Health Care Reform, Part 2: The Devil's in the Details

I'll be out of town for the next couple of days -- a quick trip to New Hampshire -- which seems appropriate, in a cosmic kind of way. Spending a couple of days in the Live Free or Die state, while Congress works on health insurance reform, just seems like the right thing to do. Especially since, when they're done, we're not likely to be living free and in fact we may be dying sooner, or dying more, or something like that. I'm guessing the devil's in the details. And as usual, getting the details is proving to be a devil of a chore.

One version of a draft bill is over 1000 pages. Pretty safe to say that most of the folks in the House or Senate, whichever version this is, will not even read much less understand what's included at anything more than a 500,000 foot level. And I will say right from the get-go that I have no idea what's included in the bill either - I can only read, and listen, and try to learn. Naturally, anyone I want to read, listen to or learn from will have a partisan opinion, so there are not a lot of options for normal folks like us to really get a straight view of things.

That being said, here are some of the things that I'm catching wind of, through a whole host of outlets:

• Congress apparently is excluding themselves from the proposed government option. If you ask me, this is a bad sign. Not an uncommon one, I think, but a bad one.


• The House plan may prevent new private health insurance policies to be written after the full legislation is effective. Hmm... if the point is to merely offer a government option to promote competition, why does it sound like that may be the only option?


• Many of the people chiming in on the conversation have indicated that we need to stop having insurance company bean counters making health care decisions. Yet, if we listen to the President himself, he's looking for a plan that will not pay for multiple tests when one test will do; he's also looking to incent docs and other health care providers to provide 'the best care' not 'the most care'. If that's not 'bean counter' language, I don't know what is.


• We have heard a lot about the 'insurance exchange' where many different options will be available either for companies or even individuals. What I don't know is, how do we offer that marketplace of carriers, when each state has their own labyrinth of laws governing what carriers can offer coverage in which jurisdiction?


• End of life care is another hot topic without a lot of detail. What really will happen to older, sicker Americans? Is someone going to be doing a cost-benefit analysis on their care?

There are a number of questions that need to be asked, and answered, before anyone votes on a bill for health care reform. All of us need to be educated, so that we understand how whatever the end result is impacts our insurance coverage, our taxes, our benefits, and our livelihoods. If you have insurance, or you don't; if you work for an insurance carrier like I do, or a small business; if you make gads of money or something less than gads - you're going to be impacted by this legislation.

Clearly there are opportunities for reform - and I do support reform, even thought I work for an evil health insurance company. There's lot of room for improvement in costs, in quality, and in coverage. But if you think for a minute that we are going to get reform without having to pay for it, or if you think that reform will come free from painful cost-containment decisions, including denial of care under some circumstances, you're fooling yourselves.

The devil's in the details, and we have to make sure someone's paying attention to them. Why not have that someone be you?

Health Care Reform (Part 1)

Right now, Organizing for America is encouraging me to be among 1,000,000 Americans to publicly proclaim my support of the President’s plan for health care reform. The plan, you know, which was originally supposed to be a done deal before the August recess, but now looks to be done ‘better, rather than sooner’ in the political parlance, which means I can safely go to New Hampshire for a couple of days next week and not have the world be completely different when I get back.

Organizing for America is now a ‘project’ of the Democratic National Committee, but it’s really the backbone of the Obama campaign for President – the Internet donors, the Tupperware-style Obama parties, the email campaigns, the ‘let’s watch him on TV together’ meetings, and so on. Even today, every email I get from OfA includes a way for me to part with my hard-earned cash in support of whatever we support.

So, back to that 1,000,000 supporters of the President’s Plan thingy – did I sign myself up? Nope. Did I send any money? Nope. Do I know what I want to see out of health care reform? Nope...well, kinda. I think I know better what I don’t want to see out of health care reform: I don't want to lose my job.

