Saturday, July 23, 2011
The Federal Deficit v. a Family's Debt: a model to use as rebuttal
I haven't updated this blog in a dog's age (well, a late-adolescent dog's age), but it seems to me that it's the best place to put my latest political rant.
It started with reading Grover Norquist's ridiculous rationale for not raising revenue in the New York Times yesterday. I was angry: the man is a menace! I mean, seriously, I knew that after seeing his appearance on The Colbert Report:
So, that's who he is. Principled, but with questionable principles. "At least he's consistent," some might say.
However, this idea that the Federal government can get out of debt—let alone that we should!—without an increase in revenue is ridiculous.
So I started a thought experiment of sorts: What if I compared myself to the Federal government and tried to show the silliness of his position that way? Then I realized that I'm hardly a good example (living with my folks because I can't raise enough revenue is closer to Greece's relationship with Germany than to the relationship the US Government has with its and the various options). So I went with a model family: A married couple with two children; both the parents graduated college in 2000, and we're going to assume that (a)they each earn the median income for those who got bachelor's degrees that year; (b) they have had some setbacks, and therefore are taking longer than the standard (though by no means "average") ten years it takes to discharge their student loans. Because of how statistical analysis and reporting works, we're pretending about this household's lot in 2010. Also, along the way, it started to show why what look like high family incomes aren't actually all that high a lot of the time. And I'd add that most families I know with parents my age don't have two earners making the median income; usually they have one working full-time in a profitable career, and one working either part-time or in a service/government/arts career, where salaries are often lower than in the for-profit sector. And a lot of families have similar expenses to my hypothetical one, but don't have two parents with college educations and therefore have even fewer financial resources. Their debts are usually even higher than the ones I make up for my model.
The couple married soon after graduation, and had their first child within a year. Their daughter is now ten, their son six years old. Average 2010 salary for a 2000 college graduate is $53,150 before deductions and taxes, so total pretax income is $106,300. Nice income! Totally sufficient to give a posh life to their children!
They live in Seattle, and rent. They did not buy a house during the housing bubble because their jobs weren't entirely stable (they might have to move to another part of the country for work at some point) and they didn't want to incur 30-year debt for a place they might not live in for more than a couple of years. Smart decision! Of course, they do live in Seattle, so the rent on their 3-bedroom apartment is $1900 (which is a steal!).
Now for the less fun stuff. Their original $30,000 in student loans isn't entirely paid off; they owe $5000 still. Not a lot, but it's a bit. They've bought a car (they live in Ballard, and it's really hard to get anywhere in the City without either a car or a LOT of time), and have an $800 monthly payment. And then there's the Inherited Death. One set of grandparents is deceased, and bequeathed their child with all their property—including about $60,000 of debt for hospital bills and a home equity loan. The $60,000 is what's still owed after the couple sells the house.
They decided to be relatively frugal; they got cell phones (including for their children, because goodness knows, they heard stories after 9/11 and desperately want their children to be able to reach them and vice-versa in an emergency). But they have a relatively simple plan: free nights and weekends, unlimited texting, and stupid phones. Their modest plan costs them about $100/month. Water, electric and gas cost about $400 more. And their basic cable and internet service costs only $49.99—at least until the promotion period runs out.
The annual cost of the health insurance they have through the job of one parent is $13,770. This is the average family premium; one parent's company offers better benefits, but for an additional $25/month, so they aren't going with that; the kids are pretty healthy, and the parents are still young. Family rates are cheaper, though they do require that a family decide which job is more stable because you can only enroll in a business's health plan for a period of 3 weeks every year.
After health insurance, life insurance (at $200/month; high, but look at what happened when that parent died!), and taxes (and they thank God there are neither state nor local income taxes!), their monthly income is about $5865. Still, this is pretty good, right?
Well...
...the family has $1665 or so to spare for things like, oh, gas for the car, food for the family, entertainment, clothes, and so on. But they'll survive. After all, they can stop eating out (sack lunches for all!), go jogging instead of joining a gym, get DVD's from the library rather than paying for Netflix. Except...
That $65,000 in debt. It needs to be paid down somehow, and they lower it by doing something like selling property (all they have are their books, their clothes, a 5-year-old entertainment system, furniture that hasn't been updated in years, and their children) or ending a contract (see: Library v. Netflix). Yet it still demands service, and the combined minimum payments push them past their budget.
So what do they do? They turn to credit cards. But those carry high interest rates as well (and in 2010, most families were already carrying a large credit card debt burden). They try cutting expenses even more: no more ballet lessons, and really they can cook a lot of meals from scratch in large batches on Sunday—it'll be a family project. They draw the line at dropping their health insurance altogether; they've seen the consequences of being underinsured, and are in fact paying the consequences of their parents' poor planning. And what else can the family cut from their budget? There's always Goodwill, but the 10-year-old is already pretty self-conscious about the fact that her new clothes are from K-Mart. They can refuse to buy any brand-name foods, but then they're embarrassed when they run into their neighbors at the supermarket. They could move, but there would be short-term moving expenses, their kids would scream bloody murder for weeks at the prospect of sharing a bedroom, and it would only cut the rent by a couple hundred dollars (even though they could give up a bedroom, they'd still need to fit a queen-sized bed into one room and two each of twin beds, child desks, and child dressers into the other; both bedrooms would have to be pretty big).
