Wildfire FireFighters Go Without Health Insurance...

According to the US Fire Administration, a branch of FEMA, there were more than  78,792 wildfires in 2009.  These fires burned a total of  6,00,000  ( 9,375 sq miles) an area larger than my home state of New Hampshire.

In the last 12 years, 179 firefighters died on the job while putting out these blazes….and that doesn’t include the numbers of firefighters who were injured or who are suffering long-term health effects from intense exposure to heat and smoke.

And in spite of the heroic efforts put forth by those who put their lives on the line saving other people’s property…the federal government refuses to allow these firefighters to access government employee health insurance, because they are considered "temporary employees."  The perverse irony of that is that more effective the firefighters are, the more they are marginalized as just 'temporary' workers.

Jon Lauer, a Denver, Colorado firefighter, has initiated a campaign to change this federal policy.  In an open letter to President Obama, Lauer writes:

“Dear President Obama,

I am writing to request an optional health benefits plan for seasonally employed federal wildland firefighters and their families.

The work that wildland firefighters perform is critical. Each year they are responsible for keeping tens of thousands of homes and businesses from being consumed, often protecting entire towns from the threat of fire.


Because wildfire is overwhelmingly more common between the months of May to October, the majority of firefighters are seasonally employed. More than 90% of these return to service year after year. They often work the equivalent of a full year's worth of hours in six to seven months, but are never given the opportunity to buy into a government health care plan even at the most basic level, because they are classified as temporary workers.


There are many risks these brave men and women take in order to serve their community. Since the year 2000, 179 wildland firefighters have been killed in the line of duty, and the conditions of the firefighting environment have been linked to cancer and respiratory disease leading to permanent lung damage.


Seasonal federal wildland firefighters demonstrate a commitment to service equal to that of permanently employed firefighters and other emergency responders. It is only right and fair that they have access to a quality, affordable health plan for themselves and their families. I urge you to introduce legislation that makes seasonally employed federal wildland firefighters and their immediate families eligible for year-round health insurance coverage.”

Lauer has an online petition at :

http://www.change.org/petitions/give-health-care-to-firefighters-who-battle-wildfires

 We encourage support of Lauer and America’s firefighters.

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Santorum’s Hypocrisy – and Ignorance – on Health Insurance

Being the week before the New Hampshire Primary, it is hard to go grab a loaf of bread in this state without running into some campaign entourage. Rick Santorum, after being booed off the stage for his anti-Marriage Equality screed yesterday, and having missed a traditional “must stop” at Lindy’s Diner this morning, finally showed at the Community Room of the Keene Public Library to press the flesh. In the most interesting exchange of the morning, Santorum tried to defend the practice of charging higher health insurance premiums to people with pre-existing conditions, and criticized the clause in the Affordable Care Act (“Obamacare”) that prohibits insurers from denying coverage to those with pre-existing conditions.

In explaining this position to one member of the audience, he stated that "Americans need to be educated” about health care costs. This condescension was met with expertise greater than his: he was speaking with a woman who had been a nurse for over 30 years, and whose son was a childhood cancer survivor. She asked Santorum why her son should have to pay higher health premiums, or even go without insurance for the rest of his life.

Santorum’s answer: “Insurance works when people who are higher risk end up having to pay more, as they should.”

Not only does Santorum lack basic compassion, his answer shows that he fundamentally misunderstands the nature of most illnesses, and, worse, is a hypocrite to boot.

If we take him at his word, then those who statistically have a higher risk of incurring health care costs should pay higher premiums. If he really believes that, then he should look at his own family size.

Rick Santorum and his wife had seven children (one died soon after birth.) As any doctor’s office or hospital can verify, the more children one has, statistically, the higher the health costs associated with those children. This blogger has 6 children, and we used to joke that the local hospital ought to have a room reserved just for our family.

But most major Health Insurance Plans do not charge “per child.” Insurers generally provide plans for singles, married couples, single parent/child plans, and family plans. The Family Plans are without regard to the size of the family or number of children. Rick Santorum's Congressional Family Plan does not charge for additional chidlren.

So does Rick Santorum support increasing health premiums for families with large numbers of children? Doubtful: in Iowa, he proposed tripling the income tax deduction for each dependent child (from $3,500 to $10,500), which would virtually make the largest families exempt from income tax at the expense of single people and smaller families. This massive distortion of the tax code would accomplish the very thing he opposes when it comes to health care: subsidizing those who receive the most services with dollars paid by those who receive the least services. The hypocrisy is palpable.

