Feeling particularly peevish one morning a few weeks ago, I crafted an aggressive letter and sent it to all of my national government representatives as well as to the president. I asked each of them to simply stop all of the initiatives regarding health care, cap and trade, etc., and let us all catch our breath.
The U.S. government had, after all, in a stunning few months, embarked on an unprecedented multi-billion dollar spending (“stimulus”) program, acquired a major insurance company and two very large automobile manufacturing companies, and assumed effective management control over the banking industry. All this at enormous and incalculable cost. I, like many of my fellow citizens, was feeling a serious sense of overload and wanted some time to digest these initiatives.
With the exception of my representative, Congresswoman Nita Lowey, neither of my senators nor the president did much more than electronically acknowledge my communication and direct me to their websites where I could witness them performing adulatory acts and read the usual pap regarding their support for the administration’s programs. I do, after all, live in a very blue state.
Ms. Lowey, however, replied with a 2 ½ page response in which she detailed her understanding of the need for health care reform and presented a case for the plan as it now stands in the House version. I was impressed and pleased with the thoroughness of her response and grateful to have an opportunity to engage in what I hope to be a meaningful dialogue absent much of the hype that so often passes for discussions.
Here is my (somewhat edited) response to her. There is so much more to say but one can only cover so much at a time. Perhaps there will be more to report as she and I may engage in further discussions.
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Dear Ms. Lowey,
Thank you very much for your thoughtful and comprehensive response to the concerns that I had expressed regarding the health care “reform” proposals that are currently under consideration.
I would be pleased if you would consider the following observations and suggestions regarding this effort as I believe that they may better inform your considerations of legislation as it may develop over the months ahead.
First and, I believe, foremost, is the financial condition of Medicare. Without reiterating the facts that are well known and confirmed by all of the analysts and budget watchers, this program, by itself, is broken and will bankrupt our nation within the next generation or two. Congress and previous administrations have been urged to institute significant changes to either increase its revenue or decrease its services but there has been no political will to address the matter. Instead, the issue has been “kicked down the road” for future legislatures and administrations to address.
Medicaid suffers from a similar problem. Before introducing an enormous restructuring of our entire health care system as is being proposed, prudence dictates that we fix the problems that we now have. I do not find it credible to believe that the proposed legislation will ever be “revenue neutral.”
Supporters of the existing House proposed legislation contend that the introduction of a government-sponsored insurance program (included in the “Exchange” as you referred to it) will enhance competition in the health care insurance market. If one can predict anything from history, the political process and various special interest groups will surely suborn a government plan and more subsidies will be provided. (I observed the president’s town hall meeting in Colorado this eve where he strongly asserted that this would not happen. Count me as a skeptic).
Under these circumstances, choice will mean very little since the sheer economics of the plans that will be presented to employers and individuals will drive them to the less expensive, government-sponsored programs. This program will, inevitably, spell the death knell of competitive health insurance.
The concept that all patients pay the same rates for their level of coverage regardless of age or medical condition is embedded in the proposed plan. There is no equity at all in such a proposal since risks vary widely based upon genetic inheritance, life style, age, occupation, etc. The assessment of such risks are made daily by the hundreds of insurance companies underwriting fire and automobile risk coverage, life insurance, disability and even, yes, health insurance. While these underwriting efforts are regularly, to some extent, inhibited by state and federal legislation, there is an underlying concept that is, in my judgment, sound, i.e., one should pay for the risk that one presents to the insurance company.
Among the serious consequences of the proposed concept is that the patient will have no apparent financial interest in monitoring his or her medical costs nor will the benefits of life-style changes accrue to the patient in any tangible way. To the extent that individual citizens are indigent and require public assistance, direct subsidies or vouchers might be provided that may not distort an efficient and effective system.
Even those plans that operate under the provisions of the Employee Retirement Income Security Act (ERISA) will, after five years (assuming no changes to the underlying plan), be forced to offer “approved” plans, imposing even more conformity in the market. These and many other details essentially call into question the assertions that one may “keep his current plan.” The government-sponsored plans will most assuredly crowd out all other insurers and self-insurers as operate under ERISA.