Then the credit cards max out, and there's only one thing left to do:
Either Mom or Dad will have to get a second job. Because the only way to keep this family afloat is to raise revenue.
Now, comparing a family's budget woes is facile, inaccurate, and dangerous. The governing principles are different (at least until August 2). But the fact remains: there is debt to pay down. We can cut expenses until healthcare drives us to bankruptcy.
But we will still, finally, need to raise revenue. For the family, that means a third employment income. For the government, it means taxes.
It started with reading Grover Norquist's ridiculous rationale for not raising revenue in the New York Times yesterday. I was angry: the man is a menace! I mean, seriously, I knew that after seeing his appearance on The Colbert Report:
| The Colbert Report | Mon - Thurs 11:30pm / 10:30c | |||
| Grover Norquist | ||||
| ||||
So, that's who he is. Principled, but with questionable principles. "At least he's consistent," some might say.
However, this idea that the Federal government can get out of debt—let alone that we should!—without an increase in revenue is ridiculous.
So I started a thought experiment of sorts: What if I compared myself to the Federal government and tried to show the silliness of his position that way? Then I realized that I'm hardly a good example (living with my folks because I can't raise enough revenue is closer to Greece's relationship with Germany than to the relationship the US Government has with its and the various options). So I went with a model family: A married couple with two children; both the parents graduated college in 2000, and we're going to assume that (a)they each earn the median income for those who got bachelor's degrees that year; (b) they have had some setbacks, and therefore are taking longer than the standard (though by no means "average") ten years it takes to discharge their student loans. Because of how statistical analysis and reporting works, we're pretending about this household's lot in 2010. Also, along the way, it started to show why what look like high family incomes aren't actually all that high a lot of the time. And I'd add that most families I know with parents my age don't have two earners making the median income; usually they have one working full-time in a profitable career, and one working either part-time or in a service/government/arts career, where salaries are often lower than in the for-profit sector. And a lot of families have similar expenses to my hypothetical one, but don't have two parents with college educations and therefore have even fewer financial resources. Their debts are usually even higher than the ones I make up for my model.
The couple married soon after graduation, and had their first child within a year. Their daughter is now ten, their son six years old. Average 2010 salary for a 2000 college graduate is $53,150 before deductions and taxes, so total pretax income is $106,300. Nice income! Totally sufficient to give a posh life to their children!
They live in Seattle, and rent. They did not buy a house during the housing bubble because their jobs weren't entirely stable (they might have to move to another part of the country for work at some point) and they didn't want to incur 30-year debt for a place they might not live in for more than a couple of years. Smart decision! Of course, they do live in Seattle, so the rent on their 3-bedroom apartment is $1900 (which is a steal!).
Now for the less fun stuff. Their original $30,000 in student loans isn't entirely paid off; they owe $5000 still. Not a lot, but it's a bit. They've bought a car (they live in Ballard, and it's really hard to get anywhere in the City without either a car or a LOT of time), and have an $800 monthly payment. And then there's the Inherited Death. One set of grandparents is deceased, and bequeathed their child with all their property—including about $60,000 of debt for hospital bills and a home equity loan. The $60,000 is what's still owed after the couple sells the house.
They decided to be relatively frugal; they got cell phones (including for their children, because goodness knows, they heard stories after 9/11 and desperately want their children to be able to reach them and vice-versa in an emergency). But they have a relatively simple plan: free nights and weekends, unlimited texting, and stupid phones. Their modest plan costs them about $100/month. Water, electric and gas cost about $400 more. And their basic cable and internet service costs only $49.99—at least until the promotion period runs out.
The annual cost of the health insurance they have through the job of one parent is $13,770. This is the average family premium; one parent's company offers better benefits, but for an additional $25/month, so they aren't going with that; the kids are pretty healthy, and the parents are still young. Family rates are cheaper, though they do require that a family decide which job is more stable because you can only enroll in a business's health plan for a period of 3 weeks every year.
After health insurance, life insurance (at $200/month; high, but look at what happened when that parent died!), and taxes (and they thank God there are neither state nor local income taxes!), their monthly income is about $5865. Still, this is pretty good, right?
Well...
Rent $1900 Childcare/After School programs
(two children)
$950Car payment $800 Internet/Cable/Landline $50 Cell phones $100 Heat/Electric/Water $400 TOTAL $4200
...the family has $1665 or so to spare for things like, oh, gas for the car, food for the family, entertainment, clothes, and so on. But they'll survive. After all, they can stop eating out (sack lunches for all!), go jogging instead of joining a gym, get DVD's from the library rather than paying for Netflix. Except...
That $65,000 in debt. It needs to be paid down somehow, and they lower it by doing something like selling property (all they have are their books, their clothes, a 5-year-old entertainment system, furniture that hasn't been updated in years, and their children) or ending a contract (see: Library v. Netflix). Yet it still demands service, and the combined minimum payments push them past their budget.
So what do they do? They turn to credit cards. But those carry high interest rates as well (and in 2010, most families were already carrying a large credit card debt burden). They try cutting expenses even more: no more ballet lessons, and really they can cook a lot of meals from scratch in large batches on Sunday—it'll be a family project. They draw the line at dropping their health insurance altogether; they've seen the consequences of being underinsured, and are in fact paying the consequences of their parents' poor planning. And what else can the family cut from their budget? There's always Goodwill, but the 10-year-old is already pretty self-conscious about the fact that her new clothes are from K-Mart. They can refuse to buy any brand-name foods, but then they're embarrassed when they run into their neighbors at the supermarket. They could move, but there would be short-term moving expenses, their kids would scream bloody murder for weeks at the prospect of sharing a bedroom, and it would only cut the rent by a couple hundred dollars (even though they could give up a bedroom, they'd still need to fit a queen-sized bed into one room and two each of twin beds, child desks, and child dressers into the other; both bedrooms would have to be pretty big).
