Sunday, January 2, 2011

Debate on Health and Healthcare

Status Update from Lawyer/Solo Practitioner: Eff you, Kaiser. I'm not paying $352 a month for health insurance in 2011. I don't smoke, I exercise, I'm not involved in any risky activities, and I avoid liquor. You people saw me about five times in 2010 and don't even provide me with my hearing aids or dental work. Does anyone have any advice for other health insurance options?

P.S. The biggest long-term medical expenditures will be on Medicare. Do you see what I mean when I say that current American society is financially stealing from the young to benefit the old? Do you really expect us to continue to be the world's superpower when we spend ever-increasing resources--already about 50% of federal tax revenues--on senior citizens? Money is finite. One dollar spent on senior citizens--who've had their chance to save money, have families, and buy homes--is a dollar not spent on the young, who have yet to have families, buy homes, and utilize compound interest.

Rob: Do you drive a car?

Lawyer: Yes, and I have the med pay option on my car insurance.

Older people drive, too. Why not let them pay a higher share of overall insurance costs, given that they've had an additional 30 years to save up for it and have also benefited from the real estate boom--unlike most people under 35 years old? Americans don't understand that the real threat against our way of life isn't Al Qaeda, Iran, or Iraq--it's older people and government workers voting in benefits for themselves at the expense of the young and unborn.

Trent: I have great insurance. Don't use it..have a DR/Hospital phobia. Only go if injured.

Laura: I feel ur pain. I was looking to switch from Anthem BC to Kaiser but rates at Kaiser were slightly higher..

Roger: Start smoking and drinking and engaging in risky activities.

Mary: I've got to point out that I'm certain there are plenty of elderly Republicans reaping the healthcare benefits for which you hold all Democrats responsible.

Lawyer: yes, but the GOP is trying to cut universal healthcare coverage while the Dems passed it, which has caused my premiums to increase drastically over the past three years. I will now have to get a reduced benefit health insurance plan b/c of the Dems. You want me to give them a medal for passing lame, watered-down, insurance-company-friendly legislation? I'd rather cut programs Tea-Party-style if it means I save money.

BTW, isn't it lovely being in a union, where taxpayers like me pay for fed, state, and local gov employees' benefits even as our own costs increase? Ah, those Dems--looking out for their unions. You want me to support a party that doesn't care about small businesses, young people, families, or inflation? I'll take the war-loving whack-jobs over the alternative, b/c the GOP has promised to cut spending and government programs. And Obama's pay freeze on federal gov workers doesn't go far enough--he should have cut salaries by 15% for anyone making more than 75K/year, including himself.

Mary: Oh, and we opened up 3 [police] dispatcher positions today. Check out the CalOpps link on my page, I encourage you to apply.

Lawyer: Re: dispatcher positions, so the government is expanding while the private sector and consumer spending is declining? This will totally long as the laws of economics and math don't apply.

Mary: we aren't expanding. We are perpetually shortstaffed. As a matter of fact, I'm finishing up day 2 of 6, with a 68 hour workweek. For lack of a more appropriate term, I am dog arsed tired... So please, apply, and encourage others to also. I'd love to have my all seriousness. I'm thankful for job security, but this still is no cakewalk. :-(

Lawyer: no well-paying job's a cakewalk. If we keep inflation under control, have a balanced budget, and stop relying on accounting gimmicks and constant bond issues, we can hire more gov workers. The private sector is getting more squeezed than the public sector--I've never seen so many hi-tech working so hard b/c of job cuts. Many engineers I know are working 19 hour days...with no job security, pensions, or lifetime medical benefits. The real problem is that so much of our taxes are going into the pockets of retired gov workers, which leaves your department with less money to hire workers now. Why can't more people see this simple fact? Public pensions cost current jobs and are unaffordable during a recession.

Also, if the private sector economy improves, the issue of gov benefits will not be at the forefront of budget discussions. Thus, the best thing gov workers can do is help the private sector get back on its feet.

Until just recently, the Dems controlled Congress for the last four years. All I see is my costs going up and my income getting more and more unstable. In fact, I've begun representing more gov and union employees now than ever before. It's scary to think that I am getting fewer calls from private sector workers because they just aren't enough of them working anymore, and the ones who have jobs are probably not willing to rock the boat under any circumstances. Sigh.

Mary: I credit divorce :-)

Lawyer: It's all a big mess, isn't it?

Mary: So in a way we are paying your salary too then?....

Lawyer: yes, except it's completely voluntary, and if I don't perform well or provide a service better than my competition, I don't get paid. Also, my services create no long term, unpredictable costs to taxpayers, and my fees are negotiable. Oh, and I have no job security or guaranteed income stream from taxpayers. So yes, to an uninformed person, it's exactly the same thing :-)

In the gov world, if you're incompetent or if they don't like you, they tend to reduce your duties and stick you in a corner somewhere until you retire. In the real world, if you don't perform, you get fired, and I might be able to get you a severance package, perhaps between three and twelve months. (It's usually easier to get a severance if you see a lawyer before you get fired, BTW.) Unlike the gov, the effects of a bad employee in the private sector are finite and definite.

Mary: I will absolutely agree with you in that sense. It is infuriating and a slap in the face to all of us that DO come to work and give our jobs and the public our all when we see substandard employees retained and given the same pay.

FWIW, the union really doesn't do everything in the best interest of even its members. I'm fighting what seems an uphill battle on right vs wrong, negligent retention and nepotism...not to mention favoritism and inappropriate relations among ranks. The union's stance is, "well let's see how it pans out." Um, for the $1,000 I pay you each year in membership fees alone, that answer isn't gonna fly! So I applied for the job in question when it interview was yesterday.

