Illegals and Health Care: A Reality Check

Once again, everyone is simplifying the arguments, and once again, everyone is wrong.

The opponents of health care reform are bleating that the Obama plan would grant coverage to illegal aliens, the clear implication being that this would be something new that they do not already have.

Health care reform advocates counter that there's nothing in the bill to give health care to illegal immigrants, the clear implication being that no illegal will be treated on the dime of U.S. taxpayers.

Both implications are false (well, depending on the final plan, of course).

The opponents' claims are false because right now, our emergency rooms are mandated to treat anyone who comes through the door, regardless of ability to pay (insured or not). Are you willing to bet any money that illegals don't know this and aren't bothering to go to the hospital when sick or injured?

Which means that it's a meaningless bogeyman. If illegals manage to slip through under the new health care system, it just replaces the way they slip through under the current system. Yes, perhaps the new system may not make things any better in this regard, but it's clearly disingenuous to argue against repairing a hole in a boat with a non-working motor on the grounds that after the repair, the boat's motor won't work. A change in plan which fixes something and leaves the rest essentially the same is a good change.

Now, as to the proponents claims, it's harder to tell how false they are, because the final plan hasn't been written, but let's assume the absolute worst case scenario (as presented by the opponents), a fully socialized medicine system. If I go to Canada, or England, or France, or Germany, and I break my arm, the hospital doesn't (as I understand it) demand to see my papers before they will treat me. The system is set up to be available to people who need it, and so if I show up, I can use it.

I'm inclined to guess that a socialized system in this country wouldn't be set up to demand passports or other serious documentation of a patient's citizenship before treating them, especially not in the case of emergency treatment.

Now, since a "single payer" (aka "socialized") system isn't even on the table right now, it's possible that proponents are actually correct in this one, that by making health care reform by way of a "public insurance option", we might actually PREVENT some illegals from obtaining care, IF insurance becomes universal for citizens, and IF the law requiring emergency rooms to treat everyone is repealed, and IF in order to buy insurance (or at least, to get subsidies for insurance), proof of citizenship is required.

In that case, only those illegals who have convincingly forged papers would still be treated, but let's be honest: forged papers aren't something we're going to take care of now or ever, certainly not as part of a health care bill.

So the truth is that yes, some people in this country illegally WILL get health care, some of which WILL be subsidized by the taxpayer (either through taxes or through higher medical costs, which in turn raises their insurance premiums, etc), but that this situation already exists, so to present it as something the plan will GIVE to illegals is wrong.

Liam.

Funding Musings...

This whole health care debate is raising my blood pressure. How an amendment, originally offered by a Republican, allowing (not mandating) end-of-life counselling (paid for by Medicare) has turned into "Obama wants to decide if senior citizens live or die" is beyond me.

Well, no, it isn't, I know very well how it happened. But it disgusts me that scoring political points is more important than even something as crucial to our nation as health care reform.

But that's not what I want to talk about this morning.

One of the charges I'm hearing a lot on the left is that the protesters shouting down Democratic town halls are mostly funded by the insurance industry.

Now, I understand how this LOOKS bad. I understand that the insurance industry is giving that money because THEY don't want additional competition. And I certainly understand how shouting down a town meeting is not only not "democracy in action", it is in fact anti-democratic, not allowing opposing voices and viewpoints to be heard.

But... the funding itself does not prove anything to me, necessarily, about the motives of the protesters.

The way I see it, there are two possibilities. I know which one I THINK is going on, but I don't believe it's proved, certainly not by the trail of money.

Possibility number one is that insurance companies give money to people who agree with them. That is, these people *ALREADY* disagreed with health care reform, and already had their agenda, and just went to like-minded people for donations. There's really nothing wrong with that. If I want my Belgian beer to cost less, I might be against a proposed tariff on imported beers. And the Belgian beer companies are probably also against the tariff, but for very different reasons. Common desires make for common bedfellows, even if the reasons are entirely different (I couldn't particularly care less whether they sell more beer or not, and they probably don't care how much I pay for that beer, except to the extent that it affects my choice as to whether TO buy the beer).

Possibility number two is that the insurance companies have contracted with these firms which specialize is ginning up "grass roots" support for one topic or another. The companies and their firms then come up with a set of talking points (like "Obama wants to kill your grandmother" and "Obama's plan will make you give up your current insurance" and "Obama's plan will ration health care", all of which are demonstrably either false or, at best, no change from the current situation) and then go out and make people angry by presenting those talking points as fact and then sending them out.

It seems to me that there's more of the second in this case, just in the fact that the protesters all seem to have the same set of false or misleading talking points. It seems to me that people who have an honest dislike for something, show up and talk about it. Those who have an agenda show up and try to shout down all opposition.

But still, I don't see that it's all that sinister, necessarily, that the funding for anti-health-care-reform might come from the people who stand to gain the most by the status quo.

Who else are the "I don't want this health care reform" groups going to go to? The DNC?

Just my thoughts for today.

Fun Fun...

There's a minor fire-storm on the internet going on about a health care reform protester named Kenny Gladney.

