Our Tax Dollars at Work?

Sorry, but today no healthcare related rant. Too much other juicy stuff going on that have made healthcare, the once hot topic, take a backseat. The most recent issues are certainly related around the economy and the resultant collapse of the credit markets and the banking system. Mortgage backed securities have become the junk bonds of the 21st century, much like Michael Milliken of the 1980’s.

The governement’s (Bush) response to the crisis was at first to ignore that there was a problem. Then, when it got smacked in the face with it, a 700 Billion dollar bailout with taxpayer money to stem the fear of a total collapse of the US markets; the likes of which hadn’t been seen for decades, or maybe even since the great depression. An economy in shambles. National debt at it’s highest ever and a deficit that will be an estimated 700 Billion to 1 Trillion dollars next year. What an inheritance for the the next president to assume and a great gift to leave our children and grandchildren.

Among all of this is the presidential election. The candidates are making their final push to sway and attract voters. TV, radio and print adds are flying with wanton abandon. Unsolicited telephone calls invade my home, and cell phone, on an almost daily basis. Emails come daily filling up my inbox with garbage I don’t want to see or read. How do they pay for all of this?

Just out in the last few days are the latest figures for both candidates’ fundraising efforts over the past several weeks. Obama, who opted out of the taxpayer funded campaign program, has raised nearly 150 Million dollars from donations for the Sep/Oct period and along with party funding, has nearly 200 Million dollars at his disposal leading up to the election. McCain, on the other hand, opted for public taxpayer money and is limited to 84 Million from now through election day. Both candidates still have their respective parties funding some of their advertising. Obama’s total raised by his campaign for this election totals more than 600 Million, while McCain raised just 240 Million.

With the kind of money these guys are raising, I think that to use public funds, when it could be used in other areas, is fiscally irresponsible. I know that camapign finance reform was designed to reduce the campaign contributions from large influential contributors and therefore reduce fraud and corruption, but they have gone from one extreme to another. And, who really thinks that our politicians are any less corrupt than they used to be?

Considering the amount of money raised by each party, the disparity in fundraising between Obama and McCain, how can anyone say the election wasn’t “bought”? Obama raised so much money after the convention, he was able to buy up every minute of available airtime on all the networks prior to the election. Even if McCain had raised more money, he would have had no real effective outlets where he could be purchasing advertising time. No one will ever doubt that Obama ran a very military precise campaign but without funds it never would have happened. Elections can still be bought despite campaign reforms.

I believe it should not be up to the taxpayers to fund the presidential elections. The individual candidates should be responsible for their own funding. But, that funding should not be a result of a popularity contest or the financial capability of their constituency. The federal governement’s role in this process should be one of oversight. Each candidate must have access to the same resources as the other. A cap on the amount spent should be instituted so that one candididate does not simply outspend or “out advertise” their opponent. Equal spending would therefore make the candidates concentrate on the content of their messages instead of the volume of their messages. We all have the same feeling this year; just get it over with.

This year’s election will be determined by the amount of money spent on the election. It is yet to be seen if that turns out to be the right choice.

Doc B

My opinion is free.
Advice is worth exactly what you pay for it.


Aletrnative Health Care Proposal-AMA Style

Finally, something else to talk about than the same ‘ol Republican/Democratic proposals. The American Medical Association has expanded it’s original recommendations for universal healthcare to the current “three pillar” approach. Overall, conceptually, it seems less painful than some of the political proposals, but has some not so pleasing aspects itself. You can read a synopsis of the plan here.

The AMA’s three pillar approach is; 1. helping people buy health insurance through tax credits or vouchers; 2 choice for individuals and families in what health plan to join; 3 regulating markets and protecting high-risk patients. I don’t think anyone has an issue with numbers two and three of the three pillared approach. What is somewhat different is their proposal for how to pay for the tax credits and/or vouchers.

Their idea is to eliminate or markedly reduce the tax benefit that employers and or employees receive by not having the employer based healthcare benefits taxed. Most employers who provide health insurance are able to deduct the cost of insurance as a business expense, and therefore, pay no tax on them. Employees are not usually taxed for those benefits either. McCain’s plan opted to tax the employers. The AMA wants to tax the employees.

