A Conversation With My ACLU-Boardmember-Cousin...

Here’s a conversation with my dad’s cousin Terry. Terry works with the ACLU, but strangely is an advocate of the 2nd Amendment….

T: Congress has gotten so polarized and dogmatic that they put the next election ahead of anything that might be good for the country. Both sides of the aisle are guilty of this mentality, but (forgive the bias) the ultra-conservatives don’t have any compunction about checking their brains and honesty at the door in order to present a unified opposition. So who is lying??? Do you believe that:

· There are death panels that will determine which old people get treatment and which ones don’t?
· That Obama wasn’t born in the United States?
· That the world is only 6,000 years old?
· That Obama is a socialist and/or communist and/or nazi?
· That maybe it’s time for some of the states to succeed from the union and that the constitution supports this position?


J: Let me answer your questions first, just so you can get the lay of the political land in my head.

1. "Death Panel" is certainly an exaggeration. The focus of any bureaucratic review of recipients of government healthcare will certainly not be on any individual. Rather the review will be a rational and objective one that compares the economic benefit of the treatment in question with the viability of the patient.
2. I don't know. Do you?
3. I don't care. Why do you?
4. President Obama certainly has expressed views that are not capitalist in nature. He has railed against "profit" and has moved to bring several large companies including banks and manufacturers into government and union ownership. That lies somewhere between socialist (state ownership) and communist (worker ownership). He has supported an ousted would-be socialist dictator in Honduras over the country's legitimate constitution and the actions of its Supreme Court and military. That is at very least tacit endorsement of socialist aggression.
5. While it certainly is the right of states to secede from the Union, I do not believe that is a good idea. States have a long history of yielding their rights under the 10th Amendment, going back at least to Reconstruction. If the States want to, they must understand that teaching the federal government that the 10th Amendment is as important as the 1st or the 14th is going to take time.

T: And CAN you believe that the same Republicans that are opposed to the government interfering with end-of-life decisions are the ones who supported the government intervention in the end-of-life family decision for Terry Schaivo?


J: So, with the Terri Schaivo case, are you saying that government will interfere with end-of-life choices; and we should be okay with that because (and you must forgive me - I was busy that summer and didn't pay much attention to the whole Schaivo thing...) some Republicans thought it was okay? (There are plenty of "Republicans" who think that government is the answer.) Do you think it's okay for government to do that? You see, on one hand I hear liberals protesting that the government will not make those decisions for us, and on the other I hear them saying we shouldn't complain about the government making those decisions for us.

T: I am easily convinced that Democrats can stretch the truth and revise history. But the outrageous allegations made by Republicans who can’t stand being out of power for 8 months outclasses anything I have witnessed before.

Given the fact that the Republicans believe that if they defeat health care reform, then it will be “Obama’s Waterloo,” I have no doubt about who is willing to lie in order to accomplish that lofty objective. And… One final question that has been niggling at me for the last couple of weeks… Why are so many Americans, even those on the extreme right, so darned concerned about preserving the fantastic profits of the insurance companies??? They are actually concerned about the company’s well-being if they are faced with… get this… competition. Please explain to me why. I await with bated breath.


J: As for "Obama's Waterloo", this is the first time I've heard healthcare reform called that. But let's look at the context of Waterloo. It was not that Napoleon's enemy was superior. The reason Napoleon lost at Waterloo was a series of mistakes he made. Waterloo is synonymous with a self-inflicted defeat. Napoleon had bad timing, a bad plan, and a set of poor leaders. He failed to execute; failed to exploit his advantages. In short, he overestimated his own forces' capabilities and underestimated his enemy. Further, he failed to see the possibility of 50,000 Prussian reinforcements arriving on the scene. In that context, whoever came up with the "Waterloo" analogy may be right.

President Obama missed the wave of popular support. He used that time to pass a stimulus package that is still largely impossible to track. That was a big withdrawal from the fledgling emotional bank account he had with the American people. It left him trying to paddle up the backside of the wave. President Obama still has not articulated a plan for healthcare reform which leaves many wondering if there is a plan at all. The extraordinarily poor quality of appointees he has made - ranging from tax avoiders to conflicts of interest - has been a distraction.

