Health Care Payment System Discussion

Recently I posted a list of 10 Things Every American should Know About Health Care Reform from moveon.org. I included this note:

This is a good start to true reform. Does anyone remember that health insurance companies used to operate under a cap on profits? If I recall, that went away in the late 80s early 90s. Insurers went from paying 95% of every premium dollar to direct services to paying 81% of premium dollars to direct services. (http:/.../dangerousintersection.org/2009/12/13/cap-the-profits-of-health-care-insurers/
) Guess where the other 14% is going? Kaiser EDU states that 2.3 trillion dollars a year are spent on health care. Using very rough math, if even half of that 2.3 trillion comes from insurance premiums paid out that means that more than 15 BILLION dollars a year go to straight into the pockets of investors. Sounds more like wealth care to me. (http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358)

Carl Wilson responded:
I don't agree that it all goes to investors at all. Insurance companies need large stockpiles of money to pay for catastophic events. In the case of healthcare that could be an emerging disease like AIDs, Swine flue, or any number of predicted emerging plagues.
I'm not saying the Ins co's are angels, far from it. I'm just saying don't malign them ... See morefor having large profits ... thats how they pay the big bills when they arrive.
Also when a stock price goes up because the earnings per share is higher its the investing market wishing to buy that stock from another investor that is footing the bill. The company is not forking out a dime unless they are buying stock back for strategic reasons.
Only when there are dividends paid is the co paying out the bucks.

To Which I responded:
you make some interesting points Carl. I always thought profits were what was left over after business operating expenses were accounted for, and I would assume reserves would be considered an operating expense, at least that's what I learned in HS accounting. Also, the jump from 5% to 19% not-for-direct-services happened after the caps were ... See morelifted on health insurance profits. So I do assume that insurance companies had reserves when they were operating at 95% for-services. But mainly the point I'm poorly making here is that I think health care for profit is immoral. And IMHO it's an unacceptable conflict of interest for a health care provider to also answer to investors who expect profit. We are each and every one of us investing in our health care system when we pay premiums (or when our employers pay premiums on our behalf), but we don't get to share in the profits. I support a single payer system, even if that payer is a private not-for-profit. I am happy to see any change to our sad system that provides more health services to people who formerly didn't have access to it.

To Which Carl Responded:

Just in the last hour on NPR they had a rep from CIGNA that said their profit margin was only 2%. That said he said the reserves would only pay for a few days of the health Insurance annual claims. CIGNA provides the Health Care for NPR. Dial in and give a listen. What he says mirrors what I have heard other Ins Co reps and CEO's state.
I think where many people get misled is that they think a billion dollar profit is a big thing. If they looked at the whole accounting of the system they would see it is perhaps not all that much.
I don't like Health Care for profit either but 2% is hardly profit in my opinion. If I don't bring in at least 10-15% profit on my jobs I would be let go, and its the retained earnings on that profit that quite literally have kept me employed the last few months while the construction industry digs out of that other mess.
Even in a not for profit scenario they would still be working to achieve retained earnings and carrying them over from year to year if they are so lucky. If they didn't have retained earnings, and that would go for a single payer plan also, the end result could likely be either higher premiums or higher taxes.
In other words there is no free lunch......... See more
Thanks for the feedback Caren....

At which point Julia P. jumped in:

Hey how about forcing insurance companies to be non profit so consumers are their first priority. For profits have to keep their shareholders as first priority. And the only way to make profits on insurance is to take in more premiums than you pay out in benefits. US is the only industrialized country that allows health insurance companies to be for profit.

And I had to answer as well:
Carl, I get what you say about your own job and the construction industry. I don't think they are comparable industries, however. I just don't think our health-care payment system should be private for-profit. Health care, like education, fire protection, and law enforcement, is essential to a healthy thriving society.

I would expect an insurance company rep or CEO to defend their status as a for-profit entity. And I have read and heard a lot of those same stories. I am leery of taking their word for it that the system they benefit from works all that well for us. The WHO rates us at 36th, behind pretty much every other developed country, for health care.

A multitude of sins can be hidden in statistics. Just ask the Enron employees. What mystifies me the most is that the fiscally conservative lawmakers don't seem to realize that the billions of dollars that go to investors pockets could pay for so many much needed services nationally. Wouldn't the truly conservative approach would be to apply those dollars to services instead of distributing them to shareholders? It seems very wasteful to me.... See more

I can't reconcile the financial reality of for-profit health insurance with my political convictions. They are just incompatible.

Thanks for giving me the opportunity to rant some more.

Carl adds a little something:
I just remembered another chat on NPR yesterday where the person bei ng interviewed was a Brit that had been living herre with his family and his son was diagnosed with Type1 Diabetes. He said that while the cost here was high his son had access to state of the art technology. When they later went back to the UK he said the cost was lower but they ... See moreno longer had access to to the technology (his insulin pump specifically).
There was a direct correlation in his opinion to access to newer technologies in for profit systems versus not for profit/single payer systems.
Something to think about...perhaps research some more. There may be unintended consequences we don't understand enough to see with changing a system so abruptly.
I am clearly a change in moderation person. I would have been thrilled to have them address the anti-trust issue and pre-existing conditions to start with, see the outcomes, and then take on some more.

