Competitive Option, a Health Care Reform?

More years ago than I would like to remember, I was the Deputy Director of Medical Assistance and Health Services (Medicaid) in New Jersey. At the time the State owned a managed care plan--Garden State Health Plan. New Jersey built the Garden State Health Plan, because no commercial/private plans were willing to enroll Medicaid members at that time.

As private plans moved into the Medicaid market, New Jersey chose to move all of the AFDC/TANF members(at the time this was the Aid to Families with Dependent Children populations, now known as Temporary Assistance to Needy Families)into managed care. At that time, the State faced a bit of a dilemma. The Health Care Financing Administration (HCFA), now Centers for Medicare and Medicaid Services (CMS, yes I know it is missing an M) questioned how private plans could compete with a state-owned plan. Further, they questioned the incentive to assign members who failed to choose a plan fairly amongst plans when the State had an ownership stake in one of the competitors.

Even in 1997, it was common knowledge that you can't make the rules, regulate an industry, and not at least have the appearance of bias. What industry would we trust to police itself...other than the legislative branch of government. Ok, it not that we trust them to do it, but they make the rules, so we can't stop them.

By definition, a public option, that is owned and operated by those who make the rules for all of the competitors can not even give appearance of fair competition. Let alone actually compete fairly. No health plan or insurance company can levy taxes or print money when it fails to meet its capital requirements.

Competitive Option--not so much. Oh, and New Jersey sold the members of the Garden State Health Plan to a private plan for $15 million. The reason for the sale noted in the New York Times and attributed to Governor Whitman was "privately run health maintenance organizations could operate it more efficiently."

Hold that thought!

Barbie and me!

So my morning Wall Street Journal read started with an article about Barbie. Yes, run off elections in Afghanistan, secret developments on the health care reform front, and this health care expert is reading an article about Barbie.

Did you know that she has had 130 difference careers since 1959? That's slightly less than the number of companies I have worked for. In the 1960s, she was an astronaut. In the 1980s she wore power suits, just like me. She even wore Jackie Kennedy's bob cut.

Even when I knew that bound feet and waist too small to accommodate ribs was not reality, I knew that any and every career that I could qualify for was a possibility. Hey, if she could do it while trying not to tip over from the upper body weight and the tiny feet, it would be easy for me.

Mostly, as girls, we knew that Barbie was plastic and an fantasy. Apparently, we had one up on designer Ralph Lauren. In our world, Barbie was just a doll. Some where along the way designers like Mr. Lauren forgot that. Firing a model for weighing 120 lbs and photo-shopping her until her head is bigger than her waist is just...crazy. I remember 120 lbs...let's see, I was 12 years old. See to me having a doll is pretty harmless, but taking real live people and photo-shopping them or requiring them to starve themselves to meet a vision is dangerous.

For my generation, Barbie was plastic...for girls now the models on magazines look like they are flesh and blood. Our daughter is in fashion school, so we watch a lot of model/designer "reality" (yeah, right) TV. When the competing models were telling one girl that she could never win. "They won't go with a plus size girl" (she wore an size 8), I was ready to blow. When the speaker of the house is so plastic surgeried-out that she can't express dismay? Houston, we have a problem.

So please give me back the days of Barbie, with the 130 careers and the you can be anything spirit. When we knew she was just a really pretty doll. Kim Kardashian run that picture with the cellulite.

This Black Barbie will proudly exhibit my Rocky the Flying Squirrel triceps, my less than flat tummy and my dimples...not in my face cheeks.

But thanks Barbie for letting me know as a kid that the only reality that mattered was I didn't have limits! Hey, what did Ken do for a living?

I miss shame!

I really miss the concept of shame...not the stone the fallen woman type. The type of shame that I miss is the let's feel accountable for our own choices type. I miss the concept of privacy.

Lately, I have been spending a lot of time in airports, over hearing cellphone conversations. A couple of things are becoming very clear to me. First, no one is accountable for their problems. Either the evil company or coworker or some other being caused their problem.

