More insurance reform responses

My father-in-law sent me an interesting blog post about health care reform, written from the perspective of someone at a small non-profit hospital in the Ozarks:
http://ochhealthcarereform.blogspot.com/2009/10/reform-letter-to-editor.html

Anyhow, he seems to have 3 main points:

• The much maligned public option is ironically exactly how the biggest for profit insurance agencies started out,
• government run health care (in the form of medicare) pays more than the big for profit insurance companies, and
  
• the government actually pays bills in a timely fashion, whereas the hospital in question has to get its employees to chase down the payments from the insurance company.

The first point is a misunderstanding of the public option, I believe. Creating a number of non-profit insurance companies to provide low cost insurance to the uninsured who cannot afford regular coverage was a separate proposal from the public option, at least according to the health care reporters from NPR. It is a proposal that made sense to me, but it was rejected by some Democrats and so didn't make it into the bill. I think the writer's point of view is also discredited by the number of people interviewed on NPR (in the talk shows and on the news shows) who say that the public option was the best way to get to a single-payer government-run system.

The second point is disputed in the comments, where a commentor from the Northwest says that insurance companies pay above 80% of costs, while Medicare pays 50%. This is what is frustrating about the insurance debate to me---I simply do not have the ability to judge between the two competing claims. Based on this, I'll go with what is "common knowledge," taking the author's viewpoint into consideration.

Finally, he says that the insurance companies do not actually want to pay the bills. I have some experience with this and agree. But on the other hand, Medicare paying the bills right away isn't necessarily a great thing. Peter Orszag testified this spring that Medicare's costs could be cut by 30% without cutting benefits because Medicare is so filled with "waste, fraud and abuse." Presidents have been trying for years to get rid of the unnecessary spending without much success. Also, Medicare is due to go bankrupt in just a few years---this does not fill me with trust in a government run health insurance option.

I think his main point is correct, though---he is afraid this will just be a way to get government money to the health care companies. Like the drug benefit before it, this plan seems to try to fix the problem of access but not of cost, using taxpayer money.

One other part of his post interested me, and that is the idea that his hospital is trying to do the right thing towards people in need, without any rewards from the government or financial rewards. The reason this whole reform is so hard is that the people who are trying just to do the right thing are not the people in charge of the bill and the debate.

Correction: The hospital is a for profit hospital----they just haven't made much of a profit.

Argumentation

Beware the argument your opponents cannot win. If your response means that there is nothing they can do to change your mind, then it's not an argument, just a couple of speeches. If your mind can't be changed, then your opinion becomes less rational and more like a gut reaction. Not that gut reactions should be ignored, but they deserve less respect.

Also beware the argument that lets you dismiss your opponent. Even if they are racist, stupid, liberal, religious, or bound to have wrong ideas for any number of reasons, almost always there is something in their argument that you need to think about. It's better to ignore the person and their motivations for making the argument, and focus on the argument itself. I know, it might lead to an outbreak of civil dialogue, but why not try it?

One of the most frustrating things about this whole health care debate is the way each side doesn't answer the pressing questions of the other. People are getting cut off by their insurance when they need it most for dumb reasons. People who work hard can't afford insurance. On the other hand, someone in the government (as opposed to private insurers) is going to decide what counts as health insurance, what gets covered and for whom. Medicare covers lots of people, but it is going bankrupt, is wasteful, people need additional insurance, and is not controlling costs (it might even be fueling some of the fast increases). Anyhow, these questions are treated rhetorically, not substantively, and I'm getting fed up.

Odd couple?

I just heard the Rev. Al Sharpton and Newt Gingrich being interviewed on Weekend Edition by Scott Simon. They were having a respectful conversation. They were working together to promote education.

They did not try to hide the fact that the two of them had serious disagreements. But they both said that what they were working for was so important, they needed to work together. I never thought I'd say that Gingrich and Sharpton are good role models for restrained, polite, bipartisan (and hopefull effective) work. But here we are..

Speech

Pres. Obama gave a "back to school" speech a week ago. (Funnily enough, many districts weren't back to school yet. But oh well.) Many people have been protesting. Some silly things have been said on both sides.

Here is my take: it is true that GHWBush gave a speech to school kids, as did Reagan, and no one complained. It's not quite the same for a number of reasons, the biggest one being the availability of technology for watching the speech. When there is a computer in every classroom, that's not quite the same as having a few TVs for the whole school. More people could watch the speech.

