Saturday, October 3, 2009

Health care: Empty arguments

Last week at a birthday dinner, I was talking health care reform with a newly licensed Physician's Assistant who works at a clinic where most of the patients are on Medi-Cal or Medicare. She has some stories to tell, mostly of client abuse of the system. We were having a nice talk...

Unfortunately for me, there were others at the table. I don't mind a good discussion, but I dislike empty arguments. I especially dislike arguments that are not well researched.

To make matters worse, the dissenter was militant and offensive.

I don't know whether he listened to me or not, but I suspect not.

I, on the other hand, mulled a bit over his comments. Here's the gist of them:

1) My premiums go up every year.
2) What is covered is less every year.
3) Insurance companies add no value.
4) Insurance companies are profiteers, gouging the populace.

As I mentioned in my last post... I research things. I even research the militant spoutings of those who don't listen.

Here's what I found:

1) Premiums are generally going up for health insurance: costs are rising.
2) In order to keep costs from rising even faster, insurance companies look for ways to reduce risk. One way is not insure it. The insurance companies work with their clients, especially the large ones, like the California teachers program (CalPers) to achieve an affordable trade-off. CalPers understands risk management.
3) This argument is just silly. It demonstrates a lack of understanding about the nature of what insurance is: pooled risk. My health insurance company negotiates with doctors and other health care providers over price per procedure. My wife recently had some routine work done that was billed at $500. The insurance company disallowed $185 in charges. My wife had a $20 co-pay. That's something.

Once upon-a-time, I was charged about $200,000 for a month-long stay in the hospital for a family member. The charges with the three surgeries pushed the figure up to $250,000ish. Because I was in a risk pool: I had insurance... the out-of-pocket limit was $3,500. Whew. (One of the reasons I had insurance was because I didn't change jobs for seven years. Why? Because I knew that insurance companies generally don't cover pre-exisiting conditions. I knew what the rules were, and I stayed in the pool.

I've discovered that insurance companies do things: they negotiate prices, they screen practitioners, and they provide a cushion against catastrophic expense.

4) Are insurance companies gouging consumers? I didn't know, so I did some research. I googled things. I found out that insurance companies profit margins are ranked 87th. (See the link to CNN Money.)One of California's largest insurance companies is Kaiser: a non-profit corporation.

I don't pretend to know-it-all, but at least I've done some digging. I've looked at what various experts say, and I've looked at their biases.

Is there a problem: yes, health care costs are rising.

But I'm not convinced that more government involvement is the solution. I think the government has a role, and they are playing it. However, most decisions about wellness, quality of life, fitness, nutrition, and health risks are personal.

Life is risky. There are financial risks, health risks, emotional risks, and even spiritual risks. What's a person to do?

Me? I'm doing the best I can by actively participating in life. I ponder the problems. I muse. Then, I do the best I can. I readjust as necessary as I navigate through life towards the goals I've set. I enjoy the journey and weather the storms.

And I try not to offer empty arguments.

Healthcare: Reasonable Solutions

I research things. That's how I roll. My friend's sometimes smile and say, "I'll bet you did some research..." (I've got a reputation.)

My dad taught be to have a healthy disregard for authority. The 60's influenced me as well. So when a debate arises that I care about, I check things out. I dig a bit.

Doing research in the arena of health care, I've found well-reasoned opinions of people I respect. Once such opinion and person is John Mackey. I've been a subscriber to his weekly newsletter for six months or so. He's a thinker and a writer who consistently makes sense. He lives in the real world: He's the CEO of Whole Foods Market, Inc. He writes about life, often based on life in the work-a-day world, but with wider application.

Recently he authored a op-ed piece on healthcare that ran in the Wall Street journal. His article obviously touched some nerves, as it generated quite a lot of press and even a bit of a boycott. Why? He questioned the authorities and shared some ideas based on his own research and experience.

Here's an excerpt of five key improvements needed in the arena of health care that he sees:

• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

• Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

• Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.

I've seen these ideas echoed elsewhere, but Mackey lays them out clearly and succinctly.

His arguments make sense... unlike many I've heard, in part because Mackey has done his homework, walked the talk, and taken the time to form an intelligent opinion.

He's my kind of guy. I learn stuff from him.

Sunday, September 27, 2009

A Balm for healing...

Life is full of disappointments and discouragements: some small, some large.

Despite my general positive outlook, some times I get "bummed out."

I'm not an avid fan of any particular team, but I like to watch sports: especially football. A week or so ago, I watched two games, and the teams I wanted to win, lost. In the final minutes. It was disheartening. It was discouraging. It was only football, but I found myself feeling a bit blue. Woe is me.

(You may be laughing. That's okay. It is a bit pitiful and shallow that such trivialities should effect my mood. But perhaps you're laughing at yourself too?)

Too often, we let the little stuff get to us. Unexpected bumps trip us up.

Being a proactive problem solver, a day or so later, I retreated to my newly fenced-in enclave with my Bible. I discovered a few decades ago, that "God is the lifter up of my head." Just like a parent who puts their over-sized hand under a child's chin to make the look up, so the Parent-God does the same for me. If I let Him.

I've been reading through the New Testament. I'm in Luke. As I was reading, in my slight funk, I came across some words of Jesus that struck home: "I came not to destroy men's lives, but to save them."

Those words were the balm my soul needed. The smoldering feelings of disappointment, loss, and helplessness that had been ignited by observing a couple of football games suddenly ceased.

God wasn't out to fill my life with destruction: small or large.

The logical conclusion of my mild despair was that God wasn't good. Though I didn't speak the words, the emotional conclusion I had reached was that disappointments, hurts, and heartache awaited me. (And it wasn't just about football.)

I had lost sight of who God is: Good.

"If God be for us, who can be against us?" God is for us, not against us.

A simple phrase from an old story lifted my heart, restored my faith, and improved my mood. In the week or so since encountering the words, "I came not to destroy men's lives, but to save them," I have reapplied the balm repeatedly, and I have benefited.

Life is full of disappointments and discouragements. But as one poet wrote hundreds of years ago: "There is a Balm in Gilead."

That Balm still reaches out to wounded hearts, discouraged souls, and downcast sports fans. Even me. Even you.

There is a Balm in Gilead.