… or, haven’t I been to this rodeo before? Why, yes I have, and not all that long ago, either. First I called to mind was poor artless Paula Deen, celebrity cook-book author, metaphorically burned at stake in the marketplace of public opinion. But the Great Duck Dynasty Imbroglio of 2013 reminds me very much more of the Great Chick-Fil-A Ruckus of 2012, wherein some fairly mild published remarks by the CEO of the company sent the usual right-thinking suspects into a frenzy of shrieking like demented howler monkeys. Boycott, shun, divest and/or fire was the general ukase for they are hateful hating bigots who shouldn’t be tolerated by truly tolerant people … and then the funniest thing happened. People went out and deliberately bought lunch, dinner and breakfast at their local Chick-fil-A outlet, to the utter chagrin of the usual right-thinking suspects. Chick-Fil-A nationwide had the best darned week they ever had, as far as sales went, and lines of hungry customers stretching for blocks.
Current Events
Backroads in the Eagle Ford Shale Country
This last Saturday was the second day of Christmas on the Square in Goliad, Texas. I had a table there, as a local author, but the cold was so pronounced that the whole event was rather a bust … but it did mean that folding up and coming home early allowed some time for taking pictures on the way back. This is a part of Texas which overlies the Eagle Ford Shale formation, and over the last five years I have noted a good many changes along the route, and in the small towns that we pass through on a semi-regular basis.
Why health care is in trouble.
Our health care system has been built up over the years in a jury-rigged, ramshackle fashion. Before World War II, there was very little health insurance and what there was often was the product of labor union contracts. The early years were concerned with accident insurance and workers compensation laws.
The American life insurance system was established in the mid-1700s. The earliest forms of health insurance, how ever, did not emerge until 1850, when the Franklin Health Assurance Com pany of Massachusetts began providing accident insurance, to cover injuries re lated to railroad and steamboat travel. From this, sickness insurance covering all kinds of illnesses and injuries soon evolved, but the first modern health insurance plans were not formed until 1930.
The Baylor program for school teachers was the first in 1929.
Medical insurance took stride in 1929 when Dr. Justin Ford Kimball, an administrator at Baylor University Hospital in Dallas, Texas, realized that many schoolteachers were not paying their medical bills. In response to this problem, he developed the Baylor Plan teachers were to pay 50 cents per month in exchange for the guarantee that they could receive medical services for up to 21 days of any one year.
In those days, the concern was lost wages more than hospital care.
In 1939, the American Hospital Association (AHA) first used the name Blue Cross to des ignate health care plans that met their standards. These plans merged to form Blue Cross under the AHA in 1960. Considered nonprofit organizations, the Blue Cross plans were exempted from paying taxes, enabling them to maintain low premiums. Pre-paid plans covering physician and surgeon services, includ ing the California Physicians’ Service in 1939, also emerged around this time. These physician-sponsored plans com bined into Blue Shield in 1946 and Blue Cross and Blue Shield merged into one company in 1971.
The modern insurance plans were very recent in origin. I was there for much of it. The commercial insurers fought the status of Blue Cross, which was not required to have reserves. Blue Cross asserted that it promised hospital care, not payment, so reserves were not necessary.
The 1940s and 1950s also saw the proliferation of employee benefit plans, and the included health insurance pack ages became more and more compre hensive as strong unions negotiated for additional benefits. During the Second World War, companies competing for labor had limited ability to use wages to attract employees due to wartime wage controls, so they began to compete through health insurance packages. The companies’ healthcare expenses were exempted from income tax, and the resulting trend is largely responsible for the workplace’s present role as the main supplier of health insurance.
The war produced much of this as wage limitations were in force but fringe benefits, like health insurance, were permitted. A lot of this history is contained in Paul Starr’s book The Social Transformation of American Medicine
From the first, commercial insurers focused on employer plans while Blue Cross and Blue Shield (which was founded by the California Medical Association to pay doctor bills) were individual plans.
In 1954, Social Security coverage included disability benefits for the first time, and in 1965, Medicare and Medicaid pro grams were introduced, in part because of the Democratic majority in Congress. In the 1970s and 1980s, more expen sive medical technology and flaws in the health care system led to higher costs for health insurance companies. Responding to higher costs, employee benefit plans changed into managed care plans, and Health Maintenance Organizations (HMOs) emerged. Man aged care plans are unique in that they involve a particular network of health care providers that have been verified for healthcare quality and that have agreements with the insurer about price and related issues. HMOs were originally primarily nonprofit, but they were quickly replaced by commercial interests, and managed care only suc ceeded in temporarily slowing the growth of healthcare costs.
Two major changes came in the 1970s. In 1978, the federal government established what were called Professional Standards Review Organizations or PSRO. All doctors had to receive training in how to do these reviews and it was immediately apparent that cost was the only consideration, not quality of care.
