Health Care Debate

I watched Meet The Press yesterday.

Really I wish I had not. Usually I don't but I made an exception yesterday because I am interested in health care.

On the Obama Health Care side were Rachel Maddow, Tom Daschle, Bill Ritter, and Charlie Rangel. I suppose really I should include the show's host, David Gregory, because his position seems pretty clear to me.

Opposition included Tom Coburn and Dick Armey.

There was a fellow from the Chamber of Commerce but I missed what side he was on if he actually said.

I agreed with Senator Coburn which shouldn't surprise anyone really

.Just as an aside I actually received a telephone call from Senator Coburn's office regarding Alzheimer's and my own caregiver role during the time I was caregiving. He was the only senator that took any interest at all in any of the letters and emails I wrote and sent during that time. Representative Tom Cole also contacted me and I believe he was the only representative.

The only thing that I know for sure is that there are two sides and they seem to me to be irreconcilable.

The Democratic position as nearly as I can tell is that "they" (meaning the Democrats in power) are in favor of improving health care and that anyone opposing is in favor of either the status quo, depriving more people of health care, and/or making health care actually worse than it is.

In terms of policy the Democrats seem to favor a government controlled health care system. They would accomplish that goal with either a government system alongside the private, or a single payer system. Eventually they would like to move to total control of all medical facilities and personnel. This they say offers the greatest opportunity for cost savings by eliminating administrative bureaucracy.

The Democrats see two very evil villains: insurance companies and anyone else who oppose them. And they are not shy about excoriating their opponents.

The Republicans are adamantly opposed both philosophically and practically. However, the Republicans did agree that health care could and should be improved. They also see an evil villain, namely the Democrats.

Actually Rachel Maddow seemed particularly angry with Dick Armey. Daschle was more angry with Coburn. Rangel was just angry at everyone.

I am pretty sure if Rachel Maddow was in charge of health care that Dick Armey would be on his way to a "government clinic" to be prepared for "going home" (using language from Soylent Green).

The Democrats have the votes to pretty much do anything they want regardless of the Republican opposition. So it seems to me that the public debate and town hall meetings and so on are public relation efforts.

That said the Democrats are not tone deaf to public sentiment either and public sentiment so far is not favorable toward too much government.

Still my guess is that some kind of reform bill will make it into law. Everyone will claim victory and we'll all go on our merry way.

End of Life

There has been a lot of discussion lately about the cost of care during the end of life period.

I wonder when you start counting the end of life period especially if you don't know when the end occurs?

In the recent house bill there was a provision, since removed, that reimbursed doctors who provided end of life counseling.

Some senator or congressman I read said that having counseling like that at the end of life was too late and it needed to happen 20 years earlier. Thought that was interesting.

I noticed an article in the Wall Street Journal that reported some rather old statistics. The article referenced a 2001 study. That's 8 years ago and I suspect things might be different now but I didn't really find more recent data (which is not to say it doesn't exist).

However, I paid more attention to the graph than the statistics after I noticed it.

But back to the stats: The 2001 study reported that each year about 5% of Medicare beneficiaries die and that spending in the last year of life accounted for 27.4% of total Medicare spending. So that last year of life is definitely expensive.

I think that was true in my parents' case but only if I include the cost of caregivers I hired and paid for myself. I never did know really what hospice cost so I can't comment on it.

Just last Friday though an attorney friend told me that he really thought we all needed end of life counseling in order to cut medical costs because that's where the most money is spent. It is kind of like robbing banks I guess.

That same idea definitely is repeated in the WSJ article.

There's even mention of a report by The Urban Institute that concluded about $10 billion per year could be saved with "better managed end-of-life care." How this would be done:

"The savings would result from training aimed at discouraging doctors from providing care simply because they would get paid for it, and from having teams at hospitals help terminally ill patients manage their pain once they chose to stop treatment, among other things."

Well there is talk about the cost of the health care plan being about $1.5 trillion over 10 years or some $150 billion per year. So $10 billion per year savings would be about 7%. Really doesn't seem like that much when you think about it that way -- at least to me.

About then I noticed the graph.

My next thought was a brief memory flash of that 1973 movie, "Soylent Green." It is set in the year 2022 in New York City where 40 million people live. There are government assisted suicide ("going home") centers ("clinics"). Soylent is a giant company in cahoots with the government that makes processed food because real food is long gone.

