Tuesday, August 11, 2009

Okay, Now I'm Getting Frustrated

I've really been trying not to politi-blog. Basically, being preggo means that whenever I get tense, I get an incredible stomach ache. So my "side notes" have mostly been focused on the alien in my stomach, or other daily trivia.

But . . . I hate misinformation. I hate blind sloganing - Two legs good, four legs baaaad! And I truly despise people of any political persuasion who knowingly spread false slogans and propoganda in order to confuse an issue. Our entire fucking democracy is dependent on informed, independent voters. So I'm going to suck it up, down a bunch of Tums, and blog.

To get an idea what I'm talking about go look at Politifact.org's healthcare page. Seriously, go. I'll wait for you.

On the first page alone, I count six "pants on fire," seven "false," one "half-true," three "mostly true," and two "true" statements. Thirteen outright lies, and only six statements with any level of truth in them. In fact, it weren't for one old guy from New Jersey who racked up one "true" one "half-true" and one "mostly-true," there would only have been three statements with any truth in them on the entire freaking page.

And these are not minor lies, either. They're flipping doozies. But before I go further, I have some bias I need to disclose. I've worked inside the insurance industry as a legal advisor. I've also worked for the government as an attorney. So I have some inherent knowledge of how each of these systems work, and some inherent biases formed by my experiences with each of them. Why is this relevant? Well, if you take away all the propoganda, we're trying to decide if we should rely solely on private insurance companies to supply health care insurance to the masses, or add a government option. That's the bottom line.

So let's look at some of this misinformation that's floating around. Palin's claiming that if we add a government option, there will be "death panels" who decide whether we get lifesaving treatment paid for, or are told to go screw ourselves because we're not productive enough. Let me think through what that might look like:
A roomful of high level bureaucrats discusses a claim, say a drunken high-school student who is rendered a quadriplegic in an auto accident. They'd probably discuss in cold terms how many wheelchairs and vans and meds this kid will need. Someone will point out that it would cost millions less if he'd just died. They'll examine the language of the coverage to see if there's any way to reduce his recovery - a loophole of some sort? It will be noted whether the kid got good grades before the crash - can he reasonably expect to get some kind of job? Or was he a blue-collar type that won't work in the future and just be a drain on society? Maybe we can work that angle? What if we can prove it was self-inflicted harm? Does that work?
Yeah, I can see it. Clearly. See, I've been in a room like that one, discussing a case like that one, and trying to convince insurance claims and underwriting VP's that we really do not have any loopholes and this kid is entitled to his benefits or the company will be in a shitload of trouble. On another case, I've had screaming middle-aged men in my face telling me they don't care what the law is, we never intended to cover that expensive of a loss. The best part? The company I worked for, which also had lots of good people who were NOT assholes and so I'm not going to name it here, is a NONPROFIT. Their policyholders were their owners. In theory, this gave the recipients control of everything, and should have acted as a check on this very type of behavior. Nice idea, in theory. Not so much in practice. The insurance industry is also regulated up to the eyeballs, and there are huge penalties for wrongful denial. And yet this continues. In a non-profit. I should note that the right prevailed in both my examples. But it was not certain and not easy. You wanna bet how much worse it gets in a for-profit company? Take a look at some of the bad faith verdicts handed down against insurers. You will see some of the most egregious behavior, on a par with big tobacco or any of the other industries that intentionally try to cover crap up in order to make a profit.

My point: Although Politifact correctly points out that Palin is lying, it calls her idea a "sci-fi scenario". I disagree. To some degree, it is very far-fetched. But in another sense, it is exactly what is happening now. Not with the public option, with private insurance. Because that's the way the industry is set up, folks. It is NOT DESIGNED TO ENSURE HEALTHCARE, but to INSURE.

Insurance as an industry started with just liability. Technically, it was people in China who shipped goods downriver who decided that if each of them put some of their goods onto ten different boats, instead of all onto one boat, they'd minimize their risk of loss. As a business, it is designed to provide coverage for uncertain, unusual events: a car accident, a lightning strike. If a bunch of people pay in premium during the many times when nothing is going on, there should theoretically be enough money to cover them when something wonky does happen. If you've got one guy who is being too risky - sending all his goods in boats with leaks - you want to exclude him out from the group because he'll always be getting payouts and never put enough in to cover it. It's branched out to auto, home, farm, and so forth, but the theory is always the same. A bunch of prudent people facing no known losses will put in premiums when they don't need to with the idea that if an unintended, rare, freak loss occurs, there will be enough money to cover it.

I know this seems like remedial insurance 101, but it's important to remember: INSURANCE IS NOT DESIGNED TO COVER CERTAIN, REGULAR, KNOWN, AND SURE LOSSES. Like getting old, getting sick, having babies, and dying. We are looking to Insurers to Ensure our healthcare is there whenever we need it. That is not what they do. You are asking a bear to be a duck.

Why are there "death panels"? To exclude people who are, in a sense, medical leaky boats. Get them out of the group. This is true even if you are a nice, middle-class, responsible person who pays large premiums, because you can't possibly pay enough premium to make up for the losses paid out. And, no, the companies don't care if you've been a loyal customer for twenty years, and always paid on time, and (blah-blah-Ginger). There's sixty gagillion more people who are also regular payers, so don't let the door hit you in the ass on your way out. Besides, by the time they get done denying your behind, you've probably missed more than your alloted sick days, so unless you qualify as disabled under the Americans with Disabilities Act and you can prove a reasonable accomodation can be made to allow you to work, well, you're fired. Say buh-bye to "Middle class."

My very long point is that having worked for both Government and Insurance, and not having an incredibly high opinion of either, it is a no-brainer to me that the public option is necessary in healthcare. We can't keep asking Insurance to be what it isn't.

I will address other concerns later, this post is already too long. But to short-cut it:

1) A Public Option will bankrupt private insurers! Like public universities have bankrupted all the private colleges? Like public buses have bankrupted taxi services? I can go on and on with this one.

2) It will make waits too long! Do you want to wait eight hours for simple care? You do realize that what you're essentially saying is that if poor people can go to the same docs you may have to wait your turn? I don't take well to snobbery.

3) If they can't make a big profit, Doctors will leave! Yeah, in droves. They'll all move to Europe. No, wait, Canada. Erm, Mexico? Seriously, here's the point: lots of lawyers do public defender work. We don't get paid jack compared to the bigshots in large firms. But we're paid much better than most of you working at lower-level white collar jobs. We're not going anywhere. If they did the same to the docs, they wouldn't go anywhere either. And BTW, it's not necessarily the dregs of the profession, either. I pulled a B average, but I'm not in a big ass firm. I want a life, thanksverymuch.

4) Economic principles will cover this in a market system! Healthcare costs are naturally limited by what people can afford to pay! Medicaid picks up the slack! Holy crap, are you out of touch. Firstly, free market only works on non-essentials. Take food, for example. In an absolutely regulation-free market, if there were a serious shortage there would be no limit to the price of food that vendors could charge. Prices would go up and up, and the number of people who could afford food would shrink and shrink, until eventually everyone else had died off and a surplus was re-established that way. Even if one of the stores tried to take a larger slice of the market by dropping prices, they'd eat through their supplies in a heartbeat and go under. Competition be damned, there's no limit to price. Medical aid is a similar commodity. If you're dealing with serious diseases, it is not optional, but essential. People will pay whatever they have to in order to stay alive, until they can't afford it and die. There is no free market.

I'll take my Tums and go off to my hearing now.

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