Health Care Reform
Trading Women’s Rights for Political Power
By KATE MICHELMAN and FRANCES KISSLING
A grim reality sits behind the joyful press statements from Washington Democrats. [The health care bill passed. What is so grim?] To secure passage of health care legislation in the House, the party chose a course that risks the well-being of millions of women for generations to come. [Are women not being allowed to have health care coverage or something?]
Is one of the most recent columns over at Vox Nova prophetic? Has Senator Harry Reid set into motion what is to be the death of health care reform because of the abortion issue?
The Senate Majority Leader unveiled the health care legislation yesterday and it is already under attack by pro-life groups because it contains language strikingly similar to the Capps Amendment—the original abortion provisions of the House health care bill until it was removed and replaced upon the passage of the Stupak Amendment which explicitly prohibited the funding of abortion or subsidizing of insurance plans that cover abortions in what would be newly-created health exchanges. Continue reading
The Senate version of the health care reform legislation has been unveiled. It has been scored at $849 billion and Senate Majority Leader, Harry Reid is expected to bring it up vote for its first procedural vote this Saturday.
If the Senate takes up the bill, the debate is expected to begin on November 30, after the U.S. Thanksgiving holiday next week, and last for at least three weeks. Senior Democratic senators, however, have said it is unlikely Obama will have a completed bill on his desk by the end of the year.
Click here if you wish to write your Senators and voice your opinion.
Time being scarce the last few weeks, I’d originally planned on writing a post of this format about one of the Senate bills, but since the House bill (HR 3962: Affordable Health Care for America Act) is currently the one in the news, I’m focusing on that. The purpose here is to try my best to cut through the hysteria and hype coming from both sides and take a realistic look about what changes we would notice as US citizens if the House health care reform bill becomes law.
The first thing to keep in mind is that nothing much happens until 2013. This could probably called the “keep incumbents from being hurt by this act, especially Obama” provision. Whether the long term effects of the bill are good or bad, change often causes pain and confusion at first, and one of the key ways of getting legislators on board for the bill is to assure them that they’re unlikely to be immediately booted out of office by voters upset about their premiums. This kind of cynicism is hardly unique to this one bill or to either party — it just is what it is. So take the below as a discussion of how thing would be under HR 3962 in the period 5-6 years from now, assuming that is passes and there are no changes made between now and then.
The bill provides several new regulations on insurance companies and on you, which you’ll notice quite clearly.
1) You will be legally required to purchase insurance. If you don’t (and unless you fit criteria for financial hardship as defined in the bill) you will be fined either 2.5% of you income, or the average cost of the plans in the lowest tier of the health insurance exchange. So, if you make 40k/yr, you would be fined $1000. If you make 60k/yr, you would be fined $1500. If you refuse to pay your fines, you’ll be treated exactly like any other tax evader (which means you can potentially be sent to jail.) The Senate bill specifically exempted non-payers from being sent to jail, but the House bill fails to differentiate those who refuse to pay health care fines from those who refuse to pay other taxes, so it is believed that standard tax evasion rules would apply. There will also be penalties placed on employers who do not offer their employees health insurance.
40 “progressive” Democrats in the House of Representatives have sent a letter to Nancy Pelosi vowing to vote “no” on health care reform the next time around if the Stupak amendment is not stripped from the bill.
Remember all of those commentaries after the 2004 elections deriding conservative voters for placing their “values” ahead of self-interest? All over the country “progressives” asked “What’s the Matter With Kansas?” to get to the bottom of the matter.
I think what we are obviously seeing now is, at least from the standpoint of the American public that supports the current health care reform effort, a group of legislators who are irrationally placing their most deeply held moral and spiritual values ahead of – not their own self-interest, since they have money – but the interest of the people who sent them to office.
I have long believed that abortion is the most important sacrament in the religion of secular humanism. In their own language the sexual revolutionaries and the radical feminists have declared it the cornerstone of women’s liberation (and as I have argued, men’s “liberation” from parental responsibility as well). The idea of having to take responsibility for sexual behavior is almost like being sent to hell. Thus the importance of this sacrament. For a materialist-hedonist, it is the gateway to salvation.