The newest Soylent product is a wafer called Soylent Green.

Turns out that it is made from humans who have "gone home."

I wonder if the "green" comes from the idea of recycling life?

You do have to admit that according to that Kaiser graph we could save a lot of money if all of us 65 and older just went "on home." Or maybe we should make it 3 score and 10.

We could save even more if we moved the age down to say 60. Then you wouldn't even have to pay social security at all. That would solve the social security problem, go a long ways to fixing the medicare problem, eliminate a lot of trouble with old age diseases including Alzheimer's and Parkinson's, and probably help the unemployment situation.

It is interesting to me that the cheapest years are 5 to 17. But really it is pretty much the same until age 45. Save a lot if you cut off at 45.

I started thinking about the cost for a family of 4 let's say: Father and mother in their 30's and 2 children say 5 to 17. It works out to about $7,500 per year. If I applied it to my family (me and my wife) then it works out to just about $10,000 per year. That's interesting because that's quite a bit less than my health insurance costs my business. My parents did not spend anywhere near $8,776 per year until they were about 85.

Then I began thinking about how much is an extra hour of life worth? Or an extra day? Or an extra week? Or an extra month? Or an extra year?

Depends I guess on whether it is you or someone else and whether or not there's pain or unawareness or depression or all sorts of other parameters.

It's quite a bit easier I suspect if it is someone else and someone you dislike to boot. If you like them then its probably harder.

What do you tell someone in end of life counseling? "Wow, you're about to die and really there's no sense in prolonging your life. Why don't you just go ahead and check on out now and save us all quite a bit of trouble and don't be so damn selfish."

Probably not that crude. Would be smoother -- more like Soylent Green I imagine or some of the dialogue in 1984. "Wouldn't you like to just lie down here and enjoy the pretty pictures of Earth they way it used to be and have a nice, long, deep sleep?"

Of course there's no problem really if someone has an advance directive that specifies no heroic measures be taken to prolong life. No problem because that's the consensus of the majority.

But what about the person that goes against the majority and either has no directive or actually has the gall to specify his or her desire for longer life? What then?

Does not society have the right, indeed, the obligation, to force that person to accede to the best interest of society?

Probably we would have some kind of boards established like the old draft boards I remember from the Vietnam War era. Everyone will get a card with a designation. Some people we need to keep around longer.

I'm going back to reading 1984 now.

Government Health Care

Here you go from our local newspaper:

Social Security deal brings relief to Durant woman
Class-action lawsuit fought denial of benefits
BY MICHAEL KIMBALL
Published: August 13, 2009

I'm just going to retell the story though rather than print the whole thing but feel free to click the link.

Seems as though Ms. Roberta Hobbs, 75, Durant, Oklahoma had an outstanding warrant from California stemming from a 2001 car accident prior to her relocation. In 2006 our government passed a law to deny social security benefits to fugitive criminals.

The SSA in their enlightened ignorance used that law as reason to suspend Ms. Hobbs' benefits along with another 200,000 benefit recipients.

Now Ms. Hobbs at the time had an electric wheel chair, a terminal lung condition that keeps her on oxygen 24/7, and $46 per month from Oklahoma Old Age Assistance.

After she lost her social security benefits she exhausted her savings, lived with no heat in her home which had been vandalized, and with no wheelchair which someone stole.

She survived thanks to a local church, her daughter, and a few other non-governmental organizations.

She asked every government agency she could find for help but was turned down by all.

That no help was forthcoming from the government does not exactly surprise anyone who has ever had to deal with the government.

Eventually though the National Senior Citizens Law Center represented Ms. Hobbs and 5 others in a class action suit against the SSA in 2008. At this point it appears that Ms. Hobbs and her fellow plaintiffs have won that case on behalf of some 200,000 people of whom 80,000 will get their benefits returned.

The other plaintiffs: a woman whose warrant was intended for someone else; a mentally disabled man whose warrant was issued when he was 12 and ran away from his home; a stolen vehicle charge that was dismissed but not recorded properly; someone who bounced a check to a grocery store in Texas; and, another California traffic accident.

The price to the SSA is $500,000,000 plus.

Why do we want to turn more of our health system over to the same government?

And by the way there are end of life provisions in the health care bills now being discussed.

Here's a link to the text of HR 3200. The section dealing with end of life consultation is Section 1233.

