There is a simple and fair solution to the increasingly common problem of doctors refusing to accept Medicare and Medicaid patients.
What point is there to giving seniors, the disabled and the insolvent Medicare and Medicaid if many doctors refuse to accept them as payment?
What kind of person refuses to accept Medicare and Medicaid? An anti-social person. A person who entered the medical profession driven by greed, not by the desire to help people. A person who does not even care about other doctors, whose own incomes are hurt when they have to take too high of a ratio of Medicare patients to make up for sociopath doctor behavior. In short, a criminal, but a white collar criminal who can do far more harm to people through negligence than an ordinary street criminal can do through theft.
Before going further, let me say that, on the whole, Medicare and Medicaid pay scales are fair. When a doctor or hospital says they are losing money when they accept Medicare or Medicaid, in truth they are saying they cannot ream these patients, and the taxpayers, the way the ream private insurance companies and the poor saps who come in without any bargaining power over the price of services. Medicare payments are enough to cover costs and provide an upper middle-class standard of living for doctors and fair wages to other health workers. If some payments for some services need to be raise a bit to be fair, I have no problem supporting that.
What happens when a doctor refuses Medicare patients? A senior will likely end up on a long waiting list, their health deteriorating while they wait. In some cases there may be no similarly qualified specialist in their area. Turning away a sick person because Medicare will pay for their treatment is a form of malpractice.
The solution is obvious. Any doctor who refuses Medicare/Medicaid patients should lose their license and pay a hefty fine. There should be a regular system to check for these abusers of our system.
In writing legislation to include good social behavior as a licensing requirement, there does need to be care taken to be fair. For instance, the Medicare load differs by location and specialty. It would not work to set a specific percentage of Medicare patients all doctor must see in order to keep their licenses. An individual doctor might reject a new patient because they are truly already fully booked, perhaps even mostly with Medicare patients.
The current Medicare bureaucracy should be sufficient to monitor physician compliance and take into account variations in locality and specialty. Some parts of America have a high percentage of seniors, others low percentages. That should not be hard to take into account with a formula that would flag potential bad eggs. Area doctors can be surveyed. If, of ten in the same specialty, nine complains that 70% to 90% of patients are on Medicare or Medicaid, while the tenth is near 0%, it should be clear what is going on.
Of course the first thing the bad doctors will do is stop saying why they are refusing patients. They might also try seeing patients, charging Medicare, but not actually treating patients, something that already happens all too much.
We all (or almost all) pay into Medicare throughout our working lives. To be denied care in our old age by a doctor is a crime. We should be able to call an authority to report such criminal behavior, and they should be happy to end up with only a suspended license, not behind bars with the other criminals, where they really belong.
It is difficult to get a slot in medical school, and so the number of doctors is limited. With a license to practice comes the responsibility to practice fairly, including taking a fair load of Medicare and Medicaid patients.
Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts
Sunday, November 10, 2013
Wednesday, April 3, 2013
Raise The Medicare Contribution Rate
If Medicare and Medicaid will need more funding in the future, the logical and fair thing to do would be to raise the contribution rates. These raises could be small and gradual, say a quarter percent (0.25%) per year until contributions come in line with projected future expenditures.
The Medicare payroll deduction is not a tax. It is an compulsory insurance premium. It is currently 2.9%. For wage slaves the accounting of the 2.9% is that 1.45% is paid by the employer, and 1.45% paid by the employee. (Self-employed people pay both halves). In reality employers pay the full amount, of which half appears as a deduction when employees get the accounting for their pay check. For the history of this arrangement see Medicare History.
I think it would be a good thing to account for any rate increase on the worker side. Most businesses are profitable, and so most workers create more value than they are paid for, the difference going to management's usually bloated salaries and the profits of the owner. Capitalist apologists (who complain endlessly for their suffering rich clients) say that increased taxes on business discourage hiring. By placing the increase on the worker side of the paycheck it raises awareness that this is a necessary expense to pay for health care in your old age.
How would paychecks change? The most commonly paid wage in America is the federal minimum wage, currently $7.25 per hour. Assuming a 40 hour work week, raw wages are then $290.00 per week. At the current 2.9% rate, employers turn over $8.41 to the federal tax authority. Of that $4.205 appears as a payroll deduction to the workers. Each 0.25% increase would deduct a further $0.725 per week.
That does not sound like much (unless $0.73 is the difference between making your rent or not), but over time it should add up to enough to keep the nation's Medicare budget balanced. It takes a lot of years of saving to prepare for almost-free medical care beyond the age of 65.
A different way to look at the problem is to admit that the medical profession has not come up with inexpensive ways to keep large numbers of people healthy once they are old. A person who never made more than $15,000 a year in their lifetime may cost the Medicare system over $100,000 a year for as long as they can be kept alive.
It almost seems as if the health system for seniors is mainly designed to extract the last penny from their pockets and from the Medicare system.
Everyone thinks medical costs need to be capped, but no one (except maybe me) wants to be accused of letting a senior die for lack of medical treatment, no matter how expensive.
The only events that could fix the system are catastrophes. A disease with high mortality that affects seniors more than working-age people would perform actuarial wonders.
We could take a lesson from the Roman Republic, upon which so much of our original system was based. Seniors could buck up and pledge to refuse treatments that do not prolong a healthy, mobile, and fully conscious life. We could make opium smoking available to seniors who can't stand pain, and let nature takes its (inexpensive) course.
Unless we are willing to take a far harder line on capping expenses, we need to raise the Medicare contribution rate.
The Medicare payroll deduction is not a tax. It is an compulsory insurance premium. It is currently 2.9%. For wage slaves the accounting of the 2.9% is that 1.45% is paid by the employer, and 1.45% paid by the employee. (Self-employed people pay both halves). In reality employers pay the full amount, of which half appears as a deduction when employees get the accounting for their pay check. For the history of this arrangement see Medicare History.
I think it would be a good thing to account for any rate increase on the worker side. Most businesses are profitable, and so most workers create more value than they are paid for, the difference going to management's usually bloated salaries and the profits of the owner. Capitalist apologists (who complain endlessly for their suffering rich clients) say that increased taxes on business discourage hiring. By placing the increase on the worker side of the paycheck it raises awareness that this is a necessary expense to pay for health care in your old age.
How would paychecks change? The most commonly paid wage in America is the federal minimum wage, currently $7.25 per hour. Assuming a 40 hour work week, raw wages are then $290.00 per week. At the current 2.9% rate, employers turn over $8.41 to the federal tax authority. Of that $4.205 appears as a payroll deduction to the workers. Each 0.25% increase would deduct a further $0.725 per week.
That does not sound like much (unless $0.73 is the difference between making your rent or not), but over time it should add up to enough to keep the nation's Medicare budget balanced. It takes a lot of years of saving to prepare for almost-free medical care beyond the age of 65.
A different way to look at the problem is to admit that the medical profession has not come up with inexpensive ways to keep large numbers of people healthy once they are old. A person who never made more than $15,000 a year in their lifetime may cost the Medicare system over $100,000 a year for as long as they can be kept alive.
It almost seems as if the health system for seniors is mainly designed to extract the last penny from their pockets and from the Medicare system.
Everyone thinks medical costs need to be capped, but no one (except maybe me) wants to be accused of letting a senior die for lack of medical treatment, no matter how expensive.
The only events that could fix the system are catastrophes. A disease with high mortality that affects seniors more than working-age people would perform actuarial wonders.
We could take a lesson from the Roman Republic, upon which so much of our original system was based. Seniors could buck up and pledge to refuse treatments that do not prolong a healthy, mobile, and fully conscious life. We could make opium smoking available to seniors who can't stand pain, and let nature takes its (inexpensive) course.
Unless we are willing to take a far harder line on capping expenses, we need to raise the Medicare contribution rate.
Friday, June 15, 2012
Healthcare Where Everyone is Above Average
In this essay, above average is bad. Out of range is bad. It is there on black and white, on a piece of paper: you need drugs. And more frequent doctor visits. And frequent diagnostics, mostly involving sucking your blood out, to make sure there are no side effects to the pharmaceuticals and to monitor just exactly where you are in the range.
It is a scam worthy of such greats as Ponzi, Madoff, and Joseph Kennedy. Going to a doctor in the U.S. is like walking into a casino: the odds are against you, the house always wins. When every last penny has been drained from your pocket, they toss you out, to go an earn some more money or to die impoverished in the streets.
Look at the nature of averages. Or more precisely, in this case, what the statistics boys call "median." Half of the population will be above the median, and half below it. The median is defined that way.
Now take some blood tests. Typically blood pressure, triglycerides, glucose, white blood cell count, and a couple of different kinds of cholesterol.
What are the chances, per the statistics boys, that you will have nothing above average, and therefore need no medication (if the average or below is the standard of health)?
Keep in mind this is not about sickness in the ordinary sense of people who feel sick or have obvious symptoms. This is a test that includes healthy people.
