And how to turn things around on health care by John Kusumi
(centrist)
Thursday, December 17, 2009
Right now, Barack Obama is in a world of hurt stemming from self-inflicted wounds as well as circumstances. His base has turned against him due to the watered-down, compromised-away health care legislation — that now might become a bill that goes down to defeat. Meanwhile, it looks like the Copenhagen world summit on climate change has had a breakdown in negotiations, and that there will be no deal or treaty issued from there. Obama was looking for two big wins in these issues; instead, the record of 2009 may record these two big failures.
Also, the handling of H1N1 flu has been a debacle and a comedy of errors. Who is wearing the pants at the federal government? Well, on H1N1, incompetence wears the pants. On health care, the insurance industry wears the pants. On drug importation, the pharmaceutical industry wears the pants. And TIME magazine just named Ben Bernanke its Man of the Year. Obama's 2009 will be remembered by two phrases, "cash for clunkers" and "cash for caulkers," and for rising joblessness.
For escalating the Afghanistan conflict, I'm ready to nickname him "President Quagmire." International Human Rights Day came and went. Obama did not remove land mines, cluster bombs, and depleted uranium weapons from the U.S. arsenal. Instead, he defended the status quo with a neoconservative speech in Oslo, Norway, where he received the oddly-named Nobel Peace Prize.
Enough about his failures. Right now, health care reform is on the ropes. Does he have a plausible pathway to achieve success — to snatch victory from the jaws of defeat? Well, yes, but the reason why Obama fails is because he has never yet heeded advice that comes from my quarter. Yes, I will discuss how to turn things around, but Obama will continue to fail as long as he continues to discount my advice.
Obama could (and in my view, should) immediately pledge to veto all corporate welfare bills. Period. This would reunite him with his base against the health care bill in its current form. The bill has become unpalatable because it is corporate welfare, and it include the noxious individual mandate which is a demerit to lay at the feet of Nancy Pelosi. To rescue the bill, remove the Pelosi mandate and insert the Kusumi health plan.
The Kusumi health plan is simple: No new bureaucracies. Just add $100 billion annually into Medicaid, permitting that system to raise the threshold amount of income that a household can earn while still being eligible for Medicaid. Consider: What is the whole purpose of Medicaid? It's there for poor people. Instead of making a new system of new bureaucracies, what if we simply fixed the existing one and allowed Medicaid to serve the purpose for which it is ostensibly there? Let's tell Medicaid to "do its job." And the prescription drug plan that exists in Medicare can and should be ported over to also serve those on Medicaid.
Along with the above, a health reform bill should include the insurance reform that's already been discussed this year. If the bill basically says, "No price – nor coverage – discrimination for sick people and those with pre-existing medical conditions," that simple rule would stop insurers from denying coverage and/or jacking up rates for people with pre-existing conditions and for those with coverage when illness strikes.
If the above does not sufficiently bend the cost curve for national outlays on health care, then proceed with more insurance reform that caps gouging. The bill could basically say, "Co-pays may not exceed $200 per month ($2,400 per year) per person, and deductibles may not exceed 10% of the patient's actual household income in the year prior to buying the policy. For whatever reason, patients may not be burdened beyond the basic premium and the amounts implied above."
That latter piece of the puzzle is likely to be resisted by the industry, because it seems to cap their revenue or expense offsets. But it's actually not a premium cap, it's just a dirty tricks cap. The above paragraph does not limit what premiums they can charge. My proposal is actually not a price cap. The invisible hand of free market forces will limit premiums to those which the market will bear.
In four paragraphs, I have explained the Kusumi health plan. Yes, it is real reform. No, it does not include the noxious Pelosi mandate. And no, it is not single payer universal health care. Therefore, the private sector insurance industry will continue to exist in a free market system. This is reform, but it is not an existential threat to the insurance industry.
Q.E.D.. A good reform is still possible, but right now is the eleventh hour for Barack Obama, who never takes any of my advice. ;)
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Posted By: Jahfre Fire Eater
Date: 2009-12-17 16:19:43
Hi John,
 Insurance is a business model for managing risk on a collective, statistical basis. If the government dictates that the business model must be compromised to cover unmanageable risk, it is no longer "insurance" it is communism pure and simple. This would be an economic black hole that only total collapse of the state can rescue us from.
Personally I LOVE the idea that leftists would block this from passing because it isn't communist enough for them. History shows that once the camel's nose is under the tent, he comes all the way in...yet the far left is so hung up on their self-righteousness on this issue that they will only accept a complete and total victory in one fell swoop. This is the same pursuit of freedom from the struggle that I have been writing about recently. They don't want to fight for their beliefs, they want to use the overwhelming force of government to end the struggle once and for all.Â
I hope they kick themselves in the ass for the rest of their lives if they don't help get the tent over this camel's nose.
