Al's Opinions

between denouncing the health care reform bill in its likely form and rejoicing that at least something was passed that can be modified and improved. I am also torn between denouncing President Obama for stretching the truth until it is ready to tear and announcing that in spite of everything he's better for the country than any Republican who is likely to get the nomination in 2012 and that I intend to vote again for Obama, assuming that I am still alive and he decides to run for a second term.

What truth did Mr. Obama stretch that offends me? On the radio this afternoon I heard a sound bite. It was Mr. Obama praising the Democrats for enacting a health care reform bill and for standing up to (and inferentially not caving to) the "special interests." After cursing Mr. Obama for being rather inaccurate in his praise (I must admit that I was safely inside my car with the doors and windows closed) I wondered to myself, what special interests was he talking about? Certainly not the Insurance Industry. At the very start, his administration decided not to take on the Insurance Industry lobby. There would be no "Harry and Louise" ads on TV opposing this bill. Insurance companies were even to be provided with new customers because the bill would require that all Americans buy health insurance. That requirement would reduce the number of uninsured and also provide new customers for insurers.

Certainly not the religious fundamentalists. Both the House and Senate versions of the bill have absolute proscriptions against even one penny of taxpayer money to be spent on an abortion. The proscription is so tight that private insurers selling plans to private customers must provide abortion insurance in plans completely separate from their other plans and make sure that consumers who buy these separate plans do not receive any subsidy from the government. The likely consequence is that most insurers simply will not bother to provide abortion insurance. Of course, that's what the fundies want, isn't it?

If you can tell me what special interests the Administration and the Democrats have stood up to in getting this bill enacted, please let me know. I welcome your comments to the blog.

Labels: abortion funding, criticism of Obama by a supporter, Health care reform, Hyde amendment, influence of health insurance industry

Unlike yesterday's post, this one is about politics and public opinion. Two items in the news this morning got my juices going. The first is that the White House is giving up on the "public option" non-profit health insurance plan. Instead, the White House will support the "cooperative" plant - whatever that is. The other item is taken from the editorial pages of the Los Angeles Times and reads as follows:

Making basic healthcare services available to those who cannot afford them is a worthy goal. If the currently proposed healthcare reform addressed only that issue, we would not be having the contentious debate currently in evidence.

Reforming the system incrementally is not a bad idea; why not try it?

Oh, yes. There was a third item. Following the White House statement about the public option, stock prices of the big health insurance companies rose smartly.

My response to the writer of the letter to the editor is that reforming the system incrementally is extremely expensive. The objective of the reform is twofold: (1) provide health care to all, not just those with enough money to pay or to buy insurance; (2) get a handle on the increasing cost of the present health care system that doesn't cover everyone. Both of these objectives have to be met, one way or another. If, through inaction, one objective has to be sacrificed, it will be the first. The increasing cost will stop when only the rich can afford health care at all at the rate of increase we experience at present.

The writer is wrong in implicitly assuming that part of our health care system works well. Not so! The part that works works badly and needs reform just as much as reform is needed to provide health care for the poor and lower middle class. In the present system, no component of it has an incentive to control or restrain costs. The providers are looking a payers with deep pockets: medicare and big insurance firms. They have no incentive to practice good medicine economically. The insurance companies have little incentive to restrain cost increases other than denying coverage for certain very expensive procedures. Increases in the cost of conventional health care procedures can be passed on to the policy holders in the form of increased premiums. For political reasons, Medicare is not allowed to restrain cost increases by negotiating prices for prescriptions or by urging medical providers to operate more efficiently.

In short, the whole system needs to be reformed. The White House is wrong in deferring to the demands of the insurance lobby to drop support for the "public option."

Labels: futility of partial reform, Health care reform, Insurance lobby

We Americans take our religious convictions seriously. The "swift boat" group that's trying to derail President Obama's efforts to reform and improve our health care system is using religion as one of its tools against reform. Abortion is a big issue among many Christians, including Catholics and many Protestants. The reformed health care system would use taxpayer dollars to pay for optional abortions. Another issue is euthanasia or assisted suicide. In the reformed system Medicare would provide free counseling about death. The fear is that taxpayer dollars would be used to persuade old people to commit suicide to save the high cost of care required during the last year of life.

I can't resist adding some silliness to these arguments. If they were numerous enough to form a significant voting bloc, Jehovah's Witnesses would be targeted with advertisements that would point out that the reformed system would pay for blood transfusions and other organ transplants with their tax dollars. Mormons would be told that the meals served in hospitals and other medical care facilities would include coffee. Muslims would be told that the meals would include pork. Orthodox Jews would be told that they would include lobster, clam, and rabbit, along with pork.