Each test is independent, so to get the answer, you just keep multiplying by 1/2. The order does not matter, but let's say it goes like this:
You have a 50% chance of having high blood pressure. 1 times 1/2 is 0.50.
You have a 50% chance of having high triglycerides. 0.50 times 1/2 is 0.25.
You have a 50% chance of having high glucose. 0.25 times 1/2 is 0.125.
And so forth: white blood cells, 0.0625. Cholesterol 1, 0.03125. Cholesterol 2, 0.015625. That is about 1.6%.
In other words, of 1000 people getting this set of tests from a doctor, only 15, maybe 16 will be fully healthy. Everyone else will need some help from the pharmaceutical industry to get "at the lower end of the risk factors."
Just to be sure to pick your pocket, they don't test you against your age class. Most people see a gradual increase in blood pressure as they age. The doctors don't say to you, "for a 60 year-old male, you are below average! See me again in five years." No, you get compared to the healthy 30 year olds. If you are 60 or older, the chances that you have average or better blood pressure are thin. In fact, there may be something wrong with you, like a weak heart.
The human body has been evolving for some 3 billion years. Modern medical science has been around for about a century. Who are you going to trust, Mother Nature or some gal or guy who went to medical school dreaming of making big money?
We don't need everyone to be below average for all health risks. We need to look at what is normal, and only treat conditions that are at least two standard deviations outside of normal. Which means only the roughly 2% of people who get extremely high results, and 2% of people who get extremely low results. May 4% at each end, just to be safe. [This would not apply to actual diseases like diabetes. Everyone with diabetes should get treatment. Almost everyone in the U.S. needs to eat less and exercise more.]
There is likely a good reason that blood pressure increases as we get older. Lowering the blood pressure to a pre-defined standard probably just insures that blood is not getting to where it is needed in our bodies. [This is my hunch, and if someone will grant me a few tens of millions of dollars, I would be happy to hire professionals to test it.] Someday some enterprising scientist will find that "normal" blood pressure causes senior dementia, or some other result worse than the slight increased risk of dying of a heart attack before your kidneys or liver or brain fails.
They never give you unbiased statistics. When have you ever seen a chart of how many people have heart attacks and strokes who don't have high blood pressure? In fact lowering blood pressure, unless you have really, really high blood pressure, is not likely to change your cause of death.
Scientists — real scientists, not the ones funded by industry — will tell you that even when you are trying to do totally honest, accurate science, there is a danger called selection bias. This amounts to rejected data that would prove your bet hypothesis is wrong.
Selection bias can happen even in an academic context. The reason is that certain results, interesting results, are publishable, but the negative results are not. Scientists like to publish. Their careers usually depend on it.
The pharmaceutical companies themselves have found that out when buying potential drugs that academic scientists claimed would be cures. One study by a major pharmaceutical company found that, for almost all of the drug candidates in a batch they bought, they could not replicate the "good" results.
I believe that doctors can help some people some of the time, and in good medical science. But you can't always believe the medical consensus.
Recently a panel of medical experts recommended against a test that has always been supposed to be indicative of prostate cancer, PSA. The knew that PSA results only correlate loosely with prostate cancer. Yet doctors turned high PSA results into a lucrative business of "cures." Looking at a broad range of statistics, the panel found that the negative results from all that expensive "curing," including death during surgery, more than washed away the occasional live saved. Cancer sounds scary, but most prostate cancers evolve slowly. Most men with prostate cancer die of something else, something unrelated. So the panel suggested stopping PSA tests unless there was a good, obvious reason for them. [New Data on Harms of Prostate Cancer Screening, New York Times, May 21, 2012]
Oh, the howls of the financially wounded. The oncologists and urologists, the main beneficiaries of the PSA scam, attacked the panel with vigor. They only care about Science when it is in their financial favor.
The average person is not in a position to argue knowledgeably with their physician about whether they really need a blood pressure or cholesterol pill. Half the American population does not believe in evolution. They don't believe the human body has evolved to optimize its own health and longevity. Sadly, the other half tends to believe in anything presented as science uncritically. In theory they know there is good science and bad science, but in reality they have to rely on their doctors.
We need to rethink medicine from the ground up. We need to ask ourselves how it fits into our other values. Do we let children live in poverty, or underfund our public schools or other important public while paying vast sums for cancer therapies for the over-80 set that, at best, extend miserable lives for a few weeks?
We have evolved a culture that has made us a nation of pill-popping hypochondriacs. Part of this is because costs are masked: for most people, someone else is paying the bill.
I am not against wonder drugs. I am not against necessary surgeries, or preventative medicine that really prevents disease. I want a science-based health system that takes into account economic realities. That is what we need, not what we have.
It is a scam worthy of such greats as Ponzi, Madoff, and Joseph Kennedy. Going to a doctor in the U.S. is like walking into a casino: the odds are against you, the house always wins. When every last penny has been drained from your pocket, they toss you out, to go an earn some more money or to die impoverished in the streets.
Look at the nature of averages. Or more precisely, in this case, what the statistics boys call "median." Half of the population will be above the median, and half below it. The median is defined that way.
Now take some blood tests. Typically blood pressure, triglycerides, glucose, white blood cell count, and a couple of different kinds of cholesterol.
What are the chances, per the statistics boys, that you will have nothing above average, and therefore need no medication (if the average or below is the standard of health)?
Keep in mind this is not about sickness in the ordinary sense of people who feel sick or have obvious symptoms. This is a test that includes healthy people.
Each test is independent, so to get the answer, you just keep multiplying by 1/2. The order does not matter, but let's say it goes like this:
You have a 50% chance of having high blood pressure. 1 times 1/2 is 0.50.
You have a 50% chance of having high triglycerides. 0.50 times 1/2 is 0.25.
You have a 50% chance of having high glucose. 0.25 times 1/2 is 0.125.
And so forth: white blood cells, 0.0625. Cholesterol 1, 0.03125. Cholesterol 2, 0.015625. That is about 1.6%.
In other words, of 1000 people getting this set of tests from a doctor, only 15, maybe 16 will be fully healthy. Everyone else will need some help from the pharmaceutical industry to get "at the lower end of the risk factors."
Just to be sure to pick your pocket, they don't test you against your age class. Most people see a gradual increase in blood pressure as they age. The doctors don't say to you, "for a 60 year-old male, you are below average! See me again in five years." No, you get compared to the healthy 30 year olds. If you are 60 or older, the chances that you have average or better blood pressure are thin. In fact, there may be something wrong with you, like a weak heart.
The human body has been evolving for some 3 billion years. Modern medical science has been around for about a century. Who are you going to trust, Mother Nature or some gal or guy who went to medical school dreaming of making big money?
We don't need everyone to be below average for all health risks. We need to look at what is normal, and only treat conditions that are at least two standard deviations outside of normal. Which means only the roughly 2% of people who get extremely high results, and 2% of people who get extremely low results. May 4% at each end, just to be safe. [This would not apply to actual diseases like diabetes. Everyone with diabetes should get treatment. Almost everyone in the U.S. needs to eat less and exercise more.]
There is likely a good reason that blood pressure increases as we get older. Lowering the blood pressure to a pre-defined standard probably just insures that blood is not getting to where it is needed in our bodies. [This is my hunch, and if someone will grant me a few tens of millions of dollars, I would be happy to hire professionals to test it.] Someday some enterprising scientist will find that "normal" blood pressure causes senior dementia, or some other result worse than the slight increased risk of dying of a heart attack before your kidneys or liver or brain fails.
They never give you unbiased statistics. When have you ever seen a chart of how many people have heart attacks and strokes who don't have high blood pressure? In fact lowering blood pressure, unless you have really, really high blood pressure, is not likely to change your cause of death.
Scientists — real scientists, not the ones funded by industry — will tell you that even when you are trying to do totally honest, accurate science, there is a danger called selection bias. This amounts to rejected data that would prove your bet hypothesis is wrong.
Selection bias can happen even in an academic context. The reason is that certain results, interesting results, are publishable, but the negative results are not. Scientists like to publish. Their careers usually depend on it.
The pharmaceutical companies themselves have found that out when buying potential drugs that academic scientists claimed would be cures. One study by a major pharmaceutical company found that, for almost all of the drug candidates in a batch they bought, they could not replicate the "good" results.
I believe that doctors can help some people some of the time, and in good medical science. But you can't always believe the medical consensus.
Recently a panel of medical experts recommended against a test that has always been supposed to be indicative of prostate cancer, PSA. The knew that PSA results only correlate loosely with prostate cancer. Yet doctors turned high PSA results into a lucrative business of "cures." Looking at a broad range of statistics, the panel found that the negative results from all that expensive "curing," including death during surgery, more than washed away the occasional live saved. Cancer sounds scary, but most prostate cancers evolve slowly. Most men with prostate cancer die of something else, something unrelated. So the panel suggested stopping PSA tests unless there was a good, obvious reason for them. [New Data on Harms of Prostate Cancer Screening, New York Times, May 21, 2012]
Oh, the howls of the financially wounded. The oncologists and urologists, the main beneficiaries of the PSA scam, attacked the panel with vigor. They only care about Science when it is in their financial favor.