To which I reply:
Again, I am skeptical of arguments about other systems' failure to meet the health needs of the majority just because they are not always getting state-of-the-art technology. Anyone with a chronic disease is at risk and deserves the best treatment available. But are we supposed to settle for a system that completely excludes millions of people ... See morejust so a few can have the best? We have an opportunity NOW to make a payment system that is both affordable and includes everyone. Our system doesn't have to be a duplicate of any other country's system. We have the ability to create our own system that allows access for everyone AND state of the art insulin pumps AND doesn't waste money on dividends to shareholders. Is that so preposterous? We are the richest freaking nation on the planet! I think the problem comes down to pure greed and selfishness. "I've got mine, it's up to you to get yours" is the underlying message I'm hearing all the time in the media. I think that's a fine business model, but an extremely poor model for health care delivery. Maybe what we need is a good old fashioned class war.

write about being tied to something -- 10 minute free-write

They started as 2. Two boxes of papers, journals, magazines, tchatchkes, keepsakes, each one a suitcase of memories packed into a box that made the move with me from Bremerton to Bellevue Ave, from Bellevue Ave to Harrison, from Harrison to 11th. Every time I packed my life into boxes a little of it stayed in a box so that after several moves, the 2 had become 5. Now there are 10, and each box holds a piece of me that is still tied to me. The cables disappear in the film of my life-- watching that movie, the boxes look like cardboard, but they follow me, of their on volition, mysteriously motorized. Keeping the boxes, I keep my life. I am tied, by the boxes to all the events, and people who have passed into the sunsets. The people are gone, the parties are over, the boxes remain. I keep them close, without them my past might drift away, my idea of myself, my sureness of my history might float aimlessly if the boxes didn't sit on top of them. Picking at the knots that hold the boxes tied firmly breaks my nails, bloodies my fingertips. But the pain makes it all the more important to finish. I've tried this hard, I've hurt this much I can't give up now. Does anyone have a pair of scissors? A book of matches?

write about a story that lives in your joints or bones--10 minute free-write

Through winter, the summer sun slowly leaches out of my bones. Sun soaked up over months of perfect sunny days, hikes in the sere desert, where my bones are parched and caked. In the snow my bones remind me that heat exists somewhere, and my store of sunshine dwindles, dwindles over sleety days, foggy weeks, and overcast months. The story of long carefree days with no jacket, impromptu trips to the beach, climbing on the warm rock to nap after lunch, all the stories spin themselves out of my bones when they are most needed. As the tales are told each bone grows dim and shrinks, until rib by rib, metatarsal by radius, femur by iliac crest, my bones become Winter waiting to be warmed by Spring.

Advocating for the underserved

This letter was submitted with an application for Energy Assistance (a federal program) on behalf of a tenant in Seattle Housing Authority. The Energy Assistance Program administrator asked that thee tenant, who claimed to have no income, make a special appointment to meet with him and explain her circumstances. For many other programs, federal and otherwise, an affidavit signed by the applicant is adequate to "prove" no income. No other applicant was asked or required to make a special appointment.

Dear Energy Assistance Program administrator,

I am submitting this application without proof of income because this SHA tenant claims to have no income. She has proved to the satisfaction of SHA to have no regular income and her rent reflects this. I understand that you require proof to your own standards and when I explained this to the applicant, she declined to follow up with you saying “If they don’t believe me then it’s not worth my time.”

Most of the tenants I work with in SHA have physical and/or mental conditions that prevent them from participating in the activities of daily living that you and I might take for granted. I do not believe that this should also prevent them from benefiting from programs designed to relieve them from the burden of poverty.

Please consider contacting this applicant to ascertain for yourself her income status.

Sincerely,

Social Worker

Red Suzuki 500

I paid $600 for that cute red Suzuki 500 and a helmet in August 1985. Don't, don't... don't you, forget about me. That $600 bought me a lot of getting around from August through April of 1986. Just 9 short months. 9 months of riding my first real girlfriend back to her group home after spending the night with me, getting me back home just in time to watch coverage of the Challenger exploding over Florida, white plumes billowing over and over again all day. 9 months of riding through the roughest weather to my job at the bar on Thursday evenings. Nearly blown over on Pine Street by a cross wind wailing down 3rd Avenue. I laid it down on black ice with a cute girl on the back and I still have two marks on my shin all these years later. That bike was just big enough to take on the freeway, but the wheels wobbling on the bridge decks made me think that longer alternate routs weren't that bad after all.

Two weeks after I bought it, in the middle of August, an early morning rain shower had slicked the road just right. In that short time it had become my habit to take my helmet off once I'd left the navy base where I was living. But looking at the morning sun glinting off the wet road, rainbows of summer oil pooling in the pock marked asphalt, this time I had second thoughts and kept going. Driving on in the humid morning, a half mile down the road I came around a bend to find 3 cars stopped on an overpass where there was no light or stop sign. A driver had stopped, perhaps confused by the on and off ramps of the freeway below. To avoid a collision I stomped my right foot onto the brake, which on a motorcycle, is the rear brake, the brake on the wheel with the least traction. The last thing I remember is falling backwards, arms outstretched, sky swinging into view. For that split second of eternity I was weightless.

