Monday, August 31, 2009

Health Care Reform

By Mr. Quarter

Early in the history of this blog during the 2008 presidential elections, I posted a lengthy dissertation on my vision of "universal health care" . Interested readers can refer back to those thoughts in the archives herein. Given the debate that is currently raging, I thought it appropriate to weigh in again, repeating and revising my earlier thoughts.

First a disclosure. Even though I am very conservative in my politics, I believe that there are certain target reforms that are necessary and beneficial to our current health care system. I do believe that some form of affordable health insurance should be available to all US citizens, although I vehemently disagree with the notion of mandatory compliance for all persons or businesses. I believe that excessive health care costs arise from some specific factors:

  1. Many of the uninsured (particularly low income individuals and families) rely on hospital emergency rooms as their primary medical provider. Unpaid or noncollectable charges are distributed to the hospital overhead costs and ultimately paid by those who have insurance.
  2. Medicare, medicaid, and private insurance disallow significant portions of the charges for service that are submitted by medical providers (think the charge is $120.00 and the reimbursement is $17.50). So there is a built in incentive to increase the volume and magnitude of charges submitted for reimbursement.
  3. The probability of tort litigation with consequent damage awards far in excess of the actual damages compels the practice of defensive medicine and drives up the cost of services in direct proportion to the cost of liability insurance coverage.

I believe that the necessary reforms to reduce the cost of health care and encourage health care insurance for all US citizens should include the following:

  • Private insurance should be made portable from job to job. Just as salary requirements are a consideration, so then would be the cost of the employee's health insurance as a hiring decision if the employer is providing this as part of the employment package.
  • Eliminate, by regulation, the existing conditions exception to health coverage. If existing conditions are known, then they can be priced into the cost of coverage as part of the carrier's total risk pool . However, this could lead to hiring or employment discrimination. Perhaps there could be set up a national risk pool for existing conditions coverage that would function like an umbrella policy. That could be contributed to by all insurers and Medicare.
  • Eliminate by regulation all barriers to purchasing insurance or insurance coverage across state lines. Open the market place and let competition set pricing.
  • Tort reform. A no brainer - and it has been done in other industries (you can't sue the airlines for wrongful death if you crash). Three key reforms here. First, the plaintiff will be liable for all legal costs if the court rules in favor of the defendant. Second, awards actual damages are based on actual lost income potential (i.e, a person who would never earn $5M in their lifetime cannot be awarded $5M) with an absolute cap on actual damages. Third, punitive damages are prohibited.

What about those who have no insurance or cannot afford it? Here I favor a quasi-public option. But again market based. The federal government should establish a minimum coverage specification. In my opinion that would include wellness care (i.e., annual physical, vaccinations, etc.) and catastrophic event coverage (i.e., appendectomy, knee replacement, heart transplant). This specification should be put out to competitive bid with all US based health insurers. The bid specification could stipulate a particular age/sex/ethnic range and risk pool size as a basis for the premium. Low bidder is awarded a 5 or 10 year contract to administer the program providing the coverage to all who apply. Annual audit of the low bidder, at the bidder's expense, would be required. A menu of additional coverages, for additional premium cost, could be offered as well.

This program would be open to anyone, including businesses who want to offer health care to their employees. Federal subsidies on a financial need basis would be available to low income individual US Citizens and their families. The subsidies will be offered on a sliding scale from 100% to the most needy to 0% above a threshold income of say $25k /yr for individuals or $40K for families.

Market competition in the private sector, market competition in offering coverage through the public sector, availability for all, subsidies for those that truly need assistance, reforms to control costs. These ideas are viable and implementable. They do not require mandates for coverage, force a one size fits all on the populace, and provide absolute freedom of choice.

One of my biggest issues with the Obamacare boondoggle as currently articulated is how they propose to pay for the costs. I have heard the number $500 billion in savings from "efficiencies and elimination of waste in medicare". Well, if we know how to do that now, what is the hold up? Get it done!

