On Thursday, February 25, 2010 President Obama chaired a televised discussion about proposed healthcare legislation. In attendance were the leaders of the House and Senate from both parties and a number of members of both parties chosen by their party leaders. Vice-President Biden and Secretary of Health Sibelius were also at the table.
The main objectives of healthcare reform are to lower and control costs for people covered by private insurance as well as Medicare and Medicaid, and to help get every American access to reliable healthcare.
Aside from my general interest in this important topic and my interest in whether this Congress could get anything done, I was also interested because of my experience as a consultant to the insurance industry. What I've seen reported on the few TV news and opinion shows gives a different picture than what I observed, so I'm writing about my impressions from what I observed.
When I was working with insurance companies I used to joke that what they needed to develop was "just in time insurance," a product that people could buy when they needed it but not have to pay premiums until they needed the insurance. One insurance executive said they could offer such a product, but no one would be able to afford the premium. That joking suggestion is very relevant to the discussion that went on at the conference.
Some of the attendees, maybe most of them, tried to be helpful as the President tried to get agreement on the large number of things that are included in the House bill and in the Senate bill. A handful were not helpful. Republican Representative John Boehner was grandstanding, and not very effectively. He stacked up about five copies of the House bill and five of the Senate bill in front of him so that he could have a pile of paper to lean on and to point to as a graphic to claim that the bills were unwieldy. Rather than cooperate or look for opportunities to cooperate, his comments were always that the work done to-date should be thrown out and that health reform should start from scratch. He refused to acknowledge the significant agreement between what is in the bills and waht Republicans - and the country - want. He refused to make suggestions about what things in the bills should be eliminated or even modified. He missed an opportunity to be useful.
Republican Representative Eric Cantor took the same approach and the same tactics as Boehner, although he is probably smarter than Boehner. Republican Senator Mitch McConnell was similarly unhelpful, although less vocal.
Sadly, Senator John McCain made the most useless comments, and did it more than once. McCain wanted to discuss the process that had been followed over the past year, rather than discuss content or make progress. The President rightly told McCain that people might care about the process, but they cared a lot more about getting something done about the healthcare crisis.
But some Republicans were helpful in trying to make progress, or so it seemed to me. To my surprise Republican Senator Tom Coburn was helpful. He is opposed to aspects of the current bills, but he was fairly specific in his objections and for putting forth reasonable suggestions. Lamar Alexander delivered the opneing remarks for the Republicans and was opposed to the bills and advocated starting over, but he did so in a reasonable, logical way and left me with the impression that you could work with him if he wasn't unreasonably pressured by his party's political objectives.
Democratic Senator Harkin explained why a piece-meal approach to health reform was not workable, that the parts are intertwined. That with one of the objectives being to provide health insurance for people with pre-existing conditions you couldn't wait until those people needed insurance before they bought. Like everyone else, they need to buy it when they can so that it is there when needed -- in other words they can't buy "just in time" insurance. Insurance doesn't work that way. Insurance is a sharing of risk across a larger body of people, and it works best when that universe of people is a normal mix.
Sibelius and others explained what is worng with "high risk pools". They should have mentioned the analogy to automobile insurance where high risk drivers are in high risk pools and pay high premiums -- because they are more expensive to insure. It is the opposite of sharing risk across a "normal mix". Unlike auto insurance though, people don't have choices over whether they will be healthy or sick or have an accident that requires medical treatment.
Everyone agreed on the need to regulate health insurance, as the President pointed out several times, although several Republicans wanted to ignore that need.
When participant pointed out that the Medical Loss Ratio (the amount of premium dollars that are spent on medical benefits) is about 85% for large companies that have a lot of people being covered, but only 60-70% for small business and individuals. That is consistent with the 1/3 that Colburn says is not being used to provide benefits.
Democrat Jay Rockefeller said that the objective for regulation is to protect consumers, and Obama comapred it to food and drug regulation.
Republican Paul Ryan was opposed and could cite lots of numbers, but I think he could be helpful in reaching compromise -- if his party would let him.
Biden explained why Medicare Advantage plans )Medicare Part C) were setup with a higher payout to private insurance companies -- to see if they produced better outcomes. They don't. That is why the bills eliminate the 15% subsidy for Advantage plans and propsoe to use the $500B annual savings to reduce Medicare D or elsewhere.
