Saturday, May 18, 2013

Contact Your Senators About Obamacare (Updated)

(Update: No, a retraction in the comment section is not enough for this one. This post, as written, contained a big bad mistake. I want to leave it as written, as an act of humility; I owe readers a correction at the very beginning. The system I describe the Veterans Administration using, below, is the one that had worked for many veterans, including my father, in the twentieth century. Around the turn of the century the V.A. switched to the insurance-based system that is not serving younger veterans nearly so well. I should have researched that before blithely posting about the system I remembered. I apologize.)

Is Obamacare "a train wreck" for the U.S. economy? Absolutely. That's why the U.S. House of Representatives voted to repeal it.

So why did otherwise decent people support it? Well, I don't know about your U.S. Senators, and only one of mine was in the Senate at the time...I think people like Mark Warner supported Obamacare because:

(1) Social Security, SSI, Medicare, Medicaid, etc., use money paid into a federal fund by working people to provide pensions and medical care payments to retired people. When the system was set up, it worked reasonably well for people in both categories. As the proportion of retired to working people in America has increased, the system has become unsustainable. We need additional funding to secure the material comfort of older people...and a lot of us are moving into that "older" category.

(2) Obamacare was what was proposed, and people all up and down the Democratic Party, like Hillary Rodham Clinton, Mitt Romney, Harry Reid, as well as Nancy Pelosi, were prodding other Democrats to support Obamacare even if they saw problems with it: "We've got to pass it in order to know what's in it!" When an occasional Democrat, like Rick Boucher of blessed memory, tried to act on principle and straighten out Obamacare before s/he supported it, these Democrats tended to fall between the two stools--as Boucher did--and lose the next election.

(3) Because some people really and truly do see Obamacare as a way of "caring about" their poor old grandparents who "have to" take $200 worth of pills every day to survive. And although these people may be clueless about real health care, they really and truly do care about their grandparents. Many Democrats are in this category. Some people who read this web site may not have many opportunities to observe the behavior of Democrats; I can assure those people that caring, though uninformed, Democrats were burning up the phone lines. "It's not decent for Americans to allow our grandparents to suffer and die for lack of medical treatment, we have to find a way to fund whatever sort of care will keep them with us a little longer," etc. etc. etc. "Don't argue about the perfect way to do it, just vote for a national 'health care' plan now and fix it later...'cos I'm due to retire soon, too!!!"

There may in some cases have been other, less honorable reasons why some of our Senators supported Obamacare. If you know for certain what those reasons are, then replacing your Senator may be a high priority. But I'd like (once again) to ask Tea Partiers to think about the most obvious reasons why anybody ever voted for Obamacare. They are reasonable reasons. We can work with these reasons and people. We can convince them that there are better ways to secure the comfort of our senior citizens, and our future selves.

If you've been thinking that we need to leave all health/medical care decisions to the individual, you should be aware by now that you're in a minority. Most of us do have some elders who aren't wealthy; most of us want those elders to be as comfortable, at age ninety, as the ones who are wealthy. Most of us are even willing to pay taxes to support some sort of federal medical care fund, if that fund is set up in such a way that there's any chance at all that it might work.

How do we make a national medical care plan workable? First we cut out the unnecessary expense of the insurance system. Our national plan has to work on a pay-as-we-go basis, rather than being a gamble. We can pay only the actual costs of medical care, which do not include the expense of maintaining any insurance companies any individuals may privately choose to support.

My own preference would be to require all existing insurance companies to refund all money they had received, and criminalize any future insurance schemes...but this is America and I have no constitutional right to impose my religious beliefs on other people. Nor have the people, like Mitt Romney, who sincerely believe that everybody ought to buy into an insurance scheme.

However, to keep the cost of a national medical care plan low, we allow funds to be used only to pay for treatments that have actually helped a patient, and only if the patient has produced evidence that s/he can't pay for those treatments.

Another consideration for many people is privacy. Medical researchers would have an easier job if everybody's complete medical history were on record in a central database, where they could count exactly how many people who received a certain treatment for, say, head lice complained of, say, hair loss fifty years later. Other people, even some people who do medical research, think about this issue a bit longer and realize that we don't necessarily want everyone to be able to find out whether we've ever had head lice.

Nor do we want busybodies telling us what to do about them if we have. I grew up hearing that eating lots of whole-wheat bread was the key to regular digestion. Around age thirty I discovered that for me, personally, eating whole-wheat bread was the primary cause of my chronic irregular digestion. Now we're all watching Mayor Bloomberg's mock war with Coca-Cola, the big pretext for inflating the price of soda pop, and being told that soda pop causes obesity and tooth decay. I drink soda pop; I've never been obese, and although I have tooth fillings I got most of them while I was a child whose parents didn't let me drink soda pop. Because nobody knows all the answers to anybody else's personal health questions, the mere prospect of a national health care plan is encouraging some busybodies to try to demand that whole cities, or states or countries, become guinea pigs for their own pet theories. This we don't need.

So, to keep a national medical care plan from turning into a scheme to enable people to harass one another, we need to build in some privacy. We need to ensure that people who seek medical treatment have the option of paying cash to maintain their medical records under the name "Cash Customer."

A third consideration is that we need to know that a system is workable. In the United States, we have a small-scale model for a workable medical care system in the Veterans Administration. Any veteran, even an able-bodied veteran who served only a few years in peacetime, has been able to obtain medical care. The process of applying for funds to cover medical expenses is long and tedious enough to motivate reasonably healthy veterans to pay cash. If and when their expenses exceed their ability to pay, veterans may apply for V.A. funds to cover unpaid expenses or even reimburse them for payments they have made, but these applications are reviewed in the year after treatment has been provided. This system has been working for many years. In fact, as I remember from my father's retirement years and as Glenn Beck has discussed in Broke, doctors have had an automatic incentive to bill these cash-paying veterans at a lower rate--not just because the cash-paying veterans tend to command respect, personally, but also because processing payment directly from the patient costs the doctors less than dealing with insurance companies and their nine hundred and ninety-nine ways to get out of paying what they might reasonably be asked to pay.

A national medical care plan does not need to emulate the V.A. system in allocating funds based on length and conditions of service and rank upon discharge. A national medical care plan would probably be better off to prioritize funding in the same way emergency medical personnel prioritize patients' admission to hospitals--the most life-threatening cases first. However, the general idea of encouraging patients to pay cash if they can, then assessing the amount of funds that need to be disbursed and budgeting to cover only what was really necessary and helpful, is something any national medical care plan needs.

(Bonus: By calling it a medical care plan, we'd be taking a long step toward reminding people that they're responsible for managing their own health care plans--caring for their personal health by eating sensibly, going to bed on time, saying no to drugs, and so on.)

Will party spirit cause the Senate to block the House vote to repeal Obamacare? Not necessarily. Awareness of how unworkable Obamacare would be caused Democrats in the House to vote to repeal Obamacare. Senators have access to the same facts and figures that those House Democrats had. If anybody in Congress is still clinging to Obamacare, the reason is likely to be that those people don't know of a better way to operate a national medical care plan. If they read this article, that will no longer be the case.

There is still hope for a national medical care plan that won't destroy our national economy. Please keep your Senators aware of this hope as legislation to repeal Obamacare comes before the U.S. Senate.