Whither Health Care Reform without Teddy?

I love this picture of Ted and Victoria Kennedy, taken by Matthew J. Lee of the Boston Globe. The picture was taken in May of 2008, after Ted Kennedy had been diagnosed with brain cancer; he had been released from Massachusetts General Hospital earlier that day. It shows his love of life, and love of living.

With the passing of Senator Kennedy last week, folks across the country were looking back, some even benevolently, on the Kennedy family and legacy. It’s a rich tapestry, filled with both the very obvious highs and lows, but also tinged with great nuance. Teddy the painter, Teddy the sailor, Teddy the history buff, Teddy the practical joker…and on and on.

Some of the more touching moments over the past several days of mourning were the younger Kennedys talking about what Uncle Teddy meant to them, as a father, uncle, grandfather, stepfather, and friend; the intercessions at his funeral by the younger generations, offered up in EMK’s own words as prayers with great poise; and of course the tales told by Senators John McCain and Orrin Hatch, and by Vice President Joe Biden at the memorial service at the JFK library, which added layers and colors to the picture as well.

Among the questions being raised now that Teddy’s gone is what will happen to health care legislation. There’s no question that getting national health care implemented was a life-long goal, and one that we are teetering on the brink of accomplishing. While he had not been present in the Senate for a very long time, he was working behind the scenes, the consummate politician, helping others try and keep the legislation moving along. Recall that, at different times in the debate over the past several months, what’s been discussed as vital to our country are covering the uninsured (which includes not only those who apparently can’t get insurance, but also those who choose not to), saving money (by reducing unnecessary services, but certainly not by ‘rationing care’), and by improving quality (through incentives to those who practice medicine well and drive positive outcomes, but definitely not about improving the quality of end of life care;, heaven forbid that even get discussed). And of course, through all of this, we must bring the evil insurance companies to their knees and get them to change their ways.

Sadly, however, we can’t cover more people, and reduce costs, and not ration care, and pay more for the care that’s provided, and bring an industry to its knees all at the same time. Even Teddy realized long ago that you can’t get everything in one fell swoop – you have to take incremental victories along the way. Incrementally, we’ve achieved S-CHIP, health insurance for children. Incrementally, we’ve achieved HIPAA, the Health Insurance Portability and Accountability Act, which requires that certain prior insurance coverage count against waiting periods under new insurance, and defines how those waiting periods are determined. Incrementally, we’ve gotten COBRA laws , which allow a person to continue their health insurance when they're between jobs, and helps make the HIPAA protections more secure. And under new legislation passed earlier this year, COBRA coverage can be subsidized by the government, reducing the burden on folks during these difficult economic times.

In this article in Newsweek, Senator Kennedy talked about the incredible health care he was able to get for himself as he underwent his treatment for brain cancer, and also when he was injured in a plane crash back in 1964; and how he’s been able to obtain the best possible care for all three of his children at various times when they were in the midst of health crises of their own. He was able to get this level of care for two reasons – one, he’s a Kennedy, and both the name and the money behind it open doors. The second reason he’s been able to get this care is because he has the best insurance in the country – the Federal Employee Program (FEP), which offers great benefits, tons of choice, and pretty much carte blanche in terms of coverage. And again, like being a Kennedy, these are benefits that the vast majority of Americans cannot access – even those with health insurance - because most plans are not as rich as those offered under FEP.

Knowing that the vast majority of Americans are neither Kennedys or beneficiaries of the FEP health insurance plan, what do we do now? Do we give up on health care reform, now that its greatest champion is gone? Or do we renew our emphasis on getting some consensus on what we need to have as critical health care reform, get that part done this fall, and then continue working on it until we have all of it figured out? I would choose the latter option, plain and simple.

If we agree that all Americans need to have health insurance as our first priority, then we mandate insurance coverage, plain and simple, and we come up with ways to enforce that mandate. This includes making young, healthy people who get coverage, whether they want to or not.

If our highest priority is that we eliminate waiting periods on health insurance benefits, as that’s preventing people from being covered, or causing people to lose their savings, homes, etc., then that’s what we focus on, that’s what we figure out how to pay for, and we get it done.

If instead our highest priority is cost savings, then we adjust the Medicare reimbursement methodologies (which are the basis for many private insurer reimbursement calculations) AND we get reductions from Big Pharma on drug costs. These actions should not only reduce outlay in payment for benefits, but also should reduce or hold the line on premiums paid.

