Not afraid of the flu?

There’s America’s problem with healthcare right there. In fact, flu kills more Americans than Ebola has. But the fear-mongering by the media has led people to think that Ebola is kind of a monster killer that’s rampaging through the countryside. Such parents are a menace to the society as they endanger their kids’ lives through ignorance.

It’s a sad day when science loses out to sheer stupidity.

Constantly Disappointed

For the past 5-6 years, I think we have been constantly living in a sense of disappointment. Perhaps the big financial crash scarred us and made us skeptical of everything around us even when things started to finally look up. The social media tools of quick feedback and need to comment on every issue you hear about often relied more on negativism. The tweets that bash people or make condescending puns tend to get retweeted more and hence subsequently get tweeted more. I’ve been guilty of this but over time, I realized the constant barrage of negativity around me. Part of the reason I stopped blogging as frequently was also because most of the posts we read during the heydays of blogging involved critical analysis, more often not constructive. So I decided to make a conscious effort of not doing that. The IIPM saga also hardened the cynic in me that nothing ever changes.

Among all the things we are constantly disappointed with, I think Obama’s presidency has to rank right at the top. More often than not, the right’s implication that he was considered a messiah by the left rings true. Things he never said or promised are often attributed to him e.g. ending all wars and waging none. What is easily forgotten that he in fact supported right until he got elected, the “good” war in Afghanistan. The drone warfare as illegitimate as it sounds is done with the complicity of the Pakistani and Yemeni governments (hence you don’t see drone strikes in Germany or India) and often result in a far fewer accidental civilian deaths. This is in no way a defense of the drone strikes. It should be subject to Congressional oversight and all legalities of conducting such strikes should be tested by the federal if not the Supreme Court; checks-n-balances and all that jazz.

However, this post tries to focus on the latest disappointment in the Obama presidency. I may often come across as an Obama apologist but this charge often comes from people who are more than willing to overlook the consequences of having the other side in charge [1] The rollout for Obamacare hasn’t been exactly smooth and the primary website where people can enroll has suffered from numerous technical glitches. If you use the relative scale, ten years ago, we couldn’t find WMDs that we were told existed before we invaded a Middle East country that cost thousands of American lives and countless civilian lives. Today, we have a slow website that can and is being fixed.

Obama clearly erred when he promised that no one would lose their existing insurance plans although such plans clearly are not up to the mark. He should’ve apologized and he did [2]. It’s like letting people drive around in cars without seat belts and unusually low emissions standards. The insurance companies have been conning people into a sense of complacency by offering junk plans and denying people benefits when it came time to pay for healthcare. How bad are these plans? Here’s one example:

Under her current junk plan, she would probably receive no more than a few hundred dollars of benefits for doctor visits and drugs. It wouldn’t cover her surgery, her chemotherapy, her many expensive medications, or the repeated diagnostic tests she’d likely require. She would end up with probably $119,000 of unpaid medical bills. With the Humana plan [from Healthcare.gov), those bills top out at $6,300 a year, no matter what.

The law addresses such plans but yup, Obama should’ve qualified his statements which I admit don’t make for good soundbites in a fast-paced media world of today. I’m no health policy wonk but the least the White House can do right now, is to let those people keep their plans (grandfathered-in) for the next three years but prevent insurance companies from offering them to new customers. The Landrieu Bill in the Senate, I believe fixes this while requiring insurance companies to also offer the higher priced alternatives and showing the additional benefits offered under them. But then, in my opinion, this would be the wrong policy choice. The overall negative impact is far worse than having to eat crow and admit you misspoke or lied earlier. But then again, there’s the reality to consider:

The other issue is that of the slow and sometimes non-responsive website. I believe that it won’t be fixed in time before the end of this month and while that is unacceptable, penalties if you don’t get insurance don’t kick in until March 31, 2014. Latest numbers suggested that nearly 500,000 have at least filled out an application but have not bought a plan. I guess they are waiting until they have to since coverage will not begin until Jan 1, 2014 anyway. But it’s a far cry from the single digit enrollments that media reported happened on the first day.

