Monthly Archives: June 2009

Dinosaurs should be extinct

2ijpxr4Try living with them and you’ll trampled or eaten. One of the many notable dinosaurs surviving today is the health insurance industry. They are really big. Have voracious appetites. And their sole purpose is keep you alive just long enough to eat every dollar you have.

Way back in the World War II era (before the internet began recording history), these dinosaurs began roaming the US as result of the wage freeze during the war. Employers saw it as way to scam the freeze and attract employees when employees were scarce. By the end of the war, employees loved these cute little scaly creatures (Yabba-Dabba Do). They didn’t eat much back then, but as we started feeding them, they started growing and got bigger and bigger. They began eating each other and fighting over the food supply – us. Thick skinned, with no known predators, lots of lobbyists and seemingly impervious to regulation, they have continued to grow to their enormous present-day size. They also seem to have a particular love for the food in the South.

Quoting researchers at the Johns Hopkins Bloomberg School of Public Health (Click here for the full report), SouthernStudies.org, says the “Health insurance industry monopolizes the South. According to the report, insurer consolidation also disproportionately disadvantages rural states. In several rural states across the nation the two largest health insurers control at least 80% of the statewide market. In Alabama, for instance, the biggest insurer holds 89% of the statewide market, the highest rate in the nation for a single company. Even more populous states in the South have serious market concentration problems; Virginia’s largest health insurer, for example, controls a 50% share of the statewide market.

The combined market share percentage of the top two insurers in each state in the South:
Alabama – 88
Arkansas – 81
Florida – 45
Georgia – 69
Kentucky – 69
Louisiana – 74
Mississippi – n/a
North Carolina – 73
South Carolina – 75
Tennessee – 62
Texas – 59
Virginia – 61
West Virginia – 54

”In the past 13 years, more than 400 corporate mergers have involved health insurers, and a small number of companies now dominate local markets“ – HCAN

“94 percent of insurance markets in the United States are now highly concentrated, and insurers are thriving in the anti-competitive marketplace, raking in enormous profits and paying out huge CEO salaries“ – The American Medical Association

”Health insurance premiums have skyrocketed, going up more than 87% on average over the past six years“ – The Department of Justice

From blog.AFLCIO.org and quoting a letter to the Department of Justice’s Anti-Trust Division, Richard Kirsch, HCAN national campaign manager, and David Balto, former policy director of the Federal Trade Commission and now senior fellow at the Center for American Progress, writes: “Simply put, the private insurance companies have secured monopolies or tight oligopolies and exercised that power to put profits ahead of patients….There were no actions taken against anticompetitive conduct by health insurers in the last administration, in spite of the fact that cases by state attorneys general have secured massive fines against these insurers. A lack of antitrust enforcement has enabled insurers to acquire dominant positions in almost every metropolitan market.”

Extinct in most of the world, the cost of maintaining these dinosaurs has soared.

According to the National Coalition on Health Care:

  • In 2008, total national health expenditures were expected to rise 6.9 percent — two times the rate of inflation.
  • Total spending was $2.4 TRILLION in 2007, or $7900 per person
  • Total health care spending represented 17 percent of the gross domestic product (GDP) – compared to 10.9 percent of the GDP in Switzerland, 10.7 percent in Germany, 9.7 percent in Canada and 9.5 percent in France.
  • U.S. health care spending is expected to increase at similar levels for the next decade reaching $4.3 TRILLION in 2017, or 20 percent of GDP.
  • The annual premium for an employer health plan covering a family of four averaged nearly $12,700.
  • The annual premium for single coverage averaged over $4,700.
  • Health care spending is 4.3 times the amount spent on national defense.
  • Health insurance cost in the United States have been rising four times faster on average than workers’ earnings since 1999.
  • The average employee contribution to company-provided health insurance has increased more than 120 percent since 2000. Average out-of-pocket costs for deductibles, co-payments for medications, and co-insurance for physician and hospital visits rose 115 percent during the same period.
  • National surveys show that the primary reason people are uninsured is the high cost of health insurance coverage.
  • A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses.Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.
  • A new survey shows that more than 25 percent said that housing problems resulted from medical debt, including the inability to make rent or mortgage payments and the development of bad credit ratings.
  • Retiring elderly couples will need $250,000 – $300,000 in savings just to pay for the most basic medical coverage.
  • The United States spends six times more per capita on the administration of the health care system than its peer Western European nations.

