Health Insurance Regulations – Go Comment

The Impractical Catholic has a very practical link to how to submit your comments on the new health insurance regulations.  Click on his link, it is very easy from there.   You can scroll through the regulations to make sure you know what you are talking about, and then submit the comment of your choice.

Naturally I forgot to copy mine for posterity before it submitted, by my talking points were this:

• I quoted the bit about how the goal of the religious exemption was to protect houses of worship.
• I observed this was too narrow a view of “religious institution”, that did not represent the reality of religious institutions such as hospitals, schools, and other benevolent works.
• I proposed a compromise, in which employees of such institutions could choose either to accept the employer-provided plan, or use a cash allowance of the same value to purchase the plan of their choice from another source.
• In that way, the religious employer is not required to directly fund a health care plan that includes treatments contrary to its religious tenets, but employees remain free to choose some other plan as they see fit.

I didn’t say it, but it’s a bit like the difference between saying, “every employee shall be given a per-diem allowance to pay for travel expenses at a hotel or brothel”, versus specifying a per diem amount per day, and leaving it to the employee to decide where he wishes to lodge.

So that’s what I wrote.  Go write something yourself.  It is so easy and fast.  Really, it is.

 

Okay, here’s the link directly to regulations.gov that I followed from Impractical Catholic’s post.  Go.  Now.  Seriously.

 

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Also: Reconsider giving your nine-year-old a blog on the same blogging program you yourself use.  I almost posted this on a hot-pink ProudKittyCat blog.  That woulda made the grandparents raise an eyebrow.

Hey, look, a Tollefsen article!

Yeah, it took me by surprise too.  You’ll be relieved to know it’s on a nice, quiet, non-controversial topic, Contraception and Healthcare Rights.  Here were my thoughts as I read:

1. Yay!  A Tollefsen article my readers will actually like!
2. Ooops.  Nope.  More mad readers.  Uh oh.
3. No, never mind, I think it’s good after all.

So, er, read at your own risk.  It’s written philosophy-style, of course, so you’re constantly behind the curve, never really sure whether you agree with the guy or not.  But I’m pretty sure he makes sense.  In that special philosopher way.*

 

 

*Keep in mind that professional philosophers have to work day in and day out with people who aren’t strictly sure they exist, or perhaps are sure they exist, but also that they only turned up at the conference or the coffee bar on account of their molecules making them do that.  I’m not making fun.  That’s what a subset of real live tenured philosophy professors actually think.  I’ve taken the classes . . . I know.  You’d write reaaally caaarefullly if you had to present your papers to those people.    (I mean, for a living.  If you’re a student, you could just write normally and live with the B.)

Living Wage Explained

Look here.  This is what we’re talking about when we say “living wage”.  Specifics.  The real deal and why it matters, and what the numbers are.  Read read read.

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FYI I’ve gone back to submersion here.  My apologies to those of you who are in my e-mail backlog, I will get to you soon.

CRS – Somalia Famine

If you are looking for a way to feed refugees of the famine in Somalia, Catholic Relief Services is there.  Here’s the CRS main page.  (H/T to Red Cardigan for the head’s up.)

 

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Utterly unrelated, but it has to do with CRS: Larry’s Beans makes really good coffee.  100% fair trade, shade grown, and either organic or transitioning to organic.  And wow, good.  Good.  CRS is one of their partners, though I learned about it through an evangelical friend who used to own a coffee shop, and now runs a local Larry’s Beans purchasing co-op.  Yes.  Sometimes (okay, usually), I think of my evangelical home group as a The Gluttony Group.  Because we eat that well.  But we also talk about God and stuff, so it’s a wash.

More applied healthcare studies . . .

The Miracle of Mid-20th Century Medicine. Croup for baby –> bronchitis for mom.  But, through the magic of amoxicillin, I went from a person who got winded checking e-mail and had to go lay down, to a more or less normal person who cooks dinner and potters in the garden.  Within about three days.   I’m a person who crusades against antibiotic overuse, but there’s definitely a time and place.  Still not 100%, but getting there.

