The Unbiased Eye

A scientist's commentary on events and culture

Health Care Poll

with 5 comments

An Oxymoron, a Paradox — Or Irony?

It looks like our politicized Supreme Court will finally bludgeon the government’s health care reform to death this week.

The people have Already spoken. A Reuters/Ipsos poll over the weekend found that a large majority of people oppose the existing health care reform, but that in the very same poll, equally large majorities favor all but one of the major provisions, the broccoli provision. I’ll explain why that one’s necessary later, but it’s the provision that requires or mandates that everyone get health insurance. Here’s Reuters report on the health care reform adopted in 2009.

Broccoli

Broccoli

Although the provision might seem to offend the American cowboy spirit of loners on the range, I am struck by the inconsistency. Actually I don’t exactly trust polls. The sampling, which pollsters love to tell you is very careful, very scientific, has a serious flaw in my opinion. The sample is dreadfully biased in that no one — let me repeat, no one — who’s too busy, too impatient or too skeptical would ever take part in an opinion poll. So you can juggle the proportion of old versus young, north versus south, rich versus poor, highly educated and practically illiterate and you still won’t create an unbiased sample.

Then, in an effort to sound scientific, the polls are written to be precise, with questions always asked in the same way, as if ambiguity was not built into human language. I’ve subjected myself to one or two opinion polls, and the experience was frustrating. I don’t live my life on a scale of 1 to 5, one being the least and five being the most.

This is interesting. Polls frequently turn up such glaring inconsistencies, really oxymorons, and logically puzzling paradoxes. It’s because of the way we talk, and the way we think. With a wave of the hand, someone dismisses all politicians. Aw, they’re all crooks. And then proceeds to say he’s voted for the same Congressmen at every election for 24 years. It’s so common, there’s an aphorism for this.

Finally, polls take on a life of their own, injecting their spurious conclusions into the political scene, and the effort to measure sentiment starts to motivate sentiment in and of itself.

I feel dread about health care. I fear that the right-wing majority on the court is satisfied that their broccoli analogy talks to the people. That would be sad. Forgot about broccoli? That’s the one in which Justice Scalia claimed that mandating health coverage is just like mandating people to eat broccoli.

Scalia

The reason I like Obama’s health care reform is the simple fact that it does something. And something has to be done — even if it’s not perfect.

We are drifting into a society where people’s lives and well-being will last only as long as your health lasts. Without health insurance — some kind of shared responsibility for each other — we will be back to the good old days, like Dickens’s London, or our own gilded age.

One of the difficulties with the politics of health care is the numbers. As long as 51% of the people are happy with their employers health insurance, the other 49% can go screw. Deep down, I’m quite sure that’s the way most people think, and it’s rational for them, selfishly, but only as far as they can trust they will keep this insurance.

Not that long ago, many people went to work, expecting to be signing on for the duration. Lifetime jobs were common. Sure there were some professions where the action was fast and furious — like the movie business, the advertising business. And there were some that were irregular structurally, like construction.

Now be honest, do you know of any contemporary job creators who promises to stay put and not pick up and go somewhere else to save a few dollars? Insecurity is built into our economy now. No one’s making an commitments.

So how do you come to have such great health care? And to be sure some of the plans that come with big corporate jobs are nice. The employee whines if his share of the premium goes up to $125 a month, from $100. If he were to buy the same plan in the free and open market, it would cost more like $1,000 a month.

Is this evidence of the generosity, or even the efficiency of your job creator? Hell, no. This is what happens:

  • Your employer gets a huge discount from the insurance company. The main reason is that the insurance company can bet that his workforce is old enough to know better; young enough to stay healthy, and stable enough not to self-destruct.
  • Your employer gets a huge tax break for buying this already discounted insurance.
  • Your employer knows that if you had to pay for it yourself, he’d have to pay you $10,000 or $20,000 more a year.

Guess who pays for all this? In part, I do. Someone pays. I have to pay huge sums to get minimal insurance. Any of you can go to the doctor any time you have a sniffle, as often as you like, and it doesn’t cost you anything. And all of us pay. We all support the uninsured when they waste resources by going to the emergency rooms because they have no where else.

Conservatives love to talk about financial responsibility and personal responsibility, but then why are they so committed to a system that gives giant handouts to businesses?

Now, let’s get back to those broccoli evaders that Scalia is so worried about. The health care system needs the participation of everyone to make it work, so we all get benefits, and we all pay for them. If you have lots of money extra, you can go get plastic surgery every five or six months, and you’ll still have all the advantages of the American health industry. But you would have to pay for the extras, and not bury it in your company’s extravagant executive benefits package, so that we have to pay for you (tax deductions) but you don’t have to pay for us.

