Tag: BCRA

My Area Of Expertise

Jimmy Kimmel had an interesting comment about his input into the healthcare debate:

“I never imagined I would get involved in something like this, this is not my area of expertise. My area of expertise is eating pizza, and that’s really about it. But we can’t let them do this to our children, our senior citizens, and our veterans, or to any of us.”

But let’s be honest here, there aren’t a lot of people whose area of expertise is the impact of public policy on health care. Kimmel does, however, have expertise in being a health care consumer dealing with a condition where there is no such thing as a rational actor: a parent trying to save their new baby.

Maybe Cassidy will claim he didn’t outright lie, as Kimmel asserts. But saying you have crafted a compassionate health care policy because a parent won’t have to watch their kid die for want of a life-saving surgery is disingenuous. Essentially any health care plan passes “the Kimmel test” unless it repeals the Emergency Medical and Treatment Labor Act (I believe the act scopes the ‘provide emergency care to anyone without considering ability to pay’ bit to facilities that accept Medicare, as it is the acceptance of Medicare funds that places the facility under federal purview … so the parent may need to go do a specific hospital, but they can find one). The hospital has to perform a medical screening, and they are not permitted to discharge the patient without stabilization (or the patient opting out of treatment, or if they are transferring to another facility better equipped to deal with the issue …. but I assume the accepting hospital assumes the same legal burden so the two end points are the condition is stabilized or the patient opts out of treatment.)

It’s an inefficient structure. My sister had a kidney stone. She could go into the hospital a few times a month in extreme pain, take up a doctor’s time, get doped up on some pain killer (which takes up even more of the doctor’s time because there are people who surf hospitals looking for Oxi), be handed a prescription she had no way of filling, and be on her way. Now if the stone ruptured something, surgical intervention may have been required to stabilize her ailment. But it didn’t, so they didn’t have to perform surgery to remove the kidney stone because the condition was stabilized by eliminating pain. It would have been cheaper to just remove the thing, but she couldn’t pay for that service.

Another facet of the long-standing federal law is that the hospital is not prevented from billing you for their services. If her kidney had ruptured and emergency surgery been required, she’d have been billed tens of thousands of dollars. If you don’t have anything to take, there’s a lien that sits on the record it expires. Or you have some assets and need to file bankruptcy to protect your car/home and clear the medical bills.

It’s not enough to say our health care system put a parent in the position of being unable to afford saving their kids life – it’s been that way since 1986. Our health care system shouldn’t make the parent bring their kid in every week to be stabilized until the situation becomes so dire that the underlying condition cannot be stabilized and actually needs to be resolved. Our health care system shouldn’t make a parent file bankruptcy to save their house and car from being liquidated to cover the lien from that hospital bill.

The Legislative Process

I am not sure what to make of the legislative process when there are Senators willing to vote for a bill if they get assurance from the House that said bill will not pass over there. That they would hold a vote on a significant piece of legislation without providing adequate time for Senators to read it. And I know exactly how much the opinion of constituents matter given the amount of time between the release of the bill and the vote.

Government by Threat

Trump is reportedly threatening Alaska, hoping to garner enough votes to pass something health-care related. No matter how bad the bill might be, no matter how it may impact *his* voters, no matter how much money it will end up costing everyone (great, I save 20$ in taxes but I’m spending 20k on insurance each year instead of 6k).

A president looking to influence legislative decisions is certainly not new, but I question the legality and ethics of this technique. What is the point of “checks and balances” if the party that implements the policy and uses the budget uses their responsibilities to force legislative direction? Or threatens to abdicate their responsibilities to the same end?

I’m reminded of every bad mafia don show ever made — that’s a really nice building you got there, be a shame if something happened to it. The president has become this caricature! That’s some really lucrative mining we’re planning to approve for your area. Be a shame if someone lost this approval form.

Goofiness aside, this (if true) is the most frightening report to come out of the nascent Trump presidency. Well, maybe not the most frightening. That dubious honor, thus far, goes to Michael Lewis’s nuclear threat piece in Vanity Fair. I have to categorize the potential for nuclear destruction due to administrative ineptitude and malfeasance as worse than the breakdown of the entire system of American governance. Despite coming in a close second to nuclear annihilation … why in the world is there not an investigation into Trump’s strong-arming of Alaska for votes?

24/7 Campaign

How can you be the president of the entire country if you cannot even be the president for the entire military?