I can speak to the euthanasia argument from personal experience. During the last few months of her life, we had home hospice care for my late wife. The care included nurses who came almost every day to assess her condition, instructions to my daughter and to the hired caregiver about pain medication, and counseling for me, the presumable survivor of the sad event we would soon experience. There was no extra charge to me for the hospice care. It was recommended by Kaiser Permanente, where my wife and I received our medical care. I can only conclude that Medicare pays for the hospice care. The hospice service included a counselor who counseled me about life after the death of my wife. I expect that after the health care system reform is in place, Medicare will still pay for hospice care (in place of much more expensive hospital care) and counseling. At least I sincerely hope so.

If Catholics and Baptists want to forgo abortions, let them. If Jehovah's Witnesses want to forgo blood transfusions and other organ transplants, let them. If Mormons want to forgo beer and coffee, let them. If Muslims want to forgo wine and pork, let them. If Orthodox Jews want to forgo clam and lobster, let them. But let them not impose their religious taboos on me and other Americans.

Labels: abortion, euthanasia, Health care reform, religious taboos

I am on many e-mail lists. I receive e-mails from both liberal and conservative bloggers. Almost every day I receive something from Richard Viguerie. I don't know how I got on his list. However, I'm going to stay on it. Even though I disagree with most of what he writes, I will continue to scan Viguerie's e-letters if only to find out what the opposition is up to. I also receive e-mail from Mov-on.org and other liberal bloggers. I look at them and delete most of them. I don't know why I bother with them. Either the writer is someone with whom I solidly disagree, like Richard Viguerie, or someone with whom I completely agree. In one case, I read and discard. In the other case, the writer is preaching to the choir and I read and discard.

All this is an introduction to an e-letter I received this afternoon, in which the writer urges me to support President Obama's health care plan. Here is part of the e-letter:

Monday morning, an unlikely gathering of health care industry and union leaders emerged from the White House, announcing a historic agreement to lower medical costs and save the average family up to $2,500. This kind of broad coalition would have been unthinkable in the past, when the old politics of division and short-term self interest held sway. But this is a new day.And that afternoon, President Obama announced the three bedrock principles that any comprehensive health care reform must achieve: (1) reduce costs, (2) guarantee choice, and (3) ensure all Americans have quality, affordable health care. And he set a hard goal for getting it done by the end of this year.

For those determined to oppose reform, the President's announcement means lobbyists are already scrambling across D.C. For the rest of us, it means there's no time to lose. As we speak, Congress is negotiating the details for health care reform, so the first step is showing where the American people stand.

I am baffled. The writer wants me to support President Obama's plan for health care reform. I don't know what the plan is. All I am told by the e-letter is that it contains "three bedrock principles." There are no details. I think the principles are good, but if I were trying to construct a plan I wouldn't classify them all as "bedrock" principles. The only I would call a "bedrock" principle is to "ensure that all Americans have quality, affordable health care." The other two goals are nice, but if I had to choose between ensuring good health care for all Americans and reducing costs or providing choice, I would go for providing good health care for all.

I know nothing about Mr. Obama's health care plan, or rather I know too little about it to become a public supporter. I am faced with the same choice I had in 1994 with the Clinton health care plan: whether or not to support a plan whose details I knew little about.

My idea is that we can provide good health care for all Americans by simply making them all eligible for Medicare. Everyone would have to pay a Medicare tax, of course. That tax could be tailored to enable very poor people to afford coverage by reducing their tax in accordance with their incomes. In Medicare, everyone has a choice of doctor. One can join an HMO as I have done or can participate in fee for service medicine as I did at one time under health insurance subsidized by my employer. Everyone should be able to have the same or better level of health care as I have had. For me, it's turned out well so far. I'm 86 years old and still enjoy good health and good appetite.

Mr. Obama has lately been talking about the importance of reducing and containing costs. Perhaps he has in mind the Canadian or English models, in which medical procedures that are deemed elective (i.e., not necessary to save life or quality of life) are delayed or rationed. He and others have talked about eliminating unnecessary medical tests and other procedures as a means of reducing costs. I have no problem with this in principle, but, as usual, the devil is in the details. Who is to determine what's necessary and unnecessary and what are the criteria?

Labels: Canadian model, cost saving by rationing, English model, Health care reform