Do You Really Choose Your Health Care Options?

The Health Care debate has been absorbing a great amount of my time lately, so, naturally, discussing it with my friends has been a common practice.  Living in West Virginia, however, conservatism runs high.  The people here live in ever constant fear of being controlled by the menacing specter known as government.  It's not surprising to me that one of the first things rebuttals I'm likely to hear during a discussion or debate on health care is that he or she "doesn't want a government bureaucrat telling [him or her] what medicine to take or doctor to see."  I know there is no way to force these people to drop their ignorance, or consider the root of their fear and whether it's reasonable.  Honestly though, I don't believe you get to choose your doctor now.

Let's look at the ideal system, the one where you can choose any doctor you want and presumably the costs would be covered by insurance.  Even under a seemingly perfect system, you are limited in your choices.  If you have the sniffles, pretty much any local doctor will do.  But let's say you need a surgery and there are a limited number of people who know how to do that surgery within 5-6 hours of you.  Let's say the surgery isn't an immediate need, because if it were an emergency the choice wouldn't be left in your hands—you would get whatever doctor was free to work on you.

Under a perfect system you should hypothetically be able to choose the doctor you want out of the pickings of doctors who know how to do what you want, or specialize in it.  In this selection there will be doctors ranging from good to bad, friendly to hateful, etc..  Of course you would want to select the doctor who is skilled and friendly, such doctors make the experience with the industry much easier.  However, your needs don't exist in a vacuum, and since we all talk about good or bad doctors this doctor is what amounts to an open secret.   Presumably, then, this doctor would be busy, be less available to talk to you, and need to see more patients in a day.  The doctor's time is limited.  Your choice now becomes seeing the doctor that you WANT but who will probably not have time to give you the attention you need, or maybe even see you at all, and the doctor you didn't want—the runner up.

And that's the perfect system!  Some choice that is.  A doctor you can't see, but want to, or a doctor you can see, but you're just hoping to survive the operation.  Of course, reality is even more restricted than that.  Does your insurance require you have a recommendation to go see a doctor? Is your insurance willing to pay for it?   Will your insurance let you get the treatment you, and your doctor, think you need before going through all of the less expensive options they prefer? Does your insurance let you see an eye doctor, or a dentist?   For millions of Americans with insurance, the amount of ridiculous restrictions on their health care is baffling, and most of the limitations don't exist for reasons of merit—they exist for reasons of cost and profit.

And if you find yourself one of the 46-47 million Americans with no insurance, woe to you.  Your choices are limited to what you can pay for out of pocket before being forced to declare bankruptcy.  So, let there be no mistake: you don't control your health care today unless you are very, very, rich.  Unless you have millions of dollars in expendable income your choices are limited to some combination of what's available, what you can afford, and what your insurance company is willing to pay for.

So, here's the truth: health care is rationed today, it will always be rationed.  It is in limited supply dictated by availability of medicine and doctors, as well as money (either how much you have, or what your insurance company will pay).  You have never, truly, had a choice of what doctor you see; your insurance company has probably reserved the right to make you see whoever they think is best, and get the treatments they think are the right price.

If you still think that the insurance industry somehow offers you choice, I feel for you.  Myself, I'm in favor of an option that operates with only my health in mind, and whether the treatments required will work.  I'm really not interested in being told I have to get the cheapest possible treatment for whatever ails me, because that's not choice: that's a CEO telling you what you can or can't have.

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Public Options are Weak and Boring: Democrats Can Do Better Than This.

In my last post I highlighted one severe problem with government institutions for social programs: those programs are highly susceptible to being changed by opposition parties who dislike the premise of government being in the market.  The benefits of a government intervention in any market, not just health care, all stem from the idea that the government has two significant advantages.  First, it can operate at-cost (meaning no-profits, just paying the bills) without fear of a stock holder revolt; and second, it has the backing and cushion of the federal government if needed (are government programs too big to fail?).  There are a few things that we Democrats should probably start reconsidering, or pushing for, in order to make our economic proposals not just stick but make them relatively untouchable politically.

I would like to draw attention to Bill Gates speech about Creative Capitalism.  This book raises the question of how capitalism can be accelerated to affect society in a meaningful way.  While the ensuing discussion in the book Creative Capitalism was mainly geared towards ending poverty in foreign countries, etc., I believe that the same concepts that they talked about could be used by the Democratic party to instill a little compassion into our capitalistic system using the levers of government in such a way as to create a new "third rail" of politics so that these ideas will remain.

One of the changes I propose that we should be pushing for is to give L3C's (Low-profit Limited Liability Companies) a revamp.  The L3C business status should be made available nation wide, and the government should offer seed money to individuals willing to start businesses in certain industries.  Think of it as how teachers can sometimes be paid more to teach needed subjects in certain areas.

