Friday, June 19, 2009

Regarding Health Care Reform

(This essay on health care reform is a work in progress but these are my thoughts at this time. More documentation and more thoughts to follow.)

I don’t want more government; I want less. I wish government nowhere built sports stadiums or convention centers. I would even support privatization of some current government services such as our Interstate Highway System, TVA, and mail delivery, so I certainly do not advocate nationalizing health care. I don’t want socialized medicine. I don’t support “single payer.” However, I think we must do something about health care in America.

In a recent CNN poll, 80% of Americans said they were satisfied with their health care. That may be seen as an excuse to say, “Leave well enough alone.” We can’t. There is a crisis. We cannot continue along the current trajectory. What we have is not working very well. We have a problem. Just saying “no” and supporting the status quo is not a solution. We need to get all the smart people in a room and figure out what needs to be done. I hope there really is a debate about health care. I am not sure what reform, I can support at this time but as I think about the issue here are some “givens” on my part in this debate.

We need health care reform. I accept that what we currently have is flawed and needs improvement. It is not sustainable.

Health care costs are rising. Health care costs are rising considerable faster than increases in the general price index.

Rising health care cost will wreck the economy and bankrupt the government. (More to follow.)

We do not have the best health care in the world. “Best” is a subjective term, but by many measures we do not have the healthiest people on the planet. What we have may be the best that money can buy but unless you are extremely wealthy you can’t afford the best.

The you-want-be-able-to-choose-your-own-doctor argument is exaggerated. Until we see the particulars of a specific plan this argument is nothing more than an attempt to manipulate people into opposing any change. Most people do not now go through a methodical process to choose a doctor. How many doctors did you interview before you ending up with your current doctor? I belong to an HMO and can choose from quite a long list of doctors but they have to be on the list. Unless we end up with a very draconian, almost boot camp military-style health care system, you will probably have about as much choice in choosing a doctor as the choice you exercised in choosing your current doctor. In many cases your current ability to choose a doctor depends on what kind of insurance your employer provides you.

Employers should not provide health insurance. There is nothing natural or inherently rational about your employer providing you with health insurance. The practice of our employer providing our insurance really took off in World War II when the nation had wage and price controls. Employers could not offer higher wages to attract labor but they could offer better benefits. Unions also had a roll in pressuring employers to provide insurance. Your employer should no more provide your health insurance than they should your home insurance or auto insurance. How many people are working at a job they dislike, just for the health insurance benefits? We are like serfs on the manor. We are often tied to our desk by our insurance. Breaking this tie would be liberating. Divorcing insurance from employment would free labor to me more mobile. I suspect that if people were freed from a dependency on their employer for health care, we would see a growth in small business and more overall economic growth.

Taxing of health care benefits should not be taken off the table. I do not want the taxing of health care benefits to be used as simply a tactic for destroying consumer choice and forcing most people into a government insurance program, but the concept that health care benefits should be taxes seems rational. If you are receiving your health insurance from your employer that is the equivalent of additional income on which you are not paying taxes. If all other factors are equal and you earn $30,000 and get $3000 worth of insurance benefits and your neighbor earns $33,000 and no insurance, should he have to pay more in taxes than you do? I don’t think so. It is usually the lowest income earners without employer provided heath care benefits. I am generally opposed to increasing taxes, but part of health care reform should consider taxation of employer provided benefits.

There is not a functioning “market” in health care/the market does not work. There is really not a price for health care cost. For some services, such as an office visit there may be a set price, but it is very difficult to actually determine the cost of a medical procedure and a hospital stay. The price is a function of who is paying the bill. Different insurance companies have different reimbursement rates. Many times those without insurance are charged a much higher rate than those with insurance, yet in many cases they default on the bill and do not end up paying it. Those without insurance who are charged the ticket price often bankrupt on medical bills. The roll of price as a reflection of supply and demand for a service is simply not functioning in heath care.

When a third party pays for a service, demand and cost will rise. It really does not matter whether it is the insurance company or the government paying the bill, when a third party pays the bill, people do not consider what something cost. Also, when the patient is not the one paying the bill, service providers are not as mindful of the cost. Imagine you paid a set fee for groceries and then someone else paid your grocery bill, would you eat more steak and lobster? Would you care what something cost if someone else was picking up the tab? If someone else is paying the tab, that someone has to have a roll in restricting supply. Whether it is your insurance company or government; someone has to control cost when the consumer is not the one paying the bill.

