Editorial: Healthcare Reform

Proper methodology of administration and payment of healthcare costs has been
a matter of serious debate, particularly since the inauguration of President
Barack Obama. This matter is of greater financial significance to our nation
than any other topic currently up for debate. Fear of change cannot be permitted
to stunt our creativity; neither can unfounded argument be allowed to scare
us into inprudent action.

At the center of the healthcare debate, we face a fundamental ethical question:
Is healthcare a privilege or a right? Before we can effectively discuss how to
pay for and administer healthcare, we must come to an agreement on what our
responsibility is. This is no easy matter since this is deeply personal. It is
conceivable that two people can look into their conscience arrive at wildly
opposite conclusions. That is, one person may justifiably conclude that
society has no obligation to provide healthcare to anyone while another may
think it is the public's responsibility to attempt a cure for every human
ailment. We must attempt to come to some agreement on where our responsibilities
lie.

In reality, the matter is not so simple. A lot of what most of us believe
should be a standard level of health we should help people maintain depends
upon the cost of procedures and drugs required to treat the ailment at hand.
In addition, we may wish to consider the rate of success of the treatment and
expected improvement on one's quality of life. For example, we may view cancer
treatment on a 90 year old man differently than we do a 25 year old man. For
one, a 90 year old man may not live through the treatment. If he does, we must
ask ourselves how much we have really improved his quality of life. How long
will he live to benefit from the treatment?

So far, I have not said anything groundbreaking. Most everyone understands that
we don't perform involved procedures on the elderly when we believe that their
quality of life will be better with no medicine at all.

We will consider issues that have come up in the healthcare debate. In many
ways, this will be a hodgepodge of ideas. It may seem disorganized and lacking
proper document. That's because it is. I am not going to properly document
this essay because some of this is a response to things I've heard said in
Presidential Addresses, and I don't think it matters much to poke at things
said in the past; rather, I will bring up arguments relating to things I've
heard said for the benefit of the reader who will undoubtedly hear debates and
addresses in the future. If these issues don't come up again, perhaps it is
because someone has laid them to rest. If you do hear these issues come up in
the future, carefully consider my argument against what you hear.

Insurance Executives Salaries and the Cost of Healthcare

I have heard President Obama say a time or two that he will work to hold
health insurance executives accountable for their salaries. Thus, he will be
able to reduce administration costs of private health insurers and reduce
overall costs.

This is certainly one way of reducing costs, but I'm afraid we are throwing
our efforts at a $1 per month problem. Healthcare costs have risen at
approximately 12% per year over the past 5-10 years. I haven't any figures to
backup this statement, but I highly doubt that executives salaries have risen
at a rate to cause this level of inflation.

Another thing to consider is the relationship between health insurance
executive's salaries and the salaries of executives in other types of insurance.
Premium rates in life and auto insurance have remained pretty stable in the
past decade. It is reasonable to assume that a CEO salary at an auto insurance
company is comparable to that of CEO at a health insurance company.
Health insurance executives are an easy target for blame. It is easy for a
politician to plant an image in our minds of insurance executives causing most
of our problems. The most likely cause of increased healthcare costs is
increased usage and the increasing popularity of expensive procedures.

Eliminating Waste in the Healthcare System

President Obama says he will eliminate waste in the healthcare system. He cites
this as one reason he will not need to increase taxes in order to support the
public plan he proposes. One must wonder, if he can reduce waste in the system,
can he do it within the confines of our current system to keep Medicare and
Medicaid from going bankcrupt? I still haven't heard a plan for reducing waste.
Instead, we only hear promises of reduced waste under the new plan. Perhaps
reducing healthcare waste under our current system would increase the public's
confidence that the government can efficiently run a healthcare plan.

Contrary to what I've heard in Presidential Addresses, health insurers would
benefit from a decrease in waste in the healthcare system. In fact, this is a
problem health insurers have been working on for some time, and they have not
been able to solve it. If initiatives are taken to eliminate waste, insurers
stand to pay out much less in claims and would increase their profit margin in
the immediate future. Until we see a clear plan from the president, it will
be difficult to believe that the government will do a better job of eliminating
waste than a profit driven market.

