Being the Change I Wish to See

Not the mainstream polls taken recently. I just heard a piece on NPR where McConnell kept saying that the American people don’t want health reform, and if Democrats pass it, reform will hurt their election chances in November. Not true.

According to a March 10, 2010 Benenson Strategy Group report, a large majority of Americans want reform, and if anything, they believe reform doesn’t go far enough.

He also said that “forcing” the bill through reconciliation is unprecedented and it denies the “majority” in the Senate the right to vote on the bill. Last time I checked, 59 out of 100 votes is a big majority. If McConnell has such a problem with reconciliation, why did he vote yea on reconciliation bills 13 times in the past? There have been 21 reconciliation bills over about the past 30 years. Sixteen were Republican bills. It’s not an unprecedented procedure at all.

Me thinks he dost protest too much. I believe the Republicans are obstructing, lying and posturing so much because they realize if health care reform passes, their asses are grass in the coming November mid-term election, and Democrats and Independents are the lawn mower.

One GOP talking point is that the Democrats will be in big trouble and lose their majorities in the House and/or Senate. Why would they give this legislation so much time and energy? Since when did the GOP care how the Democrats will do in an upcoming election as long as it’s worse than GOP candidates? It’s because they are terrified at how much passing health reform will boost Democrats in the mid-term election. If they believed their own rhetoric, they would get out of the way and let health reform pass, and reap the benefits of extremely poor Democratic policy.

Another talking point is health care reform will increase the budget deficit substantially. Also not true. According to the CBO, it will decrease the budget deficit substantially:

This bill isn’t perfect by any stretch of the imagination. I would like to see a lot of changes, and I believe over time, all the fixes, including a public option or single-payer system, will become part of the legislation. The problems will be fixed as needed in the future just like Medicare has been amended since it first passed. One thing is certain. Doing nothing is not an option.

What do you think?

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Let’s start with quotes from the polling sources:

A clear majority of Americans — 72 percent — support a government-sponsored health care plan to compete with private insurers, a new CBS News/New York Times poll finds. Most also think the government would do a better job than private industry at keeping down costs and believe that the government should guarantee health care for all Americans. – CBS/New York Times June 20, 2009

Polls of the general public about health care reform:

• 90 percent of respondents to a CBS/New York Times poll of the general public earlier this year said the U.S. health care system needs to undergo fundamental change (54 percent) or be rebuilt completely (36 percent).
• 95 percent of the public believes the fact that many Americans do not have health insurance is a very serious (70 percent) or somewhat serious (25 percent) problem, according to that same poll.
• 84 percent of the same respondent pool said they would favor expansion of a government program that provides health insurance for some children in low- and moderate-income families in order to cover all uninsured children.
• 85 percent of respondents to an Associated Press poll earlier this year said health care was either extremely or very important to them as an issue while 86 percent of those polled in another CNN survey around the same time agreed.
• 76 percent of Americans either strongly support (53 percent) or somewhat support (23 percent) providing guaranteed health care coverage for every American, according to a recent Gallup poll.

Polls from spring and summer 2009.

Source: AFL-CIO Website

The polling results of many sources over many months clearly show most Americans want government health care reform and most people want all Americans to be guaranteed coverage.

That means those who are so vehemently against any health care reform bill are clearly in the minority, though they are a very noisy minority. They would have you believe they are winning the debate and they really represent the majority view. This is obviously not true, and I’ll be charitable here and call it wishful thinking on their part.

My own Senator, David Vitter, quotes the CBO report in his campaign against any health care bill, but fails to see the flaws in the way the CBO report ignores the savings of stopping the majority of the uninsured from going to emergency rooms for routine care.

Say someone with a sore throat and moderate fever who has no insurance and can’t pay goes to the emergency room for care. The average cost of an ER visit of a minor nature is about $1000. That includes being triaged by the nursing staff, taking up an ER room or bed, seeing the doctor, receiving some sort of diagnosis and minor treatment (a breathing treatment, a  shot, a single x-ray, a blood test, a nasal swab, etc), getting doctor’s orders so you can be discharged, and handed your prescriptions to take to a pharmacy to be filled. The prescription costs are in addition to the $1000. But, lets say the ER doctor has some samples and gives them to uninsured patients.

If the same someone had enough money or insurance to go to a doctor’s office for the same sore throat and moderate fever, the office visit would be about $75, the diagnostic tests would be about $30 each (say the patient  needs a throat swab for strep and a nasal swab for flu so that’s $60), and a shot as treatment can vary from $5-$50, depending on what the medication is. If you don’t have insurance or prescription drug coverage, the doctor will often give you enough samples of the medications you need for your entire course of treatment. Total cost for this visit and treatment: $185 if the shot is $50.

If you pay in full at the time of the visit, you will often get a 20%-30% discount because that’s how much dealing with the current insurance system costs the doctor. If we assume a 25% discount, that’s a $46.25 discount, so you would pay $138.75.

The figures I use are from recent personal receipts from both an ER visit for a minor injury that required an ER visit excluding treatment for the injury and a doctor visit for a respiratory illness. Costs will vary with market.

Not only is going to an emergency room for non-emergency care expensive, it takes up resources that need to be available for people having a real emergency.

Seven people can be treated in a doctor’s office for the same cost of treating one person in the emergency room.

Who pays the $1000 instead of about $139? Everyone who has insurance or who pays cash. The cost of those uninsured people who can’t pay gets distributed throughout the total cost of each procedure performed in the emergency room. Total cost of procedure/total procedures paid for gives the average cost of a single procedure. If the bill can be reduced by $861 per uninsured patient, medical costs and insurance premiums will go down.

If the cost doesn’t go down, it will be because either the providers or the insurance companies (or both) are taking extra profits. Preventing profit-taking requires laws to control it, and sufficient competition to keep rates reasonable. Competition can be inserted by a public option or non-profit option, or an insurance exchange where companies have to outbid each other to get business.

Insurance regulations must become national rather than dictated by the states so insurers have to compete with every company in the nation, not just those who operate in a few states. State regulations for health insurance must be removed.

If the costs are compared and the fact that those who pay insurance premiums or pay cash already pay for those who can’t at far higher rates than they should have to, why is anyone against insuring everyone and reducing costs? For $860 per visit, that money could pay for a heck of a lot of monthly insurance premiums or about 7 doctor visits per single ER visit.

Think about it.

The United States spends nearly $100 billion per year to provide uninsured residents with health services, often for preventable diseases or diseases that physicians could treat more efficiently with earlier diagnosis. — Institute of Medicine. Hidden Costs, Values Lost: Uninsurance in America. The National Academies Press. 17 June 2003  http://www.iom.edu/Report.asp?id=12313.

Also think about catching and treating illnesses earlier and having better outcomes for every American. We pay the most money of any industrialized nation for health care and our outcomes are worse than most other industrialized nations. Add calculations for improved productivity and less missed work and missed school. That’s a lot of money we could recover.

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