The average person is not in a position to argue knowledgeably with their physician about whether they really need a blood pressure or cholesterol pill. Half the American population does not believe in evolution. They don't believe the human body has evolved to optimize its own health and longevity. Sadly, the other half tends to believe in anything presented as science uncritically. In theory they know there is good science and bad science, but in reality they have to rely on their doctors.
We need to rethink medicine from the ground up. We need to ask ourselves how it fits into our other values. Do we let children live in poverty, or underfund our public schools or other important public while paying vast sums for cancer therapies for the over-80 set that, at best, extend miserable lives for a few weeks?
We have evolved a culture that has made us a nation of pill-popping hypochondriacs. Part of this is because costs are masked: for most people, someone else is paying the bill.
I am not against wonder drugs. I am not against necessary surgeries, or preventative medicine that really prevents disease. I want a science-based health system that takes into account economic realities. That is what we need, not what we have.
Monday, May 7, 2012
Obama Pisses on California Before Primary
Barack Obama may be the first sort-of black President of the United States, but his political heritage is not much different than the entire line of Presidents starting with real-estate speculator George Washington. Barack will be the only choice on the Democratic Party Presidential ballot line for the June 5 election. The total corruption and march-in-line behind the leader mentality of the party is shown by the lack of even token progressive and anti-war opposition.
Knowing the Democratic Party nomination is locked up, and wanting to appeal to right-wing voters, Barack Obama ordered widespread, unconstitutional raids on our perfectly legal medical marijuana purveyors. It's a funny thing, the way almost all media sources keep the Obama name out of the stories about the raids. It is always the Justice Department. Like Obama is not head of the government. Like he could not order the stormtroopers to go after other crimes. Are there no Islamic teenagers who might be entrapped by agents offering them a chance to play with government-supplied C-4? Are there no criminals violating Disney's copyrights needing to be rounded up and put in concentration camps?
It is not just his Reaganesque marijuana policy that mocks California's enlightened citizenry. There's his anti-gay marriage stand. His ongoing military attacks on Afghanistan, Pakistan, Somalia and Yemen, plus anti-Iranian saber rattling. His promotion of the very men who created the mortgage derivatives and banking meltdown to be his top economic advisors. His failure to vigorously protect women's reproductive rights. His half-ass reformulation of the healthcare for profit system.
But what is a Democrat to do? It is too late to send Him a message by re-registering Green or No Political Preference (the new Decline to State, known everywhere else as independent). You can do that after the primary.
All you can do is vote for your favorite local candidates (up to and including Congress) and then not vote for Barack Obama. Barack does not give a damn how you feel about him, as long as he is the head of the corporate security state. He's going to be the next President. What not voting for Obama will do is show, when the votes are counted, that you care about California and your fellow Californians.
According to my readings of John Steinbeck, pretty many California citizens were smoking marijuana long before the 1960s rolled around. Since the 1960s California citizens have almost all been tolerant of their neighbors who choose to smoke. Sure, there are occasional problems with stoned citizens, but they pale compared to the problems of drunk citizens, and they don't seem to be significantly higher than the problems we encounter with perfectly sober citizens, either.
We Californians are a nation of individuals, but we do mostly share some cultural values, like respecting individual diversity. We have a disproportionate number of agnostics and atheists among us, and even our religious citizens tend more to humanist spirituality and ethical conduct than to memorize-the-text orthodoxy. We believe in evolution, and are evolving, but are ruled by people whose brain capacities froze at Middle Ages levels of memory and compute capabilities.
There are about 38 million of us. There were less than 4 million people living in the original 13 states at the time of the American Revolution, and that included slaves and Native Americans.
We should demand some respect from the rest of the states. If they do not respect our ways and our values, including ending marijuana prohibition, we should began the process of (hopefully without a civil war) leaving other United States and governing ourselves.
Because we can govern ourselves a lot better than the eastern states can govern us.
We don't need the national parties, either. Even if we stay in the Union, California citizens should have their own political parties, subject to our own corrupt bosses and political machines, rather than to the corrupt national bosses and machines.
Let's make that a goal: at least one California-centric party by 2014.
Knowing the Democratic Party nomination is locked up, and wanting to appeal to right-wing voters, Barack Obama ordered widespread, unconstitutional raids on our perfectly legal medical marijuana purveyors. It's a funny thing, the way almost all media sources keep the Obama name out of the stories about the raids. It is always the Justice Department. Like Obama is not head of the government. Like he could not order the stormtroopers to go after other crimes. Are there no Islamic teenagers who might be entrapped by agents offering them a chance to play with government-supplied C-4? Are there no criminals violating Disney's copyrights needing to be rounded up and put in concentration camps?
It is not just his Reaganesque marijuana policy that mocks California's enlightened citizenry. There's his anti-gay marriage stand. His ongoing military attacks on Afghanistan, Pakistan, Somalia and Yemen, plus anti-Iranian saber rattling. His promotion of the very men who created the mortgage derivatives and banking meltdown to be his top economic advisors. His failure to vigorously protect women's reproductive rights. His half-ass reformulation of the healthcare for profit system.
But what is a Democrat to do? It is too late to send Him a message by re-registering Green or No Political Preference (the new Decline to State, known everywhere else as independent). You can do that after the primary.
All you can do is vote for your favorite local candidates (up to and including Congress) and then not vote for Barack Obama. Barack does not give a damn how you feel about him, as long as he is the head of the corporate security state. He's going to be the next President. What not voting for Obama will do is show, when the votes are counted, that you care about California and your fellow Californians.
According to my readings of John Steinbeck, pretty many California citizens were smoking marijuana long before the 1960s rolled around. Since the 1960s California citizens have almost all been tolerant of their neighbors who choose to smoke. Sure, there are occasional problems with stoned citizens, but they pale compared to the problems of drunk citizens, and they don't seem to be significantly higher than the problems we encounter with perfectly sober citizens, either.
We Californians are a nation of individuals, but we do mostly share some cultural values, like respecting individual diversity. We have a disproportionate number of agnostics and atheists among us, and even our religious citizens tend more to humanist spirituality and ethical conduct than to memorize-the-text orthodoxy. We believe in evolution, and are evolving, but are ruled by people whose brain capacities froze at Middle Ages levels of memory and compute capabilities.
There are about 38 million of us. There were less than 4 million people living in the original 13 states at the time of the American Revolution, and that included slaves and Native Americans.
We should demand some respect from the rest of the states. If they do not respect our ways and our values, including ending marijuana prohibition, we should began the process of (hopefully without a civil war) leaving other United States and governing ourselves.
Because we can govern ourselves a lot better than the eastern states can govern us.
We don't need the national parties, either. Even if we stay in the Union, California citizens should have their own political parties, subject to our own corrupt bosses and political machines, rather than to the corrupt national bosses and machines.
Let's make that a goal: at least one California-centric party by 2014.
Tuesday, March 27, 2012
Supreme Court on Healthcare Mandate: What Else Would Go Down?
The conservative judges on the United States Supreme Court would very much like to find that requiring Americans to buy health insurance is unconstitutional. Their problem, if they rule that way, is that it could endanger the legal basis of much of the corporate security state and its control over the economy.
In Department of Health and Human Services v. Florida (No. 11-398), it is being argued by the State of Florida and opponents of the Patient Protection and Affordable Care Act that the federal government, in this Act of Congress, exceeded the powers granted to it by the Constitution. Supporters of the Act will want to rule that it is constitutional, in line with many prior findings, over the course of two centuries, that the Commerce Clause effectively allows for national laws telling citizens what to do or not do about all manner of things.
At the mass media story line level, this case is about whether the federal government can tell a citizen to buy medical insurance, and fine any citizen who does not do so (just $95 per year in 2014, but rising to $695 per year by 2016). Or, and this is important, to put it in the negative: citizens may not walk around without having some sort of medical insurance.
If you think about it for a moment, the federal government tells us we cannot do many things, even if we don't need to cross state lines to do them. We cannot grow, harvest, consume or smoke marijuana, for instance. We may not own heavy armaments. We can't manufacture a fleet of cars that only gets an average of 12 miles to the gallon, nor can we use American Eagles for target practice.
If the Supreme Court says that we cannot be required to buy health insurance, the entire house of cards may collapse. There are a lot of cards that conservatives like, and a lot of cards that liberals like, and probably some cards that both teams like.
The liberal position has consistently been that the federal government has all the power it wants as long as it does not violate certain key sections of the Constitution. The building of this position began in Gibbons v. Ogden, [22 U.S. 1 (1824)], where the Supreme Court decided that individual states could not grant monopolies to steamboat lines that prevented competing companies from offering interstate service. It made a big leap forward when railroads and other trans-state corporations began to be regulated in the late 1800's.
