J.C. Moore Online

Current events from a science perspective.

 The author once attended a retirement seminar sponsored by AG Edwards. The speaker tried to convince the participants that no matter how much money they had saved, they would eventually run out if they lived long enough. That is unless, of course, they let AG Edwards invest their savings. The speaker did not mention Social Security, and fortunately for those who put their money in stocks, Social Security was there as a safety net.

 Social Security was created by the Social Security Act of 1935 in the midst of the Great Depression to provide for retired workers who had lost their life savings. Congresses right to create Social Security was established on the general welfare provisions of the Constitution and by  Article 1, Section 8 which establishes Congresses power to collect taxes and provide for the general welfare of the United States.  It says, “The Congress shall have power to lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defense and General Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States.”

Several challenges to the Social Security Act of 1935 were decided in its favor by the Supreme Court. The most notable of these was U.S. v. Butler (1936) that held that the Spending Power Clause of the Constitution gave Congress broad power to tax and spend for what it determined to be the general welfare of the country. Because Congress has discretion to determine what is the general welfare, no court since Butler has ever invalidated a federal spending program on the ground that the general welfare of the country was not being promoted.¹  Also, in Helvering v. Davis ( 1937), the Supreme Court defended the constitutionality of the Social Security Act of 1935 requiring only that the welfare spending be for the common benefit as distinguished from some mere local purpose. It affirmed a District Court decree that held that the tax upon employees was constitutional. ²

Social Security is certainly a government manage retirement program but it has not put private retirement funds such as AG Edwards out of business. Social Security provides a safety net so that no matter how fortunate or unfortunate you are in your choices and investments, you will never be destitute. Congress has the authority to create a government managed health care safety net for Americans. It would likely not put private insurers out of business but it would certainly provide a safety net for health care.

We are now in the midst of an economic downturn that has cost millions of Americans their jobs and their health insurance. What better time to enact health care reform.

(1) http://qanda.encyclopedia.com/question/butler-decision-428463.html

(2) http://en.wikipedia.org/wiki/Helvering_v._Davis

The debate on the healthcare has been filled with red herrings. Swallowing red herrings makes people irritable and they often say things in anger without thinking them through. If we trace the red herrings to their source, we would probably find that they were created by those who have the most to gain from the failure of health care reform. However, health-care reform is too important to let it be sidetracked into pointless arguments.

One of the red herrings popped up dramatically in the President’s address to Congress. When President Obama pointed out that the Health Care Reform Bill would not provide coverage for illegal aliens, Senator Joe Wilson (R-SC) shouted out “You lie.” Clearly someone had planted a red herring as the health-care bill specifically says on page 146: “Sec 246 — NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS: Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”

The problem with illegal immigrants arose from a truly bipartisan and humanitarian effort.  In 1986, two major pieces of legislation were passed by the Democratic Congress, approved by the Republican Senate, and signed into law by President Reagan. The 1986 Immigration Reform and Control Act provided amnesty for 1.5 million undocumented aliens. Its purpose was to halt illegal immigration, but we now have 12 million illegal immigrant so it has apparently failed. The connection to health care came also in 1986 with the passage of the Emergency Medical Treatment & Labor Act which ensured public access to emergency services regardless of ability to pay. Those without money or health insurance now use the emergency room as their primary healthcare provider. The cost of that is staggering, and much of the cost is eventually paid by citizens in the form of higher taxes and more expensive medical services. Illegal immigrants have become a serious problem, but it is not one that can be corrected by the health-care bill.

There are strong feelings on both sides of the abortion issue. Health care reform is too important to those on both sides to let it become a battlefield for ideological differences. The Health-care Reform Bill does not provide public funds for abortions. The bill does not mention abortion. There are those who wish to insure that public funds are not used for abortion and their wishes should be respected. There are those who think providing health care to women who are now uninsured would surely reduce the number of unintended pregnancies and they are right. There are methods of birth control acceptable to every religious faith. Certainly, providing health counseling to women, good prenatal care for expectant mothers, and excellent health care for babies are goals that everyone can share.

 Tort reform is another red herring. The malpractice system is clearly broken. Doctors are afraid to admit error for fear being sued, malpractice insurer will not pay a claim without an admission of error, and an injured patient has little recourse but to sue.  A University of Michigan¹ study has shown that malpractice lawsuits could greatly be reduced if doctors would admit their errors, apologize, and compensate the patient fairly for their mistakes.  It has been estimated that litigation costs and malpractice insurance add about 1-1.5 % to total health-care costs.² The malpractice system needs to be fixed but doing so will not substantially reduce medical costs or help the uninsured. Perhaps malpractice insurance co-ops for doctors should be considered.