On the other side, I can totally relate with the problems experienced in launching a website that will contain information from multiple sources and be useful to all. Because I’ve been doing exactly that for the past few months. However, my task was a millionth times as small as the Healthcare.gov website but it gave me an in-depth understanding of how state procurement even for technical services worked and I suppose the federal one is even more convoluted. The state agency originally tasked with contracting out the development was restricted in the choice of vendors it could seek out. It could, by law, only select from the vendors in its database and the program manager had nothing to go by in the list apart from names of the vendors and she had to pick ten at random without even knowing if they were capable of developing what we wanted. Clearly this was a sub-optimal solution so the process of contracting a vendor fell to our office and we could reach out to many more people, lay out specific requirements, and eventually select a private development company after an exhaustive search that included an on-site demonstration.

In our example, we had to design the system such that it could accept data from four different data systems from our sites and yet be flexible enough to handle additional fields that we could factor in for research. People often told us one thing about their systems and the data they had and it turned out to be completely different when they eventually delivered the data. Luckily we could go back and redesign the interface to handle such inconsistencies. From what I understand, the Healthcare.gov directly connects to 50 state exchanges that have been developed independent of each other and may be subject to different requirements. To top it, it contained health data so was subject to HIPAA regulations that made it doubly complicated. Further, this development and testing was happening just as the other party was willing to shut down the government in order to defund the law that administered this venture. It would have been a massive surprise if everything worked perfectly from the start.

So as much as disappointed we want to be in our state of affairs, it’s always useful to place things in context and view it relatively. Of course, we should complain but to argue that we would be better off than what we are doing right now just makes me dismiss you entirely. Changes to the status quo may hamper one party’s political future but to use that to convince the otherwise-sensible among us that we are doomed is downright evil. And it’s sad that people are willing to outrightly dismiss the efforts rather than rolling up their sleeves and saying, ok lets fix this thing and get it going.

  1. They say, politics is about choosing between the lesser of the two evils so your choice is always relative. You have to constantly think about, ok, I don’t like this guy but then whom would I rather have in his place? []
  2. Remember when Bush apologized for the Iraq war? Yeah, neither can I []

ObamaCare upheld

While I’m loathe to calling it ObamaCare, it has been referred to as such by both parties enough so as to negate any perceived negativity that it was intended to begin with. ObamaCare or Patient Protection and Affordable Care Act was upheld (with caveats) by the Supreme Court of the United States today. In a surprising and unexpected move, the Chief Justice John Roberts joined the liberal judges in saving Obama’s landmark and signature legislative achievement. While the law in full is difficult to explain in its entirety, this Reddit comment comes close to explaining it like you’re a five year old.

However, the majority opinion on why the case was in front of the Supreme Court and why was it in danger of being stricken down can be best explained by SCOTUSBlog‘s succinct summary:

“In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.”

If you read the above two links, you will know more about ObamaCare than 95% of Americans who identify with it purely on ideological grounds. Of course, it is not the perfect solution but given the politics and the dire situation of healthcare, it is, in my opinion, a step in the right direction. If you aren’t satisfied by these two links, you are free to read the full official opinion as written by the Justices or the full text of the bill. You may be intimidated by the legalese. It takes reading more than half a dozen such opinions to get the hang of it; something that I had to do for my Law and Planning class (by the end of the class, I had actually begun to enjoy reading briefs and opinions).

What this means for Obama’s electoral chances is a secondary concern but for millions of uninsured and underinsured, it is a much-needed relief from the uncertainty of the past two years. If the GOP, that is head-scratchingly staunchly against any healthcare reform, gets to control both houses in the Congress and the White House, they may choose to repeal it (remote possibility but still a possibility). So in that sense, it is very important politically for those who care, to get out and vote in November.

Healthcare Reform comes to America

Healthcare Reform Passed

[image source] After decades of trying, healthcare reform finally made it through the halls of the U.S. Congress and is headed toward the President’s desk. In the events leading up to this historic legislative moment, several canards and lies dominated the discussion but when the dust settles after, the effects of this legislation for healthcare in America will be known. No one is coming for your grandma and socialism doesn’t reign supreme in America (if you had lived in India pre-1991, this lie will always make you laugh). Although like most, I too do not believe that this bill is perfect as it perpetuates the reliance on insurance as means of controlling healthcare costs. I would’ve preferred a Medicare for all (or for none) option but neither is politically feasible. This bill although imperfect still sets us in the right direction. So now that the bill is law, what happens immediately? Here is a list:

