Monday, August 31, 2009

it doesn't take a genius | Medical Bankruptcies in the US

In 1981, 8% of families filing for bankruptcy did so in the aftermath of a serious medical problem.*

A 2001 study in five states found that illness or medical bills contributed to about half of bankruptcies.

In 2007, using a conservative definition, The American Journal of Medicine discovered that 62.1% of all bankruptcies were medical.

Most 2007 medical debtors were well educated, owned homes, and had middle-class occupations.

Three quarters had health insurance.

Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%.

The odds that a bankruptcy had a medical cause in 2007 were nearly two and a half times higher than in 2001.

It doesn't take a genius to see where this curve leads. The knuckleheads who say we can't afford to fix health care are not thinking clearly. We can't afford not to fix it. Tell them to snap out of it and get to work.

* Sullivan TA, Warren E, Westbrook JL. The Fragile Middle Class: Americans in Debt. New Haven, CT: Yale University Press; 2000

photo by Andy Kiel

Torture Debate Lost in Maze

h/t David Wagner

Thursday, August 27, 2009

Health Insurance Reform | An Exchange with Beetlejuice

I've had an interesting exchange about health care reform with someone called Beetlejuice who responded to my clipping from Garrison Keillor in London a few days ago. See what you think.

Beetlejuice said...
I'm on the right but I'm not paranoid,I just like my health care and insurance the way it is. The liberals want free healthcare for everyone including non-citizens and non-taxpayers,and taxpayers to pay for it for them.If you like socialism, that's cool.We're not paranoid,we just have a different opinion.

jim hancock said...
Beetlejuice, you've misunderstood or been misled about what liberals want in health care. We want affordable world class coverage for every citizen and we're not willing to concede that the US is the only developed nation on the planet incapable of delivering that.

Your willingness to accept second-tier economic status is inscrutable to people like me who refuse to settle for less than the American ideal. I do not like my health care the way it is—it is expensive and restrictive and getting more so every year. My health insurance premiums have risen 59.56% since 2005—my monthly insurance premiums are greater than the take home pay of a full-time minimum wage worker—and my deductible has risen to $5,000.

The US leads the OECD in health care spending measured per capita and as a percentage of GDP. US per capita spending on health insurance and administration is double that of the next ranked OECD nation.

To our shame, the US also leads the OECD in infant mortality measured by the number of children who die before reaching their first birthday.

The US—my nation and yours—lags well below the median for life expectancy among OECD states. In short, we are paying too much money for too little value and I don't think there is anything smart or noble or principled about that.

You are the tiniest bit paranoid. You're afraid thoroughgoing health care reform would inevitably lead to socialism driven by the liberals. But you've misunderstood or been misled about what we want. We want this nation to be as great in every way as we—you and I—say it is.

Beetlejuice said...
I am worried that i will pay much higher taxes AND not have a choice to get my own healthcare. We are a free country after all, Under Obama-care if I drop my current (Blue Sheild) policy with my employer I will automatically be put into the goverment plan. I believe that is page 16 of the Bill. My free choice is to have the healthcare I want, not what the govt wants me to have.Personal freedom is important.

jim hancock said...
Beetlejuice, apparently, you've never experienced the joys of COBRA coverage from an existing carrier and the search for new insurance while the 18-month clock to secure coverage winds down (tck, tck, tck). When I neared the end of my COBRA mandated coverage in 2000, my existing insurer told me they would be happy to continue my policy at a premium of $6,000 per month. I thought health insurance that cost $72,000 a year should probably come with no deductible but that, of course, was not to be.

Page 16 of H.R. 3200, America’s Affordable Health Choices Act of 2009 as proposed (I don't know what this Obama-care proposal you refer to is and find no trace of it in the public record) begins with Section 102. Protecting the Choice to Keep Current Coverage and says pretty much exactly the opposite of what you believe or have been led to believe it says.

You can find a certified US Government Printing Office copy of H.R.3200 as a downloadable pdf here.

Not to put too fine a point on it Beetlejuice but under the current regime you have virtually no rights to affordable health insurance coverage whatsoever starting 18 months and one day after you leave your current employer-provided health plan. Without health care reform, if you leave your employer-provided program, your "free choice" of insurers will be determined by what you can afford to pay ($6,000 a month in my case, but your mileage may vary). You might get another 36 months of coverage if you are HIPAA-eligible, but I wouldn't count on it if I were you.

I hope you don't find it disrespectful when I observe that we're living in a broadband world and your language suggests you've gotten most of your information about health care reform from narrowcast sources.