 Unfortunately, the cost of health care reform is not a red herring.  Most estimates put the cost at slightly less than $1trillion over 10 years. To put that in perspective, that is about the amount spent in seven years on the Iraqi war; the amount spent in one year to bail out the banks, insurance companies, and the auto industry; or half the amount spent over 9 years to provide tax cuts to those in the highest income tax brackets.^{3 (See note below.)} Healthcare reform could easily be paid for by letting the 2001 tax cuts expire . The United States has a graduated income tax scale based on the idea that those who profit the most from the resources and opportunities our country offers should pay more in taxes. Perhaps seeing that every citizen has health care would let us feel good about paying more in taxes.

(1)   See: http://www.msnbc.msn.com/id/32011837/

(2)   http://www.upenn.edu/pennnews/sourcesheet.php?id=529

(3) Citizens for Tax Justice, using data from the Congressional Budget Office, calculate  that  the 2001 tax cuts have cost  about $2.1 trillion in lost revenue and another $0.4 trillion in  interest  on  the deficit created. Letting the tax cuts expire would  save about  $2.5 trillion over the next 10 years which would pay for Health Care Reform twice over.    See  http://www.ctj.org/pdf/bushtaxcutsvshealthcare.pdf  for their figures.

Research Credit:  Barbara Moore

          “Your family’s health depends on the health of everyone.”

The advantages of health care reform have been lost in the politics and arguments about the Health Care Bill.  Here are some advantages :

 We would have happier and more productive citizens. lMost people receive health care insurance from their employer.  There is a good reason for that. Healthy people are happier, perform better, are less likely to be hurt on the job, and miss fewer days of work  Offering healthcare benefits lets companies attract and retain better-qualified employees, shows that management cares about the workers, and is a great morale builder.  Couldn’t the same principles work on a national level?

 It would create job openings. One great way to create jobs would be to provide health benefits to those who wish to retire early. There are about 45 million baby boomers who are now between 55 and 65.  Many of them have the resources to retire early but feel they must continue working to retain their health care benefits.  Health care reform would let them retire early, opening up more jobs.

 Bankruptcies could be  reduced by better health coverage. A Harvard study found that about 50% of all bankruptcies in the United States are caused by illness and unpaid medical bills. Bankruptcies affect everyone because the health providers, banks, businesses, and credit card companies who lose money in the bankruptcy pass the cost on to the rest of us. Bankruptcies were a big factor in our recent housing crisis that negatively affected us all.

Your family’s health depends on the health of everyone. Unless you are a hermit, you will likely come into contact with thousands of people during this next winter. People without health care are less likely to receive immunizations and are much more likely to have untreated communicable diseases.   This is particularly important since a Swine Flu epidemic is a possibility.

 The advantages of health care reform are obvious to those with no health insurance.  Remember, except for the Grace of God, that could be you.

Healthcare co-ops are now being promoted as a way to keep government out of healthcare. They might be effective at doing that but it is questionable whether they would be effective at providing health care reform. Most people don’t know about healthcare co-ops because they are not really an option for their healthcare. Senator Kent Conrad (D-ND) has proposed a co-op system in which the government would provide $6Billion in seed money to doctors, businesses and hospitals to form the co-ops. Eventually the co-ops would have to become self-supporting with premiums paid by members. Senator Conrad should be commended for his effort to find a bipartisan compromise but health care co-ops will do little to bring about health care reform.

 During the depression, the Farm Security Administration encouraged the development of rural health cooperatives, and at one point, they had about 600,000 members. Unfortunately, few co-ops survived after the FSA removed its support in the late 1940s. One that did is the Group Health Cooperative in Washington State and it is an example of a successful co-op. It has its own hospitals, hires its own Doctors at salary, and tightly manages its costs and membership. It took eighty years for the co-op to get where it is today and it is unlikely that a start up co-op could achieve the same success in a short time. When the seed money runs out, new co-ops would likely disappear and we will have spent $6Billion with little to show for it. Many health care co-ops have gone bankrupt. An example is Sunkist Growers , once a licensed insurance co-op that covered about 23,000 people. It fell into insolvency because claims outpaced income in 2001 and it left employers and medical providers holding the bag for about $11 million in unpaid medical claims.

