The Flu Shot Factor

Today at lunch the Bus Riding Conservative announced that he had received his flu shot.  It made me realize I’ve never had one.

Even during the years when you hear the direst predictions about virulent flu strains sweeping the nation and knocking people down for weeks, I refrain from getting a flu shot.  I’m not sure why, exactly.  I’m not afraid of needles, nor am I one of those people who is opposed to immunization on the basis of some obscure religious belief or sense of social consciousness.  I’ve received all my vaccinations and am happy to obtain booster shots when the doctor instructs.

They didn’t have flu shots when I was a kid, so I never got used to having them.  And when I first heard about them as an adult, there always seemed to be issues about shortages.  The news stories would say that the flu shots really should be reserved for young kids and seniors, and I was neither.  I figured I would leave the shots for the people who really needed them, and that mindset still lurks — even though I’ve moved a lot closer to the senior citizens category over the years.

I’ve never really had a problem with the flu, so I don’t have any awful experience that would motivate me to change my approach.  (This probably means, of course, that this year will be the year.)  And there are studies that raise questions about the effectiveness of flu shots from year to year.  If there’s a chance that a flu shot is just going to make me feel bad, and isn’t going to provide much assurance that I’m not going to get the flu anyway, why worry about it?

So this year, I’ll leave the flu shots to the seniors, the kids, and the BRC.  We’ll see if I make it through flu season flu-free.

Taking The “Affordable” Out Of The Affordable Care Act

This week, enterprising journalists discovered that the Obama Administration has delayed another key provision of the Affordable Care Act.

In this instance, the delay affects one of the core selling points of the Act — the provision that capped the total amount of out-of-pocket expenses, in the form of deductibles and co-payments and other contributions by the insured toward health care.  It was supposed to take effect in 2014, but the newly discovered ruling gives insurers a one-year extension.

The delay wasn’t exactly announced in a way that befits an Administration that President Obama recently described as “the most transparent Administration in history.”   The New York Times article linked above describes the relevant ruling as follows:  “The grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language — which appeared as an answer to one of 137 “frequently asked questions about Affordable Care Act implementation” — department officials confirmed the policy.”  I guess “transparency” means burying the bad news in an avalanche of regulatory drivel and minutiae, rather than being honest about the many delays and snags that have affected legislation that was passed three years ago amidst confident predictions about its implementation, enforceability, and impact.

And speaking of impact, Forbes has a very interesting article about the impact of the Affordable Care Act on, well, getting affordable care.  It discusses the inevitable effect of caps on out-of-pocket expenses like co-payments and deductibles.  Because they don’t have anything to do with the cost of health care, that just means more of the cost will be paid through premiums imposed on everyone, rather than through contributions by the users (and, often, overusers) of health care.  The article notes that some colleges that used to offer cheap plans to their healthy students have had to drastically increase the premiums and other schools have stopped offering health care plans altogether.

Of course, the whole notion of burden-sharing underlying the Act means that some people will pay more — the question is, how many people, and how much more?  What we’ve seen of the Affordable Care Act so far doesn’t instill great confidence that we know the answers to those two important questions.

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.

Fat And Fairness — And The Federal Government

What to do to deal with the obesity epidemic in America?  (And not just in America, either — recent studies also are showing increasing obesity in places like Scotland.)  Normally you might say that the eating and exercise habits of individuals are their own business.  The problem, however, is that obesity, like smoking, is statistically likely to cause significant increases in health care costs.  And when most working people participate in group health care plans, where expensive health problems inevitably produce increased premium costs, individual cases of obesity and cigarette smoking end up being everybody’s problem.

The companies that sponsor group health plans for many Americans have tried to deal with this problem by sponsoring wellness programs and offering incentives to employee participation.  But you can’t force a person to exercise or quit smoking.  Now some companies are taking a harder line, and making obese employees and smokers pay more for health coverage to reflect their increased likelihood of incurring health care costs.  Predictably, those efforts are being met by questions about the legality of distinguishing between people on the basis of weight, whether the programs have a disproportionate impact on the poor, who are said to be unable to afford health clubs and good nutrition, and the propriety of companies getting into the personal lives of  employees.  Those on the other side of the debate argue that non-smoking, non-obese employees should not pay the tab for the risky, costly lifestyles of co-workers who can’t curb their appetites for cigarettes and sugar.

It will be interesting to see how this issue plays out — and even more interesting to see what happens if President Obama’s health care statute is upheld and the federal government becomes increasingly involved in health care.  Does anyone think that federal regulators, having been given the power to require people to buy health insurance, would hesitate to mandate certain kinds of individual behavior — like eating less, quitting smoking, and exercising regularly — and punish non-compliance in an attempt to hold down costs?

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?

 

An Alternative Perspective

I thought this article was an interesting, alternative perspective on the much-maligned (in some quarters) health care system in the United States.  The article indicates that although the World Health Organization ranks the U.S. number 37 in the world in terms of overall performance, based largely on the WHO’s view that the United States’ overall performance suffers due to lack of “universal coverage,” it ranks the U.S. system as number one in terms of “responsiveness to the needs and choices of the individual patient.”  And when you look at the other statistics listed by the author’s article, and the litany of medical advances catalogued in the article, you begin to understand why that is so.