No, those provisions don't explicitly state that sick people should be killed in the interest of saving money. Likewise I am certain no one that voted for the provision to deny benefits to fugitives intended to nearly kill Ms. Hobbs. But that's what happened.

In my own experience as just one example there is the case where my mother was in the hospital with a broken leg. At 3 days I was told she was due to be discharged but they had managed to secure us 3 more days. After that we had to leave. Her doctors did not want to discharge her. Her nurses didn't either. Nor did the hospital officials. It was Medicare rules that forced us out. Just a few days later my mother died. Would she have lived longer if she had been given more time? I suspect so.

So there was no explicit conspiracy on the part of the government to kill my mother. But there was certainly a lack of regard for her personal condition in light of their sacred rules.

I do not consider myself an alarmist or an extremist but I can certainly appreciate the concern that people have about this issue.

And that is from someone who had to try and talk to my own father about end of life directives after he was diagnosed with Alzheimers.

Health Care Insurance

11.9% increase in our health care insurance premiums we were told by our agent.

Then he presented several options that would reduce the cost of our premiums. Of course this was achieved by either reducing some level of benefit or increasing the employee's share of medical cost or both.

But the increased cost of insurance is not really the subject of this post.

Rather I was interested in the discussion of health care and insurance and the ongoing political struggle.

The most significant thing I noticed was a stunning paradox. On the one hand there was uncertainty about the government plan we'd face in the future. On the other was absolute certainty that whatever plan the government ultimately enacted it would be more bureaucratic, less efficient, less effective, and more expensive.

The next most significant thing I noticed was the anger and disgust about the process that is underway to implement a broader government plan. It is the sense I think that the plan has been determined and is going to be forced upon the country period.

Our agent's clients are all relatively small businesses. He said there was not one among them that was not terribly upset about the prospect of increased government intervention.

I know something about government health insurance since I dealt with medicare for the last 10 years on behalf of my parents.

My experience does not make me very confident. I just imagine Medicare on steroids and there is this nightmarish vision of all the terrible problems I had with Medicare magnified by an order of magnitude that looms in my mind.

That's not to say that I am overwhelmingly positive about the current health care system.

It's just that I think if anyone can make it worse it is the government.

TriLyte®

Welcome to TryiLyte.com

Does anyone besides me think that message is funny?

I mean the "proper preparation is the key to a successful colonoscopy" part of the message? It just strikes me funny. Cost wise this is certainly the least expensive part of the colonoscopy. I paid the Walgreens folks $35 for the jug which already had powder stuff in it. On the top were 5 flavor packets but you only use 1. The surgery center part is taking a good hunk of a $1,000. I haven't found out yet what the doctors are costing. I think the whole deal is going to bust a big hunk of $2,000.

My health insurance pays for it. Except for my coinsurance amount that is which is $250 or something. And then there is my deductible amount. I have spent ZERO so far this year. Anyone want to take bets on what my deductible is? Yep: $2 grand.

Interesting how that works. Not just on health insurance but all insurance that I buy. Except life insurance and I haven't used any of yet.

The jug is 4 liters it says. That's 135.26 ounces or 16.91 glasses of 8 ounces each. I decided to use 12 oz foam cups though. That's 11.27 of them. At 7:00 a.m. Sunday evening I began drinking two-thirds of the total. I rounded that to 8 cups.

That's a lot to drink. Took me about 2 hours. Then I had to drink 3 glasses of water. I managed 20 oz of water in another hour or so.

The result is pretty much what you might guess. I definitely did not want to drink anymore by the time I went to bed. It made me feel a little sick and "mentally off" -- kind of inebriated feeling almost.

At 3:10 a.m. Monday morning I proceeded to drink the rest -- a little more than 3 of my foam cups. I am definitely not wanting anymore of this stuff.

It is the same foam cup by the way. Is that recycling? Somehow I managed to distort the bottom of the cup.

In case anyone is interested in what this stuff does and can't guess given the scanty information provided thus far I will say only that a toilet is a good idea to have nearby when ingesting.

This will be (I haven't had it yet as I am writing this) my second colonoscopy. The last one was 3 years ago. The same doctor though. He's the one that said I should do this because he found a polyp last time which he removed.

People have asked me what the colonoscopy was like. I didn't think it was too bad actually. Honestly drinking this TriLyte® stuff is the worst part and it doesn't bother me that much. On the scale of disagreeable and disgusting things I've done this is way down the list. But that's just me.

