Is Truth Ineffective

Is it naive to believe that in our free society that the truth will percolate through the density of lies in the debate over pinocchio vintagehealth care reform? If legislation in its current forms are so bad, won’t the truth defeat them? If so, then why the lies? Does something rest below the surface?

The keenest fact is that we spend in the US twice as much as any other wealthy, industrialized nation on health care but we don’t get the same quality of results. We rank near the bottom of this group in key measures like infant mortality and lifespan, a decline in health stature since 1960. This doesn’t argue that our doctors and hospitals aren’t of quality. Something is broken when nearly 46% of people diagnosed for care don’t receive it.

A landmark study indicated that surveyed participants received recommended care only 54.9 percent of the time. This level of performance was similar in the areas of preventive care, acute care, and care for chronic conditions. The level of performance according to the particular medical function ranged from 52.2 percent for screening to 58.5 percent for follow-up care.
(“The Quality of Health Care Delivered to Adults in the United States,” The New England Journal of Medicine, June 26, 2003. http://content.nejm.org/cgi/content/full/348/26/2635)

As a small business owner, I want to provide a health insurance choice to our employees. This morning, I spoke in the cafe with a customer who was happy to find a $14,000 a year policy for the four employees in her company. At this stage of our business, we cannot afford the policies we’ve been quoted.

The average family health insurance premium, provided through an employer health benefit program, was $11,480 in 2006. Employees paid an average of $2,973 towards the premium amount. Source: Kaiser Family Foundation

These averages amount to about $45,000 we just don’t have, though, to be sure, it might be a bit less because some employees won’t need family coverage, just single. I’m concerned about aspects of the reform legislation that would require provision of benefits or payment of an annual fee (the word is “fee” not “penalty” or “fine” but the outcome is the same). I’ve not seen a clear definition of exceptions for small businesses. (Here’s a side by side comparison of the two major health reform proposals.)

Addendum, 8/12/09: Found some clarifying reference in the Kaiser Family Foundation’s side-by-side comparison linked directly above.

From the Senate Bill:

  • Require employers to offer health coverage to their employees and
    contribute at least 60% of the premium cost or pay $750 for each
    uninsured full-time employee and $375 for each uninsured part-time
    employee who is not offered coverage. For employers subject to the
    assessment, the first 25 workers are exempted.
  • Exempt employers with 25 or fewer employees from the requirement to
    provide coverage.

From the House Bill:

  • Require employers to offer coverage to their employees and contribute
    at least 72.5% of the premium cost for single coverage and 65% of the
    premium cost for family coverage of the lowest cost plan that meets the
    essential benefits package requirements or pay 8% of payroll into the
    Health Insurance Exchange Trust Fund. [E&L Committee amendment:
    Provide hardship exemptions for employers that would be negatively
    affected by job losses as a result of requirement.]

The US needs health care and health insurance reform. The temper of the current debate isn’t leading to a solution we can live with: It’s simply blocking, by intent, any solution at all. The cost of inaction is crippling the economy.

CNN tonight reported on a Price Waterhouse estimate that $1.2 trillion a year in the current system is wasted, about half of health care spending. That seems unbelievable but then the reasons: 1) our behavior (we’re fat, don’t exercise and too many still smoke) 2) clinical problems like over medicating or people going to emergency when they shouldn’t or defensive (from lawsuit) medical practices 3) waste in operational costs like filing insurance papers, with some hospitals facing 700 different insurance plans, rules and paperwork. (Link to follow when CNN posts its episode.)

It looks like we’d save a lot of money by just making a uniform claims form, just like the uniform application for mortgages. Also, few people are mentioning tort reform in the current debate, though belief is that tort reform would reduce medical liability insurance, thus costs, and could ease the cost of  “defensive medicine” practices.

On the point of cost, the GAO says the current House bill will add some $239 billion to the budget deficit, a huge number on its own. Want some perspective? That’s about 17% of the first year tax cut of the Bush administration.

Even arguments against this reform that appear reasoned rely on arguable conflations and fear. Shawn Tully, writing for CNN/Fortune, argues Five Freedoms You Will Lose In Health Care Reform. His article is widely distributed and Google reveals much adulation but few critiques.

I wondered about Tully’s first “freedom:” That of choosing what’s covered in your plan. Really? If you’re covered by an employer-paid program, as most of us with insurance are, do you get this freedom? No. If you’re covered by Medicare or the military, where benefits are established by law, do you get this freedom? No. Who does? Those wealthy enough to buy insurance coverage privately: a tiny fraction. Individual, private insurance is what Tully touted as the best aspect of Sen. John McCain’s plan during the election.

Tim Foley, of HealthCareChange.org, concurs with this criticism of Tully’s “first freedom” and breaks down Tully’s pro-business (he’s Fortune’s editor) analysis, including the 5th freedom — that you won’t be able to choose your own doctor. Foley notes that beyond Tully’s statement of this lost “freedom” his following narrative carries no argument to that effect.

Granted, Foley writes for an organization that clearly desires health care reform and in our current climate, that means many will quickly dismiss his critique as socialist, or Maoist, or Fascist or whatever pejorative screams to mind.

For a coffee-drinking, ordinary Joe, in this debate, it’s tough to find anyone or any organization that can rightfully claim objectivity for its point of view, except the St. Petersburg Times award-winning Politifact.com.

At this point, let’s get back to truth and lies.

I started out to focus on the current 60plus.org advertising that forwards the nutty notion that the health reform plan will create some bureaucracy that will determine whether a course of care for the elderly is somehow “worth” it, an only slightly more subtle predecessor to Palin’s “death board” Facebook post. But, Googleing that subject is depressing, seeing how widely supported it appears though its claims are simply a fraud. Do these people know that Pfizer is a major financier of 60plus.org*? What’s Pfizer’s interest in the status quo or in defeating reform in this round? Do you share the same interests as Pfizer if you’re not among its senior management? Do people care about truth or reason or is it simply easier to side against words like “death board,” “rationing,” and “socialism,” without delving into the intent for power or profits of those, like Palin or Pfizer, who promote them? It’s falling for the big lie.

In today’s climate it’s not a surprise that 60plus.org and its corporate supporters are busy demonizing its critics, including AARP. That’s what passes for debate: “I don’t respectfully disagree, I disagree because you are a) neocon b) facist c) socialist d) granny-killer e) a #$#%% and I’ll shout you down if you try to talk.” So much more demonizing than listening.

Common sense seems to fail. No one — no one — is in support of what 60plus.org claims this bill will do: set up some sort of euthanasia-focused, medical-care rationing board. If their claims were indeed true, the bill will fail on the weight of its own faults. So, why the lies? Because the a majority last November in the ultimate act of our democracy set in motion something that was clear during the campaign: Most people support some level of health care reform. The truth of this might not work to protect the recently gained monopolies of the health insurance industries. Now for a reader of history, this is scary. The Republican trust buster Teddy Roosevelt is rolling over in his grave.

Yes, we should worry over the reach of “big government,” but we should also fear “big business” left unrestrained, as we just learned from the unregulated housing bubble. And, when we recognize the “big lie” spewing from corporate propagandists and their fronts, we should crouch into a mindful defensive position. Our skepticism should be placed on alert; our hands firmly on our wallets.

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