Just Take a Pill

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Developers for the i-Phone are gifted with an audience who relish cool stuff.  It seems that if you can imagine it, someone else beat you to it and has provided an "application" for download.

So amidst all the utilities, games, photography tools, search functions, and other iJunk, I somehow came across iDie.  Similar to the counter for iDie - on an iPhone near you!the National Debt, this wonderful life-affirming application asks your gender and birth date, then provides you with a running percentage of how much of your life you have lived!  It even includes a visual slider bar if you aren't too good with math.  So, my life is 57.905386334% complete.  Well, at last glance, it was.  It's already edged upwards.

For those who don't fathom math so well, it's also translates the percentage to cold, hard facts.  I'll die at age 77, in 11,958 days, 11 hours, 7 minutes and, well, the seconds keep counting down.  I better get on with the business of living!

There's some adjectives that might apply to iDie.  Shallow, morbid, macabre, pointless and useless come to mind, but even though we know death is a certainty, we don't think too deeply upon it.  We're too busy!

Every now and then, however, something arises which causes us to pause and reflect.  This may be as catastrophic as a hurricane, as unexpected as 9/11, or as penetrating and unsettling as a loved one diagnosed with cancer.  It may also be as spectacular as the arrival of the newborn or one of the many joys we take pleasure in.

Life matters, but we don't often dwell upon the end of it.  To a degree lesser than the examples above, the nation's consciousness has been brought to matters of health.  Topically, discussion this week has centered around a woman's challenge to Senator Arlen Spector (D)(this election cycle) that the Obama Health Care Plan would result in a 75 year old man being denied life-saving medical treatment. 

Fact from fiction:  There is no Obama Health Care Plan.  Nada.  He hasn't publicly issued any specific program or content.  There is only House Bill H.R. 3200 - America's Affordable Health Choices Act of 2009, which you can read by clicking on the link above.  Go ahead and read what our elected representatives, the opposing forces, and just about everybody else has not.  I recommend caffeine whilst you try, but guarantee a solid 8 hours of sleep afterwards.

Opinions are never given without underlying assumptions and biases, so I'll make mine clear.  I consider the government's overhaul of 13% of the National Gross Domestic Product very troubling.  I vehemently oppose the addition of yet more entitlement spending.  I do not consider "health care" to be an inalienable right, and I do not think the Constitution (under "promote the social welfare") means provides for it.  That's all irrelevant, as every elected politician sees a benefit in doing something, regardless of where "something" might stand on the scale between increasing healthcare access to the complete government takeover, socialist approach.

So, as an interested party, I set about reading H.R. 3200.  I didn't finish it.  It's written in a language similar to the Code of Federal Regulations.  It can mean anything to whoever is empowered to determine its meaning.  But I tried.

Section 1233 (Advance Care Planning Consultation) is the section du jour, instilling fear amongst those that see a wide variety of dangers amongst government control of healthcare.  It's not a long section - scroll just shy of about half way down, and you can find it. 

The point of this section is that the elderly would be required (though that word is not used) to have 5 year checkups in which they would receive "An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliatave care and hospice, and benefits for such services and supports that are available under this Title." 

The word "palliative" is not necessarily a common one, but it means "relieving or soothing the symptoms of a disease or disorder without effecting a cure." - American Heritage Stedman's Medical Dictionary.  It's not a leap to see that this means take a pain pill rather than seek a cure. 

The key aspect of this section is that it is a consultation.  It does not mandate any course of treatment or withholding of same, or, in what further reading I could endure, indicate what particular authority having jurisdiction would make that specific decision.

And that's one problem with this Bill and likely most others.  Each paragraph is obviously provided intentionally to suit a perceived need.  Instead of saying "this is to be done," it would be very helpful to say "this is to be done and this is the reason why it is necessary."  The link I provided above allows people to comment on the sections - many attempt to guess what the sections actually mean.

Reading through (okay, skimming) the pages upon pages of content, I can only guess at much of the intent.  I suspect that as our elected representatives also know zilch about the healthcare industry or the specific issues resulting in the Act (other than the knowledge bequeathed by interested parties associated with campaign contributions) they don't know the purposeful intent either... not that every reason is necessarily bad.  But it is bad governance to push through as significant a legislation as this without understanding its points and likely effects.

In short, it's fair to say that whatever sinister things are in H.R. 3200 are worded in such a way or buried at such a depth that I'm unable to find them. 

This isn't to say that I think it's a good idea.  The government already runs the VA program (with frequent accusations of poor healthcare) and Medicaire (with frequent fraudulent abuses), and I don't see the government as a responsible entity in best managing either of these areas. 

There are three problems as I see it.

1) Aside from most of the rhetoric (an example being the home visitation issue, where opponents fear the government intruding into the parenting habits of every home with children.  The program would be made available to States who request the money to serve those constituents most in need), is the Law of Unintended Consequences. What behaviors will result from this implementation?  Will doctors still want to invest in the years of schooling and training for lesser rewards?  Will pharmaceutical companies invest in new drugs if their returns are mitigated or otherwise controlled?  Will free access to healthcare (to a significant number of citizens) swamp available healthcare services? Will the development of another governmental department that spends all its money for no other reason than to avoid getting less funding the next year actually control costs?

