A Canadian who loves her health-care system

This morning a Canadian woman wrote such an interesting comment on an old post of mine, "Rationing is not a four-letter word," that I want to share it with you. I don't know the author, her full name (though she tells me her first name is LaVonne, so she's obviously a great person), or her contact information, so I can't give her full credit. But thanks, LaVonne-in-Canada: I learned a lot from you.

Here's what she wrote about how Canadian health care works for her. I've added a few comments in red, in case you want to compare the situation of LaVonne-in-Canada with that of LaVonne-in-the-United-States.

As a Canadian, I can't understand why a medicare plan such as we have is not feasible in the USA.

As a a retired person, I pay $65/mo. When I was working, it was less - employer paid a touch more than half. [As an American retired person, this year I paid $265.85/mo--that would be $104.90 for Medicare Part B (medical insurance), $44.10 for Medicare Part D (prescription insurance), and $116.85 for Medigap Plan G (to cover Medicare's very high co-pays). When my husband was employed, my insurance cost was half that amount because his employer paid about 3/4 of the total cost--but three months ago, the employee's cost for that policy at least doubled.]

Since 2008 I have had two major operations which didn't cost me anything except $35 per day for a private room in the hospital (my choice...a 4-bed ward would have been free). [In 2011, before going on Medicare, I had a major operation which cost me $2,111.35, which seemed like a real bargain since the hospital bill was originally $172,833.97. Insurance agreed to pay $116,748.28. Earlier this year--again, before going on Medicare--I had an outpatient procedure that cost me nothing, even though the hospital bill was originally $47,914.28. Insurance agreed to pay $15,763.77. It's a strange way of doing business.]

Moreover, no charge to Canadians for doctor's office visits. We don't have to delay need for care, might save worsening condition. [Because I bought a Medigap policy (Plan G), I first pay a $147 yearly deductible, after which I am not charged for doctor's office visits. Under our former Blue Cross Blue Shield plan, I was charged $20 to see my primary care provider and $40 to see a specialist.]

We have a population of less than 35 million. Our population can support a universal healthcare plan. The USA has more than 10 times the population of Canada. Surely 350 million people can support a universal health care plan successfully - many more people to pay into it, and as well, more healthy employed people than sick people by far to support the plan, I should think.

By the way, my $65/mo covers 60% of my dental care, too, however this is an option my former employee-plan (union job) allowed me to take. If I'd wanted to pay in more, I could have opted for 80% dental coverage, or 100%. Medicare without the dental would cost $57/mo.(rather than $65). [Alas, my $265.85 includes no dental coverage. And even though I pay for prescription insurance, I also pay out-of-pocket for prescriptions: in my case another $57/mo as long as I don't need anything next year that I'm not already taking.]

Do you think that if your legislators could corrall Big Pharma and Big Insurance Co., that maybe your country could get something even better going? The current Obama-care is not the whole way your President wanted to go (he wanted something more along the lines of the Canadian plan) but he was hog tied, he had to compromise.

We are not socialists in Canada. We have a capitalist system, too. However we don't fret at the thought of socially subsidized provision for people's health, and I think as a consequence we might have a healthier population. The Native Indian people in Canada have totally free healthcare - they don't have to pay any monthly premiums at all.

Now if you happen to think that the Affordable Care Act (aka Obamacare, in spite of what Jimmy Kimmel's interviewees believed) will give us a Canadian system, please, please, please read "Obamacare vs. Canada: Five key differences." The two systems are very, very different--and the differences help to explain why I pay hundreds of dollars more a month than LaVonne-across-the-border, and get significantly less.

And if you're itching to point out that Canadians have to wait longer than Americans for health care, or that Canadians stream over the border to American hospitals, or that Canadian seniors can't get hip replacements, please, please, please read "5 Myths About Canada's Health Care System" and learn what is really happening across our northern border. It's probably not what you think. It's certainly not what the U.S. anti-health-care lobby wants you to think.

These are short articles. You have time.

The truth is, as LaVonne-in-Canada noted, the Affordable Care Act is not exactly what President Obama wanted. He had to compromise, and as a result, Obamacare is not nearly as effective as Canadian health care--though it's somewhat better than what we had before. And Canadian health-care benefits aren't as amazingly good as, say, French or Swiss benefits (which still cost considerably less than ours, by the way), though if our aim is to keep costs as low as possible while still insuring everybody, we still  might choose to imitate Canada rather than some of the more generous countries.

But until the American people come to realize that our current mishmash of a system is costing them a lot more than a more centralized system could--and until our lawmakers find the courage "to grapple in a systematic fashion with the overall inefficiencies in health care delivery and financing, the administrative burden of multiple payers, providers and plans, and the cost pressures of defensive medicine," as the "Obamacare vs. Canada" article suggests--we will keep on paying more, getting less, and regularly shutting down the U.S. government and (who knows?) maybe crashing the entire world's economy.

Medicare Part D: Another year, another huge price increase

I signed up for Medicare last month. In addition to standard Medicare, I added Part D, the prescription drug benefit. My 2013  costs, if they had covered the entire year, would have come to $529 for insurance and $330 for prescription copays.

Today's mail brought the rates for 2014. The insurance premium has increased to $650, or by about 23%. Copays have also increased, to $616, or by nearly 87%. The total increase - assuming I won't need any additional medications - comes to 47%.

I was not happy when President Bush proposed and AARP supported Medicare Part D, the prescription drug benefit. The idea of insuring seniors' drugs was good. The resulting law, which specifically forbids the federal government from negotiating prices with pharmaceutical companies, was insane.

Well, "insane" is putting a good face on it. The financiers who supported the companies who bought the politicians who voted for the law were by no means insane. They were lining their own pockets, never mind the rest of us.

It's obvious, isn't it? If the government gives away money without limits and accountability, retail prices rise, insurance premiums rise, and consumers end up paying as much (or more) out-of-pocket than before the government stepped in.

Want proof? Take a look at this chart from the Kaiser Family Foundation. Notice that the U.S. government spends about as much of its GDP on healthcare as other developed countries (without, however, insuring everybody, as the other countries do). Notice that, unlike citizens of other countries, U.S. citizens spend a whopping amount in addition to what the government spends. The difference? Those other countries put strict limits on what pharmaceutical companies and other medical suppliers can charge.

Some Americans suggest that the government should just stop subsidizing things like health care and education. That doesn't make sense unless you think that only rich people should have access to schools and hospitals. But it makes more sense than subsidizing something without putting a ceiling on what the lucky recipients can charge for their goods and services.

I am going to look for a different Medicare Part D insurance company. I don't expect to find one that's much better, however, until our lawmakers learn to say Yes to middle-class and disadvantaged people and a loud, resounding No! to rich institutions and individuals who want to get even richer at our expense.