64022626_711ca081eeWe obviously need a dragon slayer. We need to kill these evil beasts off once and for all. We cannot afford to wait. They will eat us all. Write your congressperson. Demand single payer and enforcement of our anti-trust laws. If for no other reason, do it because dinosaur farts contribute to greenhouse gases and some believe brought on the last ice age.



Over Stimulated in Atlanta

Post_PropertiesDon’t get me wrong. I’m all for the stimulus bill. I think it is absolutely appropriate for Washington to replace the imaginary money lost on Wall Street with imaginary money from the treasury.

Don’t get me wrong. I know they have to spend it on something. Roads are easy. Might as well add a lane or two everywhere. It means jobs, which means people can eat. And, I love the hardworking people we have invited from other countries to do the work. It’s just, well, I really don’t like the inconvenience of the construction delays.

I think it might have been much better for all of us if the stimulus bill was just spent on government buildings. For instance, why not rebuild the Capitol, the White House and the Treasury Building? Do the same at the Stock Exchange. Yeah, they’d have to tear the buildings down first. Then it would take years to rebuild. Couldn’t that be wonderful? They’d be soooo inconvenienced. It would be years before they screw us further. We need a local stimulus, too, so we could do the same in each of the states and our cities.  That could be even better.

This morning (Saturday), the workers appeared on the scaffolding outside my window promptly at 9:05 AM. They won’t leave until about 6:00, unless it rains. They have been at it for almost three months and will be here at least another two. They are wonderfully hardworking, respectful and well-mannered young men. No, none of the 120 workers on the crew are female. A handful do speak English, but mostly it is a Spanish lesson for us.

They are repairing the building I live in because the owner needs to sell it (Post Properties; current stock quote). Something about a bad economy, a depressed stock price and needing to raise cash. They tried hard last year to dump it, but the windows weren’t flashed correctly and there was some wood damage under the stucco in a few places. The section of the building I live in was perfectly fine, but they replaced the doors, ripped off the stucco, re-flashed, re-insulated, etc. anyway. Made a real mess. Loud. Dirty. Stressful. No privacy. No views. Makes me angry to walk down the hall and feel the crunch of construction debris under my feet. To see the security doors wide open. To hear the saws and the hammering. I truly hate them for it. Good for the economy, I guess. Just not convenient.

I talked with some of the workers about it. I asked what it is like to tear down a perfectly good building and build it back? The younger workers looked to the older ones for signs of how to answer this Anglo. They smiled and nodded politely. Laughed. Waited patiently to see if I were going to continue asking them questions in a language they didn’t understand. I knew I was talking to myself, but they were the only ones who would listen.

The stimulus spending will start most everywhere soon. You’ll learn what it is like. Inconvenient, but good for the economy.

Saving the airline industry

obama-high-speed-rail-plansThe airline industry is in deep trouble. The planes flown today were not manufactured in enough powerful Congressional districts and lobbyists prefer their own jets.

I drove 14 hours last weekend to visit family. I try hard, but I’ve never been a very good driver. I hated almost every moment. I like cruise control, but there are way too many other cars driving way too many different speeds to use it. I cursed as I drove. Not at the other drivers. I have too much empathy for that. No, I cursed that I had to drive. I cursed because there were no trains to get me there and back safely – and with a lower carbon footprint.

Sure, I could have flown, but mercy, do you pay a price for the privilege? The tickets, the tax, the advance planning, the trip to the airport, the x-rays and the strip search, the lifting, the lugging, the running, the waiting, the lines, the small pouches for liquids, the overhead bins, the numbness in my extremities, the shared air and shared germs, the stress of monitoring the bathrooms, being separate from my phone, remembering the safety instructions. No, I chose to drive it.

