The Miracle Of Modern Medical Technology

Yesterday our family had urgent need of our American medical system . . . and boy, did it ever deliver!

In our case, the medical problem was a blockage caused by a large blood clot in the brain.  A skilled surgeon was able to use a new, less invasive procedure — one that has been in use at the hospital for only about six months — to follow the blood vessel up into the brain and use suction to dislodge and then safely remove the clot.  The entire procedure took less than an hour and left the blood vessel and brain tissue undisturbed.

Americans often complain about the cost of our health care system, but we also should boast, even more frequently, about the amazing quality of the care it provides.  In our case, the very recent technological advances permitted a result that is nothing short of miraculous — and it was a result that wasn’t reserved for royalty or the super-rich, but instead was available to a worried family that brought a loved one to a neighborhood hospital in Columbus, Ohio.  Where would we be if our hospitals were not striving to provide the best care imaginable?

Without lapsing into the political realm, I think it’s fair to say that our experience is one of the reasons why the Affordable Care Act is of concern to so many people.  Yesterday, when time was of the essence, we received the care we needed immediately, without having to cut through red tape or waiting to receive bureaucratic approvals.  I’d hate to think that things might change that would change that result — or, in some way, remove the incentives that our hospitals have to purchase and use the space-age technology that consistently delivers the modern medical miracles to which we’ve become so accustomed — and for which we are so grateful.

Looking For A Quick, Clean Exit, Far Into The Future

How do you want your life to end?  An even more difficult question:  how do you want the lives of your loved ones to end?  An article in New York magazine, about a family’s struggle with their mother’s long, slow decline — and the related emotional and societal costs — raises those stark heartbreaking issues.

I think most people would like to go out like my grandfather did.  He lived to be 99, kept his mental and physical health until the end, then had a stroke while eating breakfast and died later that day.  No institutionalization.  No dementia.  No months or years of a twilight existence, apparently unaware of his surroundings, experiencing bedsores and diaper changes and incomprehension.

Of course, we don’t get to make stark choices between the ideal and the awful.  Instead, families deal with impossible judgment calls.  Should the frail 84-year-old woman with the bad hip endure the pain, or have an implant operation that could give her a pain-free existence — or produce a shock to the system that causes her to slide into an irreversible downward spiral?  If an elderly relative decides not to undertake life-extending treatment, should the grief-stricken children try to argue him out of his decision?  How should a family deal with an institutionalized Alzheimer’s victim in the bewildered, angry, unrecognizing end stages of mental decline and the guilt that comes from not wanting to see their relative in that terrible condition?

The author of the New York article yearns for a “death panel” — he calls it a “deliverance panel” — where family members could appeal for a relative’s death.  There’s a reason why the concept of such panels provoked such opposition during the recent debate on health care reform, however.  What modern Solomons would staff such panels?  The doctors who want to sharpen their skills at an aggressive life-extending procedure and get paid for their efforts?  The bureaucrat who sees his health care budget exploding and wants to rein in costs?  The hospital administrator who thinks the room the patient occupies could be better used by someone receiving more care and treatment?  The children who are heartsick about the potential loss, hoping for a miracle, guilt-ridden, exhausted, overwhelmed, and concerned about their inheritances, all at once?

There are no easy answers to these terrible issues.  I think the appropriate first step is for everyone to make their own decisions about their own care, when they are still healthy and capable of doing so, and memorialize those decisions in some kind of binding way so that their surviving relatives aren’t saddled with impossible choices.  Is the prospect of long-term institutional care and constant pain a source of unimaginable horror, or would you be willing to put up with it in order to meet your great-grandchildren?  Only the individual can know how much of a deviation from the ideal end-of-days scenario they are willing to endure.

To All Webnerhouse Readers

I think that Bob would agree with me that one of the fun things about the family blog is that even when I am not blogging I like scrolling down through the comments that readers take the time to make. A special thanks goes out to Elroy Jones and Mike N who have made the bulk of the comments on Webnerhouse.

