Sunday, November 22, 2009

What About This "Public Option"

Two posts ago (Paradoxes in the Health Care Debate), a reader posted a thoughtful comment, which included the following:

"As a lawyer, Barry, would you want to see the government subsidizing other lawyers in your area of specialty? Sure, you can compete with other private lawyers, but can you compete with lawyers being subsidized by the government? The government could lower their rates to zero if it so desires, which you cannot do."

This got me thinking.....the government DOES subsidize lawyers in the criminal law field. The government pays for lawyers for indigent defendants. This takes the form of legal aid, and in New York there is also an "18-B" panel, which represents criminal defendants when a conflict of interest prevents legal aid from representing a defendant. This subsidized lawyering directly competes with private criminal attorneys. Criminal law is not my specialty, but I know plenty of lawyers who do this work, and I have never heard a complaint about "competing with a government subsidized program". Let's look at a few reasons, and see if there are analogies to health care:

1. Some private criminal lawyers, but not all, are on the court appointed panel. They do this to subsidize their income, and because it is also a source for future "private" cases. Many criminal law attorneys derive a serious portion of their income from participating in the court appointed panels, and are PAID by this "government subsidized" program.

1(a) I suspect that many, but not all, doctors in private practice will choose to accept payment from the government option health plan. (They may be required to accept it, which seems right to me too). Will that plan be paying much less than the private insurance plans? I see how little my private insurer (GHI) pays my doctors under the present system. Sometimes it's embarrassing. I maintain that the public option will be a bonanza for many doctors in private practice, and for hospitals.

2. Some clients who would be eligible for legal aid or a court appointed lawyer ELECT to retain a private attorney. There are many reasons they may do this, but the obvious ones are better service, higher skill level, personal attention, and what may be at stake (their liberty). Clients pay extra for this if they (or their family) choose to, and they generally get value for their money.

2(a) I suspect that many, but not all, patients and health insurance buyers will ELECT to pay a premium to stay out of the public option and will pay for private insurance. There will be factors determining how many do this, but the main factors will be "how competitive is the price" and "how much better is the service". It will be all about competition, and the private insurers will be quite able to compete. It's just that as it presently stands, they'd prefer not to.

3. Even in the non-criminal areas of practice, there are times when lawyers compete with subsidized programs, and clients who can obtain legal services for zero cost. There are civil matters where clients can get legal services without paying, or by representing themselves. Housing Court is an example of this. People can pay a private attorney, but many either "can't afford it" or elect not to pay a private attorney. I don't have a problem with this. Legal clients have an option medical patients don't have, they can represent themselves, and some do.

3(a) Doctors already have "competition" from a subsidized source......the emergency rooms that do not turn people away. Who pays for these services? Some patients are on Medicare and Medicaid, some pay the hospital, some stiff the hospital. Where the ultimate cost falls is a big shell game, but if I had to guess at the biggest reason private health insurance is so expensive, its that the hospitals make up the difference on all the "stiffage" by banging the private insurance, who simply bangs it back to its customers. Like I said, a big shell game.

3(b) People without health insurance, and who are not old enough for Medicare, or poor enough for Medicaid, are different than poor legal clients in one important way. They can't be their own doctor. Instead, they either delay care, or go without it, or they face financial ruin when an emergency happens. All because of a shell game. A zero-sum gain shell game designed to benefit those presently running the game.

The "public option" makes for a fairer shell game.

Saturday, November 21, 2009

Y'all Asked For It

Why is this all happening?
Why is there going to be massive health care "reform" and a big old new immigration extravaganza behind it?

The Republicans have wielded power or "veto power" in either Congress or the White House since 1980. Their political mantra has been, and still is "the best government is that which does least". They have sold the message so well that in actuality, they caused the government to do NOTHING.

They did nothing, and would still prefer to do NOTHING about our disgraceful health care system. I don't love every aspect of the current proposals, but I despise the notion that a responsible government would do NOTHING, with costs spiraling out of control and a significant percentage of our citizens lacking basic health coverage. What was the Republican plan to address these issues? The plan was to do NOTHING, and the plan was executed.

