Round peg, square hole, health care edition

So Aetna is pulling out of Obamacare exchanges because the Department of Justice wouldn't approve of their merger with fellow healthcare provider, Humana.

This is what happens when you construct a system in which for-profit companies control health care delivery. Until someone has the fortitude to fight for a system in which the healthcare companies are taken out of the equation, health care will remain a privilege and not the right it should be.

My religion is more important than your health

When the US Supreme Court released its decision in  Burwell v. Hobby Lobby Stores, Inc. yesterday it pointed out yet another flaw in the delivery system for the Affordable Care Act. By yet another 5-4 decision, the Court held that family businesses and for-profit closely held corporations could opt out of providing contraceptive coverage for their employees if it went against the religious beliefs of the owners of the company.

As I have written before, the biggest problem with the ACA is that it left the current medical care delivery system in place. Thus, most folks are beholden to their employers for health care coverage. Rather than creating a program of universal health care, the ACA is nothing but a corporate welfare system for the insurance companies. They are guaranteed their profits while no one else even has a guarantee of coverage.

In Burwell, Hobby Lobby argued that the contraceptive mandate in the ACA violated the religious beliefs of the owners of the company. They argued that since religious non-profits were allowed to opt-out of contraceptive coverage that they should get to opt-out, too. Let's just forget for a second that Hobby Lobby is a for-profit company that employs over 16,000 people.

Let's also forget for a second just how specious the company's argument really is. It is of no concern to the owners of Hobby Lobby what their employees do when they go home at night. The last time I checked, there is no commandment telling folks not to have sex as often as they want - provided they aren't committing adultery. But I do seem to recall a commandment that says we shouldn't go around killing folks.

So, is Hobby Lobby also arguing that shouldn't have to pay that portion of their taxes that go to war-mongering? Are they asking the states to exempt them from that portion of their state taxes that go to pay for executing prisoners?

No, you say? Well that's awfully damn funny, ain't it?

So the fine Christian owners of Hobby Lobby have no problem with spending money to build war planes and guns and bombs and drones. They have no problem spending money to send troops overseas to shoot at people. They have no problem with remote controlled aircraft shooting missiles at groups of people. They haven't the slightest problem with strapping down prisoners and killing them with questionable drugs. But someone wants to put on a condom or take a birth control pill and the whole world's going to stop spinning.

Give me a fucking break.

Religious belief is the straw man in all of this. The real target is paring down the ACA so that companies don't have to provide decent health care coverage for their employees. The more watered-down the coverage offered by a company, the less money it costs them and the more money the top managers and owners can walk away with.

People who work for Hobby Lobby aren't working their because they share the same religious beliefs with the money-hoarding owners of the company. They're working there because they need a paycheck to pay the bills. More and more folks are forced to work for low-wage service companies because the manufacturing jobs are being shipped overseas in the name of higher profits.

What will be the next domino to fall? Which company is going to step up next and argue that they shouldn't have to comply with one provision or another of the ACA because it goes against some principle by which the company stands? And how many more workers are going to see their coverage pared down so that the owners of the company can put more money in their pockets.

As with most everything he has done over the course of his presidency, Barack Obama made a half-assed effort to appease those on the left. The ACA was a very cynical attempt to placate those who demanded a single-payer health care system that guaranteed coverage for all. The ACA will fail not because the wingnuts defunded it, the ACA will fail because the courts sanctioned a death of a thousand cuts.

The gospel of the corporate church

On Tuesday the Supreme Court heard oral arguments in the latest challenge to President Obama's tragically flawed Affordable Care Act. The antagonist this time was Hobby Lobby, the chain of craft stores, who challenged the law's mandate that employers provide contraceptive coverage for their employees.

To set the stage for yesterday's challenge, the Obama administration exempted churches and faith-based non-profits from the contraceptive mandate. That fight opened the door for for-profit companies to try to avoid the mandate.

Hobby Lobby is a closely-held corporation whose main owners are over-the-top superstitious devoutly religious. They are opposed to abortion and believe that the IUD and the so-called morning after pill are abortions by a different name. They sought to challenge the mandate on the grounds of religious freedom.