Then the credit cards max out, and there's only one thing left to do:
Either Mom or Dad will have to get a second job. Because the only way to keep this family afloat is to raise revenue.
Now, comparing a family's budget woes is facile, inaccurate, and dangerous. The governing principles are different (at least until August 2). But the fact remains: there is debt to pay down. We can cut expenses until healthcare drives us to bankruptcy.
But we will still, finally, need to raise revenue. For the family, that means a third employment income. For the government, it means taxes.
Friday, September 19, 2008
McCain and the quest for health insurance
it's been over a year since i've had the energy/impetus to post something on this blog. but tonight i'm fired up about john mccain's health insurance proposal, as outlined in contingencies, a magazine for actuaries.
paul krugman notes on his blog that john mccain suggested recently that we should allow health plans to compete for customers because it would work as well for the health insurance market as deregulation has worked for banks!
actually, now that i've read the article, i'm even more wigged.
mccain is proposing individual choice in health insurance products via a $2500 individual/$5000 family tax credit. which is not indexed to inflation. presumably (though he does not state this), the cost of health care should go down through an increase in government regulation of medical providers. this would happen via mandates for what he calls "patient-centered medicine," which will reward doctors by outcome rather than volume and encourage coordination of services so that a patient's care is coordinated in the optimal way, and by gutting state regulation and the right of injured patients to sue. this latter for me is troubling, especially in the way that he describes it: that doctors who practice according to standards of care should be protected from lawsuits. i believe that "practice according to standards of care" is what is discovered during litigation's "discovery" process. but i digress. my point is that he is so confident of his proposal's ability to cut costs that he assumes that the cost of a policy won't even keep pace with inflation, totally ignoring the reality that costs have been spiraling astronomically since the late 1990's.
mccain also proposes that coverage be able to follow the individual rather than the job (which i like), and that there be protections in place for folks with pre-existing conditions so that we can either buy individual coverage through private insurers or through what he calls "GAP" programs administered by the states (basically, programs for individual coverage sponsored by states to cover those who cannot get coverage anywhere else). oh, and there would be neither mandates that individuals purchase coverage nor mandates that insurance plans accept persons with pre-existing conditions. furthermore, there is no mentioned regulation stating that companies can't require whatever sort of medical screening they want before accepting an applicant to their plan. not even screenings for what are currently assumed to be risk factors (not just current physical manifestation, but also potentially family history).
unfortunately, these ideas totally undermine the advantages of what used to be understood as "social insurance": that those who are sick are protected from astronomical costs because they are covered in the same plans as those who are not (yet) sick. because what is likely to happen under mccain's plan is that some healthy people (especially the young) will opt for minimal (limiting the patient's liability if the patient gets hit by a car or something) or no coverage (many are already doing this), thereby pooling the healthy people away from the sick people. the healthy people would get to have the entirety of their health insurance premiums covered, the sick (and prudent) would not have any help if their premiums exceed the amount of the tax credit.
public health programs (medicare, medicaid, GAP) would not be guaranteed the ability to do things like negotiate with pharmaceutical companies, either.
so yeah. now the really gross part (since i've spent most of this post attacking the economics of the plan): mccain ends his article by basically scapegoating sick people. he states something about as close to the antithesis of my position that "good health is not a reward for good behavior" as possible:
there is so much blaming and ignorance in that passage that i can barely stand to retype it (which i did, as the article is on Contingencies in pdf form, so i couldn't cut-and-paste). first off, diabetes is a cause of diabetes? uh.... also, while those things may be "on the rise," there isn't a body of research to support holding parents accountable for all of it. focusing on "childhood obesity" seems to me to run the risk of instilling disordered thinking and behavior (that is, thinking and behavior associated with eating disorders) in our young people -- especially if the focus is on "healthy numbers" rather than "do this! it feels good!" and helping children enjoy a variety of food, etc. mccain also scapegoats diabetes in particular, which pisses me off because there are certainly problems that are more prevalent -- asthma, for instance. problem here is that it's become increasingly harder to blame the parents for this, as the number of households in which parents smoke has decreased steadily over the past 40 years, even as the percentage of children with asthma has climbed. (mccain also leaves out personal responsibility for causing your own skin cancer -- seems he can't be fussed to publicly claim culpability for his own condition).
the claim that "political correctness" has toasted nutrition and phys ed curricula in the public schools is ridiculous, as well. health curricula have largely been decimated by republican fear of sex ed, and both health and phys ed have been scratched for the same reasons art, music, and language programs have: they are expensive and draw time away from the "fundamental" skills that are measured by the standardized tests upon which schools' success rates are based. it's the most "politically correct" (read: wealthy) school districts that have retained such programs as part of the school day, and such districts also have a larger percentage of parents who are able to pay for extra-curricular sports programs. mccain also doesn't seem to remember that ronald reagan once famously suggested that ketchup could count as a vegetable in subsidized school lunches. he similarly doesn't mention the fact that coke and pepsi, as well as candy and chips, were for a long time available by vending machine in our public schools. or that free lunch programs tend toward overly fried, overly salted foods rather than fresh ones. nor does he seem to acknowledge that poor nutrition for poor people is exacerbated by the lack of choice for buying food in many poor neighborhoods -- that many of our poor people live in "food deserts." you can't put all the blame on parents here, john.