During the New Deal, in the 1930's, the Supreme Court at first resisted, and then admitted (after some changes of personnel), that the power of the federal government to regulate commerce, and anything related to commerce, was virtually unlimited. Famously, in Farmer Filburn (Wickard v. Filburn, 317 U.S. 111 (1942)), the Court ruled that the Department of Agriculture could tell Roscoe Filburn how much wheat he could grow on his private property, even if the wheat itself was not sold, but was used to raise chickens.
The current case is not about States Rights, but has a similar feel to it. Conservatives want federal laws when that helps them get their way, with states rights allowed to stop federal laws they don't like. For once Liberals are completely in agreement: they want federal laws when that helps them get their way, with states rights allowed to stop federal laws they don't like. For instance, when slavery was federal law, liberals wanted states rights to apply so that they could have slavery-free states. Later, when trying to enforce civil rights legislation in the 1960's, liberals were against those very same ideas of states rights, proposed by Democratic Party leaders in the South as a means of preventing segregation.
What we are likely to see is the conservative members of the Court trying to distinguish the Affordable Care Act from other laws that they wish to keep in place, like the marijuana laws and the laws against various tactics that unions would like to use.
We might, in fact, be about to see the Gruel of Law cooked up before our eyes. We may see the pure power of having 5 like-thinking judges on a Supreme Court. They are likely to try to find a way to disembowel the Affordable Care Act while protecting their favorite federal no-nos, like the war on recreational drugs.
I particularly hope that Justice Clarence Thomas writes an opinion. In the liberal-to-left spectrum Thomas is often derided as not just plain wrong, but as beneath the intellectual level as other members of the court. I tend to disagree with Judge Thomas on issues, but I have read a number of his opinions, and found they were well-argued, and illustrate lively intelligence. Thomas dissented in Gonzales v. Raich, in which the majority ruled that the Commerce Clause gives the feds the power to criminalize patients who grow their own medical marijuana. So if he votes against the mandate in the current case, at least he could claim consistency. Ginsburg, Stevens, Kennedy, Souter and Breyer all voted to persecute sick people who use the herb. If any of them (of those still on the court) vote against the Affordable Care Act, they have a lot of explaining to do.
In Department of Health and Human Services v. Florida (No. 11-398), it is being argued by the State of Florida and opponents of the Patient Protection and Affordable Care Act that the federal government, in this Act of Congress, exceeded the powers granted to it by the Constitution. Supporters of the Act will want to rule that it is constitutional, in line with many prior findings, over the course of two centuries, that the Commerce Clause effectively allows for national laws telling citizens what to do or not do about all manner of things.
At the mass media story line level, this case is about whether the federal government can tell a citizen to buy medical insurance, and fine any citizen who does not do so (just $95 per year in 2014, but rising to $695 per year by 2016). Or, and this is important, to put it in the negative: citizens may not walk around without having some sort of medical insurance.
If you think about it for a moment, the federal government tells us we cannot do many things, even if we don't need to cross state lines to do them. We cannot grow, harvest, consume or smoke marijuana, for instance. We may not own heavy armaments. We can't manufacture a fleet of cars that only gets an average of 12 miles to the gallon, nor can we use American Eagles for target practice.
If the Supreme Court says that we cannot be required to buy health insurance, the entire house of cards may collapse. There are a lot of cards that conservatives like, and a lot of cards that liberals like, and probably some cards that both teams like.
The liberal position has consistently been that the federal government has all the power it wants as long as it does not violate certain key sections of the Constitution. The building of this position began in Gibbons v. Ogden, [22 U.S. 1 (1824)], where the Supreme Court decided that individual states could not grant monopolies to steamboat lines that prevented competing companies from offering interstate service. It made a big leap forward when railroads and other trans-state corporations began to be regulated in the late 1800's.
During the New Deal, in the 1930's, the Supreme Court at first resisted, and then admitted (after some changes of personnel), that the power of the federal government to regulate commerce, and anything related to commerce, was virtually unlimited. Famously, in Farmer Filburn (Wickard v. Filburn, 317 U.S. 111 (1942)), the Court ruled that the Department of Agriculture could tell Roscoe Filburn how much wheat he could grow on his private property, even if the wheat itself was not sold, but was used to raise chickens.
The current case is not about States Rights, but has a similar feel to it. Conservatives want federal laws when that helps them get their way, with states rights allowed to stop federal laws they don't like. For once Liberals are completely in agreement: they want federal laws when that helps them get their way, with states rights allowed to stop federal laws they don't like. For instance, when slavery was federal law, liberals wanted states rights to apply so that they could have slavery-free states. Later, when trying to enforce civil rights legislation in the 1960's, liberals were against those very same ideas of states rights, proposed by Democratic Party leaders in the South as a means of preventing segregation.
What we are likely to see is the conservative members of the Court trying to distinguish the Affordable Care Act from other laws that they wish to keep in place, like the marijuana laws and the laws against various tactics that unions would like to use.
We might, in fact, be about to see the Gruel of Law cooked up before our eyes. We may see the pure power of having 5 like-thinking judges on a Supreme Court. They are likely to try to find a way to disembowel the Affordable Care Act while protecting their favorite federal no-nos, like the war on recreational drugs.
I particularly hope that Justice Clarence Thomas writes an opinion. In the liberal-to-left spectrum Thomas is often derided as not just plain wrong, but as beneath the intellectual level as other members of the court. I tend to disagree with Judge Thomas on issues, but I have read a number of his opinions, and found they were well-argued, and illustrate lively intelligence. Thomas dissented in Gonzales v. Raich, in which the majority ruled that the Commerce Clause gives the feds the power to criminalize patients who grow their own medical marijuana. So if he votes against the mandate in the current case, at least he could claim consistency. Ginsburg, Stevens, Kennedy, Souter and Breyer all voted to persecute sick people who use the herb. If any of them (of those still on the court) vote against the Affordable Care Act, they have a lot of explaining to do.
Monday, February 14, 2011
Ruinous Competition: Doctors and Healthcare
According the free-market theorists, the best of all possible economic worlds is one in which there is no government regulation. First developed coherently in Adam Smith's Wealth of Nations, this theory was based on practical observations of a society, England, that had been high regulated by a monarchical government working with feudal institutions that tried to determine most people's occupation by their status at birth.
Business men and trade-guilds that had done quite well for themselves in the past found it hard to make a profit, or even a living, once anyone could compete with them. In a free market, if a profit can be made in a certain occupation, new people will enter that occupation until competition for customers results in profit levels becoming unattractive. We call that ruinous competition.
Certain industries require quite a bit of capital to enter, so even back at the dawn of this new era, around the time of the American Revolution, profits could be made in those industries without the help of government restrictions on entering the business. Just as a beggar cannot enter the farming business without the price of at least a down-payment on a piece of land, so a laborer or small merchant would not have the capital to set up an iron-mill or buy a coal mine. So even under the growing free market system, larger enterprises had some shelter from ruinous competition.
The United States of America began as a sort of natural free-market area, and people generally benefited from that (neglecting here the use of slave labor and violent capture of Native American Indian real estate) for some time.
In the course of the 1800's, however, mainly at the level of individual states, those who did not want to be exposed to ruinous competition developed a strategy. Aside from the practice of the law, which was always limited by the government, it was argued that professions having a direct impact on the health and safety of the public needed to be vetted by the government. For instance, it was argued that not anyone could simply declare themselves to be a medical doctor. And again, there was some truth to it, although in the 1800's it appears that trained medical doctors were so ignorant of basic biology that many were just as dangerous to the public as the so called fake doctors, or charlatan (originally, sellers of Roman Catholic indulgences, but a term that came to be applied to untrained healers).
Allowing only doctors licensed under the authority of the government, and making sure there was always a shortage of such licensed doctors, would allow the group to charge more than the free market value of their medical services. In short, to overcharge the sick. This was the purpose of the American Medical Association, formed in 1847. The AMA did some good things, which don't concern us here. What they did on the economic front was require that medical practitioners be licensed (and they set up boards of their own members to decide who would qualify for a license) and they also licensed medical schools. In licensing such schools they carefully studied the demand for doctors and made sure that not enough doctors were graduated to meet the demand.
Now of course practically every profession, from cutters of hair to real estate agents to accountants and carpenters, requires a license. Some professions have not been as successful at keeping their numbers small and profits high as the doctors have done, but the general idea is there. Barriers to entry, no free market, no ruinous competition. Those who work without license are sucked dry by the fees of those who are licensed to work.
Those doctors who scream for free markets and against "socialist" government health care plans should take a good look at themselves and their ill-got millions. Because of the government preventing the operation of free markets in doctoring, in the 1950's and 1960's the term millionaire-doctor was synonymous with doctor.
If doctors don't want socialized medicine, we should open up doctoring to anyone who feels they can heal. Pharmacists should be able to make diagnoses and sell basic drugs without a doctor's prescription. For that matter doctors should be able to sell drugs in their offices, rather than having to write a prescription. People should be able to self-diagnose, if they wish to take that risk, and get any legal drug without a prescription.
