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Face to Face With Insanity The dark 1970s film Taxi Driver depicts an aimless young man distintigrating rapidly as he fixates on a plan to assassinate a political candidate. In an improbable twist of fate, he ends up doing something of a good deed. There will be no such neat wrapup of the real life violence on Saturday, January 8, in Tucson, Arizona, when a distintigrating young man took aim at a Congresswoman and shot six people to death, and wounded 19, including his target.


Sex, Drugs, and Whose Business Is It Anyway? A big German drug company is betting that women will buy a pill that will make them want to have more sex. The logic is twisted: trying to get people to want to want. The company says it has collected evidence that many women are unhappy with their libido. Whether or not this is true, the safety trials are under way.


Writing on the Bathroom Wall in the 21st Century Anonymity on the World Wide Web is both a boon to free expression and a bonanza for boors, who abuse their freedom. Personal blogs are easy to set up, and almost all issues-oriented web sites allow readers to post comments freely under phony names. Is all the shouting and name-calling helping to destroy what rational debate we have left?


Yesterday's Tea Bags Is it possible that the teabaggers are something more than a mixed bag of established far-right groups, offered up under a catchy name? Is it possible that they are a spontaneous outcry against big government? Although the national news media is taking them very seriously, I don't think so.


God — Not Dead Just Nowhere To Be Seen At first, it amusing that Pat Robertson said that the earthquake in Haiti last month was god's wrath for a pact with the devil. But considering that Robertson has a huge following, and that disasters always prompt an outpouring of prophets warning about the price of sin, one has to wonder why naïve beliefs persist despite all evidence to the contrary.


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GOP Discovers Political Correctness as a Weapon Something was bothering me when I read the stories about Harry Reid's faux pas in race relations. Weren't the Republicans just blowing smoke to confuse the public on an issue they are losing: health care?


Google, Oprah and the Decline of Western Civilization Was it necessary for Oprah to batter down the walls of individual privacy for Google to charge in and classify and categorize all of us for the sake of more efficient advertising?


Health Care Blues A sense of déjà vu surrounds the health care debate. For the 15 years since the Clinton health care reform flopped, the problem has grown worse, but lobbyists and conservatives of both parties are out for blood again


The News Business Buries Its Dead A former insider, now outside, looks at the trouble in the news business with a fresh, unbiased perspective.


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Health Care Blues

I woke up this morning and had the strange sensation that I'd lived this day already — about 15 years ago, after Bill Clinton had replaced Bush Sr. and was promising to reform the dangerously ill health-care system. The headlines then were the same as they are now: Did the Democrats have the votes or not? The stories are eerily similar, informing us of how many thousands of pages are in the bills, and how many hundreds of billions of dollars they will save. Then, as now, the sour-faced Republicans were flatly telling us reform is dead on arrival because the people don't want more big government. Then my head cleared, and I realized that it is now and not then, that Obama has just replaced Bush Jr. and that the nation is still stuck with an expensive, unwieldy, inefficient health-care mess run by the insurance industry's bureaucracies. No one argues that our current system is working or disputes that it consumes a larger and larger share of the nation's wealth and still leaves many millions of people in the cold to face shorter, sicker lives.

You don't need the Congressional Budget Office to know how large a percentage of the gross national product that health care consumes. Health care costs continue to rise faster than overall inflation, faster than anyone's paycheck. For an example, take my own situation in the health insurance market.

My wife and I are both self-employed and get insurance through a professional organization, so it's a bona fide group plan. Last year, we paid $881.50 a month for insurance that covers nothing until we ourselves have shelled out $10,000 a year in medical bills — this is a high-deductible plan. We were shocked when our friendly insurance company efficiently raised our premium for 2010 by 15% to $1,034.31 a month. That's quite a hit for two people who are healthy. So the benevolent insurance industry takes that money from me, who has never been in a hospital overnight since my birth, and it keeps it. As 2011 begins, the insurer has collected its $12,000, raises the premium again, and rewinds the deductible meter. Not a bad business.

Individuals who have no such group have a much tougher time. The insurance lobby and its pals like to talk about the freedom and choice we Americans have. This is bull. Here is the choice for individuals who live in New York, as I do:

That's it. That's the choice, for individuals, people who don't have jobs with big companies, and don't qualify for a professional group, and don't qualify for welfare. People who were employed but have lost or quit jobs have a right to continue their coverage under the COBRA regulations. This is OK for the short term, but the cost goes up over time. I looked the costs when I left my last job. Our cost would have been up around $1,500 a month after a short while.

I want you to understand that I go into this detail about my own affairs not to make you feel sorry for me, but to persuade you that I am a typical case, an average case, and you can multiply my problem tens of millions times. I'm not one of the rare cases. I haven't been out of work and uncovered for years and years. I haven't been pushed into bankruptcy court by hospital bills.

What gets me is that I see Senators and Representatives, like Mitch McConnell, standing in front of cameras on the news with straight faces telling me how big government will drive my premiums up, how big government will eliminate the wonderful choices I have, and how the taxpayers will have to shell out more of their hard-earned dollars to support medical care for all the people. I want to scream out, I am shelling out more of my hard-earned dollars already, Government is not fueling the rapid increase in health care: it is the system we now have, with an impenetrable bureaucracy, different for all companies, in all states. Do we know how much of the billions that flow into the big insurance companies are spent on executive lunchrooms, private jets, office remodeling? One of our big national myths is that private industry is efficient. The truth is we don't have any way of measuring administrative efficiency. We do have some insight into the prowess of big business when we consider the giants like A.I.G., General Motors, Citicorp, Merrill Lynch, and many others. If not for us, the already-burdened taxpayer, they would have collapsed and dragged the world economy with them just one year ago. I realize that the reason these businesses crashed could be largely due to stupidity rather than inefficiency, but we are splitting hairs. I take small comfort in thinking that perhaps the insurance companies are stupid rather than inefficient.