Moreover, people did complain. GHWB spent $28,000 on what was called a campaign ad for a captive audience. Hearings were held in congress. People did complain. (See Byron York in the Washington Examiner for details.) For those who are saying, "I would have been fine if GWB had given a speech," I remind you that people were calling for his assassination, comparing him to Hitler, 35 % of democrats believed as of 2007 that he knew about and did not prevent, or planned the 9/11 attacks (See Jay Nordlinger at The National Review Online for details). I really don't believe that all of the people who are saying this so blithely would have let their kids sit for one of GWB's speeches.

The reason they wouldn't is the same problem that people have with Obama: people don't trust the president to give a non-political speech. Or at least, a not outwardly political speech---everything a politician does is by definition political. And in fact, I wouldn't want to have any politician, even one I agree with, give a speech to my kids without my having watched or read it first. I don't let my kids watch commercials without me, for goodness sake! People are too good at manipulation, and my kids are too sensitive to manipulation.

That said, the moment the text of the speech was released, there should have been no problem. I also think that schools who decided to show it on Friday made a good decision---parents who were interested could watch it or listen or find out about it, parents who were not were shirking their responsibility anyway. I was happy to let Eleanor watch it at school, no notice was sent out asking if we wanted to get her out of class, I don't think anyone kept their kids home.

Eleanor's impression is interesting. When I first asked if she had a speech from Obama in class today, she said she didn't remember. Then, "Oh, yeah, I think we did." I asked her what she remembered. She said she remembered the part when Obama said his mom would wake him up at 4:00 AM. I asked her why she did that. Eleanor said, "So he could learn."

I liked the speech. I wish people would listen and learn from it, instead of flying off the handle.

Requiring health insurance

One of the ideas that is being batted around as we talk about universal coverage for health insurance is requiring people to have insurance. Some feel this is unreasonable, that people who are healthy (or who think they are healthy) shouldn't have to pay to be insured. I disagree.

First, we require people to carry insurance on their cars because no one plans to get into an accident. Even the best driver can get rear ended, even the healthiest person can have a gene for cancer or get in an accident or be exposed to a virus. If you decide not to carry health insurance, but then need it, you are cheating the rest of the covered people who pay, even when they are well.

I read someone say that insurance companies should be allowed to not cover pre-existing conditions because getting sick and then getting coverage is cheating the other people in the plan. That's why I think we need to get these people covered in the first place, so that no condition is pre-existing.

That said, I think that having extremely high deductible plans for some people makes sense. They shouldn't be for everyone, but a high deductible plan with a HSA makes sense for healthy people without kids, who don't expect any problems. They're still paying in to the pot, but they shouldn't have to get the deluxe plan.

One thing I've read in this debate that makes sense: The well pay for the sick, and we will all die one day. I think sometimes we forget this and behave as though we need to get something out of health care, or we need our wants taken care of. In reality, we'll all need it someday, and a bit of compassion is a good thing.

Protecting Children

One of my favorite parenting blogs, Free Range Kids, has an article about the recent laws protecting kids from lead and other poisonous substances in toys. It sounds like a great idea, but the devil is in the details, as you will see by reading the article.

I can't add much to the discussion, except to slap my hand on my forehead and whimper. Michael had an interesting thought, which I will try to reproduce. The idea is that liberals think that more laws mean more protection for people, while conservatives think that if we just got rid of the laws people would behave well. I'm not sure that this is the case in all senarios, but in this case it certainly holds true.

The visual picture of libraries cordoning off their children's sections, Goodwill and such turning away children's toys, small businesses facing the decision of testing their handmade toys or shutting down, blows my mind. Michael's other idea was that we could resign from the human race----I wouldn't go that far, but I would point out that when we get something wrong the first time, we are obligated to try to fix it.

Protesting

I have been interested in the tea parties for a while---I admit that I read Instapundit, otherwise I would never have heard of them, since I don't watch live TV or listen to anything but NPR and classical radio. (I certainly never heard of it from conservative talk radio or Fox TV.)

It is interesting, but I am not really tempted to join in the protests. My view of protests has been influenced in an unflattering way by two examples I have seen in the past few years.

