There is a big increase in Texas of mothers dying in childbirth.*
The rate at which women die in Texas from pregnancy-related complications is higher than in any other US state—or even in the rest of the developed world, reports theGuardian. A study in the journal Obstetrics and Gynecology found that the maternal mortality rate in Texas doubled in a two-year span, from about 18 per 100,000 births in 2010—a year with 72 deaths—to about 36 in 2012, which saw 148 deaths. In the 48 states not including Texas and California, the rate was 23.8 deaths per 100,000 in 2014, up 27% from 18.8 in 2000. California was the only state to see a drop. The authors say the hike in the death rate in Texas—no other state saw a similar uptick—is difficult to explain "in the absence of war, natural disaster, or severe economic upheaval," per the Guardian.
The increase coincides with Texas cutting health care funding for women.
http://www.newser.com/story/229968/texas-saw-spike-in-maternal-mortality-hard-to-explain-in-absence-of-war.html?utm_source=part&utm_medium=united&utm_campaign=rss_home
Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts
Wednesday, August 24, 2016
Wednesday, May 13, 2015
RETAIL SALES 01-04/2015
The year before a presidential election (such as 2015 is) usually a positive year for the stock markets. This year, however, is not so good from the start. You will note in the April figure (on top below), gas station revenues is the second from worst category.* But the question is how important is gasoline station revenues to the total retail revenues?
This can be seen in the following figure. Gasoline station revenues comes in 6th among the various categories, ahead of Health Care, Electrical Appliances, Furniture, and Miscellaneous.*
I find the categories to be rather confusing. For example, what is the difference between Food and Drinking Places or Food and Beverages and does beverages include soda?)? I suppose the former includes places like restaurants and the latter retail stores like grocery stores and liquor stores. I suppose a Nonstore Retailer would be on-line places like Amazon.com.
* http://www.cnbc.com/id/102675509 (Source: Commerce Dept., seasonally adjusted)
This can be seen in the following figure. Gasoline station revenues comes in 6th among the various categories, ahead of Health Care, Electrical Appliances, Furniture, and Miscellaneous.*
I find the categories to be rather confusing. For example, what is the difference between Food and Drinking Places or Food and Beverages and does beverages include soda?)? I suppose the former includes places like restaurants and the latter retail stores like grocery stores and liquor stores. I suppose a Nonstore Retailer would be on-line places like Amazon.com.
* http://www.cnbc.com/id/102675509 (Source: Commerce Dept., seasonally adjusted)
Monday, August 5, 2013
THE GOVERNMENT YOU VOTED FOR
On rare occasions, someone writes a piece in which almost every word carries weight. Paul Krugman did just that on Sunday, August 4 (http://www.nytimes.com/2013/08/05/opinion/krugman-republicans-against-reality.html?nl=opinion&emc=edit_ty_20130805) I wish everyone would read it. Prof. Krugman writes:
Think of it this way: For a long time the Republican establishment got its way by playing a con game with the party’s base. Voters would be mobilized as soldiers in an ideological crusade, fired up by warnings that liberals were going to turn the country over to gay married terrorists, not to mention taking your hard-earned dollars and giving them to Those People. Then, once the election was over, the establishment would get on with its real priorities — deregulation and lower taxes on the wealthy. (emphasis added)
Then they held the pointless vote on Obamacare, apparently just to make themselves feel better. (It’s curious how comforting they [Republicans] find the idea of denying health care to millions of Americans.) (emphasis added)
An article quoted by Prof. Krugman says, The June bill included $20.5 billion in proposed cuts to the food stamp program, plus amendments calling for mandatory drugs tests for recipients and employment requirements. Democrats protested the food stamp cuts, while many Republicans said the cuts did not go deep enough.* (emphasis added) But now it appears the Republicans are proposing a cut twice as large though there is to be an automatic cut in food stamps amounting to $29/mo. for a family of three to $319/mo. in any event as a result of the Stimulus bill that carried a temporary increase in food stamps. (http://www.nytimes.com/2013/08/02/us/politics/gop-push-to-slash-food-stamps-puts-farm-bill-in-jeopardy.html)
The House already had passed a meaningless farm bill stripped of food stamps and proposed a series of benefits to wealthy farmers. Some of the members or their spouses of the Senate and House Agricultural Committees benefit from the farm subsidies the committees oversee. 9http://www.taxpayer.net/library/article/political-contributions-conflicts-of-interest-taint-u.s.-ag-policies)
Cuts are being made to the Federal budget anyway because of across the board cuts in the Sequester (But congress made an exception for air controllers so they wouldn't be inconvenienced in flying.). Though no one says they like the Sequester, Republicans let it happen because it did make cuts in programs for the poor. Democrats aren't too upset because at least there are some cuts to the defense budget and the Sequester seems the only way to get these. Congressmen are not to be inconvenienced. A part of Obamacare was that congressmen were to get their health insurance from the Exchanges like everyone else, but it looks as if they will also accept a subsidy from the government as well.
