Wednesday, March 29, 2017

HR676, Health insurance, broadband and the public option

There is a story floating around that Bernie Sanders will introduce a single payer plan in Congress. That story is being pushed by Politico, but there are scant details and plenty of other distractions in the same article. It is a wonder why Sanders does not just put his weight behind HR 676, the Improved and Expanded Medicare for All Act. Yes, it's still in the House, and he's in the Senate, but he's one of the most popular politicians in the country. He could bring HR 676 to national attention and gather support for the same. But he has not done so, at least not yet.

Health Over Profits has a story the one that seems to explain why Sanders has not touched HR 676. From the article:
Right before our eyes, we are seeing the transformation of single payer Bernie Sanders into public option Howard Dean.
During the 2016 Presidential campaign, Sanders took off like a rocket, fueled by the promise of a single payer, Medicare for All single payer system.
His single payer plan paralleled HR 676, the single payer bill in the House of Representatives that now has 72 co-sponsors.
HR 676 is the gold standard of single payer bills.
It would deliver one public payer, no deductibles, no co-pays, lower costs, everyone in, nobody out, no more medical bankruptcies, no more deaths from lack of health insurance and free choice of doctors and hospitals.
That was the promise of Bernie Sanders during the 2016 campaign.
But since then, Bernie Sanders has endorsed Hillary Clinton for President.
Then become part of Senator Chuck Schumer’s Senate Democratic leadership.
And this weekend, Sanders has been telling people he will introduce health care reform legislation in the Senate within a couple of weeks.
But it’s not going to be a companion bill to HR 676.
Health Over Profits has found a logical progression in the actions and statements of Bernie Sanders, an apparent drift away from a part of what made him so popular in the election last year to the position that he has taken now. There is no obvious reason for him not to endorse HR 676. Unless he has become a captured regulator.

Setting his motivations for his changing posture aside, that means it's up to us to encourage him, even implore him to co-sponsor and promote HR 676 (or a Senate bill identical to it). We should keep our eyes on the prize as a public option might only confuse and distract voters and consumers. Yes, a public option could help, but we already have that in the form of Medicare. It's just the Medicare is restricted to people over 65. The rest of us are left with private plans that treat health as a profit center commodity, not a public good.

Public health is not a commodity because it varies with the person and a person's behavior. Consider how we treat our cars. A car is a commodity. My health is not.

I have a car that has a little light on the dashboard that tells me when to take it in for maintenance. I also have a sticker on my window reminding when to take it in, by mileage or date, whichever comes first. The car has sensors that measure the health of the oil in the engine. When the sensors determine that the oil life is 15% or less, I see a light indicating maintenance required.

Changing the oil in a car is the single most important maintenance to be performed for the engine. Take care of the oil, and the rest of the engine stays clean. Pass on changing the oil and every part that requires lubrication begins to see contact with other parts. Bearings see contact with journals, pistons see contact with cylinder walls and things begin to break down from there. Keeping the oil changed when needed is the most important task for maintaining engine life, and that's the path to 250,000 miles on an engine.

People may not be machines, but with regular maintenance, other costs go down. Catastrophic costs are minimized. Regular doctor visits allow us to keep bigger problems in check and increase awareness about the health of our own bodies. Regular doctor visits also allow us to develop historical records (just like taking our car to the same shop over the life of the car), to see our progress. A body in poor health also has an effect on the mind. Allow a body to fall into disrepair and we may find we make poor decisions based on poor judgement based on a brain that is not operating in the best environment. Universal health care makes regular maintenance a breeze.

Under current conditions, people are often afraid of going to the doctor or getting that health screen because they're afraid of a catastrophic cost. They're afraid of losing everything else to health care. Who profits from this system? The shareholders of our largest insurance companies and health care providers. Health insurance companies and health maintenance organizations also have far greater influence on public policy than the average person. They will fight tooth and nail to keep the profits flowing. And thanks to decisions like Citizens United, they will use their profits to influence Congress away from universal health care. To those who profit from the system and use their money to keep it the same I say, "I want to buy your products, not your politics".