Like Robert Coram, I long for a time that once was, but for different reasons than in his parody. I long for a time when the airline industry was regulated, safe and allowed a profit. Run with the efficiency of old-time public utilities. Their employees were adequately compensated and brought union-ensured competence. When maintenance was absolute. When my ticket was currency that could be traded for another ticket that would get me there. When my greatest problem was the drunken businessman staggering with a long cigarette ash – okay, I don’t miss that and it did happen more than once on every flight.

Problem was, it didn’t last. Powerful people with powerful connections saw an opportunity to “deregulate.” Code for busting unions and opening up juicy opportunities for cronies. The promise of a better deal for all, through market-based regulation and highly leveraged mergers that benefited investments firms worked just as well for the airlines as  it did for banks. The memory of being on Eastern’s last flight from Miami to Atlanta and shared tears of employees and passengers are still with me. A scene repeated for so many of the great airline companies, their devoted passengers, their shareholders and their hub cities.

Transportation has long been out of kilter in the US. We went along with the world’s model for a while. We were just too big, too greedy and shortsighted to notice when we got off track (intentional).

The rail industry was developed by private business and was very profitable. They lived in peace for a while with the car, the bus and later the airline industry. But then we messed with tax policy (1932). The Federal excise tax to create a “trust fund” to build roads – roads, of course, to benefit the real estate developer, to enlarge the property tax base, create suburbs and the service industry. A tax that increased over time, but could never used for another purpose. With unfair car-favored transportation tax policy in place, the car won. And in the next 80 years, we have laid a lot of asphalt. But almost no rail.

What’s this got to do with the airline industry? A lot, but it takes a leap of logical thinking. Cars are ideal for short trips when mass transportation is not available. Even slow trains are ideal for medium trips, a few hundred miles – if they would just go where you want to go when you want to go. Airlines travel at current prices, however, can only be efficient and profitable for longer distances.

The combination of huge spending for roads and no spending for rail meant that we tried to make airlines work for the missing link of medium trips. The trips when the cabin service is provided as you de-plane. The trips that create the congestion and delays. The trips that are popular at the local chamber of commerce, but the carbon-footprint brings tears to Al Gore’s eyes. The trips that are sold by the airlines below cost so they will connect for longer profitable flights. The trip that made me drive last weekend.

The way to save what’s left of the airline industry is by laying rail. Busting the trust fund and investing in mass transportation and high-speed passenger rail. Creating intermodal infrastructure to connect mass transportation to train to airports and back again. And by regulating transportation like the utilities they should be.

Do that, and there will be investor financing. Jobs. A stable stock price. Shorter security lines. Perhaps a return to more leg room. Happier passengers. And I can quit driving. We’ll all be better and safer for it.

Be careful what you wish for

mosquitoThe drought is now officially over. With the return of normal rain patterns, Sonny’s prayers have been answered. Most of the lakes are full with the stumps covered and the docks floating. Our lawns are green and the sprinklers are back on automatic. We are free to flush. Hallelujah.

They’re baaaack. With all the wishing and hoping, you might have forgotten what had made our Southern nights so wonderful these last few years. You won’t for long. Close your screen doors. Grab your insect repellent. Light your citronella. Fire up your fogger. The dreaded state bird of all the deep South, Diptera: Culicidae (aka: mosquito) is laying eggs and sucking blood like we haven’t seen in years. Yes, be careful what you wish for. Mother Nature can be a bitch. Though she’s got a heck of sense of humor.

Click here to get your local mosquito forecast.

Change we can only believe in

carrier5America was founded on change, wasn’t it? Why is it so hard to change now?

Didn’t our fore-parents unabashedly give up their lives in the old world for a new start in a new land? Not really. While some adventurers and liberals came for the promise of a new start and riches in this new land, more came to escape their struggle against the monarchs and entrenched power of the old world or to escape religious persecution. Others came as indentured servants or to escape debtors prison. Many more were forced to come as slaves. Change is hard. Seldom voluntary. Often forced. And, typically, when other choices are worse, or no longer possible.