Actually, the U.S. is NOT spending more than any other country on health

Old News: US spends more on healthcare, gets worse results

We Americans are first in the world when it comes to per capita healthcare spending, and yet we don't live as long (we're in 51st place), more of our mothers die in childbirth (we're in 47th place), more of our babies die in their first year of life (we're in 50th place) ... well, you've seen the statistics, and they aren't pretty.

Interesting Spin on Old News: Medical and social spending should be seen as a whole

"The truth is that we may not be spending more," wrote Elizabeth H. Bradley and Lauren Taylor in a 2011 New York Times article—"it all depends on what you count." If you count "the combined investment in health care and social services," such as "rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support and other services that can extend and improve life," we're in 10th place among developed nations. To compare:

For every dollar we spend on health care, we spend an additional 90 cents on social services. In our peer countries, for every dollar spent on health care, an additional $2 is spent on social services. So not only are we spending less, we’re allocating our resources disproportionately on health care.

Bradley, a professor of public health at Yale, and Taylor, formerly a program manager at the Yale Global Health Leadership Institute, believe that healthcare (primarily intervention after a health problem has occurred) is less effective than social services (primarily services that may prevent health problems) in keeping a nation healthy.

Unfortunately, we Americans do it backwards, and our ratio of healthcare spending to social spending is getting worse. In their forthcoming book, The American Health Care Paradox: Why Spending More Is Getting Us Less (November 2013), Bradley and Taylor write that for every dollar Americans spend on health care, we spend only an additional 60 cents on social services. Here's a picture of OECD spending compared with US spending:

Really Disheartening Current Situation: Many US legislators are trying to cut back social spending

Republicans in Congress are trying mightily to reduce or eliminate food stamps, for example. Yesterday the Health Impact Project (in collaboration with the Robert Wood Johnson Foundation and the Pew Charitable Trust) released a white paper called "Health Impact Assessment of Proposed Changes to the Supplemental Nutritional Assistance Program" (translation: the program formerly known as food stamps). Two scary sentences from the 218-page document:

Using a model employed by the U.S. Department of Agriculture to administer SNAP, Mathematica Policy Research conducted an analysis of how many people could lose eligibility or receive lower benefits under the proposed policy changes in H.R. 1947 and S. 954. Under the changes proposed in H.R. 1947, as many as 5.1 million people could lose eligibility for the program.

 Lest you think this has nothing to do with health care, the document points out that

it is well established in the literature that food insecurity (defined as difficulty in obtaining enough to eat) increases the risk of diabetes, heart disease, and depression or anxiety in adults; and asthma, cognitive impairment, or behavioral problems in children. Children in food-insecure families are more likely to be hospitalized in early childhood than those from food-secure households. Medical costs related to food insecurity in the United States amount to as much as $67 billion per year in 2005 dollars.

At the same time, Republicans in Congress are still trying to repeal the Affordable Care Act.

Hey, let's go back to 1900 before any of those lefty innovations got started!

No income tax! No government-backed social welfare programs! No Department of Health and Human Services! No Department of Education! No Medicaid or Medicare! No Social Security! No Maternal and Child Health Program!

Paradise, right?

Except that if you were lucky enough to make it to age 20, your lifespan was 62 if you were a white male, nearly 64 if you were a white female, and a lot lower if you weren't white at all. Worse, you had a 23% chance of dying before your 20th birthday. And out of 100,000 women who gave birth in 1900, 600-900 died (compare with 21 in the U.S. today).

Well, that's one way to keep Social Security from going broke...

Infant mortality - why is America in 51st place?

[Picture by Brian Hall, Wikimedia Commons]

After I blogged about expensive American childcare earlier this week, my daughter Molly directed me to a March of Dimes web page showing the extremely high rate of preterm births in the United States. "Born Too Soon," a 124-page report issued in 2012, "ranks the U.S. 131st in the world in terms of its preterm birth rate of 12.0 per 100 live births, almost tied with Somalia, Thailand, and Turkey. Nearly half a million babies are born too soon in the U.S. each year."

According to a 2009 report from the Centers for Disease Control, "the main cause of the United States’ high infant mortality rate when compared with Europe is the very high percentage of preterm births in the United States" - in spite for the fact that "infant mortality rates for preterm (less than 37 weeks of gestation) infants are lower in the United States than in most European countries." In addition, "infant mortality rates for infants born at 37 weeks of gestation or more are higher in the United States than in most European countries."

It costs a lot to keep those preterm babies alive and healthy.  According to a 2012 article in The Lancet as reported by US News, infants born prematurely account for "12 percent of U.S. live births per year, but their care consumes close to 60 percent - or $6 billion - of total spending on initial neonatal care."

How effective is the spending? Quite, if you compare America to Poland: for every 10 preterm American babies who die, says a CDC report, about 15 Polish babies die. Not so much, if you compare America to Sweden: for every 10 preterm American babies who die, fewer than 8 preterm Swedish babies die.

Here's the question: why does America have so many preterm babies?

• Is it because American mothers are waiting to have babies until they're older? So are Western European mothers. In fact, the birthrate for women ages 40-49 is higher in most Western European countries than in America (you can check it out here).
• Is it because Americans are really into assisted reproductive technology, which is more likely to produce twins or triplets? According to the CDC, just over 1% of American babies born in 2011 were the result of ART. However, "in Belgium, Slovenia, Denmark, Netherlands and Sweden more than 3.0% of all babies born [in 2009?] were conceived by ART" (source: European Society of Human Reproduction and Embryology).
• Is it because "20 percent of U.S. women (18.7 million) ages 19-64 were uninsured in 2010, up from 15 percent (12.8 million) in 2000, according to a new [2012] Commonwealth Fund report on women's health care"?

That's my best guess: a lot of our babies come early because their mothers can't afford prenatal care. And because so many of us think it's somehow un-American to provide good quality healthcare for everyone, we end up spending huge amounts to save the babies who, lacking prenatal care, are born before their time.

Sadly, our efforts are too much, too late. Though we spend more than twice as much on childbirth-related expenses as any other country in the world, our newborn infants have a higher death rate than newborns in some 50 other countries.

Economically, this is a stupid approach to childbirth. Morally, it is reprehensible. For bereaved families, it is tragic.

How to make childbirth safer for mothers and infants (hint: not by spending more money)

"American Way of Birth, Costliest in the World." 

That's the headline of an article by Elisabeth Rosenthal in yesterday's New York Times. The article includes a chart comparing childbirth costs in seven countries. In the United States, the average amount paid for a conventional delivery in 2012 was $9,775; for a Caesarean section, it was $15,041. Those are the highest prices for childbirth anywhere in the world.

To get an idea of just how high, I made a chart using the figures in the NYT chart. Childbirth costs in the other six countries range from 21 to 43% of US costs, even though American women typically spend far less time in hospital.

This chart is based on prices that are actually paid, whether by individuals, insurers, or the government. [Chart by L. Neff; data from the International Federation of Health Plans 2012 Comparative Price Report]

You'd think America's higher costs would mean that American women and infants get better care. Not at all. "Despite its lavish spending," Rosenthal writes, "the United States has one of the highest rates of both infant and maternal death among industrialized nations." And among lots of other nations as well: according to the CIA's World Factbook, 50 countries have a lower infant mortality rate than the US, and 47 countries have a lower maternal mortality rate.