Our longest comment was from Mizuno Girl who took the time to make the following comment to Bob’s blog on the Supreme Court deciding whether or not the Healthcare Reform Act is or is not constitutional –

I’m a huge fan of the Healthcare Reform Act and I actually do wish that much of Obama’s healthcare policies had come to pass. You see I am an emergency room nurse and I see patients each and every day who have no access to healthcare. They attempt to use the emergency room for all sorts of things. We can help many of them, but a guy came in the other day who had a sore throat for four months and it turned out to be a tumor. Unfortunately we can’t treat a tumor in the emergency room. Of course he had no insurance and said he would have gone to the doctor much sooner had he been able to. Had he done so the tumor would have been much smaller and probably quite easy to treat.

So we see this which is disheartening and then we are required to see people who arrive complaining that their left toe has been hurting for ten minutes. I sure would love it if we could try to make healthcare more affordable and accessible for all. I am not sure why it has to be such an inflammatory issue. I mean we are supposed to be an advanced country aren’t we ? I think I would rather pay a bit more in taxes to support affordable healthcare, but I suppose I am in the minority. As Americans I know we are said to give generously to charity, but at times we sure can be selfish.

Thanks Mizuno Girl for taking the time to put down your thoughts in writing and giving us some food for thought – we very much appreciate it !

Government By Waiver

One of the more troubling aspects of the “health care reform” legislation enacted into law last year has been the ability of companies and unions to get waivers that relieve them from having to comply with certain aspects of the law.  The waivers relate to provisions of the law that prevent plans from using high deductibles or low annual limits to control benefits.  Unfortunately, many plans need such provisions to manage costs; without those provisions, employers and unions would need to jettison their plans as unaffordable.

The Department of Health and Human Services may waive those provisions for certain employer and union plans.  The HHS website explains that, to be eligible for a waiver, the plan must certify “that a waiver is necessary to prevent either a large increase in premiums or a significant decrease in access to coverage” and must inform plan enrollees “that their plan does not meet the requirements of the Affordable Care Act.”  Whether to grant the requested waiver then seems to be entrusted to the discretion of the HHS and its Secretary, Kathleen Sebelius.  To date, 733 company and union plans, covering 2.1 million Americans, have received waivers.

This concept of “government by waiver” is troubling.  I’m skeptical of the claims of some conservatives, who believe that the waivers are being handed out as rewards for prior political support.  I do, however, question a process that allows unelected bureaucrats to grants waivers from a law that is supposed to apply to everyone.  The waiver process is symptomatic of the accumulation of power in the Department of Health and Human Services that seems to be the true hallmark of the “health care reform” legislation. If the law remains in force, Americans will need to get used to the idea that HHS will be making all kinds of decisions that have a direct impact on our health care.

In addition, what does it say about this hastily drafted, poorly considered law that more than 700 plans have certified that one of the law’s provisions will either vastly increase costs or cause coverage to be sharply curtailed?  Does anyone doubt that, if all American businesses had been aware of the possibility of obtaining waivers, that 700 number would have been multiplied by a significant factor?  It also is worth noting that the waivers aren’t limited to small, Mom and Pop plans.  To the contrary, some of the plans that have received waivers have hundreds of thousands of participants.  According to the HHS website, the plans that have received waivers include the United Federation of Teachers Welfare Fund (351,000 participants), CIGNA (265,000 participants), Aetna (209,000 participants), and BCS Insurance (115,000 participants).  Given these waivers, how can the proponents of the “health care reform” legislation continue to contend that the legislation will neither increase costs nor reduce coverage?  By granting the waivers, the bureaucrats at HHS are admitting that the exact opposite will occur if the law is enforced as written.

Making A Statement And Fulfilling A Promise

The House of Representatives, now under Republican control, has passed legislation to repeal the “health care reform” legislation passed by the last Congress.  Democrats in the Senate, who control that chamber, are saying that repeal legislation will never come to the floor for a vote — and, of course, President Obama would be expected to veto any repeal legislation that would happen to reach his desk.

