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Mr. Walz, you asked for it you get it...
So I got a mailing from Tim Walz tonight that reads "Congressman Tim Walz wants to hear your opinion on health insurance" - well that's good because I have an opinion, I did send him that opinion twice in an email and spoke to one of his staffers for about 20 minutes at his town hall meeting about my opinion. I am glad he is still open to ideas.
Great! The mailing even has a little card that I can mail back to Tim with my important thoughts! Lets fill it out together shall we?
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1. Do you agree with those who believe that access to affordable health insurance is the right of all Americans? Or, do you believe it is a privilege only for those who can afford it?
Okay, put down your pencils for a second - let's not answer yet. Those are the two choices I get? Declare affordable health insurance a right or say that it is a privilege for fat cats? Seems a little narrow to me. Okay lets try an answer.
No, Tim, affordable health insurance is not a right. You cannot have a right that compels somebody else to do something against their will. There is no historical basis for it, it is simply something that has been made up in the last few years. A right is a powerful, dare I say, sacred notion — we cannot apply the status of right to everything that is nice to have. Oh wait, we can't write all that — Tim only allowed us three 2.75" lines to respond to his question. Lets move on for now.
2. Do you believe our health insurance system is in need of reform? Or, do you believe it works well enough as it is?
Another question with two narrow choices phrased to elicit the answer Tim wishes to hear? Again just a small amount of space to write my answer — let's give it a shot...
Tim, our health insurance system is made up of over a thousand insurance companies, Medicare, Medicaid, millions of people who self insure and thousands of companies that self insure for their employees — how can I declare the system in need of reform? Millions of people are very happy with their health care insurance, millions are not happy and most don't have a clue. (we wrote really, really small and fit all that in there)
3. Do you believe we should pay doctors for the outcomes of the medical care they provide or the amount of services they provide?
Okay, that seems a little better — still no room for a well thought out answer that probes at the heart of the economic structure of the doctor patient relationship but at least he didn't pigeon hole us quite as bad this time.
Tim, we live in a free market society we should be free to choose to pay a doctor for outcomes or for services provided and doctors should be free to charge for outcomes or for services. That is the very notion of our contract based economy. Ideally our congressional representatives would be working tirelessly to tear down government regulations that hamper such mutual interaction
4. What is you insurance story? I want to hear from you.
Again only a couple of lines, and of course I have already shared this story but here we go.
Congressman Walz,
Thank you for your service to our country and for representing me in Washington D.C..
I have a very passionate interest in health care reform. In January of this year my wife Stacy and I along with my daughter Josephine and son Isaiah adopted three wonderful boys from Texas. Eddie, Davit and Jose have been a wonderful addition to our family and have fit in quite well.
The boys are the children of illegal immigrants, their father was not a nice person and is either back in Mexico or in prison. Their mother died just a few years ago of a condition called Alports disease. Alports disease attacks the kidneys and eventually people who have this disease will need lifelong dialysis or a kidney transplant in order to survive. The boys father told their mother that if she sought treatment she would be deported, this led to her death.
All three boys have been diagnosed with Alports syndrome, a precursor to the disease. Last month they visited the Mayo Clinic and we received the news that they would likely experience kidney failure somewhere between their teenage years and 30th birthday. The oldest boy, Eddie, already wears hearing aids; hearing loss is common in people with kidney disorders. He is still happy and well adjusted he just has to remember to take them out before swimming.
We are truly blessed to be well insured, I work at Brown Printing Company and they have great insurance. Additionally the state of Texas and Minnesota have an arrangement to provide Medicaid insurance for all children adopted out of foster care. So right now for us the insurance and health care systems are working well.
But then on Monday morning I read an article in the New York Times that made break down in tears — as a former Marine I hate to cry and I hate admitting it even more. The article tells of a young woman with Alports that was able to get a kidney, donated by her mother, transplanted into her body so she would be able to live free of dialysis ($9300/month). Medicare paid for the transplant ($125,000) and covered the medications needed to keep her body from rejecting the kidney ($1000-$3000/month). But sadly, Medicare only pays for 3 years of drugs. The young lady did her best to stretch out the pills but eventually her body rejected the kidney and she went into a coma. Her biggest pain is that it was her mothers only spare kidney that was destroyed. Why does Medicare only pay for 3 years of medication? It costs too much. At some point in time congress made the decision to stop paying for the drugs at 36 months - not based on outcomes, or service or even best practices - just based on cost. Happily the young woman has had a second transplant, again covered by Medicare, and will get 3 more years of drug coverage and then...
Congressman Wilson of South Carolina called President Obama a liar last week, I hope you too have the courage to call the President a liar when he says that death panels are a myth. Under a single payer system when a line is drawn on coverage, which congress has already shown they will do, those who cross the line are damned.
My wife and I have two kidneys between us to share, I have hope that if there is a need that Isaiah or Josephine will step forward to help their brothers in a time of need as well. My brother has already made the offer. Every financial decision my wife and I make is made with an eye towards making sure we can cover the costs of transplants and medication that they boys will need. But it is awful damn hard to stomach the thought that when someone literally gives a piece of themselves that it can be destroyed for something as trivial as money. I use the story of my family not as a plea to solve my problems but as a backdrop to workable solutions to deal with health care.
First - move the health insurance tax incentive from employers to employees. Brown Printing Company has wonderful insurance but they buy a policy for my family, a young person right out of high school, a wise and kind man who just turned 60 and all other shapes and sizes. They cannot tailor the plan to suit us all, in the end they buy a group policy that, while having employees in the front of their mind, is based in their self interest. Let me buy the policy for my family - I know what my needs are better than anyone else. The biggest benefit is continuing coverage, if I am buying the coverage I can cover my children even after they reach 18. Insurance companies have less of an interest to drop sick people when they can count on premiums paid over a longer period. Most importantly it attaches incentives and disincentives much closer to health care consumers.
Second - end patents on drugs. Currently drug companies get 20 years of exclusivity from the date a drug is invented, given that it might take up to 8 years to get the drug approved that means a drug company must capture all the costs and profits of a drug in 12 years. Take away the patent time lines and the drug can be monetized over a much longer time period - this will drive drug costs way down. Generic drug makers will be a thing of the past - Duncan Hines and Betty Crocker do not have a patent on chocolate cake mix - do you by the store brand? Neither do I.
Third - tackle tort reform, we all know that malpractice insurance only constitutes a small portion of the health care economy but fear of a practice ending lawsuit changes the way health care is delivered - not to the benefit of the patient.
Fourth - Congress can finally use the interstate commerce clause for what it was intended for and prevent states from restricting commerce. There should be no barriers between the states on insurance portability.
Fifth - Require Medicare and Medicaid to pay market prices for services rather than shifting costs to others.
That, Mr. Walz, is my health insurance story. I don't suppose it fits into the questions on your questionnaire, it doesn't fit with President Obama's speech, it doesn't fit with Republican head in the sand approach. It is just my story. As I submit this to be published on the Waseca County News website I will submit it to you again. I hope you read it, I hope you read the story in the New York Times. I don't want you to solve my problems, I'll do okay, I'll make sure my boys do well. I ask you to consider the options I laid out above for every other parent with a child facing the same uphill climb. Universal health care sounds good on paper, but none of us live on paper. The real world failures are all to real.
Sorry I have nothing shiny to share today.
Stay alert, stay alive.
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