Some may argue that the waste the president hopes to eliminate is the
administration costs in insurance companies. It is reasonable to say that
the government will be able to administer its health plan cheaper than the
private sector, but we need to look no further than the Department of Motor
Vehicles to see what kinds of inconvenience lay in store for us under a public
health plan. Private health insurers administrative costs may be high, but the
consumer is getting something for their money.

Healthcare Rationing

I will simply refer you to an excellent article on this subject published in
the New York Times.

http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?_r=1&ref=magazine

Mandatory Health Insurance

Before we can discuss whether or not people should be forced to carry health
insurance, we need to consider the fundamental principle of insurance. That is,
health insurance at its roots is a community pool of healthcare resources to be
consumed by society. Health insurance provides a way for a community of people
to spread the risk of financial catastrophe due to accident or illness.

In our society, we are reticent to pay for something without a guarantee of
return. When we pay an insurance premium and see the six months elapse without
receiving care, we see the amount we paid in premium as being wasted. If our
insurance premiums are not viewed as paying into a community pool to provide a
resource for those who need it, we get frustrated with our lack of return on
our premium investment.

Under the health reform bill, all citizens will be required to carry health
insurance. A couple of weeks ago I went to the chiropractor. While I was in
his office, he received a call from someone hoping to sell him health insurance.He told the agent that he had gone without health insurance for 30 years and
was very healthy. He had no need for health insurance.

For as long as this man stays healthy, this presents no problem him or the rest
of society. A difficult ethical question is presented to us in the event that
this man contracts a serious illness. Should society pay for this man to receive
treatment after he has refused to pay into the community pool for so many years?
If so, then why should he make premium payments in the meantime unless he is
compelled by law to do so? The only way we can go on without forcing
participation in an insurance community is if we decide that we are prepared to
allow uninsured people to die without treatment if they contract an illness.

In the example above, the man has the means to pay premiums, he just refuses to
do so because he does not want to participate in a community pool. We have not
considered what to do in the case of someone who does not have the means to pay
insurance premiums. Currently, Medicaid helps those who cannot afford insurance.
Medicaid does not appear to be a sustainable long-term solution. As part of
health reform, those who do not have the means to purchase health insurance
should have a deductible and co-payment levels set to put them on an even playing
field with those who do have health insurance. That is, those who have health
insurance have to meet a deductible before their insurance picks up the tab on
their treatments and drugs. Even after the deductible is met, the insured is
usually required to pay a co-payment upon receiving treatment. Deductible levels
and co-payments are set so that the insured feels some financial impact upon
receiving services. This helps keep usage down. If we allow a group of people
to receive care without having any skin in the game, we will see that their
usage rate will be much higher than if they had to pay some amount to receive
care.

Other Considerations

The fact is that most of us don't have enough skin in the game. We don't think
too hard about the financial impact of receiving services. Most of us are kept
out of the doctor's office only because we have other things to do and don't
believe a visit will help. Usage has been affected greatly by persistent poor
health habits in the individual lives of Americans. Obesity continues to rise
and is linked with many chronic diseases.

Unfortunately (or rather, fortunately), many of the treatments provided at the
doctor's office could be prevented if more people would take responsibility for
their own wellness. We cannot prevent people from getting old and sick, but we
can take steps to improve our own diet and exercises habits to prevent chronic
illness.

Pack Rats

One simple rule as a young single adult. If you haven't used an item all year and have no immediate plans to use it, then toss it in the dumpster and acquire a new one if you ever do need it. 

The desire to retain loads of crap stems from the feeling that one day this item will be vitally important to my survival, and because I did not keep it, it will cost me money to replace it at some point in the future. So, a pack rat feels as if they are saving money by keeping all kinds of useless junk, but in reality there is a great expense to keeping valueless stuff. 

Perhaps I should consider being an entrepreneur. I could start a service-based business where I come over and throw out everything in your house that looks like trash to me.