I woke to find someone pulling on my arm. I was flat on my back but my arm was being pulled with such force that my shoulder shrugged off the road in rhythm to the tugging. At first I thought, "what day is it?" Maybe it was Friday, but maybe it was Sunday, Friday? Sunday? Friday? Sunday? Panic! Amnesia? What's my name? Tons of information about me, my name, my address, my whole life, rushed into the void that time had left, but I still didn't know what day it was. But that didn't matter so much. After all, that's what they make calendars for. Finally I focused on the man still pulling on my arm. I let him pull me to my feet, and looking around, I saw several cars had pulled over, drivers staring at me. My face became a furnace, glowing down my neck. Shame sered my cheeks, weighed on my eyelids, I had lost control. Helplessness is a bed of broken glass for me. Someone called out "Are you OK?" Seriously. Are you going to take the word of the person who was knocked out? "Uh, yeah, I'm fine." I gave a half hearted wave, the reluctant celebrity. I had no idea how long I'd been unconcsious on the road. And I was too ashamed to ask. No one had cell phones, no one had called for help. The man who'd pulled me up helped me put my bike back on its wheels. It wouldn't start of course, no gas in the carburator. I walked it home, couldn't get away from the scene of my ignominy quickly enough.

I slowly pushed my bike the mile back to my house, dizzy, mind racing, heart pumping the whole way. The rest of that day I was scared to death I would die in my sleep. I knew just about that much about concussion. For two weeks I woke up with the spins, no matter where I slept. About a week after, I was changing the oil in the motorcycle with the help of a friend in his back yard. He showed me where the plug unscrewed so I could do it by myself next time. I bent over to look and the grass flew up and hit me in the face. It took a bit to realize I had fallen over as soon as I my head and heart had aligned. 2 weeks after, I went to a party at a friend's and 1/2 a glass of wine did horrible, unspeakable things to me.

Before the concussion I had a nearly photographic memory. The injury shaved a point or two off my average. To this day I have regular word finding problems. I attribute this to the injury, though most people don't notice and it could be the stress of having a brain too full of the come and go of daily life and work.

Over time the cost of maintenance--oil changes, front forks, tires, new tabs, not to mention the motorcycle endorsement I never bought--all of this added up to a charge I could not afford to pay. $600 bought a lot of good times and getting around, wind in my hair, bugs in my teeth, riding friends around Volunteer Park. It also bought a ride to the end of the road I was ready to take.

5 Word Prompt Poem for Claire

Spa Love Pineapples Chocolate Hugh

When Hugh said "We need to talk,"
In his thoughtful voice
The one he uses when
He thinks I might argue with him.
I stopped cutting the pineapple,
Put the knife down carefully,
Pushing the edge away,
Thinking about the three other
Pineapples patiently waiting
On the washboard,
And the people arriving soon
That Hugh had wanted to invite
And the chocolate still not sauced.
"Honey," he juts his chin as he pulls
his words out of his gut
"I'm not sure I love you anymore."
I'm not sure if her hears my sigh
"Of course you love me, dear. You've
Just forgotten how it feels."
I kiss his cheek and ruffle his hair.
He is so proud of his hair at his age.
I put the knife in his hand,
Holding his hand over the handle.
"Now chop the fruit for your friends,
They'll be here any minute."
Already I'm thinking
about the spa tomorrow,
To relieve his guilt with my pleasure.

Moon: a review

Well, this is more of a psalm than a review. I loved Moon. I loved everything about it. I loved it's mystery. I loved the pacing of the plot. I loved the low-tech special effects. Models and sets still got it, baby! CGI not required. I loved the music. I loved watching this movie after spending loads of time alone over the past few weeks. I loved the details of dirty entropy pock marking the sterile pristine space station, the coffee stained Gerty. I especially loved when a bloodied, feverish Sam was being carried, while he was not quite in his space suit and it looked like he had 4 arms and 4 legs...

This movie is what I've been waiting for. It's beautiful. Space, the moon, the station where Sam lives, it's all so beautiful. The funny thing is, we, the audience, have seen enough of space in movies to know how utterly silent it is. How would we deal with being alone in space for 3 years? How much effort does it take to maintain your humanity when you are alone in space? Clearly we measure our humanity by our relationships, even the most basic relationship of perceiving and being perceived gives us a sense of self. What interaction we can program into a computer is by definition limited. Watching Sam lose his humanity and regain it is a beautiful process.

Everything about this movie is what I yearn for in a film. It is so lovingly, meticulously crafted that it looks effortless.

Did I mention the music? I love the music. I love how the moon rocks being mindlessly digested by the Helium 3 mining machines cause the surface dust to billow.

I want to cuddle this movie. I want to hold it close, like a couple of highschool sweet hearts at their locker between classes. And when the bully Avatar walks by, we'll snicker and cut our eyes, and whisper, all the while knowing that what we have is so much better than anything Avatar has to offer, with all it's bling and gusto.