For RSS Readers: Yes, this is a political post. My blog, my POV, generally uncensored (although I keep it pretty clean). Sorry if you don’t like. I rarely, if ever mix politics with anything else, but this was important. If you ARE interested in more articles like this one, please see ReformHealthCare.US, which I also run.
Recently I wrote my local House representative, Ginny Brown-Waite (R-FL) about health care. With all the news going on about it, I really wanted to make sure she knew what my wishes were. Maybe, just maybe, I wouldn’t be the only one and she could be persuaded to support a plan which brought about universal coverage without giving the health insurance industry a big wet kiss and a present.
Here are the points I made in my first email:
- She should support a plan with a public option. Of course, I could understand if she was philosophically opposed to it. I respect that. In lieu of a public option she should…
- Support a plan which regulates insurance companies more tightly, and optimally makes it illegal for primary health insurers to make a profit. (The US is the only place in the world in which it is legal or insurers to make a profit from primary health care insurance.) If the government does this it does not have to set up a mega-system. In fact, a well structured system can eliminate the need for Medicare/Medicaid and offer a cradle-to-grave care system.
- Canada and England get talked about all the time, but they’re not the only systems out there. In fact, unlike those two, which are completely socialized, most systems are a combination of public and private plans. (I then listed examples of various capitalist democracies (just like we are) which give everyone health care and have a more private competition than we do here.)
- We already have a great, cost-efficient and well run public system. It’s called the VA, and it has one of the best track records in the world (for everything other than mental health). If a public option is to be considered, let it be modeled after that.
I went on to explain each of these points in detail (something I may do here if called upon to do so). A few weeks later, here was her response to me:
On Thu, Sep 24, 2009 at 5:50 PM, Congresswoman Ginny Brown-Waite [fl05ima .email@example.com] wrote:
Thank you for bringing your concerns to my attention. I appreciate the time you took to contact my office on this important issue and welcome the opportunity to respond.
President Obama recently told Democrat leaders in Congress that any bill proposing reform of the health care system must include a new insurance plan run by the federal government, akin to Medicare or Medicaid. If this option is available to all, it will likely underpay physicians and hospitals the same way Medicare and Medicaid does. Therefore, it will be much less expensive than private insurance, and the Congressional Budget Office (CBO) says Americans will rush to join this new system. This will cause employer-based insurers to lose business and many will be forced out of business altogether. While President Obama has called these claims “scare tactics,” a recent report by the CBO confirmed that a government run plan will move people off private insurance and in to the government’s plan.
There is no country in the world with government-controlled health care that does not ration care. We are constantly told by President Obama that the quality of care in these countries is so much better than our own, yet he conveniently neglects to share with you any of the horror stories. Trust me, they are not to difficult to find and serve as an excellent reminder that the grass is not always greener on the other side of the street. Furthermore, Americans have become accustomed to a health care system that spares no expense even in the face of grim odds. This fact leads me to believe that Americans would have a difficult time adjusting to the inevitable rationing of health care services.
While I disagree with many of the proposals I have seen thus far, I am committed to trying to influence the final product with provisions I think are absolutely necessary. First and foremost, I believe that everyone should have access to a physician, and also have a choice in which physician to see. In England, physicians are assigned by zip code, which is just absurd. It is imperative to protect the doctor-patient relationship and not allow the government to intervene.
As your Representative, I will continue to advocate for proposals that place the choice of health care in the hands of citizens and keep the government out of your doctor’s office. One plan I greatly favor is allowing the purchase of insurance across state lines. State legislatures are responsible for determining which services insurance companies must cover, and some states have more mandates than others. For example, individual insurance plans in New Jersey cost six times as much as if the same person were to buy insurance in Kentucky. If the federal government could allow everyone to buy insurance from a different state than they reside in, the choice of plans would increase and price would decrease dramatically. Unfortunately, I am not aware of any Democrat proposal that has adopted this outlook.
Throughout my tenure in public service, I have always kept an open door and an open dialogue with my constituents. As Congress addresses the many challenges facing our nation, I hope you will continue to share your thoughts and views with me. Accordingly, I encourage you to visit my Web site at http://brown-waite.house.gov to email me and find useful information about our 5th Congressional District.