It's still the plan, and it may still work. Now that change is at hand, the entire propaganda machine is mobilized to stop the change. Never, EVER is there an actual workable counter-proposal, which reveals the basic problem......the view that the government should do NOTHING, and somehow let things get worked out in some "Darwinian (or creator-oriented)" way.

NOTHING was a bad and evil strategy. And now, the Republicans have probably lost their ability to negotiate and improve the details. It's a ramrod job.

Y'all asked for it.

Tomorrow - Y'all REALLY asked for it on immigration, and you're going to get it.

Monday, November 9, 2009

Paradoxes in the Health Care Debate

Wow, this stuff is complicated.

Some people told me that I've made some good points about certain issues in the health care debate, but they "don't know where I stand". I apologize for not yet deciding which slogan to latch onto, and for not yet being on auto-answer. I'll leave that to "Democrats" and "Republicans", who have decided they must condescend to all of us by taking thinking, reasoning and logic out of the discussion. Can't say that I blame them.....we make American Idol a top rated show, we buy Disney products, we allow hip-hop to be called culture, and we act like drinking diet soda is a healthy choice. If I were elected, I'd keep the debate to slogans too.

Fortunately, I didn't run, and if I did, I couldn't win. I can't do slogans. I'd rather look at the slogans, and use them as a basis for something unintended.....thinking and discussion. Here are a few:

"If health care reform is passed, a bunch of bureaucrats will be coming between me and my doctor about MY healthcare" ----- To anyone who says or thinks this, I ask the following:
Are the people at insurance companies who reject and reduce medical claims not "bureaucrats"? Are they better...somehow? Lemme see if I understand this....someone whose job it is to reject your claim so their company can maintain profits is better for you than someone who works for the government?

"We have the best medical care in the world" ------- Yes, if you have insurance. (Actually, I don't know if we have the best medical care; I'm as ethno-centric as the next person.....and truthfully, we don't seem like a particularly healthy country). I've heard the argument that even people without insurance still get treated, but the inequities in our current system are stark, and shameful.

"We want to improve the current system, but we do not need a drastic overhaul" ----- This one really gets me. The current system was and is spinning wildly out of control....anyone who is paying their own way for health insurance KNOWS this. This has been going on for years. Eight years Bush was President, and he had a Congress too, and they did not even sniff at this issue. Now a little tweaking won't do it. Now an attempt is being made to make it fair. It's worth the effort.

"Illegal immigrants should not be covered" ------ I actually agree with this one, but I have no problem with taking every undocumented person who is here working, giving them status, and making them work ON THE BOOKS, and paying to be in the health care system. If having them all in the system and paying brings the cost of health insurance down, I vote "aye".

"It will lead to socialized medicine" ------- I know a lot of doctors. None of them are socialists. Most of them are capitalists, and appreciate being among the best paid professionals in our society. Most people do not begrudge them this. Mandated health insurance will be the biggest boon to medical business in the history of business. That's why you don't hear many doctors speaking out against this, except a few insurance company whores. If you were in a business, and there were tens of millions of customers who needed your products and services, but couldn't really afford it so they held off buying it, and now it would be law that everyone would be able to pay for your products and services, would you like that law? Multiple choice question....... If you were a doctor in a small practice, how would you feel about universal insurance?
(a) You'd be sporting a woodie.
(b) You'd be creaming your jeans.
(c) You'd be humming the "Anticipation" song.
(d) All of the above.

"It's part of a master plan by Obama (and the Dems) to turn the country socialist" ------Note to people who say this....paranoia is not attractive.

"The public option will drive the insurance companies out of business" ------- Are they really going to just roll over and let that happen? Nah, what they will have to do is COMPETE, which I thought was the American way. Oh, is it "not fair" to have to compete with the government? If you give good service and fair prices, and people HAVE TO buy insurance, a private company should be able to kick the governments butt and get huge new business. Have the insurance companies gotten so fat that they can't compete? (How utterly American of them) Can anybody show me where they are competing with each other now? Are they competing on price? On service? Never and nowhere.
No, they will NOT go out of business....they will compete, and the strongest will survive. As it should be.

I'm getting closer to knowing whre I stand.
Can't wait to see what the Senate does.