People in politics are pretty sure that without a mandate, young people simply won’t buy insurance and therefore won’t participate. They don’t often get sick, so it’s a logical decision, but it kills the system. This argument rings true to me. When I was 20, I’d never have wasted my money on health insurance. When I was a little older, I had it, however, because I was employed by companies that gave it to us. And still I almost never went to the doctor.

Notice that I have not mentioned the insurance companies, the ones who have created the mess we have, and continue to rake off 10% or 15% of the health economy. They have create a bureaucratic nightmare and have imposed firm control over decisions doctors make.

But the health care reform law didn’t touch them. Like I said, Obama had to start somewhere.

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Written by theunbiasedeye

June 25, 2012 at 3:59 pm

5 Responses

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  1. The healthcare reform will make things worse, my friend. For many reasons. I work in healthcare in California. We are so overLoaded with illegal aliens getting free healthcare, that many hospitals are in the red. Um…illegal aliens won’t pay the penalty tax because….they don’t pay taxes! So guess what…that won’t change, and prices will continue to go up for healthcare, which mean you will have to pay more for, your now mandatory insurance. What this is going to do is drive out MDs from practice (they can’t afford to get minimal reimbursements to no reimbursements), hospitals will have to close, and you will have to wait for services just like those countries with socialized healthcare. We are already seeing government dictate medical practice….go to the Centers for Medicare and Medicaid website. If MDs and hospitals do not follow the government’s prescription for certain diagnoses…we don’t get reimbursed. No reimbursements lead to higher costs to those others that allow for individualized treatments.
    The care you will receive will decline. Not because the skill level is less, but because the healthcare worker will have less time to devote to you. Hospitals are going to have to make cuts as reimbursements decline, just to keep their doors open.
    I can go on with the reality of healthcare reform. What needs to happen is a reform in costs, not in the system. Reforming the system means too much govement involvement. And unfortunately, reforming cost will also mean renegotiating wages with the Labor unions, SEIU being the biggest.
    In theory, healthcare for all sounds great. But in reality, the consequences of what we have to look forward to is not good at all.

    C R

    September 10, 2012 at 12:59 am

    • Thanks for your comment. I know the U.S. health care system only as a client, a buyer of health insurance and an occasional consumer of health services. I’ve worked for all but perhaps a few months of my adult life, mostly as an employee of a fairly large company, and recently for myself, as the vaunted small businessman — very small, since I’m on my own. My view of the current system is that it can hardly get worse. It’s entirely run by big profit-making corporations, mainly the insurers and the drug companies. The former is as bureaucratic and rigid as any state’s Department of Motor Vehicles and the latter is out of the wild west. It’s not possible for doctors to spend less time with patients because they barely spend any. I understand that the emergency rooms are overloaded with the uninsured, precisely because they are uninsured. Surely you don’t think that migrant farmworkers who are taken advantage of by everyone want to sit in the waiting rooms for eight hours. They would much rather go to a family doctor, but they’re uninsured and cannot afford one.

      One of the many quirks of our super-efficient system is that if you are uninsured you pay two, three or four times more out of pocket than the insurance companies pay. Why? Because they cut deals with hospitals and doctors and drug companies to get discount prices since the insurers only insure the best bets — younger, healthier, more successful and more stable people. I had a recent thing, and I can read the insurer’s “explanation of benefits”. The list price for a individual without insurance was four, yes four times higher, than what the insurance company paid, including my copay. They also give bargain prices to businesses. I don’t know what you do in health care but perhaps you know something about the pricing. I’m in business, a sole proprietor, but as a single employee, I can only get individual rates. If I hired one person, I would qualify for some insurers business plans, and cut my cost in half. In addition, if I did that, my employee’s benefits would be tax deductible to the business. Does all that sound fair, reasonable?

      There are many big things that the new law fails to address, mainly the rising cost of health care. The bureaucracy we have prefers tests and checklists over medical judgments. Whenever a doctor suggests a recommended procedure, I look it up. Most times, medical researchers are hotly debating whether this very same test is useful in any way. I find that doctors do as much as possible with regard to these tests and minor procedures (sometimes major procedures) as the insurers are sure to pay. In a very real way, the insurers don’t care about the rising costs, because in the end the government (us, you and me) pay through the generous tax deductions handed out to our nation’s corporations.