So, was the House vote a waste of time?  I don’t think so.  By voting to repeal the “health care reform” legislation, the Republican majority was fulfilling a campaign promise.  We should applaud politicians who do so, not condemn them.  The general public would have a more favorable view of politicians generally if more politicians actually tried to keep their promises.  By acting so promptly, the Republicans are demonstrating that elections have consequences.  And, of course, you never know whether political pressure will build on the Senate to consider some form of repeal legislation.  If Democrats in the Senate consider the legislation to be such a great success, why should they duck a vote on its proposed repeal?

Now that the Republicans in the House have met one of their promises, they need to turn to working on the others.  If I had a vote, I would urge them to focus on deficit reduction and a careful analysis of potential federal spending cuts.

Phony Figures

Today Kathleen Sebelius, the Secretary of the Department of Health and Human Services, released a report that concludes that up to half of all Americans below age 65 — 129 million in all — have some kind of “pre-existing condition” that might otherwise cause them to be denied health insurance coverage.  The report, which was released on the day the House of Representatives began debate on a bill to repeal the “health care reform” legislation, notes that under that legislation those individuals with “pre-existing conditions” cannot otherwise be denied coverage, or be charged significantly higher premiums.

HHS Secretary Kathleen Sebelius

As is the case so often these days, this report seems to be motivated almost entirely by political concerns — in this case, trying to make a case for retaining the “health care reform” legislation.  Consider the study itself.  It concludes that “50 to 129 million (19 to 50 percent of) non-elderly Americans have some type of pre-existing health condition.”  Can’t we expect a bit more precision from our governmental studies than a margin for error of 79 million Americans?  No doubt the political manueverers at HHS realized that the news media would report the higher number — which is exactly what has happened.  The headline on the ABC News website report on the study, for example, is:  “Half of Americans Have Pre-Existing Health Conditions”.

And consider, too, the fact that the report itself notes that “as many as 82 million Americans with employer-based coverage have a pre-existing condition.”  In other words, those conditions — if they exist at all — have not stopped those 82 million Americans from getting and keeping insurance through their employers.  If the insurance companies were really as evil as Secretary Sebelius and the supporters of “health care reform” legislation argue, how could that have happened?  Why didn’t the greedy insurance companies immediately eliminate coverage for those 82 million Americans?  The fact that, according to the government, as many as 82 million Americans are maintaining health insurance notwithstanding their purported “pre-existing conditions” refutes one of the basic arguments for having “health care reform” legislation in the first place.

Finally, the report shows, I think, that our federal government really doesn’t have much respect for the common sense of Americans.  Does anyone honestly think that if half of all Americans under 65 really had pre-existing conditions that made it impossible for them to get private health insurance we would see the kind of vigorous opposition to the “health care reform” legislation that has continued, unabated, despite the best efforts of the news media and the federal government to quash it?

 

What a Difference a Few Years Makes

While in Chicago last weekend I spent some time reading an interesting article in Vanity Fair on John McCain and how he and his views have changed over the past two years from the man who almost became president.

The article mentioned a long list of issues and what might have been done if anything under a McCain administration. Here’s the list below with a couple that I researched and added myself :

Lily Ledbetter Fair Pay Act – video shown above was the first piece of reform President Obama signed into law which offers fair pay to women – the reform was twice vetoed by President Bush and McCain was also opposed to the legislation.

Iraq – probably no troop draw down under McCain.

Iran – under McCain the United States would have maybe blockaded or possibly bombed Iran due to their nuclear ambitions and their flawed election last year.

Student Loan Reform – John McCain was not in favor of the government takeover eliminating private banks as the middlemen in the loan process.

Auto Bailout – General Motors and Chrysler would have most likely been allowed to go bankrupt causing thousands more to lose their jobs.

Wallstreet Financial Industry Reform Act – probably no significant regulation of the financial industry allowing them to continue to police themselves.  

Repeal of Don’t Ask Don’t Tell – McCain’s comments on the Senate floor railing against DADT in recent days make it clear that he did not want DADT repealed.