Now, before we go any further, I find it quite interesting that the first justification any group seeking to limit the rights of others is religion. That was the justification for the proposed law in Arizona that would give business owners the right to refuse to serve gays and lesbians. You see it wasn't because there are a bunch of bigots living in the desert, it's because they are all such devout Christians that they feel the need to discriminate against those who don't believe as they do.

Hobby Lobby's argument is that the law infringes upon the religious freedom of the corporation. Nevermind the fact that if Hobby Lobby had its way it would be forcing the religious beliefs of its owners on its employees. Apparently that's perfectly acceptable for the bible-thumpers.

There are three points that stick out in those arguments. The first is that religion serves primarily to divide people. Sure, we're fed the line that religion brings us all together but that belief couldn't be farther from the truth. Religion creates an us-against-them dynamic everywhere it's practiced. Christians engage in holy wars against Muslims. Muslims and Jews fight over miles and miles of sand. Catholics and Protestants argue about who's right and who's wrong. And bigots hold their bibles high in the air and argue in favor of segregation, racism, intolerance and prejudice. Oh, and pass the plate while you're at it.

The second point is the notion that corporations are people. Yes, the Supreme Court held in a 19th century case that a corporation is an artificial person for legal purposes. That ruling allows corporations to sue, and be sued, and allows the government to tax their profits. But corporations can't vote (though it is permissible after the Citizens United case for corporations to buy elections). And, I would argue, since a corporation is business structure in which multiple shareholders own the company and share in the decision-making and the profit-taking, and not a person, it is impossible for a corporation to be superstitious religious. Therefore, since a corporation is not a corporeal being capable of having beliefs, a corporation has no First Amendment right to freedom of religion.

My final point is this case, and the others that will follow, point out the reason the ACA is doomed to failure. The use of private employers and insurance companies as delivery devices for health care coverage is an idea that will never provide health care coverage for everyone. Health care is a human right and should not be conditioned upon one's ability to get a job or pay an insurance company for coverage. The decision to use that model will continue to fuel lawsuits against various portions of the law for years to come. Access to health care should have been severed from employers and insurance companies.

The only way to guarantee universal coverage is to eliminate the profit motive from the delivery system. As it stands right now, your health care options are dictated by bean counters sitting in the corporate suites of the health insurance companies and for-profit hospitals. Those decisions have everything to do with profits and nothing to do with your health.

Using Jesus to deny healthcare benefits

Last week Hobby Lobby pointed out the most basic flaw in the overhaul of our health care regime. For those of y'all who don't know, Hobby Lobby is an Oklahoma City-based craft store chain whose owners are devout (read: nutty as the pecan tree in my backyard) Christians who equate emergency contraception (the so-called "morning after pill") with abortion.

Hobby Lobby has appealed an adverse decision in federal court to the 10th Circuit Court of Appeals arguing that businesses should have the same right as religious institutions not to offer certain types of coverage in the health plans that cover their employees.

And therein lies the rub.

For all of the good in the Affordable Healthcare Act, it left our regime of employer-based healthcare coverage in tact. If health care is a basic human right then it shouldn't be tied to whomever you punch a clock for. If it's a basic human right the level of care you receive shouldn't be decided by the company who employs you, or by the mid-level managers of an insurance company.

"They ought to be able, just like a church, just like a charity, to have the right to opt out of a provision that infringes on their religious beliefs,'' said Kyle Duncan, who will argue before the 10th U.S. Circuit Court of Appeals on behalf of the Green family, the founders of Hobby Lobby Stores Inc. and a sister company, Christian booksellers Mardel Inc.

If health care is a basic human right, then it should be available to all regardless of income level or employment status. If you want to know why health care is so expensive in the United States, just take a look at the delivery model we use. There are so many folks with profit motives controlling who has access and what level of care they receive that the result is we pay far more than we should for far less health care that we should receive.

I couldn't care less about the religious beliefs of the owners of Hobby Lobby. They can be as superstitious as they want. However, their particular superstitious beliefs shouldn't affect the health care coverage their employees receive. Their employees chose to work there for a variety of reasons - including the need for a paycheck. To deny them particular coverage because it is somehow offensive to an employer should be offensive to all of us.

