Category: Health

There's a great line in an early scene of the musical "1776". Richard Henry Lee of Virginia has introduced a resolution declaring the 13 colonies "free and independent states" and the Second Continental Congress is deciding if it should consider the proposal and open debate. A tied vote is broken by Stephen Hopkins of Rhode Island, who declares, "In all my years I never seen, heard, nor smelled an issue that was so dangerous it couldn't even be talked about. Hell yes. I'm for debating anything."

There were no transcripts of the proceedings of the Continental Congress. Playwrights Sherman Edwards and Peter Stone used writings by and about the founders for much of the dialog, but I've never been able to find anything to prove that Hopkins really said that, or anything resembling it. Still, even if we do not know what the founders said, we know what they did. They did debate and approve the resolution, even though their action put them individually at grave personal risk as it moved their constituants from insurrection to outright war.

The October unemployment data shows that we've topped 10 percent, with broader measures above 15 percent, even as GDP (thanks mostly to misguided government spending) grew in the third quarter. Unemployment has historically been a lagging indicator during recoveries, so it's not that much of a surprise to see trailing as other small signs of recovery seem present. However, there might be another explanation for unemployment being not only "slow to recover" but still rising: the health care debate.

The debate surrounding the future of health care in the US produces a great deal of uncertainty. Firms who see an even more competitive future in which they will have to be even more cost-conscious might be very hesitant to hire until they have a much clearer sense of what, if anything, will come out of the current debate and what its effects on the costs of hiring will be. With so many unknowns, most of which will matter for hiring, firms might be holding off. This is a version of the regime uncertainty problem that kept private investment low during the Great Depression (discussed in my last entry). In this case, it's affecting employment rather than investment.

So it's on to the Senate. And if you think it was tough getting health care reform through the House, wait until the self-proclaimed "world's greatest deliberative body" gets hold of it.

In the end, majority rules in the House. So while the process of making law resembles the making of sausage, in the end, something usually comes out. If HR 3962 were to become law, most Americas who do not have insurance will no longer have to choose between death and destitution if a serious illness arises; Americans now insured through group plans arranged by their employers will no longer have to fear being thrown to the wolves running the market for individual insurance policies if they lose their group coverage; and Americans swimming in the individual coverage pool will no longer have to fear being denied coverage or priced out of the market due to a previously existing condition, or having coverage rescinded if a claim is made. We will all be free of the fear of running into a life-time cap which means a catastrophic illness leads to bankruptcy.

That old adage, "lies, damn lies, and statistics," popped into my head after finishing my story tonight. How much will a public health care plan cost? The House bill allows for $2 billion dollars to seed a public option plan. That money would pay for administrative start-up costs and initial reserves. The bill expects the plan to pay back that money over ten years. The American Academy of Actuaries and the Society of Actuaries figures it would take between $1 billion and $42 billion in the first ten years to start up a public plan. The wide range depends on how many people enroll, how high their claims are, and how much they pay in premiums.

Economists have been monitoring Influenza A H1N1, better known as "swine flu," since its appearance in the U.S. this spring -- fearing a widespread outbreak of the deadly virus might disrupt America's nascent economic recovery.

How can the flu hurt the economy? A large chunk of the population gets sick, many for weeks at time, missing work and bringing productivity to a screeching halt. People stop going to public areas like restaurants or the movies to avoid exposure. Tourism and world trade decline as people avoid travel to infected areas. And costs for treatment skyrocket, putting further strain on companies and individuals to cover rising insurance costs.

Health care spending makes up 16% of the U.S. economy. Reforming the system won't happen overnight. But Democratic lawmakers are sure to add enough immediate benefits to make it pay off for them politically. You can see how the policy and political goals come together in the Senate Finance Committee bill (aka America's Healthy Future Act). People with pre-existing conditions will have immediate access to a high risk pool and get subsidies for coverage. After a couple of years small businesses and low income Americans get tax credits to buy insurance. There would be no tax penalties for employers or individuals until after the 2012 election.

Mr. Conrad (D., N.D.) votes no, Ms. Lincoln (D., Ark.) votes no, Mr. Nelson (D., Fla.) votes no, Mr. Carper (D., Del.) votes no, and the Chair, Mr. Baucus (D., Mont.) votes no. While it is true that there will be more opportunities, as health care legislation staggers through Congress, to add some sort of government insurance plan to the package, these five Democrats certainly drove a nail deep into the coffin of the "public option" as they rejected a proposal offered by Sen. Jay Rockefeller (D., W.Va.) before the Senate Finance Committee.

Even when Sen. Chuck Schumer (D., N.Y.) followed up with a proposal with payment procedures more generous to doctors and hospitals than those in Sen. Rockefeller's plan, Sens. Lincoln, Carper and Baucus still voted no; along, of course, with all the Republicans on the Committee.

Too see my primary care doctor for my regular check-up, I usually schedule the appointment 3 to 6 months in advance. But it's still possible see the doctor within one or two days for more pressing concerns. Adding more people to the ranks of the insured is sure to create some log-jams, but it may also open up more possibilities. Some doctors already have additional evening and weekend hours. Others are looking at team treatment, where doctors, nurses, dieticians, and pharmacists coordinate patient care. Also called a medical home, this type of coordinated approach, along with new technology, makes it easier to treat patients with chronic disease and multiple health issues.

As someone who covers health care a lot, I've wondered whether it might be easier to write my stories if I could have the phrase "rapidly rising cost of health insurance" assigned to the F-1 or F-2 button at the top of my computer keyboard. After experiencing several decades in which the cost of health insurance rose faster than the rate of inflation, Americans have come to grudgingly expect that health insurance (if you're lucky enough to have it) will be significantly more expensive each year.

But is the "rapidly rising cost of health insurance" (there it is again!) truly a fait accompli? There's some evidence that it is possible to buck the trend. How? Well, in the past, companies typically looked at managing the cost of health benefits. Fair enough. But the companies which "buck the trend" take a different approach: instead of focusing on the health plan, they focus on the health of their workforce, and how to improve it.

I had one of the 24/7 cable-blabber channels serving as white-noise for my office the other day when I saw a comely anchor look up at the ceiling and muse, "I wonder if health care should be a right?" The non-comely guy in the co-anchor chair next to her nearly had an attack of apoplexy, and as he gagged she added, "Just asking" and moved on.

This was not to be the end of it, of course. Later in the day a producer who knew a good thing when she heard it brought in a couple of "experts" to discuss the issue. The word "discuss" has an unusual meaning when applied to these talk channels, where a rational exchange of ideas and a meeting of minds is the last thing that they want. Informative discussion is, you see, considered boring in the world of talk television. What sells are raised voices, belligerence and name-calling. The more, the merrier.