 Here's some comparative data in graph form. The longer the line, the more dangerous the country is for mother and child.

South Africa is so dangerous for childbirth that its graph line would not fit on this blog page. For every 1,000 births, there are 56 infant deaths. For every 100,000 births, there are 400 maternal deaths. [Chart by L. Neff; data from WHO]

Rosenthal mentions one reason that high costs often do not translate into low death rates: "The fact that poor and uninsured women and those whose insurance does not cover childbirth have trouble getting or paying for prenatal care contributes to those figures." I decided to use the Gini Index - a scale that measures "the degree of inequality in the distribution of family income in a country" - to compare the seven countries in the NYT graph. Here are the results:

South Africa's red line is missing because for every 100,000 births in that country, there are 400 maternal deaths. The chart would have had to be six times wider to accommodate the data. [Chart by L. Neff; data from CIA and WHO]

Wow. I didn't expect the results to line up so neatly, but there you have it: The more inequality in a country's  distribution of family income, the more mothers and babies die in childbirth. Of the 136 nations reported by the CIA, South Africa is #2 on the inequality list. Chile is #15, the United States is #41 (that means that 40 countries have less income equality than the US, while 95 countries have more). Britain, France, the Netherlands, and Switzerland, at numbers 60, 101, 111, and 117 respectively, all have significantly more income equality than the US.

Number 136, the nation with the least inequality of all, is Sweden. Swedish infant and maternal mortality rates are even lower than Switzerland's - in spite of the fact that Sweden spends about 1/3 less per capita on healthcare.

Money: The God of This World

This week Pope Francis spoke out against the cult of money. Here is how Catholic News Service's Carol Glatz summarized his remarks:

Pope Francis called for global financial reform that respects human dignity, helps the poor, promotes the common good and allows states to regulate markets.

"Money has to serve, not to rule," he said in his strongest remarks yet as pope concerning the world's economic and financial crises.

A major reason behind the increase in social and economic woes worldwide "is in our relationship with money and our acceptance of its power over ourselves and our society," he told a group of diplomats May 16.

"We have created new idols" where the "golden calf of old has found a new and heartless image in the cult of money and the dictatorship of an economy which is faceless and lacking any truly humane goal."

His words reminded me of one of the most significant books I've ever read, Protestant French philosopher Jacques Ellul's Money and Power.

First published nearly 60 years ago as L'Homme et l'argent ("Man and Money"), new French-language editions appeared in 1979 and 2007. I translated the English-language edition in 1984 and have been grateful ever since for the opportunity to immerse myself in this paradigm-bending book.

Money, Ellul argued, is not morally neutral. It is "Mammon, a demigod, a demon, an idol, a power from which we need liberation" (I'm quoting from David Neff's review of Money and Power in the February 15, 1985, issue of Christianity Today--and yes, he may have been biased, but damn, his review was good).

The problem isn't money, we say. The problem is that we don't have enough. Or that somebody else has too much.

No, says Ellul. Money is not neutral. "Jesus personifies money and considers it sort of a god. He does not get this idea from his cultural milieu. … This personification of money, this affirmation that we are talking about something that claims divinity . … reveals something exceptional about money, for Jesus did not usually use deifications and personifications" (p. 75).

Ellul explains that in Matthew 6:24 and Luke 16:13 Jesus shows that money is a power, a law unto itself that acts in the material world but with a spiritual orientation. In the Bible, power is never neutral. And it is often personal. Just as Scripture often portrays death as a personal force, so it also portrays money.

In the 60 years since Ellul wrote Money and Power (and even more in the 30 years since I translated it), the love of Money has taken root throughout the world in ways even Ellul might never have imagined. We fight wars to keep it, and to gain more of it. We damage the earth, deny social services to the poor, and pay ever smaller wages for ever longer hours, because to do otherwise would be bad for business. We don't enforce safety regulations or we outsource production to places with no regulations, so we can make higher profits on cheaper goods. And we have developed a theology of money in which the "free market" is the giver of every good and perfect gift - never mind the evidence.

Perhaps this is nothing new. It's been 2000 years since Jesus identified money with Mammon. But whether our love of Money is worse than ever before in the history of the world, or whether it is just business as usual, Pope Francis joins Jacques Ellul in reminding us that Money is a powerful false god.

If you like to get your reminders straight from Scripture, read Revelation 18, a gorgeously dark and dreadful poem about the fall of Babylon, surely Mammon's capital city, for she has deceived "all nations." As Babylon falls, so do the political leaders who "committed fornication with her" and the business tycoons who "have grown rich from the power of her luxury" and the multinational merchants whose ships "grew rich by her wealth."

The good news in Scripture is not that our stock portfolio has doubled or that our taxes have been cut or even that our nation's GDP is in recovery. The good news comes through an unmarried pregnant teenager: The Mighty One

has brought down the powerful from their thrones,

and lifted up the lowly;

he has filled the hungry with good things,

and sent the rich away empty.

                                                  Luke 2:52-53

FAT CHANCE by Robert H. Lustig and SALT SUGAR FAT by Michael Moss

If you eat food, here are two newish books you should know about.

You may already have met Robert H. Lustig, author of Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease (2012). Lustig is the UCSF professor whose surprisingly riveting 90-minute lecture, "Sugar: The Bitter Truth," has already had nearly 3.5 million hits on YouTube. The thesis of his lecture: it's not dietary fat that's making Americans gain weight, it's sugar. And sugar is doing much worse things than increasing our clothing size. It's setting us up for a whole range of lethal diseases that are almost entirely avoidable.

In Fat Chance Lustig writes about sugar, going into much greater detail about what it does in and to our bodies. He also writes about how various foods cause physical addiction, how the food industry keeps us full of junk, how the government helps the food industry ruin our health, why people gain weight, why diets fail, how people can lose weight--he's all over the map. But if you're not enslaved to linear thinking, you may well enjoy this fascinating collection of data and explanations as well as Lustig's sassy attitude.

Don't be put off by the title, by the way. I think it and the cover illustration are both insulting and misleading, and the subtitle makes the book sound like either an extended scold or a dreary set of rules for would-be ascetics. No, no, no. Lustig goes to great lengths to avoid blaming or shaming people who wish they weighed less. His concern is with keeping people--both convex and concave--in good health, and he'd like all of us to join his battle against the Evil Food Empire that is doing us in.

Once you've read Fat Chance you'll be loaded for bear. Michael Moss to the rescue--he'll tell you where to aim your rifle.

In Salt Sugar Fat: How the Food Giants Hooked Us (2013), Moss, a Pulitzer Prize-winning investigative reporter, tells what the food industry has been up to during the last couple of decades. Food executives, Moss says, are nervous: people are figuring out that convenience foods aren't good for them.