I was telling someone about my philosophy on being a pack rat, and I mentioned that I threw out my missionary plaque awhile back. They thought this was a bit extreme. Still, somehow I have two to three boxes of books in my parent's basement right now. Someday, these will go on bookshelves in my house and rarely be touched. Am I a pack rat?

The Long Night is Over

I haven't posted for a long time. A couple people have told me that they read my blog. I should be scared into taking this thing private; instead, I will post more from my mediocre mind to appease the masses.

The school year is over. I'm off to Seattle to work for the summer. The position is very exciting, so I can't wait to get started. 

I've determined that one of my pet peeves in life has to do with final exams. A couple of weeks ago, I heard an unbearable amount of whining about finals from students. In truth, that week is a lot of work, and it usually isn't just exams that causes panic attacks. Clean checks, moving, end-of-semester projects, and final exams themselves all push together. I really can see where it is a challenging week, but no one is impressed. College students as a whole have the best lives imaginable. Where a lot of people have extremely stressful, busy weeks every week except two weeks out of the year (without i-pods, laptops, etc), college students have extremely good lives with a few rough weeks a year. Most college students have more vacation than any other group of people in the world given their quality of life. So, in short, muscle through your difficult seven days or so and be on with it. 

Hmmm...did that sound harsh? I'm going to let it stand. 

Straightforward Passivity

Good news everyone! I have a girl entry to make. The shortage thus far is accounted for by my lack of social life this school year.

Let's get down to business, shall we? I will give the interested reader some background. I will leave out enough details so that this person will be very difficult to identify unless: 1) you are her, 2) I have already told you this story.

I'd been acquainted with this girl for some time before moving to Provo for graduate school in September. Starting in October, we went on a few dates, not in rapid succession. I can't imagine worse discussion on a date. We had a hard time stringing sentences together. An hour and a half would pass as if to be an entire day. After our third date, I walked her to her car and said, "Boy, we don't have a whole lot to talk about do we?" We both laughed it off, but it wasn't really funny.

I know what you are thinking. Why would I ask this girl out on three dates if they were so dull. Recall that I was acquainted with her for awhile and know she is a solid girl. That kind of thing goes a long way. I thought it might just take a little while for us to get things off the ground. No reason not to be patient. Also, my mom translated, "Boy, we don't have a whole lot to talk about do we?" According to her, it translated into girl as, "You sure are boring!" Is this true? I certainly didn't mean that. I just figured we didn't connect.

So, I figured I wouldn't call her again. A few weeks later I was going to "A Christmas Carol" at the Hale Theater in Orem (I include this level of detail for posterity's sake). After the first five girls I asked turned me down, I called her to ask if she wanted to go. She agreed, so we went out that night as well. Things weren't much different than the previous three dates, so that was that.

I can't think of a time when I contacted her between that night and a couple of months later. So it was February when I ran into her and noticed she gave me a pretty unpleasant look. I wondered what the deal was. After some investigation, I figured out that it was possible I'm a butthead for calling her boring, so I tried to get in touch with her to chat. Also, as I already said, she's a great girl, so a friendship still makes sense. It was only three dates and there was no physical contact at all as far as I can remember, so there is no reason things should be weird.

Well, over the course of the three weeks after my first attempt to get in touch with her, I tried to get in touch with her a few more times. I didn't have any luck.

Finally, there was light at the end of the tunnel last week Sunday. I checked my email and had one from facebook telling me I had a new message from Gertrude (that's what we'll call her to protect her identity). Gertrude and I were about to reconnect, and I could feel that it would be magical; indeed, it was so. I received the following message:

Hey, sorry I haven't called. Life has been really busy with work and I'm dating someone, so I haven't had time to call back. Just thought you should know, I've had a lot of fun getting to know you better and you're a great guy, but I've been thinking about it a lot and I don't see things going further between us. I'm sorry if I've hurt you at all and hope the best for you. Take care! Gertrude

For some reason the end of this message reminds me of this song. There is probably no relationship between the two.