so yeah. i'm horrified by this article, because it demonstrates more ideology than understanding.
i'm almost a single-issue voter; my issue is health care. i pray that this guy doesn't get elected.
paul krugman notes on his blog that john mccain suggested recently that we should allow health plans to compete for customers because it would work as well for the health insurance market as deregulation has worked for banks!
actually, now that i've read the article, i'm even more wigged.
mccain is proposing individual choice in health insurance products via a $2500 individual/$5000 family tax credit. which is not indexed to inflation. presumably (though he does not state this), the cost of health care should go down through an increase in government regulation of medical providers. this would happen via mandates for what he calls "patient-centered medicine," which will reward doctors by outcome rather than volume and encourage coordination of services so that a patient's care is coordinated in the optimal way, and by gutting state regulation and the right of injured patients to sue. this latter for me is troubling, especially in the way that he describes it: that doctors who practice according to standards of care should be protected from lawsuits. i believe that "practice according to standards of care" is what is discovered during litigation's "discovery" process. but i digress. my point is that he is so confident of his proposal's ability to cut costs that he assumes that the cost of a policy won't even keep pace with inflation, totally ignoring the reality that costs have been spiraling astronomically since the late 1990's.
mccain also proposes that coverage be able to follow the individual rather than the job (which i like), and that there be protections in place for folks with pre-existing conditions so that we can either buy individual coverage through private insurers or through what he calls "GAP" programs administered by the states (basically, programs for individual coverage sponsored by states to cover those who cannot get coverage anywhere else). oh, and there would be neither mandates that individuals purchase coverage nor mandates that insurance plans accept persons with pre-existing conditions. furthermore, there is no mentioned regulation stating that companies can't require whatever sort of medical screening they want before accepting an applicant to their plan. not even screenings for what are currently assumed to be risk factors (not just current physical manifestation, but also potentially family history).
unfortunately, these ideas totally undermine the advantages of what used to be understood as "social insurance": that those who are sick are protected from astronomical costs because they are covered in the same plans as those who are not (yet) sick. because what is likely to happen under mccain's plan is that some healthy people (especially the young) will opt for minimal (limiting the patient's liability if the patient gets hit by a car or something) or no coverage (many are already doing this), thereby pooling the healthy people away from the sick people. the healthy people would get to have the entirety of their health insurance premiums covered, the sick (and prudent) would not have any help if their premiums exceed the amount of the tax credit.
public health programs (medicare, medicaid, GAP) would not be guaranteed the ability to do things like negotiate with pharmaceutical companies, either.
so yeah. now the really gross part (since i've spent most of this post attacking the economics of the plan): mccain ends his article by basically scapegoating sick people. he states something about as close to the antithesis of my position that "good health is not a reward for good behavior" as possible:
The final important principle of health care reform is to rediscover our sense of personal responsibility to take better care of ourselves and our children. We must personally do everything we can to prevent expensive, chronic diseases through better health behavior. Our rights in this country are protected by our sense of personal responsibility for our own well-being. Cases of diabetes are going up, not only in the baby boom generation, but among younger Americans where obesity, diabetes, and high blood pressure are all on the rise. Parents who don't impart to their children a sense of personal responsibility for health, nutrition, and exercise -- vital quality-of-life information that political correctness has expelled from our schools -- have failed their responsibility. Also, parents have to share in the responsibility to ensure that their children are covered by health insurance if, as is often the case, options are already available to them. (Contingencies, Sept/Oct 2008).
there is so much blaming and ignorance in that passage that i can barely stand to retype it (which i did, as the article is on Contingencies in pdf form, so i couldn't cut-and-paste). first off, diabetes is a cause of diabetes? uh.... also, while those things may be "on the rise," there isn't a body of research to support holding parents accountable for all of it. focusing on "childhood obesity" seems to me to run the risk of instilling disordered thinking and behavior (that is, thinking and behavior associated with eating disorders) in our young people -- especially if the focus is on "healthy numbers" rather than "do this! it feels good!" and helping children enjoy a variety of food, etc. mccain also scapegoats diabetes in particular, which pisses me off because there are certainly problems that are more prevalent -- asthma, for instance. problem here is that it's become increasingly harder to blame the parents for this, as the number of households in which parents smoke has decreased steadily over the past 40 years, even as the percentage of children with asthma has climbed. (mccain also leaves out personal responsibility for causing your own skin cancer -- seems he can't be fussed to publicly claim culpability for his own condition).
the claim that "political correctness" has toasted nutrition and phys ed curricula in the public schools is ridiculous, as well. health curricula have largely been decimated by republican fear of sex ed, and both health and phys ed have been scratched for the same reasons art, music, and language programs have: they are expensive and draw time away from the "fundamental" skills that are measured by the standardized tests upon which schools' success rates are based. it's the most "politically correct" (read: wealthy) school districts that have retained such programs as part of the school day, and such districts also have a larger percentage of parents who are able to pay for extra-curricular sports programs. mccain also doesn't seem to remember that ronald reagan once famously suggested that ketchup could count as a vegetable in subsidized school lunches. he similarly doesn't mention the fact that coke and pepsi, as well as candy and chips, were for a long time available by vending machine in our public schools. or that free lunch programs tend toward overly fried, overly salted foods rather than fresh ones. nor does he seem to acknowledge that poor nutrition for poor people is exacerbated by the lack of choice for buying food in many poor neighborhoods -- that many of our poor people live in "food deserts." you can't put all the blame on parents here, john.
so yeah. i'm horrified by this article, because it demonstrates more ideology than understanding.
i'm almost a single-issue voter; my issue is health care. i pray that this guy doesn't get elected.