You see, I have a confession to make. I’m an employee of an evil, untrustworthy insurance company that’s trying to derail health care reform . At least, that’s what my hometown newspaper thinks. To paraphrase Sally Field, "they don't like us, they really don't like us". It's apparently what my own Senator, Chuck Schumer, thinks of me too.. After all, “we don’t trust the private insurance companies left to their own devices, and neither do the American people” he said. It’s also what my President thinks of me too – he talks about “…force(ing) the insurance companies to compete and keep them honest…” in some of his remarks.

(For now, I’ll ignore the idiocy of politicians badmouthing anything – animal, vegetable, or mineral – on the trust factor. After all I’m admittedly jaded on this point. I live in New York, home of the most dysfunctional state legislature, and one where earlier this month the Dems pretty basically committed a felony by bribing one of their most ethically-challenged members to come back into the fold, after the Reps pretty basically committed a felony by bribing him to cross the aisle in the first place. Criminal charges are not likely – but they would be well-received, if anyone had the courage to file them. See here , here , and here for more of my humble opinion on this subject.)

Sorry, I digress…back to health care. I work for a regional not-for-profit carrier (yes, we’re Blue) that is actively trying to educate employees and our elected officials about the potential risk for our future if our government gets any further into the health care business than they are already. Clearly, a company of our makeup – again, we’re regional, and we’re not-for-profit – is not in the same position as, say, a United or an Aetna. And so, we have basically two options. Sit and do nothing, waiting on the sidelines for the shoe to drop, or we can try and get our view heard by our legislators, just as the huge national carriers can, and the American Medical Association, and AARP, and our BlueCross BlueShield Association, and a whole host of other organizations who are trying to have a say in how this plays out.

So, my company took the step of asking us to sign postcards to be delivered en masse to Senators Schumer and Gillebrand, suggesting that any health care reform bill the Senate comes up with strike a balance “between what government can do, and what private companies do best.” Pretty subversive, don’t you think? An employer trying to get a point across; trying to encourage us, as employees, to get engaged in the conversation? Oh, the humanity!

Was it a self-serving gesture? Probably. A lobbying effort? Sure – we’re not stupid. What would be stupid is the first option described above –sitting and doing nothing while the debate rages around us. I don't want to lose my job because of health care reform. It may not happen, but it might. And I hope that some one's at least thinking about that as they try to come up with a plan.

Woe are us?

The other day at work, we had what’s called a ‘close encounter’, which is an opportunity for folks to meet in small groups with one of our senior executives, get the view from the top, and ask or say pretty much anything we want. One of the things that made this one interesting was a comment made by one of my co-workers who had spent much of his life living in other places, both in New York and around the country. He didn’t have a solution, or really a question – just an observation - that of all the places he’s lived, Syracuse has the most downer attitude he’s ever seen. It’s as if we think we have nothing going for us – and so, sadly, we act accordingly.

Our group had some conversation on this topic; whether we thought it was true (we did); whether it was just our area, or if it included the other areas spanned by our parent organization (just our area); and whether we had any ideas about why. The local media was mentioned as a possible focal point; another was our blue-collar history, now facing tough times as we lose manufacturing jobs; and of course the weather – we are, after all, the perpetual winner of the Golden Snowball and have just come off our rainiest June in decades. The discussion then turned to how we deal with that kind of attitude at work, and the challenge from the executive to do what we could to combat it, individually, with our staff and with our peers.

Since we had that conversation on Wednesday, I’ve given it more than a passing thought. Was I personally guilty as charged? Did I perpetuate the negative even in the face of the many positives around us? I laugh quite a bit, find humor in things that others may miss; but even so, I decided that I’d try and keep myself honest on this at work, focus on the positive, and try and keep my innate sarcasm and cynicism at bay. I also decided I’d see what the world looked like if I were to keep a positive attitude for the entire weekend.

Can I tell you, I didn’t encounter a single miserable person the whole weekend? My Sweet Baboo and I spent hours Saturday at the Syracuse Nationals where we saw maybe half of the almost 7000 cars that made the trip. Not a single person was grumpy there – probably because it’s hard to be grumpy looking at cars of every old make and model, every color under the sun (and some that were made up, I’m sure), and every style of pin-striping and ghost flames you can imagine. Besides, many of the cars look like they're looking back at you - which makes it harder to keep from grinning at them.