The AMA idea is to tax all, or a portion down to a minimum allowable, of the healthcare benefits to recoup the estimated 125 Billion in lost tax revenue. Those additional taxes would be used to pay for, or subsidize, low income or uninsured persons though tax credits or vouchers. The credits or vouchers HAVE to be used for the purchase of health care benefits. In essence, it amounts to another entitlement program through a redistribution of “wealth”.

Their thinking is that the highest income earners who receive the same employer-based health insurance benefit, receive the largest tax break since they are in a higher tax bracket. True, but only if those benefits are universally taxed for all recipients. They are not at the present time. This amounts to the same type of taxation and redistribution of wealth that occurs now. People of higher incomes are taxed at a higher rate. Those dollars are used to pay for the government funded entitlement programs that the higher income individuals will NEVER benefit from.

This is not a “government funded” or subsidized program. It is the creation of a new tax and the subsidy is coming from, on a percentage basis, the same taxpayers who are already providing a larger percentage of their income for entitlement programs. That is a perfect definition of a distribution of wealth.

I am all for a form of universal healthcare that takes care of all of us, including those who contribute no taxes into the government coffers. But, I do not think that the first place to look is in the pocket of the populous who are already paying their fair share of taxes. Why not look to the greed of the insurance companies or the horrible inefficiency and waste of government programs? Pay for it with the SAVINGS that can be wrung out of the current failed system, not by creating ANOTHER tax.

I’m tired of working the first 6 months of every year just to pay taxes. How about you?

Doc B

My opinion is free.
Advice is worth exactly what you pay for it.


Democratic Health Care is Obama Health Care

Well, now that Obama has finally clinched the nomination without having to bargain with Hillary, we’ll get to see what the campaign should have looked like over the past several months. McCain has had an easy trip so far since the two front running Democrats were fighting each other instead of their Republican opponent. Obama has a lot of ground to make up, but so does McCain.

The campaigns will need to move hard and fast to cover all of the pertinent issues before the big push leading up to their respective conventions. Both would like to have momentum going in and a be on fire coming out.

McCain has been relatively quiet over the past few months while Clinton and Obama beat each other up and, likely, split the Democratic party. Obama is now left with trying to reunite the party and energize them over the next few months. Clinton made a mistake by not conceding sooner and possibly using her delegates as bargaining chips. Now that Obama doesn’t need Clinton’s delegates, he doesn’t need her either. Or does he?

Most likely Clinton and Obama will have to kiss and make up if Obama has any hope of truly uniting the party. Making peace means that Obama will have a better chance of keeping the Clinton voters in the Democrat’s fold. Keep in mind that each of them performed well with different groups within their party. Combined thay would be a force that could easily beat McCain in November. Obama will have to find some way of appeasing Clinton but, I think, without offering her the VP spot. The post will have to be a juicy one and lots of face time at the convention.

I also think that the Democrats will combine Clinton and Obama’s health care plans into a single plan. To be honest, they really weren’t that much different to begin with. Clinton wanted mandatory participation and Obama mandatory coverage for children. Either there is some form of mandatory coverage and some choice for all participants. I still think they’re all going about it the wrong way. As long as profit is a motivating factor, greed and corruption will be an inevitable component of the program. But, the government can’t run an efficient program either.

It appears we’ll have to take the lesser of two evils. But which one is less evil?

Doc B

My opinion is free.
Advice is worth exactly what you pay for it.


Health Care Crisis

Been way too long again, but no one is saying anything of much value. What has been occurring more and more often is the withering away of your health insurance benefits. With every renewal period that passes, employers are faced with higher and higher premiums. In order to make sure that they continue to provide health insurance coverage to their employees, employers are faced with tough decisions. And the decisions they have to make amount to the “lesser of evils”.

In any business, for profit or not for profit, the bottom line is the same. “Do we have enough money to pay our expenses”. Next to payroll, health insurance is the next largest employee related expense, even more than an employers matching Social Security and Medicare taxes. It goes without saying that of those three expenses, health insurance is the only variable at their discretion to change (unless you would like your employer to fire you).