Wednesday, October 3, 2007
SCHIP and the Presidential Veto
According to the New York Times, President Bush today vetoed the bipartisan bill to continue and expand the State Children's Health Insurance Programs, or SCHIP. This bill had overwhelming support in the House, and a "veto-proof" majority in the Senate (though I will note that 67 votes in the Senate is only veto-proof if all 67 are committed to overriding the presidential veto). It is overwhelmingly popular among American citizens, because who wants kids to suffer?
Now, President Bush claims many things about the bill, most of which are, I think, at least somewhat true. The expansion of New York State's SCHIP coverage did lead to some employers deciding to drop the families of employees from the insurance coverage they sponsored (this actually occurred in the non-profit agency I was working for in 2002, and it happened because the choice was to eliminate coverage for families or make the employee contributions so high that none of us could afford it). We were pissed, but since most of us didn't make that much money anyway, we had the option of signing our kids up for SCHIP. Or having the childrens' fathers cover them (which is what most married women in the agency did).
There's also President Bush's claim that those calling for the expansion of SCHIP actually want to establish something along the lines of Medicare-for-all, a single-payer system in which the government would be the one to pay for our medical expenses.
There's a lot of information and rhetoric to back up this claim. Largely, the grassroots folks most committed to the expansion of SCHIP (including myself), do support Medicare-for-all. Hell, Diane Archer (founder of The Medicare Rights Center) is particularly vocal about it. (An article quoting Archer and describing the problem particularly well is here.)
So, Bush's concerns are valid in that they are based in fact. But that begs the question: are they morally valid?
Now, many would castigate me for posing the question of universal health care provision as a moral issue, but I don't see any other way to pose it. Sure, you can break down the economics of how lack of access to care leads to lost wages and costlier treatments due to lack of access to preventative care, screenings and timely interventions, but at the bottom it's a question of valuing human life and livelihood.
In the United States, there are currently 47 million uninsured. That's a lot (more than the population of all west coast states, of all northeastern states, etc.).
Uninsured persons in the United States are much less likely to seek health services when they need to. A 2005 report based on 2003 CDC data found that a huge proportion of uninsured Americans with chronic health problems did not seek adequate health services, and sought services far less than their insured counterparts. This has serious long-term consequences, folks. It leads to serious complications, resulting in greater need of inpatient hospital services, greater stress on families, and greater risk of such negative sequelae as, oh, bankruptcy and death.
This is even more dangerous for children who miss out on important immunizations, health screenings, and care for chronic conditions. Furthermore, if you don't have a regular health care provider (more likely if you are uninsured, as it is hard to prioritize paying for routine check-ups over routine food and shelter), you are more likely to seek your care at local emergency rooms. Now, the president may not see this as problematic, but I do. Emergency rooms are not places to seek basic care. They are centers for acute, emergency care. But when your child has a high fever and no pediatrician, that does seem to qualify as an emergency. I do believe, though, that a child is more likely to get worse before they get better if she has to go through the trauma of many hours in the emergency room; this is after she's already become sicker than she would have been had she had access to a regular doctor.
Seeking basic care through the ER also does a disservice to patients in that it is nearly impossible to have meaningful continuity of care. I work at a hospital. We keep excellent records. But a consistent human-to-human interaction is essential to creating trust between patient and physician, and also essential in allowing the physician to make visual, aural, and affective assessments. This is why good hospitals try to have some continuity of care for all inpatient visits. There's a head doctor assigned to your care, even if that doctor isn't the only one you see. In the pastoral services department at my hospital, we try to provide continuity of care for those who are frequent patients. In some instances, the chaplains, nurses, physical therapists, or personal care assistants are the ones with enough contact with patients to know when there has been an unusual change. But it also goes for any continuing medical relationship; sometimes, only a doctor that has seen you over a period of time knows what sort of questions to ask to get to the bottom of your current problem.
Getting into confessional mode, I have been having a helluva time with health insurance lately. I am working part-time to the degree that my basic needs (rent, food, phone and electric) are met, and applied for individual coverage. My application was denied because of pre-existing conditions, the treatment of each of which actually reduces the cost that I might add to health systems down the road if they were untreated. That is, it's cheaper to pay for insulin now than amputation later. And so on. So I applied for continuing coverage from the university through which I got care as a student, and that application has been held up.
The thing is, I am able to do amazing work part-time and still have the opportunities to engage in community building, caring for family members (which has, as always, uncounted economic value), volunteer, etc. I live more simply than most folks do, and I am happy with the way the economics of my life work.
Except for the fact that I have several chronic illnesses, which necessitate my having health insurance, which is contingent on having employment that will provide it.
So, in theory, I need to work more hours, hours that another worker might need the earnings from, in order to get what I do need: access to doctors and medicines.
