More thoughts on Health Insurance

So we're trying to solve a lot of problems at once with all the health care debate. One of them seems to be that people can't find affordable health care. I should have done this a long time ago, but just this morning, I shopped around for health insurance for the first time. A site called ehealthinsurance came up and I no longer believe that it's not possible for people to find affordable health insurance.

Before you disagree with me, let me define a few things. By health insurance, I mean partial coverage for future, uncertain, catastrophic events. In my opinion, this is what insurance was created to do and when we try to use it for something other than it's intended purpose, we will obviously run into some problems.

Insurance wasn't designed to cover events that have already happened. You can't buy home insurance on a burning house and expect them to fix it. And you can't expect us to manage pre-exsisting conditions in the same way that we manage future, uncertain, catastrophic events.

My point is, there are a lot of issues out there and we need to look at each them individually in order to find the best solution.

I'm going to attempt to list out the separate issues that seem to be lumped together when discussing health care reform.

Increased costs
1. Increased costs due to inflation
2. Increased costs due to lifestyle
3. Increased costs due to increased coverage
4. Increased costs due to better care
5. Increased costs due to medical malpractice
6. Increased costs due to medical malpractice insurance
7. Increased costs due to doctor fraud
8. Increased costs due to patient fraud
9. Increased costs due to an increased number marginally decreasingly effective medical procedures
10. Increased costs due to uninsured patients' care
11. Increased costs due to uninsured patients' use of emergency room care
12. Increased costs due to aging and the correlated increased risk of illness
13. Increased costs due to increased out-of-pocket expenses during prolonged illnesses.
14. Increased costs due to a lower risk group subsidizing a higher risk group
15. Increased costs due to increased risk of future, uncertain, catastrophic events
16. Increased costs due to increased cost of future, certain, catastrophic events
17. Increased costs due to increased cost of future, uncertain, normal events
18. Increased costs due to increased cost of future, certain, normal events

Uninsured
1. Uninsured because they don't want insurance
2. Uninsured because of a preexisting condition
3. Uninsured because of the high cost of the desired insurance plan
4. Uninsured because they don't want a cheaper plan with less coverage
5. Uninsured because a cheaper plan with less coverage is not available
6. Uninsured because of citizenship
7. Uninsured because of loss of employment
8. Uninsured because they are no longer covered on their parents plan
9. Uninsured because their policy was canceled
10. Uninsured because their policy was not renewed when it expired

Limits
1. Limits on maximum annual payments
2. Limits on maximum lifetime payments
3. Limits on approved medical tests
4. Limits on covered events
5. Limits on out-of-pocket expenses

I don't think I've listed out every aspect of health insurance, but my point is there is no silver bullet that is going to address each of these issues. Mainly, I'm just frustrated that politicians don't approach the topic of health care in any sort of deliberate or well-thought out way.

None of their proposed solutions are linked back to the problems they are attempting to correct. And none of the politicians give an objective and intelligent analysis of the proposed solution's effect on the issues at hand. If there is a politician that is doing this, please point me in the right direction.

College interns are better at responding to emails than Senators

So, I've been frustrated with my Senators for the past few weeks. There's a lot going on with the new health care proposal, so I thought I would do what I thought responsible citizens did and read the health care bill and write a letter to my senators. So I read the bill, not all of it, but most. There's a big section on how the health care bill will affect the IRS tax code laws and I'll admit that I skipped that part.

So after reading the bill (HR 3962), I felt like I had a much better understanding of what the proposal was. Since most information you get about the bill is usually slightly biased, I'd encourage everyone to at least take a look at the actual bill for themselves.

So I read it and had some questions about some parts of it, so I sent the following email to my senators, Dick Durbin and Roland Burris. The email has 10 fairly straight forward questions. Nothing that I thought would be particularly tricky, especially for someone who's job it is to read and vote on the bill the questions were addressing. And even more so for someone who is strongly in support of the bill.

Well to say the least, I was very disappointed. Bottom line, they sent me a form letter that acknowledge that the subject of me email was health care, but nothing substantial beyond that. What are we paying these guys for? We have over a dozen college interns at my office, and all of them do a better job of responding to my emails than my senators do. I just don't get it.

Now you are probably thinking some they don't have time to do it or his staff responded, not him. I may be the only one, but I don't see how either of these things are valid excuses.

