Who's really trying to ration health care

In the debate over the health care reform bills coming before the House of Representatives (pdf) and the Senate, the go to objection for conservatives and Republicans has been, "Do you want the government to be able to tell you what care you can receive?" Setting aside the logical inconsistency that care right now is rationed (either directly by insurance companies or indirectly through overpriced care and employment risks) this argument is hypocritical and self serving.

First, the bill linked above from the House expressly prohibits restricting coverage A (I)(C)(121)(c) pg. 26:

A qualified health benefits plan may not impose any restriction (other than cost sharing) unrelated to clinical appropriateness on the coverage of the health care items and services.

In fact, throughout all of Division A (the section that establishes both the public option and defines what meets the mandate specifications as an eligible private plan) the only restrictions this bill sets are on minimum quality of coverage. Most of these minimums go above and beyond what I see in private plans (mental health parity, elimination of pre-existing conditions, etc.) This isn't rationing of care, this is the opposite just as then candidate Obama promised on the campaign trail (although with the addition of a mandate as Hillary Clinton and John Edwards had proposed).

Throughout this entire debate I have heard only one group call for any government imposed restrictions on the type of care you can receive. This hasn't been Democrats trying to tell doctors to give this drug instead of that one. This hasn't been progressives trying to say which doctor you get to see.

The only people asking that the government not provide coverage has been Republicans. It is the Republican leadership and Congressmen that are trying to get an amendment passed that would restrict the care a woman can receive from her doctor. They want to impose a restriction on coverage that would prevent a woman from accessing legal safe abortions.

They're not trying to impose this restriction on medical grounds. They're not even trying to impose it based on cost savings. The one and only reason they have for proposing this is because their religious base says so. Because their religious base believes abortion is wrong, they want to deny this essential and sometimes life saving procedure to those who need it.

There is a reason our founders created a firm wall between church and state. They knew that forcing one's religious beliefs on another took away the freedoms of everyone. In fact, many of the first European immigrants came to these shores because others were attempting to force their religious beliefs on them.

Could you imagine the outcry if representatives with large Amish constituencies passed a provision banning the coverage for MRIs because they view that as wrong? Or Scientologists banning treatment of depression? The outcry from the "libertarian" right would be deafening. We can not let this hypocrisy stand or go unchallenged.

Remember this the next time you hear the "rationing" health care argument these reforms. Those who preach it the loudest already are the first to attempt to do so.

Please contact your Senators and Representatives and ask them to keep government out of decisions that should be between patients and doctors. Sign this petition from Democrats.com or contact them directly (Senator contact information, Congressperson contact information)

On Redefining "Universal"

As can be seen throughout the media and on a growing number of blogs, the Democratic candidates' health plans is drawing a lot of attention. There is, however, one word that is drawing this attention more than anything else - "Universal". The meaning of the word, in this usage, is to mean that everyone will be covered. However, both candidates miss that mark and instead redefine it in significantly different ways.

Going back over the basics of their plans they are very similar: Both want to offer plans similar to the Congressional insurance plan (no specific information found about the coverages). Both want to expand Medicaid and SCHIP. They will both give subsidies and tax credits to help people afford the premiums. And both will force the removal of "pre-existing condition" clauses. These plans are an attempt to make insurance coverage more affordable and available to everyone.

Unfortunately, because insurance companies are for-profit and beholden to their stock holders to keep increasing those profits, these plans will never push the citizen payout to zero (at least not without bankrupting the government [further] and making it a short lived program). This means that there will be those who: can't afford one more bill, don't believe that the insurance companies that have screwed so many people over time and time again deserve their hard earned money, or are healthy and never see a doctor anyway who don't think they need to pay for health care when they can buy something they want/need. These people will not automatically be covered under the cores of these candidates' plans.

This is where Barack Obama has chosen to redefine "universal" to mean "universally available". He has said that he will make it affordable enough that anyone who wants insurance can get it easily. To make it even easier, he intends to set up a national institution to allow people to compare coverage side by side and get the plan that best suits their needs, if any. But he does not provide insurance to everyone. He has said in debates, speeches, and interviews that he doesn't want to fine people who can't afford it. And when someone uninsured does show up at a hospital or doctor's office needing care, they will likely face fines or have to pay back premiums - to keep everyone else's premiums down.

Hillary Clinton, however, does go another step. She believes that in order for her plan to be "universal", everyone has to pay for an insurance plan. This is how she changes "universal" to "universally enforced". She as yet has not explained how this will be enforced, but if her interview with George Stephanopoulos is any indication, if someone doesn't choose their own plan, one that matches the premium the government believes they can afford will be chosen for them and they will have to pay for it (either through garnished wages as former Senator Edwards proposed or fines/taxes - again, a very vague, dodgy answer).

Unfortunately, both candidates miss the real problem - although Obama comes closer in some of his related proposals (see the Providers heading on my previously linked chart). The problem isn't just getting insurance. I have insurance, and half the time I feel I would be better off without it. The problem is quality of insurance. It's all well and good for me to be able to say I have insurance, but if my deductible is $2,000+, I'm still bankrupt at my first medical emergency.

Just to throw some real numbers in here, lets say my premium is $200 per month (lower than what I expect the lowest rate they will get for middle income earners) and the limit of my health care needs is going to see a doctor once a year for an annual physical. I just wrote a check for $2,400 to an insurance provider (plus $20 to my doctor, who gets maybe $50-$100 more from the insurance company). Now, taking the long view, that $2,300+ is supposed to go to help Joe down the street when he is diagnosed with cancer and has to get treatment, but 1) there are, roughly 250 more "me"s than there are Joes (otherwise this would be an idiotic business model), and 2) Joe's coverage has an upper limit of (for the sake of argument) $500,000, even though his treatment is going to cost $1,000,000.