It seems ridiculous.
And this doesn't even start to count the ridiculousness of refusing to provide government-sponsored insurance for those who cannot afford (or find enough flexibility in) full-time work on account of family obligations but earn too much to qualify for Medicaid. It seems that, rather than living out the value of supporting real families, the Bush Administration is committed to valuing only families that are high earners.
This veto of the SCHIP bill today is another sign that President Bush does not support families. He doesn't support the families of soldiers and veterans, he does not support the children of working people, he does not support non-traditional families, and he does not support the families of individuals with chronic health problems.
Now, President Bush claims many things about the bill, most of which are, I think, at least somewhat true. The expansion of New York State's SCHIP coverage did lead to some employers deciding to drop the families of employees from the insurance coverage they sponsored (this actually occurred in the non-profit agency I was working for in 2002, and it happened because the choice was to eliminate coverage for families or make the employee contributions so high that none of us could afford it). We were pissed, but since most of us didn't make that much money anyway, we had the option of signing our kids up for SCHIP. Or having the childrens' fathers cover them (which is what most married women in the agency did).
There's also President Bush's claim that those calling for the expansion of SCHIP actually want to establish something along the lines of Medicare-for-all, a single-payer system in which the government would be the one to pay for our medical expenses.
There's a lot of information and rhetoric to back up this claim. Largely, the grassroots folks most committed to the expansion of SCHIP (including myself), do support Medicare-for-all. Hell, Diane Archer (founder of The Medicare Rights Center) is particularly vocal about it. (An article quoting Archer and describing the problem particularly well is here.)
So, Bush's concerns are valid in that they are based in fact. But that begs the question: are they morally valid?
Now, many would castigate me for posing the question of universal health care provision as a moral issue, but I don't see any other way to pose it. Sure, you can break down the economics of how lack of access to care leads to lost wages and costlier treatments due to lack of access to preventative care, screenings and timely interventions, but at the bottom it's a question of valuing human life and livelihood.
In the United States, there are currently 47 million uninsured. That's a lot (more than the population of all west coast states, of all northeastern states, etc.).
Uninsured persons in the United States are much less likely to seek health services when they need to. A 2005 report based on 2003 CDC data found that a huge proportion of uninsured Americans with chronic health problems did not seek adequate health services, and sought services far less than their insured counterparts. This has serious long-term consequences, folks. It leads to serious complications, resulting in greater need of inpatient hospital services, greater stress on families, and greater risk of such negative sequelae as, oh, bankruptcy and death.
This is even more dangerous for children who miss out on important immunizations, health screenings, and care for chronic conditions. Furthermore, if you don't have a regular health care provider (more likely if you are uninsured, as it is hard to prioritize paying for routine check-ups over routine food and shelter), you are more likely to seek your care at local emergency rooms. Now, the president may not see this as problematic, but I do. Emergency rooms are not places to seek basic care. They are centers for acute, emergency care. But when your child has a high fever and no pediatrician, that does seem to qualify as an emergency. I do believe, though, that a child is more likely to get worse before they get better if she has to go through the trauma of many hours in the emergency room; this is after she's already become sicker than she would have been had she had access to a regular doctor.
Seeking basic care through the ER also does a disservice to patients in that it is nearly impossible to have meaningful continuity of care. I work at a hospital. We keep excellent records. But a consistent human-to-human interaction is essential to creating trust between patient and physician, and also essential in allowing the physician to make visual, aural, and affective assessments. This is why good hospitals try to have some continuity of care for all inpatient visits. There's a head doctor assigned to your care, even if that doctor isn't the only one you see. In the pastoral services department at my hospital, we try to provide continuity of care for those who are frequent patients. In some instances, the chaplains, nurses, physical therapists, or personal care assistants are the ones with enough contact with patients to know when there has been an unusual change. But it also goes for any continuing medical relationship; sometimes, only a doctor that has seen you over a period of time knows what sort of questions to ask to get to the bottom of your current problem.
Getting into confessional mode, I have been having a helluva time with health insurance lately. I am working part-time to the degree that my basic needs (rent, food, phone and electric) are met, and applied for individual coverage. My application was denied because of pre-existing conditions, the treatment of each of which actually reduces the cost that I might add to health systems down the road if they were untreated. That is, it's cheaper to pay for insulin now than amputation later. And so on. So I applied for continuing coverage from the university through which I got care as a student, and that application has been held up.
The thing is, I am able to do amazing work part-time and still have the opportunities to engage in community building, caring for family members (which has, as always, uncounted economic value), volunteer, etc. I live more simply than most folks do, and I am happy with the way the economics of my life work.
Except for the fact that I have several chronic illnesses, which necessitate my having health insurance, which is contingent on having employment that will provide it.
So, in theory, I need to work more hours, hours that another worker might need the earnings from, in order to get what I do need: access to doctors and medicines.
It seems ridiculous.
And this doesn't even start to count the ridiculousness of refusing to provide government-sponsored insurance for those who cannot afford (or find enough flexibility in) full-time work on account of family obligations but earn too much to qualify for Medicaid. It seems that, rather than living out the value of supporting real families, the Bush Administration is committed to valuing only families that are high earners.
This veto of the SCHIP bill today is another sign that President Bush does not support families. He doesn't support the families of soldiers and veterans, he does not support the children of working people, he does not support non-traditional families, and he does not support the families of individuals with chronic health problems.