Whatever we do, we must do quickly enough that the states have time to respond, adjust their regulations to align with the new federal statutes, and make appropriate changes in their programs as needed. This is critical, because whatever comes down the pike at the federal level will certainly have consequences at the state level, 50 times over. Taxes, safety net programs, benefit mandates, subsidies, costs for businesses (including insurance companies) and individuals are all in play in this debate once the feds decide what we're going to look like.

I’m not so naive to think there wasn’t a political motivation or undercurrent to some of the tributes to Teddy; after all, while you can take the Kennedys out of politics, you can’t take the politics of out the Kennedys. I also don’t agree with everything he ever said or did, but instead recognize him as a human being, flawed as are we all. But I think we can learn from his undeniable drive, determination, and ability to achieve consensus as we try and solve this animal that is health care reform.

Cash for Clunkers Redux

First and foremost, let me say that I have already apologized to my Mom for the title of this post. I don’t want that hanging over my head as you read this. But I’m thinking Cash for Clunkers – the name of the program that rewarded people who foolishly drove inefficient, costly vehicles for the past several years and then ‘found religion’ and got a newer, more efficient car using our tax dollars – would be a great name for a bailout program designed to give seniors a payment in lieu of COLA. Read on.

Back on May 2, 2009, the New York Times published this article which projected that there would not be a cost of living allowance in 2010 or 2011 for the 50 million of our friends, family and the total strangers who receive Social Security.

For some reason or another, I don’t recall hearing much about this back then; it wasn’t until yesterday’s news that I heard the AP story that sounds pretty much like what the NYT had a few months ago. There’s some added commentary in this version of the story, including a proposal that a one-time bonus of $150 be given to beneficiaries. This will only cost about $8 billion, according to the National Committee to Preserve Social Security and Medicare (NCPSSM); the costs, they figure, could be covered by an increase in the income eligible for social security taxes.

Back in July, the NCPSSM sent a letter to US Senators asking them to do something about the COLAs in light of retirement income losses and likely increases in the amount Medicare beneficiaries would have to pay for health care services or health insurance premiums. And chances are, the senators will listen, and the COLAs will be restored.

My favorite Social Security recipient is my Mom. And trust me, she’s no clunker. She’s busier at 79 than many people half her age can imagine. In many respects, she’s fortunate – she’s got a pension, and she has a health insurance plan that picks up the bulk of what Medicare doesn’t and also includes a strong pharmacy benefit program that pays all but a small co-pay on her prescriptions. All things being equal, she should be able to hold on to these going forward. So, when it comes to being concerned about Mom not getting a raise for the next couple of years, it’s not the health insurance costs that I’m really worried about.

It’s the school taxes, town taxes, county taxes, and all the other taxes that are being raised; her house was recently revalued, and that’s going to have an impact for a few years. And it’s not just the taxes, it’s the fees that are being rolled out or increased (to protect politicians who swore off tax increases). It’s all of those things that apparently don’t go into the calculation for inflation, but which do come out of her wallet, that are going to make it harder for her to enjoy the next two years with no raise.

Now, don’t worry… if she needs anything, we’ll find a way to help her out. And I appreciate that everyone has to do some belt-tightening, and she’s no different. But it is hard now to watch us sort of ignore our seniors, while at the same time we’re giving well over 150 million dollars (in New York alone) to public assistance recipients, free and clear; and when we’re (as mentioned above) spending $3 billion to reward people who were too foolish to give up their gas-guzzlers years ago like My Sweet Baboo did; and when we’re doling out $750 billion Bush dollars and $787 billion Obama dollars to help the banks, auto companies, and bad mortgage lenders and recipients.

At a time when we’re watching governmental jurisdictions of all levels – from the state of California to the County of Onondaga to all the cities, towns, and villages in between - try to cover massive deficits, it’s pretty easy to see that the folks who have paid their dues and are now on fixed incomes might be in need of some assistance. I’d rather see something go their way – within reason, and with a means test, of course – than to some of the places we’ve been throwing money lately.

Thoughts?