      And the problem of overtreatment, especially for the elderly, remains unspoken. And if I were a politician, I wouldn’t breathe a word about overtreatment because of the firestorm and lies such a discussion would entail — as we saw in 2008. But my main point of view is that we will never do anything, if the insurance-run system we have gets to block any reform less than perfect.

      theunbiasedeye

      September 10, 2012 at 8:00 am

      • Thank you for expounding on your side of the issue, specifically individual cost vs. contracted costs. This may not be the best analogy, but it is almost like buying bulk/wholesale vs. buying one of something.

        As a healthcare worker, I worry about the quality of care that will be compromised. Hospitals and doctors are businesses/businessmen in the business of caring for people. But, in the end, they are businesses. I work in a hospital, and we are already paring down to brace for the impact. With less resources (people) around, the quality of patient care suffers, not because of a lack of caring about sick people, but because you can only do so much. And I also tell you that government agencies from the state to federal level, require so much reporting and documentation (jumping through hoops) to either certify us to keep our doors open or just for reimbursements. And this is just the beginning.

        Cost, in my view, is a huge problem. I have seen, recently, a clinic open up or the uninsured or underinsured that is funded by the govement, and I think this is a great idea. We need more of these as well as urgent cares to alleviate the burden on ERs.

        And I also agree with you that over treatment is an issue. I see unnecessary testing all the time. Physicians will tell you, however, that if they don’t cover all of their bases and miss something, a malpractice suit threatens them. This opens up a whole other problem…..

        Instead of coming up with a blanket health care reform act, why not tackle each issue? Pick it apart and spend time instead of throwing a cup of water on a burning house.

        C R

        September 10, 2012 at 10:41 pm

      • I think that you have gotten to the heart of the question: is health care a business or a public service? The notion that business does it better, no matter what it is, is an insidious, destructive trend in our country.

        Society doesn’t buy health care from some amorphous, supernatural realm, but it provides health care as best it can, the same way society provides education, national defense, and, yes, the social safety net. It is good for all of us to do these things. Despite the claims of the hot dog stand owner who maintains that he built his business empire on his own, I suggest he relies on government supplied roads, fire and police services every day, and that he learned enough in school to run his operation. He is not out in the wilderness on his own with a musket and his wits, but part of society, whether he is willing to admit it or not.

        There are two reasons for doing this. One is that it is the right thing to do. The other is for the greater good and health of society as a whole. Just a few years ago, much was made of a lie referred to as death panels. It was one of many slanders against health care reform, a political tactic to build support for blocking and then overturning the reform bill.

        Actually, a businesslike, balance-sheet approach to health care is one of death panels, only the panels are the receptionists in doctors’ office and hospitals. No money, no treatment.

        It doesn’t matter that many people who go to the doctors and hospitals of our nation will recover without medical intervention. But for some, the trip to the doctor or hospital is a matter of life and death, and a businesslike, balance-sheet approach will turn your triage nurses into insurance experts.

        You mention patchworks of government regulations that you in your hospital must deal with. From my consumer’s point of view, I see a patchwork of insurance company regulations that both you and I must cope with. Businesses, profit-making or nonprofit alike, are bureaucracies, and as such, the people who run them all operate by the same rules. No bureaucracy is particularly rational or efficient. The most grotesque example of what I mean is on the profit-making side, where almost all banking executives kept their jobs and their bonuses despite the debacle in 2008. Where was the balance-sheet dispcipline that you imply?

        I understand what you say about doctors’ malpractice fears, but my consumer’s point of view tells me doctors start recommending unneseccary test as soon as the insurance companies allow reimbursement. That’s not as dramatic as a malpractice suit, but it’s pervasive. Luckily, I have no personal experience with medical malpractice, but the fears surely sound oversold to me.

        But I take your comment about the blanket approach to the problem serious. From what I understood of reading the health care bills three years ago, it is a patchwork reform whose main value is to recognize the larger, overall issue. I haven’t seen any serious reform effort other than blanket reform acts, such as those attempted by presidents Clinton and Obama, and even the one instituted in Massachusetts by former governor Romney — much as he tries to escape his own history. It is a political tactic to reject the larger effort and call for more study and contemplation. That is the way bureaucrats avoid change and inconvenient improvement.

        In any case, I appreciate this discussion and thank you for it.

        theunbiasedeye

        September 11, 2012 at 6:56 am

  2. Every ER must evaluate patients for a medical emergency before asking for insurance info or payment.
    So, there is no worry of death panels in triage.

    I have not appreciated the exteme viewpoints on either side of the isle that politicians have degraded to. It shuts down open communication and leads to no viable solution.

    Thank you for the conversation. I must leave it there or this will become a political conversation, and since we seemingly do not have common ground politically, it is best to leave it.

    Kindest regards

    C R

    September 11, 2012 at 11:45 am


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