At renewal time, health insurance companies present the “new” premiums for the employees. Invariably, the rates almost always go up. Often times, insurers will offer a product that is slightly cheaper than the product up for renewal. Only problem is that the slightly cheaper product offers less coverage; higher deductibles, highercopays , reduced drug coverage, fewer covered services, etc. In essences it’s the same as when the coffee companies reduced the size of a can of coffee but kept the price the same. Who do they think they’re kidding?

Many employers have the same health insurance coverage as their employees. I was at a gathering where I met an entrepreneur. He and his partner have been in business for 15 years and have been doing quite well, as small businesses go. After 15 years with Anthem BC/BS, and no catastrophic illness in their group, they had an employee with a family member who battled and thankfully won, her fight with breast cancer. Unfortunately after paying over 3.5 million in premiums over the years (I’m being kind-the actual calculation is $800/month per employee X 30 employees X 15 years), they were given a renewal premium that the small company could not afford. The company began looking at other insurers for affordable health insurance coverage and were surprised to find that their “group” was uninsurable for some carriers. They were able to find coverage but with reduced benefits and higher deductibles and copays. The owners have the same coverage as their employees. The company is also considering having the employees pay a portion of their premium. That is something the company has never done in the past and never anticipated asking.

My own group has faced the same issue but without the catastrophic illness. For the first time in our existence, we’ll be asking employees to pay a portion of their premium. Costs to employers continue to increase, employees are asked to pay more and more out of pocket, hospitals and physicians are reimbursed less and less, but the insurance companies still find a way to make a profit.

The next time you buy a one “pound” can of coffee (it’s actually 13 oz), remember how upset you were when you found out you were paying the same money for less coffee, but the coffee companies were still making the same profit. It’s so ingrained in society that many of our food items have been reduced in the same way. We just accept it now. Only difference between healthcare and coffee is that you can choose not to drink coffee. You can’t choose not to get sick.

Doc B

My opinion is free.
Advice is worth exactly what you pay for it


Health Care Recession

Well, it’s been quite awhile since my last post. To be perfectly
honest, there hasn’t been a whole lot to talk about. Since the last
round of Democratic primaries and the debate, even the candidates
haven’t been giving healthcare much lip service. But, thankfully, Hillary came through for us.

She has been recounting a story of a young pregnant woman who was
supposedly denied care, and later died. The story, which you can read
here, states that as a pregnant uninsured patient, she presented herself for care at the ED but was told she needed to pay $100 dollars first. Depending on the version of the story you hear, somehow she was able to be seen and “billed” for the $100.

After being seen in the ED she was told they couldn’t help her but gave her a referral for outpatient follow up. The physician’s office also refused care because of inability to pay. She later presented as an emergency case where her child was stillborn. She later died of complication of her pregnancy and childbirth.

First and foremost, if you read my previous blogs, there IS absolutely Universal Healthcarein the US. The Emergency Room may not be the best or most efficient place to receive that care, but it is FREE to anyone who presents themselves to the ED with NO ability to pay.

The Emergency Medical Treatment and Active Labor Act (EMTLA) is a Federal law that requires a hospital’s Emergency Room to evaluate and treat anyone presenting with an emergency condition, regardless of their ability to pay. It is that ER’s responsibility to evaluate any person who presents to the ER for the presence of an emergency medical condition. If needed, the patient must be admitted for treatment of that condition, or stabilized and transferred to another facility that can provide the necessary care. Failure to comply with the law could mean criminal charges, fines or being barred from participating in the Medicare and Medicaid programs, combined the largest insurers in the US.

Second; the woman in question DID have insurance and was seen and treated
appropriately. She had been receiving prenatal care prior to her entering the hospital. Unfortunately, both she and her child died. The exact details aren’t available, likely due to HIPPA.

Certainly is a shame that politicians have to take a tragic story, place their own “spin” on it and try to use it for their own personal gain. Shameful. And, after learning that the story was not only incorrect but potentially damaging to the hospital and doctors ivolved, do you think she was at least classy enough to apologize or retract her statements? NO. Look here. But then again, she’s done that in the past, hasn’t she?

My opinion is free.
Advice is worth exactly what you pay for it.

Doc B