Then there is the canceled vote in the House on a transportation bill because not enough Republicans showed up. Prof. Krugman writes: But it turned out that a significant number of representatives, while willing to vote for huge spending cuts as long as there weren’t any specifics, balked at the details. Don’t cut you, don’t cut me, cut that fellow behind the tree. (emphasis added)
* This seems to be the new way to get a bipartisan agreement. Democrats vote against it because the cuts for the poor go too far and Republicans vote against it because cuts for the poor doe not go far enough.
Think of it this way: For a long time the Republican establishment got its way by playing a con game with the party’s base. Voters would be mobilized as soldiers in an ideological crusade, fired up by warnings that liberals were going to turn the country over to gay married terrorists, not to mention taking your hard-earned dollars and giving them to Those People. Then, once the election was over, the establishment would get on with its real priorities — deregulation and lower taxes on the wealthy. (emphasis added)
Then they held the pointless vote on Obamacare, apparently just to make themselves feel better. (It’s curious how comforting they [Republicans] find the idea of denying health care to millions of Americans.) (emphasis added)
An article quoted by Prof. Krugman says, The June bill included $20.5 billion in proposed cuts to the food stamp program, plus amendments calling for mandatory drugs tests for recipients and employment requirements. Democrats protested the food stamp cuts, while many Republicans said the cuts did not go deep enough.* (emphasis added) But now it appears the Republicans are proposing a cut twice as large though there is to be an automatic cut in food stamps amounting to $29/mo. for a family of three to $319/mo. in any event as a result of the Stimulus bill that carried a temporary increase in food stamps. (http://www.nytimes.com/2013/08/02/us/politics/gop-push-to-slash-food-stamps-puts-farm-bill-in-jeopardy.html)
The House already had passed a meaningless farm bill stripped of food stamps and proposed a series of benefits to wealthy farmers. Some of the members or their spouses of the Senate and House Agricultural Committees benefit from the farm subsidies the committees oversee. 9http://www.taxpayer.net/library/article/political-contributions-conflicts-of-interest-taint-u.s.-ag-policies)
Cuts are being made to the Federal budget anyway because of across the board cuts in the Sequester (But congress made an exception for air controllers so they wouldn't be inconvenienced in flying.). Though no one says they like the Sequester, Republicans let it happen because it did make cuts in programs for the poor. Democrats aren't too upset because at least there are some cuts to the defense budget and the Sequester seems the only way to get these. Congressmen are not to be inconvenienced. A part of Obamacare was that congressmen were to get their health insurance from the Exchanges like everyone else, but it looks as if they will also accept a subsidy from the government as well.
Then there is the canceled vote in the House on a transportation bill because not enough Republicans showed up. Prof. Krugman writes: But it turned out that a significant number of representatives, while willing to vote for huge spending cuts as long as there weren’t any specifics, balked at the details. Don’t cut you, don’t cut me, cut that fellow behind the tree. (emphasis added)
* This seems to be the new way to get a bipartisan agreement. Democrats vote against it because the cuts for the poor go too far and Republicans vote against it because cuts for the poor doe not go far enough.