But I wonder if all of those Democratic voters who were counting on health care reform will see it the same way if the bill does come back to the House with the Stupak amendment in-tact.
Ezra Klein has a post up trumpeting a new paper from MIT economist Jon Gruber which purports to show that Massachusetts significantly reduced individual health care premiums through its 2006 health care reform bill — which in many ways was similar to the Democratic proposals currently moving forward in congress. (Needless to say, this would be contrary to what most people who have actually experienced health care in Mass., even this liberal speech writer, have experienced.) However, looking at all the findings is key:
In their December 2007 report, AHIP reported that the average single premium at the end of 2006 for a nongroup product in the United States was $2,613. In a report issued just this week, AHIP found that the average single premium in mid-2009 was $2,985, or a 14 percent increase. That same report presents results for the nongroup markets in a set of states. One of those states is Massachusetts, which passed health-care reform similar to the one contemplated at the federal level in mid-2006. The major aspects of this reform took place in 2007, notably the introduction of large subsidies for low-income populations, a merged nongroup and small group insurance market, and a mandate on individuals to purchase health insurance. And the results have been an enormous reduction in the cost of nongroup insurance in the state: The average individual premium in the state fell from $8,537 at the end of 2006 to $5,143 in mid-2009, a 40 percent reduction, while the rest of the nation was seeing a 14 percent increase.
Dr. Peter Pronovost is a distinguished physician known for his efforts to decrease the frequency of deadly hospital-borne infections. His remedy to the problem is surprisingly simple: a checklist of ICU protocols that directs physician sanitary practices (e.g. hand-washing). Hospitals that have put Pronovost’s checklist into practice have had immediate success, reducing hospital-infection rates somewhere between (estimates vary) well over a third to a whopping two-thirds within the first few months of its adoption. Yet as the story goes, many physicians have rejected this solution and Pronovost has struggled to persuade hospitals to adopt his reform.
The Centers for Disease Control and Prevention estimates that nearly 100,000 American deaths are caused or contributed to by hospital-borne infections. Blood clots following surgery or illness are the leading cause of avertable hospital deaths in the U.S., which by the most liberal estimates might contribute t o the death of almost 200,000 patients annually. Given such a hideous fact, why exactly does a doctor need to travel about and emphatically seek to persuade other medical institutions to adopt, in effect, a cost-free idea that could save so many lives?
How is that an industry which stridently decries the high cost of liability insurance or the absolute injustice of our tort system(which does need reform) need such petitioning to embrace such a simple technique to save thousands of lives? Moreover, in the United States it is not unheard of for a whole business to shut down due a single illness from some suspicious food—yet, we tolerate the killing-via-negligence on such a grand scale in our hospitals? Medical mistakes and institutional carelessness do not qualify as some must-be-accepted inevitability.
This reality has been almost entirely been neglected in the discourse on health care reform. Beyond the structure and financing troubles of our medical system, the institutional practice and governance of hospitals are in need of severe criticism. For example, in what alternate dimension does the peculiar scheduling of hospital work shifts in any way benefit the patient? A few weeks at the hospitals virtually guarantees a never-ending string of new personnel assigned to one patient’s care. If this can be avoided, should it not? It seems quite reasonable to presume that passing patients off from doctor to doctor, or nurse to nurse, might increase the chance of someone making a mistake? The effect of changing such a seemingly small problem could be huge. Or, take for example, the “sanitary” environment of hospitals in general, which contribute to the nearly 100,000 annual American deaths. Anyone who has ever worked in “corporate America” or in a large building in general might note that the trash is picked up once daily. Is it any different in a hospital? It takes some sort intellectual schizophrenia to insist on ICU sterility in a building if one has not the slightest care over how many times trash (never mind what is in it) is picked up in a day.