He has failed to execute; failed to exploit his advantages. In short, he overestimated his own election. Rather than reading it as the rejection of a spineless and double-dealing Republican president he read it as a whole-hearted mandate of his socialist agenda - which was largely hidden from the ignorant voting population that numbs its mind on CNN and the Today Show. That misreading caused him to fail to see the possibility of really upsetting a large number of people who would take time off work and travel long distances to express their disappointment (and some contempt) to their elected representatives.

Anyone who paints those folks (of which I am part) as "astroturf" is living in denial.

Your final niggling question about why we Americans are concerned about preserving the profits of insurance companies has a simple answer that ought to be crystal clear to any of you who are drawing down a 401k, 403b, or IRA. All of our financial futures are tied to the profitability and the future profitability of large companies, not just insurance companies or auto makers. Take away the profit potential for any company and what is the investment value? Zero. Now, go try to cash in your investments so that you can live with dignity in retirement when the profit potential for even a small portion of your portfolio has been taken away. You WILL be eating dog food, as the fearmongers in the 1980s asserted.

Competing with the government never was competition, Terry.

Don't point to UPS and FedEx, either. They are not allowed to play in the first-class postage arena. If they were, we might see some very interesting things happen at the USPS. You see, government writes the rules and, as is the case in parcel post, government writes them in its favor.

If you want to open up competition in healthcare, let's deregulate the market and allow companies to practice in all 50 states. I'd love to have the Kaiser Permanente option here in Arizona, but becaus the market is so tightly regulated Kaiser is locked out. Level the playing field, as the liberals say.

And let's get some tort reform going here. When I try to understand what trial lawyers add to the cost of medical care in the country my head swims. I think back to Tina's OB in Ohio who paid $500,000 per year in malpractice premiums - although she'd never lost a case and was only sued 2 or 3 times per year.

I return to my assertion: We do not understand the root problems of healthcare in this country. Therefore we cannot fix them by addressing the symptoms of cost and availability.

More From the AP on America's Health "Crisis"

By SCOTT HARRINGTON
In his speech to Congress last week, President Barack Obama attempted to sell a reform agenda by demonizing the private health-insurance industry, which many people love to hate. He opened the attack by asserting: "More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. It happens every day."

Clearly, this should never happen to anyone who is in good standing with his insurance company and has abided by the terms of the policy. But the president's examples of people "dropped" by their insurance companies involve the rescission of policies based on misrepresentation or concealment of information in applications for coverage. Private health insurance cannot function if people buy insurance only after they become seriously ill, or if they knowingly conceal health conditions that might affect their policy.

Traditional practice, governed by decades of common law, statute and regulation is for insurers to rely in underwriting and pricing on the truthfulness of the information provided by applicants about their health, without conducting a costly investigation of each applicant's health history. Instead, companies engage in a certain degree of ex post auditing—conducting more detailed and costly reviews of a subset of applications following policy issue—including when expensive treatment is sought soon after a policy is issued.

This practice offers substantial cost savings and lower premiums compared to trying to verify every application before issuing a policy, or simply paying all claims, regardless of the accuracy and completeness of the applicant's disclosure. Some states restrict insurer rescission rights to instances where the misrepresented or concealed information is directly related to the illness that produced the claim. Most states do not.

To highlight abusive practices, Mr. Obama referred to an Illinois man who "lost his coverage in the middle of chemotherapy because his insurer found he hadn't reported gallstones that he didn't even know about." The president continued: "They delayed his treatment, and he died because of it."

Although the president has used this example previously, his conclusion is contradicted by the transcript of a June 16 hearing on industry practices before the Subcommittee of Oversight and Investigation of the House Committee on Energy and Commerce. The deceased's sister testified that the insurer reinstated her brother's coverage following intervention by the Illinois Attorney General's Office. She testified that her brother received a prescribed stem-cell transplant within the desired three- to four-week "window of opportunity" from "one of the most renowned doctors in the whole world on the specific routine," that the procedure "was extremely successful," and that "it extended his life nearly three and a half years."

The president's second example was a Texas woman "about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne." He said that "By the time she had her insurance reinstated, her breast cancer more than doubled in size."