First was a man who came to my mathematics department, ostensibly to get a graduate degree in mathematics, but really to participate in politics on campus. (I know, this is probably not the real reason he came, but he certainly wasn't interested in attending classes or in passing tests.) He would often email the whole department (professors, administrators, adjuncts, graduate students) to let them know about a demonstration or teach in or gathering going on for one of his causes. I know some of the other students were interested in his posts, and in the mathematics department, deleting an email was easier than asking him not to spam the department mailing lists. The straw that broke the camel's back was when he emailed, rather breathlessly, "The Student Coalition has a demonstration going on today at 1 down in the pit. I don't know what they're protesting, but let's all go show our support." Just the idea that you would go demonstrate against something---anything---without even knowing what it was, still blows my mind, and I think it points out the superficiality of the "culture of protest."

The other incident that influenced my view of protest was in the run up to the huge demonstrations against the Iraq war. NPR had hours of reports from all over the country, from large demonstrations and small, and interviewed many of the participants. One of the interviews was with a woman who was taking a bus from a small college in the middle of the country to Washington. When asked why she was protesting, she said "The difference between us and the people who supported the war is that we actually think for ourselves, we don't just believe what our parents tell us." This typifies the arrogance I see in many protesters: the people who disagree with me haven't thought about the issues enough, and if they were to think for themselves, they would agree with me.

Do protests change minds? I know that when people marched for civil rights and were beaten, the video of their treatment changed minds. It is possible that the protests against the Vietnam war changed minds, although I think the fact that we couldn't win changed more minds. And I also think there is a danger that the language at these protests inflames rather than informs the debate. I have seen many sensible signs from the teaparty protests on conservative websites, and many offensive ones on liberal websites. During some anti-Bush protests, I saw the opposite---in other words, we see what we want to see (and what people with agendas want us to see).

I think facts will change minds, and if I thought protests brought out the facts to people who otherwise wouldn't have heard them, I'd protest more. But I don't think so, so I think I'll sit this round out.

The Daily Me

Nicholas Kristof has an article in today's NYT about people confronting opinions that are different than their own less and less. He says that the demise of the daily newspaper makes this more prevalent. I'm not sure that that's true, since people's dose of different views in the paper came only from the opinion pages, but not usually from the rest of the paper, unless I'm misunderstanding him. One quote I especially like:

One 12-nation study found Americans the least likely to discuss politics with people of different views, and this was particularly true of the well educated. High school dropouts had the most diverse group of discussion-mates, while college graduates managed to shelter themselves from uncomfortable perspectives.

When thinking of different cultures' attitudes towards different views, I remember in particular one Thanksgiving we spent at my friend's house. There were a Palestinian woman (mathematics grad student) and a Jewish man (law student) who spent hours of the visit arguing. It made me a bit uncomfortable to watch---polite people don't do that! but they were enjoying themselves and actually listening to each other even while they disagreed mightily. I wish in our culture we could disagree so strongly and with so much grace: nowadays, if you disagree, you're either stupid or immoral and not worth listening to, it seems.

Another thing that is interesting is the completely different universes that commentators and even news editors live in, depending on their viewpoints. Just read the NYT and the WSJ on the recovery effort from the government, for example. It's hard to see that they are commenting on the same things! In order even to have an intelligent discussion, it seems that they would need to agree on some basic definitions and facts, their viewpoints are so different. It also seems as though merely acknowledging that the other has a valid point is equated to conceeding defeat (or claiming victory, depending on which side you're on), which is very unhelpful for fruitful discussion

I always like to say that I would listen to 6 things I disagreed with before breakfast. His last quote: think of reading things that you disagree with like going to the gym, also rings true for me: I wish that the heart rate elevation I get from reading other people's opinions would translate into better cardiovascular health. Ah, well, that's why I have this blog, to calm me down again.

Who is John Galt?

Disclaimer: I have never read "Atlas Shrugged" by Ayn Rand. I have read the Wikipedia article, and several summaries over the past few days. The book's standing on Amazon has apparently shot up recently. Who knows, I might even read it someday.

I read the summaries in response to seeing the suggestion that some top income earners are planning on "going John Galt," i.e., withdrawing their productivity from the economy, in response to Obama's plan to tax their income at a higher rate. At first glance, this sounds ridiculous. It's not like they're planning on taking 30 percent more of your earnings above $250,000, they're just planning on taking a few percent more. If you are earning close to the limit, the extra tax won't apply to very much money. If you earn further away from the limit, then you would have to work really hard to get your earnings down below 250,000, and although you might pay a lot more money, you have more to give.

Actually, at second glance "Going John Galt" still looks silly to me. I can't imagine anyone making over 250,000 who is working only for money. There are so many other reasons to do a good job (not being able to live with yourself if you do a shoddy job being one of the highest) that I can't imagine the money making enough difference that a person would decide to retire rather than work.