Any array of complaints about institutional malpractice must lead to the inevitable question: how is it that the most technologically advanced medical institutions in the industrialized world miss out on a just as modern, just as recent, revolution of quality control and customer-service that has pervaded every other consumer-based industry? The answer to this question is telling. Continue reading
Health care reform has been at the forefront of the American political discourse in the past few months. One of the most difficult tasks in this debate is to discern an authentically Catholic approach to reform efforts. The Catholic Church takes no official position as to how a health care system ought to be structured, but rather presents enduring moral principles that must be present in public policy.
Adhering to the richness of Catholic social teaching, the ultimate goal for Catholics must be to establish a system that is capable of universal access and coverage for all American citizens, one way or another. Any number of schemes might achieve universal health insurance and preferences will differ based on political philosophy, but the end result seems to be a Catholic moral obligation. In this sense, no Catholic ought to oppose universal health care, if it means achieving coverage for all Americans citizens either through market schemes, government assistance, “third sector” non-profit organizations, co-operatives efforts (co-ops), or some combination of these depending on the social need, the ethical principles at stake, and the resources each solution offers.
Catholic social teaching treats health care as a profound social interest and essential for the common good. Health care, because of this, ought not to be viewed as a mere commodity. The poor and vulnerable, by default, are immediately disadvantaged as health care costs increase. The United States, we are told, has the most technologically advanced and best quality medical care. But, one must inquire: at what cost? Other consumer “goods” are not essential safeguards to the indispensable good of human life in the same way as medical care.
Health care markets that are laissez-faire, an inherently utilitarian mechanism, do not necessarily yield nor are they ordered toward natural justice. Natural law theory is alien to such a mechanism— it is not intrinsic to it, neither is solidarity or preferential option for the poor, though these things are not necessarily excluded by it.
It is self-evident that different spheres of society appropriately employ different standards of distribution. College professors assign grades based on merits of achievement; athletic competition employs the same principle. Parents might distribute slices of cake at a birthday party to strict equality. In the same way, numerical equality governs votes in a democratic society. Food, clothing, shelter, electronic goods, clothing, automobiles, jewelry, etc, receive unequal distribution by market mechanisms—sometimes justly, sometimes not.
Need is one of those principles of distribution (and one of those things often argued about) recognized in some spheres, but not others. Need is terrible for distributing grades, but the proper principle for distributing emergency food supplies. Need, arguably, is a proper principle for the distribution of health care. Health is necessary for a community’s proper functioning. Justice, in terms of health care, will require a redeveloped way of distributing health care based on personal responsibility, collective interest, and legitimate need—the weakest and most vulnerable among us first and foremost.
Many important areas of life must resist “commodification,” at least in the same sense as dispensable goods. This could not be more evident than by the fact that people are becoming commodities to other people. Children are the prime example of this, from abortion to assisted reproduction. Fundamentally, justice demands that we re-examine our consumerism for it is the heart of the issue and I believe, the life-source of the “Culture of Death.” Continue reading
I’m not sure that I like this line of thinking, but I’m starting to think that it’s true, so I’ll put it out there and see what people make of it in debate.
It’s starting to look fairly certain that while a bill called “health care reform” will pass the congress and be signed some time before the 2010 elections (because the administration needs to sign something, even if it’s a fig leaf that does little and doesn’t go into effect until after 2012) what passes will not in any sense be a “comprehensive” health care reform package. Given the people who would be in charge of designing it if it made it through right now, I think that’s probably a pretty good thing.
A pair of Megan McArdle posts underline an interesting political dynamic which is applying itself to the various health care reform bills percolating in the congress.
There’s been a lot of talk about how lack of sufficient health care is a major cause of bankruptcy in the US. Some of this is based on a couple of very bad studies, which essentially assumed that anyone who declared bankruptcy who had any outstanding medical bills at all must have done so because of medical costs, regardless of the relative size of their medical and other debts. But there’s also a legitimate aspect to this, though it doesn’t have to do with medical costs. Bankruptcy is often the result of some sort of unexpected circumstances (lost job, divorce, medical problems) which drastically increases expenses or lowers earnings. Obviously, if you come down with major medical problems, you may well end up earning less regardless of your medical bills, and this can cause bankruptcy.