If someone puts out a shingle and causes harm, they could be sued for malpractice. If they claim to have graduated from a medical school, but did not, they could be charged with fraud. If the government wants to certify people, or the AMA wants to identify their members, that is fine, but there should be no rule that you have to go to the AMA men or government men.
What do you say, Republicans and Tea-Party people? Are you really ready to give free markets a chance? I'm certainly ready to hang out a shingle, if the Republican run government is willing to let me. I'll start a medical insurance company too, a coop that benefits the members. That should put some pressure on Anthem et. al.
Business men and trade-guilds that had done quite well for themselves in the past found it hard to make a profit, or even a living, once anyone could compete with them. In a free market, if a profit can be made in a certain occupation, new people will enter that occupation until competition for customers results in profit levels becoming unattractive. We call that ruinous competition.
Certain industries require quite a bit of capital to enter, so even back at the dawn of this new era, around the time of the American Revolution, profits could be made in those industries without the help of government restrictions on entering the business. Just as a beggar cannot enter the farming business without the price of at least a down-payment on a piece of land, so a laborer or small merchant would not have the capital to set up an iron-mill or buy a coal mine. So even under the growing free market system, larger enterprises had some shelter from ruinous competition.
The United States of America began as a sort of natural free-market area, and people generally benefited from that (neglecting here the use of slave labor and violent capture of Native American Indian real estate) for some time.
In the course of the 1800's, however, mainly at the level of individual states, those who did not want to be exposed to ruinous competition developed a strategy. Aside from the practice of the law, which was always limited by the government, it was argued that professions having a direct impact on the health and safety of the public needed to be vetted by the government. For instance, it was argued that not anyone could simply declare themselves to be a medical doctor. And again, there was some truth to it, although in the 1800's it appears that trained medical doctors were so ignorant of basic biology that many were just as dangerous to the public as the so called fake doctors, or charlatan (originally, sellers of Roman Catholic indulgences, but a term that came to be applied to untrained healers).
Allowing only doctors licensed under the authority of the government, and making sure there was always a shortage of such licensed doctors, would allow the group to charge more than the free market value of their medical services. In short, to overcharge the sick. This was the purpose of the American Medical Association, formed in 1847. The AMA did some good things, which don't concern us here. What they did on the economic front was require that medical practitioners be licensed (and they set up boards of their own members to decide who would qualify for a license) and they also licensed medical schools. In licensing such schools they carefully studied the demand for doctors and made sure that not enough doctors were graduated to meet the demand.
Now of course practically every profession, from cutters of hair to real estate agents to accountants and carpenters, requires a license. Some professions have not been as successful at keeping their numbers small and profits high as the doctors have done, but the general idea is there. Barriers to entry, no free market, no ruinous competition. Those who work without license are sucked dry by the fees of those who are licensed to work.
Those doctors who scream for free markets and against "socialist" government health care plans should take a good look at themselves and their ill-got millions. Because of the government preventing the operation of free markets in doctoring, in the 1950's and 1960's the term millionaire-doctor was synonymous with doctor.
If doctors don't want socialized medicine, we should open up doctoring to anyone who feels they can heal. Pharmacists should be able to make diagnoses and sell basic drugs without a doctor's prescription. For that matter doctors should be able to sell drugs in their offices, rather than having to write a prescription. People should be able to self-diagnose, if they wish to take that risk, and get any legal drug without a prescription.
If someone puts out a shingle and causes harm, they could be sued for malpractice. If they claim to have graduated from a medical school, but did not, they could be charged with fraud. If the government wants to certify people, or the AMA wants to identify their members, that is fine, but there should be no rule that you have to go to the AMA men or government men.
What do you say, Republicans and Tea-Party people? Are you really ready to give free markets a chance? I'm certainly ready to hang out a shingle, if the Republican run government is willing to let me. I'll start a medical insurance company too, a coop that benefits the members. That should put some pressure on Anthem et. al.
Note: many doctors have come out for Universal Health Care. For instance see Physicians for a National Health Care Program.
Thursday, November 11, 2010
Sarah Palin to Introduce National Health Prayer Plan
As part of her bid to win the Republican Party nomination for President of the United States, Sarah Palin is preparing to announce a National Health Prayer Plan, according to sources close to Mrs. Palin.
An early draft of her speech on the subject says National Health Prayer will not "interfere with doctors or private health insurance companies." Instead it will eliminate Medicare, Medicaid, and other federal subsidies to "false, science-based health schemes."
"God invented the free market to scourge the lazy and reward the diligent. He invented disease to punish people for their sins. Tax payers should not be penalized for other people's sins."
While the details of the National Health Prayer system remain to be worked out, Palin's vision involves a computerized system of matching sick people to the local church of their choice. "It is a rewards based system for faith healers. Those who are cured will be required to give 10% of their incomes for the rest of their life to the church that cured them."
"God created free markets; the devil created safety nets and socialism," according to Palin. "When you interfere with free markets, you interfere with God's plan for us." The savings to taxpayers would be substantial. The Medicare tax, currently 2.9% of wages would be eliminated.
"Employees will have the equivalent of a 2.9% wage increase. What better gift could the Republican Party give to the voters of the United States of America? However, we do plan to lower the minimum wage to a new global fair wage scale of $1.88 per hour. At that wage level we believe the United States will hit full employment within 2 years of my taking office."
A number of groups are already planning responses to the Palin plan, soon to be known as the Prayer Deal. Commented Roberta Hell of the Flaming Atheist Alliance: "Sarah Palin knows prayer is ineffective, otherwise she would be Vice-President right now. Seniors who rely on Medicare will have their medical care rationed by their limited ability to buy private insurance or at soak-the-patient private doctor prices. That is what this is all about: rationing. Under Palin, America will become one big forced labor camp with monopoly corporations rationing out food, shelter and medical care."
An anonymous source close to Barack Obama said, "The President is aware of the Palin Health Prayer Plan and wishes he had thought of it first. If the Republican Congress presents such a bill to him, the President will look at the specific provisions of the bill before deciding whether or not to sign it."
I asked a local senior about the Palin National Health Prayer Plan. "But I've been paying Medicare tax all my life! It's not fair to cut me off now," she commented. "I'm going to pray that Sarah Palin beats me to the grave, [the rest of her comment was unprintable]"
Sadly, life is not about fairness. It is about free markets and politicians who worship money and power. Not even prayer can change that.
See also Sarah Palin Blasts Health Care [MiamiHerald.com, November 11, 2010]
Category: Satire
An early draft of her speech on the subject says National Health Prayer will not "interfere with doctors or private health insurance companies." Instead it will eliminate Medicare, Medicaid, and other federal subsidies to "false, science-based health schemes."
"God invented the free market to scourge the lazy and reward the diligent. He invented disease to punish people for their sins. Tax payers should not be penalized for other people's sins."
While the details of the National Health Prayer system remain to be worked out, Palin's vision involves a computerized system of matching sick people to the local church of their choice. "It is a rewards based system for faith healers. Those who are cured will be required to give 10% of their incomes for the rest of their life to the church that cured them."
"God created free markets; the devil created safety nets and socialism," according to Palin. "When you interfere with free markets, you interfere with God's plan for us." The savings to taxpayers would be substantial. The Medicare tax, currently 2.9% of wages would be eliminated.
"Employees will have the equivalent of a 2.9% wage increase. What better gift could the Republican Party give to the voters of the United States of America? However, we do plan to lower the minimum wage to a new global fair wage scale of $1.88 per hour. At that wage level we believe the United States will hit full employment within 2 years of my taking office."
A number of groups are already planning responses to the Palin plan, soon to be known as the Prayer Deal. Commented Roberta Hell of the Flaming Atheist Alliance: "Sarah Palin knows prayer is ineffective, otherwise she would be Vice-President right now. Seniors who rely on Medicare will have their medical care rationed by their limited ability to buy private insurance or at soak-the-patient private doctor prices. That is what this is all about: rationing. Under Palin, America will become one big forced labor camp with monopoly corporations rationing out food, shelter and medical care."
An anonymous source close to Barack Obama said, "The President is aware of the Palin Health Prayer Plan and wishes he had thought of it first. If the Republican Congress presents such a bill to him, the President will look at the specific provisions of the bill before deciding whether or not to sign it."
I asked a local senior about the Palin National Health Prayer Plan. "But I've been paying Medicare tax all my life! It's not fair to cut me off now," she commented. "I'm going to pray that Sarah Palin beats me to the grave, [the rest of her comment was unprintable]"
Sadly, life is not about fairness. It is about free markets and politicians who worship money and power. Not even prayer can change that.
