Month: November 2013

Health Care Reform Bibliography

I promise to publish part 2 of the substance of this multi-part thread soon, but I wanted to get this out there, as a general link to some good sources for more information on health care and the Affordable Care Act.  I’m sure there are many more sources, but these are some I’ve found to be quite helpful.  I’m including a short description to help you understand the source, so that you can consider  the source’s bias as you’re reading.  I encourage everyone to always read skeptically, and always to consider the source, so you can determine their bias and weigh their message accordingly.

So, in no particular order (man, it’s great to be out of Grad School!  No rules!):

The Affordable Care Act of 2010.  The whole thing (actually, this is a compilation of the ACE and the Patient Protection Act.)..  All 900+ pages (don’t let it intimidate you, there’s lots of white space) in searchable PDF format.  I have not read it all; I am somewhat skeptical of pundits who claim they have.  I’ve had many years of practice at reading government regulations and laws, so I’m somewhat immune to the boredom they bring, and I couldn’t do it, and quite honestly didn’t find it fruitful to try.  For those who are not in the business of health care who claim to have read the whole thing, I would love to test their comprehension of what they read.  I found it much more productive to drill down into topics I was wanting more info on, either through the table of contents, or through PDF search functionality.  Some search hints:

  • If you look for “Death Panels” you’ll come up empty.  What Sarah Palin refers to by that catchy moniker is titled the “Independent Payment Advisory Board.”  Search the PDF by that term instead.
  • Brown Shirts:  Not there.  There is a section on page 543 (Sec 203) titled “Commissioned Corps and Ready Reserve Corps” that modifies existing law authorizing the existing US Public Health Service Commissioned Corps, which has been around in current form since shortly after the Civil War.  (If you think this is Obama’s secret army, akin to Hitler’s Brown Shirts, I wouldn’t worry too much.  Their “commanding officer” is the US Surgeon General; and the few interactions I’ve had with these folks have clearly demonstrated that Bill Murray’s platoon in Stripes had more military discipline.  These guys may be good doctors, nurses, and health care professionals, but I’m more intimidated by Girl Scouts selling cookies at my door than I am by the threat of any of these folks.).  More recently, people are linking Obama’s Brown Shirts to FEMA, but that’s outside the scope of the ACA or this post.

The Kaiser Family Foundation: This is a great site with a ton of information, and their data is good enough that their pricing indexes are used in some places as an industry standard (this is from my personal experience in labor contract negotiations, where we needed a health insurance price index to include in contracts.  I can’t comment as to how widely spread this usage is).  They bill themselves as trying to be a trusted source of information in a space where most sources have a vested interest.  They’re set up to try to minimize outside influence.  I’m not going to claim they’re unbiased, but they seem to do a very good job of providing the facts, and presenting the data so one can analyze it for oneself.  They certainly are thorough in their coverage and analysis; you could get lost for days on this site, and learn more than you ever wanted to know.  They also keep it very fresh, with current insight and analysis.  This page details their CEO’s perspective on KFF’s approach to the ACA–if you want to dig a little deeper.

Centers for Medicare and Medicaid Services website.  This link actually takes  you to their National Health Expenditure Data page, but this is a good site to get federal government “official” data on health care information.  Yes, they’re the federal government.  I’m not asking you to blindly trust the government, but I don’t recommend blindly dismissing them either.  They’re a good source of data.  If you’re convinced that their data is corrupt and deliberately skewed to deceive, I’m not sure what to tell you, other than you should be as skeptical of every other source.

Health and Human Services Agency for Healthcare Research and Quality Another federal government website, but a source for data on health care in the US.  Some pretty detailed data here, and it’s not the easiest site to navigate, but if you want to find a particular nugget, it’s probably here somewhere.

Health Affairs (online journal):  Quote from their “About” page:

Health Affairs is the leading journal of health policy thought and research. The peer-reviewed journal was founded in 1981 under the aegis of Project HOPE, a nonprofit international health education organization. Health Affairs explores health policy issues of current concern in  domestic and international spheres. Its mission is to serve as a high-level, nonpartisan forum to promote analysis and discussion on improving health and health care, and to address such issues as cost, quality, and access.