Stimulus Bill – McCain was against the Stimulus bill and wanted a bill with more tax cuts – its hard to tell what condition the economy would be in at this point in time under his admistration.

Healthcare Reform – perhaps some modest reforms under McCain, but nothing even close to what has been passed under Obama.

Supreme Court Justices – McCain would have almost certainly nominated two conservative judges to the court. White males ?

Hate Crime Prevention – McCain like most Republicans is against hate crimes legislation saying state laws already cover hate crimes and passing the Hate Crime Prevention Act could criminalize religious opposition to homosexuality.

Credit Card Reform – perhaps modest reform under a McCain administration, but McCain has typically voted against additional regulation of banks and their credit card practices.

While it is impossible to know for sure what might have happened had McCain taken office I think this list speaks for itself and that the President deserves some credit for his persistency to get his agenda enacted.

Your Tax Dollars At Work, Protecting Americans From Unlicensed Neighborhood Lemonade Stands

Does anyone in government stop and think about what they are really doing, anymore?

Here’s the latest story of some ridiculous lack of judgment by a government regulator.  A 7-year-old girl in a suburb of Portland, Oregon sets up a lemonade stand at a neighborhood festival and starts serving lemonade made from bottled water and Kool-Aid mix, at a price of 50 cents a cup.  Some county health inspector with a clipboard comes up and asks the kid to show her temporary restaurant license.  Not surprisingly, the child doesn’t have one — they cost $120, after all — and the health inspector tells the kid that she has to close up shop or face a $500 fine.  The child left in tears.  Of course, the county health inspectors defend the action, saying that they “need to put the public’s health first” and must “protect the public” no matter how small the business or how young the proprietor.

Didn’t anyone at the county health department ever have a lemonade stand?  Doesn’t anyone at the county health department have any common sense?  Is unlicensed lemonade sold by a 7-year-old really such an enormous risk to public health that the full weight of the country government must be brought to bear?

Whether a 7-year-old gets to run a lemonade stand without being harassed and reduced to tears by clipboard-waving bureaucrats doesn’t mean a lot in the grand scheme of things.  This story reveals a greater concern about how government works, however.  One reason why some people, at least, oppose the government making decisions about their health care is precisely because they are worried that those momentous decisions will be made by nameless bureaucrats who don’t have the sense to determine that a 7-year-old’s lemonade stand doesn’t pose a fundamental risk to public health.

The Voters Begin To Speak On “Health Care Reform”

Tuesday’s election in Missouri included a ballot initiative where voters were asked to weigh in on whether a key provision of the “health care reform” legislation — the “individual mandate” that requires people to either get health insurance or pay a penalty — should be invalidated.  More than 71 percent of the Missouri voters voted yes on that issue.

I’m sure supporters of health care reform have lots of rationalizations for the landslide in Missouri — it was a special election, Republicans were more motivated to go to the polls, serious people understand that ballot issues aren’t going to decide the matter and therefore we shouldn’t pay attention to the results, etc. — but I think the Missouri election result has to be viewed as having some significance.

The reality is that, when voters were asked to pull the lever on a key feature of the “health care reform” legislation, they rejected it overwhelmingly.  Commentators can pooh-pooh the results if they wish, but does anyone doubt that if Missouri voters had overwhelmingly approved of the individual mandate that result would have been cited as evidence that popular perception of the legislation was changing?

I don’t know whether an up or down vote on one part of a complex bill can tell us much about how voters will treat members of Congress when they stand for re-election in November.  Most voters aren’t single issue voters; they typically consider an incumbent’s overall record.  Still, if I were a Democrat who had voted in favor of the “health care reform” legislation and its individual mandate centerpiece, the Missouri results would leave me feeling queasy.

Recognizing Taxes As Taxes

The New York Times recently carried an interesting article on the Justice Department’s arguments against claims that the “health care reform” legislation is unconstitutional.  The “linchpin” of the argument is that the individual mandate, which requires people to obtain health insurance or pay a penalty, is constitutional as an exercise of Congress’ broad taxing power.