There are certain areas where a strictly for-profit sector has its sights on the wrong mark.  Health insurance is a great example of that.  By making the L3C national, and more prominent, an entire crop of businesses that make low profits but work for beneficial social change could be grown.  This would undoubtedly bring down costs in a lot of areas where we consider the product to be a requirement, as no doubt the for-profit competitors would have to learn to compete in an environment that no longer just favored those with a high balance sheet.  Some sectors I might highlight for this would be in health care, energy, and education.  Is it any coincidence that those sectors happen to be the ones where we have a huge argument going on?

I believe that the creation of a strong low-profit sector (through a flood of government capital into such a sector) would offer many of the benefits of a government intervention in the market with several other side benefits:  (1) The American people are infinitely more creative than bureaucrats that have to compromise to pass legislation; (2) Once these social corporations become intwined in the economy in such a way that they hold a significant number of American jobs messing with them will be political suicide.

So, instead of pushing for more government intervention, let's start pushing for more government promotion of business via the creation of new business structures, changes in tax code to favor such businesses, and a flood of government capital to help such businesses get started.  

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Health Care Reform: Please "Set It and Forget It"

Health care reform is such an interesting issue, and so politically divisive. I am wary to post a strong opinion one way or the other about it, because that may inevitably lead to an argument. Both sides of this argument are absolutely correct in their core stances. For instance, the left believes Health Care should be available to all, and at a reasonable, price, etc. While the right does not oppose this, they are scared to death of government doing anything other than military matters. This is a case where I find the middle ground to be the truth: The leftists are correct, in my opinion, but the Right is right because, well, they exist. Our political right-wing is why a government health insurance plan should not exist—to keep them away from it.

Let me just issue a couple disclaimers here. I'm a Democrat. I consider myself to be slightly left of the center of American politics in most matters, and I have no opposition to the idea of a leftist government running and operating a health care plan. I am, however, concerned about our government running and operating a health care option, or even having the ability to manipulate it once it's created.

I philosophically agree with the public plan. Health care is an essential part of living in any developed nation. It's one of the things that increases the quality of life for everyone, enabling everyone to give their all and live happily. In an ideal government, a government with unchanging morals but forever changing tactics, we could trust that a public plan would be top-notch along with a bustling medical industry running right beside it. If the spirit of this health care reform could thrive eternally, I would support a public plan.

With that said, however, our government is anything but consistent. That is both a strength and a weakness. It is a strength in that, during extraordinary times, we will be capable of responding rapidly in theory, and always adjusting what our nation is. But at the same time, our nation's politics are fairly consistent and reliable. The left, in general, enjoy the government—and the right hate it. Sometimes we see a convergence on certain issues, sometimes the parties start switching roles, but always there is a group for larger, more effective, government and always a group who seek to minimize the role of government.

It is because of that eternal consistency in our politics that I am very wary of a public insurance plan. During the last 30 years (what I will call the Reagan Era) the very people who openly professed to hate our government have been in control of it. They have been extremely effective at dismantling, disabling, deviating, or otherwise rendering impotent, our social institutions. If it was a progressive tax system that favored the middle, it was changed. If it was an organization that could not be easily removed, it became fodder for political appointees with little to no experience (Heckuva job, Brownie!), or they sought to change it (privatization of Social Security, anyone?). Over the last 30 years of Republican rule (largely uninterrupted) many of our government's institutions have been broken because the party favored private industry and small government (even the military was not spared the private industry treatment). They, and the parties that will come after them, are the source of my fear of government health insurance.

Yes, I'm afraid of heavy handed government intervention in a public insurance plan. I'm afraid of it because the current minority party has never been shy about taking social programs and demolishing them. The tide that brought the Democratic party into power will eventually leave, even if it is 30 years from now, and another party will take the helm for a time. The health care plan being proposed is too important to be subjected to the political whims of a party that often can ride into office on a single issue (Like happened directly after Sept. 11th) that has nothing to do with these institutions. The neo-conservative Republicans like Bush were given authority politically because they were the party of military action and might—not because we didn't like our social institutions, or because we agreed with their economics.

So, when they say: "Americans don't want government messing with their lives," I have to agree: We don't want a government ruled by people who hate government messing with social institutions that help us live our lives. We don't want important social agencies controlled by people who desire to shred them. We don't want medicare prescription plans adjusted so that not every medicine can be covered, leaving the patient to pay out of pocket for some. We don't want millions left homeless, in desperate conditions, while Brown's doing "a heckuva job." And we don't want Social Security thrown to the dogs in the stock market, just so the friends of the Republican party can get a little more rich.

