October 6th, 2009 by EvanFalchukJD in Better Health Network, Health Policy, Opinion
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For months, Congress has been debating health care reform proposals that would have the effect of dealing a heavy blow to the system of state-by-state insurance regulation. State governments have stood by, silently. I’ve been wondering (
here,
here and
here) when the states would start to raise objections.
Slowly, it’s starting to happen. What has been a mostly overlooked factor in the health care reform debate may end up being one of the most important.
In fourteen states, legislators are trying to pass constitutional amendments that would ban health insurance mandates. Meanwhile, a bi-partisan group of governors are objecting to provisions of the Baucus plan that would leave the cost of expanding Medicaid to the states (by contrast, the House bill provides federal money for this). It’s an emerging trend that may reflect growing unease in state governments. Read more »
*This blog post was originally published at See First Blog*
September 29th, 2009 by EvanFalchukJD in Better Health Network, Health Policy
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Joe Biden unveiled a White House study on the rise of health insurance premiums. He pressed for consumer protections the President wants to see in any reform legislation. Among these are a pledge to pass a law that “ends exorbitant out-of-pocket expenses, deductibles or co-pays.” Presumably this is meant to address worries many feel over the growth of high-deductible health plans.
The St. Petersburg Times looked into it to find out what this pledge means, in practical terms. David Axelrod at the White House pointed them to the proposed House legislation, which would create limits on out-of-pocket expenses, deductibles and co-pays of $5,000 a year for an individual, and $10,000 a year for a family.
Read more »
*This blog post was originally published at See First Blog*
September 22nd, 2009 by EvanFalchukJD in Better Health Network, Health Tips, Opinion
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There’s a case for killing Granny? I guess so, or at least according to Evan Thomas’ article in the most recent
Newsweek. Thomas, after sharing the story of his mother’s last days, concludes that
death is the key to health care reform:
Until Americans learn to contemplate death as more than a scientific challenge to be overcome, our health care system will remain unfixable.
Does everything need to have a political spin on it nowadays?
But let’s take Thomas’ advice and talk about death. Not “death panels,” not the politics or the cost of end-of-life care. Just plain old death.
I was reminded recently of how fragile life is. It made me remember something I read after our oldest child was born. I realized that one day she would learn the truth about death. And I thought how bad that was, and how I wanted to protect her from it. But then, by chance, I happened across this interesting little saying.
When your children are young, all you think about is that you don’t want them to die. But when they get older, all they think about is that they don’t want you to die.
It touched me, and it made me think about how my responsibility to protect my children extended even unto and beyond my own death.
It’s a nice philosophical point, but there are very practical things each of us can do to fulfill this responsibility. Here is my list of just a few of the very important things we all should do to plan for our deaths:
Buy life insurance
If you’re young and in reasonably good health you should be able to buy a term life insurance policy for a few hundred dollars a year. You should do this so your family can have your earning potential replaced in the event of your death. Find a good insurance broker and make sure you get coverage that suits your needs. Even if you have a pre-existing condition (like a chronic illness) a good broker should be able to find you some kind of coverage. You won’t be able to buy any coverage at all if you become acutely ill, so don’t wait until it’s too late.
Make a will
This is so much more than just planning for your family’s financial future. For example, if you have children, have you figured out who will take care of them if both you and your spouse die? There are many important and potentially difficult conversations that go along with this kind of planning – but you’re much better off having them now. After you die, those left behind will end up fighting out these issues not knowing your wishes. Find a good lawyer to help you.
Make an advance directive
You need to think about what kind of medical care you want if you become incapacitated and unable to decide on your own. Do you want to live for 30 years on a ventilator, unconscious? Do you want to undergo extensive and painful treatments if you don’t have much hope of a meaningful recovery? Don’t leave your family alone trying to make that decision for you, wondering what you would have wanted. Write down what your wishes are.
Appoint a health care proxy
Pick someone who you trust to make your medical decisions for you if you are unable to do so. Write it down and make clear what you want that person to do, so if the time comes there isn’t any dispute among your family as to who is in charge.
There are many other things you can do, but to me these are four of what I think are the most important things you can do to prepare for your death. Maybe some commenters can add some more that I missed.
Now, with all that said and done, I will still disappoint Mr. Thomas.
Why? Because I still prefer to think of death as a scientific challenge to be overcome. And you know, I’m glad that many other people feel that way, too.
Especially the people who make medical breakthroughs – I’m really glad they feel that way.
*This blog post was originally published at See First Blog*
September 14th, 2009 by EvanFalchukJD in Better Health Network, Opinion
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Eight quick reactions to the President’s speech:
1. It was a good speech. Reaction around the blogosphere and elsewhere seems to be dependent on how you felt about reform plans going in. If you were in favor, you thought it was terrific (warning strong language at the link); if you were against, you thought it was disingenuous.
2. The interesting question is how people who weren’t sure will react. By this I mean people who are anxious that reform will affect their health care in ways they don’t like. There is still the mixed message that created this anxiety in the first place. On the one hand, the President repeated “Nothing in this plan will require you to change what you have. “ Sounds like no big deal. On the other hand, he quoted Ted Kennedy as saying the plan “is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.” Sounds like a very big deal. Which is it?
