I'm James Maxey, the author of numerous novels of fantasy and science fiction. I use this site to discuss a wide range of topics, with a heavy emphasis on cranky, uninformed rants about politics and religion and other topics that polite people attempt to avoid. For anyone just wanting to read about my books, I maintain a second blog, The Prophet and the Dragon, where I keep the focus solely on my fiction. I also have a webpage where both blogs stream, with more information about all my books, at jamesmaxey.net.


Sunday, July 01, 2012

Thoughts on the Health Care ruling

It looks like I let June be my first month since starting this blog without a post. Sorry. I have a deadline of July 31 to turn in my next book, Witchbreaker, but due to buying a house, renovating it, and moving in, I basically wrote almost nothing on the project between mid-March and mid-May. Fortunately, when panic finally sets in, I can crank out some words, and I just finished the second draft yesterday. So, I'm taking a few days before jumping into the third draft to catch up on some of the stuff I've let fall by the wayside during my writing frenzy.

I used to write about politics frequently on this blog, but my enthusiasm for politics has waned in recent years. I used to have this vague, half-formed hope that as our countries problems worsened, we'd finally have some leaders step up to pull us back to a path of sanity. I took some amusement from the cowardice, hypocrisy, and stupidy of elected officials because it reinforced my libertarian prejudices that government just messes everything up.

But all joy sort of seeped away during the unending Republican primaries. Amusement changed to terror as I realized our next president might be the oops guy, the pizza guy, the crazy lady, the religious nut, the wife-leaver, or the spineless rich guy. Sweet merciful jesus, has a political party ever fielded a worse slate of candidates? Ron Paul was okay, but he was doomed by crazy talk, i.e., explaining his true beliefs clearly and plainly without shaping them to make them more palatable to his audience. Romney makes his opinions palatable by seeming not to have any. He doesn't like Obama's temporary immigration fix, and says he wants a permanent solution... without saying what that will be. He wants to repeal and replace Obamacare... but replace with what? He claims he understands the economy, but if he has any ideas beyond cutting taxes I haven't heard them.

Meanwhile, Obamacare. I have to admit, I didn't expect the individual mandate to be upheld, and I certainly didn't expect that it would be Roberts that pushed it over the top. But, I do think there's a fundamental honesty in calling the "penalty" a tax. And, if even once in the bill it had been called a tax, there's no question it would have been constitutional. I'm deeply offended, even outraged, that elected representatives might vote to tax me for things I might not do (like having health insurance), but I can't deny that the constitution grants congress the power to levy taxes.

And, I did appreciate what I thought was the most important sentence in Robert's ruling: It's not the court's job to protect the public from the consequences of their political choices. Robert was basically slapping the American public in the face and shouting, "If you don't like this law, vote for people who will overturn it. Don't come crying to us!"

So, should we vote for people to overturn the law? My immediate impulse is yes, completely, 100%. The law is too complex, and way too expensive. I have little doubt that it's a drag on the economy that's making companies reluctant to hire people. And, because of the individual mandate, unemployed people no longer have the option of trying to start their own business. As someone self-employed as a writer, I can tell you that my income is marginal and unpredictable enough that it would be extremely difficult for me to pay a monthly health care premium. I do have a day job, and get my health care coverage through this. But, like most writers, I dream about quitting my day job. It's possible that, if I did so, I might be taking a gamble on having a few years uninsured. Lots of people do this, and, if you're in good health, and young enough, it's often a gamble that pays off. You go without insurance while you're starting your small business and ten years later, when your hard work is finally paying off, you get insurance.

Now, with the individual mandate, you can't have those just-scraping-by years to launch your own business because you either need to earn enough to buy insurance, or you get charged a hefty tax. This is going to be a burden discouraging millions of people from trying to be their own boss. The law tilts the employment playing field in favor of large corporations, who get the best insurance rates. But, of course, now the large corporations don't want to hire as many people, because the law also removes things like payment caps, meaning any given employee can be a time bomb just waiting to explode into multi-million dollar health care price tags.

On the other hand, if Obamacare truly does cause more people to have insurance, maybe this will keep down the costs. If we add more healthy young people, it subsidizes sicker old people. I think the costs of the plan outweight the benefits, but at this point I'm open to the argument that we need to try something. If Romney wants to repeal and replace, let me hear about the replace.