This message followed about three weeks of absolute silence from her end. A simple text saying, "Ewww, get away from me creep" would've been great after the first time I tried to call. I would've got the idea.

It should not be overlooked that this is a textbook message to send a guy who is interested in you to let him know you don't want to see him anymore. You can just paste that baby right over into your own message to someone and you're done. It includes all of the cliche phrases you'd expect and accounts for three weeks of silence by citing busy for an excuse.

The problem is that you actually have to talk to the other person to figure out if the situation necessitates a dear John. After all, nothing feels sillier than being the giver or receiver of a message like this when it is unwarranted. It comes off as presumptuous, and you seem like you lack people skills. The take home message is that if some guy wants to declare his undying love for you, let him get started first. I know it is annoying to listen to when you aren't interested back, but you may as deal with it to prevent such an embarrassing misunderstanding.

Super Sunday

Church today went really well. My bishop (ecclesiastical leader) gave a spirited sermon on dating and marriage. Some people where out of this topic, but I'm all for it.

There is no need to get into the particulars of the talk, but suffice it to say he thinks we should all get off our electronic devices and socialize.

******************************Unrelated Material Next****************************

I was thinking this evening about how bad news always seems like an emergency while good news can wait until the weekend. I've noticed that whenever I get bad news, it shows up at 4:00 am while good news comes on Saturday or Sunday. It's as if i need to be depressed right away, but if there's something out there that could lift my spirits mid-week, it's never urgent enough for a phone call.

There is a connection between this and compliments/insults. I have a compliment to pay someone, but it hasn't seemed important enough to pick up the phone and call. In fact, I will probably put it off until I don't remember what my observation was and there won't be any compliment to pay. Fortunately, I have a bad memory, so I won't have to feel any amount of guilt for ignoring the opportunity to brighten someone's day.

If I had an insult or criticism for this person, I probably would've called Wednesday afternoon around the time I thought of it. I may have left it in a message feeling that this person needed to hear it immediately or they would have no chance of correcting their behavior. Yes, I would be quite on top of this if it were an insult.

Probably the biggest reason I don't seek out the chance to give a compliment is because I figure the person wouldn't really care. It escapes me why I think someone would care about a criticism I have for them. Admittedly, when someone gives me a compliment, I take it far less seriously than when someone calls me a jackass although I'm far more surprised to be complimented.

Girl Musings and More

I have an observation. I was reading the blog of an acquaintance today. I noticed that she tries too hard to seem smart. I have another acquaintance whose blog I read occasionally. She makes no effort to appear brighter than she is; rather, she just presents her ideas and is clearly a talented writer. This has led me to thinking.

It's obvious that the first girl I mention doesn't have much confidence that people will think she is clever, so she shoots beyond the mark. The second girl knows she is bright and just says what she has to say. It comes off very insightful and natural.

I can't help but think we are always perceived negatively when we make too great an effort to have people notice something positive about us. The desire to overachieve is almost always a consequence of low self image.

We've all probably had someone flirt with us who was trying too hard to seem better than they are. It may be that they try to appear more interesting, insightful, smarter, adventurous, easy to please, righteous, or better looking than they really are. Ironically, in their effort to appear too good to resist, they are often the easiest to dismiss. I'm sure most of us have been on both sides of that one.

Don't Read This One Unless You Think Everything I Say is Fascinating

This is my favorite time of the school year. I get to figure out where I'm going to be for the summer. I've been a different place each of the past 5 summers. I don't think this summer will be any different.

I had a phone interview last night with a company in Portland. They are the first health insurance company I've applied with for the summer. All the other ones have been in the property and casualty insurance industry. It seems like health insurance has some similar characteristics to P&C, so I'm excited about this one. Either way, I want to work on a project with a ton of data this summer. Also, Portland seems like the kind of place I'd be happy to settle down. I'd love to check it out for a summer.

Other possibilities so far are located in Hartford, CT and Los Angeles. Both of them would be exciting places to be and would be very interesting jobs. Both are P&C as well.