As it relates to health care reform:

a) I was definitely happy to have a $25 co-pay instead of a huge office-visit bill, in order to go see my GP and get dx’d and prescribed.  (Yay Publix pharmacy, though, for free oral antibiotics.  Not that amoxicillin is all that expensive to begin with.)

b) But really, there’s got to be a better, lower-cost model for delivering this kind of basic care.  Health insurance makes it easier for one to afford the office visit — mostly by spreading out the cost over time and among buyers — but it doesn’t actually lower the cost of care.   Just as I wouldn’t go to the ER for something that can be treated by the GP, there ought to be a widely-available step-down option for conditions like this one that didn’t require all the training and equipment of the GP even.

c) Prescription Drugs and Responsibility vs. Safety (Or: What do I do with my leftover cough suppressant?) The way we set up our prescription drug laws is a real cost-benefit trade-off.  In the interest of safety, the law, as I understand it, says that you’ve got to destroy perfectly good medicine if you don’t need it yourself for your current condition.   From a purely economic standpoint, this approach prevents harm, and therefore makes us wealthier.   But it also makes up poorer, because we have to destroy valuable property in the interest of safety.

Because I happen to be a responsible person related to a number of intelligent, responsible, honest people, I tend to lean towards liberalizing the law.   I travel in circles where you really could borrow some prescription cough supressant from your in-laws, and it would be done safely and honestly, and hey we even have the same GP so he could chart it.   I don’t know the details of what I am proposing.  But I know that a lot of people (not myself) violate the laws concerning sharing prescription drugs, because they find in their particular situation the law does more harm than good.

–> And it is damaging to the fabric of society, when large numbers of would-be law-abiding citizens feel it is acceptable to break the law, and in fact do so in order to do genuine good. Prescription drug laws are not like laws against robbery or murder.  Helping another person by freely giving them what their doctor has prescribed is not inherently evil.

Now I realize the law is there to protect against fraud, and to protect against the injury or death that can occur if you use the wrong medicine, or the right medicine in the wrong amounts.  I understand this. I do not propose we eliminate all safeguards.

What I’m saying is that our current laws don’t seem to quite match-up with our best interests.  As far as I can tell.

Topic on which I do not have a firm opinion at this time.  Still thinking about it.

Croup

We seem to be running a ‘healthcare’ theme to fit the national mood.  Trying to predict what will happen once everyone has affordable, decent health care coverage?  Here’s our experience:

-When a small child nearly sheared off her pinkie, why yes, we did spend two surgeries, PT, etc etc to get it back in order.  Knowing full well it was was only a pinkie.  Felt a little extreme, but on the other hand, we’re glad to have a pretty useful little finger in exchange.   If said finger hadn’t survived the attempt, we’d feel like we had been extravagant.  But it did and is faring quite well, so instead we feel like it was money well spent.   That said, sincerely doubt anyone — us or doctors — would have put such an effort into the little finger if we lived in a place where we expected to pay the full cost out of pocket.   We are quite grateful for insurance.

-When a much smaller child came down with croup in the middle the night (4th child, but our first run-in with croup), the first instinct was to run to the ER.   Which is close to home, well-run, and for which we have insurance.  But, would have involved being out for hours, and probably would have ended with “Your child isn’t on death’s door.  Go home and put her in the shower”.  Luckily we had a handy baby book  and DH remembered a co-worker telling us what to do for croup. Between the two, we were set.  Shower did the trick first time, out into cool wet night air did it the second time, and in between we (I) just stayed with her through the night to make sure nothing worse developed.  Next day I considered calling the pediatrician (no charge) for some advice and reassurance, but decided we had it under control and didn’t need to speak to the nurse in order to be told what we had already figured out.  Croup summary: Even with a kinda scary incident and inexpensive or free healthcare, the hassle factor outweighed the need for reassurance.  [I assure you, we’d be in the ER in a second if the baby was showing signs of distress.]

My brilliant economic analysis based on those anecdotes: I don’t have any idea what will happen post-Obamacare.  I know that good insurance does encourage us to seek treatment we otherwise might decline.  I think in many cases we end up with a better health care decision as a result.  More accurately: we end up with better health.   I also know that “just because it’s free” doesn’t always mean we’re going to seek the treatment or professional advice.

My best guess on health care usage is that we”ll see an increase in visits for more “minor” situations.  Including much more preventive care, which means we’ll see a corresponding decrease in last-minute emergency care for people who put off going to the doctor.  I think on the whole, this will help with our nation’s overall physical health.