Friday, July 29, 2011
HEALTH INSURANCE: THE INDIVIDUAL MANDATE
Now Republicans oppose the individual mandate as being unconstitutional, but formerly a number of bills were introduced by Republicans that espoused the individual mandate: http://healthcarereform.procon.org/view.resource.php?resourceID=004182
These bills and articles include those by Senator Don Nickels (R, Okla.) and 24 cosponsors, John H. Chaffee (R, RI) and 20 cosponsors, the conservative Heritage Foundation (Oct. 2nd, 1989), Heritage Foundation (Mar. 5th, 1989 ). So Republicans were, to paraphrase a former presidential candidate Kerry, for the individual mandate before they were against it.*
There also were some Democratic proposals for individual mandate: Senator Ron Wyden (D, Or) and 17 cosponsors, Senator Ron Wyden (D, Or) and 124 cosponsors.
*This sort of thing has happened before. Expecting to elect a Republican president in 2006, Republicans passed the line item veto bill which was signed by President Clinton on April 9, 1996 (http://www.pbs.org/newshour/bb/white_house/line_item_veto.html). Much to the surprise of Republicans, President Clinton was reelected. President Clinton and Senator Bob Dole had agreed that the act would not be implemented until 2007 after the presidential election of 2006. In 2007, Republicans claimed the act was unconstitutional. President Clinton tested the constitutionality of the act, and the Supreme Court ruled it as unconstitutional by a 6 to 3 vote.
Sunday, March 28, 2010
OBAMACARE & A FEW OTHER THINGS
I'm really, really surprised that Obmacare passed. I guess you have to chalk another one up to the comeback kid. The funny thing is that it is largely a Republican bill. Most things that are in it have been proposed in the past by some Republican. This was underlined in an article by the Secretary of Health and Human Services and someone else who told of a number of issues which Republican had proposed what item. I have trouble figuring out why Republicans are so enraged about it.
And why are Right To Lifers so enraged by the bill, especially when the President has issued an edict that no Federal money will be used for abortions (I guess they think an executive order is not binding.). It all seems irrational to me. Beside outlawing Federal money for abortions only applies to the poor and probably the lower middle class, The more wealthy can pay for their daughters abortions or even send them to some country where abortion is legal if abortion of any kind was outlawed in this country. Bring back the coat-hanger abortions? But ruling that no Federal money can go to abortion is made several different ways: now by the executive order and also the Hyde amendment. I would feel better about it if so many right to lifers weren't also for the death penalty. If life is sacred, how can you justify the death penalty. Apparently right to life only applies to the unborn.
The bill is 2,404 pages, I believe, including 900 pages of amendments of which 170 of the amendments are by Republicans. Of course it is hard to believe that anyone can keep in their mind all the things in such a bill. I guess we will just have to let things develop and see. But the big thing as I see it is the inclusion of the 32 million new uninsured. If we can't do this, maybe we don't deserve to be a country? Well, I have heard the problem is that people with health insurance say, "What's in it for me?" There are 14 items that will begin this year: http://majorityleader.gov/docUploads/Top14FINAL.pdf
Adding 32 million people to health care presumably will put a strain on our stock of primary care physicians. We are told that the poor now are covered by going to emergency rooms. So the thought occurs to me that if this is true, there will be less need for physicians in emergency rooms so they can have private practices to see new patients at less than one-third the cost of an emergency room visit. Hm, maybe not that many of the poor go to emergency rooms for their primary care. I took my wife once, and her visit lasted seven hours (this in northern Virginia). A lady we know went to an emergency room here in North Carolina because of a bad fall, and it took her six hours. After you do this once, you maybe try to avoid emergency rooms? So maybe there will be a shortage of primary care physicians. One of the things that will begin soon with the passage of Obamacare is support for the training of more primary care physicians. I know not how many.
Well, I think there is some legitimate concern that the budget balancing in the health plan bill will actually be sustained by future congresses. As to financial reform, it is certainly necessary. We cannot allow so many "too big to fail" organizations affect out country. The first big thing was repeal of the glass Steagal Act which Clinton signed; I believe it was his biggest mistake. It may be that the SEC has been lax in its enforcement, but we have had 20 years of deregulation of the financial industry in this country, and there is no regulation of hedge funds. And Bush idid things that have ruined the economy for the rest of my life (unfunded wars accompaying tax cuts, an unfunded prescription drug paln, among others.). Even closing down Lehman Brothers has almost done in the country. I suggest you read a book called The Big Short which has come out recently. I have not read the book, but I've heard the author on many occasions on radio and TV.