Post Script - After posting this, I thought about another aspect of the health care debate that has been tossed out there and is actually one of some significance. Employer paid health care insurance is a substantial benefit (income) that is not taxed. While I take offense at the characterization of this as a loophole (like not taxing the air that we breathe is a loophole) there are some legitimate arguments around this issue. I have a lawyer friend, a partner if a major Philadelphia law firm (yes, I know, a "Philadelphia Lawyer"). The business is a LLP (Limited Liability Partnership). Partners get no salary or benefits. They receive a portion of the firm's profits on a periodic basis. So when he purchases health insurance for himself and his family, he is paying full boat for the coverage (no employer contribution), and pays income tax on the money he uses to pay the premium. Not fair. I am not advocating taxing employer paid health insurance. But I do believe that the laws should be changed to allow for a personal tax deduction or tax credit for the cost of purchasing health insurance.

Tuesday, August 25, 2009

The Deuce Ponders 4

A current events quiz.

1. Guys...if you absolutely had to choose, drooling banjo players with shotguns demanding an answer, who would you rather marry?

A. Jeanane Garafalo
B. Whoopi Goldberg
C. Barney Frank
D. Nancy Pelosi

Answer: C. Barney Frank. Sure, the lisp is a turn off, but maybe he likes football. In any event, he can't possibly run his yap as much as the other ladies. Plus, if you find you can't stand him, Fox News won't run reports 24/7 on his disappearance...since he's not a blond chick.

2. Ten African leaders, meeting at African Union Headquarters in Ethiopia, are asking for $67 billion dollars annually from the West to combat...

A. Tribal Warfare
B. Crocodile Predation
C. Global Warming
D. Female Virginity

Answer: C. Global Warming. Never mind all that Hutu vs. Tutsi genocide or the AIDS pandemic or the devolution of South Africa, global warming may cause the Sahara to get one degree hotter in the next fifty years and the mosquitoes in the Congo will get a little more aggressive. You know, if you're trying to pick my pocket can't you at least try harder to come up with a more believable excuse, like you're a Nigerian prince and if I'll just cash your check for $750 thousand and send it to you, you'll be able to claim your rightful kingship and I can keep $25 thousand for myself? No wonder the entire African continent is a write off...they can't even run a believable scam.

3. You're a CIA intelligence officer tasked with interrogating high value Al-Qaeda prisoners. Which of the following interrogation techniques are allowed under the Obama administration guidelines?

A. Water Boarding
B. Sleep Deprivation
C. Hate Speech ( "Tell me what I want to know or I'll kill your family!", or "That cheesy mustache makes you look like a pussy!" )
D. Let a pissed off Poodle bark at him
E. Atomic Wedgy

Answer: E. Atomic Wedgy. The Atomic Wedgy may be administered to the prisoner, but only after he's been given a prayer rug, told which direction Mecca is, given a signed first edition of the Koran, fed a seven course culturally correct meal free of pork and allowed to cut the head off of an infidel Christian or Jew ( video made available to Al Jazeera, of course ). And the Crusades stopped at three because...?

4. Cash For Clunkers was a bad idea because...

A. The federal government shouldn't be in the business of selling cars.
B. Car dealers shouldn't rely on the federal government to help them sell cars.
C. I didn't pay my taxes just so they could help your sorry ass buy a new rice burner.
D. Cash For Clunkers could morph into yet another welfare program, like Cash For Appliances.

Answer. All of the above. If you took advantage of the Cash For Clunkers program you should hang yourself right now. You just used $3500 to $4500 of my tax money to subsidize the purchase of your new ride. Have you no shame? Have you no pride? You're a parasite. When you have that head-on crash because you're so busy texting your BFF I hope your airbags fail.

5. The "Public Option" of Obama's health care plan is creating so much controversy because...

A. The Federal Government should not be involved in health care insurance programs.
B. It makes private medical records available to the government.
C. "End of Life" counseling sounds too much like "Time to give it up geezer!"
D. Any legislation that takes over a thousand pages to describe is prima facie evidence that it is an abomination that will bankrupt the country while fixing nothing.