Lawyer: Some unions do a great job protecting their workers, but some are terrible when it comes to protecting the rank and file, especially in some California county hospitals. That's why some union members come to me for advice, even though their union should be the one assisting them. (Hey union reps, you might want to return a phone call once in a while and keep your members appraised of deadlines, including the deadlines to file grievances. I'm just sayin'.)

British Citizen: I love the NHS [national healthcare system in the U.K., which is free for British citizens.]

Rick: I cannot believe I'm attempting to defend Obama, but blaming Obama and fed govt employees for the high cost of your crappy health insurance is just silly and childish. Let me get this right; G.W. Bush and the Republican policies (dragging our troops into Iraq costing us billions of dollars a year, deregulating banks and insurance companies allowing multi billion dollar profits for those companies and their CEOs at the peril of poor and middle class Americans, and more...) took this country into the worst recession in our history since the Great Depression. Now, Obama has been trying to get the country out of recession, stabilize our economy, and yet help millions of Americans who lack any type of health insurance (a very sad condition for any civilized country) and regulate those greedy bank executives. There are many wealthy corporate executives, including the ones at insurance cos, that see their corrupt money-making ways endangered, hence are raising the cost of your less than adequate health insurance to compensate for it. If there are blames to go around, it should be directed to greedy and corrupt corporate executives and their lobbyists and Republican policies, not federal govt employees and the new Health Care law.

Lawyer: it's perfectly consistent to criticize Bush II and also increased healthcare costs. My comments were directed at Congress, which has been in Democratic hands for the last four years. Bush II was a moron, but like any American president, he doesn't have much control over domestic spending. Outside of of a war situation, an American president is just the mouthpiece for his party, especially if his or her party controls Congress.

I don't think the Dems realized that insurance companies would jack up policy premiums so quickly. And I still don't see any plan on their side to deal with the increased premiums.

[Speaking of unfinished business, we also need better financial regulation--we still have not solved the "too big to fail" problem, which is actually worse than before (all the big banks got even bigger).]

With respect to health care, I remember our president saying that the expanded coverage would be paid for by cutting the fat from programs internally, especially Medicare. I supported that and continue to support anything that will cut long term, unpredictable fiscal obligations. I never heard our president say anything about me paying 10 to 15% increased premiums each year for the past three years.

I recently got a pain in a tooth. I have no dental coverage, b/c individual dental coverage plans are generally worthless. (There aren't enough individuals buying dental insurance to make the plans beneficial or worthy of consideration.) I am going to India soon. I am not sure if I should wait to go to India and get dental care there on my vacation, or just pay up here. I am going to take Advil and see what happens in the meantime. It's a bit astounding to me how our country talks so much about small businesses and entrepreneurs and yet does nothing to assist us except when it comes to retirement plans (like individual 401ks, SEPs, etc).

Rick: I completely share your sentiment re rising cost and lower quality of health and dental insurance. Our president and the Congress need to address the outrageous cost of living, including dental and health insurance costs. It's incredible that US corporations are making record breaking profits while unemployment rate and cost of living continue to rise, and the average American is hurting. And then, there are elected politicians who argue less govt and more tax breaks for the wealthy. Meanwhile our country stands in a mountain full of debt which if not properly addressed will break our back. But hey let's give the wealthy more tax breaks so they can enjoy their yachts, luxury cars, and Tiffany & Co jewels, because the rich can stimulate the economy better than average Americans. And let's deregulate big banks, insurance companies and other large corporations and let them make more profits for their executives while they treat their employees like slaves...advantages of smaller government and less regulations.

Lawyer: this post was never about "smaller government," which is a different discussion. My post was about a poorly conceived healthcare law that has caused my premiums to increase 10 to 15% annually over the last three years, when the Democrats controlled Congress. The Dems passed a healthcare law that was supposed to be paid by cutting spending, not increasing premiums. They apparently did not anticipate insurance companies increasing premiums quickly or did not pass a healthcare law properly drafted to protect the young and middle class.

Insurance companies are a necessary evil that keep healthcare costs in check. Without them, our long-term healthcare costs would be even higher. We ought to have better procedures for contesting denials of care and reimbursement, but we shouldn't lose sight of the fact that insurance companies prevent healthcare costs from spiraling out of control.

Democrats like to joke that Republicans want older people to die quickly, and the GOP talks about rationing and death panels, but no one is questioning the wisdom of paying billions of dollars annually to give grandma and grandpa an additional 6 months of life and all the morphine they want. How did healthcare costs increase so much in 30 years? Is it b/c we used to let older people and people with terminal illnesses die comfortably instead of doing everything we could to prolong their last six months of life? How did Americans survive 30 years ago without Xanax, Prozac, etc.? Are we a more healthy society than we were 30 years ago?

The medical doctor who helped draft the original healthcare bill knew that healthcare expenses during the last six months of a patient's life were outrageous and needed to be reduced. In other words, the Democrats did in fact try to pass a law rationing medical care, which would have been a significant achievement. But insurance and drug companies quickly realized that the original bill would cut their profits and watered down the legislation using GOP scare tactics of "death panels." Now, instead of paying for universal coverage via spending cuts, people like me, you, your children, and the middle class will be paying for it. And it's b/c Americans were too naive to understand that rationing over the last six months of a patient's life is necessary to control healthcare costs.

Rick: I agree with end result of your proposal, but the way to get there should be better articulated than to cut govt employee salaries or reduce the size of govt agencies. Now, if studies prove wasteful spending in certain areas of govt, then yes they should be cut off. Govt should be here to protect the citizens not to waste their tax money.

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