Monday, August 31, 2009

Extreme Shepherding

I received this via email recently. I found it entertaining, and thought I'd share it with you all:

Thursday, August 27, 2009

The Universal Health Care Debate

There are a lot of folks who disagree with the current proposal for health care reform. Many think we don't need reform at all. Others simply dislike the terms of the current proposal - or perhaps they dislike the terms that the extreme right-wing media has convinced them are in the proposal, even though they are not (there is no “death panel” for example). I am not here to argue the details of the plan. Those can and will be tinkered with over the years and certainly there is room for debate about how we should provide health care for our citizens. But in my view, we should not be debating whether to provide some form of basic health care for all of our citizens. We should just find a way to do it.

Here are some things to think about before you pooh-pooh the idea of universal access to basic health care:

Do you know how much it costs to buy private insurance? Or does your employer provide it for you? If your employer provides it for you, you may pay a portion of the premium, anywhere from $1 to $500 per month, say (and you likely complain every time your contribution to the plan is raised). According to the National Coalition on Health Care, the average employer-sponsored plan premium for a family of 4 costs $13,000 per year. And employers generally get a discounted group rate!

So if you are complaining about paying $400 per month for your health care plan this year instead of the $300 per month you paid last year, just stop it. Instead, thank your employer for paying the lion's share of the premium for you, and be thankful you don't have to pay the entire $13,000 per year yourself. Also thank your employer for providing your insurance. Many employers do not, particularly for part time and lower-paid employees.

Now imagine yourself in the position of someone whose employer does not provide insurance. Suppose you are working a job that pays minimum wage. Or even $12 per hour. That would be $24,000 per year if you work full time. This amount likely is high enough that you are not eligible for any federal or state income-based health coverage. If you need to provide health insurance for your entire family, and assuming you could get a policy with the same coverage at the same rate your employer pays (on average, $13,000 per year), that would be more than half your income for the year - and likely about two-thirds of your take-home pay!! Could you afford to pay 2/3 of your take home pay for insurance? I thought not.

Suppose you are one of the few very lucky minimum wage (or thereabouts) or part-time laborers whose employer does provide some sort of health insurance plan.

What if you wanted to change jobs? What if you got laid off? Imagine that you have applied for several different positions but the new job offers you are able to obtain do not come with health insurance, either because the company is small and thus exempt from the requirement to provide it, or because the position is part-time, so the company is exempt from the requirement to provide it. Thus, to take the new job, you will have to absorb the cost of insurance yourself. Will the new job give you a raise of more than $10,000? Those of you earning upwards of $100,000 or more per year will find a raise of $10k (approximately 10% of your current salary) to be within the realm of possibility. But if you are earning $10 per hour ($20,000 per year), the chances of finding a new job that comes with a 50% pay raise are between slim and none. And the reality is that most lower paying and/or part-time jobs do not come with health care. So if you are merely unhappy with your new job, it's hard to financially justify changing jobs, and if you’ve been laid off, you will probably have to take one of the new jobs and simply go without insurance.

OK, you say to yourself, but if you are buying your own insurance, you don't need the fancy plan your employer provides. You would be willing to settle for true insurance against disaster instead of the fancy, full-coverage-for-every-mosquito-bite HMO (health maintenance organization) or PPO plan your employer provides. You might see ads from Blue Cross for policies for $50 per month that will cover catastrophic health problems and you might think, "Great! I can afford that!" But that would be for an individual, with no pre-existing health issues. The family premium would be substantially higher - often $400 to $1000 per month. That’s a large chunk of change for a person earning minimum wage or thereabouts.

Now suppose you or a family member have a pre-existing health condition. Perhaps you had cancer, or your spouse has diabetes, or your child suffers from food allergies, asthma, or a skin condition. Any private policy you obtain likely will charge a substantially higher premium than it would for "healthy" policy holders, and will preclude coverage for the pre-existing condition for at least a year. If you were previously covered under your employer's health plan and are seeking a new policy due to a job loss or change to a new job, the federal Health Insurance Portability Protection Act likely will apply, and will prevent the new insurer from excluding coverage for the pre-existing condition. But it won't stop the new insurer from charging huge premiums for coverage. You will be quoted a premium price that is far more than the $13,000 per year your employer was paying for your coverage.

