Who will Health Care Reform Help?

Hey you tea partiers, before you get too wound up about the "unconstitutional" health care reform, or encourage South Dakota to opt-out, you really should read this guest post from Barbara O'Brien, who shared it with me in the hope that someone in South Dakota with ears to hear will listen...

It's worth a try anyway.

(Close your mind, Bob, here comes some reality for you to avoid....)

by Barbara O' Brien (of Mahalablog)

Many Americans assume the new health care reform act will benefit mostly the poor and uninsured and hurt everyone else, according to polls. As Matt Yglesias wrote, “Basically, people see this as a bill that will take resources from people who have health insurance and give it to people who don’t have health insurance.” Those who still oppose the reform say that people ought to pay for their own health care.

We all believe in the virtues of hard work and self-reliance, but these days it’s a fantasy to think that anyone but the mega-wealthy will not, sooner or later, depend on help from others to pay medical bills. And that’s true no matter how hard you work, how much you love America, or how diligently you take care of yourself. The cost of medical care has so skyrocketed that breaking an arm or leg could cost as much as a new car. And if you get cancer or heart disease — which can happen even to people who live healthy lifestyles — forget about it. The disease will not only clean you out; it will leave a whopping debt for your survivors to pay.

And the truth is, we all pay for other peoples’ health care whether we know it or not. When people can’t pay their medical bills, the cost of their health care gets added to everyone else’s bills and insurance premiums. When poor people use emergency rooms as a doctor of last resort, their care is not “free.” You pay for it.

Another common fantasy about medical care is that the “free market” provides incentives for medical companies to develop innovative new drugs and treatments for disease without government subsidy. It’s true that private enterprise is very good at developing profitable health care products. But not all medical care can be made profitable.

For years, the U.S. government has been funding medical research that the big private companies don’t want to do because there is too much cost for the potential profit. This is especially true for diseases that are rare and expensive to treat. An example of a recent advance made possible by government grants include new guidelines for malignant pleural mesothelioma treatment developed by Memorial Sloan-Kettering mesothelioma researchers. Another is a blood screening test for mesothelioma developed by thoracic surgeon Dr. Harvey Pass. The health reform act provides for more dollars for such research, from which even many of the tea party protesters will benefit.

The biggest fantasy of all was that people who had insurance didn’t have to worry about health care costs. But the fact is that in recent years millions of Americans have been bankrupted by medical costs, and three-quarters of the medically bankrupt had health insurance. And yes, insurance companies even dumped hard-working, law-abiding patriots. But the health care reform act will put an end to that, and now America’s hard-working, law-abiding patriots are more financially secure, whether they like it or not.

South Dakota didn't get the memo...

AP story from the RC Journal today:

Gov. Rounds, AG Jackley study legal challenge to health bill

PIERRE -- South Dakota officials are studying the possibility of joining other states to challenge the constitutionality of the federal health care overhaul, Attorney General Marty Jackley said Monday.

Jackley said the measure could violate states' rights to govern and would aggravate South Dakota's budget problems by forcing it to spend even more on Medicaid, the state-federal program that covers health care for low-income people.

and....

Joe Kafka, press secretary for Gov. Mike Rounds, said the governor and attorney general will meet to decide whether the state should take legal action.

Kafkaesque, adj., marked by surreal distortion and often a sense of impending danger....

The adjective refers to anything suggestive of Kafka, especially his nightmarish style of narration, in which characters lack a clear course of action, the ability to see beyond immediate events, and the possibility of escape. The term's meaning has transcended the literary realm to apply to real-life occurrences and situations that are incomprehensibly complex, bizarre, or illogical.

Kind of like Republican ideas about health care?

For once I agree with David Frum

David Frum today blogged today how badly the Republicans have hurt themselves over health care:

(BTW: Who says liberals don't listen to the other side?)

Frum said:

Conservatives and Republicans (including Rep Herseth Sandlin -ed.) today suffered their most crushing legislative defeat since the 1960s.

No kidding.

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the "doughnut hole" and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

We [conservatives] followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

As for Rep HS? May I quote the comments section from this Friday story on Rep HS in the Argus:

kris843 wrote:

I'm a lifelong Democrat who has supported Stephanie from the very beginning of her career in the House. I will vote against her this fall. I hope my vote against her will come in the primary with Steve Hildebrand. She has in her hands the ability to change healthcare in America for the better for the first time in decades and she says NO to 32 million Americans. She says NO to lowering my costs. She says NO to stopping insurance companies from dropping people because they get sick. She says NO to helping small businesses afford healthcare for their people. No-No-NO! Well, Stephanie, I SAY NO TO YOU!