Stripped of nature's nutrients and loaded with fat, sugar, and salt, most of today's grocery-store items are engineered to provide the maximum taste thrill for the minimum price so food companies can make maximum profits and give Wall Street maximum satisfaction.

As engineered foods have gained popularly, however, their consumers have gained weight. At the same time, obesity-related diseases have added billions of dollars to health-care costs.

"Obesity is literally an epidemic in this country, and some people's ideas for addressing this public health issue could directly or indirectly affect the entire agriculture industry, from farm to consumer," a Philip Morris vice president, Jay Poole, warned an agricultural economics group.

Yes, that Philip Morris. The cigarette manufacturer, who once fought any publicity indicating that smoking might be bad for you, owned General Foods and Kraft in 1999 when Poole issued that warning, and they acquired Nabisco the next year. The food giants--including not only Philip Morris affiliates but also Kellogg's, Coke, Oscar Mayer, Cargill, Frito-Lay, and Dr. Pepper--had no intention of letting customers slip away to the produce aisle.

They would fight back with whatever weapons they could muster: the science of addiction, misleading labeling, false claims, selling to less regulated countries, advertising to children, relentless lobbying of legislators and government agencies.

I especially enjoyed Moss's repeated observation, after lunching with one food company executive after another, that the executive looked trim and healthy--and would not eat his company's products. You might not want to either after you've read this book.

Oh, and never fear--Salt Sugar Fat is not a downer (unless you read it while drinking Coke and eating Fritos). It reveals, but it doesn't preach. You'll enjoy the stories Moss tells. He hopes you will find it a useful tool for defending yourself when you walk through the grocery store doors.

HOW AN ECONOMY GROWS AND WHY IT CRASHES by Peter D. Schiff and Andrew Schiff

One of my fiscally conservative friends told me I should read this book if I wanted to know why Keynesian economics are a politican's best friend. I interpreted that to mean "why Keynesian economics suck." Oh no, I thought. Booooring. But then she added that the book was funny, and my heart leapt up. I like funny books, even if they're about economics.

Yes, How an Economy Grows is funny. Peter D. Schiff and his brother, Andrew J. (known mostly for his lament about how hard it is for a family to live in Brooklyn on $350,000 a year), explain free-market economics by means of an extended fairy tale enhanced with hilarious cartoon illustrations by Brendan Leach.

The story begins with three men, Able, Baker, and Charlie, who live alone on an island and stay alive on a diet of one fish per person per day. (If it occurs to you that the first man's name should be spelled "Abel," that could mean you're a proofreader, in which case this book will drive you nuts: it is littered with typos.) Many generations later, the island has a brisk fish-based economy, a strong manufacturing sector, and a booming trade with other islands. But then a monsoon hits, and the powers that be (especially Franky Deep) decide to issue Fish Reserve Notes to use in trade instead of actual fish, and Lindy B. funds the Great Society by issuing ever increasing numbers of Fish Reserve Notes (without keeping actual fish in reserve), and Slippery Dickson closes the bank's fish window to foreign depositors, and Roughy Redfin grossly outspends his revenues, and George W. Bass and Barry Ocuda bail out the banks--every one of these leaders egged on by villains such as Ally Greenfin and Ben Barnacle--until eventually the Sinopians, who by this time own most of Usonia, decide to cut bait and keep their fish for themselves.

On the positive side, the Schiffs managed to keep me awake while they explained their economic beliefs. I am impressed by the fact that Peter Schiff accurately predicted the recession of 2008 while many economists were still saying "Don't worry, be happy." As a parsimonious descendant of Puritans, I agree that savings are basic to economic health and that excess debt is perilous. Like the Schiffs, I think we're in trouble when the goods we consume are mostly produced elsewhere and our major export is dollars. I fear that the Schiffs may be right when they say (as David Stockman recently did in the New York Times) that we're in for a big crash in the near future.

But when I look at the kind of government the Schiffs would like to have, I see some really big theological problems. You don't have to be religious to see the problems, however: I suspect they are theological problems because they hurt people.

First, everything in this book's imagined universe is about money (well, fish), and how to get more of it. Oddly, the actual fish that sustain life in the early chapters become means of exchange and even storehouses of reserves in the later ones. Our daily bread (Matthew 6:9-13) transmutes into the rich fool's overstuffed granaries (Luke 12:13-21). People who are poor are barely mentioned in the Schiffs' tale: on their island, the poor do not exist. By contrast, in both the Hebrew Bible and the New Testament, the duty to care for the poor is one of the major themes. "Blessed are you who are poor," said Jesus, "for yours is the kingdom of God" (Luke 6:20). "You cannot serve both God and money" (Luke 16:13).

Obviously the poor are not well served by an economy that crashes, and perhaps the Schiffs would argue that their principles would be better for the poor than is our present precarious situation. Perhaps so, but that brings me to the second theological problem: the system the Schiffs describe might have worked very well before Adam and Eve developed a taste for apples, but in a world where everyone is infected with a touch of greed (see concupiscence), the Schiffs' system  is as dangerous as any other system we might invent. They do a fine job of showing how the government can screw things up--and indeed it can--but they are silent about how businesses can do the same. In their story, "Franky Deep" established disastrous policies in response to a monsoon--a natural disaster. In the real world, the Great Depression happened after decades of industrial monopolies, inhumane labor practices, and wild stock-market speculation--all unrestrained by the government.

I have no illusions about government. On the depravity scale, big government may be just as depraved as big business (though it's getting hard to distinguish between the two, since one buys the other and then uses it to accomplish its purposes). Ideally the two would form some sort of reciprocal deterrence system, checking each other's excesses, though that's not easy to accomplish in our multinational economy. But I think I know enough about greed to suggest that if businesses were left entirely to their own devices, the world's economy would soon consist of an interlocking network of immensely powerful monopolies that would "grind the faces of the poor" to an extent undreamed of by the prophet Isaiah (3:15). Heck, it's happening already.

So what's the answer to our economic woes? Well, if we--as individuals and as a nation--could somehow manage to understand that we need to pay (now, not during the next administration) for what we want, we could probably come up with something, especially if what we want includes concrete ways to lift people out of poverty. And yes, there are politicians (like Bill Clinton) and CEOs (like Bill Gates) who are devoting a lot of time and money to meeting human need.

But most businesses turn a goodly percentage of their profits into marketing whose aim is to persuade us that we always need more now; and most politicians spend vast sums trying to persuade us that if we elect them, we can have something for nothing; and most self-help books tells us that we really need to take care of ourselves better... and the beat goes on, and will go on, until one day it turns into the loudest crash yet, followed by ominous silence.

The Schiffs' ideas will not stave off the evil day, because the Schiffs do not take human nature into account. Politicians who follow their libertarian approach most likely have something other than ideas to sell. As do the Schiffs, for that matter, and they make no secret of it. Peter Schiff owns the brokerage firm Euro Pacific Capital, "an SEC registered investment advisor and full service broker/dealer that seeks to help American investors prepare for a global economy that may no longer be dominated by the U.S. dollar." His brother Andrew--the financially struggling one--is its director of communications and marketing. Peter is also CEO of Euro Pacific Precious Metals: that is, he sells gold.