As for the procedure itself about all I remember from last time is someone saying something about counting backwards. When I awoke I felt pretty good. I remember telling someone that I thought I could drive just fine.

Of course I always think I can drive just fine.

So if anyone is reading this before about 8 am central you know where I am and what I am doing.

I've decided to forego twitter and facebook. Unseemly. Have to draw the line somewhere.

American Legion Versus The White House

Update: The Administration backed off this proposal March 18, 2009

I could not believe this when I was first told about it. I find this terribly upsetting. There are several articles around but I think this one from The American Legion Our Voice page is good so I chose it.

It seems to me that if we ask our military personnel to serve and while they are serving they become injured; then, at the very lest we owe them appropriate medical care.

This idea of pushing this obligation onto the private insurers seems unconscionable as well as impractical.

Legion to White House: Don't Bill Our Heroes

Legion to White House: Don't Bill Our Heroes
By administrator
Created Mar 16 2009 - 9:51pm

WASHINGTON, DC (March 16, 2009) – The leader of the nation’s largest veterans organization says he is “deeply disappointed and concerned” after a meeting with President Obama today to discuss a proposal to force private insurance companies to pay for the treatment of military veterans who have suffered service-connected disabilities and injuries. The Obama administration recently revealed a plan to require private insurance carriers to reimburse the Department of Veterans Affairs (VA) in such cases.

“It became apparent during our discussion today that the President intends to move forward with this unreasonable plan,” said Commander David K. Rehbein of The American Legion. “He says he is looking to generate $540-million by this method, but refused to hear arguments about the moral and government-avowed obligations that would be compromised by it.”

The Commander, clearly angered as he emerged from the session said, “This reimbursement plan would be inconsistent with the mandate ‘… to care for him who shall have borne the battle…’ given that the United States government sent members of the armed forces into harm’s way, and not private insurance companies. I say again that The American Legion does not and will not support any plan that seeks to bill a veteran for treatment of a service connected disability at the very agency that was created to treat the unique need of America’s veterans!”

Commander Rehbein was among a group of senior officials from veterans service organizations joining the President, White House Chief of Staff Rahm Emmanuel, Secretary of Veterans Affairs Eric Shinseki and Steven Kosiak, the overseer of defense spending at the Office of Management and Budget (OMB). The group’s early afternoon conversation at The White House was precipitated by a letter of protest presented to the President earlier this month. The letter, co-signed by Commander Rehbein and the heads of ten colleague organizations, read, in part, “ There is simply no logical explanation for billing a veteran’s personal insurance for care that the VA has a responsibility to provide. While we understand the fiscal difficulties this country faces right now, placing the burden of those fiscal problems on the men and women who have already sacrificed a great deal for this country is unconscionable.”

Commander Rehbein reiterated points made last week in testimony to both House and Senate Veterans’ Affairs Committees. It was stated then that The American Legion believes that the reimbursement plan would be inconsistent with the mandate that VA treat service-connected injuries and disabilities given that the United States government sends members of the armed forces into harm’s way, and not private insurance companies. The proposed requirement for these companies to reimburse the VA would not only be unfair, says the Legion, but would have an adverse impact on service-connected disabled veterans and their families. The Legion argues that, depending on the severity of the medical conditions involved, maximum insurance coverage limits could be reached through treatment of the veteran’s condition alone. That would leave the rest of the family without health care benefits. The Legion also points out that many health insurance companies require deductibles to be paid before any benefits are covered.

Additionally, the Legion is concerned that private insurance premiums would be elevated to cover service-connected disabled veterans and their families, especially if the veterans are self-employed or employed in small businesses unable to negotiate more favorable across-the-board insurance policy pricing. The American Legion also believes that some employers, especially small businesses, would be reluctant to hire veterans with service-connected disabilities due to the negative impact their employment might have on obtaining and financing company health care benefits.

“I got the distinct impression that the only hope of this plan not being enacted,” said Commander Rehbein, “is for an alternative plan to be developed that would generate the desired $540-million in revenue. The American Legion has long advocated for Medicare reimbursement to VA for the treatment of veterans. This, we believe, would more easily meet the President’s financial goal. We will present that idea in an anticipated conference call with White House Chief of Staff Rahm Emmanuel in the near future.

“I only hope the administration will really listen to us then. This matter has far more serious ramifications than the President is imagining,” concluded the Commander.