Answer: All of the above. Obama's health care plan is not about health's about controlling you. Once Obama wets his beak in health care he can then say, "You're too fat. Lose weight or we'll withhold coverage for conditions related to obesity." Or, "stop smoking or we'll deny coverage for any respiratory diseases.", or "Injuries sustained in a car crash and you weren't wearing a seat belt...claim denied.", or "Born with Down's Syndrome, your carbon footprint will be humongous...can't use to the post-birth abortion chamber you go."

What did the Chinese philosopher say..."May you live in interesting times." Well folks, it's getting real interesting.

Sunday, August 16, 2009

The Deuce and John Hughes

Film director and writer John Hughes died last week. I knew I liked some of his movies, but I didn't realize how many until he passed away. My bad John. John's best movies featured humor above all, but were layered with themes of the importance of family and friends, of courage, of honesty and the power of the individual.

Animal House (writer): Are you kidding me? A genre creating, young man drink/sex/prank/puke fest. Lesson; Fight the Power. Favorite quote; "Food fight!" An American classic. Bluto lives!

Uncle Buck (director): Just one of several collaborations with the genius John Candy. Loser uncle comes to the rescue of brother's family in time of need. Meets resistance from cynical niece, wins her over with caring, tough love and forgiveness. Hilarious and heartbreaking. Lesson; trust family. Favorite quote; "Ever heard of a ritual killing? Hee-hee-hee."

Home Alone (writer): Now a Christmas classic. A young boy is mistakenly left home alone when his family takes a Christmas vacation in Paris. Boy thwarts would be burglars, learns self sufficiency and realizes importance of family, even if they're flawed. Lesson; man up...and allow for imperfections in those you love. Favorite quote; "Keep the change, ya filthy animal."

Planes, Trains and Automobiles (director): Two men try to make it home during a blizzard at Thanksgiving time. John Candy and Steve Martin team up for this hilarious and heartfelt romp through middle America. Bumbling loser Candy and repressed businessman Martin accidentally share a nightmare trip in an epic struggle to get home by the holiday. Lesson; patience, forgiveness and fellowship. Favorite quote; "Those aren't pillows!"

The Breakfast Club (director): Easily the most serious of Hughes' films. Five high school students meet for the first time while serving detention on a Saturday. The jock, the thug, the nerd, the princess and the freak compare notes on what it's like growing up. They hate each other but they band together to fight the 'fascism' of the teacher monitoring their detention. In the end, the barriers of class and stereotype come crashing down as the five unite in teenage angst. Lesson; we're not as different as we seem. Favorite quote; "Eat my shorts!"

Ferris Bueller's Day Off (director): The best of them all. High school senior Ferris takes yet another day off from school, his ninth of the semester, by faking an illness. Left alone at home by his parents he sets out to free his best friend Cameron from his neuroses and inability to stand up to his father by talking Cameron into a a day on the town (Chicago) with Ferris' girlfriend Sloan and transportation provided by Cameron's father's classic Ferrari. Hilarity ensues and lessons are taught by the irrepressible Ferris. Lesson; "...believe in yourself." Favorite quote: "Life moves pretty fast; and ya don't stop and look around once in a while, ya gonna miss it."

Other movies directed or written by Hughes include Weird Science, National Lampoon's Vacation, Pretty In Pink, Sixteen Candles and Only the Lonely.

Hughes' movies made stars of Matthew Broderick, Emilio Estevez, Molly Ringwald and Ally Sheedy.

Film critics describe Hughes' movies as the soundtrack of teenagers lives in the '80's. Perhaps so. I was well past high school when these movies were released, and I love them all. They're not serious films and none of them have ever won an Oscar, but they all share the most important thing a movie must have in my feel good at the end.

Uncle Buck saves his niece, wins the love and respect of his brother and sister-in-law, finally gets a nine to five job and seals the deal on his girl friend...

Kevin fights off the burglars, reunites his fearsome neighbor to his son and his family, and reestablishes the love and respect of his family...

Neal suffers all the indignities Del can accidentally dish out and still invites Del to share Thanksgiving with him and his family...

Five disparate kids come together to fight a common foe and learn to respect one another...

Ferris wails on Twist and Shout, saves Cameron's mental health and wins over his jealous sister...

You feel good at the end. Is there a better critique?