It is my honor and privilege to serve the people of Florida’s 5th Congressional District and my offices and staff are here to provide you with any assistance you may need.
Member of Congress
Yeah, this lady’s a partisan hack. Fear-mongering, misinformation, childish name calling… that’s exactly the kind of message you want to send your constituents! The tone is that of a person who is elected to be a representative for her party, not a representative for her district.
I’m considering the following as a response, which I wrote in anger (so yes, it’s somewhat ranty.) The first letter was in email form. This would ether go via snail mail or hand delivered. Of course, I might just go into her office and see if I can meet with her (not likely).
Dear Congresswoman Brown-Waite,
After reading your response it’s hard for me to tell whether you even read what I sent you. It was obviously scanned, and the overarching subject matter addressed, but it is obvious you either didn’t read it and sent me a canned response, read it and decided to send me a canned response anyway or simply thought addressing me was beneath you and threw a party line of “Government takeover! Rationing! Democrat leader! Scary!” I’m disappointed. Not responding would have been better than what you sent.
That said, you’re my representative, and as such I will continue to make sure you know my viewpoint if you are to speak on my (along with my district’s) behalf.
Had you read my previous letter, you would have at least acknowledged that there are VARIOUS other models out there other than the NHS (which is indeed MOSTLY socialized, not totally) at work in capitalist representative democracies. In fact, most of the world has a hybrid public/private system where private insurers, hospitals and providers are allowed to operate and are able to cover everyone for far less than we do here. (A lot of that, by the way, has to do with the culture, but this isn’t something we’ll take care of in 2 or 3 years. It may take a generation.)
By the way, your gross oversimplification (and mocking demonization) of the NHS is an insult to the British, to all Americans who get health care through socialized medicine (i.e., the VA), and to anyone to whom you’ve ever sent that letter. You’ve done your country a disservice. In addition, it reveals a certain level of ignorance on your part. (You obviously don’t know that Britain actually has a very robust private insurer market. It’s not all socialized.) Please take the time to educate yourself on this very important subject, learn how other thriving capitalist republics do this health care thing, and look past the blinders of party politics and Washington spin:
(Disclosure: the aforementioned links were all created by T. R. Reid. He offers some of the most complete international health care analysis available.)
And you also talk about “horror stories.” Yes, sure they have horror stories. Everybody can dig up a horror story. But unlike those other countries, we are the richest country in the world, and have THOUSANDS of people losing their homes and going bankrupt due to health care, IN ADDITION to people who are denied care, rescissions in the middle of therapies, random rationing based on a profit motive and more! Sorry dear Congresswoman, you live in a glass house. Don’t throw stones. If we’re to compare side by side, you’ll see that socialized health care systems like the NHS tend to produce better overall health care results according to the World Health Organization. Alas, my interest is not in a socialized health care system like the NHS (although if that were on the table I would have little problem supporting it. A VA-style system for all sounds GREAT! Did you know that the VA has the highest satisfaction rating of any insurer?) My interest is in universal health care that is not subservient to corporate interests. Whether this happens with a socialized system or with a capitalist system is inconsequential. (If you could step away from the party lines, you could clearly see there are more than two sides to this debate.)
In fact, let’s look at systems which use private insurers.
Take Switzerland’s system, for example: Switzerland is a country, but it’s more like a collection of independent states than a completely coherent nation. (Sounds familiar, doesn’t it?) Because of that independence, which culturally works much like the US, a national, socialized system there does NOT make sense. In fact, until 1993/4 they ran their health care system almost exactly like that of the US. They had the same problems! Since then our paths diverged: we gave up the idea of universal health care, and instead instituted HMOs, creating a health insurance problem in the US which is costing us billions a year. The result: ~40-million uninsured. Switzerland, on the other hand, made it illegal for providers of primary care to make a profit, but made insurance compulsory. The result is that now everyone there is covered, everyone can afford insurance, and their per-capita expense is lower than ours. No socialized health care, not even socialized insurance, but a thriving health care market nevertheless.