I’m hopeful that the health care exchanges will help the economy by allowing individuals to start small businesses without the fear of losing corporate health care.  I’m concerned that this will be run about as well as we run our other government functions: sometimes quite well, but sometimes quite badly.

I think that financially it is all very much part of the current national habit.  Take a look at this year’s 1040 forms.  Have you noticed the creep in complexity over the past decade?   (Have you noticed that an awful lot of people don’t do their own taxes anymore?  Um, excuse me?  How have we gotten to the point that a worksheet of basic arithmetic has generated an entire profession?)  I think we have reached a point where we expect our government’s work to be complex and burdensome, and we expect to be in debt.   As long as we think all that is normal, we should not be surprised our economy isn’t so healthy.

Which reminds me, I need to go clean my house.   Happy Holy Week.

Price Lists

This is why we need price lists.  There can be no real health care cost reform until medical prices become publicly available.

Basic economics.  You cannot have secret prices and expect the market to function.

Health Care and the Living Wage

So when I started writing about the Just Wages, I intentionally left health care out of the picture.  Why?  Because health care is a virtually unlimited need.

I have no qualms about telling you that a person only truly needs so much living space, this much food, that much clothing, and so on.  It is important that we not make an impossible wreck of a straightforward moral teaching, by trying to tack on burdensome ‘extras’, as if love of neighbor were synonymous with ‘upper-middle class 21st century American’.

But how much health care does a just wage pay for?  Not so easy to define.   Set aside all the debates about which care is most helpful, and which is not helpful at all — those are medical debates.  Pretend you know what the useful stuff is, and focus on just the question of ‘how much’.

It can’t be nothing, we are certain of that.  But does the requirement extend to providing every care that might possibly help the worker-patient?  We have an arsenal of extraordinarily expensive tests, procedures and medicines that will extend life a few months or a few years; we have treatments that, in the event they work, will give back the recipient a nearly-normal lifespan, but for which the probability of sucess is quite low.

Those rescued months and years, those chances of success, are absolutely priceless.  I am easily persuaded that, as a society, we should value the medical progress that cutting-edge technology offers.  We should choose legal structures that encourage both doing the research, and making new forms of care more widely available.

But should every business owner consider it a normal cost of business, to provide wages that will cover high-cost-low-expected-return medical treatments?

I think that we need to fall back on the same pragmatic approach used for discerning just wages in other areas:

1) Remedy gross injustices. Keeping in mind that, say, access to a safe water supply remains a significant health problem for many workers around the world.  Employers should begin there.  I’m reminded of my friend Jenn Labit, whose factory in Egypt includes such basic amenities as a safe way to store lunches.  Sounds self-evident, but it was not the standard local business practice.

2) Use the love-neighbor-as-self standard. If senior management and members of the board are willing to accept a given level of health care, it is reasonable to assume the company is making an honest effort at providing a just wage for health care.

Beyond that?  We want to set up laws and regulations that make it possible for employers to efficiently provide a good health-care wage to workers.   We can disagree over the details — I’m not convinced the current legislation coming out of Congress is going to be an efficient and effective fix.   On the other hand, I’m entirely in love with my local water company, and do think that providing clean water is an appropriate use of community — read: local government — power.   Assuming it is done well, as it is where I live.

–> The imperative to pay a just wage works both ways.  On the one hand, it is up to local governments to set up community structures in a way that makes it affordable for businesses to pay a fair wage.  Think: utilities, transportation, policing, insurance regulations, medical safety standards.  On the other hand, the requirement to pay a just wage ought to spur businesses to use their importance in the community to push for change when the local government has fallen short of its mandate.

MS & The Dreadfulness of Being

So in my very sporadic reading lately, MS & assisted suicide seem to be frequent partners.   Take a look here, for example.  Ironic, since multiple scelrosis is not a terminal illness, and people who are in favor of assisted suicide and euthanasia usually use ‘terminal illness’ as the excuse for their position.

Which got me to thinking . . . what is it that makes MS dreadfuller-than-average?  Not worse, necessarily, but more dreaded?  A few brainstorms:

It won’t kill you. Not usually, anyway.  Catch a nice case of terminal cancer, and you can be dead in short order, without having to a lift a finger.  Come down with MS, and you’ll probably live about as long as previously planned.   So if you develop a death-wish, your disease won’t fulfill that desire for you.