The government is already involved in health care. Many opponents of health care reform argue they do not want the government involved in health care. The government is already involved. Medicare, Medicaid, SCHIP (State Children’s Health Insurance Program), and Veterans hospitals already account for over 50% of American health care spending. On top of that, each of the fifty states has massive bureaucracies to regulate health insurance and often dictate what insurance must cover and what they can and cannot do. Also, many cities support charity hospitals and public health clinics. Most cities and states have a Department of Public Health. A lot of medical research is paid for by government grants.

Too much is spent on health care administration. With a variety of complicated health care plans and a different set of government rules in each of the fifty states, we have too much of our health care dollars spent on paperwork, bureaucracy, and administration. Surely there is a way to reduce the overhead.

Too many people are without health care. 46 million Americans do not have health insurance and the number without health care is rising. A third of the companies in America do not offer their employees insurance. Many individuals are uninsurable. This of course does not mean all of these people are totally without health care. Hospital emergency rooms are required to serve anyone with an emergency. So, without regular health care, many people depend on the emergency room for all of their health care. Who pays? We do. Free services given away by hospitals are covered by increasing the cost to the paying customers. When this happens, your health insurance cost increases. Also depending on the emergency room care for health care means many people do not get preventive care or get diagnosed for an illness until it is advanced.

Not all of those without health care are unable to get it. There are some people (we don’t know how many but maybe up to half of those without insurance) who are now now covered by insurance who could now get insurance if they wanted it. Some of those without insurance are young adults who think they are invincible and prefer fancy cell phones and electronic gadgets, eating out and going to concerts over having health care. They are people who could afford insurance; it is simply not a priority. There are other people who qualify for Medicaid or some other existing program but are too ignorant or trifling to enroll.

Mandatory Health Insurance should not be taken off the table. I don’t like the concept of mandating that one purchase health insurance, but we should not out right dismiss making people at least carry catastrophic health insurance. Most states require people who own a car to have auto liability insurance. I am not so sure that mandating health insurance is any more odious than mandating that one pay taxes or be subject to a military draft. Another person’s failure to have insurance does impact my financial standing, because we all pay higher prices for our insurance to care for those without insurance. There should perhaps be creative opt-out provisions for those who will bear the full cost of their own care, but the idea of requiring one to have some sort of responsibility for their own health care, even if it means mandatory health insurance coverage should not be summarily dismissed.

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Monday, June 15, 2009

Prejean says her beliefs got her fired

Carrie PrejeanPosted on Jun 11, 2009 by Staff, Baptist Press

SACRAMENTO, Calif. (BP)--One month after being allowed to keep her crown, Carrie Prejean was fired Wednesday by the Miss California USA pageant, with both sides in the dispute disagreeing over the reasons.[full article]


I support Ms Prejean. I applaud her for standing up for traditional marriage. It was refreshing to see someone speak her mind instead of bowing to politically correctness. It is refreshing to see a God-fearing young woman stand up for traditional moral values. It is just wrong that she was stripped of her crown. (Did I say "stripped"?) I feel sorry for her. I would like to put my arm around her and comfort her for the cruel way she has been mistreated.

Since this controversy erupted she has become a Christian celebrity appeared on Focus on the Family and appearing at the Gospel Music Association Dove Awards here in Nashville where she got a standing ovation and she has made appearances at other pro-family and Christian events. She has been praised in the religious press. She is the kind of poster child the religious right needs.

I can’t help but be amused by the whole thing. I love to see puritanical prudish Baptist defending a pin-up babe. Politics makes strange bedfellows. (Did I say "bedfellows"?)

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Sunday, June 14, 2009

Top Ten Reasons David Letterman .....

David Letterman

Maybe I don't have a sense of humor, but I don't find jokes about raping 14 year old girls very funny.

Rush Limbaugh once made some unflattering remarks about Chelsey Clinton's appearance when she was about 14 years old, and the news media crucified him.

Don Imas made a comment about a Black women’s basketball team calling them “nappy-headed hoes” and was kicked off the air.