It also shows that Santorum’s understanding of Insurance Pools is crude at best, and simply parroting Corporate Insurance Lobbyists at worst.

Insurance pools are based on the notion that everyone’s risk is shared. The first known successful Insurance pools existed as far back as 1235 with the birth of the "Hanseatic League," an alliance of shipowner-merchants along the Baltic Sea. Because this was the height of the era when Vikings ruled and pillaged the seas, there was always a good chance that a merchant's ship – and along with it, the merchant's life investment – would be captured by marauding Danes. Members of League chose to each take an ownership stake in all the other members’ ships to prevent against the possibility of a total loss. Shipowners forced to sail closer to Denmark were not thrown out of the pool in favor of those who plied waters further away; each shared equally in the losses – and surpluses – recorded by the entire group of merchants. It was a system that lasted for 300 years.

An insurance pool that favors the low-risk members, and penalizes the higher-risk members (as Santorum defends), is not an insurance pool at all, but a profit-making engine that distorts and misrepresents its purpose.

Fortunately for those with large families, most Americans really do understand this concept, and Mr. Santorum has benefitted from it.

Perhaps it is Mr. Santorum, not the American people, who need to be educated about health care costs.

H1N1 Vaccines, Breast Cancer, and the Congressional Health Care Bill.

The Anti-Government Health Care Arguement: "Around the world, socialized medicine has resulted in a rationing of care. Governments have found themselves limiting access to services and establishing waiting lists. In Canada, patients wait an average of 27.9 weeks just to see an ophthamologist after referral by their GP ( http://www.fraserinstitute.org/researchandpublications/publications/2548.aspx )

Americans will end up with higher costs and less care as it is rationed."

Real? Or just fear-mongering? Those in favor of government-provided insurance and care say this is nonsense, and point to anecdotal incidences of friends receiving care in Canada and finding it just fine.

So let's stop talking "what ifs...," and look at Current Reality:

The H1N1 vaccine *is* a socialized, government program. The shot is free.
It is also in short supply everywhere, and doses are restricted to only the most at-risk patients. Conversely, the usual vaccinations, provided by the market, are readily available.

The Federal Government recently funded a study released by the U.S. Preventive Services Task Force, which recommended that women of average breast cancer risk start mammograms at age 50, not 40, and have them every two years rather than annually. Breast Cancer is currently the leading form of cancer in women. Many of us know women who are alive today because they caught a vigorous form of breast cancer early (including my own mother).

But now, the feds are recommending that women reduce their preventative mammograms. Meanwhile, page 1,190 of the House health care bill specifically states that Government Insurance shall not pay for preventative care that exceeds the Task Force's guidelines - even though NOT ONE member of the Task Force specialized in cancer or women's health!

There is the reality of Socialized Medicine. Rationing. Less Care. But we can all feel 'good' because Government is Caring for us, right?

Health Care needs reform - but this bill must be defeated.

And if it is passed, it needs to be repealed.

Health Care Bill HR 3962 passes House - overall, a bad bill

I am not one of those Republicans who opposes all health care reform. However, I strongly oppose bad reform, and on balance, this bill is very, very bad.

The Good: The bill removes Insurer's exemptions from antitrust laws, and creates a national marketplace for shopping for insurance. This is good for consumers, good for competition, and will improve insurance access. The bill also eliminates restrictions on pre-existing conditions, an important aspect of any insurance reform. While it is true that insurers need to make a profit to survive and pay claims, it is also true that the purpose of an insurance pool is to spread the risk - both good risks and bad risks - across the entire pool of insurees. For far too long Insurance companies have gotten away with creating pools that are guaranteed 'winners,' further enhanced by their near monopoly status in some states and ability to limit competition across state lines. These are positive aspects of the bill, and aspects that the GOP ought to get behind in the public marketplace of ideas.

The Bad & The Ugly: The bill requires large companies to offer insurance, and requires citizens to secure insurance, period. The element of freedom of choice will been eliminated, as the government forces us to purchase a product. The cost to individuals and employers in terms of premiums could be disastrous in a recession. Worse, the Government Budget Office readily admits it is planning on offsetting the cost of the new program through 167 BILLION in fines on individuals and employers over the next 10 years. In other words, they are actually counting and planning on consumers and businesses being unable to comply in order to pay for the program!