Good info from a peer-reviewed journal; problem is that only the content from more than three years ago is free.   Unfortunately, most of the pertinent info on health care reform and the ACA has been published in the past 3 years, and I didn’t want to pony up $144 to read it.  However, you can get the key talking points of those more recent articles from the abstracts.

“The Clock is Ticking. More Americans Losing Health Coverage”  Families USA: Washington DC, July 2009.    I pulled some statistics from this report, that gives data on the status of private health insurance access prior to adoption of the ACA.  This site is definitely supportive of the ACA.

I’ll probably embed more specific article links within the text of the posts, but this ought to get you started in your research.  I’m not claiming all of these are perfect, and that you should trust them blindly, but instead that they are good starting points to inform yourself, rather than just believing sound bites, emails, and blog posts (even mine!).

Seek first to understand…

With fear and trembling…

I’ve been preparing to write this post for months, and putting it off for the last several weeks.  Truthfully, I don’t want to write it, because I’m actually expecting a lot more backlash and disapproval than I expected (but surprisingly, didn’t get) from my most-read post:  “The Post That May Just Offend Everybody.”  But I’ve been alluding to writing about this for some time, and have done a lot of research in preparation, in hopes that I can present a clear, detailed perspective that just might clarify one of the biggest issues facing our nation right now.  That, and I think this is one of those ones that God told me to write (OK, truthfully I know God leads me to write all of these, but this one seems to be one he won’t let up on).  So, with that ominous introduction, I will attempt to share my understanding and position on the Affordable Care Act (ACA). (1)

Bear with me on this one, I beg.  I know it’s all over the news, but I’m hoping I can provide some reasonable perspective.  I won’t claim to be totally objective, or unbiased, because I’m not.  I’m getting kind of passionate about the topic of health care reform.  What I hope to do, though, is to be clear what my biases are (as I understand them), as well as trying to address other perspectives as objectively as possible.  I’ll lay out my biases and motivations shortly, but my objective in tackling this controversial subject is to try to advance a reasonable dialog that might just provide an impetus to achieving real, productive improvement to our nation’s health care system.

I’m going to have to break this up over several posts, because it’s a complex subject, and trying to cover it in People magazine-style, let alone TV news sound bites, or Tweet-format, is not only impossible, but also a recipe for inaccuracy (see, for example, “you can keep your plan”).  Part of my reluctance to start has been simply that I wasn’t looking forward to all the disagreement, but I would hope that we can have a more reasoned discussion here, among friends, than is taking place in the media, or the halls of Congress.  The rest of delaying has been in trying to figure out how to organize this thing.  I’m probably going to tax WordPress.com’s publishing capabilities (I’m certainly going to exceed my abilities to use the site to organize a complex document), but I want to ensure that I provide good jumping off points for further research, or to at least demonstrate the due diligence I’ve performed in my research.  To that end, I’ll be posting a “bibliography” of sorts.  I’ll try to link to specific sources for statistics or quotes I reference.  I’m also going to provide my definition the problem as I understand it.  I will describe several possible approaches to solving the problem, and how those approaches are incorporated within the ACA.  Either embedded in that discussion, or separately (depending how all this comes together for organization purposes and readability) I’ll identify what I see as the strengths and the shortcomings of ACA.  Finally, I hope to talk about what I believe is the best path forward.  Somewhere in all that, I’m going to try to tackle a lot of the misperceptions that are out there today.

