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Tuesday, March 23, 2010

Myth: The "Patient Protection and Affordable Care Act" is a terrible law

This bill stinks because the Democrats could have easily included some important essentials, including:
(1)A National insurance exchange, including a public option
(2)Repeal of the anti-trust exemption for health insurers
(3)Allowing Medicare to bargain for lower drug prices.
Ideally, a national, single-payer system (Medicare for all) would have saved us the most money and left no one uninsured. This bill allows the poor to opt out of buying insurance if they can't afford it. Huh?
But here are some of the good, and weird, parts:
Good: Insurers can't rescind (retroactively cancel) your coverage unless you committed fraud or intentionally misrepresented material facts. So if you forgot to mention that visit to the dermatologist they can't then cancel coverage after you have a mastectomy (actual case). The acne was immaterial, and, you didn't intend to conceal it.
Good: Will require health plans to report on benefits or reimbursement structures that improve health outcomes, prevent hospital readmission, improve patient safety & promote wellness. Do ya think?
Good: Maximum waiting period for pre-existing conditions will be 90 days.
Good: Requires a whole host of experimental "demonstration projects" to test various cost and care strategies. This is an admission that they can't possibly know all the best solutions up front, unlike Rush Limbaugh.
Good: Creates an ongoing "Interagency Working Group on Health Care Quality" which will have a results oriented focus on best practices.
Good: Makes Medicare reimbursement rates more equitable among the states, which will benefit Oregon and- I hope -stop the mass exodus of doctors from Medicare patients.
Good Expands student loan forgiveness to include health professionals who go to work for public health agencies.
Weird: Increases from 10% to 20% the penalty for using HSA funds for nonmedical purposes. Was that a problem?
Bad: Raises the AGI threshold from 7.5% to 10% for deductiblity of medical expenses, with few exceptions.
Weird but Good: 10% tax on indoor tanning. Yes, tanning salons should pay for the skin cancer they cause.
Weak and Weird: The requirement that everyone buy insurance. Except sometimes. This may change soon, but right now an individual making less than $150,000/yr. will be penalized $750/yr. for not buying health insurance. Over that income level, add 0.5% of the excess income to your penalty. Let's see. Should I spend $500/mo. for health insurance or pay a $750 penalty, and then when I do get sick, enroll in a plan because they can't refuse me? Might work. But what if you have an accident? Or heart attack? Or some other event that renders you unconscious or otherwise incapacitated, or, needs immediate attention? You will not be covered until you enroll in a plan. And then there's that pesky 90 day waiting period. I know that coverage will not be retroactive.

Monday, March 8, 2010

MYTH: People want Jobs

All the politicians are talking about "jobs creation" (has a nicer ring to it than the singular "job creation" apparently). But nobody really wants a "job". They want satisfaction, a sense of fulfillment & confidence in the future. They want the pursuit of happiness. But not in the perverted, egomaniacal sense used colloquially. When they put that phrase in the Declaration of Independence, Jefferson & Franklin weren't referring to the vapid notion of "enlightened self-interest" that the free-for-all market wonks like to mindlessly babble about. Jefferson & Franklin intended that the greatest expression of human virtue- and therefore the greatest source of enduring satisfaction -was the pursuit of happiness not only for ones self but also for one's community at large. They felt that this was an inalienable right for which government should be structured to support and protect. Great contributions to happiness in general should be greatly rewarded.
And therein lies the myth of "jobs creation" being a source of happiness. Shouldn't workers also share in the rewards of their productivity?
Between 1990 and 2006, worker productivity increased 135%. But during the same time period, average wages were up only about 10%. Workers have been disconnected from the fruits of their labors! Where did it all go? The rewards were siphoned to the top and/or out of the country. See Follow the Money. Between 2001 & 2007 (the Bush years, remember?) the top 400 income recipients saw their after tax income skyrocket 476%. During the same period median family income soared, well . . . zero %.
Our government has failed- by the design of the multinational corporations that run it -to create a level playing field, a place where everyone has the freedom to pursue happiness for themselves and their communities, a place where creation of value- rather than decimation of it -is fairly rewarded.

Tuesday, March 2, 2010

BOOMERS; you're more realistic than your parents think.

A study by financial behemoth, Allianz Life, revealed something that surprised me. One of the survey questions asked: Please indicate how important it is for you personally that you receive [if you're a boomer]/provide [if you're an elder parent] any of the following as an inheritance.
Surprisingly, "stuff" wasn't at the top of the list. 77% of Boomers and their parents felt that "Values and life lessons" were the most important inheritance. Only 10% of Boomers felt that "financial assets or real estate" were most important while 39% of elders did. Let's rephrase that to be sure it's clear: Elders were four times more likely than their children to believe that money and property were the most important inheritance. Elders vastly overestimate their childrens' expectations of inheriting financial assets and/or real estate.
This is borne out by my experience that many parents even endanger their own financial welfare by attempting to leave too much to the kids. What a shame, if it's not even that important to the kids.