So, here is an open plea to my senators. Please, please, please pay attention to us. We're the people you are representing. We're relying on you to help us govern the country so that we don't have to govern ourselves. Part of me thinks we would be better off with out you guys. Part of me thinks we would be better off governing ourselves. Please, please, please, show me that I'm wrong. Please show me that I can count on you. Please show me that you know that you really are working for us and that you still realize that we are the ones that are paying your salary and that it's ok for us to expect something in return.

My email:

I have a few questions about the public health care option.

1. What will the limits on coverage be under the public option? Since we obviously can't spend an infinite amount of money curing every disease, how much coverage will each person have under the public option?

2. If the premium is less than the expected costs (such as the limitations proposed in section 213 of HR 3962 and section 222.a.3), where will the remaining premium come from?

3. In section 222.a, paragraph 5 and paragraph 3 seem to be in contradiction. Can you please explain this?

4. What is the difference between the Health Insurance Exchange and the Public Health Insurance Option?

5. From reading the bill, it looks like the Basic Plan of the Health Insurance Exchange will offer the same benefits as those outlined in title II. With no limitations on annual or lifetime benefits, how will this type of unlimited coverage be paid for? Will we spend an unlimited amount of money on health care claims? If not, what will the limits be?

6. What problems are the proposals in title I and title II attempting to solve? How will Title I and Title II solve those problems? What are the pros and cons of these solutions?

7. What are the health insurance Cooperatives in Section 310?

8. Section 322.a.1.b.i says that the premiums for the public health insurance option will fully finance the costs? How will individuals that can't afford health insurance benefit under the current systems benefit from a public option that still requires them to pay the entire premium?

9. Section 343 seems to say, basically, that the premium will be lowered depending on the households income. Am I understanding this correctly?

10. It doesn't seem like there will be enough money to pay for this public health insurance plan. Can you explain that part to me?

Dick Durbin's Response:

Thank you for contacting me about proposals to give Americans the choice of a public health insurance option that will compete with private insurance plans.

I believe Congress should work to bring meaningful health care reform to American families. Health care reform should reduce costs for families, businesses and government; protect people's choice of doctors, hospitals and insurance plans; and assure affordable, high-quality health care for every American.

We are crafting a reform bill with these goals in mind. Those who like the health insurance they have will be able to keep it. However, a public option will provide a valuable alternative to today's private health plans for those who do not like their current plan or cannot afford coverage.

Too many Americans cannot afford the health plans offered by today's for-profit insurance companies. A public option will provide competition that will hold private plans accountable and help moderate the price of health insurance. No one will be forced to join a public option - it will be a voluntary choice available in addition to existing plans.

I will continue to work for a reform plan that provides stable and secure coverage, stable and affordable costs, and better quality care.

Thank you again for contacting me. Please feel free to keep in touch.

Sincerely,

Richard J. Durbin

United States Senator

RJD/kg

Roland Burris' Response:

Thank you for contacting me about healthcare reform. I appreciate the benefit of your views.

As your United States Senator, one of my top priorities is to ensure that my constituents have access to affordable, quality healthcare. Today, nearly 3.5 million Illinois residents, 30.8% of the under 65 population, lack health insurance. Those who remain covered face rapidly rising premiums. A Kaiser Family Foundation report found that average insurance premiums have more than doubled in the past nine years, and the New America Foundation projects that, by 2016, coverage costs for an average Illinois family could top $25,000 a year.

In the face of these challenges, I support reforms aimed at improving efficiency and access while reducing cost. A focus on prevention and primary care will help Americans avoid getting sick, saving billions on costly specialist and emergency treatments. Increasing competition in the insurance market, through a public option, will put pressure on insurers to reduce administrative costs, marketing, and high profit margins. This will result in a higher percentage of premiums spent on treatment and a better overall value for consumers. Expanded access to health insurance, provided through affordability credits, will eliminate the $1,200 “hidden tax” that the average insured Illinois resident pays in additional premiums to subsidize expensive emergency care for those who currently cannot afford insurance and bring premium costs within reach for millions of middle class families.