But so long as our healthcare coverage is provided by employers and supplied through insurance companies, we will continue to fight a rear-guard action to prevent our access to a basic human right from being whittled away.

Supreme Court upholds insurance industry bailout

Okay, people, it would appear that the world survived yesterday's Supreme Court decision on the Affordable Care Act. Of course you couldn't tell from the reaction of conservative commentators who seemed united in their message that this decision marked the end of Western civilization as we know it (not that would be a terrible thing).

The reality is that the Supreme Court did what the robed ones are supposed to do. They began with the premise that the law was constitutional. They looked for a provision that authorized Congress to require individuals to purchase health care coverage. They made their ruling as narrow as possible.

As to the merits of the individual mandate, the states have for years required motorists to purchase liability insurance on the cars they drive. The difference here is that it was the federal government requiring the citizenry to purchase an insurance product rather than the state.

But, having said that, the individual mandate amounts to the biggest chunk of corporate welfare in this nation's history. The real beneficiaries of the decision are the health insurance companies who will now get a new flock of customers to buy their over-priced products. Keep in mind that these insurance companies the government is trusting our health care to have failed miserably to keep costs down over the last 20 years.

What these companies have done is reduce benefits and services while at the same time increasing premiums and profits. This drive to squeeze out every possible penny in health care dollars will continue unabated as long as the government mandates that we purchase coverage from a private company.

The companies fought tooth-and-nail against the public option - realizing that should the keys to the health care system be handed over to the government, the days of milk and honey would be over. Instead, under the guise of providing coverage for the uninsured, the ACA will keep insurance company executives rolling in the dough.

Access to health care is a human right, but so long as the profit motive runs our health care system, the people will always be on the short end.

The economics of choice

Today the U.S. Supreme Court will hear the second day of oral arguments regarding the constitutionality of the individual mandate provision of President Obama's health care reform legislation. The question being posed is whether the government can require a citizen to purchase health care coverage under penalty of a financial penalty.

Now even those who don't like the legislation don't want folks with pre-existing conditions to be discriminated against by the for-profit health care insurers.

But here's the rub (and I have yet to hear Mr. Romney or Mr. Santorum explain just how they plan to get around this little bump in the road). If you forbid the insurers from denying coverage based on pre-existing conditions without everyone purchasing coverage you will end up with what's called negative selection. In other words, there will be an influx of new enrollees suffering from pre-existing conditions. Without an proportional increase in the number of healthy folks, the cost of coverage for everyone will increase because there are fewer healthy bodies in the pool.

The only way to prevent negative selection is to create a mechanism by which more people who aren't suffering from pre-existing conditions enter the pool of insureds. And the only way to do this is to mandate that everyone purchase coverage either through their employer or privately.

This is the problem Congress created by continuing to rely on employer-based health insurance issued by for-profit companies. A for-profit insurer will always be intent on reducing the amount per premium dollar being spent on actual health care. The lower that percentage, the higher the return for management and for investors. But, while Mr. Santorum and Mr. Romney will harp on the thought of a government bureaucrat making your health care decisions for you, you won't hear a peep from them about profit-maximizing corporate managers doing that very thing.

But is the individual mandate constitutional? Well, let's think about that. Our state government requires that anyone driving a car carry a minimum level of liability insurance. The state requires that we wear a seatbelt if we're riding in a car. The state requires that our children ride in car seats until a certain age. And let's not forget that the federal government forced states to raise the drinking age and lower the speed limit (back in the 70's) under penalty of losing highway construction funds.

I have no idea how the Supremes are going to rule but, should the Court strike down the individual mandate, the entire health care plan goes down in flames. And, if that happens, the only beneficiaries are the insurance companies.

Yes, it's going to cost some people more money to purchase health care coverage. But we all end up footing the bill when an uninsured person receives medical treatment - either through higher taxes to fund public hospitals or through increased fees at private hospitals to cover the charity care.

Does more of the same make any sense?

I heard portions of a Mitt Romney speech the other morning in which he urged folks to vote for him to put an end to the health care bill signed by President Obama.