Letterman should go. I don’t expect it to happen. There is obviously a double standard. Letterman would not dare make a joke about the children of President Obama. Political correctness is a one-way street. Indignation is very selective. Feminist don’t care for women, only liberal women. Apparently it is OK to make jokes about the statutory rape of a 14-year-old girl by a 34-year-old male if that girl is white and the mother is a Republican.

Here are the top ten reasons David Letterman should be retired
From hillbuzz

(10) He is a demented, 62-year old pervert who thinks it’s funny to joke about a 14 year old being raped and forcibly impregnated.

(9) His show stopped being funny at least 15 years ago.

(8) He’s a pig who wears diapers.

(7) Living in a glass house where he refused to marry his girlfriend of many years despite fathering a son, Harry, with her, making the little boy a bastard for nearly 7 years, means this particular hypocrite shouldn’t throw stones at ANY family, for ANY reason, lest stones be deservedly thrown back at him.

(6) Where are the jokes about Sasha and Malia being raped by baseball players? Where are the jokes about dirty watermelon pickers and greasy chicken fryers instead of “slutty flight attendants”? If vulgar, sick racial jokes are never allowed, why are vulgar, sick misogynist ones? If the First Daughters of the United States are clearly off limits, why isn’t a First Daughter of the State of Alaska? Answer us that, Leftists.

(5) Would Letterman think it was funny if Conan O’Brien or some other Late Night jester joked about Letterman’s son Harry being raped at Little League? Where does Letterman draw the line, exactly, on whose children it’s funny to joke about being raped.

(4) What would CBS do if a rival network DARED air something as vulgar as (5) or (6) above?

(3) Calling him a pig who wears diapers is an insult to pigs, diapers, and pigs who wear diapers.

(2) How phallic is it that Letterman obsesses not just over rape, but of rape specifically by a large man with a giant bat? That pervert has serious Freudian, Oedipal, anger, bad hair, gruesome teeth, you name it issues.

(1) David Letterman has a teeny wiener.

Top Ten Reasons David Letterman should apologize
From Copacetic City

10. He's jealous because Arod didn't knock him up.

9. He confused being a jerk with being a clown.

8. Alzheimer's made him say it.

7. To keep from losing his fan.

6. Set an example for his great-grandson-I mean son.

5. He's giving gap-toothed, misogynistic pedophiles a bad name.

4. He's scaring little girls.

3. Was smoked up on crack when he said it.

2. He stole the joke from his brother, Satan.

1. It's the right thing to do.

Top 10 Reasons to Snub David Letterman
By Jack Engelhard

10. He’s not funny.

9. His jokes are written by 20 frat boys who have an IQ of 180 – combined.

8. His audience gets in for free – and even that’s paying too much.

7. On his best day he’s no Johnny Carson. Carson would never stoop for a laugh.

6. Letterman’s reference to Sarah Palin as “slutty” was an insult to all women.

5. Letterman’s routine on Monday took up the Palin family’s visit to New York, which included a trip to the ball park. Here’s Letterman in his own words: “During the seventh inning, her [Palin’s] daughter was knocked-up by Alex Rodriguez.” Todd Palin, the father, responded like this: “Any jokes about raping my 14-year-old daughter are despicable.”

4. A perverted crack like that, by Letterman, got on national TV. (Try that on Obama’s daughters, Dave, and see how quickly you get booted.)

3. But a quip like that against a 14-year-old girl would most likely require registration as a sex offender in my neighborhood.

2. Letterman and his staff of writers misunderstand the phrase – “Women and children first.”

1. On the pretense of contrition, Letterman denied that he was a “celebrity.” Now we know what he isn’t – and we know what he is.

Top 10 Reasons to Take Letterman Off the Air

10. He gives gapped-tooth people a bad name.

9. Main stream media will have to report on actual news instead of reporting on a Letterman monologue the next day.

8. He can concentrate on giving Barack Obama ad lib lessons without a teleprompter.

7. His writers can take a well needed hiatus to recover from obvious writers block.

6. The Ed Sullivan Theater will regain some dignity.

5. The audience will be spared the stooge test in order to be admitted to a show.

4. He can write new gaffes for Joe Biden.

3. He’ll have plenty of time to develop material for the next Democratic National Convention.

2. He’s just too old to be up that late at night.

1. Guests would rather be on Conan O’Brien

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