On the way home, we stopped off at a local church festival to pick up some Middle Eastern food and sweets. There, a few teenagers were helping explain what the food items were, getting orders ready, being very patient with both young and old, with not a groan or mutter to be heard. We went grocery shopping today, and not a single person I interacted with seemed unhappy. We also hit Lowe’s for mulch and a couple other things, and again, not a disparaging word was heard, no frowns to be found. We even went to a dollar store for some shiny Mylar to scare deer out of the garden, and even there, everyone seemed to be in pretty good spirits. At the dollar store!

This seemed out of the ordinary – we never go through this type of weekend, with lots of public contact, without encountering at least one person who is abjectly miserable. Then I got to thinking, maybe people weren’t abjectly miserable because I was on my best behavior. If I’m being grumpy, that likely rubs off on others. If they’re being grumpy, that will inevitably shade my interaction with them. All the sudden, it seemed like there was something to this whole idea of positive thinking. Maybe I don’t need to carry a Taser when I go to the grocery store, which My Sweet Baboo’s sister BeeJuhTay suggested might make the trip go a little better. Maybe I only need to remember to bring my smile. Hmm…I hope it'll fit in my purse.

Here are some pictures from the car show. Viewers beware – you may find yourself smiling as you look at these!

PPOD 7/13/09: The 24% Solution

I'm guessing that most New Yorkers would have to think pretty long and hard to remember the last time (the first time?) we got a 24% raise...with six months of retroactivity thrown in. But that's exactly what happened, on average, for eleven Senate staffers. According to the New York Daily News, several senior staffers got nice raises at the same time the BiCauFoF seized power and became the short-lived majority.

Among the recipients of the raises was a legislative analyst who received a 51% increase, a special assistant (I guess so!) to John Sampson who got a 46% increase, two deputy secretaries who each got over 30%, the administrative assistant to John Sampson, a 28% bump, and oh yes - the counsel for Latino and immigrant affairs, who got a mere 10% increase.

While on the whole the raises for these staffers will cost us only about $200,000 in annual salary, it's really not the money that is my Pet Peeve of the Day. It's the audacity, and it's the particularly ridiculous comment of Austin Shafran, the press secretary, who likely said this with a straight face: "... because of the budget crisis and the general fiscal uncertainty of the state, the decision was made to delay the allocation of some of the salary increases." The entire story is here in the Albany Times Union's Capitol Confidential blog.

Seems to me that things aren't much different now at the All-Star break than they were back in June when these increases went into effect. The budget crisis, the overall fiscal condition of the state - pretty much the same as they were, except we're a month later in the year and have had to deal with the foolishness of our elected officials.

Amazingly, at a time when the Senate was not able to do any of our business, they managed to take care of their own. At a time when New Yorkers are losing their jobs, and unions are taking wage and benefit concessions to keep working, our senators find a way to give someone a 51% salary increase.

This could be my PPOD any day of the week.

Open Letter to all New York State senators

I’m willing to pretend for a minute that I don’t think you’re all self-serving, what’s-in-it-for-me-thinking, party- over-all, damn-my-constituents, full-speed-ahead goofballs; you pretend to be honest; and we’ll pretend to have a conversation.

Here are two simple questions for which only a yes or no answer is required:

1. If you are a Democrat, do you approve of Pedro Espada as your majority leader?
2. If you are a Republican, will you admit that your party is for sale to the highest bidder?

There, that wasn’t so hard, was it?

At this point, after the month of nonsense we've been subjected to, most of us in the Empire State are not really that concerned about who gets to bring bills to the floor, or who gets how big a legislative staff, or who has the biggest office. Truth be told, we don’t care who’s in charge of the playground that is our State Legislature. What we are concerned about are the budget, the economy as a whole, the unfair distribution of taxes, special deals for people who don’t need them, unfunded mandates, fees, and surcharges that are killing businesses large and small in our state, our backwards way of funding education through property taxes, whether or not we’ll allow gay marriage, health care, and so on down the line. These are the things that you were ignoring while you were pretending to work on 'reform'.

