Friday, July 31, 2009
And yet, this will all change. And it is my job to make it change, to turn my little ones into people that I might only see once or twice or year (as I see my parents), or talk to on the telephone every now and then. In some ways, I can't wait for them to grow up; in other ways, I can't imagine anything more dreadful.
And Michael Gerson writes today, "So this is the independence we seek for our children -- to turn our closest relationships into acquaintances. Of course, I knew this getting into parenthood. But the reality remains shocking. For a time, small hands take your own -- children look upward, and you fill their entire universe. They remain, to you, the most important things in the world. To them, over time, you become one important thing among many. And then an occasional visit or phone call. And then a memory, fond or otherwise."
Paul Krugman has an excellent column today in the New York Times. He begins with an amusing anecdote about a man who recently exclaimed during a recent town hall meeting: "Keep your government hands off my Medicare." Not only is this quote funny (Medicare is, of course, a government program), but it is also instructive. People simply don't know how health care works in this country. Americans covered by Medicare generally report being more satisfied with their coverage than do people covered by private insurance; however, they often don't think of Medicare in terms of a government program. It is, in fact, America's best example of "single payer," socialized medicine. In short, people love "socialized" medicine, but don't know it. The same goes for other government interventions. Krugman argues:
Yet private markets for health insurance, left to their own devices, work very badly: insurers deny as many claims as possible, and they also try to avoid covering people who are likely to need care. Horror stories are legion....
And in their efforts to avoid “medical losses,” the industry term for paying medical bills, insurers spend much of the money taken in through premiums not on medical treatment, but on “underwriting” — screening out people likely to make insurance claims. In the individual insurance market, where people buy insurance directly rather than getting it through their employers, so much money goes into underwriting and other expenses that only around 70 cents of each premium dollar actually goes to care.
Still, most Americans do have health insurance, and are reasonably satisfied with it. How is that possible, when insurance markets work so badly? The answer is government intervention.
Most obviously, the government directly provides insurance via Medicare and other programs. Before Medicare was established, more than 40 percent of elderly Americans lacked any kind of health insurance. Today, Medicare — which is, by the way, one of those “single payer” systems conservatives love to demonize — covers everyone 65 and older....
Still, most Americans under 65 do have some form of private insurance. The vast majority, however, don’t buy it directly: they get it through their employers. There’s a big tax advantage to doing it that way, since employer contributions to health care aren’t considered taxable income. But to get that tax advantage employers have to follow a number of rules; roughly speaking, they can’t discriminate based on pre-existing medical conditions or restrict benefits to highly paid employees.
And it’s thanks to these rules that employment-based insurance more or less works, at least in the sense that horror stories are a lot less common than they are in the individual insurance market.
So here’s the bottom line: if you currently have decent health insurance, thank the government. It’s true that if you’re young and healthy, with nothing in your medical history that could possibly have raised red flags with corporate accountants, you might have been able to get insurance without government intervention. But time and chance happen to us all, and the only reason you have a reasonable prospect of still having insurance coverage when you need it is the large role the government already plays.
Which brings us to the current debate over reform.
Right-wing opponents of reform would have you believe that President Obama is a wild-eyed socialist, attacking the free market. But unregulated markets don’t work for health care — never have, never will. To the extent we have a working health care system at all right now it’s only because the government covers the elderly, while a combination of regulation and tax subsidies makes it possible for many, but not all, nonelderly Americans to get decent private coverage.Now Mr. Obama basically proposes using additional regulation and subsidies to make decent insurance available to all of us. That’s not radical; it’s as American as, well, Medicare.
Tuesday, July 28, 2009
Claim: We have the best health care system in the world.
Truth: This is wrong by pretty much any broad-based measure. We pay much more for health care than any other nation, yet many health outcomes (like life expectancy, infant mortality, and so forth) are worse here than in many other OECD countries. The World Health Organization ranks the USA health care system 37th, below such countries as Dominica and Costa Rica. True, we do some things well, like treat cancer. Overall, though, we are less healthy and we are paying much more money. Polls show that Americans are more dissatisfied with their health care than they are in many other developing countries.
Truth: The reality is, in fact, that in American you can’t choose your own doctor. I, for example, have a very limited choice of primary care doctors under my plan, which is a very generous plan.
Claim: But in other countries, you have to wait a long time for procedures.
Truth: Actually, polls show that our wait times are often longer than in other countries. In my family, for example, we have waited weeks to get a procedure for our baby Stephen (and, again, we have good insurance).
