Midwest Voices

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Time for Romney to get specific about health care

Midwest Voices contributing columnist: George Harris

The Kansas City Star

The Supreme Court will soon issue its decision on the constitutionality of the Affordable Health Care Act. Meanwhile, presidential candidate Mitt Romney says that, if elected, he will start to deconstruct the legislation on his first day in office if the Supreme Court doesn’t do the job for him.

And he then says, vaguely, he’ll start to fix the health care problem. Romney says he will (but doesn’t say how he will) guarantee that people with preexisting conditions can continue to buy insurance if they have had insurance but lost it. He doesn’t address at all what he would do about people with preexisting conditions who don’t have health insurance but basically implies they’ll have to use charity services. State high risk insurance pools already provide a way for people to continue insurance coverage for preexisting conditions, and Romney doesn’t say what he would do better or differently than the existing system.

The Ryan plan, that Romney endorses, hopes to create competition and tax incentives for people to buy health insurance, including its voucher system to replace Medicare. But I have not seen a credible explanation for how the plan will allow people with preexisting conditions to get into a market that summarily excludes people with previous health problems. The Affordable Care Act attempted to solve the problem by requiring people to buy coverage and requiring insurance companies to sell the coverage. Without these provisions, what’s the practical alternative.

To further understand the dilemma, let’s take a look at what would happen to Medicare under the Ryan plan and then discuss the general problem of preexisting conditions.

My understanding is that under the Ryan plan Medicare recipients would receive a voucher to help pay for insurance premiums and that the value of the voucher would be adjusted annually to partially offset increases in costs. I’ve heard various figures of what the voucher amount would be, so let’s guess that it would start at $1,000 per month per Medicare recipient.

Now let’s look at the cost of insurance for people age 65 and older. There aren’t a lot of data on this because most people 65 and over have the existing Medicare plan. But there are exceptions, and those individuals are eligible for insurance in the high risk pools most states have, though preexisting conditions may be excluded for one year.

Missouri’s High Risk Insurance Pool plans can be found on the internet. There are five plans. Let’s examine the high and the low cost plan. On Plan 1 a 65 year old male can buy insurance for $1925 per month with a $3000 out of pocket maximum. On Plan 4, a 65 year old male can buy insurance for $812 per month with a $10,000 out of pocket maximum. An 85 year old male would be charged $3615 monthly on Plan 1 and $1527 on Plan 4.

As you can see, a voucher for $1,000 wouldn’t go very far in covering premiums and deductibles even on the plan with the least expensive premiums. People with uncovered preexisting conditions would for their first year have to pay those costs, which would be in addition to the deductible and premiums. The Ryan plan would provide some assistance to people without means to pay, but would it be enough to get people to buy coverage when the rates look something like the high risk pool plan costs?

Well, you may say, those are the high risk pool premiums. People in good health could get cheaper coverage. But I suspect that most 65 year olds have a preexisting condition that would put them in a high risk category, and almost all 85 year olds would have a health condition that would exclude them. Just do a Google search on “uninsurable medical problems” and you’ll see that insurance companies exclude almost everyone who takes any medication, such as statins to control cholesterol, or anyone who has any chronic condition, such as diabetes, or anyone who has had cancer, even if successfully treated.

So what would retired people do with their voucher? Well, if the voucher wouldn’t cover the monthly cost of a policy, or come close to it, many older people would go without insurance just as many people do already, relying on public hospitals and clinics for their medical care. Under the Ryan plan, younger people, even those who get extra assistance, would likely decide not to buy coverage just as they do now but especially if the premiums exceeded their means, which they surely would for people with health problems unless they were pooled with everyone else, in effect averaging out the rates. This is what the Affordable Care Act tries to do.

But the bigger problem is what insurance companies would do. Would they choose not to sell insurance to a senior who has a preexisting condition? Could they be required to sell insurance to someone who decided to forgo insurance for a few years and then reenter the game later, possibly after developing an illness?