The Weekend Trifecta

A new feature for veritablepastiche: the trifecta. A trifecta is generally described as a type of bet where, in order to win, the bettor must pick the top three finishers in the correct order. Here are this weekend’s top three:

• My Sweet Baboo, my mom and I went out to dinner on Saturday night. No particular reason, really – just an opportunity to get together, relax and let someone else do the cooking. We went to Zabroso, a restaurant in the village of Sherrill, east of here. The menu this weekend included a four-course feast of local products, all of which were creatively prepared and delicious. It was also a great trip down memory lane. My Dad grew up in Sherrill, where my grandfather worked for Oneida Silver. The restaurant is located in the Mansion House, the original home of the Oneida Community, and also was home to my Dad for a time when he was young and to my grandmother on a couple of different occasions. On the way in, we drove past the golf course, and saw that the memorial tree purchased by my generation to honor my late uncle is thriving; after dinner, we wandered around the community garden, sharing the evening air with a couple of fawns who quietly made their way across the lawn near the tree line. Friday would have been Mom and Dad’s 55th anniversary; to be at the Mansion House on Saturday seemed very fitting.

• Our garden journeys continued this weekend; Saturday, MSB and I were in our respective gardens weeding, planting irises, and for me, rehabilitating a garden which had not done as well as I had hoped in the past couple of years. We also dug out an old wild rose with roots as big as our arms, and moved into its place a young, vigorous wisteria which needed more structure than it was getting. Three wheelbarrows full of debris later, we were done; everything was watered in, and I even managed to get the front lawn mowed before exhaustion set in.

• Syracuse needs a new mayor, not only because the one we have has not lived up to his promise, but also because he’s done at the end of the year due to our two-term limitation. As a registered Democrat, my opinion is apparently a hot commodity in the primary. On Friday and again today, I had the opportunity to participate in telephone polls regarding the mayoral contest. I know to some folks this type of phone call is a distraction or intrusion, but I’d rather be asked for my opinion than be completely ignored. The questions were slightly different on each survey, but I hope I was consistent in the overall gist of things. One question asked in both surveys that I could answer without hesitation was, how likely am I to vote in the primary – absolutely will vote, likely will vote, may vote, not likely to vote, or will not vote. I can say for sure that I will be voting.

Time now to put this weekend to bed; tomorrow's likely to be another fun-filled day, and I don't want to miss any of it. I'll leave you with a short video that I got via email from my brother-in-(common)law, which clearly illustrates the value of perspective. It's about six minutes long, but worth sitting through it. Enjoy, and have a great week!

PPOD 8/16/09: The Back to School Cash Debacle

Ya gotta love this.

According to this article in my local newspaper, chaos ensued when the government decided to send food stamp and public assistance recipients a $200 bonus for each child in the household between the ages of three and seventeen. Grocery stores gave out tons of cash back, ATMs were emptied, and hundreds lined up at the DSS office when their benefit cards went on the fritz.

The suggested use for the money was to purchase back to school items such as clothing or school supplies, as indicated in the letter sent to recipients . But the only ‘mandatory’ thing the letter calls out is that there’s some sense of urgency in tapping into the cash, because ‘this payment may expire if your cash account is not accessed within 90 days.’ As if there was any chance that would happen.

It’s also interesting to note that, per the Office of Temporary and Disability Assistance the matching portion of the money from the Federal Stimulus program specifically could not be used to provide support to organizations who give school supplies to kids – it could only be sent directly to public assistance beneficiaries. Here in Onondaga County, 21,000 people received $4.2 million; statewide, there were over 813,000 'eligible' kids (39% upstate, 61% NYC-area) in about 433,000 PA/food stamp cases. Some of them may not yet have gotten their letter telling them why they were getting the windfall.

From the right, skepticism and dismay was quick, including this from the newly reform-minded, bipartisan Republicans: “The grants announced today by Governor Paterson would be given out regardless of whether a welfare recipient complied with work and other requirements or whether a child was enrolled in school, attending school or even dropped out…”

On the flip side, from the Dems, we get lots of pap about how this is a great idea, including these glowing comments from our Senators:

• U.S. Senator Charles E. Schumer said: “This funding is a smart investment in the futures of our students. Each $200 grant will provide access to much-needed resources and back-to-school supplies so that our students are prepared and ready to learn on their very first day of class.”


• U.S. Senator Kirsten E. Gillibrand said: “Nothing is more important for our children and for the future of our State than a good education. I am humbled and proud to see leaders at all levels coming together to deliver the resources that our children need for school in these tough economic times. Together, we are working to arm the children of this State with the tools they need for a strong start to the new school year.”