What many of us are dealing with, in case you’ve been so completely wrapped up in your games in Albany that you’ve forgotten, are the actual or potential loss of our jobs; temporary pay cuts; forced shortened work weeks; loss of current or future benefits; and of course the increased fees, taxes, and costs that you and your brethren are imposing upon us. I’m thinking you need to feel some of the pain that we’re feeling. So here are a few more easy questions, again a simple yes or no answer is all that’s needed:

1. Will you immediately and permanently give up your lulu, the added thousands of dollars you’re paid above and beyond your salary? The rest of us don’t get these types of payments; if we were lucky enough to be eligible for a bonus, most of us have lost them.2. Will you immediately and permanently give up the per-diem payments you receive for going to work? Again, your constituents don’t get this type of pay, particularly not for a volunteer job. Besides, with your salaries, you should be able to afford to buy your own lunch. Or, like us, you can bring it from home.
3. Are you willing to immediately reduce your staff and office costs by 20%, or furlough your staff for 20% of their work hours, without pay? This is the kind of thing that many New Yorkers have been forced to do.

And I have one last question for you. Your ability to ‘bring home the bacon’, something of which you all are pretty proud, is primarily a tool to ensure you get re-elected, but guess what? The money to pay for the bacon comes out of our pockets, and they’re pretty empty these days.
So: will you give up – completely give up – the so-called member items for your district, and include all requests for funding as line items in the State budget?

An honest, on-the-record answer to these questions is requested.

Thanks.

PPOD 7/9/09: I'm at a loss for words

They made him the majority leader.

PPOD 7/5/09: America's Front Yard

Last night while My Sweet Baboo and I were watching the news, filled with stories on how America celebrated our Independence Day, we watched in amazement a story about the National Mall and the fact that it needs $400-$500 million in repairs, at least a 10-year backlog of deferred maintenance. The last major overhaul was done for the bicentennial in 1976. That makes this my Pet Peeve of the Day (PPOD) - how can we let stuff like this happen?

About 25 million people visit the Mall each year – according to the National Park Service, this is more than Yosemite, the Grand Canyon, and Yellowstone parks combined. And that’s likely in a normal year, not an extraordinary year such as this, with 1.8 million attending the Obama inauguration alone. In addition to inaugurations, there’s the Cherry Blossom Festival, the July 4th celebration, Veterans Day ceremonies, and a whole host of other festivities occurring on the Mall.

The list of repairs is monumental (pun intended), ranging from additional bathrooms to supplement the 100+ that are already there; more food kiosks (natch), new sod; and something to stop the flooding at high tide near the Jefferson Memorial. High tide flooding at the National Mall? Never even occurred to me...

Beyond the repairs, the Mall suffers from the same overlapping jurisdictional issues that plague our country at every level. Both the House and the Senate have multiple committees with oversight; there are planning agencies, and review boards, and authorities – by the time you add them all up, there are some 30 or so different ‘overseers’ for the National Mall. This report outlines all of them, as well as some interesting plans to prepare the mall for the future.

The Mall is also politicized, which is not surprising given the fragmented oversight. Initially, there was quite a bit of TARP money – $200 million or so – for repairs. However, that’s been reduced to about $55 million, because of the usual barking that occurs when we talk about spending tax payer dollars. The needs for the Mall were trivialized -- as if the entire $200 million were to be spent on grass seed. And as far as jobs, who does this goofball think would be doing the work, the Keebler elves?

I’m with this guy - we can’t spend 1/150th of what we’re spending in stimulus funds on roads to fix up America’s front yard? Give me a break. Regardless of whether we end up with a master plan - which sounds logical - and fewer jurisdictions - which also sounds logical - we need to do something to bring the National Mall back to its rightful prominence and beauty. Otherwise, we might as well just build a WalMart.