I decided to educate myself and took a course from an organization called “The American Board of Quality Assurance and Utilization Review Physicians. I took the exam and passed, then attended the annual meeting. This was about 1986. People I met at that meeting informed me that the exams were graded by throwing them up in the air. Any that landed balancing on one edge were flunked. Nonetheless, the experience was valuable because I could see what was coming.
I was president of the Orange County Medical Association that year and had served for eight years on the Commission on Legislation of the CMA, now called The Council on Legislation. This gave me an opportunity to meet many legislators, many state level and some federal. The impression they made on me was that few knew anything about medicine and most were not very intelligent.
You Can’t Keep Your Plan
We just re-upped our health insurance for the employees of our small company. The price increase was breathtakingly astounding. The increase will be coming right out of the profit sharing. There isn’t really anything we can do.
Our policy is so good that we are forced to pay a one thousand dollar a month tax on it. Thanks.
It took Blue Cross a very long time to get us a quote because of the insane maze of new regulations. Due to this and time constraints, we basically had no choice besides sign up and take the increase, or cut everyone loose to the disastrous healthcare.gov site and give them a stipend of some sort – but we actually like our employees so no dice on that.
Besides, we have employees in two states – Illinois and Wisconsin. Wisconsin deferred to the federal plan, Illinois did a mixture. I am sure that will go very well. So that would create another issue we would need to address – how to stipend who so our employees are treated fairly.
All of our employees received a card from Blue Cross saying that their current plan will expire. And this is true. The new plan is similar, but not exact.
We have absolutely no idea what will happen next year, since our Blue Cross person said that the plan that we just signed up on will not be available when that rolls around.
Our employees are furious at the Obama administration for this debacle. Here’s hoping this will change some votes.
A rolling catastrophe
Obamacare debuted on October 1. It is now November 4 and the mess is worse. I have been posting about it, here, and here, and here, and even here.
The political left is trying very hard as can be seen here.
It’s kind of complicated so I will summarize. You are screwed !
There are accusations that insurance companies are using this to drop high risk subscribers. Maybe that is true but it is the consequence of ignorant people designing Obamacare. Did these guys ever set up a new business ? As Casey Stengel once said to the Mets , “”Can’t anybody here play this game?”
I guess not.
The New York Times has done what it can.
We are also told that “in all the furor, people forget how terrible many of the soon-to-be-abandoned policies were. Some had deductibles as high as $10,000 or $25,000 and required large co-pays after that, and some didn’t cover hospital care.” Never mind that we have seen cancellations of insurance policies with deductibles much lower, and customers forced to purchase replacement policies with higher deductibles, and with premium increases of 100%, if not higher.
Then there is this argument.
Why can’t people opt out of mental health coverage if there is not a reasonable chance that they will need that coverage? Why can’t they get mental health coverage when it is needed? After all, pre-existing conditions can no longer be denied, so in the event that mental health coverage is needed down the line, it can be obtained and the insurance companies cannot deny people who already have pre-existing mental health conditions. The Times assures us that over-coverageand the high premiums that come with itis “one price of moving toward universal coverage with comprehensive benefits.” They don’t explain why having unnecessary coverage is a step towards social justice, but as we saw from the beginning of this intelligence-insulting, repulsively dishonest op-ed, the New York Times is less about explaining, and more about covering up a disastrous rollout with disastrous policy consequences for the country.
Peggy Noonan, who has frustrated me with her obtuseness at times, gets it now.
Politically where are we right now, at this moment?
We have a huge piece of U.S. economic and social change that debuted a month ago as a program. The program dealt with something personal, even intimate: your health, the care of your body, the medicines you choose to take or procedures you get. It was hugely controversial from day one. It took all the political oxygen from the room. It failed to garner even one vote from the opposition when it was passed. It gave rise to a significant opposition movement, the town hall uprisings, which later produced the tea party. It caused unrest. In fact, it seemed not to answer a problem but cause it. I called ObamaCare, at the time of its passage, a catastrophic victory—one won at too great cost, with too much political bloodshed, and at the end what would you get? Barren terrain. A thing not worth fighting for.
So the program debuts and it’s a resounding, famous, fantastical flop. The first weeks of the news coverage are about how the websites don’t work, can you believe we paid for this, do you believe they had more than three years and produced this public joke of a program, this embarrassment?
She assumed that it wasn’t worth it if it worked !
The problem now is not the delivery system of the program, it’s the program itself. Not the computer screen but what’s inside the program. This is something you can’t get the IT guy in to fix.
They said if you liked your insurance you could keep your insurance—but that’s not true. It was never true! They said if you liked your doctor you could keep your doctor—but that’s not true. It was never true! They said they would cover everyone who needed it, and instead people who had coverage are losing it—millions of them! They said they would make insurance less expensive—but it’s more expensive! Premium shock, deductible shock. They said don’t worry, your health information will be secure, but instead the whole setup looks like a hacker’s holiday. Bad guys are apparently already going for your private information.
This is the worst that could be imagined.