The Amazing Maze of US Health Care

As the debate on health care reform legislation creeps towards a finish line, it is apparent that certain so-called “pro-life” Democrats in the House or Senate could determine its fate.

Are they really “pro-life”?

Since 2000 the number of deaths annually attributed to the lack of health insurance has increased between 30% and 35% depending on whose numbers you look at.

During the same period, the number of women choosing legal abortions has decreased by 5% – 50% since 1990 when they hit a peak.

Which trend is more disturbing?

There are a number of reasons to oppose the current bill.  It is overly complicated.  It still relies on employment-based health insurance.  It does nothing to eliminate the disparities in payments to providers based on who the patient is.

Where do you stand?

The current system is an unsustainable model.  And the forces arrayed in its defense are formidable.  When the issue comes to closure, I do not want to find myself on the same side of the fence as those who have consistently opposed a more rational health care system.

I don’t like the idea, but I can live with a final health care bill that includes restrictions on the financing of abortion.

But I have a hard time understanding how the same people who support the social justice record of the US Conference of Catholic Bishops (USCCB) could impale progress on health care reform on the stake of abortion.  Do they really want to align themselves with those forces of greed and power?

This is not a theological discussion.  If Catholics and other “pro-lifers” oppose abortions, they are still free to choose not to have an abortion.

They couch their opposition by saying that their position respects the legal right to have an abortion but opposes using their tax dollars to fund abortions.  But the Stupak Amendment goes far beyond using tax dollars to fund abortions. Their position opposes using a tax supported health insurance exchange to allow people to purchase insurance with their own money that would include coverage for abortions.

With that dangerous logic, could they also argue that tax dollars support current federal and state regulation of insurance plans and therefore no health plan should cover abortions?  What is next?  You can’t drive to an abortion provider on tax supported highways?

Pro-life?

And what about other priorities of the USCCB?  Do they consistently apply their own teachings?  Or do they prioritize their abominations?

Do they block appropriation bills that fund prisons because they oppose the death penalty?

Do they block war funding because they oppose murder?

In a democratic society a tax budget reflects a variety of constituent interests.  There is not and cannot be unanimity on every budget item.  Why else, for example, would tax dollars support tobacco farmers and smoking cessation programs at the same time?  Yet that was the situation for many years.

Why else would tax dollars support meat and dairy farmers while at the same time urging us to eat less meat and diary?

Tax programs support energy exploration and conservation programs, and also sugar farmers and diabetes education.

The number of abortions has dropped by half in less than two decades in an environment where abortions are legal and only 14% are paid for by tax dollars. The pro-life Guttmacher Institute reports that the number of abortions tracks the number of unplanned pregnancies more reliably than public funding of abortions.

An earnest effort to decrease the number of abortions should be directed at unplanned pregnancies and not those struggling to stay alive without health insurance.

That is a pro-life policy that pro-choicers could agree to.

Imagine that an employer can hire professional talent for a day, a week or for years and not have to consider health care as a fixed cost.

Imagine that same professional talent is without work, whether through illness or simply lack of work, and yet does not have to worry about paying for health insurance.

Sound like a health reformers ideal.  Provide employers the flexibility to hire talent as needed.  Provide health care for workers even when they have no income.

This model exists now

This is the model of the multi-employer health & welfare plan.

Multi-employer plans are common in those unionized industries with seasonal or irregular employment: transportation, needle trades, construction trades, and theater trades, for example.  They are governed by a board with equal numbers of employers and union representatives.  Employers pay a negotiated rate per hour worked into the Fund and the Fund provides benefits through periods of employment and transitional unemployment.  Some funds are fiscally sound enough to provide benefits through retirement. Read the rest of this entry »

The American Benefits Council, the preeminent advocate of employer-sponsored benefit programs in Washington D.C., offers this prescriptions for health care reform – build on what works.

Fit for the Scrap Heap

Employer sponsored health insurance is not a system that works.  I say that as a 25 year employee benefits professional.

Despite what its proponents say in its support, their actions tell a different story.

Employers want out.

And the numbers over the last 15 years show they are getting out.

They are dropping their health care plans.  Fewer employers offer plans and those plans cover fewer employees. Read the rest of this entry »

Wednesday, September 9^th, President Barack Obama stood before the American people and a joint session of Congress and said:

If you are among the hundreds of millions of Americans who already have health insurance through your job, … nothing in this plan will require you or your employer to change the coverage or the doctor you have.  (Applause.)  Let me repeat this:  Nothing in our plan requires you to change what you have.

Someone will need to explain to me why this is a good thing.

The door may blocked

As the President was speaking these words, the 70 workers at SK Hand Tool Corp in Chicago, IL were without health insurance because their employer had made that decision for them.  It had unilaterally stopped paying for health insurance for its employees.

An inviting portal

As the President was reassuring Americans that they could keep their health insurance, the employees of SK Hand Tools, represented by Teamsters Local 743, were starting the third week of a strike to keep their health insurance.

That strike would eventually last for ten weeks.

There is an overwhelming body of health policy research that supports the necessity of continuity of care to improve population health outcomes.  Yet for most Americans, employment is not a continuous engagement.

Why do we build a system that relies on continuity on another system that flourishes on discontinuity?

Read the rest of this entry »

An improved patient delivery system is a necessary pre-condition for affordable and quality health care.

What do I mean by a “patient delivery system”?

Understanding  patient delivery system means recognizing that people without health insurance do not receive treatment until they are in an immediate life-threatening situation.

I cannot back this up with a scientific study, only my daily experience.  But that experience contradicts an oft cited myth that no one who needs health care is turned away.  One of the most common reason that people call our office is because something happened to their health insurance that lead to a denial of treatment. Read the rest of this entry »