Of course we need to overhaul the income tax code, but everything that is in it is in it because some interest group wants it (We are a country of push and shove and anything goes.) so the reform is never done, and I doubt it ever will be, just made more and more complicated with time. I spend a large amount of time for about a month on our income tax.
In this blog, I have noted that you cannot balance the budget by eliminating the discretionary spending (which includes DoD,. by the way) of the Federal government. Total budget for discretionary spending is $1.4 trillion whereas the Federal deficit this fiscal year is currently estimated to be $1.55 trillion. So you could close down the entire Federal government as we think of it and not balance the budget. Actually the deficit would rise a lot because of the 2 million (about) Federal workers put out of work and discontinuation of all their contracts with industry.
So if we are to balance the budget, then we have to address entitlements (e.g. Social Security and Medicare) plus raise taxes. Any kind of even modest Federal budget decreases raises alarm. Obama proposed ending a program for manned missions to the Moon and a number of Republicans objected. Can you think of anything we need LESS than to send men to the Moon? It certainly is not essential. Yet, there are loud squeals.
The latest thing is about companies, that provided health care for prescription drugs, will have this benefit taxed. What is interesting about this is that the tax will be on a Federal SUBSIDY (!) given to such companies to continue drug coverage to their employees and retirees. In other words, it is a decrease in a Federal SUBSIDY. The Wall Street Journal loves to tell which company is taking what kind of hit. ATT, for example, is taking a billion dollar write down, and they have a hard time decreasing their prescription drug coverage because of all sorts of union agreements. Disclosure: We own some ATT stock. I still have trouble getting excited about this small decrease in a subsidy.
Personally, I feel companies shouldn't be providing heath care to employees anyway. It started as an accident in WW-II when salaries were frozen and Henry J. Kaiser decided to offer health care as an inducement to get more of the limited pool of workers. Among other things, it put a terrible onus on workers who will lose their health care if they quit, but companies are free to fire them any time they feel like it, costing them their health care. Labor is the main elastic component of business. I think that, at the very least, the health care insurance should be owned by the employee and a company could make donations towards it if they like. At least the employee can take the health care with them if they quit or are fired.
It would be even better to have a government operated health insurance system such a Medicare now (Ah, the Public Option which is not in the bill?). There is no restriction in Medicare as to which physician you go to. The doctor bills Medicare which pays some part of the bill (usually), and our backup plan pays the rest. If Medicare refuses payment, then our backup plan can too. Not every physician will accept Medicare, but there are a large pool that do. And Medicare doesn't pay everything. For example, they won't pay for anything they judge to be cosmetic surgery. And there are some tests they will only pay for once a year (I think some tests have even a longer time frame.). But overall, I think it works well for the patient.
And why are Right To Lifers so enraged by the bill, especially when the President has issued an edict that no Federal money will be used for abortions (I guess they think an executive order is not binding.). It all seems irrational to me. Beside outlawing Federal money for abortions only applies to the poor and probably the lower middle class, The more wealthy can pay for their daughters abortions or even send them to some country where abortion is legal if abortion of any kind was outlawed in this country. Bring back the coat-hanger abortions? But ruling that no Federal money can go to abortion is made several different ways: now by the executive order and also the Hyde amendment. I would feel better about it if so many right to lifers weren't also for the death penalty. If life is sacred, how can you justify the death penalty. Apparently right to life only applies to the unborn.
The bill is 2,404 pages, I believe, including 900 pages of amendments of which 170 of the amendments are by Republicans. Of course it is hard to believe that anyone can keep in their mind all the things in such a bill. I guess we will just have to let things develop and see. But the big thing as I see it is the inclusion of the 32 million new uninsured. If we can't do this, maybe we don't deserve to be a country? Well, I have heard the problem is that people with health insurance say, "What's in it for me?" There are 14 items that will begin this year: http://majorityleader.gov/docUploads/Top14FINAL.pdf
Adding 32 million people to health care presumably will put a strain on our stock of primary care physicians. We are told that the poor now are covered by going to emergency rooms. So the thought occurs to me that if this is true, there will be less need for physicians in emergency rooms so they can have private practices to see new patients at less than one-third the cost of an emergency room visit. Hm, maybe not that many of the poor go to emergency rooms for their primary care. I took my wife once, and her visit lasted seven hours (this in northern Virginia). A lady we know went to an emergency room here in North Carolina because of a bad fall, and it took her six hours. After you do this once, you maybe try to avoid emergency rooms? So maybe there will be a shortage of primary care physicians. One of the things that will begin soon with the passage of Obamacare is support for the training of more primary care physicians. I know not how many.