  • Adult children may remain as dependents on their parents’ policy until age 26
  • Children under age 19 may not be excluded for pre-existing conditions
    No more lifetime or annual caps on coverage
  • Adults with pre-existing conditions may buy into a national high-risk pool until the exchanges come online. While these will not be cheap, they’re still better than total exclusion and get some benefit from a wider pool of insureds.
  • Small businesses will be entitled to a tax credit for 2009 and 2010, which could be as much as 50% of what they pay for employees’ health insurance.
  • The “donut hole” closes for Medicare patients, making prescription medications more affordable for seniors.
  • Requirement that all insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments.
  • Authorizes early funding of community health centers in all 50 states (Bernie Sanders’ amendment)
  • [source]

The above list makes the 2000+ page bill sound simple or probably too simple and may not cover all bases. Reuters breaks it down much better according to year of implementation and more specific changes. the New York Times also has an excellent interactive feature on how the healthcare overhaul affects you whether you are insured or uninsured. Given the number of positive and popular changes in the bill such as barring people based on pre-existing conditions, closing of the Medicare ‘doughnut’ hole, elimination of lifetime coverages, etc. it will be next to impossible to repeal this bill, as Republicans propose doing. Partisan bickering aside, this bill recognizes healthcare as a right and not a privilege, much like education.

All Tort, No Shit Reform

Recently I had to visit the emergency room (more on that later) for some not-so-serious stuff. As I waited for the doctor and filled out different forms that would effectively shield the hospital from any legal hassles or allow them to spread the word of my illness, I had the chance to ponder about the high cost of health care in America. I wasn’t even on the proverbial tip of the healthcare iceberg and I could cite a dozen reasons. Of course, the doctor didn’t meet me first; instead his assistant ran the initial tests and made copious notes on her little pad. Once inside, I was given my own scrub (for a minor injury, why? reasons follow later) and then asked to lie down on the examining bed, complete with a fresh (and new) white sheet. Hesitantly, I asked if I should remove my shoes, the assistant seemed amused and told me that it was my own sheet and I could choose to keep it clean or dirty it if I wanted implying that the sheet would be disposed off once I was done. The rest of procedure also involved what would be otherwise considered wasteful processes (by Indian standards).

Only later, did I realize that I had grown accustomed to scrimping ways of hospitals to reduce the overheads which in fact, put the patients at a grave risk in the process. The entire rigmarole of defensive medicine was practiced not only to be doubly safe from repeat occurrences or complications but also to safeguard the physician and the hospital from disgruntled patients. Patients suing doctors for millions for overlooked symptoms, sometimes exaggerated have been the bane of American healthcare, driving malpractice insurance premiums through the roof. But is malpractice insurance solely to blame for rising healthcare costs?

The costs of malpractice premiums are only about 1 percent of total U.S. health-care costs, says Richard Posner in an excellent essay on Tort Reform. Tort reform was publicized a lot during the election campaign with Bush advocating caps on atrocious punitive damages in malpractice suits. But maybe sometimes, the cost of your life can be beyond the highest compensatory award. The big handouts are often designed to make the big conglomerates think twice. Punitive damages often make doctors practice safe or defensive medicine. They would rather conduct umpteen tests to validate their diagnosis rather than rely on their educated guess and pay up in case of a goof-up, however minor it might be. Such defensive medicine, although a bit cumbersome for the patient, ultimately reaps benefits higher in proportion to a bungled up treatment. the patients gain ultimately. Caps on malpractice suits is a bad idea, as it doesn’t deter the doctors from messing up although few atrocious suits do exist but we really can’t base a major policy decision on few sporadic cases. After all, $25 million that John Edwards won for a girl whose intestines were sucked out by a faulty swimming pool drain won’t help her much, it did herald in mass changes in swimming pool safety that prevented future accidents. The class action suits that are expectedly filed against Merck for its Vioxx messup will partially drive up drug costs but in the long run will usher in double-checking drugs for side effects before it is too late.

Being extra-cautious and spending more or just going with your doctor’s informed guess and getting a great deal for your medical expenses is an unfair tradeoff. Defensive medicine is here to stay, and tort reform trying to cap damages will only result in skewing the balance that ultimately results in trickle-down benefits for the consumer.