See also Sarah Palin Blasts Health Care [MiamiHerald.com, November 11, 2010]
Category: Satire
Wednesday, March 24, 2010
Healthcare Diagnostics
If you read my columns, you know I favor single-payer health insurance, which is to say, government run insurance. Getting that from Congress would have been a major benefit to the American people. I see no downside to universal single-payer insurance. In addition, I would like to try a health care services system run by the government (state or federal). Even though I see some potential downside to that. But as anyone who has experienced our private, profit-motivated system, there is a lot more downside to the current system. Doctors recommending unnecessary procedures or branded drugs when effective generics are available are just two examples. Hospitals buying expensive capital equipment, then running patients through it whether they need it or not, is another. Just plain incompetence being covered up by colleagues - probably get that in a government system too.
In any medical system you will have human error. Diagnostics can be tricky; some times the most probable explanation for a set of symptoms turns out to be wrong. A good system would minimize human error and diagnostic error, but would not be able to eliminate them.
But what of the new health care bill [H.R. 3590] signed into law by the chief administrator of this nation on Tuesday, March 23, 2010?
Frankly, no one can be sure what its real effects will be. Most of its provisions don't come into effect until 2014. That means there are two elections between now and when it takes effect, so it could be changed or even deleted from the books.
One could also see this as a first step towards a government-run insurance system or health care system. I doubt that is the case. The public option was dropped. Supervision of the insurance companies by the government will be minimal. We will all still be at the mercy of the "free market." Imagine an outdoor market. Now imagine there are no police there, and half the people walking around, and three quarters of them behind the stalls, are thieves or con artists. There you have a good picture of the "free market" in health care services and insurance.
The thieves are not having their hands cut off for past practices, but at least they are being told that certain forms of theft are no longer acceptable. You can't drop someone who has been paying insurance just because they get an expensive illness. Why was that ever allowed? Isn't it just plain fraud to sell insurance that you have no intent to pay on?
It should be easier to find and transfer insurance under the plan. The pre-existing condition redlines should go away.
I worry about the idea of forcing people to have insurance. I suppose it is not so very different than forcing them to have a birth certificate, social security number, and a drivers license, and automobile insurance. But forcing people to buy from private, unregulated insurers seems like the government is just helping herd the sheep towards the wolves.
I have not read the bill, and don't intend to. Often what appears to be plain language in bills turns out to be an excuse for a special interest group to rape and pillage.
In 2014, those of us who are still alive can see what actually happens. We can get mad or be glad. In the meantime, let's get the hell out of Afghanistan, and close all of our military bases overseas. We need the money that is wasted on them here at home.
In any medical system you will have human error. Diagnostics can be tricky; some times the most probable explanation for a set of symptoms turns out to be wrong. A good system would minimize human error and diagnostic error, but would not be able to eliminate them.
But what of the new health care bill [H.R. 3590] signed into law by the chief administrator of this nation on Tuesday, March 23, 2010?
Frankly, no one can be sure what its real effects will be. Most of its provisions don't come into effect until 2014. That means there are two elections between now and when it takes effect, so it could be changed or even deleted from the books.
One could also see this as a first step towards a government-run insurance system or health care system. I doubt that is the case. The public option was dropped. Supervision of the insurance companies by the government will be minimal. We will all still be at the mercy of the "free market." Imagine an outdoor market. Now imagine there are no police there, and half the people walking around, and three quarters of them behind the stalls, are thieves or con artists. There you have a good picture of the "free market" in health care services and insurance.
The thieves are not having their hands cut off for past practices, but at least they are being told that certain forms of theft are no longer acceptable. You can't drop someone who has been paying insurance just because they get an expensive illness. Why was that ever allowed? Isn't it just plain fraud to sell insurance that you have no intent to pay on?
It should be easier to find and transfer insurance under the plan. The pre-existing condition redlines should go away.
I worry about the idea of forcing people to have insurance. I suppose it is not so very different than forcing them to have a birth certificate, social security number, and a drivers license, and automobile insurance. But forcing people to buy from private, unregulated insurers seems like the government is just helping herd the sheep towards the wolves.
I have not read the bill, and don't intend to. Often what appears to be plain language in bills turns out to be an excuse for a special interest group to rape and pillage.
In 2014, those of us who are still alive can see what actually happens. We can get mad or be glad. In the meantime, let's get the hell out of Afghanistan, and close all of our military bases overseas. We need the money that is wasted on them here at home.
Thursday, August 27, 2009
Capitalists Announce Five Year Plan
The new capitalist five year plan for the economy of the United States of America (including its empire of affiliated nations) was announced August 26, 2009, in a secret underground bunker in Manhattan. The plan covers the years 2010 through 2014.
The usual report on the prior five year plan was handed out in advance. Although there were some minor glitches in 2008 and 2009, the plan was deemed to be highly successful. The political baton was successfully handed off between the two parties without any real change in policy. Large numbers of workers were impoverished, which will ensure their loyalty and hard work during the coming years, if they are rehired. Almost all value was squeezed out of the economy and into a much smaller number of individual capitalists and banking institutions than had been necessary in the past. The heroin supply from Afghanistan was assured, military spending increased, and China and India got in lockstep with the plan for global development.
The key components of the new five year plan can be summarized as: maintain a stable trajectory. Military spending is to grow, but not so much as to jeopardize other segments of the economy. Unemployment is to recover, as its primary purpose of indebting large numbers of people and insuring their future loyalty has been largely accomplished. Stock market and housing price booms are designed in towards the end of the plan, to be facilitated by easy credit from the Federal Reserve. New regulations are planned to minimize competition, and new loopholes have already been worked into them that can be used to advantage only by the largest corporations.
The health care system in the United States is to remain mainly as it is, with only the most minor of reforms. Sick people are an economic liability once their wallets have been drained, but using tax dollars extracted from workers, high prices for drugs, insurance, and doctor services will be maintained.
The view on global warming has changed since the last five year plan. Super profits will be made by reluctantly accepting government and private dollars for "clean energy" projects. Meanwhile, heavy equipment manufacturing plans will be laid for the vast system of dikes that will be needed to protect sea coasts from flooding.
"Above all," said Michael Milkem, this year's chairperson, "we must remember to not try to micromanage the situation. Our strength is in sticking to fundamentals. Don't sweat the small stuff. Control the politicians, interest rates, and bank lending policies and the small stuff will take care of itself."
The usual report on the prior five year plan was handed out in advance. Although there were some minor glitches in 2008 and 2009, the plan was deemed to be highly successful. The political baton was successfully handed off between the two parties without any real change in policy. Large numbers of workers were impoverished, which will ensure their loyalty and hard work during the coming years, if they are rehired. Almost all value was squeezed out of the economy and into a much smaller number of individual capitalists and banking institutions than had been necessary in the past. The heroin supply from Afghanistan was assured, military spending increased, and China and India got in lockstep with the plan for global development.
The key components of the new five year plan can be summarized as: maintain a stable trajectory. Military spending is to grow, but not so much as to jeopardize other segments of the economy. Unemployment is to recover, as its primary purpose of indebting large numbers of people and insuring their future loyalty has been largely accomplished. Stock market and housing price booms are designed in towards the end of the plan, to be facilitated by easy credit from the Federal Reserve. New regulations are planned to minimize competition, and new loopholes have already been worked into them that can be used to advantage only by the largest corporations.
The health care system in the United States is to remain mainly as it is, with only the most minor of reforms. Sick people are an economic liability once their wallets have been drained, but using tax dollars extracted from workers, high prices for drugs, insurance, and doctor services will be maintained.
The view on global warming has changed since the last five year plan. Super profits will be made by reluctantly accepting government and private dollars for "clean energy" projects. Meanwhile, heavy equipment manufacturing plans will be laid for the vast system of dikes that will be needed to protect sea coasts from flooding.
"Above all," said Michael Milkem, this year's chairperson, "we must remember to not try to micromanage the situation. Our strength is in sticking to fundamentals. Don't sweat the small stuff. Control the politicians, interest rates, and bank lending policies and the small stuff will take care of itself."
Monday, June 29, 2009
Insurance and Casinos
Health insurance is the big issue of the moment. All kinds of politicians made all kinds of promises to all kinds of people during the 2008 elections, and now they are pretending to act on those promises. An improved health care insurance system was promised by many to many. My own expectations are low. But I am happy to debate the issue.
It helps to look at insurance in general, as well as looking at the specifics of insuring people's health.
And to understand insurance, you need to look at it outside the box. A good way to look at something outside its box is to take a look at a similar box, then compare and contrast. The ideal other box to look at, when considering insurance, is the casino, or gambling industry. This is not just my being satirical. It has to do with statistics and probability, which were originally studied and understood by considering games of chance.
Most people know, when they walk into a casino, that the casino is not really in the business of philanthropy. Casinos make money, they don't lose money. People suspend that knowledge by overriding it with another idea. They may get lucky. An individual, going to a casino and playing games of chance for any given period of time, may gain money.
But the money that individual makes is not, except in very unusual circumstances, a concern for the casino. Because other individuals, who are also there hoping to get lucky, are losing a whole lot more money than the individuals who are winning.