Even assuming you can find coverage for your healthy family at a rate you can afford while working at your minimum wage job, private insurers often raise premiums yearly, even for their healthy policy holders. What happens is that insurers bundle policy holders into “groups.” Then, as the members of the particular group of policy holders start using the coverage, it costs the companies more to run the program. Companies are not allowed to drop policy holders (unless they fail to pay the premium), but nothing stops them from raising the premium costs substantially. So they raise their rates. Then the healthy policy holders seek out and find a new insurer that will charge them less. The less healthy ones cannot find a less expensive policy, so they stick with the initial policy. But now there are fewer remaining policy dollars to cover the remaining health problems among the remaining, somewhat-less-healthy policy holders. So the insurer raises the rates again. And more of the relatively healthy members seek and find other coverage, dropping the current policy. And then the insurer raises the rates again...

.... which means that if you get a private policy that costs you $200 per month for your family this year, and then you or any member of your family develops any sort of health problem, in 10 years you will likely be paying substantially higher premiums (perhaps $1000 per month or more), and may be unable to find new insurance at any price due to the pre-existing health issue.

Now suppose you don't have health insurance, and you are working at your minimum-wage job, which is the only employment you can find in this economy despite your college degree. And suppose your child develops a sore throat, cough, and a fever. You know you cannot afford a “quick trip to the doctor” to make sure it isn’t strep throat. So you give her an over-the-counter medicine and hope she gets well soon. Probably she does. But suppose that cough just won't quit. Do you pay the $200 or more to take your child to the doctor? If so, how will you pay the rent (or the mortgage, if you were able to obtain one) this month on your $1000 per month take-home pay?

Suppose you take your child to the doctor anyway, figuring you will find the money somehow or beg the landlord for leniency, and that cough turns out to be asthma or bronchitis or something worse, like lung cancer. How will you afford the bills to treat these expensive conditions? If you cannot afford the $500 to $1000 per month for private insurance, I can pretty much guarantee you cannot afford the medical bills to treat cancer or diabetes or even somewhat less deadly but still debilitating conditions like asthma.

And now how will you ever obtain affordable insurance for your child? You won’t. She now has a "pre-existing condition"!!

* * *

The current system provides fantastic health care for the wealthy and those covered under their employer's group insurance plans, and no care at all for the vast majority of the working poor (those on welfare generally are covered by state medical plans). It strikes me as hugely unfair that the wealthy, who can afford fantastic health insurance at a discounted rate through their high-paying jobs, will often have expensive elective procedures covered by their insurance, such as fertility treatments, vasectomies, and reconstructive surgery after an accident, while the less wealthy, whose employers do not provide insurance and whose salaries are so low they cannot afford expensive private insurance, cannot even obtain necessary medical treatments for non-emergency, yet serious, conditions such as cancer, bronchitis, asthma, or even the flu.

I agree we should not take away the option of purchasing private insurance that covers a huge range of elective and necessary medical procedures, for those who can afford it and wish to pay for it. I also think we should keep in place the option to pay privately any doctor who is willing to treat you for whatever medical treatment you and your doctor deem necessary. In a country that allows and even values income disparity because it is an incentive to work harder, better, more intelligently so as to raise your income, there will always be some disparity in the quality and amount of health care available to folks with more, or less, income. Some folks will be able to afford vasectomies (and vasectomy reversals, too!) and try every experimental and cutting-edge cancer treatment known to mankind, along with the more traditional treatments. Others will have to settle for using condoms and being provided with only the tried and true, proven-to-work, more widely available, and thus less expensive cancer treatments.

But I ask you this: Shouldn’t access to basic and decent health care - the proven-effective cancer treatments, for example - be a right for every citizen in this wealthy country of ours, rather than a privilege for only the lucky (or wealthy)? Just as it is critical to our national security and national well-being to provide a free basic education for our citizens so that they can become productive members of society, isn’t it just as critical to ensure that our citizens are reasonably healthy so they can be good students and become productive members of our society?