So – the government and an extremely generous billionaire combine to hand out money which people can spend on school supplies, if they want, or they can spend it on whatever else they have a hankering for.

But what are regular folks doing? They’re collecting and handing out school supplies! A quick Internet search and I was able to find these, from different areas across the state:

• For the eighth time, a local woman in Syracuse has coordinated a giveaway that benefits thousands of kids.
  
• The NAACP in Elmira is purchasing supplies and hoping to help around 100 school kids in the Southern Tier.
  
• The New York Liberty basketball team collected supplies at a game and is donating them to a Manhattan homeless shelter.
  
• This group in the Utica area, who has handed out over 30,000 backpacks in the past few years, cannot afford to do as much this year, but will still donate 300 this year, to a refugee center.
  
• An Eagle Scout in Rochester is collecting supplies for several local schools .

And of course, hundreds of business, like my evil health insurance company, are collecting supplies for their adopted schools or other community organizations.

Don’t get me wrong. I don’t mean to imply that every single family who got this free money immediately turned around and bought big screen TVs, or the bling of the day, or steaks and lobster – I’m sure there are many families who either used this money to purchase back to school items, or pay bills, and that’s fine. Heck, from an economic standpoint, it’s fine if they bought big screen TVs – I guess any money spent in a slow economy is good money, and something that benefits all of us.

What I do have a problem with is simply throwing money around, without any accountability. How much better could this program have been if instead of cash to individuals, they had purchased the actual school supplies and handed them out through churches, schools, youth groups, social services departments, and so on? Or provided the money to organizations that could have then spent the money purchasing the supplies and ensuring that they made it into the hands of the kids that the program aimed to serve?

I'm donating school supplies this week at work; I hope you'll do the same if you have the chance. What I won't be doing, however, is standing on a corner handing out cash to anyone who walks by. I'll save that for the politicians. And hopefully, we'll have the chance to vote them out of office before all of the money is gone.

A Kiss Before Bouckville

Every August, My Sweet Baboo and I head both east and back in time to the Madison-Bouckville Outdoor Antiques show. 

We’ve gone every year that we’ve been together, and it’s now part of our ‘must-do’ list. We do own some antiques, nothing special and sadly, we don’t have any of those ‘oh my goodness’ items that we see on Antiques Roadshow. You know, the vase that someone picked up for two bucks on the last day of an estate sale that’s a rare Tiffany and worth tens of thousands? Yeah, that's never happened to us (or anyone I know). 

We will buy things if we can reasonably convince ourselves that we’re getting a deal, but we’re more lookers, happy to wander in and out of booths in our famous hazy, hot, humid weather, working our way up and down row after row after row in a field looking for just the perfect….well, whatever perfect thing we find. 

We’ve had some comical adventures along the way, including two that are always mentioned as our Bouckville trip draws near. The first is the time I took everything I needed – tote bag for carrying purchases, umbrella for the scattered thunderstorms we usually encounter, allergy medicine. Everything I needed, except my wallet. 

It made for interesting shopping, as you might imagine, because my eyes were likely bigger than my own wallet, but definitely bigger than MSB’s wallet. I think I kept my spending to less than $40 that day, and I can confidently say that I repaid him for my purchases immediately upon arrival home.

Another trip started strong – I found a couple of great Christmas things at one of the first booths we visited. Remember, the show is advertised as 1000 dealers, so the things you see at the first place you stop might likely be found at any number of other places - but the price may not be found later. So, being some what impetuous, and having my wallet with me this time, I decide to try a little negotiation. I got the price I wanted, paid for the things, and dropped them in my tote bag. Off to a great start! It didn't take more than about 10 minutes for me to realize that carrying around a tote bag containing cast iron Santas was going to make for a really, really long day. 

One year, we opted to not go into the main show field, but instead focused our attention on the many dealers that set up shop on both sides of Route 20, and we were not disappointed. I would guess that we must have seen close to 500 dealers just wandering around. Signs were up everywhere, pointing to parking, food, and 200 dealers! 75 dealers! 100 dealers! Three huge tents full of dealers! Another hundred dealers! For some reason - we haven’t figured out why - it seemed like a more friendly, more social atmosphere on the street than in the field. With only one or two exceptions, everyone was smiling, laughing, and having a good time. I was able to continue my concerted effort at enjoying myself and trying to overcome our famous CNY malaise, and had some fun in the process. 

