Hip hip hooray for Belgium!

Opponents of Obamacare like to talk about how long it takes to get a hip replacement in, say, Canada (even though the Affordable Care Act is nothing like the Canadian health plan). Let's put this in perspective. How about a system that charges so much that some middle-class insured people can't afford a hip replacement at all?

Unless they fly to a Western European country with "socialized" medicine and pay out of pocket. Check out this story about Michael Shopenn, a man whose artificial hip was manufactured in Warsaw, Indiana, "a global center of joint manufacturing." Shopenn, who had health insurance, could not get coverage for a hip operation because his insurer deemed it a pre-existing condition (note: that should no longer be a problem now that we have the ACA). So he ended up flying to Belgium.

A Belgian citizen with no supplementary insurance would have paid only 25-50% of what this American paid for "not only a hip joint, made by Warsaw-based Zimmer Holdings, but also all doctors’ fees, operating room charges, crutches, medicine, a hospital room for five days, [and] a week in rehab." And the Belgian would not have had to add airfare to the rest of the cost.

But for Schopenn, the Belgian tab was a good deal--far, far less than he would have paid in the U.S., and no more than his co-pay would have been if his insurer had been willing to cover the surgery.

If you're curious about Belgian healthcare, you can read about it here.

And yes, Belgian taxes are high. But if you total up American taxes (income, Social Security, Medicare, property, sales) and add them to the cost of American health insurance (what you pay and what your employer pays), you may notice that we Americans are spending a lot of money for our services, too, whether we can afford to use them or not. Maybe even more than the Belgians.
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I put "socialized" in scare quotes because that's the word Obamacare detractors love to use, even though it's wildly inaccurate. Belgian healthcare is actually based on mutually owned insurance companies that compete for state funding based on membership. A high percentage of the hospitals are private.

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.

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.

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*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.