It is because of historical precedent, and the guaranteed change of the political tide, that I cannot easily support a full blown public insurance option run by the government, and why you should strongly reconsider it if you do. The staff that run this government right now will not always be there. The staff that run it in the future will be varying degrees of knowledgeable, or worthy. And I don't even want to think about the future "changes" that could be made by a small-government party in the future. We cannot build a lasting institution off of a political institution that is about as consistent as a sand dune in a windstorm prone area.

A few months ago, I privately told my friends that I didn't see any reason health care couldn't be operated like a credit union: for the benefit of everyone who participated in it. I'm glad to see that co-op (roughly analogous) is not just on the table, but has been worthy of several mentions in the New York Times. I'm glad that Republicans support the idea for all the wrong reasons, and that Democrats think the idea is workable. If we do get a public insurance option though, the bill creating it must be armed with teeth, tricks, and traps to prevent tampering in the future by people riding in on a political movement. No matter what though, it is my hope (and it should be yours too) that our government creates an effective program for all americans, capable of managing and funding itself, and then forgets about it; lest future generations have their health care service altered in disgusting ways to push money back to private industry.

As Ron Popeil might say to the government right now: "Set it and forget it!"

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How Easily We Forget.

Image by jurvetson via Flickr

I don't think I need to detail all the news items lately that have people proclaiming Obama has turned his back on promises, broken our trust, and betrayed America.  I am, however, fascinated by the language and the words that are being lobbed at our president, compared to the most important words that were used to describe him during the campaign: pragmatist being my favorite.  It seems very interesting to me that the people who lauded our now-president's pragmatism during the campaign, his ability to shift with the times and make decisions based on information and reality, are now turning against him on the basis that he has followed through on his pragmatism and remained true to himself at the core.  These events make me wonder where the people who campaigned for Obama are at today.

Look at the issue with the detainee photos, or the the trials of certain terrorists.  Of course, we were made to expect that the photos would be released, the trials conducted in the United States, whatever.  Our beliefs were rooted not in any real hard commitments from the white house or any official source, nothing more than speculation by journalists who, feeding the 24 hour news cycle, decided to speculate on officials' speculation.  However, when our vision of reality, the one where everything is just and right according to our newly adopted still-right-of-center-but-farther-left-than-we-were point of view, came crashing like a boat against the reef of reality—we were utterly dismayed.  We lobbed words like "hypocrite" at the President, the man who has seemingly stayed true to his principle of pragmatism.

If we wanted an ideologue, unchanging in his stance, unmoved by the facts we should have written in Dick Cheney on the ticket.  We voted for a pragmatist in droves, we trumpeted his flexibility, and when the time came that he exercised those character traits in ways that our anti-Bush/Republican ideologies found bitter, well, he'd turned on us! Isn't that interesting considering part of the criteria for a "good candidate" during the 2008 election was whether he or she could work with both parties?  We need to recognize that the ideologues on both sides of our political spectrum are not working for the change we seek, but they are still people we need to work with in order to achieve the changes we need.  Compromises will happen—set backs will happen.

All of us, including myself, need to take a deep breath and realize that the road of change is paved with compromises,  small victories, and set backs.  The road is imperfect.  The road is not the end location, it is a means of getting to the end location—the changes we seek.  The road is winding, shifting beneath our feet, and we will either move with the road or we will simply arrive at a different place than we wanted to be.  Our eye must be on the goal, and we must be willing to accept the blows and the set backs, including compromises, that come with confronting a power structure that has been firmly entrenched for decades. 

So, instead of worrying about the latest dramatic political episode and being every bit as reactionary as we accuse the republicans of being, why don't we work on the goal?  Health care for every American citizen, a public education system and students that foreign countries will admire, and a green economy that will do more than just metaphorically light the way for sustainability.  We can do all that, we knew we could do it during the campaign.  Let's summon that spirit again, the spirit of pragmatism, and then get to work. 

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The Flow Culture: Is the Internet More Natural for Media?

Image by luc legay via Flickr

Recently, two—seemingly independent—news items showed up my feed reader: Linkin Park is hyping a new single, and I received a flurry of blog posts about the New York Times new feature: "TimesWire." These events don't share much in common except perhaps a paradigm shift that could, in my mind, bring media profitability back in. Release early, release incrementally, release often.

What do I mean by that? Well, I'm going out on a limb here and describe the culture that I believe has created this situation. The internet has us looking for the next notification, the next fix, the next sign that something new has occurred. It's the flow culture, a culture that doesn't want to stop moving—not for a second. How often do you refresh Facebook to see if there were any new comments, photos, etc., that your friend posted? How often do you glance at Twitter? If you answer any of these questions with an answer other than "I don't" then you are part of what I'm calling the flow culture, in some fashion.

