Moving into the 21st Century

My cell phone has been on the fritz for several months now -- shutting off spontaneously all the time. I hadn't had time to get down to AT&T in Kona until today. So I went in hoping they'd just fix my phone. Instead I came out with the above. Now I feel sooo au courant. I'm told it will change my life. At least, it works!

More Thoughts on Medical Care

A local doc (surgeon) had a piece in the West Hawaii paper Tuesday advocating for more government healthcare. I couldn't resist submitting a response. Here it is:

Dr. Bairos’ recent Viewpoint repeated several arguments frequently made in favor of the current health care reform proposals. They need further examination.

1. He points out that our emergency rooms are often utilized by patients that would have been more efficiently served if they had seen a doctor earlier -- before there was an emergency. He suggests that the problem is a lack of insurance. Most patients in our emergency rooms on the island have insurance -- often medicaid. Overuse of the emergency room most often occurs either (i) because the patient does not have a primary care physician due to the doctor shortage and the fact that some doctors will not take medicaid patients due to the low reimbursements, or (ii) because the patient failed to use good judgment and attend to his problem in a timely manner. A lack of insurance is not a primary cause of such over use.

2. We are frequently told that U.S. health care is not as good as that of other industrialized countries. The statistics cited are misleading. Higher infant mortality is primarily the result of more low birthweight babies, in turn the result of more teenage pregnancies. Our lower life expectancy is primarily the result of our obesity and other unhealthy lifestyle choices. Neither will be improved by government health insurance (unless diet and exercise are mandated as a condition of obtaining medical care). A better comparison would be the survival rate from breast or prostate cancer or from heart disease. I suspect the U.S. is near the top in these areas.

3. I agree with Dr. Bairos that insurance does not lower the cost of medical care, it increases it – both through the insurance company’s administrative costs and through the costs incurred by the provider. Consequently, it makes no sense for us to be using insurance to pay for routine medical care. It is analogous to buying car insurance to cover oil changes. It would be more cost effective for us to buy high deductible policies (say $5,000 per year) for the unexpected medical crisis and to pay for our routine medical needs ourselves. If that seems unaffordable, consider that the premium for an individual insured by HMSA is currently about $5000 per year. If a high deductible policy cost half that amount, the difference could be set aside, perhaps in a medical savings account, to pay for our routine needs. Moreover, if we were paying for our own care, we would be more cost conscious and concerned about the value received for the payment.

4. The founding fathers never intended that my right to “life, liberty and the pursuit of happiness,” included a right for me to have my medical care paid for with taxes on my neighbor. Many of our society’s values have been undermined by a greater reliance on the government. Many no longer feel obliged to support charitable efforts because they believe that the government has assumed those responsibilities – and they gave (through taxes) at the office. Beneficiaries of private charity generally feel grateful for the generosity of the donors. Beneficiaries of government programs more often feel “entitled.” An assurance that the government will take care of us has undermined our sense of personal responsibility to provide for our own needs.

Food and shelter are even more basic needs than medical care. As yet, we haven’t had a call for government programs to provide for these.

Extreme Makeover

J. Lynn's been wanting to replace our 24-year-old carpets for some time. It finally happened! The pix don't really do justice to the change, because you can't feel how soft and nice it is. The pad under the old carpet had pretty much disintegrated.

Here's the before in the living room
And the after
Dining room before
And after
I didn't shoot the stairs before -- maybe you remember them? Here's the new version:
J. Lynn's favorite addition: real carpet in our closet!
Do you remember the pretty pink bedroom? Look at it now!

Our next effort will be to refinish the floor in the kitchen and family room. Hope to get that done while we're away. It almost feels like a new house -- except that we never have the courage to change colors, so I guess it's really the old house renewed.

Thoughts on Health Care Reform and the "Public Option"

I submitted the following to the local papers. We'll see if I get published.

There has been much written pro and con on the proposal for a “public option” as part of the Obama administration’s health care reform. It will supposedly provide competition to keep the insurance companies honest. Some proponents have suggested it will be the equivalent of letting everyone sign up for Medicare, with Medicare being touted as a wonderful, efficient medical insurance program.
Not enough has been discussed about the economics of this proposal. Two questions must be answered: How high will the premium be? How high will the reimbursements to providers be?
The effective Medicare premium is hard to calculate. Medicare is supported by a payroll tax on everyone of 2.9% of income – half paid by the employer, half by the employee. Those actually on Medicare pay a small monthly premium – under $100/month. We don’t know what the effective premium is per Medicare enrollee. What we do know is that despite the tax on all workers and the additional premium, Medicare is forecast to be bankrupt within a few years without either a substantial increase in the tax and/or premiums or a reduction in benefits, or both.
On the other hand, Medicare reimbursements to providers (doctors and hospitals) are low – only about 80-85% of the provider’s cost of providing care, based upon the government’s own calculations. (Reimbursements from Medicaid are even lower.) This leaves a shortfall that must be made up by a combination of private insurance paying significantly higher reimbursements (about 130% of cost nationally, less in Hawaii, due to HMSA’s near monopsony) and, for the non-profit providers, fundraising. It is also responsible for many hospitals suffering financially. Note, also, that even at the low levels of reimbursement, the cost of Medicare has risen to about ten times what it was projected to cost when passed by Congress.
Moreover, Medicare reimbursements are not uniformly related to the cost of living. Hawaii’s rate of reimbursement is significantly lower that that of other high cost of living areas of the U.S. These low reimbursements account, in large part, for the fact that two Oahu hospitals have filed for bankruptcy in recent years, all three hospitals on the Big Island have reportedly been struggling financially, and a number of physicians have left the island in recent years to practice in areas where they can make more money.
What does this suggest for a new “public option”? It will likely be underpriced and provide low reimbursements. Low premiums will attract participants away from their existing insurance companies. Later, after it is discovered that the premiums are too low to sustain the program, the private options will be gone.
Despite the low level of reimbursements, providers will participate. With the government’s large market share, they won’t have any choice. However, the low reimbursements will exacerbate the existing financial problems of many hospitals – especially those in rural areas – and the departure of physicians from less lucrative areas. If reimbursement patterns hold, Hawaii will get the short end of the reimbursement stick again.
The only possible way a “public option” would be helpful is if it reduced costs through greater operating efficiencies, while paying out reimbursements on par with private insurers. As I know of no existing government enterprise that is more efficient than its private counterparts, I am not optimistic.

My Day Off

J. Lynn wouldn't let me work today. Looking for something fun to do, she found horseback riding at Kahua Ranch. We haven't been on horses for years, so sounded fun. It was windy, but green and beautiful up on top.

Our guide Maki

Defunct wind farm

Guess who's the cowboy and who's the Indian?

Do we look at home in the saddle, or what?

You can just make out Mauna Loa in the background.