Made a section in the sidebar for Haiti blogs, including a few extras I didn’t have on my list the other day. The Pye’s write about their work distributing emergency food aid:

We talked with World Food Program and they said we could use their food if each pastor wrote their name, their church, a phone number, and each person’s name that would receive the food. So we did and we were given hundreds of list; from 14 people to 2,000 people on them. Saturday we started calling pastors. We would get a pile of food together that would feed the number of people on their list. They would come in a vehicle and pick it up. On Saturday we were able to give to 20 pastors food and water for the needy in their congregations.

I think this is a good response to the WSJ op-ed the other day questioning the role of foreign aid.  Using the Pyes as a distribution-point, World Food Bank is getting food into the hands of specific individuals.  There is a mechanism in place for accountability and transparency.  (On the topic of corruption and graft, see Mary Anastasia O’Grady’s  WSJ column today.  Chilling.)

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On another note, I signed up for the Coalition for Clarity.  I’m not usually the joining type, but I make an exception for this worthy cause.  Because you know, torturing people is just plain wrong.  FYI, you don’t need to be catholic to join.   Just as you don’t need to be catholic to know that torture is evil.

Haiti Blogs

Three blogs I’ve been following for Haiti updates:

The Anchoress, who has been posting reports from a friend in Petit Goave.

The Livesay Weblog, missionaries working in Haiti with several ministries — currently running a makeshift hospital at their location.

The Rollings — their ordinary work is making water filters for Clean Water for Haiti, based out of Pierre Payen.

Follow these.  When you can do almost nothing, at least you can know how to pray.

(Thank you to the several people who first pointed me to these.)

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.

RE: ‘climate change’

I’m a sorry linker, when it comes to WSJ articles .  But anyway, the other day* , after I posted about the beetles, the journal’s “The Numbers Guy” column was on climate models.  Long discussion about how these models are inaccurate, unreliable, not good for making policy, etc. But then there was this graph.  A very eye-catching graph.

–> Which showed, to my slightly-trained eye, that sure enough, over the past century the average global temperature (that’s got to be fun to measure) has been steadily increasing. Plenty of up-n-down blips, but the overall trend was mighty obvious.

Now what to do with that data another question entirely.  I’m not persuaded it’s a man-made phenomenon, though I can certainly see why someone might think so — industrial revolution, all that.  But as I think about Romans-to-Renaissance industrial ebb and flow, and then ponder the climate variations that went alongside, I just don’t see the connection.

It could be that my memory is poor — it’s not like I’ve got 2,000 years of ecomic and weather data neatly filed here at my  hand.  I’m just going off of bits and pieces pasted together from various reading over the years.  So if someone has a nice readable [short, if we could] article fitting that slightly longer-term data into the current climate-change theory, do post.  I really am not at all decided one way or another.

 

*That’s a technical citation, meaning “it is in my mulch box, no longer in the living room”.  Which is how we date newspaper articles here.

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.

Nice economics link here.  Haven’t read the article cited, just the blog post.  But it looks promising.

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.)

***

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?

***

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.

On the other hand . . .

Something the WSJ hasn’t taken up yet, and really, really needs to be addressed in this whole health-care-reform debate:  The way our current insurance system supresses entrepreneurship.

What works well right now is the company-sponsored health insurance plan.   Go to work for a large organization with good benefits, and you’re in pretty good shape, healthcare-wise.  Thus it goes against the grain, when thinking about improving access to health care, to do anything to fiddle with the one part of our system that is actually providing decent care.

–> But because it is the *only* method that is working well, people who need good insurance at an affordable rate are essentially barred from entrepreneurship.

It needn’t be this way.  There is nothing special about insurance pools formed by grouping co-workers.  Individuals could be be grouped by location, by industry, by favorite color — however you like, the principle of pooling risk works the same, as long as you have a large number of buyers over whom to spread the risk.

–>  A reform of the insurance industry could open up affordable insurance options to individual buyers, regardless of their employer.  Transparent pricing policies would further enable individuals to make confident health care purchases without relying on an insurance company to do all the negotiating for reasonable rates.

But as the system stands now, large companies are able to suck in a disproportionate amount of talent because they hold the key to reliable, affordable health care.  And specifically, they are able to suck in over-qualified talent because of the cost/price differential between health care costs in the corporate versus the individual markets.

***

People work around it.  You start your own business on the evenings and weekends, and hold onto the corporate job until you finally have enough income to go on your own.  Or your spouse works the corporate job, any job, just to get the benefits, so you can be covered while you get the business up and running.   As you grow your little company, at first you try to hire employees who already have insurance through a parent or spouse or a 2nd job.  There are ways to work the system.

But I think economically it is a drain.  We would be better off– and better able to whether economic downturns — if our structures for providing health care were more favorable towards entrepreneurship and small businesses.

health-care: private versus public rationing

One of the arguments in favor of Obama’s health care program is something like this:

“Insurance companies effectively ration care, too — deciding what treatments the insurance will and will not cover.  Therefore, going to a government-run program will make no difference.  Those who complain about possible ‘rationing’ are throwing out a red herring.”

I disagree, for all the reasons Darwin Catholic lists here.

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[Review: I am not a person who is opposed to health care reform.  Indeed, I am a person who has written on this very blog about what kinds of health care reform I think are needed.  I have specifically given examples of why charitable assistance is needed for those who can’t afford adequate health care.  I just happen to think that going to a single-payer, government-run system might not be the best of our available options.]

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I would add that in my opinion, effective health care reform would free up our insurance system so that consumers have *more choice* and *more information* in order to choose an insurance progam that best meets their preferences.  For example, someone has proposed making insurance portable from job to job.

–> I think the idea is that insurance pools would not be formed by companies on behalf of their employees, but rather by individuals.  The role of the employer would be to provide the means to pay for the insurance.

***

And of course for all this to work, yeah, you’d need pricing transparency.  You’ve got to know what your costs are, if you mean to control them.  You just have to.