One example? We were taking a break and enjoying a rare breeze while nearby a woman was trying to decide if she should pay $25 for a full length fur coat. The owner of the booth told her she looked terrific; we told her she looked terrific, but she wasn’t convinced. She stood on a chair and checked out how she looked in a car window, but she really wanted to see what it looked like. None of the nearby booths had a mirror. We encouraged her to buy, not because we had any skin in the game, but because the coat looked great and even if she only wore it one time, it would have been worth the money. 

As we walked away, she was still talking to herself about whether to get the coat. And then, lightbulb – I remembered I had my digital camera. So, back I went to the booth, the woman and the coat, took a few pictures of her, and let her see what it looked like. As soon as she saw the pictures, she was convinced, and bought the coat, a huge smile on her face. There were many other smiles too; we laughed with a couple who sold art tiles, dating back to the mid-to-late 1800’s, who were astonished when they overheard someone say the tiles were ‘just like the ones they have at Home Depot’, or the person who thought that a gorgeous tile with a $100 price tag really could be had for one dollar. 

There was a lot of stuff that caused My Sweet Baboo to wonder why on earth anyone had made the item in the first place, beyond wondering why anyone would buy it for a second time now. And of course we smiled at our finds: an expandable silver trivet, to go along with the others in my collection; two small art glass tiles that will complement our living room nicely; a bird print; an old brown bottle from a defunct Syracuse business; a great doorknob to add to the garden; and a couple of old printer’s plates that look really cool, even for folks who can’t read backwards. 

Next year, come August, we’ll get geared up for the Bouckville trip again. And like I always do, as we’re leaving the house, I’ll give My Sweet Baboo a kiss and thank him in advance for the day we’re about to have. One way or another, I know we’ll have a good time, even if we don’t buy a thing. And I know if I do find some cast iron, we’ll pick it up on our way back... 

One Pedro is Better Than Two...

As hinted late yesterday, Pedro G Espada has resigned from his freshly-minted $120K job working for the State Senate.

It may have been the review by Attorney General Cuomo. It may have been the outcry that echoed across the Empire State at this latest round of nonsense from Albany and the audacity of Pedro 'padre'. It may have been editorials like this one in my hometown paper that spelled out bribery-related statutes. Whatever the reason, one Pedro is better than two.

But none would be better than one.

PPOD 8/11/09: Two Pedros Are NOT Better than One

I promised I'd take a break from talking about health insurance reform for a couple days, and I'm going to keep my promise. Instead, let's have a Pet Peeve of the Day, it's way more fun!

Not long ago, I had the opportunity to post a PPOD on Pedro Espada Jr, the 'leader' of the New York State Senate. Regular readers will remember that the NYS legislature is the country's most dysfunctional, not in my humble opinion but in the opinion of really smart people who know about these things and have spent lots of time researching this stuff. Me, I just live here.

But now, as a New Yorker, I'm hardly proud to announce that not only do we have Pedro Jr in Albany, but we have managed to find a way to create a job for his son, the highly qualified Pedro G Espada, and pay him $120K per year. During a hiring freeze. When the State is offering some employees a buy-out to reduce the size of the workforce.

I know, folks are going to tell me that nepotism is a way of life in politics, and that I shouldn't be shocked by this. And I agree -- I'm not shocked. I'm peeved at the audacity of this man, and at the lack of basketballs on the part of the rest of the Dems in the Senate who sit idly by and watch this nonsense go on, all in the name of being in the majority.

So, two big thumbs down for the two Pedros. I say it again: we deserve better.

Health Care Reform, Part 4: Noodling Around

So, with Washington on recess for August and our elected representatives home for vacation and hopefully gathering the pulse of their constituents, here’s a few things for them (and us) to noodle on. And you know of course the fun with noodles is trying to figure out where the end is, which end is up, and how to separate them into individual noodles worthy of your attention.

What's the metric for inclusion in my bowl of noodles? Well, whatever strikes my fancy – some of it is opinions, some of it’s facts (and a nickel to those who can tell the difference) and one’s just hysterical. Let's roll:

The Washington Post has a panel of experts who discuss health care reform. Here are some excerpts of their views on the public option.