In other words, we’d be back to the problem we have now. The government realistically shouldn’t compel insurance companies to sell insurance to people who buy it only when they get sick. And the government can’t compel people to buy insurance if the individual mandate is deemed unconstitutional.

And people will choose not to buy insurance if the premiums aren’t affordable. They will instead throw themselves on the mercy of charitable hospitals, just as they do now, and hospital rates will raise their rates for the insured in order to cover the costs of the uninsured.

Most of this conversation has been cussed and discussed many times before today. But the facts of the existing premiums under Missouri’s high risk pool ought to give caution to anyone who thinks that a Medicare voucher is going to come close to covering the cost of insurance for senior citizens.

Say what you will about the Affordable Care Act, but the president put his cards on the table for the public to see. We know what he signed into law (or should know if we take the time to read a little about it.)

Now it’s Mitt Romney’s turn to be specific. He says he’ll repeal the act, but the details are still fuzzy about what he would do to replace it and fix the health care mess. That’s how politicians campaign, I suppose, but only if we let them.

Comments

  1. George Hunsucker

    Northland

    1 year ago

    “We know what he signed into law”. This is not true George and you know it…

    Agencies are continuing to formulate “da rules” as we speak.

    0’care was not a well thought-out “plan”. It was merely an overreach by libs wanting govt. control of healthcare vs. letting private enterprise do it. You libs refused tort reform and cross-state buying, both of which offer significant savings. And of course the main thing is the unconstitutional mandate.

    Luckily we have the SCOTUS which will protect Americans from the lib onslaught of our basic freedoms.

  2. George Harris

    Kansas City

    1 year ago

    George, you’re right that the regulations are being written, but we know the basic rules, the health care exchanges, and, of course, the mandate. If you’re saying the law is too vague to know what’s in it, then why all the hatred?

  3. George Hunsucker

    Northland

    1 year ago

    My “hatred”, which it does not rise to that level George, is threefold.

    First and foremost TELLING people they have to buy health insurance. This, to me, is a basic attack on being a free American. If people choose to not have health insurance I am fine with that. What I am not fine with then is your side agreeing to bail them out when catastrophe strikes. I am not going to deliberately let a person die, but I for damm sure am going to take every dime they have when I fix them-up. Why is this personal responsibility so wrong in your side’s eyes????

    The second and third major dislikes, again not hatred, are that the two KNOWN improvements to costs were left out of the bill; tort reform and cross-state buying. The tort reform was of course to appease the libs’ ambulance chasers, while the cross-state buying was to keep bureaucrats telling people what to do. How else to keep this slice of humanity employed and voting D??

  4. George Hunsucker

    Northland

    1 year ago

    Better said then me chazzy….

  5. Kent Mueller

    1 year ago

    George, earlier you asked for specific examples of bad regulations. That is a very good request. I don’t know how else to communicate with you, so I’m leaving this here. This is not enacted, but rather is in a bill sponsored by Diane Feinstein.

    Excerpts are:

    S. 3239: Egg Products Inspection Act Amendments of 2012

    Section 2.6.b

    ‘(b) The term ‘adequate housing-related labeling’ means a conspicuous, legible marking on the front or top of a package of eggs accurately indicating the type of housing that the egg-laying hens were provided during egg production, in one of the following formats:

        ‘(1) ‘Eggs from free-range hens’ to indicate that the egg-laying hens from which the eggs or egg products were derived were, during egg production--

        ‘(A) not housed in caging devices; and

        ‘(B) provided with outdoor access.

    ‘(2) ‘Eggs from cage-free hens’ to indicate that the egg-laying hens from which the eggs or egg products were derived were, during egg production, not housed in caging devices.

    ‘(3) ‘Eggs from enriched cages’ to indicate that the egg-laying hens from which the eggs or egg products were derived were, during egg production, housed in caging devices that--

        ‘(A) contain adequate environmental enrichments; and

        ‘(B) provide the hens a minimum of 116 square inches of individual floor space per brown hen and 101 square inches of individual floor space per white hen.