Senator Grassley made the surprising, to me, comment that future Congresses wouldn't be any braver than this Congress a d wouldn't address the problem -- indicating that this Congress shouldn't do anything!!! He also said that 75% of of Advantage dollars go to benefits and 25% go to the government. He couldn't be peruaded that that was impossible since his numbers allocated no money to the insurance companies that administer Advantage plans.
Boehner and McCain wanted to focus on limiting medical liability claims which they say wil lower malpractice insurance costs and thus lwoer medical costs. But doing that, while saving a lot of money, abut $50B. it is only 0.2% of the medical spending, much smaller than other factors.
Democrat Charles Rangel said that people don't care about how thick the bill is nor about the process. They care about producing results.
Obama tried to get people to agree that the bills include provisions that almost everyone seems to want: cover people with pre-existing conditions; eliminate rescission (canceling policies after they are issued, often when they are needed); eliminate annual and lifetime caps on coverage; expand coverage to more people; extend the life of the Medicare fund.
But the session ended without agreement and I'm skeptical that there will be any movement by Republicans to work toward compromise. Lamar Alexander and John McCain wanted assurances that the Democrats in Congress would not use a technique to bypass a filibuster and pass the legislation anyway. Obama would not give that assurance, saying if they couldn't reach an agreement then the majority party would have to look at their options. I hope they do.
Thursday, February 25, 2010
Sunday, November 8, 2009
Health Care Reform - a first step
Last night, November 7, 2009, the US House of Representatives passed a Bill, HR 3962, that is a first step toward guaranteeing health care for all Americans. Shamefully, my Representative, Pete Sessions of Texas, along with all but one of his Republican colleagues, voted against the Bill. And immediately after the vote Sessions sent out an e-mail bragging about his vote and trying to scare people about the Bill that did pass. I've just sent the following reply:
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I remain very disappointed in the position that you and your colleagues have taken with respect to Health Care Reform. I have read the Democratic Bill and I have tried to read the Republican proposal that you linked to in your note. I must tell you that understanding the Bill that passed the House is a breeze compared to trying to understand the Republican Alternative Bill.
It is my hope and request that when the Final Bill returns to the House for approval that you will find a way to act in good faith in favor of that Bill. That you will actually examine the benefits of Bill that passed the House and conclude that the benefits far outweigh any concerns that you may harbor. And that, most importantly, that you and your colleagues stop treating Heath Care Reform as if it is a football game where your side can only win by defeating the other side. This is too important for that and it is disappointing that you chosen to obstruct rather than to participate and negotiate.
We are fortunate that on November 7 the United States took a significant step toward becoming a 21st Century nation, rather than sliding into mediocrity. I hope that you will become a part of that movement toward a future that lets us remain proud to be Americans.
-----------
I remain very disappointed in the position that you and your colleagues have taken with respect to Health Care Reform. I have read the Democratic Bill and I have tried to read the Republican proposal that you linked to in your note. I must tell you that understanding the Bill that passed the House is a breeze compared to trying to understand the Republican Alternative Bill.
It is my hope and request that when the Final Bill returns to the House for approval that you will find a way to act in good faith in favor of that Bill. That you will actually examine the benefits of Bill that passed the House and conclude that the benefits far outweigh any concerns that you may harbor. And that, most importantly, that you and your colleagues stop treating Heath Care Reform as if it is a football game where your side can only win by defeating the other side. This is too important for that and it is disappointing that you chosen to obstruct rather than to participate and negotiate.
We are fortunate that on November 7 the United States took a significant step toward becoming a 21st Century nation, rather than sliding into mediocrity. I hope that you will become a part of that movement toward a future that lets us remain proud to be Americans.
Monday, September 7, 2009
Comments on Mark R. Levin’s Liberty and Tyranny, A Conservative Manifesto
Comments on Mark R. Levin’s Liberty and Tyranny, A Conservative Manifesto
A friend asked me to look at this book, published March 24, 2009, and comment on it. My comments follow.
Mark R. Levin is a “Conservative” radio talk show host in New York City. He could accurately be characterized as being at the extreme end of current (2009) American Conservatism.