Thanks but no thanks. I have a better solution: Get off your ass and take care of yourself. Work, save, and pay your own way. It's much more rewarding than sitting on the porch and waiting for the next handout to come in the mail.
Health insurance doesn't become affordable until your income is in the $40K ballpark. So what are you saying to (e.g.) America's clerical workers at $25K? -"Quit your $25K job which is equivalent to sitting on the porch"? And of course, the reason why to quit (in turgid reasoning) is because $40K jobs are so plentiful. Reality doesn't support the solution that you suggest for those of lesser means. I suggest that you either (a.) try spending only $25K for a year, then report back how well you made ends meet that way; or (b.) never employ any uninsured people. If you cross (a.) or (b.), then it's purely hypocritical to write what you wrote.
And it's easy for me to read the mean spirited sneer that you have for those of lesser means, when you know full well that reality places more positions at $20K than at higher numbers. Send my regards to the Church of Beggar Thy Neighbor.
Posted By: Scott McMorran
Date: 2009-12-26 18:07:34
John:
Loved your article. There is not a single suggestion that I agree with, but that is O.K. You're an honest Liberal, you believe government can solve the H.C. problem and that is your perogative. I would only ask one question, "What government program isn't on the brink of banckruptcy or losing billions annually (USPS, AMTRAK)
Posted By: Scott McMorran
Date: 2009-12-26 21:31:12
Jahfre Fire Eater:
I have spent 30 years in the Insurance business, 25 of them in Health Insurance and I have to say your definition of insurance is one of the best I have heard. It really does put the problem into perspective.
Posted By: Ross Williams
Date: 2009-12-29 07:50:26
The current proposal is not a health care bill. You can actually say, with much support, that it has nothing to do with health care.
It is, instead, a health coverage bill.
Health care is diagnosis and treatment, and except for a few very notorious examples, the government does not do health care.
Health coverage, on the other hand, is the mundane matter of who pays for it.
Anyone who calls the current proposed legislation "health care reform" is advertising he doesn't understand the subject in its very elementary basics.
In either event, the government's track record on both are unimpressive. Current government health care programs are confined to the military -- military and dependent care for active duty/retired service members; and the entire VA ineptitude.
The military provides admirable "catastropic care"; they'll swoop in with helicopters to pluck a single wounded soldier from a battlefield and zip him back to a hospital lickety-split and bandage him all up. But the soldier's kid gets the flu and needs to see the doctor? can't get an appointment unless you call the switchboard at 8AM and are lucky enough to get through. By 8:05 the appointments are filled up and you'll have to wait until tomorrow. If you use the emergency room for routine medical care? they'll send you away.  And if you try it often enough, the sponsoring military member can get reprimanded. Goodbye promotions and a military career.
And the VA? the 'continuing care' and 'rehabilitation' for wounded vets? Notorious for leaving patients unattended in hallways, or vegetating in over- or under-medicated stupors.
Only a fool or an idiot would want the government to provide health care with these as the model.
Government health coverage programs are not much better. The two programs the government runs are MediCare and MedicAid, health coverage for old people and poor people, respectively.
And with all due respect, [which is none], they are worthless.
Both are run by shills and incompetents, chock full of graft and corruption, they cover little, pay for less, and demand to consume an ever-larger share of the national budget ... all so they can become more corrupt and less useful.
A fixture on certain cable stations is the MediCare Supplement Insurance commercial. Why MediCare Supplement Insurance? Because MediCare doesn't cover what it purports to. Not in routine treatment, not in medication, not in anything.
And MediCare Supplement Insurance is actual insurance. Not like the ersatz "insurance" that the government calls it which isn't. Like Social Security. Many people -- including idiot Democrat Senators -- call Social Security an "insurance" program. To which the first appropriate response is: "BZZZZZZZT!!"
Insurance -- as Jahfre indicates -- is based upon risk, and your premiums are predicated on your statistical likelihood of receiving benefits. If Social Security were run like a legitimate insurance program, then women would pay more in "premiums" than men, and black would pay less than whites.
The supporters of the more-liberal version of the current health coverage proposals would have us all believe that the government is going to create another "insurance" program to cover those currently uncovered -- the "public option". And if it were an actual insurance program, then it might be worthwhile: an individual pays in according to his statistical likelihood of receiving benefits.
But that would not work for the uncovered folks in our country who are too wealthy to be not-quite covered by the fraud-filled MedicAid, and who are too young to be not-quite covered by the fraud-filled MediCare. Why? because they are frequently uninsurable. Their likelihood of receiving benefits requires their premiums exceed their ability to pay them.
Hence the "public" part of the option. In other words, wealth transfer from rich to poor. And it should be understood that for these purposes, particularly when described by tear-stained Uber-Liberals, "rich" includes the middle class.
In still other words [and as stated]: communism.
Because communism, along with guvmint-run health care and health coverage gimmicks, also has a sterling track record of success and has not gone bankrupt all over the world in the last generation.
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