The Sage Forge

Healthcare is such a big issue these days it is difficult to realize most of the people writing about it really are not touched by the consequences of the morass of the medical marketplace.  I am.  The ridiculous expense of medical insurance forced me out of the policy I was carrying for myself and my four children last month. (And, as of this writing I have not received a promised refund from World Insurance.)  What follows is a letter I wrote to my Congressman, Kevin Brady, on this issue.  It reflects some of my philosophy on the medical marketplace and what I thinkg government's role is in that marketplace.

Representative Brady,

I saw in the Huntsville Item this morning that your were in town discussing health care issues. Because I am self-employed with pre-existing conditions I have found it extremely difficult to find affordable health insurance. The policy I did have until this week started out expensive, only to become onerously so in their most recent price increase. The policy for myself and four healthy children had increased from about $450 per month to over $720 per month in less than two years- creating the impression that the insurer (World) simply finds strapped families and offers them moderately affordable premiums and then, knowing they have no place to go, profits by abusive increases till the policy holders on that particular class of policy have been driven out.

Then they can offer a different class of policy and repeat the procedure with a not-yet-jaded new batch of customers.

I was stuck in this cycle by a recent diagnosis of bi-polar disorder, making it virtually impossible to do the responsible thing and provide my own insurance affordably with a new insurer. My wife, by the way, is already covered under the Texas Health Insurance Risk Pool. By the time I had to drop my coverage this week our expense in insurance costs alone was more than $1260.00 per month. Several hundred additional dollars of regular medical expenses went on top of this total. That, sir, is a hefty nut to crack each month.

All that said I am not in favor of single-provider solutions (government-run health care) or the single payer variants we see bandied about. I would rather see the issues attacked in terms of the number of people covering doctor's tusches on the one hand (as a result of fear of tort conditions prevalent today) and the complexity of the medical payer marketplace on the other.

In the first instance medicine is a bloated industry. My wife, working for what was then Woodlands (TX) Pediatrics, used to spend virtually all her time just trying to make her way through a maze of blatantly intentional dodges on the part of insurers (Unicare was the worst) in which billing statements were "lost" or "misfiled" or otherwise avoided until she had cornered the company. That means, of course that the money of insured patients is going to pay people to avoid paying at the insurance company and to get payment at the doctor's office, none of which does a damn thing toward the delivery of medical care. Furthermore, in the event of a lawsuit (and each doctor in the practice at which my wife worked could expect to be sued an average of once a year, though most suits amounted to nothing) records can be seized and much of the staff would become bogged down in that useless jumping-through-hoops. This does not even mention that quite a few lawyers also live off the money we pay for medical care and their service to good medicine is questionable in the extreme.

As to the complexity of the market- Would we not benefit as a marketplace if insurance markets had to function the same way computer markets had to through the early years of the development of that industry? Computers became accessible and, ultimately, remarkably cheap because there was a sort of enforced interchangeability that permitted independent vendors to find the best providers for components that accomplished given functions. This forced major providers like Dell and H.P. to compete on price because they really could not compete on function tailored to the individual consumer.

What I am suggesting is that certain functions be forced to standardize and that there be strict parameters set to exclusions. Force an a la carte marketplace on the health insurance industry. Also, create a uniform class structure for rating different conditions, such as my bi-polar disorder. We don't choose to be bi-polar, (though lifestyle choices do affect some diseases like type 2 diabetes) why should the government condone a system that uses us to subsidize the rest of the marketplace until we look like too great a risk and then shunt us off simply to make the industry more profitable while making access to health care more difficult for those who really need sensible, systematic access. Is that not a form of taxation for the genetically unlucky?

That rating structure should take things into account that can improve public health, encouraging us to exercise and reduce the intake of empty calories, for example. Things over which human beings have no control, genetic disorders, age, and the like should not be avoidable for the insurance industry. No one should be fired because their age made their insurance expensive! If they would not have a rating system imposed on them from above (as computer manufacturers' standards have not been government imposed) require that the industry set standards that themselves meet strict requirements.

This has rambled a bit, but to summarize- 1. We need to make the process of delivering medicine and getting paid for doing so simpler. As many people as possible in the medical industry should deliver medical care. 2. Lawyers and courts should not regulate medical care ad hoc. Regulation should be done by governmental entities that can take away a doctor's (nurse's, organization's, etc.) right to practice nationwide and those entities should not be dominated by doctors. 3. Health insurance should become a far more uniform marketplace with instruments performing specific functions widely available and competeing clearly with each other. 4. Those things the industry can reject individuals from the marketplace for should be only things for which the individual can be held personally responsible.