When you made a comment here, I offered a thoughtful response gleaned from a variety of credible, publicly available sources. Your response seems to be repeating something you heard someone say...where? on talk radio? cable tv? at a barbecue? It seems to me that one of us is doing most of the heavy lifting on something that matters a great deal to both of us.

People who lie about health care reform are not protecting democracy and they are not your friends. People who repeat lies without attempting to find out if what they're saying is true are not journalists or intellectuals or patriots, they are gossips and gossips are not to be trusted.

There's an old saying which, at the risk of being offensive, I repeat here in it's original form.

"Eat shit," the saying goes, "50 million horseflies can't be wrong."

Well...yes they can.

jim hancock said...
Oops, I forgot to speak to your concern about paying higher taxes Beetlejuice. You're partly right about that and partly wrong.

Here's a post that explains what I mean.

follow the link to the original source if you want more detail.

Beetlejuice said...
Jim, respectively, healthcare is really not a right,according to the constitution.If I choose to buy insurance on the open market that should be my choice,not Uncle Sam's.Your links and factoids may be valuable in some respects, but the bigger picture is still personal liberty.

jim hancock said...
You're spitting into the wind Beetlejuice. No one is trying to take away whatever right you believe you have to pay as much as the market will bear for as little service as the provider can get away with.

America’s Affordable Health Choices Act of 2009 is being shaped to protect that right along with providing a higher standard of care and a greater level of protection for you should your employer lay you off or decide it can no longer afford to contribute to your health plan. As things stand, if that happens, you are SOL.

And then you will have the government-guaranteed right to go to an emergency room when you're so sick you can't put it off any longer and see how that level of care suits you—knowing that taxpayers like me are footing a much higher bill for your care than we would pay if we scaled health care now so that people who want and can afford private health insurance can buy it; and people who don't want or can't afford private health insurance have access to care that keeps them out of the emergency rooms except for emergencies.

I get it. Someone has frightened you with lies and half-truths and has framed this discussion as an assault on your personal convictions so you would sooner lose your home than allow the rest of us the liberty to opt into a different, demonstrably better health care plan.

You're being punk'd, and not in the ha ha, we're all in this together, you're a good sport, let's have a beer way. Those people—the ones who know what they're doing—are not your friends.

I'm glad you think my links and factoids might be useful in some respects. I'm sad you believe people like me want to take away your personal liberty.

Thanks for the polite tone of your comments. We're in this together.

Tuesday, August 25, 2009

Of Health Care and Other Marks of Civilization

Get a Grip US Citizens...

Garrison Keillor writes from London:

Sunday is a day for parents to bring their children into the city to see where the parents might be living had they not had children, in the posh flats above the smart shops, leading the cool life. The children look irritated, bored, the parents thoughtful. If you're 40 and have three whiny children, 25 looks awfully good. But late last night I hiked around Chelsea and the cool life looked thin to me, the sorrows of intoxication evident everywhere, people whose big night out turned out too small, people with people they were wanting to not be with right now, the lonely late-night walkers like me.

When you walk alone, you soak up the sorrow around you until it's not bearable and you must return to the hotel, and then comes morning, a sunny day in a rainy summer, and you attend Mr. Christopher Wren's church and then hike up to Regents Park and Primrose Hill for a view of the great city, a grassy hillside populated by hundreds of Londoners sunning themselves, and you feel a sort of rarefied blessedness and lightness.

It helps that, an hour before, your sins were forgiven and the priest waved her hand and blessed you, and it also helps to be far away from America and the mounting drumbeat of Democratic defeatism on healthcare reform. Nobody is so ready to embrace martyrdom as my fellow liberals, and here they are, seven months after Mr. Obama took the oath, crying out, "Where did it go, the glory and the dream?" Get a grip. Solid majorities in the House and Senate and yet a few puffs of smoke from the other side and Democrats are full of consternation. If they back out on this young president, and if this Congress cannot pass the public option and meet the basic human needs of our people, what does this say about us?

Here in London, people are amused at the wild paranoid fantasies of the right. I don't care about that, I hold weak-kneed Democrats responsible, and if they get spooked by a few hecklers, then it's time to find replacements.

photo by chrisjohnbeckett

Sunday, August 23, 2009

Health Insurance Reform | A $5,400 Metaphor

In this simple model, if US taxpayers had been covered by Medicare instead of private insurance we would pay about $7,000 in family premiums instead of the $12,400 we spent in 2006 for comparable services.