No, the individual complaining didn't contribute to the situation.

Secondly, people seem to be entitled to promotions, bonuses, jobs, unemployment, free health care, free food, pay without work, etc...not on the basis of hard work, but just because they showed up and spent the time.

Thirdly, corporations, the media and politicians are collections of people--individuals, and should be judged accordingly. All (fill in the blank) are not the same. Like people there are good corporations, media and politicians, just like there are bad ones.

Now back to the cell phone. Here are some basic rules to keep in mind:
* If your conversation involves sex, body parts, body functions or things that come out of body parts--don't discuss it in public.

* At least two people in any waiting area know your company, and probably one of the people you just maligned.

* Yes, you are great and all knowing. Everyone else is misguided and too stupid to take your advice...Isn't it enough for you to know that? Must I know it, too? I don't even know your name.

* If you are not ethnic, and do not actually come from an ethnic background, don't add it for affect in your cellphone conversations. (If I hear one more white man talking like a tv ghetto woman, or one more young girl trying to sound like a gangster...I will be a headline)

* Mostly, I know you are as bored in the airport as I am. Don't let boredom rob you of your privacy and dignity. Think about how you would perceive a stranger having your conversation in public. Then picture that person sitting across from you at a job interview...would you hire them?

Health Care Reform/Independence

The Wall Street Journal published an article entitled, "Spine Surgery Found No Better Than Placebo". Let's not get caught up in whether or not the spinal surgery works, let's look at the politics of this article. Health care reform, as currently proposed, allows the government to use "expert advise, based on the 'best' research to determine which procedures will be paid for by health insurance...not just government insurance, but health insurance. These decisions, in theory will be based on, independent studies. Who funded these studies? The federal government. Doesn't that make these studies about as independent as my right hip is from left hip?

One can not be considered independent if you have dog in the fight. The studies were conducted in the US, Britain and Australia. Does it matter that two of the three countries have government health care? Does it matter that the sample of participants was limited in the US because many surgeons who believe the procedure refused to participate? Does this affect the sample, and thus the outcome? Maybe.

What is clear, is that the outcome of these government funded studies may allow the governments to stop covering a service that people and physicians have evidence is helpful to patients.

The issue here is the definition of independence. Shame on the researchers and the reporters who use the word independent in this situation. We must change our thinking to match the times!

Faith of My Father

My father is buried at Logan National Cemetery under a federal headstone with a cross on it. Around him and near him are those with Stars of David on their stones. They are buried on federally owned ground. The federally owned ground that they died protecting.

The Mojave Desert Cross, a memorial to World War I veterans, has been declared unconstitutional by the Ninth Circuit Court of Appeals. The Supreme Court of the United States will hear an appeal of this ruling. This simple cross, that has stood for 75 years as a symbol of healing for veterans was attacked by a person in Oregon who felt that if they should ever drive through the Mojave desert, the sight of this cross would offend them.

There is a wonderful video at http://www.donttearmedown.com. This cross is currently hidden from those it heals by an ugly plywood box. I don't want to see Arlington Cemetery or any other military cemeteries shrouded in plywood. This must stop now!

If this case is won by the ACLU, how much time do think it will take before they want to cover the crosses, stars of David and other religious symbols on these Federal sites.

Please share this. Stop the madness! Donate what you can to the wonderful lawyers who are willing to fight for those who fought and died for us. If you are offended by my father’s or other soldier’s faith, then don’t look, but let them keep in death, the symbols that meant so much to them in life!

Do Big Tents Work?

I just had a birthday. Thank you. As part of this birthday, friends from all walks of life and times of my life contacted me to say HBD. One friend, who is really family and someone that I can truly say I love indicated that he felt that abortion was one of the topics where our President wants a big tent.

I am trying to figure out what a big tent means. Not just for abortion, but for any life and death, health or hurt issue.

It is vital to have big tents for talking. We need safe places to speak with one another. To talk and really listen to one another, or no new ideas or changes can ever occur. However, at some point we must agree to disagree. At that point how do we stay under the same tent? Supporting the same people?