The pending reform effort has received the support of many of the nation’s most prominent medical, consumer, and senior groups. The American Medical Association, the Pharmaceutical Research and Manufacturers of America, the American Federation of Hospitals, Families USA, and the American Association of Retired Persons (AARP) all support reforming our health system, because they know that we face a crisis. As costs skyrocket, more people lose the coverage they need. Patients suffer, and businesses lose productivity. Insurers, hospitals, and doctors lose customers, and the entire healthcare system begins to break down. Currently, 14,000 people lose their insurance every single day. This is not acceptable in America.

A number of groups that profit from the current inefficiencies have spread false rumors about reform. I would like to take this opportunity to correct some of the misinformation.

“Government Takeover”: Some believe that a public insurance option will mean the end of private health insurance. On the contrary, the nonpartisan Congressional Budget Office (CBO) reports that if insurance reform passes with a public plan option, the number of people covered by private, employer-sponsored coverage will actually increase.

Rationing: Rationed care will not happen with reform. In fact, the bill takes a number of steps to prevent insurance companies from making your coverage decisions. Insurance reform will restore your doctor’s ability to treat patients properly, without deferring to insurance company bureaucrats who deny coverage and treatments.

Medicare: Rumors abound that reform jeopardizes existing Medicare coverage. The truth is, cutting waste, fraud, and abuse will assure the security of the Medicare trust fund for years to come. In addition, insurance reform will end cost sharing for preventative care, cut the prescription drug “doughnut hole” in half, and lower Medicare premiums.

Abortion: None of the reform proposals being considered would mandate coverage of abortions. Current federal law preventing government funded abortions; except in cases of rape, incest, or danger to the life of the mother; will remain unchanged. All versions of reform include a “conscious protection” clause, which allows doctors the right to refuse to perform an abortion, if doing so conflicts with their values.

Federal Employees: The Senate reform bill requires all Members of Congress and their staffs to enroll in the public insurance exchange. I fully support this proposal, as I believe that we Senators should have a personal stake in the reforms we propose.

Cost: President Obama has repeatedly stated that any reform must not increase the federal budget deficit and must control growth in medical spending. The Senate reform bill reduces our federal budget deficit by more than $100 billion over the next ten years, and takes important steps toward paying for quality, not merely volume of service, in our healthcare system.

Investing in reform now will ensure stability in coverage. President Obama has made very clear that reform will protect Americans’ right to keep their current health insurance policy, but changes will slow the rate of increase in premiums, offer protection and options for those who lose their jobs, and help those who cannot afford insurance.

I will continue to listen closely to what you and other Illinoisans have to say about matters before Congress, the concerns of our communities, and the issues facing Illinois and the nation. My job is not about merely supporting or opposing legislation; it is also about bridging the divide that has paralyzed our nation's politics.

Sincerely,

Roland W. Burris
United States Senator

As you can see from their responses, it's clear that they didn't read my email. I'm not sure, but they could have used the same approach when they decided to support HR 3962. It's frustrating that nothing in their response makes me confident that they have actually read the bill that they support.

Durbin's Reply to 11-8-09 post on Health Care

His reply to my email about how our interns could put together better proposals than congress can. I don't think he really addressed that concern, but here is his response anyway:

Thank you for contacting me about the health plans available to other federal employees and me. I appreciate hearing from you.

Senators have the same health insurance options as other federal employees. The Federal Employees Health Benefits Program (FEHBP) offers a menu of health insurance plans, and federal employees can choose the plan that is best for them. Senators have the same choices and pay the same premiums and co-payments as any other federal employee.

I have been working to give all Americans a similar opportunity. Two years ago, I introduced legislation that offers small businesses the same range of choices available to me and other federal employees. President Obama has proposed to extend the choice of private health insurance plans to millions of individuals who have few options today.

Too many Americans cannot afford the health plans offered by today's for-profit insurance companies. A public option will provide competition that will hold private plans accountable and help moderate the price of health insurance. No one will be forced to join a public option - it will be a voluntary choice available in addition to existing plans.

If health care reform gives Americans a chance to choose the public option, I believe federal employees also should be given that option. Since the public option is intended to be a voluntary choice, no one should be forced into it. Any federal employee who does not want to choose the public option should have the right to remain in the private plan of his or her choice.

Thank you again for contacting me. Please feel free to keep in touch.

Sincerely,
Richard J. Durbin
United States Senator

RJD/kg

More Health Care questions for Senators

Below is an email I sent to both our senators.

I have a few questions about the public health care option.

1. What will the limits on coverage be under the public option? Since we obviously can't spend an infinite amount of money curing every disease, how much coverage will each person have under the public option?