Well, I think there is some legitimate concern that the budget balancing in the health plan bill will actually be sustained by future congresses. As to financial reform, it is certainly necessary. We cannot allow so many "too big to fail" organizations affect out country. The first big thing was repeal of the glass Steagal Act which Clinton signed; I believe it was his biggest mistake. It may be that the SEC has been lax in its enforcement, but we have had 20 years of deregulation of the financial industry in this country, and there is no regulation of hedge funds. And Bush idid things that have ruined the economy for the rest of my life (unfunded wars accompaying tax cuts, an unfunded prescription drug paln, among others.). Even closing down Lehman Brothers has almost done in the country. I suggest you read a book called The Big Short which has come out recently. I have not read the book, but I've heard the author on many occasions on radio and TV.
Of course we need to overhaul the income tax code, but everything that is in it is in it because some interest group wants it (We are a country of push and shove and anything goes.) so the reform is never done, and I doubt it ever will be, just made more and more complicated with time. I spend a large amount of time for about a month on our income tax.
In this blog, I have noted that you cannot balance the budget by eliminating the discretionary spending (which includes DoD,. by the way) of the Federal government. Total budget for discretionary spending is $1.4 trillion whereas the Federal deficit this fiscal year is currently estimated to be $1.55 trillion. So you could close down the entire Federal government as we think of it and not balance the budget. Actually the deficit would rise a lot because of the 2 million (about) Federal workers put out of work and discontinuation of all their contracts with industry.
So if we are to balance the budget, then we have to address entitlements (e.g. Social Security and Medicare) plus raise taxes. Any kind of even modest Federal budget decreases raises alarm. Obama proposed ending a program for manned missions to the Moon and a number of Republicans objected. Can you think of anything we need LESS than to send men to the Moon? It certainly is not essential. Yet, there are loud squeals.
The latest thing is about companies, that provided health care for prescription drugs, will have this benefit taxed. What is interesting about this is that the tax will be on a Federal SUBSIDY (!) given to such companies to continue drug coverage to their employees and retirees. In other words, it is a decrease in a Federal SUBSIDY. The Wall Street Journal loves to tell which company is taking what kind of hit. ATT, for example, is taking a billion dollar write down, and they have a hard time decreasing their prescription drug coverage because of all sorts of union agreements. Disclosure: We own some ATT stock. I still have trouble getting excited about this small decrease in a subsidy.
Personally, I feel companies shouldn't be providing heath care to employees anyway. It started as an accident in WW-II when salaries were frozen and Henry J. Kaiser decided to offer health care as an inducement to get more of the limited pool of workers. Among other things, it put a terrible onus on workers who will lose their health care if they quit, but companies are free to fire them any time they feel like it, costing them their health care. Labor is the main elastic component of business. I think that, at the very least, the health care insurance should be owned by the employee and a company could make donations towards it if they like. At least the employee can take the health care with them if they quit or are fired.
It would be even better to have a government operated health insurance system such a Medicare now (Ah, the Public Option which is not in the bill?). There is no restriction in Medicare as to which physician you go to. The doctor bills Medicare which pays some part of the bill (usually), and our backup plan pays the rest. If Medicare refuses payment, then our backup plan can too. Not every physician will accept Medicare, but there are a large pool that do. And Medicare doesn't pay everything. For example, they won't pay for anything they judge to be cosmetic surgery. And there are some tests they will only pay for once a year (I think some tests have even a longer time frame.). But overall, I think it works well for the patient.