We like to give lip service that we are open to change, but we fight to our deaths to maintain and protect what is known and comfortable. It is human nature. We will work harder to not to lose something (pick one or more: ❑ money; ❑ power; ❑ possessions; ❑ prestige; ❑ love; ❑ status quo; ❑ beliefs; ❑ big cars ; ❑ guns; ❑ private health insurance; ❑ farm subsidies; ❑ political party affiliation; ❑ immigrant labor; ❑ electoral college; ❑ air and water pollution; ❑ oil subsidies; ❑ import taxes on sugar-based ethanol; ❑ tax cuts for wealthy; ❑ disposable containers; ❑ long patent protection; ❑ no regulation of hedge funds; ❑ no real regulation of Wall Street; ❑ miserly minimum wage; ❑ predatory credit card charges; ❑ alternative minimum tax; ❑ off-shore tax havens; ❑ tax subsidies for highways; ❑ stem cell research; ❑ drilling, mining and timber harvesting in our parks and wilderness areas; ❑ seldom disclosed stock options and exorbitant executive compensation; ❑ policies toward the southern hemisphere; ❑ Cuba policy; ❑ wall at Mexican border; ❑ Predator drones bombing civilians; ❑  independent contractors in war zones; ❑ no-bid Pentagon contracts; ❑ military weapons development we don’t want or will use but are in multiple states protected by Congress; ❑ domestic spying; ❑ exporting weapons; ❑ detention without trial; ❑ torture; ❑ genocide; ❑ nuclear proliferation; ❑ airport security lines; ❑ voter ID cards; ❑ polls only open on Tuesday; ❑ green lawns; ❑ war on terror; ❑ spam, etc.) than to change something, even when it is in our best interest. And the more you have or the longer you’ve had it, the more ferociously you’ll fight.

Our business leaders and politicians know this (so does cable news). They know how easy it is to create a constituency against change than for change. Just play the fear card. Turn on that primal fear of change and logic loses its voice. Facts become suspect. Us against them. Join the mob and kill the monster.

If change is so hard, how does it ever happen since we no longer persecute religious preference, have debtor prisons, monarchs, entrenched power, slavery or the opportunity of a new land? Good question. Coke got rid of sugar just by not telling us. Ditto smaller amounts of potato chips per pack. Digital TV passed because they made it so far in the future that no one cared (the future is here and it is too late to care). Poisonous drugs get removed from the shelf when we find out that enough of us have died. Ditto toxic waste. Election laws changed when enough people took to the streets. It took a war to end slavery and may take another one to end economic slavery. It took the depression to regulate banks, but only took the promise of an unlimited expansion to deregulate them. It took Al Gore to give us the internet, Bill Gates and Steve Jobs to get us computers, but it took porn sites, Facebook and Craigslist to get us high speed access. It took Bush and McCain to give us our first non-pink President. And, the almost-great depression to give us the economic prozac of TARP and the stimulus.

I haven’t answered the question of change ever happens. I “believe” change takes some combination of strong leadership; faith; common sense; promised treasure; compromise; luck; timing; spin; good marketing; patience; and the absolute promise of all out voter retaliation. Speaking in April to students in Turkey, President Obama said of change, “States are like big tankers. They’re not like speedboats. You can’t just whip them around and go in another direction. You turn them slowly, and eventually you end up in a very different place.” Have we started turning, yet? It sure looks like we’re heading nowhere.

Suggested Reading:

The healthcare system is killing us

ilanakohn_sketchForbes, yes, Forbes, reports today on a new study finding that “medical problems and expenses contributed to nearly  two-thirds of all bankruptcies in the United States.”

In fairness, the American Journal of Medicine, Harvard Law School, Harvard Medical School and Ohio University study used data from 2007 and, according to the researchers, was “collected prior to the current economic downturn. It’s likely that the current rate of medical-related bankruptcies is even higher.”

Those of you who haven’t experienced how this can happen to “solidly middle class” people with jobs, insurance and college degrees, get ready. You will.

Generally, what happens first, is that you go to a doctor. Your financial advisor and the health insurance industry strongly discourages this step. After co-pays, deductibles, tests, more co-pays, referrals, uncovered expenses, out-of-network anonymous radiologists and labs, and more co-pays, you find out that you are sick and need treatment for something. Researchers estimate that the likelihood you will at some time see a doctor and find you are sick is 99.95%.