No matter which candidate wins the debate over this, who do you think is the real winner?

P.S. Don't even get me started on the Republicans' "plans"

Break Down of the Issues - Part 6

Domestic Policy

Back on track. After a one week battle with our bathroom, we finally have a new floor in. My advice to anyone planning to do any work on ceramic tile, buy a wet saw. The other tools out there are important (tile scorer, tile nipper, etc.) but after fighting with these tools for three days to almost no avail, the wet saw let me cut everything and get it in mortar in about six to eight hours. And now on to the second most commonly discussed subject in this campaign - health care.

Domestic policy will be broken up into numerous sections as the candidates go in depth on plans for numerous topics. See also Part 1, Part 2, part 3, part 4, part 5 and part 7. Again, all of these policy statements are taken from the candidates' campaign websites.

Hillary Clinton	John Edwards	Barack Obama
Health Care
Link	Link (PDF)	Link
Insurance
Give people the choice of current insurance plans or allow them to select from the congressional health plans Strengthen Medicaid and CHIP Require large employers to provide insurance at least partially, give small business tax cuts to provide insurance Give individuals a tax credit for coverage designed to keep premiums to a fixed percent of income Remove hidden taxes to reduce premium cost for current civilian plans Include mental, physical, and, in some plans, dental coverage End unfair health insurance discrimination	Create regional health care markets allowing individuals and businesses in a region to pool their money to get lower premiums Expand Medicaid and SCHIP to cover families with children making 50k or less Require businesses to cover employees, at least partially Refundable tax credits to reduce insurance costs Cover mental health care as well as physical Reform insurance laws to ensure everyone is eligible Lower premium incentives for healthy lifestyle	Create a public benefit program similar to the Congressional one Expand Medicaid and SCHIP Employers will be required to provide at least partial coverage, or contribute to a national plan Individuals who aren't eligible for Medicaid/SCHIP can receive federal subsidies if needed Create the National Health Insurance Exchange - watchdog group that will monitor participating insurance companies and provide individuals with a way to compare them Dependant coverage through a parent's plan expanded up to the age of 25 Cover preventative, mental, and pregnancy health care Guaranteed eligibility, no matter pre-existing conditions Simplify public plan enrollment Regular audits of participating insurance companies Set minimum standards for state health initiatives, but will not overrule plans that meet/exceed this standard Reimburse insurance plans for catastrophic event coverage, if reimbursement is used to keep premiums down
Providers
No new provider initiatives provided on her site	Pay doctors based on results Easily available health care provider quality reports Push the use of electronic medical records Restrict direct to consumer drug advertising for new drugs Strengthen FDA monitoring policy	Reward providers who give better quality results Require health care providers to publish care reports Independent institute to review providers Invest 10 billion to move paper records to electronic records over 5 years Bring antitrust laws to bear against malpractice insurance providers that overcharge physicians Allow consumers to buy drugs from other developed countries
Mandates*
Require individuals to obtain insurance	Require all Americans to get insurance (special case exemptions)	All children must be covered

*A mandate is a requirement for each individual to purchase insurance. Candidates have not yet specified on their sites what penalties will be faced by those who do not.

Objection Overruled

Or "Every sperm is sacred"

Alice pointed me to an article about the Pope pushing "conscientious objection" as what "true" Catholic pharmacists should use to prevent people from getting pharmaceuticals their doctors believe they should have. Numerous religious leaders have been pushing this as a religious freedom issue, but I believe this is another area where one person's rights can do serious harm to another person.

The drug most commonly brought up in this discussion is the morning after pill. This is often claimed by objecting pharmacists to be an abortion pill, but that is patently false. Here is a quick bio refresher. After sex, sperm survive at most seven days, in that time they have to find their way to the egg and fertilize it. This does not create a human being yet. There are several more things that must happen, and only rarely do, before this embryo can have a chance to become a child. After becoming fertilized, the egg needs to embed itself in the uterine lining. This happens in, on average, less than 25% of fertilized eggs.

The standard birth control pill does the following (from Go Ask Alice):

The synthetic estrogen in the combination pill works to prevent the ovaries from releasing an egg. If no egg is released, there is nothing to be fertilized by sperm and the woman cannot get pregnant. In addition, the synthetic estrogen works by suppressing the body's normal hormonal pattern (which involves one egg being developed per menstrual cycle and released for possible fertilization). The synthetic progestin (present in both types of pills) works to:

1. thicken the cervical mucus which hinders the movement of sperm,
2. inhibit the egg's ability to travel through the fallopian tubes,
3. partially suppress the sperm's ability to unite with (and thereby fertilize) the egg, and
4. alter the uterine lining so (in the event that an egg is released and fertilized) the egg will likely not be able to implant into the uterine wall. (A fertilized egg would then be discharged with the rest of the menstrual blood.)

The morning after pill is a much stronger dose of the synthetic progestin in order to rush the last effect. This causes the egg, like 75% of fertilized eggs, to fail to attach, thus preventing (not ending) a pregnancy.

As far as reasons for use of this, and the other drugs the Pope and others would like to see effectively banned from sale, they are legion. Many women aren't healthy enough for a pregnancy. Others have been raped or are in an abusive relationship. The pharmacists have no knowledge of this, and don't have a right to such knowledge. The prescribing doctor should have made all of the objections already. The doctor knows about the patient's living status, everything leading up to the prescription, and should have already discussed this with the patient. If the pharmacist has questions, feel free to call the doctor, but the doctor should be the arbiter of care, not the pharmacist.