Last Sunday I happened to watch a bit of one of the Sunday news shows, and one of the talking heads said, earnestly and with complete conviction, that once the American people learn about what is in the “health care reform” legislation, they will begin to be happy with it.  There is a lot of innate arrogance underlying such remarks, which implicitly communicate the view that the American people are too stupid to understand what is good for them, or simply have been gulled by right-wing ideologues, insurance company spin, etc.  In any case, statistics like those quoted in the article linked above go a long way toward explaining why many people are worried about a 2,000-page bill with contents unknown even to the Senators who are voting on it.  In America, where individualism is a treasured value, a health care system that is the best in the world at being responsive to the choices of individual patients is going to be viewed very favorably by most people.  Those people are fearful that the current system may be ruined by new government regulatory schemes that will have unknown effects, by vaguely described mandates that may well make delivery of health care more cumbersome, and by yet more bureaucratic agencies interfering with their personal health care choices.  Against that fear, the paternalistic assurances of talking heads about a handful of provisions that they think are useful is cold comfort, indeed.

Let The Debate Begin

On Thanksgiving, after we had finished our dinner, some of us sat around the table and talked about the issues of the day.  Inevitably, the talk turned to health care reform.  We discussed what to do about people who are uninsured through no fault of their own and those who are uninsured by conscious choice, how much we value personal choice and control in making our health care decisions and how much of that choice and control we feel comfortable giving up, and other core issues that lie at the center of the health care debate.  Although we approached the issues from different personal circumstances and different points on the political spectrum, our discussion was respectful and, I think, enlightening.  I suspect that many other families had similar discussions over their Thanksgiving dinners.

Now the Senate is poised to begin debate on the massive health care reform bill.  As the debate begins, I hope that our Senators have actually read, themselves, the thousands of pages of the bill, had it read and carefully considered by a trusted aide or two, and asked pointed questions about provisions that are not immediately easy to understand and received truthful answers.  I hope that, over the Thanksgiving holiday break, the Senators have talked to at least some of their constituents about the core issues and explained how those issues actually will be affected if the legislation is enacted in its current form.  I hope that, when the debate begins, the canned and stale “talking points” get discarded and there is an actual vigorous but respectful debate about the core issues in which Senators listen to their colleagues with an open mind.  Finally, I hope that Senators will cast their votes not as members of a Democratic or Republican caucus, but rather in faithful performance of their constitutional role — as representatives of their states, supposedly possessed of a more secure, long-term perspective about what is good for the nation as a whole.

As we talked about health care over the dinner table on Thanskgiving, I sensed a real undercurrent of concern about how any legislation would affect us, personally.  We all have different health histories and job histories and family needs.  Our Senators needs to consider that their actions will have enormous real-world consequences for average Americans like us.  The Senate vote should not be about politics, but about doing the right thing for our nation and its people.

Sausage Making

Right now we are getting a glimpse into the reasons why the legislative process has been compared to watching sausage being made.  In the Senate, five committees deliberated and produced bills, and then Senate leaders went behind closed doors and produced a proposed bill that includes an “opt-out” government plan that, so far as I can determine, wasn’t in any of the five bills.  The obvious reason for the “compromise” was to try to come up with an approach that placates liberals who are demanding that the legislation include a government plan but also has the chance to attract the votes of moderates who are leery of a “public option.”

Senate Majority Leader Harry Reid is now trying to make sure that Senate Democrats have the 60 votes needed to overcome a filibuster and pass a health care reform bill — and it seems that, at this point, Democratic leaders would be happy to pass just about any bill that could be called a health care reform bill.  So, he is making further modifications to the bill that are specifically designed to get the votes of hesitant Senators, one by one.  According to the linked article, Reid has agreed to cut a tax that would have had a special impact on a company in Indiana, apparently in an effort to get the vote of Senator Evan Bayh.  We can expect to see more of this kind of unseemly, individualized wheedling and horse trading.

In the House, where passage of a bill with some kind of non-opt-in public option seems assured, the debate is over how the public option will set the rates to be paid to doctors and hospitals for care.  Should it be done by government fiat, or by “negotiation”?

There is one significant difference between legislative politicking and sausage-making.  Although the process and ingredients used to make a sausage may upset the tender sensibilities of some people, the end result usually tastes pretty darn good.  The legislative process, on the other hand, can produce a monstrosity filled with unfunded mandates, poorly conceived and ill-considered requirements, objectively nonsensical exceptions, and phony budget impact estimates — to the point where purported “reform” legislation is more appalling and Frankensteinian than the existing reality.

A Poll For Every Perspective

I was interested in UJ’s post, below, on the AP Poll on health care.  The most recent Pew Research survey, on the other hand, shows sharply declining support for the health care reform proposals since September, and particularly a decline in the number of people who — like UJ — strongly support the reform proposals.

What does this discrepancy mean?  Who knows?  It may be as simple as how the questions were framed, or the definition and contours of the populations that were asked the questions by the two polls — or it may be that polls just aren’t a very good gauge of what people actually think, when you are talking about something complicated like health care reform.

Healthcare the “Third Rail”?

Sure, Obama and Congress have been hurt in the polls by the recent discussion of healthcare, a personal and complicated topic for Americans. But what would the public’s perception of President Obama and Congress be like if they weren’t discussing healthcare?

Much of Obama’s support last November came from his promise to reform our increasingly costly and ineffective healthcare system. If he didn’t talk about it now, or at any time in his presidency, he would be seen as reneging on his campaign promise in order to avoid the bitter struggle that any healthcare reform would involve. He would suffer in the polls more than he is now.

Most Americans realize our current healthcare system can’t be sustained and support some kind of reform. Even Republicans admit that some action must be taken. Any substantial attempt at reform, however, is bound to make a majority of Americans worry about the federal debt, the expansion of the federal government, and the future of their current plans, however inadequate they may be.

While healthcare is a touchy issue that will give a headache to whatever politician has the balls to deal with it, it is not a “third rail.” At this time, inaction would harm Obama and Congress even more in the public eye than action.