To these I would also add- 5. The "group" structure used to provide low cost to big employers must become available in some form to small businesses and to individuals. Failure to do so represents an unfair tax on individuals and the small businesses that really grow the nation's economy.

Posted by emmerichjamison at 07:38 AM | Permalink | Comments (620) | TrackBacks (0)

Oh, Well...

To say I was exasperated with the world over the summer is putting it pretty mildly.  In these posts it should have been obvious I usually vote Republican, but I am a Republican of convenience.  That is to say the GOP is my party only so long as they stand with me and the values I recognize as a valid means of putting a society together and keeping it that way.  Most of those who vote with me feel the same way.  That means that, apparently unbeknownst to the so-called "leaders" of the party, Republicans are a fundamentally different kind of constituency than Democrats are.

The difference means that what, in the hands of Democratic candidates, is simple and nominal disrespect for a constituency they can reasonably expect to allow them to do their thinking for them is, in the hands of Republican candidates, fraud.  I and my Republican bretheren are tired of fraud.

The Democratic Party is designed around two very distinct constituencies.  Their upper class is a well educated, prosperous elite that thrives on large organizations with inherent institutional inertia and deep, incestuous, governmental connections.  This, in the popular misconception, implies governmental entities and unions.  In fact it also encompasses large corporations and international institutions both large and small.  These lumbering organizations use their govenmental connections to gain protection from the inherently more nimble and aggressive small companies with which they could not compete on a level playing field.

The Democrats' lower class is a vast cadre of undereducated and compromised peasantry who are maintained in perpetual economic and electoral servitude by assurances that, once they have been politically empowered, their lot will be made right.  Without this vast body of serfs the party would disappear politically.  Actually doing what the party promises would, of course, devastate their upper class.  The lesson of history, though, is that one may keep a people who are assured they have not the means to lift themselves from poverty enslaved by the mere HOPE that someone will do that lifting for them.  Since the inception of the Democratic Party this has been their method- promise a backward people they will be made whole, lifted up from above, while keeping them poor and backward so that hope is always meaningful to them.

When Democrats run for office, then, they expect to offer promises they have no intention of fulfilling.  They know their voters expect them to do their thinking for them and they promise no different.  When they can't do what they promise they stand on nearly two centuries of political precedent.  There was no fraud in what they did.  This is, at least in Democratic politics, an honest bargain.

Modern Republican politics is altogether different.  There are, of course, rich Republicans.  But there is not a distinct break in the class structure of the party as there is in the Democratic Party.  Poor members of the Republican Party, for example, are distinctly better educated, on average, than poor Democrats.  They read more and are more politically aware than their Democratic counterparts.  Rich members of the party are far more likely to have achieved their wealth through small businesses or entrepreneurial enterprises than would be the case with Democrats. 

These are people who see government sapping opportunity away from them, who equate taxes with punishments, and who see every paper-pushing bureaucrat and the paper-pushers in private practice (tax accountants, tort lawyers, and clerical support staff) bureaucrats force on them as freeloaders, people who produce nothing but live handsomely for what they have not accomplished.

These hard working folk are people who DO NOT expect their representatives to do their thinking for them.  They are also people who listen carefully to what their would-be representatives promise them before they choose to vote for them.  For these voters when their office holders make them promises and then run away from those promises in an effort to broaden their electoral appeal what has happened is not a wink and a nod to history.  It is a lie.

Republican office holders of late grew up in a world in which a subject called "Political Science" was the supposed key to understanding the electorate and the acquisition of power.  What they didn't understand was that political science was the product of decades of Democratic dominance of politics.  Look at it with a jaundiced eye and what you will see is a form of political guerilla warfare the goal of which is not empowering the people, but CONQUERING the people.  It is no accident that "The Art of War" is a book title one will see on the desk of Karl Rove.  Nor is it to be wondered at that his revolution is faltering. 

Many of the current crop of Republican office holders gained their offices under false pretenses, believing we needed to be led in feudal chains as Democrats have long led their unwitting constituencies.  Republican's recent reverses are the result of the fact we are aware of the world in which we live, unlike the vast Democrat underclass we know what we want that world to look like tomorrow and, we are paying attention.

Here's some advice for the next set of Republican office holders, then.  You're not smart enough to lift us up.  We can handle that ourselves.  Don't even quietly make war on us.  We hold the spears.  When we are talking to you, SHUT UP AND LISTEN.  We pay you to keep the shop, watch the money, and keep the place safe and clean.

And at every opportunity get government, and yourselves, out of our way.

Posted by emmerichjamison at 10:04 AM | Permalink | Comments (3) | TrackBacks (0)