Saturday, July 14, 2012

The High Cost of Birthing

Why Health Care Reform Is So Important

In order to allay any fears that I might have been born in Kenya or somewhere like that, I am today releasing, not my birth certificate, but the bill for my delivery.

This little piece of paper, which I found among my late father’s effects, tells an astonishing story. It’s not only evidence of how health care costs have grown during my lifetime, it reveals some of the major changes that have been made in medical procedures.

As you can see, I was born on December 20, 1947, and my mother and I remained in the hospital for ten whole days! No, it wasn’t a caesarean delivery, and my mother didn’t have complications. It was just standard procedure that women who had given birth stayed in the hospital for a long time.

But, to us, what is most astonishing is the cost of that stay. It only cost $5.50 to deliver me and $8.50 a day for my mother to recuperate. (She must have just about gone mad lying in bed that long, I’d think.) Anesthetic for childbirth was standard, and that cost $3.00, as did circumcision. (I know: way too much information.) The total was $119.25.

In 1947, all the dimes, quarters, and halves in your pocket were made of 90% silver, and that continued to be the case through 1964. Now, a bag of those silver coins with $1,000 face value and no numismatic value will set you back almost $20,000. But even at 20 times the cost, $2,385, you can’t get born today for anything close, and your mother will probably be discharged from the hospital by dinner time.

That’s why reforming health care is so important. Here’s another graphic, from Wikipedia, showing the cost of health care in this country as a percentage of Gross Domestic Product. Back in 1947, people spent less than 5% of their income on health care. I might add that doctors made house calls back then.

I realize that there have been incredible changes in medicine during my lifetime. There were no hugely expensive CAT scan or MRI machines back then, and a whole panoply of wonder drugs has been developed in the meantime. Lots of people who survive major illnesses and traumas today would have died from them in 1947.

But there are other factors. St. Joseph’s Hospital was a Catholic institution and wasn’t in the business for the money. Blue Cross-Blue Shield, when it started, was a non-profit organization. There were no for-profit HMOs adding another layer of cost. There were few drugs available, but those there were relatively cheap.

Whatever the causes, and there are many, we have been paying an increasing portion of our income on medical care. As you can see from the graph, it reached 16% in 2007, and there has been no reduction in the rate of increase since then.

This increase was the impetus for Barack Obama to make health care reform a major plank in his platform when he ran for president in 2008. It was also the impetus for many voters who supported him.

He was true to his word. When the Affordable Care Act finally made it to his desk, it was probably a lot less than he had hoped, but it was a good start. It didn’t promise to reverse the trend, but the non-partisan Congressional Budget Office reported that it would reduce the rate of increase by a substantial amount over time.  

We need to give this new program a chance. The best way to do that is to vote for President Obama and the Democrats running for Congress and local offices.

Thursday, July 12, 2012

A Well-Beaten Dead Horse

Repeal and Replace – With What?

On Wednesday, after hours of debate, the U.S. House of Representatives voted for the thirty-somethingth time to repeal all or part of “Obamacare.” It was a belligerent but futile gesture to exhibit once again their contempt for that Black man that sits in the White House, whom they feel can do absolutely nothing right or praiseworthy.

Many Republicans really believed the assurances from “the bubble” of Faux News and the Limboids that the Affordable Care Act was unconstitutional, and they were really surprised when the chief justice appointed by George Bush, Jr. himself was the swing vote.

(When I was a kid, there were billboards around for years demanding, “Impeach Earl Warren,” the former Republican governor of California appointed chief justice by President Eisenhower. I wonder if we’ll soon see “Impeach John Roberts” versions.)

“Repeal and Replace” has been the recent mantra of the GOP. One wonders what they hope to replace the ACA with.

I’m a C-SPAN junkie. More precisely, I have C-SPAN2, which covers the Senate, droning on in the background much of the time. The grammar, rhetoric, and logic of the Senate are of a higher quality than those found in the House, although sometimes not by much. Nonetheless, I can only take so much of Louie Gohmert and Michelle Bachmann.

Anyway, for almost a year I watched and listened as many congressional committee sessions and interminable floor debates led up to the moment when the Democrats “sneaked” the ACA through Congress. I well remember the Republican talking points, because there were so few of them and they repeated them endlessly.

One of the only substantial proposals that I can recall was to permit interstate sales of health insurance. This was a “lowest common denominator” approach, which would allow a person in one state to buy an approved health insurance policy from any other state. No federal regulation was included, just the chance to find the state with the least restrictive insurance commissioner.

As I recall, there was also a proposal to allow corporations to join with each other to create more stable pools, and, of course, a call for some sort of individual medical savings accounts. The latter would certainly be appreciated by the banking industry, which contributes substantially to candidates and incumbents. But, I have to admit, there was some substance there.

Everything else was what used to be called a “red herring.” If the hounds are after you, drag a dead fish across your trail and throw it in the bushes, and maybe they’ll get sidetracked. That was the GOP strategy.

They spoke at great length about abortion and illegal immigration, two of their favorite topics that are always a hit with their base. The ACA didn’t give new rights to undocumented residents or expand abortion rights, but they endlessly warned that it would.

And then there was their spirited defense of the Medicare Part C program. This was a big giveaway to the insurance companies to entice them to offer policies that “wrapped around” Medicare and covered co-pays and provided extra health services. Under the ACA, this program would be cut by about half a billion dollars. That it was a bloated and inefficient program that they had all probably voted against was not mentioned.

I don’t recall them calling the “individual mandate” unconstitutional at the time, but of course that became the new mantra as soon as the measure was passed. It wasn’t mentioned that the concept had originated at the Heritage Foundation, a right-wing “think tank.” (Boy, there’s an oxymoron.)

And then there was the “death panel” issue, which had no basis in fact, and the dire warning that “the government will come between you and your doctor.” And that was it. If I’ve missed something substantive, please let me know.

There was nothing that dealt directly with the real problems of health care in our for-profit system. It wasn’t mentioned that the insurance companies routinely came between patients and their doctors and made decisions without any regulation. There was no mention of pre-existing conditions and lifetime limits and all the other excesses of the industry. It wasn’t brought up that the federal government runs its Medicare and Medicaid programs for one or two percent of the cost while insurance companies were raking in ten and even twenty percent. There was no solution proposed for the rampant use of emergency room services, at public expense, by the millions of people who couldn’t afford health insurance. There was nothing to stop the health care industry from gobbling a bigger and bigger proportion of our resources. And they didn’t have a fix for the “doughnut hole” in Medicare Part D, the prescription drug benefit, that they had created during Bush-Jr. and didn’t pay for.

So now they want to “repeal and replace” the ACA. From what the Republicans say, I take that to mean a return to the status quo ante. That would be a disaster.

Let’s face it, the Republicans don’t want a federal health insurance program. They didn’t want Medicaid either, or Medicare, or Social Security, for that matter. They really hated Brown vs. Board of Education, which is why they wanted to impeach Earl Warren, and, of course, Roe vs. Wade. If given their way, they would dismantle them all and replace them, if at all, with programs that benefit the banks and corporations, and the bigots and xenophobes, that they represent.

But, unless they can keep their majority in the House, get a filibuster-proof supermajority in the Senate, and replace the president in November, we will have this new program, long overdue, to deal with one of the major problems in our society. Is it perfect? No. Is it a step in the right direction? Yes. Is it the right thing to do? It is.

So, my suggestion is: Don’t repeal and replace the ACA. Reject and replace the Republicans.