Tuesday, August 25, 2009

out she goes

I wrote this ten days ago. Not sure that I really want to post it, but I'm going to anyway.

It’s the end of an era and the beginning of a great future.

I got home from a weekend in Leadville watching Lance tear up the LT100 to find a pile of things returned to me from my oldest daughter who cleaned out her room to move to college.

As a side note, we have a clash of parental philosophies at our house. I grew up in a house where the kids’ rooms were kept for them after they moved out. Heck, my room at Dad’s house still has my old high school wrestling paraphernalia hanging on the wall. Kind of like a shrine and I’d say, needing cleaned out, but a room where the kids are supposed to be welcome to come back.

My wife wants the room cleaned out to create a guest room, which we truly need.

The room was cleaned out, of course.

I now have back some wool socks that were worn when we went hunting, some cycling gear and what just crushed me, one of our family campaign shirts. (it’s four years old and doesn’t fit her anyway)

It all seems so final to me. Like it is actually sinking in that this beautiful little girl who I’ve cared so deeply about for almost 19 years is now gone.

I realize that they are never (we hope) completely gone, but dang, I also know that I won’t see her more than a few times a year, possibly, from now on.

Nineteen years, gone in the blink of an eye.

Have you ever listened to that Kenny Chesney song, “There goes my life”? That’s my song right now.

Sunday, August 16, 2009

Public Option - a state perspective

With all the talk about a federal “public option” for health insurance, I thought I should give a state government perspective.

We already have a public option and it’s going broke. Medicaid and SCHP are effectively publicly paid health insurance programs for people in Colorado. The federal actuaries tell us that Medicaid will be out of money by 2016. I have news for them; they are already out of money. The feds have a $1.3 trillion deficit and it’s growing.

Medicaid serves, for the most part, the poorest people in Colorado or those that can manage to prove themselves “poor”. You have to find a way to get rid of or hide assets and show income of less than $30,000 for a family of four to qualify for Medicaid for your kids. That same family of four can put their kids on SCHIP, the State Children’s basic Health insurance Program if they make less than $55,000 per year.

In most cases, if you are in, you get to go to the same doctor and you pay a co-pay for an office visit of no more that $3 for Medicaid and no more than $5 for SCHP. Compare that to the full rate we pay for our kids with our high deductible plan and the $30 you’d pay if you were a member of Kaiser, for instance.

There is no premium to pay to be in Medicaid and the annual premium for that family of four in SCHP is $35. That’s annual as in 35 bucks a year!

My insurance costs $1150 a month! I pay $280, my employer (State of Colorado) the rest. The Kaiser plan is $1250.

It’s a wonder that anyone would add their kids to their health insurance plan if they make less than 2.5 times the federal poverty level. As a matter of fact, many people don’t. Almost a quarter of all kids in Colorado are on Medicaid and another 6.6% are in SCHP.

I’d save $30 per month if I dropped the kids off the insurance plan we have and went to SCHP in premium alone and another $300 per month in out of pocket expenses. We qualify but we don’t join; I’m opposed to government run health care, but I wonder how long we can hold out?

Is it any wonder that health care expenses are gobbling up a huge and growing share of Colorado’s budget? How long can we afford to have a system in place that encourages people to seek practically free health insurance and care over a really expensive private system? What happens when everyone who could do so enrolls?
I know the answers. If you are giving things away for free, it doesn’t matter what you are giving away, whether health care or chocolate chip cookies, eventually you run out of supply. Then, you have a real problem.

Wednesday, August 5, 2009

socialized medicine vs private insurance

In the debate over socializing health care, there are two fairly credible arguments from my point of view.

One is that this is the US of A and we can do anything, therefore, we can produce a workable government run health care system even though no other country in the world has.

The problem with this argument is that even in this country, you can’t repeal the basic laws of human nature. In this case there is and can be no free lunch. Utopia cannot be achieved where men (and women) are involved. I appreciate this line of thought, but think that it doesn’t mesh with reality.

The other is that our current system is out of control, insurance companies make arbitrary decisions on individual’s health care, and a government run system would be no different; just more efficient. The people making this argument suggest that government can run the system for 3% when the insurance companies get 30%.

This line of thinking takes more deconstructing.

In the short run, I suspect that the proponents of socialized medicine would be proven right. That we, as individuals, wouldn’t notice much of a difference between what we have now and what a socialized system would provide. After all, most people who have insurance just go when they want and rarely ever pay what it really costs to see a doctor. A socialized system would be much the same, initially.

But what would happen when the government finds out that it costs more than they thought? And by the way, this always happens with everything that the government gets involved with. Medicare was supposed to cost $15 billion in year 25, but it ended up exceeding $100 billion.

Soon enough, the government would have to find a way to reduce the cost of the system. They can do it in two ways:
1. Lower the reimbursement rates paid to doctors, pharmacists and other health care providers. This is most likely as it’s what states already do every time there is a budget pinch; just ask the docs and pharmacists in Colorado about reimbursement rates.
2. Reduce the number of services offered to patients. Want cancer treatment for liver cancer – too bad the probability of success is too low we won’t cover it.

Either of these options produces the same results for you and me. We will eventually find ourselves searching for a doctor that will see us or we will be searching for a provider that has set up shop outside of the government system, either here or in another country. This is the experience in Canada and the UK. We’re fools to think it will be different here.

People really want our existing system reformed, but they know that what the Democrats are offering isn’t reform. It’s more of the same, but worse.

If we have to choose between the public option and what we have now, status quo is better, not the best, but better.

What we really need is to introduce true market principles into this area.
1. catastrophic coverage only, with a cap
2. multiple state purchase options for consumers of insurance
3. some more tort reform
4. immigration reform – too many free-loaders

Basically copy what works well in the auto and life insurance models. Both are much more affordable. We don’t buy auto insurance to cover oil changes and new tires. We buy liability and coverage to replace the car if it’s totaled and we buy it as individuals with a real risk analysis based primarily on our claims history.

We have to empower the market to drive costs down and quality up – it works every time it’s tried.

I realize that I have oversimplified some of the arguments but I’m convinced that I’m accurate. This is a complicated subject and it deserves more than a blog post worth of discussion.

Fortunately, as a nation, we are able to have that discussion and the people are participating. Really participating and thinking deeply about this. They are figuring out that while what they have needs to be improved, what Obama, Pelosi and Reed are offering isn’t an improvement.

Hopefully my side can offer some leadership in alternatives and not make a compromise that leads us the long way around the hill to where Obama and Co want to go in the first place.