up without a single conservative vote.

You wonder if the GOP will change tactics, or if they will double down yet again. I don't believe bipartisian legislation is inherently more virtuous or effective, but I think that unavoidable problems require legislation, and scorched earth politics just prolongs our national agony.

If this was a Waterloo - I'm hoping the GOP's old guard gets left on the battlefield. They'd be a better party without them.

(H/t TPM)

Bolsheviks and Baby-Killers, Unite!

Well, I'll be damned - the Dems actually grew a pair and passed a bill.

Golf clap, anyone?

Now how's about passing the reconciliation bill, add a robust public option, and get off my tv for a while, eh?

I'm sick of you people.

Wide Open

The NYT has a jaw dropping article about fatal mistakes in radiation treatment.

Mr. Jerome-Parks died...in 2007. He was 43.

A New York City hospital treating him for tongue cancer had failed to detect a computer error that directed a linear accelerator to blast his brain stem and neck with errant beams of radiation. Not once, but on three consecutive days.

The accompanying graphics do a first rate job of laying out the situation and resulting mistakes.

I won't even try to summarize - it's worth a read.

Heath Care: The End Of The Beginning

In the confused dialog of what passed vs. what ought to have passed in the Senate - I've found two items I'd highlight.

Nate Silver (of FiveThirtyEight.com) and Marcy Wheeler (at Emptywheel) are going at it hammer and tongs over whether the Senate Health Care bill is or is not the apocalypse.

Unlike virtually everything you are likely to see on network - this is a discussion of people who are data driven and committed to having an informative debate.

Nate: Postscript

Marcy: “Affordable” Health Care

Nate: The Senate's Bill Helps Working Families

Marcy: Why Can’t Bill Supporters Say “Affordable”?

Nate: Health Insurance and the Family Budget: Highly Affordable for Some, More Affordable for All

I have great respect for these two bloggers - and a written back and forth can do a lot to clarify an otherwise very murky landscape.

---

The other item is just the observation from a blog I wish I could remember (it'll come to me)...

This nonsense coming out of the right to run on "repealing ObamaCare" makes for a good demo, but puts the GOP in the unenviable position of telling America that they want to restore recission. That the GOP wants people to be disqualified for pre-existing conditions.

Of course the GOP does not want that - or at least those in the GOP that want that are smart enough to know they cannot say that. So they will have to say they will keep the good parts of ObamaCare and just remove the bad parts - which is a much harder soundbite to serve or swallow.

Another health care case study

Trudy Lieberman shows us how little the current health reform will do for a family unfortunate enough to have high deductible health insurance.

The net effect of all the "reforms?" - They get to keep the lousy coverage they have.

Health Care, cost controls, and choice

It's really hard to know what to believe about heath care reform these days.

You read Robert Reich and this much ballyhoo'ed Public Option sounds more like a horse that's been compromised into a camel:

...the compromise that ended up in the House bill is to have a mere public option, open only to the 6 million Americans not otherwise covered. The Congressional Budget Office warns this shrunken public option will have no real bargaining leverage and would attract mainly people who need lots of medical care to begin with. So it will actually cost more than it saves.

But even the House's shrunken and costly little public option is too much for private insurers, Big Pharma, Republicans, and "centrists" in the Senate. So Harry Reid has proposed an even tinier public option, which states can decide not to offer their citizens. According to the CBO, it would attract no more than 4 million Americans.

Yet this is the provision that will be filibustered by the right wing. Because it will destroy private health insurance and turn us into a socialist state.

Uh-huh.

Then you read Ronald Brownstein - and get a totally different perspective on what is and is not happening in the bill when it comes to cost controls:

...the Reid bill's fiscal strategy, and its vision of how to "bend the curve," almost completely follows Baucus' path from September. Baucus' bill was the first to establish the principle that Congress could expand coverage while reducing the federal deficit; now that's the standard not only for the Senate but also the House reform legislation. And, perhaps even more importantly, the Reid bill maintains virtually all of Baucus ideas' for shifting the medical payment system away from today's fee-for-service model toward an approach that more closely links compensation for providers to results for patients. In the Reid bill, there is some backtracking from Baucus' most aggressive reform proposals, but not much.

Almost everything Baucus proposed to control long-term costs have survived into the final bill. And, with only a few exceptions, that's just about all the systemic reforms analysts from the center to the left have identified as the most promising strategies for changing the economic incentives in the medical system. (The public competitor to private insurance companies championed by the Left would affect who writes the checks in the medical system, but not what the checks are written to pay for.)