Then I realized that I have actually been doing this for years, in two ways. First, when I was a grad student, I thought about increasing the number of hours I tutored. But if I did that, then I might have earned enough to have to pay taxes, including self employment taxes, and I knew from experience as a consultant that it would take about 50% of the money I earned, maybe more. Tutoring recalcitrant students for $20 an hour was pretty good. Tutoring for less than $10 an hour was not so attractive, so I didn't increase my working. So government taxes have actually kept me from working more.

The second way I have gone "John Galt" actually has to do with the free market. The market doesn't value my skills as a teacher or tutor enough to pay for child care for 3 kids. So I don't add my productivity to society in that way. I do feel like I am being productive, but it is not worth it right now for me to go out and add to GDP, so I don't.*

Does this mean that I am only interested in working for money? Not really (I hope) but it does mean being rewarded definitely influences how I feel about how hard I'm willing to work. It's interesting to think about in light of the idea of going Galt.

*This may change when they are all in school, or old enough to take care of themselves after school.

Housing bailout

I see very well that many people need help staying in their homes. And I see the upside for me if someone gets help paying their mortgage, or a lowered principal. But I don't see the obviousness of this help. Diane Reams is especially bad: she seems to lose patience with anyone who suggests that they don't want to see their neighbors bailed out. But here is one scenario for why bailing out one's neighbors might be seen as bad.

When we bought our first house, we looked at our budget and figured out what payment we could afford. Then we went online and used a mortgage calculator to figure out what houses we could afford. Then we went to our realtor and asked her to show us houses in that range. She showed us a few houses that were more, but not many, and she stopped when we asked her to. She sent us to the mortgage broker in her business (I think we eventually went with a special "first time buyer mortgage" from a different bank) and he looked at our income and told us we could afford much bigger payments and could get a bigger house. We said "no thank you." Then he said, if we got one of these "ARMS" we could have a lower monthly payment, and the rate wouldn't be adjusted for 5 years and we would likely move by then anyway, and we said "no thank you." We got our 30 year mortgage with the slightly higher rate for what we could afford and moved into our little house.

Suppose we had neighbors who bought in to the snake oil the broker was trying to sell. They got the bigger house (which we would have liked, but we decided we couldn't afford). They got the lower payments so they could afford the nicer TV, the vacation, going out more, etc., while we had our less risky but less profitable mortgage. And now, they can't make their payments because their ARM went up. I understand that they were probably taken advantage of to some extent, but in the end, they were greedy instead of sensible. They had the upside of taking the risks. Now the government wants to make the lender lower the principal on their house so their payments go back down to something they can afford. What downside (other than sleepless nights) do they face?

Note: some truly horrible things went on in tempting people who truly should not have bought a house to get one, or in manipulating innocent uneducated buyers without giving them full information. Dishonest brokers should face the consequences of their actions (is roasting over a spit done anymore?), and the homeowners who were taken in by them should be let down as easily as possible, either by staying in their house or getting out as painlessly as they can. My problem with the bailout is with people who should have known better, but who decided to take risks in return for money. Even if they didn't understand the full extent of the risk (i.e., they didn't realize they could lose their house, or they didn't believe it would happen to them) they should see some downside from their behavior.

It may be that there is some downside, I just haven't seen it in the description of the programs.

Despite my discomfort with some of the homeowner bailout propositions, I think that the policy of allowing people who are "underwater" on their mortgages to refinance with a lower interest rate is a great one. I think it is true that most people want to keep their house, whether they are underwater temporarily or not. These people are less likely to walk away from a house if they can afford the payments than if they cannot, so it seems to me there is no increased risk. Of all the possible ways to bail out homeowners, this makes most sense to me, which is probably why it is not liked by the pundits out there...

And the bailout/stimulus package should come with mandatory personal finance education classes for every citizen of the US unless you can pass a test showing minimal competence.

Stem cell research

Rants:

• Many people say that "now we are basing our decisions on science rather than religion." The truth is, nothing about the science of a human embryo can tell you whether you ought to destroy it for some benefit. Only ethical guidelines (which are based on religion for many people) can tell you that.
• When people say that embryonic stem cell research does not imply cloning, they are misinformed. My friend's medical textbook explains: we don't just want any old stem cells, we want stem cells that are a genetic match for the person undergoing the treatment. Which implies that we need to create an embryo with the genetically identical stem cells. Which means we need to clone the person undergoing the treatment.
• There are many people who have diabetes, spinal cord injuries, etc. who do not want their diseases treated with embryonic stem cells. These people are never interviewed on the radio for programs about embryonic stem cells.
• The president's decree today rescinds another order of President Bush which encourages funding for non-embryonic stem cell research. This seems unnecessary, and backwards, since these stem cells have actually been useful against disease.
  