Sunday, January 31, 2010
Health Care For The Masses - RIP
Last December 24th, I wrote on Universal Health Care which now appears to be dead. A good deal of the blame goes to Republicans who demonized any sort of universal health care, but, ultimately, the Democrats did it to themselves. With the election of a Republican Senator from Massasschusetts who says he will vote against whatever health care bill comes out of the conference committee, there are now not enough votes to establish cloture in the Senate so any version of the two health care bills passed by the House or Senate is dead on arrival. The problem could be avoided by having a "hurry up" conference committee, but this idea has been rejected. Now the House could avoid this problem by simply accepting the Senate bill, but Speaker Nancy Pelosi has said she does not have the votes (I believe that the Senate could also vote to accept the House bill before the new Senator is sworn in, but this seems even more unlikely.). So in the end, the Democrats themselves did not want to pass a universal health care bill. A problem with the Democrats is, of course, that they are less disciplined than the Republicans.
So once again, it is proven that trying to pass an "ultimate solution" to a problem fails. In my experience, they always do.
So the idea now is to attack some pieces of the problem. President Clinton did this, most notably with his State Children’s Health Insurance Program, and President Bush the younger did it with Medicare D, a prescription drug program (but with some strong arm twisting to get the votes). So what pieces seem to be possible?
President Obama has reiterated that he would consider some form of tort reform which Republicans now say they want. I like the idea of tort reform, especially for "pain and suffering," but Republicans had six years in which they controlled the Presidency, the House, and the Senate and did nothing about tort reform. So my guess is that when push comes to shove, tort reform is dead.
Republicans in particular say they would like to have health insurance by insurance companies the is not restricted by state. I personally like this idea, but I am surprised that Republicans like it because insurance regulation has been one of the things that that been left to the states so to have national health insurance would obviously require some Federal regulation. Republicans are supposedly for states rights. Why take something away from the states? There is a second problem. It sounds nice to say you live in a state with expensive health insurance so you can buy insurance from a state with cheap health insurance, but, to stay in business, wouldn't the prices of insurance in the cheap states have to increase? Perhaps the health insurance in the expensive states would come down some to flatten costs over the U.S., but this would be to the detriment of the low cost states. Since medical expenses in low cost states is probably because the people have low incomes, the people of these states probably can ill afford increased health insurance costs. Thus I think when the issue is looked at closely, it is no go.
It seems like everyone doesn't like the fact that insurance companies can take health history into account in accepting applicants for health insurance. The insurance companies say there will be no preconditions so long as everyone is required to have health insurance. This sounds fine to me, but seems to have a lot of opposition from Republicans who have said this is just another give away to seniors. Well, this is what insurance is all about, isn't it? You take out fire insurance on your home, but it is very unlikely that your home will catch on fire during your occupancy. So you pay for the unfortunates whose homes do burn down or are damaged by fire on the off chance you will be one of them. While youth in general may have fewer health problems, there are those that do, and they would be covered also. As it is there are a number of thousands of people in their early 20s who collect Medicare for kidney problems (You have to have paid a certain number of quarters into Social Security to qualify.). But this idea seems to be a nonstarter.
Interestingly, none of the above deal with people currently unable to get health insurance because of costs though the last item addresses preconditions. So my guess is that maybe some more wheels will be spun on pieces of health care, but in the end nothing will be done. I will be happy to be proved wrong because no action is one of the most ecpensive options.
So once again, it is proven that trying to pass an "ultimate solution" to a problem fails. In my experience, they always do.
So the idea now is to attack some pieces of the problem. President Clinton did this, most notably with his State Children’s Health Insurance Program, and President Bush the younger did it with Medicare D, a prescription drug program (but with some strong arm twisting to get the votes). So what pieces seem to be possible?
President Obama has reiterated that he would consider some form of tort reform which Republicans now say they want. I like the idea of tort reform, especially for "pain and suffering," but Republicans had six years in which they controlled the Presidency, the House, and the Senate and did nothing about tort reform. So my guess is that when push comes to shove, tort reform is dead.