That post heaps praise onto Sen. Reid's bill for a host of measures that are not part of the current media scream fest.

Then you have Lieberman. No, no - Trudy Lieberman - the one with a soul. She's been dogging this story since the beginning, dredging up all sorts of untidy details. Here's her latest find:

[it's] one of those pesky details embedded in both the House and Senate bills—a clause that lets insurance companies cross state lines to sell their wares. Way before last year’s election, Ronald Williams, the CEO of Aetna, told the Senate Finance Committee that allowing cross-state purchasing of health insurance was a necessary ingredient for reform. The Senate Finance Committee, along with the House, heard his plea.

The provision, euphemistically named the Health Care Choice Compact, would work like this: Two or more states could join together and allow insurers selling health coverage to be governed by the laws and regulations of the state where the policy was issued, not the rules of the state where they’re sold. So a company wanting to sell in, say, Wyoming or South Carolina—which may have weak regulations—could choose to issue its policies in those states but actually sell them in New York or California—where the rules are tougher. If policyholders have problems with their coverage, too bad: the rules of the weaker state would apply, and they could be out of luck.

Insurers, looking toward lucrative new markets, want to fashion their new policies without having to deal with the restrictions and consumer protections required by some states. In other words, the current definition of market reform will mean they have to insure sick folks; in return, they will offer policies with less coverage and fewer protections. Think of it as back-door underwriting—a process that limits these companies’ liability for high-cost claims.

This is the core of the insurers’ business strategy, wrapped in the guise of consumer choice. Remember, this is the Health Care Choice Compact we’re talking about. If consumers want a policy with few benefits or no protections, that’s their choice. It’s kind of like letting a U.S. toy manufacturer sell yo-yos that conform to Chinese—not American—regulations. Take your choice: a yo-yo with lead, or one without?

This is the same crap McCain tried to sell in the election. The same notion that candidate Obama dismissed as something that would lead insurance to follow the pattern of credit cards: a race to the bottom of customer service and value.

Seriously, WTF is going on up there? We're going to have grandstanding about the Public Option and miss the fact that insurance companies are going to end run consumer protection laws? And what about the cost control stuff? If it's good, how come we're not seeing it placed front and center in the discussions?

Instead, we breathless coverage of the vote count, and who's in and who's out. This isn't a horse race - this is the future of how families get health care. Let's nut up and talk policy, now. Otherwise we're going to see a CMFA for the health care industry squeak through while the talking heads blather on about the vote count.

Health Care: Us vs. Them

Ezra Klein had some eye-popping charts on the relative cost of health care in other countries.

Now, you know that we pay more, right? But check out the details on specific services.

Here's Ezra:

The health-care reform debate has done a good job avoiding the subject of prices. The argument over the Medicare-attached public plan was, in a way that most people didn't understand, an argument about prices, but it quickly became an argument about a public option without a pricing dimension, and never really looked back. The administration has been very interested in the finding that some states are better at providing cost-effective care than other states, but not in the finding that some countries are better at purchasing care than other countries. "A health-care debate in this country that isn't aware of the price differential is not an informed debate," says Halvorson. By that measure, we have not had a very informed debate.

It is interesting that those who denounce the cost of health care reform, spend precious little time discussing controlling the costs of procedures.

(H/t GOOD blog)

[Not] adjusted for inflation

Trudy Lieberman's eagle eye has caught a rather devilish detail in the health care bill concerning government subsidies of mandated health insurance premiums.

...the first year the legislation takes effect (2013, as of now), people getting subsidized coverage would have to pay between 2 and 12 percent of their incomes for the insurance, depending on how much they earn. The government, of course, would pay the rest of the cost—that’s the carrot to entice people to buy in the first place. Those with lower incomes would pay less; those with higher incomes more. Okay—seems reasonable.

But in the second year and afterward, Appleby reports that the subsidies will be “based on a percentage of the premium that was paid the first year, no matter how far premiums rise.” Because wages don’t go up as fast as premiums, families, particularly those at the lower end of the income ladder, could easily find themselves paying far more for coverage as a percentage of their income than they were led to believe they would pay. And with premiums going up and up, which is the likely scenario, they will struggle and perhaps forgo insurance altogether.