Pages 2 and 3 he describes people wanting the pursuit of Life, Liberty and the pursuit of Happiness, that people have God-given natural rights, . a social contract or civil society, who lives by a moral order and who is “restrained, ethical and honorable. He defines those people as Conservatives. And then, on page 3, says the Conservative “rejects the relativism that blurs the lines between good and bad, right and wrong, just and unjust, and means and ends.”
On other words, there are no shades of gray, no other point of view, that my way is the only way. But then goes on to say that the individual has a duty to respect the unalienable rights of others.
Then as soon as page 4 he defines the Modern Liberal as someone who believes in the supremacy of the state and who rejects the principles of the Declaration of Independence and the order of civil society. This, of course, is absurd.
On that same page he decries a government where the few dictate to the many, and in the next sentence decries the rule of the mob.
According to Levin, the problem started with the New Deal, which “breached the Constitution”! Roosevelt effectively intimidated the Supreme Court. The New Deal prolonged the depression. World War II is what really ended the depression. The Democratic Party and the Federal Government are intertwined.
Levin makes the same mistake that Karl Marx made. He believes that people are not greedy and that everyone will freely and independently work cooperatively to the best of their ability and that will take care of the needs to the less fortunate and less able, and will somehow provide for a civil society that builds roads and achieves the common good. Ironic that this arch Conservative makes the same error as Karl Marx!
Chapter 2 is almost too absurd and self-contradictory to even comment on. It is too bad Levin is disdainful of academics and thinking people, because he could benefit from an awareness of Maslow’s hierarchy, He doesn’t understand that as America achieves a higher and higher standard of living, in all respects, for everyone, that we then go on to achieve even higher standards of living and quality of life. Like the ayatollahs in Iran and other primitive regimes, he is afraid of growth and evolution and condemns change as evil.
Not worth the time to more than skim the rest. His assertions are often incorrect, and almost always devoid of an ethical basis. He ignores the “social contract” that he acknowledges in the first chapter but clearly doesn’t understand. In the Manifesto that concludes the book, in fact, he advocates completely dismantling America’s social contract. Alas.
I wonder if Levin ever actually read Rousseau’s The Social Contract -- and thought about it. It is not necessary to agree with all of it, but it interesting to contemplate a real thoughtful, philosophical look at how people must interact in a modern society. It is online at http://www.constitution.org/jjr/socon.htm. A useful extract is at http://www.fordham.edu/halsall/mod/Rousseau-soccon.html.
I recommend Rousseau, but I wouldn’t recommend Levin’s book to anyone.
A friend asked me to look at this book, published March 24, 2009, and comment on it. My comments follow.
Mark R. Levin is a “Conservative” radio talk show host in New York City. He could accurately be characterized as being at the extreme end of current (2009) American Conservatism.
Pages 2 and 3 he describes people wanting the pursuit of Life, Liberty and the pursuit of Happiness, that people have God-given natural rights, . a social contract or civil society, who lives by a moral order and who is “restrained, ethical and honorable. He defines those people as Conservatives. And then, on page 3, says the Conservative “rejects the relativism that blurs the lines between good and bad, right and wrong, just and unjust, and means and ends.”
On other words, there are no shades of gray, no other point of view, that my way is the only way. But then goes on to say that the individual has a duty to respect the unalienable rights of others.
Then as soon as page 4 he defines the Modern Liberal as someone who believes in the supremacy of the state and who rejects the principles of the Declaration of Independence and the order of civil society. This, of course, is absurd.
On that same page he decries a government where the few dictate to the many, and in the next sentence decries the rule of the mob.
According to Levin, the problem started with the New Deal, which “breached the Constitution”! Roosevelt effectively intimidated the Supreme Court. The New Deal prolonged the depression. World War II is what really ended the depression. The Democratic Party and the Federal Government are intertwined.
Levin makes the same mistake that Karl Marx made. He believes that people are not greedy and that everyone will freely and independently work cooperatively to the best of their ability and that will take care of the needs to the less fortunate and less able, and will somehow provide for a civil society that builds roads and achieves the common good. Ironic that this arch Conservative makes the same error as Karl Marx!