I mentioned earlier that I’m biased, and indeed passionate about the topic of  health care reform.  I guess the passion comes from the fact that I used to be pretty strongly biased against anything that smacked of government assistance.  I wrote papers in my undergrad days decrying the need to provide health care, unemployment, welfare, or any other type of handout.  I’m guessing my old Econ professor has probably departed this earth by now, but if he hasn’t, and were to read this today, he’d probably be dead from shock before he finished.  At one point, while acknowledging that the welfare system had become a multi-generational issue, I went so far as to advocate for systematically and forcefully removing all children from these dysfunctional welfare homes in order to break the generational cycle (one of the reasons I don’t get too excited about what any public figure over the age of 40 wrote, studied, or read while in college!).  As the saying goes, though, there’s nothing worse than a reformed smoker, or in this case, reformed ultra-conservative.  I believe that in the richest country in the world, that spends more per capita on health care than any other nation in the world, that people should not be impoverished because of catastrophic health issues, nor should they be forced to go forego necessary treatment because they can’t afford it.

So what happened to bring about this radical change in my thinking?  Several things.  First, somewhere along the way, I figured out that I had been the beneficiary of blind luck (ok, I don’t believe in luck, but providence gave me something that I never once sought or planned for).  I have had (virtually) free health care for all of my adult life, courtesy of the US government.  Even when I retired from the military, my annual expenditures for health care for my entire family, including annual premiums, co-pays, etc, was less than the monthly premium most people paid for private sector health insurance, not even considering deductibles, co-pays, and other out-of-pocket expenditures.  I wasn’t some genius who planned out how to achieve this level of health care security; I just joined the Army to jump out of airplanes.  Free health care came with the package–not that it meant anything to me when I signed the contract.

But my free government health care alone wasn’t enough to reform me; for many years my mantra was that I earned it through my service.  What really started me doubting my convictions that anybody could pull themselves up by their own bootstraps, was when I started discovering friends who had worked way harder than I had, and were much stronger than me, whose bootstraps had broken.  I have a friend who owned a construction company, who literally built million dollar homes.  His work was amazing, and his business skills were quite good, but he lived in a rented duplex, and couldn’t afford health insurance for his family.  He wrenched his shoulder one day helping me get my snowmachine unstuck, and still has problems many years later, because he never went to the doctor to get the damage repaired.  He couldn’t afford it.  He eventually had to shutter his business, and go to work at a large company that offered benefits, just to take care of his family’s health needs.  I have another friend who is an amazing mechanic, and worked for many years on military vehicles as a civilian contractor.  Bouts with cancer and other medical issues, even with employer-provided medical insurance, bankrupted him, and continues to wreak havoc with his finances.  I just recently discovered that since he was medically retired, he no longer has the insurance he needs to pay for his liver transplant, and has been removed from the list.  Neither one of these guys were welfare bums; heck, they work harder than I do!  They are both smart, talented, and hardworking; they just ended up on a different life path than me; not through destructive choices, but because they decided to open their own business, in one case, or contracted some nasty disease in the other.

The final straw was when I started studying Christianity–that belief system that I have devoted my life to trying to live by.  The Bible says that man is created in the image of God; that all human life has intrinsic value.  Jesus didn’t give us the option to pick and choose who we would love or show Christian charity to; in fact in response to a religious legalist, who was looking for justification that he was loving his neighbor, and thereby obeying God and earning eternal life, Jesus told a health care parable.  Around the same time I was confronted with my own hypocrisy, the health care reform debate was going on in earnest, and I’d started blogging.  I wanted to engage in the discussion, but I wanted to do so from an informed position, so I started researching the issue, and writing about it.  (If you click on the “Health Care” category in the right column, you’ll get a list of posts I wrote starting back in 2009 on this topic, before ACA became law).  The more research I did, the more I discovered that our health care system in our country isn’t getting the job done, and lives are lost, and ruined, because of it.