    ‘(4) ‘Eggs from caged hens’ to indicate that the egg-laying hens from which the eggs or egg products were derived were, during egg production, housed in caging devices that either--

        ‘(A) do not contain adequate environmental enrichments; or

        ‘(B) do not provide the hens a minimum of 116 square inches of individual floor space per brown hen and 101 square inches of individual floor space per white hen.’;

    Due to space limitations, the rest will be in the next comment….to be continued…

  6. Kent Mueller

    1 year ago

    This is the rest of the post……

       (7) by inserting after subsection (c), as redesignated by paragraph (1), the following new subsections:

‘(d) The term ‘brown hen’ means a brown egg-laying hen used for commercial egg production.

‘(e) The term ‘caging device’ means any cage, enclosure, or other device used for the housing of egg-laying hens for the production of eggs in commerce, but does not include an open barn or other fixed structure without internal caging devices.’;

(8) by inserting after subsection (k), as redesignated by paragraph (2), the following new subsections:

‘(l) The term ‘egg-laying hen’ means any female domesticated chicken, including white hens and brown hens, used for the commercial production of eggs for human consumption.

‘(m) The term ‘existing caging device’ means any caging device that was continuously in use for the production of eggs in commerce up through and including December 31, 2011.’;

(9) by inserting after subsection (o), as redesignated by paragraph (3), the following new subsections:

‘(p) The term ‘feed-withdrawal molting’ means the practice of preventing food intake for the purpose of inducing egg-laying hens to molt.

‘(q) The term ‘individual floor space’ means the amount of total floor space in a caging device available to each egg-laying hen in the device, which is calculated by measuring the total floor space of the caging device and dividing by the total number of egg-laying hens in the device.’;

(10) by inserting after subsection (t), as redesignated by paragraph (4), the following new subsection:

‘(u) The term ‘new caging device’ means any caging device that was not continuously in use for the production of eggs in commerce on or before December 31, 2011.’; and

(11) by inserting at the end the following new subsections:

‘(jj) The term ‘water-withdrawal molting’ means the practice of preventing water intake for the purpose of inducing egg-laying hens to molt.

‘(kk) The term ‘white hen’ means a white egg-laying hen used for commercial egg production

    George, up until now, eggs have been a source of good quality, cheap protein. I bought a dozen eggs this morning for 50 cents. The apparatus necessary to put the additional labeling on the cartons costs money. Also, there will be government employees checking up to make sure the egg companies comply. That costs, also. And for what? If an egg producer wants to carve out a niche and label cartons as such, then they are free to do so. But don’t mandate everyone follow those silly rules.

  7. George Hunsucker

    Northland

    1 year ago

    You hit the nail on the head Kent, when you said “there will be government employees checking up”. This is the bottom line to the libs, MORE GOVERNMENT employees.

    We need smaller govt., fewer regulations and lower taxes.

  8. George Harris

    Kansas City

    1 year ago

    Kent, I spent a lot of time on my grandfather’s farm, fed the chickens, etc. etc. And at first glance, the regulations you quote do seem absurd. But only until you start reading some of the current problems with bird diseases, such as avian flu. Do a quick google search with the terms biosecurity chicken farm, and you’ll pull up scores of sites discussing the need for regulation of chicken farms. We live in a complex society, and I wish we could have simple regulations, such as “Treat your chickens right, don’t overcrowd. If a bird dies, have it tested for disease and do what the veterinarian says for the rest of the birds. If you think there’s a problem, don’t sell your eggs until you know it’s safe. Be nice and charge fairly.” But that’s not what happens. I did the Google search and read several articles and am never going to eat chicken again :) I already don’t eat eggs because I got food poisoning from eggs once at my uncle’s lake cabin. Despite my best efforts to overcome the Pavlovian response to eggs, I can’t do it, and just reading about eggs makes me sick to my stomach. If you’ve ever driven by a cattle processing yard, such as out in Kansas, you might never eat beef again, too. And if you ever got mad cow disease, your widow would be screaming about the lack of regulation of these places. I actually knew somebody who died from mad cow disease, and to my mind, there may not yet be enough regulation of these places. And don’t get me started on importation of foreign fish, beef and chicken. http://www.fao.org/docs/eims/upload/238303/ah751e.pdf