Republicans in particular say they would like to have health insurance by insurance companies the is not restricted by state. I personally like this idea, but I am surprised that Republicans like it because insurance regulation has been one of the things that that been left to the states so to have national health insurance would obviously require some Federal regulation. Republicans are supposedly for states rights. Why take something away from the states? There is a second problem. It sounds nice to say you live in a state with expensive health insurance so you can buy insurance from a state with cheap health insurance, but, to stay in business, wouldn't the prices of insurance in the cheap states have to increase? Perhaps the health insurance in the expensive states would come down some to flatten costs over the U.S., but this would be to the detriment of the low cost states. Since medical expenses in low cost states is probably because the people have low incomes, the people of these states probably can ill afford increased health insurance costs. Thus I think when the issue is looked at closely, it is no go.
It seems like everyone doesn't like the fact that insurance companies can take health history into account in accepting applicants for health insurance. The insurance companies say there will be no preconditions so long as everyone is required to have health insurance. This sounds fine to me, but seems to have a lot of opposition from Republicans who have said this is just another give away to seniors. Well, this is what insurance is all about, isn't it? You take out fire insurance on your home, but it is very unlikely that your home will catch on fire during your occupancy. So you pay for the unfortunates whose homes do burn down or are damaged by fire on the off chance you will be one of them. While youth in general may have fewer health problems, there are those that do, and they would be covered also. As it is there are a number of thousands of people in their early 20s who collect Medicare for kidney problems (You have to have paid a certain number of quarters into Social Security to qualify.). But this idea seems to be a nonstarter.
Interestingly, none of the above deal with people currently unable to get health insurance because of costs though the last item addresses preconditions. So my guess is that maybe some more wheels will be spun on pieces of health care, but in the end nothing will be done. I will be happy to be proved wrong because no action is one of the most ecpensive options.
Thursday, December 24, 2009
UNIVERSAL HEALTH CARE IN THE U.S.
As I write this, the health care bill has finally passed the Senate with the required 60 votes. The bill is so long (over a thousand pages) with so many amendments (over 300 pages) that it is hard to know what is in the bill. But it seems something like 30 million more people will be included in health care nsurance, that you can not be refused insurance because of prior health conditions, and that nearly everyone will be required to have health insurance.
But there are some things that are not in the bill that ought to be:
(1) Tort Reform: Neither political party seems to want tort reform. For six years that Republicans had control of the Presidency, the Senate and the House and did nothing about tort reform. It is felt that Democrats are in the pocket of the trial lawyers so it is no surprised Democrats don't want to address tort reform. Further, it is said that the total amount of savings would be "only" about 4%. Assuming this is true, we are still talking about at least hundreds of millions of dollars. There are other reports that say the litigation and malpractice insurance total only about 1.5% of the medical costs (http://prescriptions.blogs.nytimes.com/2009/08/31/would-tort-reform-lower-health-care-costs/), figures that seem absurdly low. I doubt, however, that any sort of accurate figure can be obtained on defensive medicine costs. But physicians malpractice insurance costs are out of sight. A physician who specializes in premature babies said his insurance is $150,000/yr. For example, if a doctor.s appointment is $100, the first 4 to 6 patients (depending on the number of days he works in a year) the doctor sees in a day go to pay his malpractice insurance. And then more patients have to be seen to pay the rent, hire a nurse, a part-time bookkeeper, and a receptionist plus other work expenses. I have read that a neurosurgeon's insurance is $250,000. Such expenses must be made up before these physicians start earning any wages.
(2) Emergency Room: A lot of people don't seem to be concerned that the primary health care for many people is the emergency room. Yet, the emergency room is the most expensive kind of health care (http://www.consumerhealthratings.com/index.php?action=showSubCats&cat_id=274) averaging $560/visit and for people aged 45-64 it was $832/visit in 2003. Blue Cross/Blue Shield of Texas gives the following figures: " What should you know before going to the E.R.? The national average E.R. visit costs $383, while the national average doctor’s office visit is approximately $60" (http://www.bcbstx.com/employer/hccc/topic6.htm). Certainly any universal health plan should aim to reserve the emergency room for emergencies. But once again, we are told that emergency room costs are only a few percent of the total costs. Tell that to people who wait 6-7 hrs in the emergency room for some sort of treatment. And much emergency room treatment is not paid for by the patient but is passed on to those who can pay.