Do we vote against our core beliefs in order to stay under the tent? Do we give our resources and support to those who work against what we feel is right?

At what point must we stand up and say, "This is what I believe. There is no way that I can acquiesce to your wishes?"

Can we stand together, under the same tent if the result is that I condone, support the death of the innocent with my presence and gentleness?

When is it time to step out of the tent, brave the weather, fight the fight? How surprised will we be when we see all those willing to leave the tent with us?

Government Health Care means Government Choice

2009 has been an eventful year for me. One of those events was the opportunity for this adjunct professor of health administration to travel to Canada to learn a little about the Canadian health care system. Like many Americans, I have been guilty of considering Canada as the attic where our strangely bilingual cousins who have some weird relationship with the British Royal Family live.

There is so much to learn from Canada's health care system as we think of reform. Oh and the Canadian health care system has a name--Medicare. You know, the same name as our government-operated health care program that is eating the Federal budget like a PAC Man on methamphetamine? Here are some observations:

You Say Single Payer-I Say Socialized--proponents of the Canadian system like to point out that in socialized systems doctors are employees of government. In Canada, doctors do not work for the government, instead the government is the only payer. You say potaaato, I say potahto. The docs still have their own offices, overhead, etc. Government run health care is socialized health care.

Payment/Insurance does not Equal Access to Care Interestingly enough, Canada proved that payment for care does not equal access. My favorite quote on this is from Canadian Supreme Court Chief Justice Beverly McLachin, "Access to a waiting list is not access to health care." Access is such an issue that Canada has a 10 year plan to improve wait times. There are websites operated by each Territory/Province publishing the wait times for covered procedures. Just a couple of examples--Manitoba-15 weeks for a Stress Test; British Columbia--8 weeks for cataracts surgery and 12 weeks for knee replacement.

Taxes? Many like to cite Canada's 29% average federal tax rate as proof that government funded health care won't be expensive. I say, not so fast. Since the Territories/Provinces operate these programs, lets add in the average ~15% tax that are collected at this level. For those who are math challenged that's 44% income tax. Did I mention a tax up to 1.95% on employers, too.

Premiums Yes. In addition to the tax load and the 30% average out of pocket expenditures for health care, many of the Territories/Provinces charge a monthly premium for this care. Folks under US Medicare you need supplemental insurance for very high co-pays and deductible (unless you join a private managed care plan), many items aren't covered and in some areas, not a single physician will accept assignment(in other words you pay and wait for the government to reimburse you). Does this sound familiar?

Private insurance is another cost for Canadians Until 2005, when the Canadian Supreme Court ruled that Canadians have the right to buy private insurance, Canada, Cuba and North Korea were the only countries in which private health insurance was illegal and one was not allowed to pay privately for any service covered by Medicare.

Payer's Choice Don't forget that the payer decides what is covered. Consider that Canada is a country without any restriction on abortions and it pays for those services through Medicare. There are waiting list for so many services, but the money is there to make sure that even someone in the last trimester of pregnancy can get an abortion without a wait. If we, in the United States, turn our health care over to government, we will turnover our right to decide what services we want covered.

Instead of building a system that 3 of the Supreme Court Justices in Canada see as possibly unconstitutional, why not just fix our system. How you ask? http://www.opinionjournal.com/editorial/feature.html?id=110006813

Address the 10% fraud and abuse in the health care system.

Address the 5-9% costs of excessive liability in our system (by this I mean frivolous lawsuits, punitive damages, the defensive practice of medicine. No, I do not mean taking away a persons right to sue for real damages related to medical malpractice or abuse)

Use the real numbers to discuss the issue of the uninsured. If we have 50 million uninsured, consider that we have between 12 and 20 million illegal immigrants here who do not have access to insurance. Government health care will not, should not address this prior to addressing the issue of illegal immigration. What about those with access to affordable insurance who do not enroll--students, young adults,etc.

Let's not throw out a system that works for 84% of Americans without first addressing the problems that we can easily fix.