There is room for debate about what things should be covered and how the coverage should be provided. Reasonable (perhaps income-based, on a sliding scale?) co-payments should be charged for services to discourage truly unnecessary doctor visits and to help defray costs.

But is it really fair to tell a sick child, “sorry honey, I can’t take you to the doctor because I chose to buy food and shelter instead of medical insurance this month”?

Is it fair that a working class man cannot afford treatment for his prostate cancer because his employer does not provide health insurance, while a wealthy stockbroker can have a vasectomy paid for by his employer-sponsored health plan?

(Note: I’m not saying the vasectomy shouldn’t be covered if the private insurer wants to cover it. I’m sure the vasectomy is less expensive for the insurer than paying for any pregnancy and childbirth that might result if the man didn’t have the vasectomy. I’m just saying that the cancer treatments should be covered somehow, too!).

We need to find a way to make decent health care available to every citizen in this country. It’s just the right thing to do.

Wednesday, August 26, 2009

Ted Kennedy's legacy

I just heard the news about Ted Kennedy's death. I hadn't watched the news on television since Monday. I had pre-scheduled my earlier post for today, so I hadn't been online today, either.

Ted Kennedy was not a perfect person. Certainly leaving the scene of an accident in which a young woman died was irresponsible and wrong. He had other incidents later in life, too - he was not a saint, but a flawed human being. He suffered his share of loss, and caused his share of heartbreak.

And he tried hard to redeem himself after the Chappaquiddick disaster. He worked hard for decades on behalf of the underprivileged in America. He was one of the few very wealthy persons in America who seemed to truly understand what it might be like to be born into a family that lacked material wealth and the privileges that come with it, such as access to health care and a decent salary for your labor. He worked hard to try to ensure that every person in America, not just the wealthy ones, could see a doctor for medical care when needed.

I hope that his work will not have been in vain. Tomorrow I'll post my thoughts on the health care debate. Meanwhile, my heart goes out to his family and friends. May he rest in peace.

He Just Calls 'Em As He Sees 'Em

According to my son's first-grade teacher, my son was in a bit of trouble for calling names on Monday.

Apparently a girl in his class was doing something my son didn't like (I'm not sure what... coloring outside the lines, maybe? crying that she missed her mom? eating pudding with her fingers? grabbing a toy away from him? I didn't get that part of the story, exactly)...

... so he yelled at her, "You are SO immature!"

* * *

He was right, you know. How else would you describe a first-grader, anyway? They're six years old!! Nevertheless, the inappropriate name-calling got him a "yellow card" for the day - after the teacher was able to quit laughing.

Monday, August 24, 2009

"Clever Cat" by Peter Collington - a Review by LegalMist

Ok, I know I promised a review of Cormac McCarthy's Pulitzer Prize winning novel, "The Road," but somehow I feel more compelled to review Peter Collington's children's book, "Clever Cat," which I checked out of the library several weeks ago for my six year old son, and which he adamantly did *not* want to return to the library when it was due. (I'm not sure what that says about "The Road." Probably it says more about my work load and motivation level than about either book, really.)

"Clever Cat" is children's literature, probably written merely to be cute, yet here I am mildly obsessed with the potential deeper meanings in the book.

I'll start by saying the illustrations are adorable, and the premise of the story is, as with most kid lit, rather fantastical, which is what makes it fun.

The story is about a cat who gets tired of waiting ... and waiting.... and waiting... every morning for his people to feed him breakfast, so he gets out the can and the can opener and serves himself.

The people are amazed at their "clever cat." The woman then gives him a cash card and a key to the house and asks if he can go buy his own food. So he does.

Then he discovers the joys of the cash card, taking out cash to spend at the local cafe (mmm, this food is so much better than cat food!), shopping, going to a movie, and even playing poker (in a cute scene reminiscent of the famous "dogs playing poker" painting on black velvet). He passes the other lazy kitties outside sleeping in the sun and feels superior to them. After all, there is so much to experience in life!