How can that be? The fact is that insurers are not much more than a payment delivery system. Why should they be allowed to profit from primary care? They don’t produce anything, they don’t add value to anything. All they do is get money from point A to point B. This is all they do and for this they charge a 30% overhead (and more), which is why they’re able to pay their CEOs millions. Think about it this way: Imagine that your bank account charged you an extra 30% every time you used your debit card. That would be criminal, and congress would be in session until something was done about it! Yet this is exactly what’s happening now with health insurance.
As for-profit entities, health insurance companies’ primary responsibility is NOT to deliver or ensure service, but rather to make a profit. How do they make profits? By increasing costs and denying care. (By the way, my insurance rates went up 30% this past year. They went up 50% the 2 years prior, and 45% the year before that. Even Zimbabwe laughs at that level of inflation.) Their main goal can either be providing care or making a profit, but not both. Frankly, if they are allowed to continue making a profit, then I beg to be put into a non-profit public option. At least then I know my costs are going to care rather than bonuses.
Now, before you scoff at this as a crazy idea, know this: THE UNITED STATES IS THE ONLY INDUSTRIALIZED NATION IN THE WORLD WHERE HEALTH INSURERS ARE ALLOWED TO MAKE A PROFIT FROM PRIMARY HEALTH CARE INSURANCE. Keep in mind the world PRIMARY. Humana and UnitedHealth and Aetna would still be able to make a profit from secondary care insurance–breast implants, cosmetic reconstruction, gastric bypasses, gender reassignment, skin removal, etc–but payment for primary care, the kind of care you can’t opt-out of by virtue of wanting to live, should NOT be a secondary consideration to profits.
Let’s take another example: Japan. Again, there is no “public option” there, no socialized medicine. In fact, 80% of the hospitals there are privately owned: even more than in the US! There, however, the government imposes very strict pricing controls on doctors and hospitals. This has given them an impetus to create cheaper machines and deliver cheaper care. Did you know that while an MRI in the US can run from $1200 to $1500, in Japan it’s $90? Also, they have private insurers. For people who can’t afford insurance (if out of a job, for example), they are provided with social care (much like our medicaid). This is very much like what’s being proposed now with one exception: PRIMARY HEALTH INSURERS ARE NOT ALLOWED TO MAKE A PROFIT. As one government official in the film to which I link says, “It is forbidden.” Let me say again that the United States is the ONLY place in the world where insurers are allowed to make a profit. For the record, Japan spends 1/2 what we do on health care and live longer. And something you might not know: they don’t have waiting times! You can walk to see your doctor at just about any time. Me? I have to wait 2 months to see my primary care physician. (By the way, I bet you didn’t know that Europe has twice as many primary care physicians as the US per capita. If you actually read this and care to ask me why I will happily explain how.)
That reminds me, since we’re talking about my PCP having to ration time, let’s talk about that subject. Here’s what you said:
“There is no country in the world with government-controlled health care that does not ration care.”
(Then you continue on about horror stories, something I’d expect from attention whoring troglodytes like Glenn Beck and Sean Hannity. I expected far better from you, Congresswoman.)
Here’s a hint: THERE’S RATIONING RIGHT NOW WITH PRIVATE INSURERS! If you honestly believe there isn’t then you don’t understand economics and should resign your seat immediately. If you understand economics then you just lied to me or haven’t taken the time to actually think things through. (Based on your email, I fear the later, though hope for the former, which would at least make you competent.) Here’s an example of very real rationing going on right now: on my health insurance receipts it states very clearly: “Lifetime maximum: $2.000,000.” That, by the way, is for me and my family. Suppose my wife gets pregnant and has a complicated pregnancy. She gets preeclampsia. Baby has to come out early because my wife’s life is in danger. Now I have a wife in the hospital with an emergency procedure and a baby on life support. How long will that $2,000,000 last me? Realistically about a month and a half.
This is rationing, plain and simple, rationing which A FOR-PROFIT SYSTEM ENCOURAGES BECAUSE THE DELIVERY OF CARE IS A LIABILITY, AND THEREFORE AGAINST THEIR PRIMARY PURPOSE OF PROFIT. Here’s what you said:
“Americans have become accustomed to a health care system that spares no expense even in the face of grim odds.”