• I can't believe that the same people who are against genetically modified food are so in favor of genetically modified people. Cloned animals have a much higher rate of birth defects, for example. We really don't know what we are getting into.

More on the first objection: we really don't let scientists work on whatever looks good. For example, we have very strict laws about experimenting with human subjects. I remember a blood substitute trial that scientists wanted to run in Minneapolis: in order to show that the techniques and products they were using saved lives, they needed lives that were in danger. But the scientists couldn't run the experiment because the people whose lives were in jeopardy couldn't sign the consent form. There was some talk about getting everyone to sign a blanket consent form, but then the doctors were accused of racism since the study was being done in the city where there was a high proportion of minorities.

Was this letting religion trump science? No, it was respect for human beings and their rights. A created human embryo is a potential human being---an individual human. Does it have value? Science can't answer. For goodness sake, YOU were once an embryo.

Sigh. My friend the pathologist's objection is that there is no guarantee that we would stop at an embryo. What if a blastocyst were more useful? What about aborted fetuses? What about a 15 week old fetus? It would be much easier to get liver cells from a cloned liver. People will say that no one is arguing for this, but it is also true that the arguments in favor of ESCR have nothing to say against using more developed human babies for "parts".

There is much more to be said, but it has been mostly said well on stand to reason (str.typepad.com/blog) and thinkingchristian.net.

Prediction

The recession will help us finally kill the old health care system and replace it with something new. When so many people are out of work and thus out of health insurance, something will need to change. The optimist in me hopes that it will change for the better, but probably not...

It would be nice if the recession would also change the crazy way college educations are valued and funded...but I doubt it. Especially since the stimulus bill kept funding for more college loans instead of hinting to people that 1) maybe a college education is not the most valuable thing for you in particular, and 2) college and university presidents need to get off the treadmill of constantly increasing budgets and tuition. There has got to be a better way.

A blast from the past

Wow. Make sure to read the date this was published.

Christians in Germany during WWII

Thanks to Thinking Christian for posting this.

Missing perspective

As usual, much of what is lacking in the news is just perspective.
Here's an article that inspired me to back off of the instant polls and
updates. It is written by Tony Woodlief He is frequently insightful
without being inflamatory (a difficult propositition.)

http://online.worldmag.com/2008/11/03/what-does-it-mean-to-be-a-christian-voter/

How to pick a president

Tom Gilson at Thinking Christian pointed out a great article from Christianity today about how to pick a president: www.christianitytoday.com/ct/2008/june/17.22.html

It points out that while policy can be important, more important is character. They go through the classical virtues and Christian virtues to show how each (or the lack of each) influences the outcome of a presidency.

They also point out many reasons that agreeing with a person on policy will probably not guarantee any particular policy being followed, from a recalcitrant congress to acts of God. I would like to add that in all likelihood, there is no candidate with whom I would agree on policy. Thus the best I can hope for is someone who makes decisions in a way that I can respect and understand.

Obama worries

I really like the speeches I have heard from Obama. I especially like his rhetoric about bringing the country together. I really think that this country has too many people fighting hard to make sure they never compromise, since compromise might imply that they don't believe what they say.

However, along with the nice (very inspiring) speeches, Obama's actions do not back up what he says. although he talks about compromise, his actions are of someone who isn't willing to give even an inch. He is rated as one of the most liberal senators. He voted against the "born alive" act (and from what I heard, worked actively to put it down). These do not give me much hope that he will actually be able do do what he is talking about, bring the country together. They sound more like someone who will bring the people who agree with him together.

On the other hand, McCain has a long history of going against what partisanship would dictate to build bridges across parties. He has actually worked with people to make real progress on (say) campaign finance and judges, even when he doesn't get all that he wants. He seems willing to give on some issues in order to do what is best for the country.

We have already had 8 years of someone inexperienced who talks a good game of bipartisanship without much effect (and Bush actually had a better track record of working with Democrats than Obama does). I'm ready for some action instead of inspiration.

That said, I would not be unhappy if Obama gets elected. I'm just skeptical that he will be willing to deliver on the bipartisanship part of his platform.