The answer for media companies, bands, artists, etc. might be to simply let go of the paradigms they used to champion, then. The large(ish) collections of media like full music albums, complete newspapers, and perhaps even books as we knew them, are inconvenient for those of us that participate heavily in the flow culture. It seems stupid, but we take in everything in "bite sizes," if you will. I feel that, perhaps, Linkin Park has grasped this by hyping up a single so much, and the New York Times has grasped this by delivering TimesWire.

What I think is the next step in media, and perhaps many other paradigms where we once lumped large portions of data together, is to break them down into smaller portions. I think books, albums, newspapers, and other attempts to lump a lot of data into a single unit only ever existed because of production limitations. If that's true then the best way to be profitable and distribute media on the internet is going to be early, often, and incrementally—then monetize if fairly.

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A word from our sponsors [short break]

I apologize for the lack of recent updates to the blog.  Currently this blog has only one working author—me—and as a college student occasionally I hit pockets of extreme activity related to school, work, or working for school.  Because this is my finals week I've been pulling many late nights preparing for tests, and so on.    Normal posting activity will resume after the first week of May.

Again, sorry for not keeping this frequently updated with new material.  I've not done as well as I would like to on this, and in the future I hope that I can create a schedule that is much more productive for blogging.

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If I Ran The [New York Times]

Replace the name of the newspaper in the brackets with whichever one you would like.  The end result should be the same.  This is a little creative exercise.

If I ran the [New York Times] I would...

• I would realize that having all my content in one place is bad business in the distributed web.  I would forge partnerships to have the content delivered to as many places as possible, asking for a cut of the revenues in return.  I would take the content to the user, not expect the user to come to the content. 

• I would slim down my front page to three columns: Breaking News, Important Stories, and Popular stories.  Every category would have a similar page.  

• I would try to forge relationships with international journalists, rather than paying to send my employees all over the world constantly.

• I would create a system that would be rewarding for the people who enjoy sharing and discussing news, so that they help spread what's important.

• I would recognize that there is no longer a silver bullet.  No one method reaches everyone, you have to be everywhere and the only way to be everywhere is to make it very easy to be talked about. 

• I would recognize that advertising needs to change.  It needs to be interesting, engaging, and useful.  If my users feel like they are being screamed at by ad agencies every time they refresh a page on my site, I will pay for it in ill will. 

• I would take down any remaining pay barriers.  Content is now free for readers, as it should be.

• I would earn some revenue by giving bloggers, etc. access to our correspondents in other countries for a fee.  In this way Bloggers can also be part of the news making, rather than just commentary. 

• I would work to build a network of up-and-coming freelance reporters to engage in a downward bidding cycle for stories.  

• I would do everything I could to encourage young minds to not just read the news, but consider it.  I would deliver a different version of the news that could be given to young children.  Lots of pictures, etc.  There is no reason that news content cannot scale with age as well. 

• I would start sponsoring bloggers by delivering their content to our readers.  This would be a way to create a useful discussion around major events and articles, and hopefully expose more sides of a story.

• I would dedicate entire sections of the site towards movements and ideas.  There is a place in the news for political activism, and it should be incubated. 

• I would make sure that people could count on us to help them be informed. 

• I would help to make the news more democratic.  I would involve our readers more. 

• I would create a series of bookmarklets that would allow a person to quickly glance at the latest news without needing to stop what they were doing. 

• I would link people together around topics and encourage a debate.  This would help to bring in new viewpoints for us to consider in future writing, as well as helping to create useful discourse. 

• I would try create a news recommendation system by offering simple ratings options for every story.  This would allow us to tailor content and advertising with accuracy.  

• I would create a new category of advertisement not unlike the idea behind pay-per-post.  Web space is unlimited and I don't think a well written article from a corporation is in bad taste.  

It'd be easy to go on, but I think you have the idea.  What would you do if you ran the [New York Times]?  Think on it. 

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You Simply Have to Read These 4/19/2009

This is the first installment of "You Simply Have to Read These" which is how I'm going to bring you news, articles, and opinion from other sources so that you can easily pass them along to your friends. 

Shai Agassi thinks he's solve the electric car problem. I'm not entirely certain I agree with the method, but he seems to have a really well thought out plan.  Take a look.

The GOP is being urged by a lot of people to drop the gay marriage debate.  Including the strategist for the McCain campaign.  Meanwhile Nate Silver at fivethirtyeight.com has a break down on the popularity of the gay marriage movement.  You can't argue with this guy's stats.

NATO rescued 20 people from pirates — and then had to let the pirates go. 

Unfortunately Iran wasn't being as friendly when sentencing a journalist to eight years in prison.

You simply have to see this.. huge meme on the web right now.

Also, looks like relations with Cuba will be improving little by little now.

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