Anti-health-care web sites are claiming Gladney was "brutally" attacked, and the post a video to "prove" it, but the video does not comport with the descriptions of the "brutal beating".

The video shows a man on the ground (reportedly, although this is not seen in the video tape) having been shoved BY Gladney. Someone else pulls Gladney to the ground (ostensibly to keep him off of the other person, who is already on the ground). Gladney jumps right back up, the police take control. A lot of yelling, but with the exception of the man on the ground at the start, Gladney being pulled to the ground and quickly getting back up, and a couple of minor pushes, there's nothing. No punches, no kicks, nothing that should lead to anyone needing medical treatment.

Presumably if it happened AFTER the police were there (and thus, after the end of the video tape), then the police report would document it.

Anyway, here's the fun part. Mr. Gladney claimed injuries and went to the hospital. He has since appeared in public in various medical accoutrements such as casts and wheel chairs. And he is asking for donations to help with his medical bills, since he was laid off from his job a while back and has no health insurance.

That's right, a guy protesting health care reform designed to help people in his EXACT situation. To me, there is a karmic justice (assuming the video tape is all that actually happened).

You can read more on it at this link:

http://www.washingtonmonthly.com/archives/individual/2009_08/019423.php

Health Care Reform - Do You Have Health Insurance?

I came across an interesting take on what it means to be insured. The site makes a pretty good argument that almost none of us are really insured (except those covered under Medicare).

You can read it here.

Essentially, the author makes the argument that since most of us have health insurance through our jobs, and a lot of people are finding that their jobs are not as secure as they once thought, we don't have reliable health insurance.

He also points out that one of the things that can cause someone to lose their job is a protracted illness, and that while COBRA does exist, losing ones job kind of makes paying the full premiums (generally over $1000/month for family coverage) very difficult. Thus, the time when you most need your health insurance is one of the times you're most likely to lose it.

I did have an issue with his take on things, which I wrote in a comment on his article, and have reproduced below.

Still, the people who are buying into the insurance-company-sponsored hype that all this reform will be bad for those of us who have insurance are not considering what happens if they contract a catastrophic illness and lose their coverage.

I would love to have someone with some actual facts give me reasons why health care reform is a bad thing. Not false claims like "reform just means the government killing the elderly" and "this is government taking over health care, which won't work" and "every country that has this has worse health care than we have, with longer lines and rationing".

None of those talking points is true, they're lies designed to scare you into letting the private insurance companies continue to treat you like a sponge, wringing you dry as long as you have money in your pocket, but tossing you aside the moment there's nothing left to wring from you.

Anyway, as promised, here follows my response to the author of the link above...

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There is one point that needs to be taken care of in your otherwise reasonable article: The people who don't grasp that paying into the system while you are healthy is an integral part of the system working.

I can't tell you how often I've heard people complain about Massachusetts' plan, saying they don't like it because they are required to have health insurance, and they don't need it, so why should they have to pay for it?

These same people are the reason why pre-existing limitations exist. If they didn't, if the insurance companies COULDN'T refuse anyone or exclude any condition, then why would any of us pay for insurance until we got sick? Skip the premiums, do something more sexy with that money, and then, when some sort of major illness occurs, run out and buy an insurance policy.

I agree that insurance companies should not be allowed to drop you if you get sick, and I agree that insurance companies should not be allowed to refuse you if you've had continuous coverage and lose it due to loss of job or other legitimate reason.

But it's entirely unworkable to expect anyone insuring anyone to be "medical welfare", standing by taking in no money from some segment of the population and then being forced to donate to those same people when they get older and sick.

Liam.

On Socialism vs Capitalism (with a touch of health care thrown in)

I'm having a debate ostensibly on health care with a friend, and he provided this link:

http://mises.org/story/3613

... as a good starting point for his position.

I read through the first of 5 parts (one of the others of which itself has 8 parts) and recognized some core assumptions the author was making with which I disagreed, and out of that came this, which I decided to also post here.

I should say, by the way, that I do agree with the author's assessment early on that "The status quo with respect to medical care does not deserve to be preserved. It does bear the earmarks of financial lunacy. It does call for reform – for radical reform. The question is, what kind of radical reform?"

At least in that article, the author agrees with me (and with most people, I think) that there IS a problem... he just has a radically different opinion of how to attack it. It appears to me that the Republicans and the Blue Dog coalition of Democrats seem to want to preserve the status quo. They talk about "taking the time to get it right", but "taking time" is nearly always code for "delay until something else takes priority, so the thing dies the slow death of attrition".

Anyway, here's where I think the author's fundamental assumptions are faulty. Note that I fully recognize here that my conclusion doesn't invalidate his opinions, merely suggests that some of his core assumptions are faulty.

I think before we can have a legitimate, honest debate over this or any other topic, we have to first all agree on which playing field we're actually on.

--------------------------

In reading the first section, I believe this author makes a fundamental mistake that is prevalent in our society today: Ignoring the middle.

Liberal / Conservative is not a binary state. Socialist / Capitalist is not a binary state. There is a middle ground.

