2005
Occasional #3

Hi

Health care was a major topic at our national conference of legislatures, for several reasons. 1. The costs are causing havoc in state and county budgets. 2. The feds are beginning to push the costs to the states. 3. Billing has several price levels. 4. Many persons/families have no coverage. Both parents may be working full time but when a child has a persistent sore throat they have no choice except to go to the emergency room, where the county is obligated to pay -- even for a sore throat. Expensive!

One big problem is that in company policies the rich pay less than the poor. Income deduction means the gov't pays the difference. A speaker from Princeton University said he pays 45 cents for each dollar of premium. The janitor outside his door pays 80 cents for each dollar of premium. [Add to that disparity, the top 80% of health care provided is received by 20% of the population.]

The wealthy are better off with company policies for another reason: hospital private pay rates are higher than insurance rates, which are higher than Medicare. So private-pay persons are subsidizing the rest of the system. We are trying to correct that. The developing theory is that insurance is only for catastrophic cases, so most bills will be private pay. Many workers will not pay, leaving hospitals with more bad debt, which then will cycle on to higher costs for all.

On a per family basis, national costs are now running nearly $1,000 a month and could double in the next ten years. One of the games we play is to take the premiums out of wages and salaries. Ford Motor Company knows how to make cars, but they are not good providers of health care. Premiums are a cost of labor. The division is misleading. Health care is paid by the worker and the gov't, not by Ford.

However, as already noted, the government encourages the division by giving a tax deduction, something most countries do not do. Our administrative overhead is more than six times that of countries with a national plan. So our taxes pay dearly to keep an inefficient system going. The wild part of this is we do have a national plan for the elderly and for low income and are very efficient in its operation. Medicare is a good deal for the country. How about dropping the age down to 21? I am guessing it would save us $$$. We pay more tax $$$ for the rich man than for the poor man. Make it even?

The bright spot in all this is community health care clinics, which are available on a sliding fee scale in larger communities. In Omaha, for example, Charles Drew in north Omaha and One World in south Omaha provide health services, including dental and eye, to tens of thousands a year. [Some who are well off go there because the care is excellent.] Many patients are desperate for health care. The city brings in the homeless. Physicians and medical students volunteer, to hold down costs. Medicaid is involved. Corporations large and small help to pay the bills. I am on the board of One World, which is taking over three floors of the Livestock Exchange building this month. Stunning. Local businesses are giving millions to make this work. Celebrate it.

It is ironic. Our businesses support this highly efficient health care delivery, while helping their employees pay dearly for a 'private' gov't-subsidized system.

Tax cutters urge that we cut Medicaid coverage. That becomes part of the problem, not the answer. For then these folks go to the county, where there is no preventive medicine. Worse, our Medicaid message is negative. When we send low income patients to Medicaid or the county we are telling Doctors that the poor have less social value than high income citizens.

Statistics. Every year total health care costs grow by 4.5%. Our Gross Domestic Product (GDP) grows by about 2% a year. So every year the 2.5% gap comes out of our economy. Health care costs now are over 15% of our national economy. With all that we can do it will still be about 20% in ten years, which is a huge difference and a threat to our economic health.

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“Nebraska in the Lead” was the editorial headline in the New York Times. Yo! We are pleased they are discovering all the news that is fit to print.

For those who did not see it, the subject was Nebraska's restoring the voting rights for felons, a privilege taken away by many states during the early 1900s in order to further erode the Negro vote. The reporter took my quote from the transcript of floor debate and called it a high point. That is so laudatory I should not quibble with the way he edited the quote. But he did leave a thought stranded. He left out my question, “If I were a felon, would I go through the humiliation of going to the parole board to have its members judge if I am worthy to vote? I think not.” The Times editorial picks up here. “I would rather keep my dignity. And I would much rather we allow (my neighbor) to keep his dignity and help him to move on.”

It is a bit surprising in Nebraska that very few voted against this action. 'It is the right thing to do' was the quiet assumption. I did get emails. One said this was a Democrat move to get more voters. No felons are Republicans? What about all these white-collar ones we are collecting from financial fiascoes? Another said that this action was useless as no felons would get out to vote. Let's have those two guys talk to each other, sharing their silly notions, so the rest of us get on with business.

I have to put in a defensive word for our President regarding the hurricane. The local response was missing, big time. The feds have been shipping every state lots of money for the last three years, with instructions to prepare plans for a nuclear disaster or a natural disaster in that state. In Nebraska, we are ready for a massive lockstep in any contingency. Every plan has evacuation components.

Yet Louisiana, with the pre-estimate that there were 100,000 residents in New Orleans with no transportation, and with two days notice on evacuation, simply had no viable plan. It could be excusable if the gov't had not been paying them to get a plan. Much worse, the plan ignored those who are poor.

Here's to real planning.

Lowen