Illustrating this is a recent study commissioned by the Canadian government investigating the high prevalence of bankrupty among older Canadians. (via Megan McArdle) The finding: medical problems is the number two cause of bankruptcy among Canadians aged 55-65, the group with the greatest propensity to declare bankruptcy. (see pages 18-19) Continue reading
Pro-life liberal Catholic writer Michael Sean Winters of the National Catholic Reporter argues that because Catholic conservatives find themselves opposed not only to a universal health care bill that funds abortion, but also to the idea of centralized health care in general, they are in fact playing into the hands of the pro-abortion lobby.
It is strange indeed to see conservative Catholics unwittingly aiding and abetting the agenda of the pro-abortion organizations they oppose. And stranger still that conservatives who spent the last election cycle saying that no political issue mattered as much as abortion are suddenly putting their idolatry of the market before adopting a sound strategy for keeping abortion coverage out of the health care reform effort. They have provided ample reason for the administration and Congress to ignore their pleas on abortion. The may see themselves as the “loyal opposition” but they are not being loyal to the pro-life cause they espouse. They are undermining it.
His argument is basically that since health care reform is currently on the table, if conservative pro-lifers do not promise to support it if it doesn’t fund abortion, then they are therefore helping those who want it to fund abortion. I can’t help like feeling that this is a bit like the old National Lampoon cover: “If you don’t buy this magazine, we’ll kill this dog.”
Blackadder pointed out elsewhere that for all of the insistence that people cannot wait and absolutely need reform right now in order to alleviate the suffering of the uninsured, the health care bills currently under consideration are designed not to begin to go into effect until 2013, conveniently after the next presidential election. It is, I’m sure, a matter of opinion whether this is a cynical political attempt to avoid the consequences of people actually experiencing one’s health care reforms, or if its the necessary time to enact all 1100+ pages of regulations in the current plan. Either way, perhaps there’s a better way if people are really serious about helping people quickly and avoiding partisanship.
By most counts, there are actually around 12-15 million Americans who are uninsured for more than a few months, do not have the financial ability to buy their own insurance (make less than 75k), are legal residents, etc. This 12-15 million includes some people who are simply poor and can’t afford insurance (perhaps it’s not provided by their employers, or perhaps they’re unemployed) and others who are middle class (but without employer coverage) and have medical conditions which make it impossible to get individual health care insurance.
Let’s assume it’s 15 million. If we also assume that they’re fairly expensive to insure ($5000/person/year) the cost of simply paying to buy them all private insurance would be $75 billion per year, or $750B over ten years — actually less than the estimated cost of the current health care reform bill. (Heck, you could pay for the first 4-5 years by canceling all stimulus spending which is not scheduled to happen until after 1-1-2010.)
In a post on the topic of health care rationing (responding to a progressive post which argued that denying care to people unlikely to see much return was one of the benefits of a centralized health system) Megan McArdle of The Atlantic makes the following observation:
There’s another intuition that at least libertarians have, which is that it is not as bad to have undesirable things result from an impersonal process than from an active decision. It is bad if someone’s house burns down and they couldn’t afford insurance. It’s worse if someone’s house burns down, and they were in the class of people deemed unworthy by a bureaucrat of having their house rebuilt.
I think almost all progressives have the opposite intuition. They think it’s better to try to produce an optimal result, even if that results in individual injustices (which it will–government rules are very broad brush, and will always involve error at the margins). I’m not sure how to bridge that intuitive gap.
It strikes me this is indeed one of the determining differences between those skeptical of and those confident in the ability of a centralized beaurocracy to actually improve the administration of health care (as opposed to its availability, which obviously could be improved simply by throwing enough money around.)
Given the range of viewpoints found around here, I’m curious what others think of this. Is this indeed one of the major dividing lines between progressive and libertarian/conservative viewpoints?
On the surface this would seem a fair evaluation but if you dig a little deeper, those on the Left may well be making another crucial misdiagnosis of the source and cause of this reaction.
First lets examine the prism that those on the Left have viewed this reaction.