To me, with respect to regulation and "socialist" policies, the current crop of "liberals" are men who just came in from the desert, thus believing that water is essential and everyone should be provided with thousands of gallons of the stuff to live in, while the current crop of "conservatives" are men who have barely escaped drowning and have thus dedicated their lives to banning all water. The truth is somewhere in between: the "liberal" policy will drown us all, the "conservative" policy will have us all dead of dehydration.

So too of communism vs capitalism. Yes, Communism SOUNDS nice, until you factor in human nature and (for just one example) the fact that once the rewards of personal effort are removed from the equation, there's little advancement that people will make, because there's no personal incentive to do so. Communism works WONDERFULLY in families. It CAN work in a small "clan-like" group of people who all care for and love each other. It doesn't work at all in larger groups, where people no longer recognize "the good of the masses" as sufficient motivation to continue working.

Also, since there's ALWAYS someone in charge making sure the system runs, the theory ignores the tendency of power to corrupt those who have it, leading not to a completely egalitarian society, but to a society with a lot of depressed people under the thumb of "the party".

Turning to capitalism. Again, the Libertarian argument SOUNDS great, set up competition and the need to compete fairly in a free market will make everyone behave nicely, so there won't be any need to artificially force them to.

But this ignores several factors. First off, without anti-trust regulation, pretty soon you don't HAVE a free market, you have a small number of big fish, swallowing up all of the smaller fish and then collaborating to keep prices artificially high. But a totally free market is regulation free, so you can't have anti-trust regulations, so we end up with a number of monopolies and two or three major corporations in other markets, "competing" with each other, but ultimately finding more profit in collaborating rather than fully competing. Sure, they'll pounce if there's blood in the water, but as long as there is mutually assured destruction, they'd rather play nice... with each other.

Also, it's very hard for me to see how anyone can still believe in free market economies when we've been so effectively lied to by all corners in the last decade or more. The basis of the free market leading to proper behavior has at its heart that people know what's best for them.

Now, when it comes to two different barbers, that's true. If one guy gives a good haircut and the other a horrible one, you know where the value is. If one guy charges a lot more than the other, you know where THAT value is. You add up all of the values and determine which barber to go to. If everyone comes to the same conclusion, then the other barber had better either change his ways or go out of business.

But suppose you were blind (a horrible caricature of blindness which serves only for the purpose of this example, but which pretty well sums up the state of humanity in more complex arenas) and everyone else you knew was, too, and the only people in town who could see were the two barbers.

Now one barber tells his or her customers how horrible the other barber's hair cuts look, and since the patron can't see, the barber takes the money directly from the patron's wallet and tells them how lucky they are that he's not over charging them, like the other guy. The other guy is ACTUALLY charging less for a better hair cut, but is humbly letting his work and prices speak for themselves, rather than maligning his competitor.

Now there's a "common knowledge" that the more-expensive, less talented barber is "the guy who gives a good haircut and charges a fair price", and more and more people go to him, while the guy whose actually acting in their better interests loses customers.

In a totally free market economy, where are you going to get the information on which drugs are safe and effective, when there are still people who take Shark Cartilage pills because "sharks don't get cancer", even though both the claim and the claimed benefits of the supplement have been proved false?

Or when you see product after product advertised with "personal testimonials", ignoring the fact that there IS random chance in the world.

If you have a stomach ulcer, and you take a pill for a month and your ulcer goes away, you're going to see a correlation, and you'll be willing to tell people that the pill worked for you.

But if you look at any 10,000 people with ulcers in any month, some number of them will heal spontaneously, in the absence of any treatment at all. Give all 10,000 of them regular sugar pills, then find the ones whose ulcers healed (naturally, not due to any sugar pill), and put each of them in front of a camera, and you have an effective commercial that convinces a significant portion of the world that your sugar pills cure ulcers.

Used in reverse, it's why Dow chemical took such a beating over silicone breast implants, when there's no scientific indication that they were anything but benign vanity items.

In any population of hundreds of thousands of women, some are going to develop all manner of illnesses... because that's how illness works. But by statistical chance, a few of them get the same disease in relative proximity to each other and decide that the implants caused the disease (even though they did not), and so they file a law suit.

An unscrupulous (or unscientific) lawyer goes looking for women with both breast implants and that disease and parades a long stream of them in front of a judge, never noting that they had filtered only the 3% of women with implants who had this disease and ignored the 3% of women WITHOUT implants who ALSO got the disease in the same period, and pretty soon it appears convincing to judge and jury that there's a correlation... and Dow chemical loses. Big time.

So, my conclusion to this rant is where I started: The truth lies somewhere in between. Too much regulation strangles, not enough leaves the powerful free to victimize the weak for their own gain. Too much free market capitalism is just as bad as too much socialism for the average person.

Which, of course, leaves us in the unenviable position of debating over WHERE on the spectrum is the best place to be, but THAT is the debate we need to be having, not looking at the end points and pretending that you have to be in favor of one or the other, and nothing in the middle.

(This very much reminds me of the arguments about the "Laffer curve" and Reaganomics, but I've gone on long enough for this time, so I'll let that one drop, unless someone asks me to continue...)