The Justice Department’s argument is interesting because, while the “health care reform” legislation was being debated, President Obama and many of his congressional allies denied that the individual mandate was a tax.  For example, Congress did not cite its taxing power as a basis for the legislation.  Now that the legislation is being challenged, however, the Administration’s lawyers have recognized the individual mandate for what it is — a tax on individuals and their individual decisions — in order to buttress its prospects for being upheld.

Just another example of how duplicitous the legislative process can be.

The Massachusetts Mess, Coming Soon To A Neighborhood Near You

The Wall Street Journal has published an article with the latest news from Massachusetts — the state whose universal health care program served as the model for the federal program that will soon be taking effect nationwide.  The news, to put it mildly, is not good.  The highlights (or rather lowlights):

*  The Massachusetts plan increased private employer-sponsored plan premiums by an average of 6 percent.

*  Massachusetts has the highest average premiums in the United States.

*  There is rampant and growing abuse of the state’s “individual mandate,” in which people buy insurance only when they are about to incur significant medical expenses and then drop the coverage after the expenses have been covered by insurance.

*  The state imposed price caps on insurance rates that had no actuarial support (but were politically popular), even though underlying state health costs are rising at a rate of 8 percent annually.

I am sure that all working Americans will welcome increased health plan premiums, to go along with the tax increases that will take effect starting in 2011.

Thoughts On The “Tanning Tax”

A few days ago a 10 percent federal “tanning tax” took effect.  The tax is one of the revenue-generating provisions of the “health care reform” bill.  It applies only to tanning beds and other devices that use ultraviolet rays to give customers tans and is expected to generate some $2.7 billion in annual revenue.  The stated purpose of the tax is to fill federal coffers while at the same time discouraging people from engaging in risky behavior.  Is indoor tanning really more risky than sitting out in the summer sun without using any sunblock?  Both approaches expose the skin to ultraviolet rays, but a recent study (criticized by some industry groups) concludes that indoor tanning is a special risk factor for melanoma.  Interestingly, the “tanning tax” replaced a different tax — dubbed the “Botax” — that would have put a 5 percent tax on Botox injections, breast implants, and other forms of elective cosmetic surgery.  The “Botax” was rejected after heavy lobbying by doctors and the medical industry.

I don’t use indoor tanning salons and can’t imagine doing so — but I question the underlying concept of the “tanning tax.”  Do we really want to get into the habit of taxing what the federal government considers to be risky behavior?   Should sports cars and motorcycles be taxed at higher rates than sedans?  Should mountain climbers, skydivers, and participants in extreme sports should be taxed more heavily than couch potatoes?  We are moving beyond “sin taxes” on alcohol, tobacco, and gambling to a new realm of governmental efforts to modify human behavior — and I am not comfortable that the government is well-situated to make those kinds of judgments.

The “tanning tax” is a good example of what can happen when the government makes these kinds of decisions.  The “Botax” would have produced more revenue than the “tanning tax,” but it had powerful opponents who were able to derail that initiative.  Most tanning salons, in contrast, are locally owned small businesses without significant political clout.  In the test of political muscle, the tanning salon owners lost.  Political clout doesn’t seem like the most scientific way to determine behavioral modification goals, however.

One other point about the “tanning tax” is worth mentioning.  Tanning salons are sources of jobs and shopping center leases in virtually every community.  The local owners of those businesses are concerned that the tax will cause customers to cut back on their visits and thereby force some tanning salons out of business.  It is too soon to tell, of course, whether those dire predictions will come to pass — but in these difficult economic times why are we taking steps that might put small businesses into bankruptcy and cost scarce jobs?

Be Careful What You Ask For

One of the first rules learned by trial lawyers is this:  when cross-examining an adverse witness at trial, you never ask a question if you don’t know how the witness must answer that question.  You don’t want surprises, and asking one question too many and getting an unexpected answer that is a spear to the chest of your case is the worst surprise of all.