MS is very unpredictable.  Will you develop horrid symptoms?  Which horrid symptoms?  Nobody knows.  Until diagnosis, you had a life map all planned out.  Now it isn’t just a matter of changing plans, but of not even knowing how to make your new plans.  Losing the illusion of control is very stressful, and stress can be depression-inducing.   Depression, of course, being what leads people to suicide.

The unpredictability can be very discouraging.  Unlike once-and-for-all disabilities, with MS you never know what is coming next.  Which makes it hard to know what rehab efforts will turn out to be worthwhile.   Your right hand is acting up — do you learn to write left-handed? What if your left hand goes next?  So you decide to try a nice dictation software — but what if your speech becomes affected?  And yet you feel a tad silly preparing to blink as your attendant points to a letterboard, when so far all you’ve got are some numb fingers . . .  It isn’t that the disabilities associated with MS are impossible, of course they aren’t.  People manage just fine with equally disabling non-MS conditions.  It’s that it is discouraging to work crazy hard to adapt to the current symptoms, knowing that at any moment all that work might come to naught, and you have to start over from the beginning again.

–> Curiously, people without MS-type conditions are also prone to having all their hard work wiped out in an instant.  It’s just that they enjoy a more insistent illusion of control than a person with a known dreadful disease.  No one says, “Darling, are you sure you want to take up archery?  What if you lose both your hands to that nasty strain of meningitis tomorrow?”

The unpredictability is hard on bystanders, too. The family members in particular who may have to provide care, pick up slack, and spend financial resources, also lack that pleasing notion of predictability.  There’s no getting into a comfortable routine, confidently determining that x,y & z are going to be needed, how can we provide for x, y & z in the most efficient, family-friendly way possible?

(And of course, your loved one *isn’t* likely to die soon, so you can count on this unpredictability to go on indefinitely, with none of that desperate emotional force of caring for a person actually on their death bed.  It is wearying.)

MS happens to adults.  Which means the raw parental passion isn’t there to fight desperately for the sick person.  Sordid truth: parents will fight to the bitter end on behalf of a sick or disabled child, in order to give that child every possible chance at life, to help that child thrive and live life to the fullest, despite whatever obstacles.  That’s how parenthood is.  (Not actually due to the disease in question — parents generally work crazy hard for all their children, regardless of health status.)   But by the time you develop MS, you usually don’t have Mom and Dad there to clear the path at every turn.   And there just aren’t many good substitutes for good ol’ Mom & Dad, when it comes to being a sick person.

And then of course, there’s the actual suffering.  MS has a deservedly bad reputation — it can be a truly vile illness.  Kinda like polio: a lotta people are exposed to the polio virus and are none the worse for wear; but if it decides get you, it can get you good.   Depending on your luck, patient and loved ones might actually have a hard time of it with MS, with the all the difficulties that come with any disabling injury or nasty illness.  Not all cases turn out to benign, or painless, or something-I-was-ready-to-deal-with.

So in all, it is a recipe for stress and discouragement.  This for the person with MS — who already is prone to depression just as a symptom of the disease, aside from everything else.  And then also for the near family members, the people who, when the depressed patient begins to think about suicide, are *supposed to be* the ones who help the patient get treatment for the depression.  Except that if you, the caregiving family member, are yourself suffering from situational depression, you are hardly in a position to think clearly on matters of life and death.

And hence MS shows up in the news, wound up in the politics of suicide and euthanasia.   Not because it is a terminal illness — precisely because it is *not* a terminal illness.

Killing People Is Not The Solution. Emotional support, social support, practical help with day-to-day problems: *these* are actual solutions to the problems related to MS.  [Hey, living wages, real health care reform, and accessible community design would be useful here! Hint hint.]   Treatment for depression, for whichever members of the family are suffering from depression, is essential.  A strong legal framework that protects vulnerable people from the temptation to suicide and euthanasia is part of the package, too.

–> Legislators, judges, and medical professionals who encourage death as the solution to discouraging medical problems are, frankly, a bunch of cowards.  Wicked evil cowards.   Deal with the actual problem, don’t try to sweep it under the tombstone.