Casinos are set up that way. They were set up that way in ancient times before probability and statistics were developed forms of mathematics. Each game in a casino has a return ratio. Over a series of games, the individual outcomes have predictable percentages. This is most obvious in a roulette wheel, where each of the outcomes is equally lightly. Given that, for the casino to win over time the betting odds are simply set to slightly favor the casino. I won't go into the details, but you can find some at Roulette at Wikipedia.
Other games are more complicated, but work on the same principle. In poker the fact that the casino always wins is even more obvious, since a certain amount of each pot is raked off by the casino.
Insurance is remarkably similar. In its simplest form, it is a pool of money. Some people make money (they get more out than they put in); their are expenses for managing the money, and also profits taken out by the owners. As a result, most people get paid back less than they put in. You could argue that as with casinos, if people were rational no one would patronize an insurance company.
But the world is complex, and fear is a primal human emotion. There is an argument that some forms of insurance do make sense for the people who pay for them. This is because decreasing risk has a value to individuals.
Look at auto insurance, for instance. If you get into a car wreck the expenses from it could be enough to bankrupt most people. You probably won't get into a car wreck on any given day or even year, but there is a good chance you will get into one eventually. You fear bankruptcy, so you buy automobile insurance every year. It is expensive, and you are unlikely to come out ahead unless you get into a wreck (make that an expensive collision, not a fender bender) within a year or two after you first take out insurance. Yet it is worth it to many people because it protects them from being impoverished by a random event, an accident.
One can fairly ask, how much is it worth, this diminishment of risk? The auto insurance company has administrative expense and takes out a big chunk of the cash flow as profit to distribute to its investors. So all the people who buy insurance, together, will get paid back less than they pay in. Insurance companies hire actuaries to calculate their long term pay out risks, and set rates high enough to cover that plus administrative costs plus profits. Individuals are not in a position to hire actuaries. All they can do is shop for auto insurance, hoping to find the insurance company that takes the least bite out of the pie.
One other aspect of insurance should be carefully considered: insurance as investment. We see this in some forms of life insurance. The insurance company pays out more in aggregate to the people it insures than they pay in! Even so, the insurance company covers its administrative costs and pays its investors a profit. How can this be?
When an insurance company knows it can hold its incoming revenue stream for a long time (because its actuaries told it so), it can invest its balance of money in bonds, stocks, and real estate. So from an individual insured's perspective, the insurance company resembles a sort of mutual fund. Your family gets paid when you die if you have life insurance, or you get payments from a set starting point until the time of your death if you purchase an annuity policy.
In theory Social Security works like this, as do most old-fashioned (defined benefit) pensions. You pay your social security taxes during your work life. The government invests this money in interest-bearing government bonds. The average person gets more than they pay in. Those who die early are out of luck. Those who live long get far more money than they put in. Of course in reality money put in today goes out today to those who are already drawing Social Security. But it shows the idea of insurance that not only spreads risk, but creates additional income for the entire pool of insured people.
Not that anyone in Congress is going to listen to you unless you gave at least $2000 to their election campaign, but given all this, what kind of federal health insurance would you like?
Should it provide roughly equal benefits for everyone? Should it funnel almost all the money to care for those with the most expensive medical conditions? Should the money that goes in the first year be paid out it once, or should it be accumulated, with interest, for the benefit of those who are doing the paying? Should it be subsidized by taxes, or should it generate a profit to the government that pays for non-medical budget items like the military budget?
It helps to look at insurance in general, as well as looking at the specifics of insuring people's health.
And to understand insurance, you need to look at it outside the box. A good way to look at something outside its box is to take a look at a similar box, then compare and contrast. The ideal other box to look at, when considering insurance, is the casino, or gambling industry. This is not just my being satirical. It has to do with statistics and probability, which were originally studied and understood by considering games of chance.
Most people know, when they walk into a casino, that the casino is not really in the business of philanthropy. Casinos make money, they don't lose money. People suspend that knowledge by overriding it with another idea. They may get lucky. An individual, going to a casino and playing games of chance for any given period of time, may gain money.
But the money that individual makes is not, except in very unusual circumstances, a concern for the casino. Because other individuals, who are also there hoping to get lucky, are losing a whole lot more money than the individuals who are winning.
Casinos are set up that way. They were set up that way in ancient times before probability and statistics were developed forms of mathematics. Each game in a casino has a return ratio. Over a series of games, the individual outcomes have predictable percentages. This is most obvious in a roulette wheel, where each of the outcomes is equally lightly. Given that, for the casino to win over time the betting odds are simply set to slightly favor the casino. I won't go into the details, but you can find some at Roulette at Wikipedia.
Other games are more complicated, but work on the same principle. In poker the fact that the casino always wins is even more obvious, since a certain amount of each pot is raked off by the casino.
Insurance is remarkably similar. In its simplest form, it is a pool of money. Some people make money (they get more out than they put in); their are expenses for managing the money, and also profits taken out by the owners. As a result, most people get paid back less than they put in. You could argue that as with casinos, if people were rational no one would patronize an insurance company.
But the world is complex, and fear is a primal human emotion. There is an argument that some forms of insurance do make sense for the people who pay for them. This is because decreasing risk has a value to individuals.
Look at auto insurance, for instance. If you get into a car wreck the expenses from it could be enough to bankrupt most people. You probably won't get into a car wreck on any given day or even year, but there is a good chance you will get into one eventually. You fear bankruptcy, so you buy automobile insurance every year. It is expensive, and you are unlikely to come out ahead unless you get into a wreck (make that an expensive collision, not a fender bender) within a year or two after you first take out insurance. Yet it is worth it to many people because it protects them from being impoverished by a random event, an accident.
One can fairly ask, how much is it worth, this diminishment of risk? The auto insurance company has administrative expense and takes out a big chunk of the cash flow as profit to distribute to its investors. So all the people who buy insurance, together, will get paid back less than they pay in. Insurance companies hire actuaries to calculate their long term pay out risks, and set rates high enough to cover that plus administrative costs plus profits. Individuals are not in a position to hire actuaries. All they can do is shop for auto insurance, hoping to find the insurance company that takes the least bite out of the pie.
One other aspect of insurance should be carefully considered: insurance as investment. We see this in some forms of life insurance. The insurance company pays out more in aggregate to the people it insures than they pay in! Even so, the insurance company covers its administrative costs and pays its investors a profit. How can this be?
When an insurance company knows it can hold its incoming revenue stream for a long time (because its actuaries told it so), it can invest its balance of money in bonds, stocks, and real estate. So from an individual insured's perspective, the insurance company resembles a sort of mutual fund. Your family gets paid when you die if you have life insurance, or you get payments from a set starting point until the time of your death if you purchase an annuity policy.
In theory Social Security works like this, as do most old-fashioned (defined benefit) pensions. You pay your social security taxes during your work life. The government invests this money in interest-bearing government bonds. The average person gets more than they pay in. Those who die early are out of luck. Those who live long get far more money than they put in. Of course in reality money put in today goes out today to those who are already drawing Social Security. But it shows the idea of insurance that not only spreads risk, but creates additional income for the entire pool of insured people.
Not that anyone in Congress is going to listen to you unless you gave at least $2000 to their election campaign, but given all this, what kind of federal health insurance would you like?
Should it provide roughly equal benefits for everyone? Should it funnel almost all the money to care for those with the most expensive medical conditions? Should the money that goes in the first year be paid out it once, or should it be accumulated, with interest, for the benefit of those who are doing the paying? Should it be subsidized by taxes, or should it generate a profit to the government that pays for non-medical budget items like the military budget?
Tuesday, May 6, 2008
My Medical Last Straw
For the usual reasons, for a long time I have figured that if we are going to have a national government we might as well had national health care for all. It could be in the guise of a single-payer medical insurance plan (only one health insurer for all Americans) with independent health providers (doctors and hospitals) that could be privately run. Or it could be one big government run health system. Either would be fine by me.
However, health care has not been an important issue in my life, and since there seemed to be plenty of people working on passing single-payer health care, I have not been active in that area. Nor have I written about that much.
Last week that changed.
About 15 years ago my wife Jan and I got a catastrophic health insurance policy from Blue Cross of California, which was then a not-for-profit organization. We were both healthy, but Jan's dad bugged us about it, and the premiums were only a couple of hundred bucks a month. We both work freelance, so we don't have an employer and can't get the better insurance rates that big corporations negotiate with health insurers.
About 8 years ago Jan started treatment for high blood pressure. That locked us into our Blue Cross policies because, as you know, when you change policies even if you have something as common and innocuous as high blood pressure, then won't insure you for anything related to the pre-existing condition. And almost everything but cancer and broken bones are in the cardiovascular category.
Jan bought a home blood pressure monitor and I checked my blood pressure with it. For years I was in the high end of normal, then it crept up into the definitely high range and I sought treatment at the only local medical provider, Redwood Coast Medical Services, known as RCMS. My doctor is Thomas Bertolli, who is also the RCMS medical director.
