Sunday, March 21, 2010

For What It's Worth.

Pavel jotted off a last minute note to our so-called representative the other night voicing all his unhappiness with the all but certain Yes-Vote that Capuano is going to make:

Count me as one more very disapproving constituent. Health care reforms, please, but NOT THESE REFORMS.

I may write you too late to influence your vote. I have just learned from here

that you intend to vote yes for the so-called health reform bill as passed by the Senate in December. Still, you should hear my opinion as one more sample of those you represent.

I am one of many who believe this bill is an opaque, bureaucracy-building monstrosity that does little to address the true causes of excessive costs for health care, while adding dangerously to the nation's future debt burdens, and failing to enlarge consumer choice.

I am strongly opposed to a national individual mandate, on pain of tax penalties -- a provision of very dubious constitutionality.

Will my middle-aged premiums then become greater without all the young people compelled to bear the costs shifted away from me?

Well firstly, that's only just. Young and healthy adults in early career with lower incomes, and looking to start their own families, shouldn't be discouraged by shifting more of their earnings to aging generations than they do already. We oldsters selfishly kill the golden goose when we deter the child-bearing generations with a regressive tax.

(And an effective tax it is, when we are compelled to purchase what we would otherwise not -- no matter whether the actual collector be a private insurer, or government. If the President makes such a provision a law, then he will have reneged on his pledge not to impose new taxes on low and middle earners. Quite simply, he will be a liar.)

And secondly, I say give me the choice to elect for less comprehensive, catastrophic coverage and just pay fee for service in routine care, analogously as I insure only for car collision repair and not for fluid fill-ups.

Is the mandate needed to make the future system work, if insurers are not to deny coverage on the basis of preexisting conditions? Well then, just drop that misguided crusade against the companies, however heartless that sounds! Insurers are not to be blamed for running real insurance businesses in a rational manner. If my uninsured house burns, I can't then demand that an insurer cover it retroactively for pennies. The insurance business would be impossible with such incentives. No, my earlier irresponsibility is my problem. I want to hear an unsentimental realist of a politician tell this unpopular but necessary message to the people.

Will I eat those words if I lose my job and my coverage with it? I can't pay COBRA premiums beyond a limited term, even if I'm willing and able to. I am prevented even from being "responsible," as I called it, even if I have means. Extraneous eventualities -- my changes of employment -- may compel me to terminate one policy and begin another, and become an undeserving victim of the precondition trap.

Well sir, there is the real unaddressed core of the "crisis."

Why should the continuation of my relationship with my insurer be conditional on anything but my continued premium payments and non-fraudulence in my claims? Why do so many of us accept it as normal that one's health insurance is non-portable after a job change? That makes no sense: we should no more buy health insurance than home insurance through employers, indirectly. But an irrational tax code makes employer-provided insurance advantageous over individually purchased insurance. Worse, the incentive to use these pre-tax dollars even for routine care (thus turning "insurance" into a health-maintenance subscription, making nonsense of the word), and resulting over-consumption, is what causes the spiral of premium inflation that we all complain about.

So end that tax advantage! (As presidential candidate McCain suggested.) Fix the incentives. Employees should get more direct, not imputed, pay in exchange for the responsibility to shop for their own health insurance and maintain it, and to become smart shoppers for routine care.

We need a true national free market in insurance policies. The authors of the Constitution were wise to know that barriers to trade among the states should not be imposed at the will of state governments -- which would have retarded economic development and impoverished all. What's good for tangible goods is no less good for a financial product like insurance. The federal government should use its authority to govern interstate commerce, to strike down the states' barriers to health insurance purchases.

We need consumers to be free to purchase as much or as little coverage as they choose. We need incentives for individually purchased insurance to become the norm. We need a wider market of many competing providers keeping each other "honest" -- and no insulting nonsense (thankfully off the table, but which certain House members would have put past us last year, if they could) about setting up a costly new governmental entity just to get us a single "competitor" with the very unfair advantage of subsidy. (Don't insult me a second time either with the promise that this entity would remain funded only by premiums collected. Political pressure would change that in no time.)

The alternative ideas for health care reform are out there. The President was downright wrong when he suggested that the opposition to the reform bill have no alternative ideas. Any insinuation that opponents to this bill's "reforms" are opponents of all reforms, satisfied with the status quo, is very dishonest.

These alternative ideas require strokes of the legislative pen to change regulations and alter incentives in the marketplace from the perverse ones existing now. What they do not require are costly new bureaucracies to direct transfers of wealth. They are easily explained and understood and could be embodied in a bill one hundredth of the size of the one that is now pending.

But I wait for that in vain in the present, deeply dishonest political and media climate, where a bloated and overreaching government, colluding with insurers that are really only too happy to add the advantage of forced consumers to that of competition barriers, is instead portrayed as the white knight slaying the big bad corporate dragons preying on the widows and orphans. Such a sham insults my intelligence.

Mr. Capuano, you had the opportunity to surprise me pleasantly, when you wavered on this bill. But if you get on that bandwagon after all, then you may not rely on my vote for your reelection.

The people of our state voted FOR obstruction of this bill in the special senate election. That was an explicit appeal in Senator Brown's campaign and in the slogans of supporters. They do not trust this bill. They want it scrapped and redrafted along fundamentally different lines. I hear it in casual conversation even in my eighth-district neighborhood. I heard it even today, from a government employee no less.

Do not delude yourself about this.


Pavel is much better with written words than I am; feel that he explained it best for the situation of an awful lot of 'average' folks.

I'm totally against the so called reform, as, being a 'consumer' (or should I say 'victim?') of the Massachusetts Jailbreak, (that the current President has considered as a national model) have my own set of problems that are more considerably and consistently costly, not to mention subject to Bureaucratic Incompetency than whenever I had to deal with a doctor's office or hospital directly.

(Have been too tired lately to detail my problems of not being able to afford COBRA for MA inflated rates, my problems with hack state a/r folks and the lack of customer service with, the fact that I live in one of the maybe three states that my alma mater's catastrophic coverage insurance plan doesn't cover for new gradutates, and the fact that, the minute I try to send off the application for Commonwealth Care's subsidized plan, I am forced to tick off a box allowing the State of MA full access to my medical records. Much, much easier, not to mention cheaper to pay the state income tax penalty and to visit and pay cash for a doctor like one did for the 'back alley abortionists' of yore.)

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