The address Trump gave at the commissioning of the USS Gerald Ford may reflect the increasingly long campaign cycle or it may reflect his complete misunderstanding of government (not to mention a complete misunderstanding of how military health care works!). He encouraged (ordered? Not speaking to intent; but as the ostensible head of the military, it would behoove him to use more care in selecting what will be communicated to military personnel) those assembled to “call those senators to make sure you get health care”.

A generous interpretation would be that he isn’t letting an opportunity to push for his legislative agenda pass by – this will be televised, reported … but who stands up at a guy’s retirement party to laud himself and ignore the retiree? Or at a commencement to congratulate yourself … oh, wait. That’d be Trump too. A man seemingly incapable of participating in an event and not making it about himself. Even the generous interpretation is essentially “I’m too self-centered to let your thing be the highlight here”.

But beyond the optics of using the commissioning of a naval vessel as a campaign rally, the ACA does not have a whole lot to do with health care for the active duty military personnel to whom he was ostensibly speaking. TRICARE covers them. It qualifies as insurance under the ACA, so they’re set. Given Trump’s other outright nonsensical ramblings on health care, this in and of itself is telling. Enlisted persons have no more need to lobby for whatever ACA replacement is currently on the table than members of Congress. It’s not going to fuck up their coverage.

Worse, though, the military may report to the president like employees report to the CEO … but it isn’t like we changed out the military for a Republican one in January. They may fight to defend the country, but they are not obligated to support the legislative initiatives of the current administration. From his speech at the CIA Memorial Wall bemoaning how unfairly the press treats him — imagine a similar topic being delivered in front of the Vietnam Veterans Memorial Wall — to this most recent address, Trump seems ignorant of the fact there are liberal government employees and military staff. There are Libertarians. Red scare McCarthyism aside, there are probably socialists too. Point being — there were people in the audience who do not want either of the current Congressional health care plans to pass (given it’s approval rating, the majority of the crowd may even feel that way!) and how insulting is it that the speaker would co-opt what was meant to be a naval celebration to rally support for something to which you object?!

Logic

Trump wants to help some poor baby in England who has an incurable disorder and really no hope for recovery. Of course he doesn’t want to help people with mitochondrial DNA depletion syndrome by funding medical research. He doesn’t want to help Americans with any sort of disorder by ensuring they have affordable health insurance. Or, hell, a single payer system where they don’t need insurance to obtain rehabilitative medical treatments. The new American health care strategy  — develop SEO and social strategies to ensure your sad medical story gets a presidential view and thus you win medical care.

Or perhaps, profiteer that he is, Trump wants to help someone who has raised 1.7 mil come here and spend it. How much does he care about thousands of other terminal kids around the world who don’t have a couple mil to blow? Consistent with the new GOP health care plan: “make sure you have a load of cash on hand”.

I’ve long maintained that humans are not able to perform as rational actors in a free market when it comes to their health care. We may be limited by reality, but I suspect anyone who could come up with a billion dollars would be willing to spend a billion dollars to save their life. Looking at the fundraising for this kid, I realize we are not capable of performing as rational actors when it comes to other people’s healthcare either. A fact which reflects well on society, but makes any capitalistic form of medical care irrational.

More telling, he doesn’t want to subjugate his desires to expert opinion or reality. Sometimes modern medicine cannot do anything to save a person. Terribly sad fact, but still a fact. The question then becomes what measures should be taken to prolong an individual’s life. I have had older friends with DNR (do not resuscitate) orders – or more specific documented requests of what they would and would not like to be done to prolong their lives. How much money is it reasonable to spend allowing machines to breathe for someone who is effectively dead? How many people’s lives could be saved with 1.7 million dollars?! It’s these kinds of questions that make health care policy “hard”, but they need to be answered in a way that is consistent with legal frameworks and funding. Especially funding — if we value life so dearly, then we are willing to pay millions of dollars to stave off physical death for those with no hope of recovery. This means either taxes, insurance premiums, or both. Or we draw a line somewhere. And, yeah, it sucks when your loved one is on the other side of the line. But it sucks that your loved one has no hope of recovery too. There’s anger and the bastards refusing to pay for this treatment are an easy target. If we could only sustain his body for a few more decades as medical science advances …

Then agree to pay more for insurance when you are younger to balance out the pricing for older and sicker people. Or agree to cede more of your earnings for taxes that will fund all available medical care for the duration of any sick person’s artificially prolonged life. Both providing infinite care and not paying for it is not an option given the freedoms we have in this country.