The mandate that Pres. Obama campaigned against and now champions - just keeps getting uglier.

Rape is a pre-existing condition

You gotta be kidding me.

Wellstone would approve

Al Franken, dishin' it out on health care.



(H/t to Where's the Outrage?)

Philip Howard, corporate slut

Yesterday I watched perhaps the most obvious corporate shill I've ever seen. His name was Philip Howard, and he was on CBS Sunday Morning to do two things:

1) pitch his new book; and
2) sell corporate privilege to the masses, disguised as a populist cause

CBS treated him at his word - which was maddening. The standard, reverent hook intro-

He's a maverick you see - a high powered corporate lawyer speaking against lawyering. Oooh, iconoclast! He zigs where other lawyers zag!

We have too much law - he argues. Lawsuits, they've made playgrounds too safe - you see...

There is literally nothing in a playground in America for a child over the age of four. There are no jungle gyms. There are no seesaws. There are no climbing ropes. There are no high slides. It's very important for children to learn to understand their own limits, to take care of themselves.

Alright, set aside the fact that modern playgrounds have all these things - they just no longer have them over bare asphalt. Let's ignore the fact that 9 year olds will play on any structure they can climb. Let's just focus on Mr. Howard's [utterly disingenuous] argument.

It's about getting rid of law in people's daily lives...Teachers feel that they can't maintain order in the classroom, and doctors go through the day seeing every patient as a potential plaintiff. Camp counselors won't put an arm around the crying child. It's this idea that anything that goes wrong can be a lawsuit, and no one's drawing a boundary about what's a valid lawsuit and what's not.

Ahh, getting rid of law in people's daily lives. We're getting closer to what he's after. Dial down the image of a crying kid not getting a hug from their counselor - focus on that last sentence:

...no one's drawing a boundary about what's a valid lawsuit and what's not.

Now we're getting somewhere. This guy wants to get rid of lawsuits he thinks are invalid.

And what lawsuits in particular? Surely this corporate soldier wasn't writing a book to save hugless children from boring playgrounds.

Here's the CBS article:

...when it comes to medical claims, he indeed has no faith in juries . . . none at all . . . and wants the law changed.

Today, says the medical profession, fear of lawsuits has pushed medical malpractice insurance through the roof, and forced doctors to practice what's called "defensive medicine," meaning more tests and higher costs.

Howard wants malpractice cases decided not by a jury of laymen and women, but by special courts.

And THERE we are.

After all the fluff about playgrounds and life being full of disappointments -we find out what Mr. Howard is really about.

He's no maverick - he's just the latest tool whining about how corporations need to be protected from litigation. He wants special courts. And we're all familiar with how corporate alternatives to civil courts have protected people's rights so well in the past. Like Binding Arbitration - where consumers are forced to sign away their right to litigate as a condition of sale. Then arbitratration judges screened by the corporations hear the case and (in the case of California) rule in favor of the corporation 94% of the time.

Civil courts are scary to Mr. Howard, because his corporate masters don't control the outcome enough. Never mind they have the dollars to outclass the majority of their potential adversaries. They don't utterly dominate - and therefore, the law must change.

Having seen the benefit to the corporate interests - less damages - let's look at the cost. Here's CBS reporter, Jeff Greenfield:

It sounds as if one of the trade-offs we would have to make as a society to get law out of our hair is indeed to accept the fact that sometimes I'm going to be hurt and there's nothing I can do about it...Sometimes I'm going to be treated badly and there is no remedy.

Howard's response? "That's absolutely right."

Got that? Suck it up, America - we're tired of paying every time we grieviously injure your loved ones - or when your child gets strip-searched unjustly.

Howard's saying there's too much law, but his proposed remedy reveals what he's really saying.
We don't have too much law in the US, we just need to stop allowing citizens to use it so much.

To it's credit, the Sunday Morning report points out that medical malpractice and personal injury claims have gone down over the last decade. I'd add that the cost of medical malpractice lawsuits (while arguably too high) is the barest fraction of what we spend on health care in this country. I'm all for minimizing the effect of medical malpractice costs to certain medical specialties - but denying a citizen the right to sue in court?

Screw that.

I'll give CBS props for rebutting a few of Howard's points, but surely they could have winnowed through his fluff to expose him as the corporate tool he was and is. He's got every right to shill for his point of view, but this man-of-the-people common sense persona he's selling should never have been allowed to stand.