But apparently, the bills add up quickly, so his people take the cash card away and tell him to get a job to help pay the bills and rent.

He gets a job as a server at the cafe where he used to dine. At the end of the week, after he pays the bills and rent, he has only enough money to buy... cat food. He is so exhausted after his one and only week of work that he oversleeps the following week and is late and gets fired.

And then he decides that working life is for the birds (or humans) and resumes his cat behavior, simply waiting around to be fed.

The humans call him "lazy," but eventually they feed him anyway and he goes outside to sleep in the sun with the other lazy cats, who smile as if to say "Finally, a clever cat."


What does this all mean?

Is this an endorsement of shucking responsibility and living off of welfare and food stamps? You're "clever" if you find a way to get "the man" to feed you and care for you while you do nothing all day long? If so, what the heck does this book teach our kids?

Or is this a cleverly disguised conservative rant about a welfare system that encourages people to shuck their responsibilities and be lazy and live off of the labor of others? Is it saying, "look what slothlike behavior we encourage with our welfare system"?

Or, more subtly, is it a liberal rant about the inadequacy of a welfare system that does not provide proper incentives for people to return to work, such as by gradually phasing out the benefits (rather than cutting them "cold turkey" style when an income threshold is met) and allowing folks to keep some portion of their benefits (health insurance or food stamps, perhaps) even while they improve their lifestyle, so that they are motivated to work instead of simply collecting welfare?

. . .

Or is it just poking fun at humans who have been cleverly convinced by cats that we should feed and shelter them even though they really do nothing for us and they just sleep in the sun all day?

After all, sometimes a children's story is an allegory or a fable, designed to teach deeper truths (such as Aesop's fables). Other times, it's just a kid story.

What do you think?

Monday, August 17, 2009

Happy News

Sorry to be gone so long, y'all. Things have been a little busy. We've been hiking, canoeing, and suffering from food poisoning at a fast food restaurant. We had kids starting at two different schools (one of which notified us two days before orientation that LegalMist's daughter was "in," and needed a uniform by Thursday, thereby necessitating an emergency shopping trip), with all the orientations and meet-the-teacher nights that entails.

And - the huge news - I got hired as an adjunct professor at a Law School here in Arizona! It's a part-time gig, teaching one course only, but should be a lot of fun (as well as a lot of work). And so I've been busy learning all about the school's policies and procedures for everything from tracking student attendance and grading to where to park when I show up to teach and how to use the school's computer and email system.

I'll be back with some fun stories soon.

I'll also be back around commenting and enjoying your blogs really soon, too.

So stick around, the best is yet to come!

Tuesday, August 4, 2009

Another Fine Parenting Moment

My (6 year old) son, known here as "LMS" (LegalMist's Son) pitched a fit yesterday evening when I asked him to turn down the volume on the television, so I told him he could not watch television for the rest of the night.

Later, after we walked the dog, my husband came in and flipped on the television. My son sat down to have a banana and watch it with him.

Here is the conversation that followed:

Me: "LMS, I thought I said no more television for you tonight."

LMS: "But mom...!"

LegalMist's Husband ("LMH"): "Oh, come on, he's just watching what I'm watching while he eats his banana. I don't want to have to turn it off just because you said he can't watch it."

Me: "I didn't say you had to turn it off; I said he's not supposed to be watching it. He could eat in the other room."

LMH: (Somewhat sarcastically) "All right, all right. LMS, turn around and face the other way. We wouldn't want you to get any entertainment value out of watching the weather report, now would we?"...

and then, seeing that I wasn't laughing,

"Oh, uh..... oops. Uh.... What I meant to say was, "You look beautiful tonight!"..."

Me: No verbal response. Just the patented LegalMist soul-chilling stare, designed to prompt him to back me up on the "no tv" decree.

LMS: (Finishing his banana and leaving the room quickly) "You are SOOO dead, Dad!"

He's rather perceptive for one so young, isn't he?