Some healthcare co-ops negotiate with private insurance companies to provide insurance for their members. Their advantage is that they provide group insurance rates to small businesses, farmers, and individuals who might otherwise have difficulty negotiating favorable insurance rates.  Their disadvantage is that their rates, co-pays, network providers, and pre-existing condition policies are very much like any other private insurer. One such company is the Farmers Health Cooperative in Wisconsin which cooperates with Aetna and functions much like a PPO.  It has been successful because its members are reasonably healthy people. Co-op health care has mostly been successful in such small demographic niches. Jamie Court, president of Consumer Watchdog, says that “if co-ops attract high-risk people, who would otherwise go uncovered, it could bleed the co-op’s funding dry.”

Government is already providing health care. It is a strange spectacle to see Medicare recipients, Veterans, Congressional Representatives, and Senators decry socialized medicine when they, in fact, benefit from public subsidized health care. Would they be willing to put aside their present health coverage and go on a co-op system? I think not!  The Health Care Reform Bill, H.R. 3200, is a reasonable bill and it should not be replaced by a health co-op system unlikely to be successful.

Research Credit: Barbara Moore

Dr. Dave Janda, an orthopedic surgeon and author, has written a letter that has been widely circulated by those opposed to the health care bill (H.R. 3200). The letter is a bit incendiary for a doctor.  Dr. Janda’s  comment about end of life counseling is: “After each American turns 65 years of age they have to go to a mandated counseling program that is designed to end life sooner.”  That is really a distortion of the document.  The bill requires your health care provider to provide information on end-of-life counseling but does not require that you go or that you end your life right away. Dr Janda’s claim that the bill is “FASCIST” (caps his) seems to be in conflict with others who claim that it is socialistic. Isn’t that the makings of an oxymoron?  Highly paid specialist may be one of the losers if the bill passes so I do not think Dr. Janda can be seen as unbiased.

  Medicare may be socialized medicine, but those on it pay about $120 a month and most of their medical bills are covered. An unemployed person or someone who retires before 65 may pay $400 for full coverage up to $800 for family coverage.  It is very difficult to change companies or coverage because of pre-existing condition clauses.  The alternative is a catastrophic health care plan which costs about $200 a month and covers 80% of all costs over $7,000. A major illness really hurts, both physically and financially.  I was recently charged $6,300 for a CAT scan but the provider wrote off $5,500 for my insurance company.  If someone on catastrophic coverage or an uninsured person had the same procedure, they would pay the full $6,300.  It doesn’t really seem fair.

 There is also a concern that there is going to be very few general practitioners in the future unless something is done about their compensation.  Many medical students choose specialties because that’s where the money is. The general practitioner pool is now  being made up more and more of foreign educated doctors. That brings me to the health-care bill before Congress.  It may have a few warts but it certainly appears better than what we now have and it would certainly correct a lot of the problems. The main arguments against the bill seem to be a little ill conceived:

 1) it will lead to socialized medicine.  Medicare, Medicaid, the VA, the Army, the Navy, the Air Force, the Marines, all federal employees, your congressional representatives, and your senators are all on socialized medicine. You don’t see them scrambling to get off.

  2) it will ration health care services. The services are already effectively rationed by the high costs and by insurance providers.  Poor people with no insurance have no healthcare at all which is about as severe as rationing can get.

 3) it requires end of life counseling.  Ministers, lawyers, doctors financial advisors, tax consultants, and hospice worker all do end-of-life counseling.  It is irresponsible to your family for you to die without planning for your demise. The bill requires that you be provided information about this counseling but does not require that you die.  To his credit, Senator Johnny Isakson (R-GA) proposed this reasonable idea and he has really taken it on the chin for it.

 4) it will run doctors out of business. We now have a shortage of general practitioners and it is getting worse. The bill provides for increased compensation for general practitioners and incentives to get more medical students to go into general practice.

5) passage of a reasonable bill will hurt the Republicans in the next election.  Possibly! Sen. Jim DeMint (R-SC) said that if Republicans can defeat health care reform it would be President Obama’s “Waterloo” because it would “break him.”  Sen. Jim Inhofe (R-OK) thinks that if the GOP can ‘Stall’ or ‘Block’ Health Care Reform, it will be ‘A Huge Gain’ for the 2010 Elections. Hmmm! Statesmanship at it’s best.

 The Health Care Bill is available at http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf  (1018 pages). There is a Library of Congress summary at http://thomas.loc.gov/cgi-bin/bdquery/D?d111:1:./temp/~bdwSmj:@@@D&summ2=m&|/bss/111search.html