  9. Kent Mueller

    1 year ago

    George, I’m going to politely, but firmly disagree. One small item that may have been inadvertent on your part was when you referenced charging fairly. That in no way can be part of the federal government. The government cannot get involved with price establishment. We have tried that a number of times in our history and it has failed every time. But to the bigger picture. If we want to run from every possible risk and seek total safety, we can do that. However, we won’t have anything to protect because the cost of safety is exponential as we try to wring more and more risk out. I laughed out loud when I saw a commenter a few weeks ago say, when promoting new regulations on food, the he was perfectly willing to pay a few cents more. Sadly, we aren’t talking about a few cents. Some cost a little, and some cost a lot, but the all add up .

    Sorry, George, it will be a hard sell to get people to want the type of free range printed on the egg carton. And yes, I said want. If the people don’t want it, then it shouldn’t happen no matter what the government thinks because after all, we are the government.

    Additional needless regulation? Look no further than what Mayor Boomberg is doing in New York. Regulating the size of soft drink cups? Oh, come on. And he is being selective and leaving out grocery and convenience stores. But, regardless, the government needs to stay out of my decision of what size soft drink I purchase. Bloomberg is now looking at similar regulation for popcorn at movies. Bloomberg has done a few good things, but he needs to go very soon now.

  10. Steve Alleman

    Kansas City

    1 year ago

    It’s all fine and good for people on this page to propose changes to the healthcare system, but the point is that if Romney is going to campaign on “repeal and replace” (and the other day I saw that he had that motto on a podium he was speaking from) then he has to say what he’s going to replace it with.

  11. George Hunsucker

    Northland

    1 year ago

    You mean like the big 0 “defined” what he was going to do Steve???? “We have to pass this bill to see what’s in it”—words spoken by the big 0’s Speaker of the House of Rep.

  12. Laura Lankester Brenner

    1 year ago

    It seems to me that the main point of the column is that we voters need to pin down candidates who say they have a viable plan about something, in this case health care reform, rather than accepting vague promises. How could anyone disagree with that?

    Political discussions get so polarized that it’s hard to have a meeting of the minds and solve community problems. Our political candidates take pride in being tough and willing to stand their ground— and are accused of flip flopping or being wishy washy if they are open to considering diverse ideas and to compromise. It’s gotten worse in recent decades and has gotten us to the point of gridlock. Our politicians are so busy posturing that nothing gets done.

    The discussion here reminds me of an assignment I had as an undergrad— people who considered themselves pro and con abortion were supposed to meet in small groups and discuss solutions. Most groups got caught up in defending their positions and got nowhere. The only group that made some progress was one that was able to agree that nobody LIKED abortion, and to work together on ways to make it rare while putting aside the issue of whether it should ultimately be made illegal.

    I wish these kind of discussions could follow the same format. Surely everyone would agree that people should ideally have access to healthcare. How to do that is debatable. I don’t know if Obama’s plan is a good one. When I hear of alternatives, they usually are explained with a lot of heat and with terms like “malicious” and it makes it hard to even know what is being proposed. I have a PhD and really am not entirely stupid but I have no idea what most of you mean with the terms you throw around. If we want to come up with a reasonable solution we need to explain our ideas and be open to questions about whether they would work. Throwing around terms like “lib” just seems divisive and insulting.

    I consider myself a moderate and most of us moderates avoid these discussions because of the vitriol. “Hatred” is too strong a word but the tone is adversarial and prevents meaningful communication.

    Laura

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