Monday, September 10, 2007
getting back on the blogging bandwagon
The New York Times published an article today about how the GAO is citing the "Bush Administration" (that is, the Centers for Medicare and Medicaid Services, or CMS) for not properly overseeing the administration of Medicare Parts B, C and D and overpaying private insurers with Medicare contracts who are neither providing the best benefits to their subscribers nor passing along "savings" (from overpayments?) to the subscribers OR the government. (In theory, at least, any savings the Medicare insurers have are supposed to result in either lower government payments, lower premiums, or both.)
The GAO abstract can be found here.
This is bad enough, but there's more.
The Times article reports that
So what we have here (and thank you for putting up with the policy-lingo summary) is a case in which the CMS has failed to keep prices down for beneficiaries, failed to achieve savings for the government, failed to make sure that services were what insurance companies said they would be, and failed to make sure that people on fixed incomes were having the correct premiums deducted from their SSA checks. However, they are hellbent on making sure that these same beneficiaries, to whom savings have not been passed on, are going to pay back premiums to the very contractors who are cheating the beneficiaries and the government.
Way to go, guys.
This is something that was predicted by many who work with Medicare, including the Medicare Rights Center in New York. Partial privatization of Medicare has always looked like bad news to the grass-roots, and to those who work with folks whose health has been compromised by the way Medicare HMO's have functioned.
It seems that the fear that Medicare Part D was mostly going to be good for private insurers has been realized.
The really sad thing is that while traditional Medicare's fee-for-service program has been breaking down for years, to the detriment (primarily) of physicians, it was a great baseline service. The problem with traditional Medicare from both the patient and physician perspective was that payments didn't keep up with inflation or with increased cost of service provision. Because the pay for Medicare patients became so low (and I saw this happening when helping an uncle in his podiatry office as a young adult), physicians were reluctant to take on as many Medicare patients as needed care.
But regular increases in pay for medical personnel could take care of that. Heaven knows, the insurers are keeping their own payments as low as they can without losing doctors willing to participate in their programs. And doctors know that all they can do is try to find insurance companies that pay them okay for most of their procedures. (Not visits; check-ups pay virtually nothing.)
On the other hand, traditional Medicare meant that docs didn't have to choose a smaller percentage of elderly patients to see (that is, you either accepted Medicare or you didn't; you didn't have to elect Medicare Advantage plan x, y, or z).
I am once again calling for a single-payer health care system, along the lines of traditional Medicare. Because even at the financial/economic level, Medicare Advantage has been a fiasco for doctors, patients, and the federal government.
The GAO abstract can be found here.
This is bad enough, but there's more.
The Times article reports that
the Bush administration is vigorously pursuing money that it says is owed to insurance companies by Medicare beneficiaries. The Medicare agency has sent letters to more than 135,000 people saying they still owe premiums for prescription drug coverage provided in 2006. In most cases, the premiums were supposed to have been withheld from monthly Social Security checks, but the government withheld the wrong amounts or nothing at all. (italics mine.)
So what we have here (and thank you for putting up with the policy-lingo summary) is a case in which the CMS has failed to keep prices down for beneficiaries, failed to achieve savings for the government, failed to make sure that services were what insurance companies said they would be, and failed to make sure that people on fixed incomes were having the correct premiums deducted from their SSA checks. However, they are hellbent on making sure that these same beneficiaries, to whom savings have not been passed on, are going to pay back premiums to the very contractors who are cheating the beneficiaries and the government.
Way to go, guys.
This is something that was predicted by many who work with Medicare, including the Medicare Rights Center in New York. Partial privatization of Medicare has always looked like bad news to the grass-roots, and to those who work with folks whose health has been compromised by the way Medicare HMO's have functioned.
It seems that the fear that Medicare Part D was mostly going to be good for private insurers has been realized.
The really sad thing is that while traditional Medicare's fee-for-service program has been breaking down for years, to the detriment (primarily) of physicians, it was a great baseline service. The problem with traditional Medicare from both the patient and physician perspective was that payments didn't keep up with inflation or with increased cost of service provision. Because the pay for Medicare patients became so low (and I saw this happening when helping an uncle in his podiatry office as a young adult), physicians were reluctant to take on as many Medicare patients as needed care.
But regular increases in pay for medical personnel could take care of that. Heaven knows, the insurers are keeping their own payments as low as they can without losing doctors willing to participate in their programs. And doctors know that all they can do is try to find insurance companies that pay them okay for most of their procedures. (Not visits; check-ups pay virtually nothing.)
On the other hand, traditional Medicare meant that docs didn't have to choose a smaller percentage of elderly patients to see (that is, you either accepted Medicare or you didn't; you didn't have to elect Medicare Advantage plan x, y, or z).
I am once again calling for a single-payer health care system, along the lines of traditional Medicare. Because even at the financial/economic level, Medicare Advantage has been a fiasco for doctors, patients, and the federal government.
Monday, August 27, 2007
The Story Thus Far
Once upon a time, I had employer-sponsored health insurance.
Then I became ambitious. I decided to go back to school, to get a Master's degree in Divinity. I wanted to spend time following God more intentionally than I had in my previous job. I knew that I could get COBRA when I left my place of employment, and also that there were options for university-sponsored health insurance with most seminaries (which, though the ones to which I applied were not part of the universities, had affiliations with local universities to allow for the universities to sponsor their students for health insurance).