Jesus said that I’m supposed to care for “the least of these,” and through his life and teaching demonstrated that I don’t get to pick and choose who is worthy of my love and my care.  I don’t get to decide who doesn’t deserve adequate health care because they don’t meet my expectations of supporting themselves, or because they had too many babies, or whatever other reason I find for them to be unworthy.  The Bible is VERY clear that judging others is outside my scope.  I’m just supposed to love them.  That doesn’t mean think fuzzy puppy thoughts about them, that means meet their needs.  Jesus was in the healing business.  Unfortunately, too many folks in the US think us Pentecostals are crackpots, so although the same healing power that Jesus used is available to his followers today (see John 14:11-14, despite the desperately twisted hermeneutics John MacArthur and his friends try to employ to deny it), until such time as more Christians of this country are all filled with the Holy Spirit, we’re going to have to go to plan B or plan C.

More on those in the next installment.

_________________________________

1.  The Affordable Care Act is the name for the 2010 legislation commonly (and derisively) referred to as “ObamaCare”.  I’m going to refrain from using that term, and instead stick to “ACA,” to try to take some of the venom out of the discussion. 

Let’s do something constructive!

Beneath the tsunami of “Obamacare Failure” coverage, a significant event occurred November 1st, and most people aren’t even aware of it.  For reasons that are too complicated to detail here, the temporary increase in the Supplemental Nutrition Assistance Program (“SNAP”, aka “food stamps) implemented in 2009 as part of the federal government’s economic stimulus program, expired.  For those who, like me, haven’t followed the details of SNAP, here’s the basics:

  • As part of the American Recovery and Reinvestment Act of 2009, SNAP was temporarily increased, with the design that the increase would phase out as inflation pushed the cost of a FDA-determined minimum food basket to the increased level.
  • The SNAP increase served a two-fold purpose:  pump cash into our struggling economy, and help those who found themselves in a financial bind due to the economic downturn.
  • In 2009, experts expected food basket inflation to cause the benefit to expire in 2014.  Subsequent government decisions accelerated that expiration to Oct 31, 2013.
  • Inflation hasn’t met expectations, resulting in a real cut in benefits:  $36/month for a family of four.

That may not sound like a lot, but when you consider that based on the FDA’s food basket calculations which value a meal for one person at $1.70-$2.00, that equates to approximately 5 meals that family of four won’t be getting through SNAP.  If you want to read all the details, there’s a pretty good rundown on this page.    Macro impact is that for FY 2014, about $5 billion dollars will be cut from SNAP, impacting 47.6 million people, or 15% of the US population.  (For those who are happy to see the $5 billion cut to SNAP, don’t get too excited, the money’s already been reallocated to aid states with teacher salaries and Medicaid federal matching dollars).

I’m not writing to advocate for an increase in SNAP.  The cut is a done deal (although there are new, much more dramatic cuts being discussed as part of current budget negotiations, which bear watching and future consideration.  If they are approved, the following proposal will be even more relevant, and on a much grander scale).  No, I’m calling on the readers of this blog to demonstrate their compassion and love for their fellow man, and to prove that we can offset cuts in government programs by stepping up to provide private support.  Google “SNAP cut food bank” and you’ll get hundreds of articles from across the US where local news sources have interviewed food bank managers who are trying to prepare for the increased demand resulting from the SNAP cuts.  The bottom line is that local food banks are already tapped out, so they don’t currently have the resources to make up the gap caused by the latest cuts.

So let’s help them out.  Find your local food bank.  Many churches sponsor one, and many areas now have consortiums that work together to provide more food, more efficiently.  You can donate money, time, or both.  Here’s the cool part:  That $1.70-$2.00 for one meal that the FDA calculates?  My local food bank can provide SEVEN meals for $1.00 through efficiencies generated by buying in bulk, wholesale pricing, etc.  You can make up that $36 cut for a family of four with just a three dollar per month donation!  [I did the math multiple times:  $36 equates to roughly 20 meals (18 meals at $2, 21 meals at $1.70).  $3 at the food bank buys 21 meals.]

Too often I hear people railing about government assistance programs needing to be cut.  Well, this one was, and people are going to miss meals because of it.  We can fix that.  Will you?  I’d invite everyone to give some, but I’d really encourage you to give sacrificially–$3/ month would be nice, but how about $20?  Or $50?  Or giving up one day off a month to go help in the facility?

“Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?’

“The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’ ” –Jesus, quoted in Matthew 25:31-46

Help me understand?

Last week I wrote about a meta-theme in our world today that I labeled a “spirit of offendedness.”  In trying to understand this phenomenon, I also observed a perceived relationship between it and the divisiveness in our country today (although I’m still not prepared to try to categorize the relationship).  I concluded the post with a commitment to try to help bring about change, at least in my little corner of the world, by focusing on not being offended, and by trying to unite people, seek common ground, and understand their perspective.  I titled that post “Radical Change”, but in reality, in some aspects of my life, it’s not so radical; I’ve got a lot of experience and training in doing exactly that in the professional world.

Divisiveness is a fact of life.  Life is a web of interactions with people who have perceived or real differences in objectives for those interactions.  Basic economic theory teaches that most of our decisions in the world around us involve taking our own selfish interests into the world in order to get maximum satisfaction (fulfillment of our needs) at minimum cost (fulfillment of someone else’s needs)–while the other person is trying to maximize his/her own satisfaction.  This concept has much broader application than the basic supply/demand curves that you were forced to try to understand in your Econ 101 class (yes, I’m an Econ major, and I think it’s important and valuable to all of life–that does NOT make me a nerd, no matter what my kids say).

I’ve had the privilege to take several graduate level courses on negotiations, with a focus on both traditional business negotiations and on less obvious negotiations such as dealing with personnel performance issues.  From that training, and lots of opportunities to apply it, I’ve come to the conclusion that pretty much any personal interaction is a negotiation.  Based on how I observe people interacting in our society today, I think that most people have come to that conclusion as well, either consciously or subconsciously.  However, most folks seem to be defaulting to the most rudimentary negotiation strategy:  I win by you losing.  If you never got much past the fourth week of Econ 101, the basic supply/demand curve was just the beginning.  Most transactions/human interactions are much more complex, and demand more intricate approaches.

In order to avoid totally derailing this post and turning it into a negotiation class, let me just say that there are volumes of studies that indicate that in almost all situations, “win-win” scenarios exist where both parties can get a satisfactory level of satisfaction that is generally greater than the outcome they achieve by approaching the scenario from a win/lose mindset.  I had a hard time believing it too; I was presented with lots of statistics and with detailed case studies to back them up.  Why, then, do we not see more of these win-win scenarios play out?  The simple answer points back to the failure to apply one of my blog themes:  “Seek first to understand, then to be understood.”  Most of us either instinctively, or through conditioning, approach an interaction with an understanding of our own desired outcome, and an assumption about the other party’s desired outcome.

We fail to achieve win-win, however, by acting on that assumption without validating it.  We just behave as if it were fact.  And in that case, we often act on really bad assumptions, particularly in our current social environment, where it seems to be the norm to assume that all those who are not in our own tribe are evil, ignorant, and have malicious intent toward us.  The reality is almost always quite different!  Whether one is exploring the opposing political party’s position (they really aren’t godless Marxists set upon destroying our nation, or heartless robber-barons intent upon getting rich on the peasant labor of the expendable poor), or frustrated at the person who cut you off in traffic (it’s entirely possible that they didn’t see you through a legitimate mistake, not that they have some superiority conflict which makes them think it’s OK to seize the right of way), our assumptions tend to be inaccurate, and more often than not, tend to deviate toward the most negative or pessimistic possibility.

Pretty big assertion there, but I can back it up with decades of personal observation that affirm it.  Just in the past week I’ve seen it play out several times, where someone takes offense at another, and builds that offense to a fever pitch, because they assume the worst about the offender.  But they never took the time to validate their assumptions!  In two of the specific situations I have in mind, I know that the offended party was totally inaccurate in their assumption.  In one case, they found out the real truth, and the situation was defused.  In the second, the party is too busy being offended (I’m talking serious anger and hatred here) to even give consideration that they totally misunderstood the interaction, and what they thought they saw was not at all the case.  In a third situation, one that’s going to have major ramifications for millions of people who should all be agreeing and working together for good, one highly influential leader has declared millions of others wrong in the most divisive, hateful language possible, without so much as a single thought to trying to understand the other side of the story.