That's $5,400 less...about 45%.

Paying $7,000 for health care instead of $12,400 would have been accomplished mainly through the mechanism of higher taxes.

But taxpayers would have had an additional $5,400 in 2006 to spend or save at our discretion.

All us Costco members know the benefits of spending 45% less for quality merchandise we could buy at full retail elsewhere.

We don't mind paying the modest price of a Costco membership to enjoy that benefit. In fact, we think we're pretty smart to do so.

Friday, August 14, 2009

Something I Worry About

Suppose one reads a story of filthy atrocities in the paper. Then suppose that something turns up suggesting that the story might not be quite true, or not quite so bad as it was made out. Is one’s first feeling, ‘Thank God, even they aren’t quite so bad as that,’ or is it a feeling of disappointment, and even a determination to cling to the first story for the sheer pleasure of thinking your enemies as bad as possible? If it is the second then it is, I am afraid, the first step in a process which, if followed to the end, will make us into devils. You see, one is beginning to wish that black was a little blacker. If we give that wish its head, later on we shall wish to see grey as black, and then to see white itself as black. Finally, we shall insist on seeing everything—God and our friends and ourselves included—as bad, and not be able to stop doing it: we shall be fixed for ever in a universe of pure hatred. — C.S. Lewis, Mere Christianity, p 118

Wednesday, August 12, 2009

Knuckleheads | What's Your Problem with the Post Office

There's this code language about government incompetence—a sort of Manchurian Knucklehead effect—that cues off the words post office.

Really? Because I write personal checks and letters and send them to faraway places where they arrive a fews days after I hand them to the post office (cue the smirking and snorting) and I don't have to get in my car and drive ten miles or 500 or a thousand miles to hand-deliver my personal message or monetary instrument and I don't have to set an appointment to make sure the recipient will be there when my envelope arrives. I pay 44 cents for this delivery service. The recipient pays nothing.

You there...yeh, you know who you are... Stop being a knucklehead. Your argument is tired and your language is tired and your imagery is tired and you have grown tiresome. The adults are having a conversation about important things. Join the conversation or go outside and play in the yard. Your choice.

[photo by xeeliz]

Tuesday, August 11, 2009

Those Crazy Christians | What's Wrong with Health Insurance Reform?

I suppose I should be beyond shock about such things...but I'm not.

A shocking number of Christians in the US are stuck pretty much where the first followers of Jesus were before he gave them a bit more instruction about the way things appear and the way things are.

They think being sick or injured or otherwise infirm is a moral failing.

As he went along, he saw a man blind from birth. His disciples asked him, “Rabbi, who sinned, this man or his parents, that he was born blind?” — The Gospel of John, chapter nine, verses one and two

And, if an American family loses their insurance coverage, their livelihood and home, and if their credit rating is destroyed by catastrophic illness or accident, these Christians don't seem to see this as uniquely American tragedy (unique in the sense that no other developed nation allows it citizens to be driven into bankruptcy by medical bills). Apparently these Christians feel affirmed in their judgement of the afflicted. Or perhaps they merely take Darwinian delight in seeing the morally weak—who wouldn't be in the mess they're in if they weren't defective, right?—brought lower still.

Is this who we are?

[photo by seiuhealthcare775nw]

Wednesday, August 05, 2009

Cash for Clunkers: don't listen to the knuckleheads

Unsolicited Advice Alert: You did not ask my opinion about what follows. Here it is anyway.

If you need a new vehicle and if you can afford a new vehicle, the Cash for Clunkers program is a decent piece of economic stimulus.

The numbers are simple. You'll get $3500 - $4500 credit for getting rid of (and thus permanently disabling) a gas-guzzler and replacing it with a vehicle that gets at least ten miles per gallon better fuel economy.

In addition to that new car smell, you'll save something on the order of $800 a year on fuel costs and contribute to a culture less dependent on oil, with all the benefits that accrue to that shift.

Upstream from you, people keep working and adding value to the economy (and, maybe, hang onto their health coverage).

Downstream from you, people keep working and the mandatory scrapping of your old vehicle produces reclaimed steel that can be repurposed for far less than producing new metal from the ground up.

This is exactly the kind of systemic benefit the American Recovery and Reinvestment Act is designed to produce—which is why the money comes from the $787 stimulus package passed by the congress and signed by the president in February.

Don't listen to the knuckleheads. They're not trying to help you.

[photo by ThreadedThoughts]