Their father, Irwin Schiff, whose ideas they develop in this book, is serving a 13-year prison term for tax evasion. His lawyer's contention that he "had been diagnosed with a chronic, severe delusional disorder relating to his beliefs about the federal income tax system" did not sway the judge.

More on why medical bills are killing us, including an account of my own recent experience

TIME magazine has put its brilliant long cover article, "Why Medical Bills Are Killing Us" (March 4, 2013), behind a paywall, so if you're not a subscriber the link won't help. I understand why they did this: my husband has been in the magazine business for over 30 years, and it's awfully hard to pay staff when readers want everything free.

On the other hand, I wish every American and especially every lawmaker (local, state, and federal) would read this article. It explains better than anything else I've read why our health-care system costs way more than that of any other developed country, and why Obamacare, alas, is so unlikely to bring our costs down. It also gives a few good suggestions about ways to improve our health-care system even if we're not in the mood to give it the total overhaul it so desperately needs.

I supported Obamacare. It's awfully hard to steer a parked car, and the Affordable Care Act got us rolling. But we can't stop reforming health-care now, because our system is still broken. I agree with American economist Tsung-Mei Cheng's tongue-in-cheek Universal Laws of Health Care systems (I'm quoting from T.R. Reid's excellent book, The Healing of America, which I reviewed here, here, and here):

1. No matter how good the health care in a particular country, people will complain about it.
2. No matter how much money is spent on health care, the doctors and hospitals will argue that it is not enough.
3. The last reform always failed.

America's health-care system is not getting the results it should. See the latest report from the National Research Council and Institute of Medicine, whose title sums up our situation: "Americans Have Worse Health Than People in Other High-Income Countries; Health Disadvantage Is Pervasive Across Age and Socio-Economic Groups."

The way America's health care is financed would be hilarious if it didn't hurt so many people (go to the library and read the TIME article to be appalled). A personal example: I recently had an electrophysiology study performed at a highly rated Chicago hospital. From my arrival at 6:15 a.m. to my discharge at 9:30 p.m., the care I received was excellent. I am a big fan of most doctors and practically all nurses.

And then I got the paperwork.

• What the hospital and doctor billed my insurance company: $56,737.28
• What the insurance company agreed to pay: $18,591.77
• What I am probably going to have to pay: $858.80
• What I would be billed if I were unemployed and uninsured:  $56,737.28

Of course the hospital wouldn't be able to collect the full amount if I didn't have it, and I could always negotiate with them - that is, if my English language and negotiating skills were excellent, or if I could afford to hire a negotiator, or if I even knew that negotiation was possible. Or I could declare bankruptcy.

A lot of things still need reforming in our partially reformed health-care system. Could we start by requiring health-care services to have uniform prices for all, and to post their prices so that clients can know the cost of treatment before they sign up? And then could we ask the government not to give health-care services money unless it simultaneously puts limits on how much those health-care services can charge?

Please hire me

[Working till she drops]

A couple of years ago my 40-something cardiologist earnestly told me that the Social Security/Medicare problem was a cinch to fix--all we had to do was increase the retirement age. Right, I thought - I'm in my 60s and facing open-heart surgery, but once I recover I can go pound the pavement. My cardiologist is not an economist, however, and he's a good doctor, so I held my peace.

Yesterday's New York Times ran an article by Economic Scene writer Eduardo Porter, who should know better. In "The Payoff in Delaying Retirement" Porter writes:

What if there were a way for the government to ease the strain that the aging place on the budget while actually increasing their income in retirement, at little or no cost to their benefits? A well-designed reform would even improve the nation’s rate of economic growth. The way to do it is simply to encourage older workers to spend a larger share of their increasing life spans in the work force.

 Sometimes solutions that look good on paper don't work so well in the real world.

First, most boomers are already planning to work until they drop, since they have saved practically nothing for retirement. I'm not sure they need any additional encouragement. What they need is reality therapy.

Second, over the last decade or so, a lot of companies have downsized. Their PR departments speak of this as right-sizing. What it means is that (a) fewer jobs are available; (b) older workers--the ones getting the bigger paychecks because of seniority--are in greatest peril of being laid off; and (c) the remaining jobs require much longer work days. Such policies, good as they may be for a business's bottom line, are not conducive toward extending one's working years.

Third, it's hard for laid-off older folks to get entry-level jobs. Not only are they overqualified (whatever that means), but the jobs just aren't there. Ask any recent grad.

Fourth, while some older people can work at full capacity well into their 70s and 80s, many cannot. However cheerfully chirpy AARP publications may be, 60 is not the new 40. Over 70% of Americans between ages 60 and 79 have some form of cardiovascular disease, for example, compared to fewer than 40% of people between ages 40 and 49 (see data here). For every person between ages 40 and 44 who is diagnosed with cancer, more than eight people between ages 65 and 69 are so diagnosed (see data here). And those who plan to die with their boots on should be aware that nearly 14% of people over 70 have Alzheimer's disease (see data here).

But let's neglect all those potential problems and stipulate that those of us who are capable of working really should be working, at least until--shall we say--age 70. OK, I'll offer myself as a test case. 

I am 64 years old. I have a solid work history with excellent recommendations, though I have not had a regular employer for some 13 years and my industry--book publishing--is in a hard place. With three master's degrees and a background in teaching as well as editing, writing, and management, I'm quite versatile. My health has been pretty good since my open-heart surgery a year and a half ago (I will require excellent medical insurance, however). I have an extended network of other aging publishing professionals.  

So keep me off Social Security and Medicare for another five years. Offer me a full-time job with a respectable salary and benefits.

Or isn't "encourag[ing] older workers to spend a larger share of their increasing life spans in the work force" quite as simple as Mr. Porter believes?

Is the West's reckless lifestyle killing our poorer neighbors?

[Africa, with Tanzania highlighted]

I spent all day Monday in an outpatient clinic (I'm fine; thanks for asking). I met a lot of nurses, and every one of them was excellent.

When Velda came to take away the remains of my lunch, I offered her my untouched can of ginger ale.

"I don't drink soft drinks," she replied. Since I rarely do either, we started chatting.

Velda grew up in Tanzania, moved to Belgium, spent several years in London, and finally came to the United States. She returns to Tanzania regularly, and she is not happy with what she sees.

"I grew up eating lots of vegetables," she told me. "We might have had ice cream once every three years. But now people are eating American-style junk food. They don't know it's not good for them."

Tanzania's cigarette industry is big. In spite of national bans on most forms of advertising, Velda vividly recalls a huge billboard for Sportsman - one of Tanzania's most popular cigarette brands - right across from a school entrance where children can't help seeing it every day. And the children are smoking - she's seen them.