It seemed to me that in settling on a blood-pressure medicine for me I was being involved in a number of expenses talks with Mr. Bertolli at $75 a pop (remember my medical insurance covers absolutely nothing but hospital care, and then has a high deductible). The only relevant information was my blood pressure readings. But I started taking medication and we upped the dose until I was getting good readings. After resisting his trying to get me to come in for unnecessary lectures, I found that RCMS did give free blood pressure readings. So I got those and my prescription was renewed without seeing Mr. Bertolli and paying $75 each time.
I knew from my wife and other patients that if you let them, they would schedule a doctor visit every time you needed a prescription renewal.
My time was running out, however, and I knew it. But my wife actually found a loophole in our favor. Our insurance, which now runs $350 a month, would pay for an annual physical. Would pay $131 for that. So I figured here was a win-win situation. I would schedule an annual physical instead of a mere office visit with Mr. Bertolli. RCMS would get more money and I would not be out of pocket.
When I called for the appointment, however, they said I would have to have a blood draw a week before hand. That means paying for the blood draw and lab tests. Well okay, I would pay for that. Who knows, maybe something would show up in the blood test. However, my wife warned me that her nurse-practitioner had popped her head in during the blood draw, chatted for a minute, and then charged us for a doctor's visit! So I was prepared to head off that scam.
I go for my blood draw. The nurse started telling me what would happen, and she said I would see Mr. Bertolli for a couple of minutes before the actual blood draw. I said I did not want to pay for a doctor visit when I would be seeing him for as long as he wanted a week later. She sent me back to the waiting area while she waited to tell Bertolli of this possible peasant rebellion.
The nurse came back with the news that to get a blood draw I would have to see Bertolli and pay for it. I said no. Then she took me back to the blood draw room anyway.
Bertolli came in and said it was medically necessary for me to see him before a blood draw. I asked him what the medical necessity was and he could not give an answer. He said he was not trying to just run up the charges. He told me medicine costs money like everything else and I would have to pay for it or leave. The fact that I have paid for it, to RCMS and my medical insurer, did not matter. I told him I elected to not see him, not have a blood draw, and not have a physical. He said fine and I walked out.
But of course, the AMA (American Medical Association) has made sure that they control the dispensation of all pharmaceuticals. I thought I could go to Tijuana, Mexico (I live in northern California, but visit San Diego once in a while), and buy my medicine without a prescription. But apparently that was old information. Now customs is seizing medications bought in Mexico unless you have a prescription from a doctor in the United States.
It is simply blackmail. Bertolli thinks he has control of my life because I would have to do hours of driving to get to a non-RCMS doctor. And his AMA gangsta friends are probably all doing this, if RCMS made it policy.
And our elected officials specialize in doing nothing, because doing nothing keeps things profitable for the AMD and the private insurers.
And despite this extortion of people who have no insurance or inadequate insurance, RCMS is widely reputed to be going under financially. The reason for this is twofold. When insurers have to pay, they bargain RCMS down to an unprofitable level. And moreso, when Medicare and Medicaid patients come in, RCMS is reimbursed by the government for less than the cost of treatment. Our area is now heavily populated with retirees, so RCMS sees a disproportionate number of Medicare patients.
And that tells you my probable health trajectory. I am 53 years old. At the age of 65 I will be able to go on Medicare and get my blood pressure treated. In the meantime, I will have high blood pressure, which increases the risk I will have a heart attack or a stroke. It isn't that I don't have $75 to donate to RCMS. It is because I don't trust someone who would blackmail me to tell me what is good for my health.
It is notable that my untreated blood pressure readings are not atypical for a man of my age. The blood pressure medicine was really preventative medicine. Unless it is provided for a reasonable cost, I have to consider it optional.
And cholesterol medicine, I suspect, is one of the biggest scams ever put over on the human race. The only people who seem to benefit from it are people who have already had a stroke or heart attack. I believe tens of millions of Americans are taking it just to enrich doctors and pharmaceutical companies.
Am I over my head here? Am I just talking nonsense? See my What I Know About Healthcare for my qualifications for analysing the health industry.
However, health care has not been an important issue in my life, and since there seemed to be plenty of people working on passing single-payer health care, I have not been active in that area. Nor have I written about that much.
Last week that changed.
About 15 years ago my wife Jan and I got a catastrophic health insurance policy from Blue Cross of California, which was then a not-for-profit organization. We were both healthy, but Jan's dad bugged us about it, and the premiums were only a couple of hundred bucks a month. We both work freelance, so we don't have an employer and can't get the better insurance rates that big corporations negotiate with health insurers.
About 8 years ago Jan started treatment for high blood pressure. That locked us into our Blue Cross policies because, as you know, when you change policies even if you have something as common and innocuous as high blood pressure, then won't insure you for anything related to the pre-existing condition. And almost everything but cancer and broken bones are in the cardiovascular category.
Jan bought a home blood pressure monitor and I checked my blood pressure with it. For years I was in the high end of normal, then it crept up into the definitely high range and I sought treatment at the only local medical provider, Redwood Coast Medical Services, known as RCMS. My doctor is Thomas Bertolli, who is also the RCMS medical director.
It seemed to me that in settling on a blood-pressure medicine for me I was being involved in a number of expenses talks with Mr. Bertolli at $75 a pop (remember my medical insurance covers absolutely nothing but hospital care, and then has a high deductible). The only relevant information was my blood pressure readings. But I started taking medication and we upped the dose until I was getting good readings. After resisting his trying to get me to come in for unnecessary lectures, I found that RCMS did give free blood pressure readings. So I got those and my prescription was renewed without seeing Mr. Bertolli and paying $75 each time.
I knew from my wife and other patients that if you let them, they would schedule a doctor visit every time you needed a prescription renewal.
My time was running out, however, and I knew it. But my wife actually found a loophole in our favor. Our insurance, which now runs $350 a month, would pay for an annual physical. Would pay $131 for that. So I figured here was a win-win situation. I would schedule an annual physical instead of a mere office visit with Mr. Bertolli. RCMS would get more money and I would not be out of pocket.
When I called for the appointment, however, they said I would have to have a blood draw a week before hand. That means paying for the blood draw and lab tests. Well okay, I would pay for that. Who knows, maybe something would show up in the blood test. However, my wife warned me that her nurse-practitioner had popped her head in during the blood draw, chatted for a minute, and then charged us for a doctor's visit! So I was prepared to head off that scam.
I go for my blood draw. The nurse started telling me what would happen, and she said I would see Mr. Bertolli for a couple of minutes before the actual blood draw. I said I did not want to pay for a doctor visit when I would be seeing him for as long as he wanted a week later. She sent me back to the waiting area while she waited to tell Bertolli of this possible peasant rebellion.
The nurse came back with the news that to get a blood draw I would have to see Bertolli and pay for it. I said no. Then she took me back to the blood draw room anyway.
Bertolli came in and said it was medically necessary for me to see him before a blood draw. I asked him what the medical necessity was and he could not give an answer. He said he was not trying to just run up the charges. He told me medicine costs money like everything else and I would have to pay for it or leave. The fact that I have paid for it, to RCMS and my medical insurer, did not matter. I told him I elected to not see him, not have a blood draw, and not have a physical. He said fine and I walked out.
But of course, the AMA (American Medical Association) has made sure that they control the dispensation of all pharmaceuticals. I thought I could go to Tijuana, Mexico (I live in northern California, but visit San Diego once in a while), and buy my medicine without a prescription. But apparently that was old information. Now customs is seizing medications bought in Mexico unless you have a prescription from a doctor in the United States.
It is simply blackmail. Bertolli thinks he has control of my life because I would have to do hours of driving to get to a non-RCMS doctor. And his AMA gangsta friends are probably all doing this, if RCMS made it policy.
And our elected officials specialize in doing nothing, because doing nothing keeps things profitable for the AMD and the private insurers.
And despite this extortion of people who have no insurance or inadequate insurance, RCMS is widely reputed to be going under financially. The reason for this is twofold. When insurers have to pay, they bargain RCMS down to an unprofitable level. And moreso, when Medicare and Medicaid patients come in, RCMS is reimbursed by the government for less than the cost of treatment. Our area is now heavily populated with retirees, so RCMS sees a disproportionate number of Medicare patients.
And that tells you my probable health trajectory. I am 53 years old. At the age of 65 I will be able to go on Medicare and get my blood pressure treated. In the meantime, I will have high blood pressure, which increases the risk I will have a heart attack or a stroke. It isn't that I don't have $75 to donate to RCMS. It is because I don't trust someone who would blackmail me to tell me what is good for my health.
It is notable that my untreated blood pressure readings are not atypical for a man of my age. The blood pressure medicine was really preventative medicine. Unless it is provided for a reasonable cost, I have to consider it optional.
And cholesterol medicine, I suspect, is one of the biggest scams ever put over on the human race. The only people who seem to benefit from it are people who have already had a stroke or heart attack. I believe tens of millions of Americans are taking it just to enrich doctors and pharmaceutical companies.
Am I over my head here? Am I just talking nonsense? See my What I Know About Healthcare for my qualifications for analysing the health industry.
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