• Umpire or Play Ball, Not Both "I work on behalf of small businesses and they need rising costs to decelerate. That means making the private insurance market more competitive and empowering consumers and providers to find ways to restrain costs. Asking the government to be both umpire and player is no way to get that job done."
• Haven't We Learned Our Lesson? "The logical answer is no, a public option is not necessary. The federal government should be doing only the 20 activities specified by the Constitution -- and health care is not one of them. Today, actually, more that 50 percent of health care is already delivered by the federal government, if one adds together Medicare, Medicaid, the Veteran's Administration, the military, employees of the federal government, etc. And yet all those are fraught with problems (not unlike "civilian health care"). So why would anyone believe a public option would solve problems, control costs and "keep insurers honest"? Haven't we learned our lessons from "managed" care, the postal system and the rail system regarding cost containment by the federal government?"
• The Only Option "A public health plan is the only option to secure affordable quality care for all Americans. Let's put this in perspective: Canadians and the British have enjoyed universal health care for over 50 years. To say that these plans aren't working after they have met the needs of a generation of people is laughable. There is no contest to facts that indicate that these countries enjoy better health and longer lives."
• Getting Everyone Covered Efficiently "The public insurance option would be built to lower administrative costs, utilize electronic health records to minimize paperwork, cover all individuals regardless of preexisting conditions, focus on prevention and wellness and generally produce healthier participants. It would allow us to start from scratch and create the ideal insurance program based on proven concepts. It would also inevitably force private insurers to examine their current practices and innovate to remain competitive."

Here’s a great opinion on cost savings, which I think fires on many of the right cylinders:
We Must Threaten the Status Quo " The health-care reform spotlight has shifted from taxes to cost savings. The danger is that Congress will fall back to old habits and make its usual cuts to physician fee schedules, medical education, social programs, etc. The "big ticket" opportunities lie elsewhere". The author goes on to list several of them, including tort reform, drug costs and a need for the government to negotiate discounts, exploding medical technology costs, preventable errors (never events, in the parlance), and payment for the volume of services done, rather than the quality of care, which is a slippery slope. He also touches on end of life care, another contentious part of the discussion on Obamacare.

Speaking of malpractice reform, here's some data on the impact of medical malpractice to health care costs in Massachusetts. There's lots of info in the study but the bottom line is, in some cases more than 25% of services rendered were 'defensive' in nature, meaning the physician performed extra services as protection against possible malpractice suits. Not sure about you, but that doesn't seem like the best way to treat a patient. It's funny how much we hear about untrustworthy, evil health insurance companies, but not so much about those nasty trial lawyers we used to hear about...wonder how that happened? Where is John Edwards these days, anyway?

Back to the public option, which is supposed to include payment for quality care in addition to all of its other benefits: "Joining the resistance against the public option have been providers held up as models by Obama, such as the Mayo Clinic, which argues that rates linked to Medicare would be too low and fail to reward cost-effective care. Reformers say that the Medicare link is needed at the outset to get the new public option off the ground quickly but that the House bill would allow the government to set public option reimbursements in a way that rewards high-quality care instead of on a fee-for-service basis. But Mayo chief executive Denis Cortese said the government should try such payment reforms with Medicare first. "I don't see why they have to create a new public plan to start paying for value," he said. "

Hmm...why is that? If Congress is convinced that it can work, why don't they test it on Medicare first, reap the benefits (assuming there are any) and then go ahead and put it into the broader marketplace? Or, why don't they try it on their own plan first, let us know how it works, and then put it into the broader marketplace?

And here’s a fun comment from Senator John D Rockefeller IV , from the same WP article: "Other Democrats disagree, saying that reform without a strong public option is doomed to fail, with private insurers reaping a bonanza of new customers while costs continue to escalate and premium subsidies fall short. "Health insurance by its very nature is a rapacious industry. [Insurance companies] want to make a lot of money," said Sen. John D. Rockefeller IV (D-W.Va.). "We have to have a strong counterbalance to them." I tell ya, you've got to love a person who inherited more money than God complaining about an industry trying to make money.

But give him credit, at the same time he’s bashing health insurance companies, he’s also focusing some attention on prescription drugs, which account for the largest portion of out-of-pocket health care costs. The problem is the prescription drug industry is helping craft health care reform. Oh wait, that's not a problem. It's only a problem that health insurance companies are trying to have a voice too. I keep forgetting that part.