And here we are again, waiting for Congress. Obama is pushing health-care reform hard and he is pushing it early in his administration. We have hope. It is absolutely essential that something pass, so that the country won't ignore the problem for another 15 years. Even if the bills are problematic, we have to start somewhere. It's a sad fact of life that between the lobbyists and the lawmakers, real reform doesn't stand a chance. And the bills themselves are frightening to read. It becomes clear that most of the proposals consist of shoveling more money, more responsibility and more reliance onto the same private companies that created the system. Sure, the proposal would set up new federal offices to better regulate the insurers — a job at which every state fails. In any case, these new officials won't be in place for a few years. Penalties will be imposed on individuals and employers who refuse to get coverage, forcing them to pay premiums to the same companies that have already failed so badly. Subsidies will be paid to an awful lot of people ‚Äì poorer, older people ‚Äì in order to allow them to shell over more money to the health insurers. Insurance exchanges will address the lack of choice somehow. Nebulous mechanisms will magically reduce costs.

The details get hairy. If a particular person wins or loses will depend on individual circumstances. For example, high deductible plans will not be allowed. This is bad for me. Reform in the end could mean higher premiums for me even though I won't be seeing any more doctors. For a while it looked like Medicare might be opened up downward to 55, and I could take advantage of that, but that idea is faltering. Anyway, Medicare expansion makes a lopsided system, with all the older (read statistically sicker) people funneled into a public plan (Medicare), and all the younger (healthier) people forced to pay something to the insurance industry, which will be relieved of the burden of taking care of the older people.

So why do I favor the passage of a bill — virtually any bill — without seeing any of the details? Because it's both the right thing to do and the smart thing to do. Because of political realities, these first steps are bound to be small, but at least we will start. I understand that there are Democrats who are afraid that their voters are afraid of change (despite all the noise about change last fall during the campaign), and there are Republicans who are hoping to build their revival on Obama's failures, no matter how damaging those failures might be to the nation. And there are lawmakers from both parties who are no more than shills for the insurance industry, like Joe Lieberman. I listen to them talk about the shortcomings in the proposals, and I hear deceit and hypocrisy. Think about the logic of someone who tells you he's protecting you from higher taxes but doesn't give a damn about your skyrocketing insurance premiums. Do they think no one will notice that they behave as if the sole duty of the U.S. government is to protect insurance industry profits?

The most disingenuous argument I've heard is how a public option will inject unfair competition into the insurance market and reduce the consumer choice. I've talked about how little choice exists now in the New York entirely private insurance market; there doesn't seem to be any choice to lose. But even stranger is their prediction that somehow the grossly inefficient government will manage to outperform these supposedly efficient private companies. This is a serious question for privatization fanatics. And why should the taxpayers, who end up paying the bills for the uninsured via welfare, defend the insurance companies, which clearly don't care a bit about their captive customers.

The damage that the insurance industry inflicts on the nation is to a large extent masked by the circumstance that a majority of people obtain insurance through their employer. Workers pay only a small portion of the premiums, and the rest is a benefit. It's understandable that they are complacent.

Still, I've known quite a few people who take jobs in order to obtain coverage for their family. The benefit seems huge when viewed as the price an individual must pay for coverage, but employers negotiate much lower rates. This isn't really isn't much of a negotiation. Anyone can price out the cost of coverage for a small employer on the web and see that the insurance companies give businessmen big breaks without negotiation. I suspect that they have actuarial reasons — since employed workers are probably more stable, more disciplined and more conventional than those who don't work. The employed eat better, sleep more, party less and stay healthier. In such an actuarial view, the rates to employers are justifiably lower than the rates to individuals. But the actual cost to employers is even lower, because a company writes off the entire amount as an expense, and pays no tax on it. For individuals, the rules are complex, and only part of the premiums may be deductible. In other words, those who need help the most are screwed the most. Some of us may have an ethical problem with the system here, but for those who are more hard-hearted, please understand that we all pay the entire cost of the nation's welfare bill, including Medicaid.

A side effect of the generous insurance bestowed by employers with their tax breaks is the sense of entitlement that middle class people get. In this lopsided system, some portion of the population has cheap coverage of exotic and trendy procedures; these are procedures that are debatably elective or can be had for only the slight effort of exaggerating pain, which of course cannot be measured objectively. Some people, like John Mackey of Whole Foods, have campaigned for high-deductible plans as a way to impose a check on unnecessary treatments since the patients would have to pay something out of pocket toward the treatment. But as it stands now, people with good jobs get a patchwork of coverage that goes outside standard medicine, and receive exotic forms of folk medicine for free — even though those treatments are nothing more than the triumph of fashion and fad over science. The system now creates the situation where one person has a bunion operation or a nose job for the asking without charge, or unlimited chiropractic services, and another person has to ignore or postpone treatment of a condition that will shorten his life because he cannot afford it. It's grossly unjust.

Posted 17 December 2009

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© 2010 Barry Schiffman