Supposedly regulated drugs are easy to buy without a prescription. Velda's 18-year-old nephew, once an honor student, is now a prescription-drug addict and a drop-out.

"The thing is," Velda said, "there's no way to get treatment for most diseases. It's not like here. If people want to be healthy, they have to take care of themselves. When they get sick because of junk food or smoking or drugs, they just die."

I checked the statistics. Tanzania's per capita income is $1700 in U.S. dollars. There is one physician for every 125,000 people (compare America's ratio of one physician for every 375 people; or Cuba's of one for every 156). Tanzanians live, on average, to age 53. Velda's twin sister died at age 23.

Velda, who is a kind and gentle nurse, gets angry when she thinks about what's happening to her people. "Why?" she kept saying. Why are international companies so aggressively promoting foods and cigarettes and drugs that will shorten people's lives and even kill them? Why is nobody stopping them? Why?

Advice for November 6: Choose your battle wisely

Vice-President Aaron Burr spoils his political career by
killing former treasury secretary Alexander Hamilton.

Yesterday during the Prayers of the People at St Barnabas, someone in the congregation spontaneously thanked God that the American election season is almost over. Everyone laughed.

One reason this election has brought out the worst in us is that we are fighting two battles at once. I fear that, no matter who wins the presidency, we will continue to fight these battles. We will probably still be fighting them in 2016.

We are fighting an economic battle between those who believe that the federal government should spend tax dollars on the military and little else, and those who believe that the federal government should also play a major role in assuring health care for all, supporting the indigent and elderly, rebuilding our infrastructure, and aiding disaster-stricken areas.

At the same time, we are fighting a moral battle between those who believe the federal government should allow individuals the freedom to decide whom to marry and whether to carry a child to term, and those who believe the federal government should outlaw abortion and recognize only heterosexual marriages.

The two major parties have divided up our concerns in unexpected ways. The Democratic ticket is communitarian in economics and libertarian in morals; the Republican ticket is just the reverse. This creates a problem for people who are consistently communitarian or libertarian.

A lot of students at Miami University of Ohio, as Bill Keller points out today in "The Republican Id," are consistently libertarian: they are enthusiastic about Republican economics but reject Republican morals. For them, economics trumps morals: the majority support Romney.

Most Catholic bishops, on the other hand, are consistently communitarian: they support Democratic economics but reject Democratic morals. For many bishops, morals trump economics (see David Gibson, "Catholic bishops make last-minute push for Romney"): they too support Romney.

The students are far smarter than the bishops.

If Romney and Ryan are elected, there's a good chance that federal programs such as Social Security, Medicare, and Medicaid will be gutted (click here for five good reasons to be worried, even if you're over 55), along with smaller programs such as highway construction, education, and food stamps. There's not much chance, however, that abortion or gay marriage will go away. Overturning Roe v. Wade would not outlaw abortion; it would return the question to the states. As long as a woman had enough money, she could simply travel to wherever abortion was available.

If you're a student at a highly rated university like Miami, you probably figure you'll be one of the elites that would be helped by Romney/Ryan economics. As one of those elites, you could find your way around Republican moral strictures. So yes, as long as you're not concerned about people who haven't done as well as you, it makes sense for you to vote for survival of the fittest. (In a decade or two you may discover you're less fit than you thought you were, but you can vote differently then.)

The Catholic bishops, on the other hand, are showing themselves to be as wise as doves and as harmless as serpents. Even if they get their way - in the name of religious liberty! - Americans will continue to use contraception. They will continue to marry or live with whomever they please. They will continue to get far too many abortions (though if abortion goes underground, a lot more women will die).

Catholic bishops have little effect on American morals (even among their own parishioners: click here to see statistics on abortion rates and here to see statistics on contraceptive use among Catholics), but if they tip the election to Romney/Ryan, they may have a major effect on American economics - an effect that goes against more than a century of Catholic social teaching. In the name of freedom and small government, more families will struggle to put food on the table, to send their children to college, to find adequate housing, to care for their aging parents. Americans will continue to die younger than people in countries with universal health care. Our highways and bridges will deteriorate, and environmental pollution will increase. We may tumble back into recession or even depression.

Here's my point. Our next president's policies will probably have a major effect on America's economic health and, very likely, the economic health of the world. His policies will probably have a minor effect, if any effect at all, on America's morals.

If you like Romney/Ryan's Darwinian proposals, if you think the financiers who are paying for their campaign will help the middle class, if you believe that trickle-down economics help the poor (or if you think the poor shouldn't be helped), if you think business can thrive in the absence of a strong infrastructure, if you think climate change is a hoax, and if you trust for-profit health insurance companies with your life, then by all means vote for Romney-Ryan.

Just don't think they're going to bring about moral renewal in America.

The best healthcare in the world

I have had only a few personal experiences with European-style healthcare, and they were a long time ago. A Swiss doctor gave me my pre-college physical. A British doctor looked at my adolescent face and prescribed skin cream. What I remember most--and what totally amazed my parents--was that the consultations and meds were free.

I thought no more about the differences between European and American healthcare until, middle-aged, I began working for a U.K. publisher. I was watching TV news one evening when a political ad came on. Cue the scary music, the dark screen. Do you want our healthcare to turn into a big ghastly mess like American healthcare? asked the portentous announcer. If not, by all means vote Labour. Save the National Health System.

Hmmm, I thought... I'd always heard we Americans have the best healthcare in the world. Is this any way to scare Britons?

Apparently, and it's a good way to scare Germans, Italians, the French, and any number of other Western Europeans as well.

Rachel's baby gets his
broken leg set in France

Want to know why? Read Rachel Stone's account of her family's experiences with healthcare in Scotland, Italy, France, Germany--and the United States.

"It should be within every person’s ability to take care of their health, and that of their children, without going bankrupt," Rachel writes. "I think the free market has had a fair shot at making that happen, and lost."

Ah, but Europeans pay awfully high taxes, don't they? Yes, but not because of their healthcare systems. The American government already spends a little more on healthcare than three of those four countries, even though, in addition, Americans fork over much more out of pocket.*

When you add government expense to private expense, American health care is 65% more expensive than France's and 100% more expensive than the U.K.'s. And for that, what do we get? Read Rachel's story. Here's the link again.
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*In 2006, the last year for which comparative data is available, the U.S. government spent $3074 per capita on healthcare. That's $135 more than the U.K., $265 more than Germany, and $880 more than Italy. Granted, though, it's $159 less than France. 

However, government expenditure is only part of the story. No country that I know of pays for 100% of healthcare; some of the funding comes from private insurers, and some comes directly from patients. In America in 2006, for example, our nongovernmental healthcare expense came to $3640 per capita. That's what we paid, on average, beyond the $3074 we had already paid in taxes.  Compare that with Germany's additional expense, $860; France's, $823; Italy's, $651; and the U.K.'s, $422.

(Data is from the World Health Organization.)