Chapter 2 is almost too absurd and self-contradictory to even comment on. It is too bad Levin is disdainful of academics and thinking people, because he could benefit from an awareness of Maslow’s hierarchy, He doesn’t understand that as America achieves a higher and higher standard of living, in all respects, for everyone, that we then go on to achieve even higher standards of living and quality of life. Like the ayatollahs in Iran and other primitive regimes, he is afraid of growth and evolution and condemns change as evil.
Not worth the time to more than skim the rest. His assertions are often incorrect, and almost always devoid of an ethical basis. He ignores the “social contract” that he acknowledges in the first chapter but clearly doesn’t understand. In the Manifesto that concludes the book, in fact, he advocates completely dismantling America’s social contract. Alas.
I wonder if Levin ever actually read Rousseau’s The Social Contract -- and thought about it. It is not necessary to agree with all of it, but it interesting to contemplate a real thoughtful, philosophical look at how people must interact in a modern society. It is online at http://www.constitution.org/jjr/socon.htm. A useful extract is at http://www.fordham.edu/halsall/mod/Rousseau-soccon.html.
I recommend Rousseau, but I wouldn’t recommend Levin’s book to anyone.
Friday, September 4, 2009
Has part of the country gone nuts?
The President of the United States is giving a speech on Tuesday, September 8, to elementary and high school students across the country encouraging them to do well in school and to graduate. Right-wing broadcasters and extremists are objecting!!!! Are they nuts?
The White House has also provided schools with a list of possible, age appropriate, discussion topics for before and after the broadcast. Things like "what do you think the President should tell kids?" and "What did you think of the what the President said?" Here are links to the materials: http://www.ed.gov/teachers/how/lessons/prek-6.pdf and http://www.ed.gov/teachers/how/lessons/7-12.pdf
But the agitators and those that listen to them are so opposed to anything that a black President (or worse, a multiracial President) does, that they can't even agree that encouraging kids to stay in school is a good thing! One acquaintance told me that the administration is "arrogant and people don't like it." I'm surprised he didn't say the President is "uppity"!
Arrrggghhh!
The White House has also provided schools with a list of possible, age appropriate, discussion topics for before and after the broadcast. Things like "what do you think the President should tell kids?" and "What did you think of the what the President said?" Here are links to the materials: http://www.ed.gov/teachers/how/lessons/prek-6.pdf and http://www.ed.gov/teachers/how/lessons/7-12.pdf
But the agitators and those that listen to them are so opposed to anything that a black President (or worse, a multiracial President) does, that they can't even agree that encouraging kids to stay in school is a good thing! One acquaintance told me that the administration is "arrogant and people don't like it." I'm surprised he didn't say the President is "uppity"!
Arrrggghhh!
Wednesday, July 29, 2009
Dispelling healthcare rumors
There is a lot of information, and even more misinformation, circulating about the proposed health care reforms. On July 28, 2009 AARP hosted an online town hall meeting to give people a chance to ask President Obama about many of their concerns and to help figure out what is true and what isn't. The town hall meeting focused on concerns of people 50 and over, but most of it applies to everyone - or members of our families.
The questions and answers from the town hall meeting may not change your conclusions, but at the least you'll be dealing with facts rather than rumors.
The entire 60 minute session can be viewed at http://bulletin.aarp.org/yourhealth/articles/townhall.html. If you'd rather read, a transcript is available at http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-in-AARP-Tele-Town-Hall-on-Health-Care-Reform/
There is an interesting example of how a tentative provision related to living wills got distorted into a scary, but false, rumor about being forced to decide how you want to die. It is at about minute 42:30 of the video.
There is a discussion about who is forced to participate (no one) at minute 53:35.
The questions and answers from the town hall meeting may not change your conclusions, but at the least you'll be dealing with facts rather than rumors.
The entire 60 minute session can be viewed at http://bulletin.aarp.org/yourhealth/articles/townhall.html. If you'd rather read, a transcript is available at http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-in-AARP-Tele-Town-Hall-on-Health-Care-Reform/
There is an interesting example of how a tentative provision related to living wills got distorted into a scary, but false, rumor about being forced to decide how you want to die. It is at about minute 42:30 of the video.
There is a discussion about who is forced to participate (no one) at minute 53:35.
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