In summary, if one can actually summarize this debate, now that our representatives are home, here’s what they’re up against – some great poll numbers from the Wall Street Journal. If most of us are happy with our coverage, and most of us think the government will screw things up, and most thing that taxes will go up to pay for it, our leaders have a dilemma.

The article’s author sums it up better than I can: "In political terms, the most important reality will be how the reform affects the 68% who say they have good or excellent health-insurance coverage. If they end up having to change their coverage, pay significantly higher taxes, or encounter some other unpleasant reality, congressional Democrats will look back on this August as a time when they should have listened more closely to the folks back home."

Enjoy your noodling.

Health Care Reform, Part 3: Preexisting Conditions

During our trip to New Hampshire, My Sweet Baboo and I spent some time visiting several covered bridges (this is the Coombs Bridge) in the area around Keene. The bridges are all restored, all on the National Historic Register, and all beautiful, but each is slightly different – long vs. short; lattice vs. closed in, and so on. They also have different restrictions on the height and weight of the vehicles that can pass over them.

We returned home yesterday evening and we were hanging with the kids last night, watching the news, and saw a commercial for a regional theme park which has several thrill rides. All of them have different restrictions for height, physical condition, and overall size of the people who are allowed on the ride. So you’re wondering, what does this have to do with health care reform? Well, the rules of the bridges and the rules of the rides are designed to deal with preexisting conditions - the condition of the user.

And, the concept of preexisting conditions is one of the more contentious issues in the health care reform conversation. There is one school of thought, supported by President Obama and many others, that there should be no exclusions for preexisting conditions – everyone should have coverage from day one for any illness or condition they may have, regardless of what it costs them or us to pay for benefit. There’s another school of thought which is that having waiting periods for pre-existing conditions is acceptable.

There is a mountain of horror stories from people who have been denied health insurance benefits for one of these conditions. Folks are always are quick to put the horror stories on the table, especially when cameras are rolling, or a reporter’s hovering nearby, but what’s not talked about quite so much is that there are protections for most of us under the HIPAA regulations, which have been in effect since 1996. For those of us who receive insurance through our employers, waiting periods are limited under these rules, as is the look-back period, which is the time period an insurer can go back into your health records to see if you’ve got any condition that may be considered preexisting.

In the big picture, consequences for preexisting conditions are everywhere in the insurance industry, not just in health insurance. Some of the obvious ones? Risk pools for bad drivers, who have to pay more for their auto insurance. Another example is with life insurance; if you don’t get a physical and disclose your medical history, your benefits may be limited, as with this AARP insurance. Logically, homeowner’s insurance would be more difficult to obtain or more expensive in areas prone to weather issues (hurricanes, tornadoes, or avalanches) or other risk factors - check out these questions. I did try to see if I could get any sense of the added cost if I had five or more smokers living in the house, a wolf hybrid dog, an all-wood home, no alarm system, 10 miles to a fire department, and 3 insurance claims in the past 5 years, vs. the reality (one smoker, darn him; no dogs; an alarm system; a fire hydrant across the street and a fire house five houses down; and no claims ever), but they don’t really offer a comparison online.

The point is, it makes sense, doesn't it, if you take the emotion out of it? Certain of our cars, houses, lives, and illnesses are more risky than others, and either they're going to cost more to cover, or there'll be a reduced benefit until the risk has passed.

Health insurance should not be a thrill ride. All health insurance carriers – mine included – need to follow the rules that govern waiting periods, just as they should follow all of the other rules that govern the industry; that’s a no-brainer. If they don’t, there are consequences, and there are layers of regulatory oversight designed to respond to cases where the carriers are not following the rules, and these should be enforced.

Consumers also should be prepared to follow the rules. Know what your policy says about preexisting conditions (and everything else); understand the consequences of not taking insurance when it's offered to you when you get a job, and also understand the consequences of not taking continued coverage if you're unfortunate and lose your job. If you follow the rules, and it doesn't seem like you're getting what you paid for, take steps to file an appeal, a grievance, an inquiry - whatever it's called under your contract.

Lastly, politicians should be prepared to discuss issues thoughtfully, with an understanding of legislation that's already on the books; they should pay a little less attention to reporters and cameras, and resort much less frequently to scary rhetoric which doesn't move the debate forward. That’s probably me asking for too much, as usual. But -- if the bar is being raised on consumers, and the insurance industry, and the financial industry, and the auto industry, I think we should raise the bar on the politics industry as well.