(3) Control of medical insurance costs has received much note as a significant percentage of insurance costs actually go to insurance companies seeking ways so that various types of coverage are not covered. The proposal to do this in the health care bill was to be a public option, but this provision has been removed. It is not clear whether the remaining provisions will have any effect. An agreement with the insurance companies has been that if everyone is to be covered by health insurance, then they would be willing to do away with "preexisting conditions" as a reason to eliminate insurance coverage. Apparently this provision is in the current bill.
(4) Rationing. Of course there is rationing of health care now, based on money. Plus certain types of treatment are not covered by Medicare - anything judged to be cosmetic surgery for example and, of course, dental expenses are not covered. And other tests are restricted - PSA tests for men and mammograms for women are limited to one per year. The word rationing conjures up bad vibrations, but they will be increasingly necessary. How many expensive organ transplants will a person be allowed to have in a lifetime, for example?
We do not yet know what compromises will be made to the current health bills in committee before a final bill can be voted on in congress and presented to the President. At best, it would appear that what is eventually signed into law will be a beginning and not a total solution.
But there are some things that are not in the bill that ought to be:
(1) Tort Reform: Neither political party seems to want tort reform. For six years that Republicans had control of the Presidency, the Senate and the House and did nothing about tort reform. It is felt that Democrats are in the pocket of the trial lawyers so it is no surprised Democrats don't want to address tort reform. Further, it is said that the total amount of savings would be "only" about 4%. Assuming this is true, we are still talking about at least hundreds of millions of dollars. There are other reports that say the litigation and malpractice insurance total only about 1.5% of the medical costs (http://prescriptions.blogs.nytimes.com/2009/08/31/would-tort-reform-lower-health-care-costs/), figures that seem absurdly low. I doubt, however, that any sort of accurate figure can be obtained on defensive medicine costs. But physicians malpractice insurance costs are out of sight. A physician who specializes in premature babies said his insurance is $150,000/yr. For example, if a doctor.s appointment is $100, the first 4 to 6 patients (depending on the number of days he works in a year) the doctor sees in a day go to pay his malpractice insurance. And then more patients have to be seen to pay the rent, hire a nurse, a part-time bookkeeper, and a receptionist plus other work expenses. I have read that a neurosurgeon's insurance is $250,000. Such expenses must be made up before these physicians start earning any wages.
(2) Emergency Room: A lot of people don't seem to be concerned that the primary health care for many people is the emergency room. Yet, the emergency room is the most expensive kind of health care (http://www.consumerhealthratings.com/index.php?action=showSubCats&cat_id=274) averaging $560/visit and for people aged 45-64 it was $832/visit in 2003. Blue Cross/Blue Shield of Texas gives the following figures: " What should you know before going to the E.R.? The national average E.R. visit costs $383, while the national average doctor’s office visit is approximately $60" (http://www.bcbstx.com/employer/hccc/topic6.htm). Certainly any universal health plan should aim to reserve the emergency room for emergencies. But once again, we are told that emergency room costs are only a few percent of the total costs. Tell that to people who wait 6-7 hrs in the emergency room for some sort of treatment. And much emergency room treatment is not paid for by the patient but is passed on to those who can pay.
(3) Control of medical insurance costs has received much note as a significant percentage of insurance costs actually go to insurance companies seeking ways so that various types of coverage are not covered. The proposal to do this in the health care bill was to be a public option, but this provision has been removed. It is not clear whether the remaining provisions will have any effect. An agreement with the insurance companies has been that if everyone is to be covered by health insurance, then they would be willing to do away with "preexisting conditions" as a reason to eliminate insurance coverage. Apparently this provision is in the current bill.
(4) Rationing. Of course there is rationing of health care now, based on money. Plus certain types of treatment are not covered by Medicare - anything judged to be cosmetic surgery for example and, of course, dental expenses are not covered. And other tests are restricted - PSA tests for men and mammograms for women are limited to one per year. The word rationing conjures up bad vibrations, but they will be increasingly necessary. How many expensive organ transplants will a person be allowed to have in a lifetime, for example?
We do not yet know what compromises will be made to the current health bills in committee before a final bill can be voted on in congress and presented to the President. At best, it would appear that what is eventually signed into law will be a beginning and not a total solution.
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