There are a few problems that incumbent interests have with universal health care. The first is accountability. A single government agency subject to political oversight, collecting data on money spent and outcomes, will make it much easier to keep insurers and hospitals accountable. Empirical evidence will show us what works and what doesn't.

The second issue is negotiation. While hospitals, medical device makers and drug companies can negotiate differently with different insurers, different insurers may not be privy to the negotiations running in parallel. In other words, one insurer can never know for sure if another company got a better deal on a product or service. With a single payer, universal health care system, there is no "hide the ball" game to play between the insurer and the provider. Attempts to negotiate will be based on evidence of performance for all Americans, all hospitals, all practices.

There will still be private practice of medicine, but in HR 676, there is one payer, one set of standard forms to complete, and 535 necks to grab in November if things are not done right.

I also notice that doctors are not exactly having a smooth ride, either. Check out this article from Dr. Cathleen London of Milbridge, Maine. She outlines the game of the insurance companies, always moving the poles, always hiding the ball, denying claims without cause and stiffing her on payments. This is a doctor on the front lines, who can see what is happening and says, without equivocation, the games insurance companies play have little if anything to do with Obamacare.

In other words, when people claim that the games insurance companies play are a result of distortions in the market as a result of Obamacare, they are exaggerating at best and lying at worst. After describing a bureaucratic nightmare with an insurance company as a health care provider, she wrote this:

"This is not the fault of Obamacare, which stopped the most egregious problems with insurance companies. Remember lifetime caps? Remember denials for pre-existing conditions? Remember the retroactive cancellation of insurance policies? Returning to that is not an option."

There are conservatives who would have us believe in the virtues and efficiency of private enterprise. But Dr. London's experience as documented in her article shows anything but that. The myth of the efficiency of private enterprise seems to stop at the border of the domain of health care. The Huffington Post noticed a curious thing about American health insurance companies. On average, they spend about 21% of your premium dollars on overhead and net profit. By overhead, if we're talking about CEO salaries, that might explain a lot. HuffPo compares that lofty overhead figure to Medicare at 1.5%. No health insurance CEO in their right mind would accept those numbers. But no health care CEO ever wants to see their insurance run as a tightly regulated utility.

Wait. I thought we were talking about health care, right? We are. But as the title of this article implies, there is another domain where the public sector kicks royal ass on the private sector: broadband. I know, I know. This is a huge segue, so bear with me.

Community Networks, a part of the Institute for Local Self Reliance, has documented more than 450 jurisdictions (towns, cities and counties) that have built their own broadband networks to compete directly with incumbent internet access providers, purely out of frustration with the big cable companies and telcos. The vast majority of those community networks are a success by any measure. Check out the story of Sandy, Oregon  (video), where the city figured out they could do what the citizens wanted for a fraction of the cost that incumbent providers were offering. For $60 a month, you can get gigabit service up and down, right there.

See? The public sector can actually offer better service than the private sector. It's just not that easy to find in the news because mainstream media has another narrative they'd like you to believe. Who buys advertising with mainstream media? Very large companies like Aetna, United Health Care and Blue Cross Blue Shield.

The legislation for universal health care has already been written. It just needs a lot of exposure to get Congress on board. I think we can make the pitch to them like this:

"I see that you're in a Skinner Box made by the biggest health insurance companies in the country. You vote their way, you get their money. I bet that makes it really hard for you to listen to constituents like me who actually live in your district. Vote for HR 676, get it on the President's desk, and you can spend less time in that Skinner Box if he signs it, because you won't have to call the health insurance companies to finance your next campaign. You could just rely upon people like me. How about that?"

If there was ever a time to call your representatives in Congress, now would be a good time to tell them about your fervent support for HR 676, just like I did.

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