Sunday, November 17, 2013

A health care solution

Years ago, I resigned myself to the fact that we were going to get universal health care in the U.S., though I didn’t quite expect the debacle we are witnessing. I suspected trouble, though, when it came in the form of a 2,000 page bill which Nancy Pelosi declared had to be passed so we would know what was in it.

There is a simple way to set up universal health care, though it pains my libertarian brain to think about it. I will describe it, but first a discussion about the subject.

We need to quit talking about health insurance, because what has been proposed is not insurance at all; it is prepaid health care.

Insurance is something you buy when you don’t need it, so you will have it when you do need it; it is a tool for risk management. For some reason, people want to think about health insurance differently than other types of insurance.

If I drove up to the insurance agent’s office with the front end of my car bashed in and asked for insurance so I could get it fixed, with the insurance company paying for it, they would turn me down. It is a pre-existing condition; people would understand. It makes sense. But they don’t understand with health insurance; people think the health insurer should cover pre-existing conditions.

When I sold insurance and a couple would come into my office seeking health insurance and asking if it covered pregnancy, I immediately asked if the wife was pregnant. That’s when many couples begin to think about getting health insurance, and it is too late. And, even if we issued a policy, many of them would cancel it as soon as the baby was born and all related medical costs were paid.

The fact that much health insurance comes with the insured’s employment, exacerbates the pre-existing condition problem. When you leave your employment, you leave your group health insurance and are then in the marketplace with your medical history. This problem was largely created by government when a tax advantage was given to employers providing the benefit. Had the advantage gone to individual policy holders, people would have signed up with a carrier and staid with them for years as they moved from job to job, rather than looking for a new policy and wanting it to cover their pre-existing conditions.

Insurance as a risk management tool only works when more people buy it than will ever file a claim. The only reason automobile insurance or home owners insurance works is because many more people buy and maintain policies than file claims. I can’t remember ever filing a claim against my homeowners policy and rarely against my auto policy, though I’ve carried them for years with the same company.

What those who are pushing for universal health care want is not insurance, it is pre-paid health care. If we as a culture believe this is something we truly want, then we need to look at how to make it work. First, it must cover everybody from birth to death, and everybody must pay for it throughout their lifetime.

We already have Medicare in place, complete with a web site that works. The program should have simply been expanded to include everyone, with all income being taxed to cover it. That means no exemptions for businesses, unions, federal workers, or anyone else. The plan should be as basic as the current Medicare system and every doctor’s visit should have a minimal co-pay to discourage people from making frivolous trips to the doctor’s. The plan would cover all pre-existing conditions and pregnancy.

Insurance companies could than design supplemental plans for those who want the “Cadillac” treatment, as they now do for Medicare. If businesses, and unions want their people to be covered for all the possibilities the medical community wants to offer and that their people want, let them buy a supplement that appeals to their constituencies. And, of course the basic plan would be a single payer approach.

The Republicans and libertarians hate the idea of a single payer plan, as do I, but what I describe would be fairer than what Obamacare has turned out to be with all the waivers, exemptions and such. Progressives such as Obama perceived that the system as it existed was unfair, but what they have created is no more fair, and it will not really solve the problem of the many people without health care.

We may simply be watching a fiasco in the roll out of Obamacare, and in time it might smooth out and provide the health care desired; I doubt it.  You can bet the reason it took 2,000 pages to write the bill was to make sure every special interest got more than their share of the pie, and that everyone who needed to be bought off to get it passed, was bought off in some way. It is going to be more costly than anyone imagined. The proposed costs stated to get it passed were just the beginning of the many lies needed to make it happen.

One of my aphorisms states whenever the government creates a cash cow, the wrong people will come to milk it, and this one is going to get milked for all it is worth.

Remember, when someone else pays for your health care, they have a vested interest, and even a right, to interfere with the things you do that might create more expense. Motorcyclists, sky divers, rock climbers, pot smokers, fast food eaters, sugary soda drinkers, take a lesson from cigarette smokers: the progressives who champion this kind of universal health care will have no compunction about excessively taxing, or even prohibiting, your favorite pastime. And they will have a legitimate right to do so.

Saturday, November 9, 2013

The fourth quarter

This was published as a column in the Issaquah Press. For you not familiar with the area, Poo Poo Point is a mountain on the edge of Issaquah where para-gliders  launch and STP is an annual Seattle to Portland bicycle ride.

I first encountered Dylan Thomas’ poem “Do not go gentle into that good night” while working on an MFA in creative writing at the University of Alaska Anchorage. It became my fourth quarter (end of life) philosophy:

Do not go gentle into that good night,/Old age should burn and rave at close of day;/Rage, rage, against the dying of the light.

The Bible allots us “three score years and ten.” Even by my poor math abilities, that amounts to 70 years. So, at 71, I am in my bonus years. When I now hear if I follow a particular diet, take a particular pill or break a particular habit, I will live longer, I keep doing what I please, as an extended life now just means a few additional months in an assisted living facility, watching TV reruns and wishing someone would change your Depends.

I keep looking for examples of those who live my fourth quarter philosophy such as Burt Munro, whose story is told in the movie The World’s Fastest Indian (motorcycles, not native Americans).

Recently, Joy Johnson, 86, ran a marathon and died the next day. Great exit Joy!

The same week, Vernon Maynard, 100, didn’t exactly “go out with joy” but he did celebrate his birthday with his first skydive. Right on, Vernon.

On June 25, Ardys Kellerman, 81, died in a motorcycle accident. Yes, she was driving and had recently been awarded a certificate for having put a million miles on her various BMW motorcycles. Great ending, Ardys.

A few years back, I watched on TV as a 90- plus year-old fellow made his first bungee jump. Residents from his old folks home came to cheer him on. He climbed on the platform, put his dentures in the bib pocket of his coveralls and jumped. He said he’d be back the next year to do it again.

The poet Edwin Robinson depicts another alternative in Mr. Flood’s Party. Eben Flood is on a hill above Tilbury Town on a moon lit night, partying all alone with his jug. (Google it.) He is lonely, because he has outlived everybody he knew in Tilbury Town, and now his biggest concern is that he find someplace he can set his jug, so it won’t fall over and break.

If you want to avoid a fourth quarter like Mr. Flood’s, buy a motorcycle, arrange a sky dive, paraglide off Poo Poo Point, take a hike, bicycle the STP, or run a race. If you’re not the adventuresome type, then check out the volunteer opportunities published weekly in The Issaquah Press. There are people and organizations that need you. Your church needs you. There are service clubs that need you. “Don’t go gentle into that good night.”