This is patently false, and if you truly believe this, you haven’t been paying attention.
I’ll use a final example, Germany, the birth place of the employer-based insurance system most working Americans are participating in today. Germany has a universal multi-payer system with two main types of health insurance. Germans are offered three mandatory health benefits, which are co-financed by employer and employee: health insurance, accident insurance, and long-term care insurance.
– Accident insurance (Unfallversicherung) is covered by the employer and basically covers all risks for commuting to work and at the workplace.
– Long term care (Pflegeversicherung) is covered half and half by employer and employee and covers cases in which a person is not able to manage his or her daily routine (provision of food, cleaning of apartment, personal hygiene, etc.). It is about 2% of a yearly salaried income or pension, with employers matching the contribution of the employee.
– The third is the health insurance system. There are two separate systems of health insurance: public health insurance (Gesetzliche Krankenversicherung) and private insurance (Private Krankenversicherung). Both systems struggle with the increasing cost of medical treatment and the changing demography. About 87.5% of the persons with health insurance are members of the public system, while 12.5% are covered by private insurance (as of 2006).
Now, this brings up something very important with both their system and ours. Under their system the top 12% of earners can completely opt out of paying for the universal insurance. This creates a situation in which some doctors are underpaid. Sound familiar? That’s because in the US we have a similar problem with Medicare. Currently, Medicare gets stuck with the sickest of the sick. The for-profit health insurer can cherry-pick all the healthiest individuals and dump the rest on the public system. At 65, when people start their decline in health and are retired (and therefore not paying into the system), people are dumped off onto the Medicare.
Think about it: those who cost more are dumped by the health insurance companies (some of which simply will NOT cover you if you’re over 65) who let the public foot the bill. The health insurance companies take all the profit from all the years of health insurance premiums when they’re young and healthy, and we get stuck with the bill. This is a big reason for the cost of Medicare. Removing the profit incentive from health insurance companies (and regulating them along the lines already being proposed) would mean that if a company wanted to make money they would continue supplying care. We could create a situation like Germany’s, where people are covered by the same company from womb to tomb. That would certainly alleviate some of the stress under which Medicare finds itself.
I could continue this with country after country: Taiwan, France, Italy, Canada, Australia, Denmark… they all insure health care differently. They all have different solutions. And unlike the US, they all cover everybody, pay less than we do, and live longer. Oh, and in none of these do you have a government bureaucrat sitting between you and your doctor, like what you suggest. Unlike now, of course, where I almost literally have a businessman sitting between my doctor and I. (It’s why they always have to ask permission for procedures, to “clear it with the insurance company first.”)
The American health care system is great in many ways. Our cancer survival rate is the envy of the world. Our hospitals are in many ways what the world strives for. Wonderful. And the health care system really has the potential of being the best in the world, as it once was. But the American health insurance industry is hampering those efforts due to profit. By keeping with the party line as you have, by fear mongering and by making arguments which have shown time and time again to be false, you are part of the problem. Either begin to fix it or do your country a favor and resign.
I look forward to hearing your reply. However, if it’s not going to be well thought out, if it’s going to be another couple of paragraphs of fear mongering and party lines, then don’t waste your time or mine. And for the love of your self respect, stop with the fear mongering: it just lumps you in with the extremists.
“Democrat Leaders”? You mean “Democratic”. If this was a mistake, then please correct it. If it wasn’t then please stop with the childish political games. All it does is alienate constituents and cast you as an ignoramus.
Thank you for your time,
Angry, I know. I shouldn’t be this angry over a form letter, but it’s disrespectful and dishonest, and so I am. Still, before sending it, I’ll cool down some.
[Edit] Upon review, I think that there’s simply too much information here. My mistake is in trying to be completely transparent with my thought process and intellectually honest. Maybe if I could some how fit this all in a bumper sticker. What do you think, “Womb to Tomb: Health Care for All”? “Socialism: Not Europe’s only export”? I don’t know, I’ll play around with this.