2. If the premium is less than the expected costs (such as the limitations proposed in section 213 of HR 3962 and section 222.a.3), where will the remaining premium come from?

3. In section 222.a, paragraph 5 and paragraph 3 seem to be in contradiction. Can you please explain this?

4. What is the difference between the Health Insurance Exchange and the Public Health Insurance Option?

5. From reading the bill, it looks like the Basic Plan of the Health Insurance Exchange will offer the same benefits as those outlined in title II. With no limitations on annual or lifetime benefits, how will this type of unlimited coverage be paid for? Will we spend an unlimited amount of money on health care claims? If not, what will the limits be?

6. What problems are the proposals in title I and title II attempting to solve? How will Title I and Title II solve those problems? What are the pros and cons of these solutions?

7. What are the health insurance Cooperatives in Section 310?

8. Section 322.a.1.b.i says that the premiums for the public health insurance option will fully finance the costs? How will individuals that can't afford health insurance benefit under the current systems benefit from a public option that still requires them to pay the entire premium?

9. Section 343 seems to say, basically, that the premium will be lowered depending on the households income. Am I understanding this correctly?

10. It doesn't seem like there will be enough money to pay for this public health insurance plan. Can you explain that part to me?

HR 3962 - Affordable Health Care for America Act

A letter to Senator Durbin:

Senator Durbin,

We have college interns where I work and we give them research projects to work on. The projects have a clear, well-defined problem that need to be solved and these college students provide us with well-documented research that provides us with all the information about the problem. Then the students put together a clear proposal that outlines the pros and cons of choosing that solution and give us an explanation as to why they have come to conclusion that the solution they chose will best meet our objectives. Why is it that college students are better at putting together proposals than our congress is? You and the rest of congress are so loyal to your respective political clubs, that you seem to have forgotten that it's your job to develop the best solutions to problems that meet the needs of the entire country. But instead, you vote on the first bill that you think will please slightly more than half your constituents and the rest of the members of your political club. Before you vote for HR 3962, please provide me and the rest of your constituents with a proposal that is as good as (but hopefully better than) what our college interns could do. If our college interns proposed solutions like congress did, they'd all be fired.

I'll let you know if he repsonds.

Dick Durbin's Response

Here is Dick Durbin's response to that last email I sent him:

Thank you for writing to express your concerns about health care reform. I appreciate hearing from you.

Millions of Americans face difficult choices between paying high premiums for health insurance coverage and meeting other basic needs of their families. Since 2000, health insurance premiums have gone up 73 percent. The high cost of insurance keeps dependable, quality health care coverage out of reach for many of Illinoisans. More than 46 million Americans are without health insurance today, including 8.5 million children, and millions of middle class families who do have coverage are one step away from losing it in this troubled economy.

We need reforms that give middle-class families the assurance of stable and secure coverage, stable and affordable costs, and better quality care. The reforms we are considering in Congress would help achieve these goals. We will put an end to discrimination based on preexisting conditions. Insurance companies will be prohibited from refusing you coverage, or dropping you, because of your medical history or because you get sick. There will be no annual or lifetime caps on the coverage you can receive if you need it, and no one will be charged more because of their gender.

To help keep costs manageable, insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses. Basic preventive care, which can reduce costs in the long run, will be provided without charge. We are also working on reforms that will reduce costs for families, businesses, and the government by paying providers for the quality of the care they provide rather than the quantity.

If you like what you have today, you can keep it. But for the millions of Americans who have no security in today's health care market, these are some of the key steps needed to fix what is broken while we protect what works. People who are uninsured or unsatisfied with their coverage will be able to choose a plan that better addresses their needs.

I believe most Americans share my commitment to these goals of health care reform. I will keep your concerns in mind as I work for an approach that provides secure and stable coverage, affordable costs, and better quality care.

Thank you again for contacting me. Please feel free to keep in touch.

Sincerely,

Richard J. Durbin

United States Senator

RJD/kg

He didn't really answer my questions, but I guess I should be grateful for getting a response, right?

New Health plan

Senator Durbin,

I have 4 questions.

1. What are the details of the new proposed health insurance plan?
2. Why is it a good idea?
3. What are the pros and cons?
4. What part of the constitution allows for it?