Congress apparently doesn’t know this rule — or at least the House Energy and Commerce Committee didn’t.  As readers of this blog will recall, after the “health care reform” legislation was enacted a number of large American companies changed their financial statements to reflect increased liabilities.  Congress responded by asking the companies to produce all of their confidential internal documents related to the impact of the new law on health care costs.  That was the question that should not have been asked.

As Fortune recently reported, the documents produced by the companies show that the companies are considering getting rid of their employee and retiree health care plans entirely — which is exactly what opponents of the “health care reform” legislation predicted.  It turns out that, for many companies, paying the penalty to the government for not offering health care plans is far less costly than the expense of continuing to offer the plans.  Part of the reason for that imbalance is that the “health care reform” legislation is going to add considerably to the cost of the plans, by requiring coverage for people who are currently uninsured, through operation of the “Cadillac tax” on certain plans, and as a result of the pass-though of new taxes on drug manufacturers, medical device makers, and health insurers.  According to the documents the Committee received, AT&T alone would save nearly $2 billion a year by junking its plan and paying the penalty.  In this highly competitive global economy, where corporations are trying to squeeze every penny, does anyone doubt that at least some American companies will lock in those savings by getting rid of their employee plans?

If corporations do jettison their plans, what will it mean?  For one, it will mean a lot more Americans will need to be covered by plans that are subsidized by the government, which in turn will cause the projected cost of the whole “health care reform” apparatus to skyrocket.  For another, it will mean a lot of people who have Human Resources jobs at American companies will need to dust off their resumes.  If companies don’t need to administer health care plans they won’t need as many HR people as they have now.  And finally, it means there will be a lot of unhappy Americans.  For all of the focus on the “problem of the uninsured” during the debate on the “health care reform” legislation, the fact is that the vast majority of Americans have insurance and are happy with that insurance.  Most of those people are insured through their employers.  If their company plans go poof, and they have to try to find some kind of alternative coverage, they aren’t going to grateful to Congress for that opportunity.

How did the House Energy and Commerce Committee react to these documents?  Predictably, they canceled the hearings and meekly concluded that the companies’ accounting treatment of the increased health care costs was just fine.  That kind of “hear no evil” approach won’t work quite as well when companies start to cancel their employee health care plans, however.

Another Three Years

I was glad to hear this week that Comedy Central and Jon Stewart were able to come to terms and the Daily Show will continue for at least another three years. I love watching his show and try to catch it whenever I can. 

I think he does a pretty good job of addressing the important issues confronting our country with brevity and a bit of humor mixed in.

In the video below he picked apart Fox News Contributor Bill Kristol’s argument against healthcare reform.

Can’t They do the Right Thing ?

I am in total agreement with Bob’s blog. It IS too bad that the president or the government for that matter had to step in and get involved. In the past I was a big proponent for less government, however recent circumstances have caused me to reconsider my thinking because I am beginning to wonder if business will ever take the initiative and do the right thing.

It was fifty five years ago this past week, April 12, 1955 when Dr. Jonas Salk came up with a cure for a devastating disease called polio. His sole focus was to develop a safe and effective vaccine as rapidly as possible with NO interest in personal profit.

When asked in a televised interview (shown below) who owned the patent to the vaccine Salk replied “the people I say, there is no patent, could you patent the sun ? “. Somewhere between then and now doesn’t it say something unfortunate about America’s drug companies ? 

In the coming weeks there will be much debate on the financial reform issue. Once again it would be nice if the government didn’t have to give instructions to the financial industry, but just a short time after the bail out a year ago it was back to business as usual. In this short period of time doesn’t it say something unfortunate about the Wall Street investment firms ?

We’ve beaten a dead horse with the endless blogs on our site about healthcare reform. It’s too bad back in the 1994 when healthcare reform was defeated during the Clinton administration that the big insurance companies couldn’t have come together and found a way to offer coverage to the uninsured and at a reasonable price. So what has happened during that time is the number of unisured has gone from 37 million to 52 million. Doesn’t that say something unfortunate about our insurance companies ?

I’d love for the government not to have to get involved, but until business steps up and does the right thing we are likely to see more government involvement.