2)  The Single Provider end-goal is in play, and the "horror stories" resulting from non-care from healthcare insurers over the years are so abundant that the moral imperative so easily carried by this President would not be resisted by those who know that we already have the best healthcare system in the world. 

A better course of action would be to "reform" the current system to address major concerns.  If the Act does ultimately lead to the government becoming the single provider for healthcare (a position that  Obama publicly stated that he advocated before the election), then there is much to be feared.  It would necessarily mean that no one else could pay for healthcare, including you, even if you had the means to pay for a treatment beyond what the healthcare program would permit. 

Obama has forthrightly stated that he will not force the private marketplace out of the picture.  The reason is that he won't have to, and I think there's a very good chance that many politicians know that the introduction of a government option will necessarily and quickly lead to the death of the evil profit seeking health insurance companies.

Why? Businesses will be all too happy not to have to negotiate annual healthcare contracts, terms of plans, enroll their employees, educate them regarding the plans, assist them when there are issues, etc.  It's much easier (i.e. less costly and more efficient) for companies to lay off a portion of their Human Resources staff, pay the healthcare tax, and not worry about being competitively disadvantaged with their peers as they would also have the same expenses (translated - the same tax to pass on to consumers of their products and services). 

3) Legitimate Fears for Cost Control.  I would hope that Americans will always have access to healthcare and the ability to pay for it if they can and choose to do so.  Some of the examples said to be arising from a right-wing conspiracy about government controlled health care are, in fact, reasonable based on monopolistic control by a government with sensitivities to the cost of the program. 

This argument evolves naturally, but for convenience, the influence of controlling expenses can be laid squarely on President Obama who proclaimed it in a surprisingly clinical manner as reasonable:

When we think of a 100 year old receiving surgery, there's a little part of each of us that recognizes that it's probably not the most prudent use of money and resources.  Nevertheless, if we enter into a system where a 100 year old cannot receive surgery, that's a danger.  Why?  Where does the person responsible for making that determination draw the line?  Age 90? 85? 80? 75? 70? At whatever age Social Security begins?

Further, does an elderly non-smoker who never had surgery in their life get approved?  Will an obese person with emphysema get denied?  Who will write the matrix that indicates which factors get a yes or no?  This is a fear not of outcome based expectations but purely of cost control.  People may hate insurers, but they manage a balance between the two.  Would the government, if totally responsible for all healthcare costs, maintain the same? 

H.R. 3200 should require a lengthy review and a plain explanation of its effects rather than a rush to push through an agenda "to sustain political momentum."  Politicians haven't earned any measure of trust in that regard. 

And besides, iDie needs to know how to adjust their calculator.  My remaining 11,958 days don't factor in a government administrator, and enquiring minds will want to know.

57.9055944950%.  Yikes!


If you're bored reading, you're done!  Thanks for making it this far.  I've even bored myself.  Following are a few of the things I found while skimming the Act.  The Sections are correct, but these are subcategories under various Levels that are difficult to track within the document.

The Good:

Section 111 - A qualified health benefits plan cannot exclude pre-existing health conditions.  I don't think any consumer would argue against this. 

Section 112 - Unless you stop paying for your coverage, you can't be non-renewed. 

Section 1173A - standardized electronic billing.  I imagine some "salespeople" for software are already greasing the halls of Congress.  In fact, there is a tremendous software industry already in place that helps medical providers translate their services into the various categories and codes required to be reimbursed.  More jobs lost?

The Interesting:

Sec 2714 - Ensuring Value and Lower Premiums.  If a Health Insurer is too profitable, they have to pay money back.  There is no comment if their loss ratio is too high.

Section 225: The Government Plan Preferred Physicians agree to the government rate without co-payments.

Section 242: Affordable Credit Eligible Individual - must be a legal resident (good), with family income below 400% of the Federal poverty level for the size of family involved.  For 2009, that figure is $22,050 for a family of four, so if you earn $88k or less and are not covered by an employer plan, premiums would be 11% of actual costs if I read the table correctly.  I would hate to be in the top 5% of earners who appear likely to be taxed for this.  Also, I fear I will be in the top 5% after those who know how to hide their incomes do so and more are asked to contribute "their fair share."

Section 313: Employers with less than $400k in payroll don't pay insurance costs.  Great time to become a corporate attorney specializing in the creation of small companies.

The Confusing: Sec 202: Employee option of using employer or government health programs.  It's hard to imagine employers providing more than the minimum required plan, or encouraging employees to use a company plan.  Fairly easy to speculate regarding the end of private insurers.

The Nauseating: Reading any more of the Bill.

1 comment :

  1. Another problem for the lay person/people is that it is hard to fight or support such a large compilation of words. You just can't grasp it all and it is much open to interpretation. This, plus the misperceptions and passions involved make for a nasty fight no matter what your opinions are.

    I personally, will feel much better when it applies to everyone, and I mean everyone. Are the speaker of the house? It applies to you. Lowly union worker? You too! Greeter at Walmart? Ditto. President of the US? For sure!

    It is only when a plan applies to everyone in the same manner can we feel comfortable with it.

    Nice write-up. I am not there yet in terms of reading it.