Rationing is not a four-letter word

This morning a friend wrote on Facebook about his expensive medications. He's grateful that Obamacare will make them more affordable. "I do have a twinge of bad conscience," he added, "about the cost of my health care coverage." Maybe death panels are a good idea?

Before cutting end-of-life care, I wrote back, we need to control costs. Otherwise "we are going to have to--gasp!--ration care, or soon only the very rich will be able to afford care at all."

A friend with osteogenesis imperfecta--and who has a child with the same condition--immediately jumped in. "Tell me more about what you mean when you talk about rationing care," she wrote. "As someone who requires fairly regular doctors' appointments just to function well, the idea makes me nervous."

The idea of rationing makes everybody nervous. Though one Merriam-Webster definition, "to distribute equitably," is what the propaganda poster above is trying to communicate, most of us think first of Collins's definition: "the process of restricting consumption of certain commodities." Hey, I need all of my office visits, surgeries, MRIs, echocardiograms, and prescription drugs. If my substandard aortic valve starts malfunctioning again, I don't want any bureaucrats telling me I'm  allotted only one surgical intervention.

OK, breathe deeply. Let's look rationally at that word rationing (the two words do have the same root, which has to do with "reason").

1. American healthcare is already rationed. That is, not everyone can have all the healthcare they want. My insurance is very good, but it doesn't cover eyeglasses, adult orthodontia, or cosmetic surgery (darn!).

A lot of people can't even have all the healthcare they need. Healthcare providers tend to be more abundant in areas of high population density and high average income, so people who live in rural areas may not be able to see a top cardiac electrophysiologist in the middle of the night when their tachycardia acts up. If they live in health professional shortage areas, they might have a hard time finding a general practitioner.

2. American healthcare funding is also already rationed. The government rations the amount it reimburses Medicare and Medicaid providers. Insurance companies ration reimbursements to healthcare providers. Before the Affordable Care Act kicked in, some insurers also denied valid claims from people who were getting too expensive, or else they dropped those people's insurance altogether.

The bottom line always wears a dollar sign. If you have enough dollars, your access to healthcare is limited only by your imagination. I doubt if there is any form of healthcare that Bill Gates (net worth: $66 billion) couldn't afford. Americans whose yearly income is in the lowest 20% (less than $27,000), however, can afford almost no healthcare without insurance--and a quarter of them are uninsured.

3. The challenge is to find an approach to rationing--i.e., allocating--public funds so as to make healthcare more, not less, widely available to all.

One way to do this is through policies that increase healthcare resources and distribute them more evenly throughout the country. Other developed nations do this in many ways, such as offering low-cost medical education so physicians aren't burdened with debt; limiting legal liability so insurance payments don't drive doctors out of business; using single-payer or streamlined private insurance systems so administrative overheads don't force medical clinics to double or triple their costs; and putting cost ceilings on medications and medical equipment.

At the same time, we need programs that reduce the need for expensive health repairs by keeping people healthy in the first place.  Adequate prenatal care, for example, can reduce expensive pediatric care for pre-term babies; and a healthy diet can prevent many cases of diabetes, heart disease, and cancer (note to Department of Agriculture: corn subsidies aren't helping).

But there are always more healthcare needs than healthcare funds ... even after we've increased healthcare resources and reduced the need for repairs. How do we ration our resources so that there is indeed "a fair share for all of us"?

Not by insisting that Bill Gates's healthcare must be no better than mine. Heck, his house and surrounding structures comprise 66,000 square feet, just a tad bit bigger than mine even including the basement. I'm guessing he eats in better restaurants and buys nicer clothes than I do too, and I expect he travels first class. That's what "rich" means.

So yes, rich people will get better healthcare than poor people, and people with good insurance will get better healthcare than people with barebones insurance or (heaven and the U.S. government forbid) no insurance at all. However, poor people also need shelter, food, clothing, transportation--and healthcare.

4. We need to get rid of our hypocritical notions about equality--which we aren't practicing anyway--and start thinking in terms of adequacy.

What if we had, say, a three-tier healthcare system? 

The foundational tier would be publicly funded; the patient would pay nothing. If you need basic medical care--an immunization, a routine diagnostic service such as a mammogram or a blood test, meds for a cold or a urinary tract infection--you go to your local pharmacy or public-health clinic and get it done. Such an approach can be wonderfully efficient, cutting out whole layers of bureaucracy.

The middle tier would be funded by private, not-for-profit insurance, which everybody would be required to carry (publicly subsidized if they can't afford it). This would include all other necessary health care--and yes, someone would have to draw lines between what is necessary and what is not. Not every possible treatment would be available to everyone who wanted it. This is rationing, to be sure. We're doing it now.

But if we've done a good job of allocating healthcare resources and reducing the need for repairs, we should have more money to go around rather than less. (For examples of how this is  being done elsewhere, see my August 29 post, "Four Countries That Already Meet the Republican Platform's Health-Care Goals.") My Facebook friend would still be able to meet her fairly regular doctors' appointments. In fact, if our reforms increased the number of physicians to a level similar to Western Europe's,* she might find it easier to get in.

The top tier would allow for unnecessary, but pleasant, healthcare. It would be funded by individuals either out of their own deep pockets or through for-profit insurance policies they've purchased. It could include things like private hospital rooms, private-duty nurses, the very latest designer drugs, face lifts, and hospitals with wood paneling and marble floors (sorry, CDH: I love you, but you do go overboard).

We Americans are smart. We could find a way to provide necessary medical care for everybody. Perhaps someday, when all our present Members of Congress have finally passed away, a totally new set of lawmakers will figure out how to do it. But first we're going to have to realize that rationing can be a tool used for the common good, or it can be a buzzword used to scare people who haven't noticed that haphazard rationing--our present nonsystem--is the cruelest approach of all.
_______________________________

*In the United States, there are 26 physicians for every 10,000 people. By contrast, there are between 27 and 35 physicians per 10,000 people in France, Germany, Ireland, Luxembourg, Portugal, Spain, and Sweden; and there are between 36 and 42 physicians per 10,000 people in Austria, Belgium, Denmark, Iceland, Italy, the Netherlands, Norway, and Switzerland.

Good government, bad government--"everybody's confused"

Before beginning the next paragraph, please click here and listen to Mavis Staples and Jeff Tweedy performing "Only the Lord Knows." If you haven't already bought the whole album - it came out two years ago - you really should. Especially during this acrimonious election season. (I commented on it here.) Mavis and Jeff knew what was coming in 2012...

I pick up the paper, I put down the paper,

Turn on the TV, I get confused.

People on this side say the people on that side,

They lyin', say they lyin'--everybody's confused.

OK, now imagine taking a dozen or so suburban Catholics--some of them staunch conservatives, others committed liberals--and making them talk to one another about public policy for two and a half hours every Wednesday evening during the two months leading up to the election. Give the group a sexy name, like "Living Solidarity: Government, the Federal Budget and the Common Good" (such a name keeps a group's size manageable). Ask them what they think the government does well, and what it does badly. Try to keep them from killing each other.