Your Constituent,
Scott

"Read the Bill"

I sent the following email to my representative, Timothy Johnson:

Representative Johnson,

When you get a chance, vote for H.Res. 554. It will make it so that bills are available to the public on the internet for 72 hours before they are voted on.

Thanks,
Scott

I will let you know if he responds.

"Cap and Trade" Bill

I sent the following email to my representative, Timothy Johnson:

Representative Johnson,

Vote against the "Cap and Trade" bill. Congress is trying to pass this bill before the people of the United States even have a chance to hear what it is about. I can't even find a way for me to get a copy of it and read it before the end of the week.

If you do vote for the bill, please send me a copy of it and explain to me why you voted for it and what part of the constitution allows congress to pass this type of legislation.

Your constituent,
Scott

I'll let you know if he responds.


Update - It took me some digging to find the number of the bill. It's HR 2454. I also found the full text. Now all I have to do is read all 1000 pages tonight and let Tim Johnson know how I feel about it before he votes tomorrow.

H.R. 1207: Federal Reserve Transparency Act of 2009

I sent an email to Representative Tim Johnson saying, "Thank you for supporting H.R. 1207: Federal Reserve Transparency Act of 2009." It's not really a question, but if I get a reply, I will post it.

HR 1424

Below are the first few paragraphs of a comment from my representative Tim Johnson:

As most of you know by now, I opposed the $700 billion bailout bill that passed the House of Representatives last Friday by a vote of 263-171.

This unprecedented government intrusion into the marketplace carries no guarantees the taxpayers will be made whole. It is a gamble on the part of the Administration and Congressional leaders. It was a gamble I was not prepared to take on the part of the American taxpayer.

For the sake of employers stretched thin by lack of credit, I hope this gamble pays off. For the sake of seniors and others who rely on stock market investments to get by, I hope this gamble pays off as well. For the sake of millions of us who have responsibly built nest eggs and paid our mortgages on time, I hope the gamble reaps great rewards.

There are many questions I believe we need to ask ourselves with each piece of legislation. I think two of the most basic questions we should ask are "What goal is this moving us towards?" and "Is this an appropriate goal for government?"

Here are additional comments from Tim Johnson in a separate address:

"This bill raises the national debt ceiling to $11.3 trillion, with no guarantees. It includes so-called fixes that are unrelated to increasing liquidity in the markets, such as raising the threshold on FDIC-insured accounts, a measure that will only cost consumers more in bank fees. Perhaps most offensive is the addition of some $180 billion in special-interest tax breaks that have nothing to do with the credit crunch.

"I simply cannot support expenditures of this magnitude that are patched together in haste, that are laden with special-interest sweeteners to attract votes because the package cannot stand on its merits. As stewards of the people's resources, we are morally obligated to do better.

"I believe government does have a role in this process and shares responsibility for this crisis. I believe we must restore confidence and accountability. But the collapse of Wall Street doesn't have to mean the collapse of personal responsibility. We are in this mess because people in privileged positions made unwise, risky decisions. I will not be part of the same mistake."

I'm not well enough informed to make bold commentary on this issue. I also don't feel I can adequately articulate the goal, the problem, or the solution. The only thing I think I can safely summarize is part of the plan as stated in the bill itself.

The Secretary is authorized to establish the Troubled Asset Relief Program (or `TARP') to purchase, and to make and fund commitments to purchase, troubled assets from any financial institution, on such terms and conditions as are determined by the Secretary, and in accordance with this Act and the policies and procedures developed and published by the Secretary. (Div. A, Sec. 101)

And the roadblock that I've now approached is whether or not this should be the responsibility of the Secretary of the Treasury? I don't know the arguments for and against granting this authority but I am of the opinion that the people should keep the responsibility of every issue they face unless there is a good reason to give that responsibility to someone else. I am looking for the reason we should give the responsibility of purchasing troubled assets to someone else.

Ford County Politics

I've begun to compile a list of the County, State, and U.S. politicians for Ford County, Illinois. The list can be found at the following address:

http://spreadsheets.google.com/pub?key=pCYAyV98d9pX8Xzeh6x8rGw&gid=0

Much of it will only be useful to the approximately 14,000 people in Ford County, Illinois, but for me, this list represents the 30+ government positions that I am partially responsible for and the positions over which I have any amount of control.

I feel one step closer, yet still miles away from role a citizen should play in society.