So, for the past 3 years, I have been insured, first via COBRA, then via the university-sponsored health plan.
I finished school in May, and have been working part-time as a hospital chaplain ever since. There are a number of reasons that this is not a permanent job, most significantly because I am both still underqualified for it (I haven't done a residency yet, and am unsure whether I will) and because I'm filling in while the hospital finds a qualified rabbi for the position. The agreement was to work on a per diem basis for a few months.
Needless to say, while I can pay my rent, pay my bills, and buy my groceries (amazing in itself on three days/week of work!) I am not receiving the benefits that would accrue to a full-time, permanent employee.
My school-sponsored insurance is about to run out, so at beginning of the month, I called my insurer (Aetna) to see whether I would be able to purchase COBRA or an individual plan.
Let me be clear: Aetna's basic student plan (what I could get while in seminary) was NOT sufficient to my needs. But it was better than nothing. Let's just say that for part of each year (after I've exhausted large parts of my benefit) my health-related expenses exceed my rent.
Of course, without insurance my health expenses would exceed any money that I earn.
More tomorrow. This story is one for installments!
Then I became ambitious. I decided to go back to school, to get a Master's degree in Divinity. I wanted to spend time following God more intentionally than I had in my previous job. I knew that I could get COBRA when I left my place of employment, and also that there were options for university-sponsored health insurance with most seminaries (which, though the ones to which I applied were not part of the universities, had affiliations with local universities to allow for the universities to sponsor their students for health insurance).
So, for the past 3 years, I have been insured, first via COBRA, then via the university-sponsored health plan.
I finished school in May, and have been working part-time as a hospital chaplain ever since. There are a number of reasons that this is not a permanent job, most significantly because I am both still underqualified for it (I haven't done a residency yet, and am unsure whether I will) and because I'm filling in while the hospital finds a qualified rabbi for the position. The agreement was to work on a per diem basis for a few months.
Needless to say, while I can pay my rent, pay my bills, and buy my groceries (amazing in itself on three days/week of work!) I am not receiving the benefits that would accrue to a full-time, permanent employee.
My school-sponsored insurance is about to run out, so at beginning of the month, I called my insurer (Aetna) to see whether I would be able to purchase COBRA or an individual plan.
Let me be clear: Aetna's basic student plan (what I could get while in seminary) was NOT sufficient to my needs. But it was better than nothing. Let's just say that for part of each year (after I've exhausted large parts of my benefit) my health-related expenses exceed my rent.
Of course, without insurance my health expenses would exceed any money that I earn.
More tomorrow. This story is one for installments!
The beginning of the blog
Today my sister and I were talking, and I was, for the umpteenth time, whining in frustration about my own difficulties with finding affordable health insurance now that I am out of school.
"You should start a blog," she said.
Joanna had several reasons why she thought starting a blog about my health care travails would be a good idea. These included the possibility that I might gain some publicity and be able to raise money to fund such a thing. "You could write about it, and become famous!" she said.
"If it were me, I'd write a song. But I think that blogging is a better medium for you."
I'm a bit hesitant to start a blog just about my own issues with health care. Not that I feel shame about it; I'm fairly public about my health issues, feeling like hte more information is out there, the more likely it is that those of us who are sick won't be considered totally weird.
And before you ask, my appropriation of the term "sicko," as in "Frustrated Sicko," is less inspired by Michael Moore's movie than it is by my ever-fabulous activisty friend 'becca, who started queering diabetes a number of years ago.
But I digress.
My hesitation about starting a Frustrated Sicko blog is more due to feeling like I don't have the right to complain. I actually am insured at the moment, and am going to remain so, thanks in large part to my parents, who have generously offered to front me the money for my continuing coverage plan through the university whose plan was covering me up until the end of this week.
I can't afford it by myself, but at least my parent's are well-off enough that I have an option.
Which is better than having no affordable option at all. Even if I can't personally afford that option.
So this is the opening post. More substance to come, perhaps even today (!).
For my personal stuff, please visit my livejournal. I expect that I am a lot more interesting over there.
"You should start a blog," she said.
Joanna had several reasons why she thought starting a blog about my health care travails would be a good idea. These included the possibility that I might gain some publicity and be able to raise money to fund such a thing. "You could write about it, and become famous!" she said.
"If it were me, I'd write a song. But I think that blogging is a better medium for you."
I'm a bit hesitant to start a blog just about my own issues with health care. Not that I feel shame about it; I'm fairly public about my health issues, feeling like hte more information is out there, the more likely it is that those of us who are sick won't be considered totally weird.
And before you ask, my appropriation of the term "sicko," as in "Frustrated Sicko," is less inspired by Michael Moore's movie than it is by my ever-fabulous activisty friend 'becca, who started queering diabetes a number of years ago.
But I digress.
My hesitation about starting a Frustrated Sicko blog is more due to feeling like I don't have the right to complain. I actually am insured at the moment, and am going to remain so, thanks in large part to my parents, who have generously offered to front me the money for my continuing coverage plan through the university whose plan was covering me up until the end of this week.
I can't afford it by myself, but at least my parent's are well-off enough that I have an option.
Which is better than having no affordable option at all. Even if I can't personally afford that option.
So this is the opening post. More substance to come, perhaps even today (!).
For my personal stuff, please visit my livejournal. I expect that I am a lot more interesting over there.
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