Actually things went surprisingly smoothly at my parish's adult-ed group last week. The moderator told us repeatedly and in manifold ways that we must be polite to one another, and we were, even when talking about government successes and failures. And then we learned that one of our assignments would be to strike up a two-minute conversation with a stranger, each week on a different topic. This week's homework: "Ask someone you don't know: What is something you appreciate that government does? What is something you hate about what government does? Be specific."

Oh, right. If someone standing in line behind me at Trader Joe's tried that on me, I'd ask him to watch my cart while I dashed back to the produce department to pick up more broccoli rabe. No way am I going to let some political nut turn my peaceful shopping expedition into a shoot-out. And no way am I going to turn myself into an agent provocateur either.

So I put my questions on my Facebook page, Madame Neff's Salon, and discovered that some people hate speeding tickets while others appreciate them. Other than that, here are the answers I got:

What is something you appreciate that government (federal, state, or local) does?
Emergency services like fire, police, and ambulance. The Post Office, which--unlike FedEx, UPS, or the Pony Express--is required to serve all areas of the U.S. Schools. A good legal system. Enforcement of laws and rights: property rights, religious rights, right to protest, freedom of speech. OSHA. The FDA drug review. Health care. Programs that help poor people and those who experience disasters. Programs that guarantee clear air, water, safe food, safe buildings, etc. Roads, transportation,some communication. A state program for at-risk children that offered subsidized physical, occupational and speech therapy for our son. Medicare.

What is something you hate that government (federal, state, or local) does?
Picky laws: Prohibiting plastic bags. Outlawing marijuana. Banning large sugary drinks. Banning smoking outside. Subsidies to private enterprise (tax breaks, funding research and development, etc.) without demanding repayment or a share of profits. Unnecessary war. War without the approval of Congress. The salaries of elected or appointed government officials. Torture.

If I got back in line at Trader Joe's, broccoli rabe in hand, and still had to answer the questions, I'd probably tell the pushy stranger that I really like--or would like--excellent public education, universal health care, Social Security, interstate highways, food security programs, regulations to protect the environment, regulations to keep financial institutions honest, family health-care leave, paid maternity leave... well, by the time I got to that many points here in Republican DuPage County, I expect my interlocutor would have scooted into another check-out line, as far from me as possible.

But if he stayed to listen, I'd also tell him that I really hate the way our government--federal, state, and local--promises so many of these good things but then refuses to fund them. On a more personal level, I hate the way so many Americans think we should have more services but lower taxes. Read, for example, Greg Sargent's article in the August 2 Washington Post, "Americans hate government, but they love Medicare, Social Security, and environmental regulations."

I'm looking forward to hearing my classmates' opinions. I think we can manage not to throw overripe fruit at one another, especially if we keep in mind Mavis and Jeff's call to humility:

What to do, what to do now?--

Only the Lord knows, and he ain't you.

Listen to them!

Romney's plan covers preexisting conditions - for the rich and the lucky

"You shouldn't have let his health insurance lapse."

For just a moment I thought Romney was actually moving toward the middle. On Sunday's Meet the Press he said he wouldn't get rid of all health-care reform. One thing he planned to do, he said, "is to make sure that those with preexisting conditions can get coverage.”

And then later, of course, his campaign clarified: He would make sure that those with preexisting conditions would be covered if they had continuous insurance coverage. In other words, he would continue to enforce the Health Insurance Portability and Accountability Act of 1996. Well, whew.

Yesterday Washington Post blogger Ezra Klein asked, "Who would be left out of Romney’s preexisting conditions plan?" Answer: "About 89 million Americans."

If you have a pre-existing condition, are covered by a good insurance policy, and qualify for and can afford a COBRA policy, you'll be OK for 18 to 36 months. After that you're on your own.

But people buy COBRA policies because they are out of work, and COBRA's rates are steep for the unemployed: about $500/month for an individual and nearly $1400/month for a family.*

If you have a preexisting condition and can't  afford COBRA, you could lose or be unable to get health coverage under Romney's plan:

• if you're the nonemployed wife or child of a man who retires or dies or loses his job
• if you stop working for several months to care for an aging parent or an ill family member
• if you lose your job due to serious illness or injury
• if you are unemployable due to mental or physical disabilities
• if you take an unpaid maternity leave
• if you're looking for your first job and you are not covered by your parents' insurance
• if your company decides to stop offering a health-insurance benefit
• if the only company who will hire you does not offer a health-insurance benefit
• if your company goes out of business, and it takes you longer than 63 days to find a new job

I understand why preexisting conditions must be tied to continuous insurance coverage: you can't have people signing up for insurance only after they've had the diagnosis or the accident. And indeed, preexisting conditions are tied to continuous insurance coverage in Obamacare (to use the Republicans' preferred term), in socialized medicine (to use another term they favor, even though they usually use it erroneously), and in those developed nations who finance health care through private insurers.

The difference between Romneycare and all those other plans is this: With the other plans, everybody has continuous insurance coverage. With Romneycare, you can have continuous insurance coverage if you can personally afford it, if you are able to work, and if you're lucky.

_______________________________
*In 2010 an individual policy cost $429 a month and a family policy cost $1170. Those are the latest figures from the Kaiser Foundation; since health-care insurance rates have been rising between 8 and 9% a year for several years, it is reasonable to assume that the average Cobra policy now costs about $505 (individual) or $1377 (family) per month.

Saving Medicare the Republican way

It's a promise: "A Romney-Ryan administration will protect and strengthen Medicare, for my mom’s generation, for my generation, and for my kids and yours." That's what Paul Ryan told the Republican National Convention last night in his acceptance speech.

How do the Republicans plan to do this? The Republican Platform spells it out: "The first step is to move [Medicare and Medicaid] away from their current unsustainable defined-benefit entitlement model to a fiscally sound defined-contribution model."

Right--that has worked so well for pension plans.

Once upon a time we were told that the 401(k) defined-contribution plans would let us retire rich. We could choose our own investments! No intermediaries would take hefty cuts! The miracle of compounding interest would do the rest!

But then interest rates tumbled, and financial institutions took hefty cuts anyway, and our houses lost a third of their value, and most of us forgot that we really needed to be socking away the maximum allowable percentage of our salaries if we planned to continue eating in retirement.

You might want to check out David Callahan's article, "A Perfect Failure: Why the 401(k) Has Been a Flop." Or you might just want to consider your own 401(k). Will you have saved a million dollars by the time you retire? That's how much you'll need if you want to draw out a modest $40,000 a year, and if you want your savings to last as long as you do.

Now ask yourself: do you really want an individualized, free-market Medicare along with your individualized, free-market 401(k)?

Soon-to-retire Boomers will remember a sentence reportedly uttered by an American officer in Vietnam: "We had to destroy the village in order to save it." That's pretty much how Mr. Ryan plans to save Medicare.

I do hope Messrs Obama and Biden come up with a better idea.