Mr. Romney said that the American people didn't want bureaucrats in Washington making health care decisions for them. He said what we needed were more market-based solutions.

Really?

Just tell me, how many people walk around telling others how much they love their health insurance provider? Is it really better for your health care decisions to be made by executives whose job it is to maximize profits? Does it make sense for those decisions to be taken out of the hands of your doctor and placed in the hands of someone sitting in an office who has never seen you?

How has the market done with allocating health care to the American people? Does reducing benefits, raising premiums and denying coverage benefit anyone other than the health insurance executives and shareholders?

And, Mr. Romney, do you have any idea just how much health coverage costs these days? Just how do you plan on ensuring that folks can carry their own insurance with them from job to job?

The health care debate is the perfect example of the perversion of the New(est) Right. If you're not happy with the current state of health care, the solution isn't for the government to step in; the solution is even more of the same.

Does that really make any sense?

Book review: Deadly Spin

Wendell Potter was the chief PR flak for CIGNA until May 2008 when he walked away. He helped coordinate the health insurance industry's response to the Clinton health care initiative. He was the point man at CIGNA when Michael Moore released his health care expose Sicko. He helped craft the message that the health insurance industry wasn't part of the problem - they were part of the solution.

Now Mr. Potter is a crusader against the ways in which the health insurance industry has restricted and limited coverage for millions of Americans - while at the same time raking in huge profits.

His book, Deadly Spin, is an insider's account of how the health insurance industry works. It's also a tutorial in how to set up public relations campaigns - including the use of so-called "astroturf" groups; that is, groups that appear to be organized on a grass roots basis that are actually fronts for whatever industry is trying to protect its turf.

Mr. Potter thinks that public relations can be a useful, and beneficial tool, when used correctly. He believes that the health insurance industry, and its allies, misused the public's trust and bastardized ethical PR principles in its quest to attain higher profits.

The practices he denounces in the health care industry are the same tactics used in other industries facing regulation. Whether we're talking the soft drink industry, nuclear energy industry, coal industry or any industry facing scrutiny due to concerns over global warming -- the tactics are all the same. Read the book and you'll have more questions anytime you see an ad promoting an industry or decrying increased regulation.

I do think that Mr. Potter is a bit too Pollyann-ish with his belief that PR is a higher calling than just shilling for a company. The entire point of PR is to create an image in the public's eye that your client is a good neighbor, that your client is concerned about the well being of the entire community. Your job is to insulate that client when the shit hits the fan - which it inevitably will at some point.

There are no absolute truths in the PR world. Everything is a shade of grey and the job of the PR flak is to make certain that his client looks good in that shade.

Book review: Deadly Monopolies

I just finished reading  medical ethicist Harriet Washington's latest book Deadly Monopolies, a look into the world of the pharmaceutical industry.

Back in the good ol' days, universities and hospitals were the breeding grounds for new medicines. Researchers collaborated in order to find ways to fight common disease. Most new discoveries weren't patented because the research dollars came from the federal government.

That all changed in 1980 with the Bayh-Dole Act that allowed corporations, universities and hospitals to patent their discoveries even if the funding to conduct the research came from US taxpayers. At that moment, medical research ceased to be a race to find the cure and became, instead, a race to lock in profits. When that is factored in along with a newfound ability to patent genes, cell lines and other biological material, big pharmaceutical companies stood to make vast fortunes.

Along the way the concept of "informed consent" was cast aside as it was a hindrance to labs, hospitals and drug companies testing their wares on the public. So much for ethical considerations - we have money to print.

In the United States, hospitals across the country subjected patients to trials involving artificial blood. No one asked these patients if they wanted to participate in the study - if they happened to be taken to the right emergency room in the right city, they received the artificial blood.

The attempt may have been noble - as may have been the trials involving substitutes for saline solution for patients who suffered a traumatic injury in the field - but the method was not. The people who received the artificial blood were never consulted to determine if they minded being guinea pigs. They were never informed of the possible risks involved in pumping the artificial blood into their bodies.