Why a sliding scale matters (health care costs)

So.  Months ago I started this health-care cost topic.  We started off on the topic of routine costs.

And to summarize the main point of that post: Routine health care — all those preventative check-ups, and the care and treatment of run-of-the-mill colds and flu and stubbed toes is not something we actually “insure”.   These are planned expenses.

Insurance is the means of having everyone contribute a modest amount to a funding pool, so that the few who suffer the unlikely catastrophe are not devasted by the enormous costs.    So, we insure against a car wreck — many drivers will never be in one.  But gasoline and oil changes are part of our routine costs — costs every driver will incur, no matter how careful you are.

When we say we have “insurance” to cover routine health care costs, what we really have is a pre-payment plan.

(The same can be said of larger unplanned-but-still-expected expenses.  Sprained ankle, the weird stomach thing that felt like a heart-attack but you went to the ER and it turned out you were okay, the  routine delivery of a healthy baby.   You might not know exactly when and what expenses are coming your way, but come on, you knew something was bound to happen.  You set aside an “emergency fund” of cash to cover these odds and ends.)

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On the other end of the health care spectrum are insurable costs.  Not everyone will get cancer, or suffer massive injuries in a car wreck, or contract some other equally expensive ailment.   Insurance to cover the cost of treatment makes sense.   We all contribute a modest amount towards paying those expenses, and if you are the unlucky one, the pool of funding is there to help pay your enormous bills.

–> Now it should be observed that as with home insurance or car insurance, there are factors that affect how likely you are to suffer the big disaster.   Within reason, it makes sense to allow the health-care corrollary to safe-driver and good-homeowner discounts.  Recognizing, however, that unlike obeying the speed limit or installing a sprinker system, a significant chunk of a person’s health is not within their control.  Like being male & under 25, slightly elevated rates are understandable, but it isn’t fair to price a guy completely off the streets for something he can’t control.

But here’s where health insurance differs entirely from car and home insurance: You can’t buy a cheaper body.

If my budget is tight, I can choose to live in a small home and drive an inexpensive, easily-repaired, fuel-efficient used car.    My insurance rates will, correspondingly, be lower.  Likewise, my routine maintenance costs will be lower.

(Indeed, how do we measure a living wage?  We aren’t looking for a wage that will pay for a mansion and a cadillac.  We look at whether it will cover such basic needs as modest housing and frugal transportation.)

With health care, we aren’t so lucky.  If I take a big pay cut, I can’t go sell my McMansion body and rent a modest little apartment of a body instead.  I can’t take my late-model BMW body to Car Max, and come home with a cute little ’92 Civic in exhange.   I can’t even park my gas-guzzler body in the driveway and take public transit for all my bodily needs instead.  Indeed, for the most part I never got to choose whether I wanted an expensive body or frugal one to begin with.  I’m stuck with whatever body I was given, and bodies aren’t given out according to income.

What does this mean for health insurance?

It means that the point where health care becomes unaffordable depends on your income.   Partly a living-wage problem, of course.   But let’s imagine a worker earning enough to cover routine appointments and modest amount of emergency health-care besides.  The illness that is an inconvenience and a bit of a strain to a wealthier family is something that would be absolutely unaffordable to a person of more modest means.

(Check out the wheelchair world for a specific example: Some people can just go out and buy the chair that suits them best, even though it costs something in between a high-end racing bike and a quality new car, depending on their needs.  Other people have to hope someone, anyone, is willing to fund a chair approximating what they need to function in a healthy manner.)

It also means that the ability to afford insurance premiums varies.  How much of your monthly budget can you set aside?

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Two very obvious points, I know.  And hence the importance of sliding-scale charges for health care.  If we mean to have a fair health care system, it is reasonable to give discounts to people who cannot afford as much.   Kind of the way we have student discounts for opera tickets.

Does that mean we have to go with a tax-funded, nationalized health-care system?  Not necessarily.  Physicians could be allowed to post discounted prices.    Insurance companies could be allowed to issue policies where the premiums and deductibles are percentages-of-income rather than flat rates.   Employers that offer health insurance benefits could be allowed to vary the “employee’s share” of the expense according the employee’s income.   If we are creative enough to think up double-coupons, Sam’s Club, and Early Bird Specials, we can figure this out, too.