After a generation or so of cruelly strategic lobbying by the extremely profitable health insurance industry, your health care system is set up as a war of attrition. By severely limiting physician reimbursements for a patient visit, you are lucky to see a doctor for more than a few minutes. You are, however, likely to wait a month or more for the appointment and an hour or more in various waiting rooms.

With expenses for the office, practice insurance, professional staff and paperwork specialists, your doctor simply cannot afford to see you, test you and treat you in a single visit for $53.50. Your insurance company prefers a system requiring the scheduling expensive tests for diagnosis and subsequent treatment appointments on the theory that you will either get better on your own, run out of money for the deductibles, co-pays and non-covered expenses, or just die.

The only exception to the rule, is gun shot wounds. Our system works really well if you are bleeding in the waiting room.

Once you get in the system, it can easily take years to find out what is wrong and treat you. During that time, you’ll miss a lot of work. Even while at work, you’ll feel like miserable, your mind will be elsewhere and you will wish you were. Eventually, your employer will announce a “strategic restructuring” and you will be out of job. You will be able to keep that lousy great insurance at a much higher cost for a few months before you lose it. Then you’ll have a preexisting condition. Just try and find another job while you are sick and have a public record of a pre-existing condition – no company will ever hire you with benefits again. Next, your credit goes to hell. The credit card companies raise your rates to 30% or so, plus whatever fees they wish especially if they have been spying on your purchases and notice you no longer buy luxury, only meds. Your spouse will lose work time taking care of you and will risk your fate. You will lose your home and declare bankruptcy. This is what happens in America.

“Our findings are frightening. Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy,” lead author Dr. David Himmelstein, an associate professor of medicine at Harvard Medical School, said in a news release from the Physicians for a National Health Program.

“For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse. And even the best job-based health insurance often vanishes when a prolonged illness causes job loss — precisely when families need it most. Private health insurance is a defective product, akin to an umbrella that melts in the rain,” Himmelstein said.

When your Congressperson speaks on CNN or Fox about your right to choose private health insurance coverage, keep in mind that what they are really saying is: Keep those campaign contributions coming and I’ll sell the chumps I represent on the idea that they already have truly great coverage as long as they are healthy. Who cares what happens went they eventually get sick? They’ll be broke, powerless and dead soon enough.

Related:

The illustration is a sketch by Ilana Kohn from IlanaKohn.blogspot.com

If we love it, we must set enterprise free

cropped_1063237Every parent knows what I’m talking about. That moment after the moment when your toddler lets go of your hand. Or you let go of the bike. Or you don’t run to the rescue when you hear the crash. Or they go under water for the first time. Or you don’t say, “did you remember to do your homework?”

Sure, there’s fear. But don’t let them see yours. Self-reliance. The most critical step in development. The proud moment. The most natural of all coming-of-age’s moments. It is repeated billions of times each day by nature’s parents. Baby birds take wing. Tiny seals slides down the ice and disappear into the water. And humans hand their teenagers the car keys.

We are all amateurs in this – and so codependent. Letting go only to grab on again because we fear the fall. Running to rescue.  Comfort before tears. Galoshes at the chance of rain. And in each of these moments, we teach our fear. We teach the limits. We stunt development. We give extra points for security in the poker game with reward. We deny the very experience that must be learned. Repeat this long enough and they will never be healthy on their own. Inevitably, they will end up as wards of the state.

I am not without empathy, but I am running short on sympathy. I have just heard too many excuses for why they can’t hack it. How it is unfair for them to compete with others when life has been so unfair to them. I have let them puke their self-absorbed fantasies in front of me too often. Heard the wretch of their indulgent rationalizations of why they can’t develop methods to cope.

I’m writing, of course, about big, entrenched, widely-held-on-Wall-Street, K-Street-represented, American businesses. The companies too big to fail and the industries too important not to be given transfusions of money, tax-breaks, incentives, regulations and/or de-regulation. What we did for textiles, steel and cars, surely, we can do for them. Screw the people who will have to work their asses off for their entire miserable lives by scraping the bottom of the barrel for basic needs while tithing taxes and being priced-gouged in order for these companies to live in luxury, worry-free.

On the other hand, maybe big business does deserve a break. They are, after all, a bunch of bastards and had no role models to teach them right and wrong, honest work for honest pay, or healthy self-reliance.