3. The boorish Congressman who screamed “you lie!” at Obama during the address must have been confused and thought he was at a town hall meeting. But I’ve always thought it would be cool if we had a “Question Time” like they do in the UK. Presidents would have to face much more interesting and uncomfortable questions than they otherwise get, and it would make for a terrific spectacle. Obviously this wasn’t the time or place for that sort of thing. And if we ever do get an American Question Time, representatives will have to come up with better questions than “you lie,” too.
4. The President talked about “30 million American citizens who cannot get coverage.” This is different from the 46 million “uninsured” he usually talks about. The Associated Press thinks the other 16 million are people who could buy or otherwise get coverage but choose not to, as compared to those who want coverage but can’t afford it.
5. I was surprised to hear the President give more than just a nod to the Facebook health care status update meme. I mean he quoted it directly: “in the United States of America, no one should go broke because they get sick.” This must be the first time a President has ever quoted something from Facebook in an address to Congress – it’s some kind of a milestone for social media. Thoughts on that meme are here.
6. The President talked about the uncompetitive insurance market, noting that “in 34 states, 75 percent of the insurance market is controlled by five or fewer companies.” It sounds like he’s not just talking about the “public option” when he talks about creating competition in these markets. His idea of insurance exchanges and a federal health insurance regulator seem to be direct challenges to the state-by-state system of insurance regulation. It will be interesting to see the reaction of state insurance regulators to this speech.
7. I was right: the President didn’t talk about the three things I said he wouldn’t talk about. In fact, he said almost nothing about the delivery of care- it was all about how to pay for it.
8. The President got some laughs with his comment that he thinks “there remain some significant details to be ironed out.” He’s right, and there’s the rub. Whether and how that ironing out happens was the question before the President’s speech, and it’s still the question today.
*This blog post was originally published at See First Blog*
September 9th, 2009 by EvanFalchukJD in Better Health Network, Health Policy
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Newsweek tries to refute the “Five Biggest Lies In the Health Care Debate.”
But I’ve heard much bigger lies than the ones in this article.
I mean, are people really showing up angry at town hall meetings over fears that “the government will set doctor’s wages”?
Misinformation – or just plain old confusion – about our health care system is common. To try to help fix this, I offer five of the biggest, most commonly repeated misconceptions I hear regularly about the U.S. health care system.
1. Government plays a relatively small role in American health care. Government actually plays a big role. In 2007, federal, state and local governments paid for more than 46 cents of every health care dollar – more than $1 trillion. In fact, since 1980, the government has paid at least 40 cents of every dollar, and as early as 1960 – 5 years before Medicare – government paid a quarter of health care expenses. Government is a massive health care customer and has the impact one might expect such a big customer to have.
2. Health insurance companies drive the increasing cost of care in America. Not true, and here’s why: perhaps 200 million Americans don’t get their coverage from a health insurance company.
Most of these people, or a family member, work at one of the thousands of companies that self-insure (the rest are covered by government programs). What this means is those companies take the health care risk themselves, and use an insurance company mostly to handle the bills. For these companies, the cost of health care directly affects their bottom line. It’s one of the reasons employers have implemented so many programs to try to help their employees live healthier lifestyles, make sure they’re getting good care, and many others. Some data suggest it is working to control health care costs.
The exception is small groups and individuals. They have to buy health insurance, and face few, expensive options. There are many reasons for this, which I’ve blogged about extensively here. One of the most important is that there is not a truly competitive market for this kind of coverage. Still, many of these insurance companies are not-for-profit (some say as many as half of Americans with health insurance are covered by non-profit plans), and so it cannot be that profit drives the premium increases they, too, experience.
3. America has a free market in health care. Health care may be the most heavily regulated industry in America, with layers of state and federal regulation of care and insurance. For example, your doctor can only practice in the state in which he is licensed. If he wants to move to another state and be a doctor there he can’t do it unless he’s gone through a licensing process in that other state.
One of the most important reasons why the market for health insurance is so uncompetitive is that it, too, is regulated by 50 different state bodies. If an insurer wants to sell in another state, it has to go through an extensive process in order to do it, and be subject to all kinds of mandates and other requirements that make it very impractical to do so. It makes for a market that is much less dynamic than it could be.
I suspect one reason people call the U.S. system a “free market” is that rich or well-connected people can get better care than those who are less fortunate. This may be true, but this is just a reality of the human condition, not the health care system.
4. There is an Obama reform plan, and you’re either for it or against it. Much of the media – and even Chuck Norris – describe the various health care reform ideas as part of an “Obama plan” or “ObamaCare.” But other than broad outlines of what the President thinks are important principles, the President has not proposed any plan. Most of what people are talking about – including the entirety of the Newsweek article I started this post with – is the 1,017-page bill from the House Ways and Means Committee. While there are indications that the President is going to propose something concrete in the coming days, calling what is on the table Obama’s plan is more politics than reality.
5. Rising health care costs are a uniquely American problem. America’s not the only country suffering with rising health care costs. In Canada, for example, the government of British Columbia has seen its health care costs increase by 45% over the last 6 years. It’s created a budget crisis, and efforts to steadily increase the premiums it charges consumers and employers. The U.K. has actually experienced a higher rate of growth in health care costs than the U.S. over the last several years. So while it is true that the cost problem is worse in America than in in other countries, this is a matter of degree, not of kind.
I’ve heard lots of others, but these are the ones I most commonly run into.
What kinds of misconceptions have you heard?
*This blog post was originally published at See First Blog*