In Africa the drug companies conducted trials of drugs to fight the scourge of AIDS. But there was a catch. In trying to determine how effective the new drugs were in fighting AIDS, the control group in the trial was given a placebo. That's right - some in the study were condemned to die while others received a chance to live.

In this country a test conducted under that dynamic would never be allowed. In order to test the effectiveness of a new treatment, the control group needs to receive the currently accepted standard of care. This gives researchers the ability to compare the effectiveness of the varied treatments. Under no circumstances should a person be allowed to die because he's been given a placebo.

Researchers argued that the trials were ethical because the current accepted standard of care in Africa for AIDS was no treatment at all. And, of course, none of the test subjects were ever told they might be given a placebo rather that the real drug.

If you're not irritated enough at the high cost of health care and prescription medications, after you read Deadly Monopolies, you will be.

County proposes plan to ration health care in case of emergency

If you're unhappy about the way your insurance company likes to question your doctor about the appropriate treatment for whatever ails you, you're going to love the new Harris County plan for dealing with a future flu pandemic.

After two years of drafting, the county is finalizing a plan on how to ration ventilators in the event of a flu outbreak the likes of which haven't been seen since the 1918 Spanish influenza epidemic that afflicted 500 million people and killed 50 million.

County officials have decided who will have access to a ventilator and who will be left to suffocate to death. Estimates are that a pandemic could cause over 10,000 residents to need a ventilator. Unfortunately, there are fewer than 400 unused ventilators in the county.

The Harris County plan notes that many patients with bird flu have required mechanical ventilation within 48 hours of hospitalization. In the event of a severe pandemic event, as many as 10,231 infected Harris County residents would need ventilators, the plan says, a number in addition to those already on ventilators for other conditions. Typically, there are less than 400 unused ventilators in Harris County at a given time.

Under the county's plan, folks needing the use of a ventilator would be placed into one of three categories: (1) patients who are healthy enough to recover without the use of a ventilator, (2) patients who are so sick that a ventilator won't matter and (3) patients who are sick but will recover with the use of a ventilator.

But it won't be the treating physician who will make that call. Nope. Say hello to the hospital review officer. That's right. A mid-level manager will be making those life and death decisions for you should you find yourself in need of a ventilator. After all, we can't possibly leave those kinds of decisions in the hands of medical professionals who have trained for years in the art of diagnosis and treatment - they'd just want everyone to have a ventilator. We need a bureaucrat with a pocket protector to work the calculus to determine who lives and who dies.

Lisa L. Dahm, an adjunct professor at South Texas College of Law, suggested that, in order to avoid lawsuits, county officials should push to suspend laws that require doctors to treat their patients with life-threatening conditions. Way to go, Ms. Dahm. Just brilliant how you took the focus off the ethics of a hospital administrator playing God to focus it on how to reduce the county's liability when someone's grandmother dies because the plan says she doesn't get a ventilator.

"These are difficult conversations none of us like to have. But the reality is, in a severe pandemic, there'll be serious shortages of medical resources and it behooves us to make the best possible ethical and clinical deliberations in advance about who should get them." -- Dr. Herminia Palacio, Director of the Harris County Health Department

In an ideal world we'll never know the public's reaction to the plan because the dreaded flu pandemic will never come. But, the increased use of flu shots will only serve to strengthen the resistance of the virus (much like gonorrhea has overpowered our arsenal of drugs). Oh, that damn law of unintended consequences can be such a bitch sometimes.

The public was invited to participate in the discussions and each participant received $75 per day. Would the fact that these meetings were held during a time when there was no fear of a pandemic affect the discussions? Would the fact that participants received a small stipend have an effect on the outcome of the meetings? William Winslade, an ethicist with the University of Texas Medical Branch thinks so. Hey, it's easy to toss around ideas like that when there's no pandemic in sight. And who would complain when they're getting paid much better than jurors to sit around a table and discuss the issue?

It's interesting that this plan is being drafted by unelected officials instead of the commissioners chosen by the people to govern the county. Is that because Ed Emmett and company don't want to take the heat from residents about rationing health care in case of an emergency? One would think that elected public officials who are paid by our tax dollars would have enough integrity to take a stand.

But, I've learned over the years never to start a sentence with the phrase one would think.