My libertarian instincts are that the best path available to lower health care costs would be tort reform and insurance deregulation. But, I also think there may be room for some federal action, though, perversely, it's probably action that's the opposite of what they would do. My wife works for a hospital, and as near as I can tell, 10% of her job is directly involved with providing drugs to customers, and 90% of her job involves filling out paperwork. Two weeks ago, I injured my hand at work, a fairly deep cut from a box cutter that was over an inch long. The treatment of the cut was pretty simple. They basically glued it shut and sent me on my way. But, I had to talk to my help line at work before I went, which involved 20 minutes of talking on the phone to a nurse who asked me a ton of information, then going to the urgent care center where I had to fill out paperwork asking almost exactly the same questions. Meanwhile, my boss had his own paperwork to fill out. Couldn't there be an infrastructure created that removed all this redundancy? And why is their paperwork at all? Anything I fill in on a sheet of paper is presumably being transfered to a computer by someone. Instead of handing me a clipboard, why not hand me a tablet computer that already has 90% of my data already filled in after my insurance card has been scanned, leaving me only to answer questions about my immediate problem?

Improved technology has cut down my costs for communication and acquiring information in almost every aspect of my life. Only in healthcare does the increasing technology seem to be driving costs up instead of down. Why?

Maybe over regulation and overlitigation has created most of these problems. Or, maybe complexity just makes change more difficult. I don't think Obamacare improves the complexity, and may actually increase it. But, does repeal lead to improvement? Or just a return to an already horrible status quo?


Eric James Stone said...

> If Romney wants to repeal and
> replace, let me hear about the
> replace.


> My libertarian instincts are that
> the best path available to lower
> health care costs would be tort
> reform and insurance deregulation.

Romney is proposing measures toward each of those goals:

> Cap non-economic damages in
> medical malpractice lawsuits

> Limit federal standards and
> requirements on both private
> insurance and Medicaid coverage

> End tax discrimination against
> the individual purchase of
> insurance

> Allow consumers to purchase
> insurance across state lines

James Maxey said...

Thanks, Eric, although I will say that I have caused some confusion with my poorly worded phrasing. I did hear some of these ideas during the republican primaries, and Ann Coulter (perhaps Romney's most reliable cheerleader among pundits) has written several times about insurance deregulation and how allowing insurance to be purchased across state lines would solve a host of problems.

My lamentation isn't so much that he doesn't have ideas for the replace as that the replace isn't what he's really running on. North Carolina is a swing state this time around since Obama carried it last time, but Republican's have since done very well in state elections. Romney is already on the air with ads here, and the ads aren't, "Hi, I'm Mitt Romney and here are some ways I'd like to improve your life." Instead, the ads are, "Hi, I'm Mitt Romney, and I'm going to undo everything that Barack Obama has done."

Of course, Obama's ads are just as bad, since one could get the impression from his ads that Romney wants to appoint George W. Bush as his closest financial advisor.

I'd just like to see Romney running more on his ideas than on the lousiness of his opponent.

James Maxey said...

I will also note that items 1 and 3 don't require the repeal of the AHCA.

Also, none of these particular 4 items gets at the important heart of ObamaCare, which prevents insurance companies from denying coverage based on preexisting conditions. This is a pretty important plus of the law, but it only works because of the pretty important minus--the individual mandate. Without a new pool of healthy people coerced into buying insurance, there's no way for insurance companies to absorb the risk of insuring people who have high risk medical backgrounds, such as being a cancer survivor.

Mitt's plan in this area seems to be to "ensure flexibility" for the states to handle the problems. Also, to prevent discrimination for those with continuous coverage (which, I believe, the AHCA already does). "Ensure flexibility" to me sounds like code words for "let the states figure it out." Unfortunately, pre-Obama, I didn't see the states taking much action toward this, aside from Massachusetts, which tried an individual mandate. In North Carolina, maintaining flexibility means having the state just ignore the issue.

MLH said...

And if you 'lose' on your 'gamble,' you end up in the ER and we all end up paying.

James Maxey said...

MLH, I'm not sure that it follows that if I end up in the emergency room, other people pay. I've never defaulted on a bill in my life. It's possible that I couldn't pay out of pocket for a bill larger than a few thousand bucks, but if I can finance a house or a car, why not a broken arm or appendicitis?

It seems to me that one problem is that we insure to cover truly large health costs like a heart attack or cancer, but wind up using the insurance for all medical costs, including relatively inexpensive drugs like my thyroid medication, and the corresponding blood tests.

Imagine how much auto insurance would cost if it had to cover not just accidents, but also routine maintenance like oil changes.

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