A letter to Stan

Stan,

I am quite disappointed in both you and Rep. Lust (and, sadly, quite a few Dems) who support this resolution.

I see SCR1, passed yesterday by the SD Senate and sent along to the House, as contributing absolutely nothing to the health care debate.

The truth is, the health care bill Congress is working on includes many many features demanded by U.S. House and Senate Republicans that will not vote for even parts of it, for apparently purely political reasons. Despite these concessions, we need health care reform so badly in this country that I think we will get something passed, but thanks to the absolute refusal of Republicans and "conservadems" to contribute anything except political theatre and gamesmanship, it will only be a start to move us forward.

One of the really bad ideas included in a vain attempt to gain some Republican votes are the multi-state exchanges, which we hear about from Republican legislature candidates like clockwork every two years. These multi-state exchanges (like credit-card regulations) direct health insurance companies to set up shop in states with the weakest consumer protections. Another idea that will provide more protection to an over-protected health insurance industry.  Without government intervention in health care, this is the way it will continue to go.

I would really like to see our Legislature do something positive in this area. Access to basic health care is a human right -- and America's refusal to stand up and recognize this is the reason our health statistics are approaching third-world outcomes. I'm ashamed of our country for putting profits ahead of the most vulnerable of us, and I urge you to bring forward constructive solutions to solve this problem.

The South Dakota Association of Healthcare Organizations Is Not On Your Side

Again I could not keep myself from calling in to Paul Guggenheimer's wonderful Dakota Midday program on SDPB.

The program is here:

Dakota Midday
Air Date: 12/22/2009
With health care overhaul legislation on the verge of being enacted, Paul Guggenheimer talks with Dave Hewitt, President and CEO of the South Dakota Association of Healthcare Organizations, to see what he thinks about the changes that are coming.

Hewitt's organization represents hospitals and medical equipment companies. It was clear that from Hewitt's comments that his organization works for the providers, NOT people. For example, the issue with Medicare reimbursement was brought up again. Ezra Klein of the WaPo has pointed out that the issue is not that rural hospitals get paid more than urban hospitals with respect to costs, but these rural health care organizations want more than they get now.

It's worth a listen. If you want to skip to what I had to say (as a Federal employee), my call comes in at about 16:15.

Another letter to Rep Herseth Sandlin

The Hon. Stephanie Herseth Sandlin
US House of Representatives
Washington, DC

January 2, 2010

Dear Rep. Herseth Sandlin

I read with interest your recent flyer sent to my home (my wife and I both received one!) concerning your admirable work supporting the Veteran's Administration and their excellent health care system. I applaud your efforts in this area – especially your efforts to inform recent veterans especially of the services available to them.

However, I would be very receptive to hear some news of your work supporting the health care for the rest of us. When I called in to South Dakota Public Radio and asked why ordinary South Dakotans don't also deserve affordable access to health care, your response included a long (quite condescending in my opinion) discussion on how we have a "special relationship" with our veterans and that we simply can't afford to provide health care to everyone. You also brought up the meme that rural health care is being shortchanged my Medicare. (This line of argument, run by protectors of the immoral status quo in health care such as you and Kent Conrad (D [sic] - North Dakota) has been strongly refuted by clear evidence (Ezra Klein, Wash. Post, 12/9/ (http://voices.washingtonpost.com/ezra-klein/2009/12/does_medicare_discriminate_aga.html).

(Dear readers: this exchange is here online at about 15:00 on the "tape") -- thank you SDPB)

Unless you turn around and support health care access, your re-election campaign may run into a major roadblock – the South Dakota Democrats who expect you to help people, not the health-care and health insurance industry. This business is one-sixth of our economy, and that is way too much.

America needs health care reform and will demand it. Even West River Republicans that I know are starting to get very impatient with Congress. South Dakota Democrats I know have gotten to the point that unless you do a major about-face on this issue, your base is likely to vote Republican for your House seat next fall to keep your inflexibility from holding up the Democratic majority in the House. The need for reform is that bad.

The Aeroflot Health Care Plan

Here's a new idea for health care...