The bill charges the IRS with compliance with the mandatory insurance provision. This is modeled after Massachusetts, which requires proof of health insurance coverage before one is able to file their State Tax Return. In practice, this has proven to be a nightmare for accountants, who with increasing frequency are preparing returns due to the complexity of the tax code. Now accountants and tax preparers will need to prove insurance coverage on a national scale, and will vastly complicate their practices and increase the costs of filing income taxes for both preparers and taxpayers.

And worst of all is the creation of a Government-run Health Care Insurance Company. There are three ways this can go:

1) It can be so successful, that private insurers, now facing stiffer competition and requirements to cover expensive pre-existing conditions, go out of business, and the government becomes a sole insurance provider.
2) It can be financially unsound, and taxpayers will be called upon to bail it out.
3) Both of the Above (the most likely scenario)

In the course of the debate, those against government health-care have pointed to a shortage of coverage in countries with socialized medicine, the rationing of care based on cost-benefit analysis, and the prospect of government-insiders having better access to medical care than the citizens in times of shortage. Could that really happen?

Well, a real-life, real-time personal case in point: The "free" government-run Swine Flu (H1N1) vaccines. The supply of vaccines is woefully short and late. Then, last week we got a call from the local hospital telling us that they ran all of their patients through a database and one of my sons 'qualified' for a shot. Meanwhile, the news reported that Goldman Sachs (you know, the company which supplied us with the Fed Reserve Governors, the Sec. of Treasury, and Bailout Gurus?) received 200 doses of Vaccines.

Oh? Why is that? Are they all children with pre-existing conditions? Health Care Workers? Or just "connected" to the right people?

Lastly, the fact that this is a 1,990 page bill that was passed in the middle of the night. I sincerely doubt how many members of Congress actually read the bill. Upon completion, Democratic House Speaker Nancy Pelosi remarked that this was landmark legislation, and compared it to the advent of Social Security.

Great comparison, Nancy. Social Security is a ponzi scheme headed for bankruptcy within our lifetime. And that's what you compare this legislation to?! Let's hope calmer heads prevail in the Senate...

5 Steps to Better Health Care

President Obama has launched his Class Warfare Health Policy Initiative. Economists, many Caregivers, and non-Socialists are understandably aghast at the proposal to spend over a trillion dollars, tax the "rich" at 45%, and let loose a system of bureaucracy-controlled health care services. But we need to do more than yell "NO!" We need to acknowledge the problems that do exist; propose solutions that address the problem; and do so within a context that has broad political support from the ideological 'middle' of the country.

With that in mind, I suggest the following parameters:

1) First, we must acknowledge that there *is* a problem in terms of affordable access to health care for many Americans. With 10% of the Labor Force out of work (and youth, stay-at-home parents, part-time workers, the disabled, many immigrants and the homeless are NOT included in the figure), estimates range from 30 to 50 million Americans living without health insurance. That means somewhere between 10% and 15% of Americans.

2) It has been demonstrated that those with a lack of access to health care delay treatment until their conditions require critical (and far more costly) attention. This adds to the expenses Providers incur (and often absorb) and the strain on existing government programs (and thus, increase cost to taxpayers).

3) We must agree that compassion and the political climate both dictate that a, "hell, tough on them!" approach is not an acceptable response.

4) Having said that, the solutions must address the problem. At my office (an Academic institution), one often hears people singing the praises of a Single Payer System. They frame the problem as the 'lack of a single payer system.' However, this response falls apart when weighed rationally. If 85% of Americans had affordable access to supermarket food, and 15% were lacking basic nutrition, we would never suggest that all 100% of the country have access to free food at the supermarket, with the bill sent to The Government. We all know intuitively that the result would be a run on food, a shortage of goods in the supermarket, wasted resources, and a broke country. And yet, that is precisely what the Single Payer Cheerleaders want for health care. If the problem is access for 15% of Americans, than the solution is a way to find access for 15% of Americans.

5) Insurance is both a blessing and a curse: it allows people to access health care (the blessing), but also permits non-emergency situations to crowd hospitals and ER rooms with unncessary service, as consumers receive thousands of dollars worth of treatment for a small copay of $10, $25, or $50. True Health Care Reform must acknowledge objective, observable economic realities and not be bases on some hand-holding kumbaya approach to human nature.