Claim: In other countries, they ration care.
Truth: We ration care in the this country. You may have noticed that your insurance company decides what you can and cannot have.
Claim: I don’t want a government bureaucrat making medical decisions.
Truth: Well, right now you have a corporate bureaucrat making your medical decisions. The trouble is, the corporate bureaucrat has a vested interest in denying you medical care. When insurance companies deny claims, they make more money; indeed, they have no interest is providing you care if they can legally get out of it. (And they do try to get out of it: check out the highly questionable practice of “rescission” sometimes exercised by insurance companies. If you made any sort of mistake at all in providing your medical history, no matter how trivial, they can void any claim you make thereafter at any time. Hence, we have people being denied treatment for breast cancer because they failed to list past acne treatments. Check out this report, about 30 minutes in.)
Claim: I don't want socialized medicine.
Truth: We already have "socialized" medicine, just a very inefficient form of it. We are socialized in that everyone can receive health care if they just go to the emergency room. Unfortunately, this is probably the most expensive way to take care of sick people, and guess who pays for it. You do. You are, in effect, already paying for an very inefficient type of socialized medicine. The question is not about socialized medicine, it is about being smart about socialized medicine.
Claim: But those darn liberals are going to take away my choices in medical care.
Truth: You don't have choices now. In most states, for example, you don’t have much choice in health insurance providers. Most states have a near monopoly of insurance providers. And, if you are employed, you have to take what your employer gives you.
Claim: Well, Obama is out to take away the few choices that remain.
Truth: No, actually, what he and Democrats have proposed is intended to give you more choices. You can keep what you have, if you want it, or enroll in a not-for-profit public insurance plan if that might better meet your needs. The public plan, if it is included in the bill, will give you a choice you don’t have now.
Claim: Markets are the best way to allocate resources. Government should not be involved.
Truth: I'm a big fan of markets. Markets are cool, nifty things. But markets are not a good way to allocate health care, morally speaking. For markets to work, we have to admit that it would be okay if certain people did not have a certain good. If some people can't afford a plasma TV, we must be prepared to accept that some people will go without. That is how demand is reduced. But, are you going to refuse breast cancer treatment to that single mom because she didn't have adequate insurance? True, if things are too expensive the market may adjust to make things cheaper. But let's be clear: things would adjust in such a way to maximize profit, not to take care of all the sick people.
Tuesday, July 07, 2009
Some comments on our experience:
1. Alas, our new diet actually hasn't saved us any money. Buying more fresh fruits and vegetables ends up costing as much as the meat did.
2. It has made me really enjoy cooking. Before, it was easy to just let meat carry the meal. Cooking without meat has made me more adventurous and made cooking really exciting for the first time. Ellie will tell you that I've pretty much taken over in the kitchen.
3. It has opened up a whole new world of food to us. I've been making Dal and Falafals, and perfecting the art of Kung Pao Tofu. Some favorite recipes we've found online include: Artichoke Lasagna, Hot and Spicy Tofu, Linguine With Snow Peas, Cucumber, and Peanut Sauce
4. We don't feel any sense of loss. We feel like we are doing the planet good and that we are living better the precepts of our religion (albeit a minor precept). I think we feel a little better physically. You could say, I guess, that it has been a success.
One of the best parts of the Summer has been having Ellie's brother Sam and his wife Emily around. Sam is working up in Akron over the Summer. They have really made us feel connected to family again in a new way.
Here we are celebrating the Fourth. We went to the Hilliard parade, grilled hamburgers and brats out back, lit sparklers, and went to the Hilliard fireworks display (well, Ellie and the kids went anyway). Ellie said it was fun to watch the kids watch the fireworks, their eyes glued to the sky, mouths frozen in an awestruck smile, gasping and cheering. After each burst, Andrew would say, "That was my favorite." Then the next one would come and he'd say, "THAT was my favorite."
Ellie celebrated her 32nd birthday. Here she is opening presents. I gave her some "body butter" from Crabtree & Evelyn. Flavor: Avocado, Olive Oil, and Basil.
On a sad note, somebody bashed out my car window in an attempt to steal...I'm not quite sure what. They didn't take anything, not even the Tic Tacs in my glove compartment. Hey guys, what part of "It doesn't even have a tape deck" do you not understand? To add insult to injury, the next day, while we were in Cincinnati, parked in the Newport Aquarium parking lot, somebody bashed into the bumper of our Highlander, then drove off without even leaving a note. Nice.