In the business world, negotiating like this might make you money in the short run (if you’ve got a lot of market power–if you don’t, you’ll find yourself bankrupt quickly), but it will soon get you branded as a heartless monster who no one wants to do business with.  In leading people, you’ll be effective only to the extent that you have significant power to wield–but you’ll also be hated as a ruthless, uncaring boss who gets ahead by stepping on the backs of others.  Competent negotiators will go to great lengths to gather as much understanding as possible of the opposite party’s position, their needs, desires, constraints, etc.  Only a foolish negotiator would enter into a negotiation by refusing to even try to gather information on the other party’s position.  Unfortunately, most of us are not trained negotiators, and we do exactly that every day.  Most of the time, it doesn’t really hurt us too much, because most of our interactions are too casual and insignificant to have lasting impact.  But when our interactions have significance, we fall right squarely in the “foolish” category if we choose not to even attempt to validate our assumptions that are the basis for our offendedness and divisiveness.

So, pitfall number one on the road to win-win is acting on assumptions without even attempting to validate them.  Pitfall number two is attempting to validate our assumptions from lousy sources.  Let’s say you’re trying to understand why proponents of Obamacare think it’s a good idea.  You assume it’s because they’re all graduates of liberal arts colleges who have been mindlessly indoctrinated in Marxist philosophy, and are programmed to destroy our nation and way of life by turning every aspect of life over to the government, that they wan to destroy the rich, and use the money of the wealthy to make it so that no one has to work who doesn’t want to.  Consulting with Rush Limbaugh, The Heritage Foundation, and Glenn Beck will certainly give you confidence in the accuracy of your assumption, but you won’t in fact have validated it.  Either of these pitfalls will knock you off the road to win-win, and leave you fuming instead in a wreck of offendedness.

OK, so I’m back to turning this into a negotiating class, and wearing out my road metaphor–let me cut to the chase:  In most cases, a well-placed question to the other party can reveal a lot of information (maybe not all the details, but enough to validate, or at least make your assumptions significantly more accurate).  “What is this magic question?” you ask!  It’s actually amazingly simple, if asked with sincerity.

“Help me understand…?” 

Now, how you finish the sentence is important.  “Help me understand how come you’re so stupid you can’t see that your idea will ruin the world?” isn’t going to get you too far.  “Help me understand the benefit you see in this approach?” is much better.  It even works when someone screws you over!  Instead of going into attack mode of “why did you provide such negative feedback about me on the recommendation?!”  try “I was surprised by your feedback on the recommendation.  Help me understand what led you to make those remarks about my performance on the last project?” creates an opportunity for the other party to explain their position.  You might just discover that there was a misunderstanding–it’s a lot easier for someone to admit they made a mistake if you give them a graceful opportunity to explain, rather than to tear into them with teeth bared.  And go to the source, not your friends, co-workers, other family members, etc.  As a leader who has made lots of mistakes, I can tell you that I ALWAYS appreciated the opportunity to own up to it to the offended party, rather than to have them ask other members of the team, and in the process multiply the derogatory assumptions.

I really need to wrap this up, and I appreciate it if you’ve hung in this long.  Bottom line:  lots of folks are offended by others today; it either leads to, or is caused by divisiveness.  Lots of science indicates that we all tend to make assumptions about others that we interact with, and that we often fail to validate those assumptions.  The farther outside our own social circle the other party is, the more we tend to assume the worst about the other party’s actions, motives, etc; which exacerbates our offendedness and further divides us.  A critical life principle and foundation of my thinking (and blog) is the idea that we should “seek first to understand, then to be understood.”  A great little tool for seeking understanding in human interaction is to ask a simple question:  “Help me understand?”

Try it.