6) The provision of care must be centered on the Doctor-Patient relationship, NOT on insurers' profits or government bureaucracies "one-sized-fits-all" approach of form and process and procedure and approval.

7) We must acknowldge that the American health care system is the best in the world, bar none. Those who point to Canada forget that there is not a single modern machine in Canada capable of removing kidney stones. Those who trumpet Britain forget that Britain has closed 40% of her hospital beds since the 1940 NHS was enacted. Those who point to Scandinavia forget that it is the American doctors who win the Noebel prizes, the American researchers who have made all the modern major medical breakthroughs in the last century, and it is America that attracts doctors from all over the world.

So..in a nutshell: we need a system that helps those without affordable access to gain that access, in a way that protects and enhances the doctor-patient relationship, lowers costs to consumers and providers, and continues to support a profitable - and successful - health industry.

With all of those as 'context,' here are my 5 Proposals:

1) Permit community groups to form for the purpose of buying health insurance. Sounds simple, isn't it? But it's illegal. Individuals can *not,* under existing law, form 'groups' whose primary purpose is purchasing insurance. (Groups may form for business or fraternalh purposes, and then choose to buy insurance as an incidental benefit, but they can not form for no other reason than to buy insurance). End this prohibition, let the market dictate rates, let competition ensue, and there will be no need for a Federal Government-related Insurance Bureaucracy. Take it one step further: end State Monopolies on insurers. The Federal Government (not States) has the authority to regulate Interstate Commerce, and since people may have an accident *anywhere* and request their insurer to cover it, this is clearly federal jurisdiction. Blow open the lid on Insurer Competition.

2) Enact Tort and Medical Malpractice Reform NOW. It was reported 5 years ago that an OB-GYN doctor in Massachusetts has to deliver EIGHTY-FIVE babies just to cover his malpractice insurance premiums for a year. Worse, 5% of doctors are responsible for 95% of malpractice claims, raising all doctor's and hopistal's premiums. Limit Malpractice Awards, raise the negligence standards (so hospitals dont need to run unnecessary tests), and relieve the 95% of decent doctors from paying the premiums of the 5% convicted of malpractice.

3) Eliminate the FDA's requirements that drugs be safe AND EFFICACIOUS. Currently, the FDA requires that pharmaceutical companies prove that their drugs meet two tests: they must prove safe, and they must be 'efficacious,' that is, they must be proven to cure the condition they claim to address in virtually 100% of patients. This is a costly and unnecessary test: Many people react differntly to different substances. The Peanut Butter that fed me through high school will kill someone with an allergy. Let *Doctors* decide what to prescribe, with the understanding that the idiosyncracies of individuals means that results WILL be different with different drugs. A drug that doesnt work, will not be prescribed. On the other hand, if a doctor determines that medical marajuana is more efficacious and cost-effective than morphine, so be it. Eliminate tiered coverage that allows Insurers to cease to cover necessary, but expensive, pharmaceuticals.

4) Engage in Multi-national agreements with other nations to accept their pharmaceuticals. The refusal of the US FDA to permit the importation of Canadian pharmaceuticals is insane. An individual can come to the US from France, or Britain, or Mali, or India, and providing only a driver's license from their own nation, get behind the wheel of a 6,000 pound rental car and take off minutes after landing - even if they don't speak English or have never driven on the right side of the road. And yet, if a pharmaceutical company goes through hundreds of thousands of tests in Germany, or Britain, or Canada, the results are not considered 'valid' in the US. Now, realistically, which is more dangerous: the driver, or a drug produced in Canada?

5) Permit every American to have a Medical Savings Account. Currently, Government workers and some self-employed people can utilize a Medical Savings Account which permits them to cover medical costs using a credit-card-like card. These citizens have a certain amount of money deducted from their paychecks, and go into an account for medical expenses: prescription drugs, eyeglasses, dental work, and even over the counter remedies. These deductions are pre-tax, meaning it lowers the person's gross income, lowering their tax and even possibly dropping them into a lower tax bracket. Better yet, these workers can 'borrow' against future deductions if they incur expenses early in the year at no interest expense. If government workers are allowed these accounts, why not ALL Americans?

These proposals will not solve all of our problems, but they will go a long way to providing access for those who do not have it, lowering costs for everybody, and enhancing the doctor-patient relationship.