The woman's testimony at the June 16 hearing confirms that her surgery was delayed several months. It also suggests that the dermatologist's chart may have described her skin condition as precancerous, that the insurer also took issue with an apparent failure to disclose an earlier problem with an irregular heartbeat, and that she knowingly underreported her weight on the application.

These two cases are presumably among the most egregious identified by Congressional staffers' analysis of 116,000 pages of documents from three large health insurers, which identified a total of about 20,000 rescissions from millions of policies issued by the insurers over a five-year period. Company representatives testified that less than one half of one percent of policies were rescinded (less than 0.1% for one of the companies).

If existing laws and litigation governing rescission are inadequate, there clearly are a variety of ways that the states or federal government could target abuses without adopting the president's agenda for federal control of health insurance, or the creation of a government health insurer.

Later in his speech, the president used Alabama to buttress his call for a government insurer to enhance competition in health insurance. He asserted that 90% of the Alabama health-insurance market is controlled by one insurer, and that high market concentration "makes it easier for insurance companies to treat their customers badly—by cherry-picking the healthiest individuals and trying to drop the sickest; by overcharging small businesses who have no leverage; and by jacking up rates."

In fact, the Birmingham News reported immediately following the speech that the state's largest health insurer, the nonprofit Blue Cross and Blue Shield of Alabama, has about a 75% market share. A representative of the company indicated that its "profit" averaged only 0.6% of premiums the past decade, and that its administrative expense ratio is 7% of premiums, the fourth lowest among 39 Blue Cross and Blue Shield plans nationwide.

Similarly, a Dec. 31, 2007, report by the Alabama Department of Insurance indicates that the insurer's ratio of medical-claim costs to premiums for the year was 92%, with an administrative expense ratio (including claims settlement expenses) of 7.5%. Its net income, including investment income, was equivalent to 2% of premiums in that year.

In addition to these consumer friendly numbers, a survey in Consumer Reports this month reported that Blue Cross and Blue Shield of Alabama ranked second nationally in customer satisfaction among 41 preferred provider organization health plans. The insurer's apparent efficiency may explain its dominance, as opposed to a lack of competition—especially since there are no obvious barriers to entry or expansion in Alabama faced by large national health insurers such as United Healthcare and Aetna.

Responsible reform requires careful analysis of the underlying causes of problems in health insurance and informed debate over the benefits and costs of targeted remedies. The president's continued demonization of private health insurance in pursuit of his broad agenda of government expansion is inconsistent with that objective.

Mr. Harrington is professor of health-care management and insurance and risk management at the University of Pennsylvania's Wharton School and an adjunct scholar at the American Enterprise Institute.

Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved

Checking the Facts with AP

FACT CHECK: Obama uses iffy math on deficit pledge
By CALVIN WOODWARD and ERICA WERNER, Associated Press Writers Calvin Woodward And Erica Werner, Associated Press Writers Thu Sep 10, 3:15 am ET
WASHINGTON – President Barack Obama used only-in-Washington accounting Wednesday when he promised to overhaul the nation's health care system without adding "one dime" to the deficit. By conventional arithmetic, Democratic plans would drive up the deficit by billions of dollars.
The president's speech to Congress contained a variety of oversimplifications and omissions in laying out what he wants to do about health insurance.
A look at some of Obama's claims and how they square with the facts or the fuller story:
___
OBAMA: "I will not sign a plan that adds one dime to our deficits either now or in the future. Period."
THE FACTS: Though there's no final plan yet, the White House and congressional Democrats already have shown they're ready to skirt the no-new-deficits pledge.
House Democrats offered a bill that the Congressional Budget Office said would add $220 billion to the deficit over 10 years. But Democrats and Obama administration officials claimed the bill actually was deficit-neutral. They said they simply didn't have to count $245 billion of it — the cost of adjusting Medicare reimbursement rates so physicians don't face big annual pay cuts.
Their reasoning was that they already had decided to exempt this "doc fix" from congressional rules that require new programs to be paid for. In other words, it doesn't have to be paid for because they decided it doesn't have to be paid for.
The administration also said that since Obama already had included the doctor payment in his 10-year budget proposal, it didn't have to be counted again.
That aside, the long-term prognosis for costs of the health care legislation has not been good.
CBO Director Douglas Elmendorf had this to say in July: "We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."
___
OBAMA: "Nothing in this plan will require you or your employer to change the coverage or the doctor you have."
THE FACTS: That's correct, as far as it goes. But neither can the plan guarantee that people can keep their current coverage. Employers sponsor coverage for most families, and they'd be free to change their health plans in ways that workers may not like, or drop insurance altogether. The Congressional Budget Office analyzed the health care bill written by House Democrats and said that by 2016 some 3 million people who now have employer-based care would lose it because their employers would decide to stop offering it.
In the past Obama repeatedly said, "If you like your health care plan, you'll be able to keep your health care plan, period." Now he's stopping short of that unconditional guarantee by saying nothing in the plan "requires" any change.
___
OBAMA: "The reforms I'm proposing would not apply to those who are here illegally." One congressman, South Carolina Republican Joe Wilson, shouted "You lie!" from his seat in the House chamber when Obama made this assertion. Wilson later apologized.
THE FACTS: The facts back up Obama. The House version of the health care bill explicitly prohibits spending any federal money to help illegal immigrants get health care coverage. Illegal immigrants could buy private health insurance, as many do now, but wouldn't get tax subsidies to help them. Still, Republicans say there are not sufficient citizenship verification requirements to ensure illegal immigrants are excluded from benefits they are not due.
___
OBAMA: "Don't pay attention to those scary stories about how your benefits will be cut. ... That will never happen on my watch. I will protect Medicare."
THE FACTS: Obama and congressional Democrats want to pay for their health care plans in part by reducing Medicare payments to providers by more than $500 billion over 10 years. The cuts would largely hit hospitals and Medicare Advantage, the part of the Medicare program operated through private insurance companies.
Although wasteful spending in Medicare is widely acknowledged, many experts believe some seniors almost certainly would see reduced benefits from the cuts. That's particularly true for the 25 percent of Medicare users covered through Medicare Advantage.
Supporters contend that providers could absorb the cuts by improving how they operate and wouldn't have to reduce benefits or pass along costs. But there's certainly no guarantee they wouldn't.
___
OBAMA: Requiring insurance companies to cover preventive care like mammograms and colonoscopies "makes sense, it saves money, and it saves lives."
THE FACTS: Studies have shown that much preventive care — particularly tests like the ones Obama mentions — actually costs money instead of saving it. That's because detecting acute diseases like breast cancer in their early stages involves testing many people who would never end up developing the disease. The costs of a large number of tests, even if they're relatively cheap, will outweigh the costs of caring for the minority of people who would have ended up getting sick without the testing.
The Congressional Budget Office wrote in August: "The evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall."
That doesn't mean preventive care doesn't make sense or save lives. It just doesn't save money.
___
OBAMA: "If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage."
THE FACTS: It's not just a matter of being able to get coverage. Most people would have to get coverage under the law, if his plan is adopted.
In his speech, Obama endorsed mandatory coverage for individuals, an approach he did not embrace as a candidate.
He proposed during the campaign — as he does now — that larger businesses be required to offer insurance to workers or else pay into a fund. But he rejected the idea of requiring individuals to obtain insurance. He said people would get insurance without being forced to do so by the law, if coverage were made affordable. And he repeatedly criticized his Democratic primary rival, Hillary Rodham Clinton, for proposing to mandate coverage.
"To force people to get health insurance, you've got to have a very harsh penalty," he said in a February 2008 debate.
Now, he says, "individuals will be required to carry basic health insurance — just as most states require you to carry auto insurance."
He proposes a hardship waiver, exempting from the requirement those who cannot afford coverage despite increased federal aid.
___
OBAMA: "There are now more than 30 million American citizens who cannot get coverage."
THE FACTS: Obama time and again has referred to the number of uninsured as 46 million, a figure based on year-old Census data. The new number is based on an analysis by the Kaiser Commission on Medicaid and the Uninsured, which concluded that about two-thirds of Americans without insurance are poor or near poor. "These individuals are less likely to be offered employer-sponsored coverage or to be able to afford to purchase their own coverage," the report said. By using the new figure, Obama avoids criticism that he is including individuals, particularly healthy young people, who choose not to obtain health insurance.
___
Associated Press writer Jim Kuhnhenn contributed to this report.