At the Radical's home we just heard that an acqaintance in Rapid City needs dental work.


Of course there is no dental insurance (who can afford it these days!!) but there is an out.... he is a Russian national so he will use the Aeroflot plan -- a flight home to the Russian Federation, getting the dental work done, and flying back is much less expensive than having the work done by a dentist here in in Rapid City, USA.

Just makes you proud, doesn't it?

At least I know I'm free...

Please call Rep. Stephanie Herseth Sandlin (866.371.8747) and remind her we're looking to her to vote for the conference health care bill!

My note to Stephanie Herseth

Rep. Herseth Sandlin,

There's a reason 80 percent of Americans want a public option -- so we will have a choice when insurance companies abuse their government-protected oligopoly on health care. And the only way it will work is if it run as a government non-profit. If we require people to have health insurance, this is the only viable option.

Many countries have done this successfully, with no socialist takeover (notably Australia and France, which have both private/public systems that both do just fine).

I have to say that if you do not support a public option, which is what the country wants and the insurance companies don't, I this is the final straw. I might as well have a Republican representing me.

Compromising anything on the health bill for "bipartisanship's" sake is a cop-out to keep your Republican base. You will lose South Dakota's Dems if you do not work hard in the Blue Dog coalition to turn this debacle around and support a *real* public option. You know as well as I do that few, if any Republicans are going to vote for this thing in the end. We gain nothing by allowing the current profit-driven system to continue the way it has.

The REALITY: One in Three Uninsured

These new numbers reflect reality more than the Census estimates, which count someone insured if they had health insurance for only one day of the year.

From Anima at DailyKos:

The non-profit, non-partisan group Families USA has been releasing state-by-state reports on the severity of the health care crisis in America since March. The reports detail: the number of people uninsured in each state at some point during 2007-2008; the number of families that will spend more than 10% of their income on health care costs in each state; the number of people who are currently losing their health care every week in each state; and a comparison of the rise in health insurance premiums against the rise of median wages from 2000 to 2009 in each state.

South Dakota came in with 184,000 uninsured... 27.1 percent!

But talk to your neighbors, these numbers are not that shocking to me.

The last of this series, comparing premium costs and median income, is currently being released, with 18 state reports out as of now. The remaining reports will come over the next few weeks.

I have no doubt we will get special distinction on that score.

UPDATE: In response to an anonymous comment, one in three is the NATIONAL figure. You would know this if you clicked the link.

And although if you calculate using an 804,000 population you something more like 22.8% is probably because the blogger probably used slightly stale population numbers in the state by state breakdown. The "one in three" national number is from the report, not the blog.

And a good chunk of South Dakota is covered by IHS, which of our existing single-payer systems is the only one that doesn't work very well-- not because it really "doesn't work" but because our nation is not honoring its treaty obligation to the Lakota people to fund it adequately. The other three I know about (Medicare, Medicaid and the VA) have their problems but are generally quite popular with their users. Hence the "keep the federal gov't out of "my medicare" comments we keep hearing.

And, also, this is a better measure of the uninsured than the Census definition...counting all who are out of the system for any time during the year. if you get cancer during that month that you are not insured, it doesn't really matter if you're chronically uninsured or not. You're still out of the system and the barriers to entry (outside of spending all your wealth until Medicaid takes over or waiting until you are 65) are considerable.

And (one of the things I'm hoping we can fix) your chances of getting any kind of insurance outside of a large employer risk pool are pretty slim, with any significant pre-existing condition or history. Its no wonder people do not seek mental health treatment when they need it -- it could render them uninsurable, so keeping it secret is an economic survival tactic.

If you are not part of a large risk pool, you are also in danger of being dropped because you reach some lifetime limit. Like a childhood leukemia in your family is your fault.

And don't get me started on the underinsured, which most of us are under the current employer-based system.

HALF of personal bankruptcies are related to medical bills. What is it folks don't understand?

(Actually I saw a recent statistic that 77% of Americans get it and want a public option of some kind, unless the question is skewed by industry reps by omitting the word "choice." )

Why not just open Medicare for an income-based price to younger people? It would sure make the risk pool cheaper for the Feds to treat, and provide a needed cash infusion to the system.

Insurance companies will not go away, they just won't have access to obscene profit margins at the expense of sick people. I don't see the market for Medicare supplemental insurance shrinking.