-By Richard J. Little
In response to a careful crafted, time consuming, and painstakingly written personal letter and multiple faxes/emails I recently sent to one of my state’s United States Senator, I received this beautifully worded but totally impersonal email form letter from Senator X (or, more likely, one of the staff) who is a member of the Democratic party:
Thank you for contacting me regarding your opposition to universal health care coverage. I understand your concerns.
When it comes to health care, our families and businesses are in a serious crisis. High health care costs are causing cuts in benefits and increases in premiums, adding to the ranks of the uninsured at alarming rates. But the impact of this problem goes beyond individual families. Skyrocketing health care costs make our businesses less competitive in the global marketplace and cost us good-paying jobs. We are already paying for the uninsured through overuse of the emergency room-the most inefficient and expensive way of providing care.
I believe that health care is a right, not a privilege. There is no doubt that the problems we face are complex, but there are real solutions. We can create a system that is uniquely American and shares the cost between the government, businesses, and individuals in a way that is fair and equitable. Now is the time to show the political will to tackle these issues because there is so much at stake. I am committed to working with both my Democratic and Republican colleagues on the Senate Finance Committee to find solutions to America’s health care crisis.
Thank you again for contacting me. Please don’t hesitate to do so again if my office can be of assistance to you or your family.
Sincerely,
X
United States Senator
In the faint hope that I will get responsive and representative governance from my Senator since according to public opinion polls my view are in line with a majority in my state and the nation at large, I took another huge block of my time to respond to the kind form letter:
Dear Senator,
I really appreciate you (or a staff member) taking the time to email me a form letter with standard Democratic talking points (which I have heard a million and one times in the media) in response to my recent mailing/faxes/emails in which I painstakingly took hours of my precious off-work time to craft.
I understand that this is probably a wasted effort on my part to try to get you to change your position on the so-called “Heath Care Reform” issue but I would again urge you to vote NO on the upcoming finance committee health care bill (the so-called Baucus Bill) and NO on cloture on any other similar so-called reform proposals that may reach the Senate floor.
I fully understand from your voting record and publicly stated positions that you are for just about any proposal that comes down the pike that increases the size, scope, and power of the government (and this is a HUGE expansion at that) and that diminishes the individual rights and Liberties of the people so I don’t hold out much hope that you will suddenly become open minded to Health Care solutions that empower families and individuals. But, since miracles can and do happen and it’s still my Constitutional right to petition my government for redress of grievances, I will make the effort one more time to change your mind.
First, let me respond to a few of the points you raise in your form letter response:
“I believe that health care is a right”
Unless you believe in some form of indentured or involuntary servitude (prohibited by the 14th Amendment to the U.S. Constitution), Health Care is not a “right” since human beings must construct hospitals, clinics, decide to go to medical school, etc. A right is something inherent in our existence as humans and in therefore unlimited and thus charged into the protection of governments to ensure it’s not infringed upon. See the Declaration of Independence and the Bill of Rights for examples; you will not find the service of Health Care as being listed anywhere!
Calling Health Care a “right” implies all citizens’ should have unlimited and unregulated access to this service. This is not possible for any Government to provide or any Individual to have in the real world. I say we need to work together to make Health Insurance more affordable and medical care more accessible to more Americans – this is a rational and achievable goal versus propagating an irrational and unachievable pursuit of universal health insurance coverage and unlimited health care.
If we acknowledge this reality, that Health Care is a service rendered by one group of citizens to another and is therefore subject to the laws of economics and supply and demand, we will all get much farther along in identifying workable solutions for specific problems in the current Health insurance and medical delivery systems. Health Care insurance and medical care being not available in unlimited quantities, the question before us becomes one of who will make the decisions on consumption and costs: the Federal Government or the Individual/Patient?
If you truly seek solutions to the problems you cite, I would argue that individual/patient empowerment and free markets would be the logical way to reform Health Care as they have been historically proven to work much better for the vast majority of citizens over centrally planned/government managed systems as you are proposing we enact. If you goal is a false equality (elites like yourself will always have access to better care) of access to degraded medical care at much higher overall costs (unless you propose government imposed rationing as well) then simply state as much clearly to us.
“When it comes to health care, our families and businesses are in a serious crisis.”
No, this is simply not true – 85% or better are happy with their current health insurance coverage and medical treatment options. All persons regardless of ability to pay receive medical treatment. The so-called crisis is manufactured by those who seek to justify further government interventions in the health care insurance and medical treatment markets since they have a political opportunity to do so. To state otherwise at this time is to insult my and the public’s intelligence. In fact, if anyone is “in crisis” it’s the Federal government since it owes 37 trillion in unfunded liability for Medicare over the next decade. The plan put forth in the Bacus Bill and other HC bills is in large part nothing but a shoddy attempt by Washington politicians to cover up for this failure. It includes a combination of budget cuts (500 billion), rationing boards, and new taxes on the young/healthy thru the Individual Mandates in an attempt to hide this bankruptcy long enough for the current generation of politicians in DC to leave town in 10 years or so unscathed.
Certainly you would agree we need to be honest with the American public and keep our commitment to Seniors who have paid taxes for years and are now dependent on this program. Either commit to real cost saving reforms by expanding programs like Medicare Advantage or stand up like a responsible Adult and tell the American people a tax increase is needed to avoid the looming bankruptcy.
“High health care costs are causing cuts in benefits and increases in premiums, adding to the ranks of the uninsured at alarming rates.”
Government Intervention at the state and federal level are one of the primary causes of this – and you propose a vast increase this government intervention! The continued underpayment by the Federal government from the Medicare program is at present made up for by medical providers by passing the losses they are forced to take treating Medicare patients on to Private Health Insurance firms and self-payers in the form of higher billings for similar treatments. For privately insured individuals, this is reflected in higher premium costs. None of the proposals you support would change this dynamic in the least. In fact, your support of the Individual Mandate provision would simply accelerate and worsen this trend. I can see where this is good thing from the perspective of a Washington politician but this is very bad for average Americans.
Additionally, several state government policies which basically prohibit Health Insurance companies from offering a full range of policies and pricing based on risk has also lead to skyrocketing costs. Rules such as one-size-fits all “community rating” and “guaranteed issue” laws to equalize pricing and mandatory coverage of everything from Mental Illness to sex changes have effectively turned Health Insurance companies into pre-paid medical plan administrators. You propose to take this bad trend and the state level and elevate it to federal law. Again, this will cause health insurance and medical care prices to skyrocket. This effect can be seen in the states of MA, VT, TN, HI, and ME where state government run health care programs have been enacted into law (similarly, we can see positive effects in states like KY that have repealed this self-defeating regulations/free market interventions).
Next, the lack of a truly competitive Health Insurance market effectively eliminates the possibility for price competition. Several states have laws and regulation such as I cited above that basically keep smaller Health Insurance firms from entering into that state’s market. This had led to a proliferation of several state semi-monopoly markets for large Health Insurance firms. Your support of a Federal Health Insurance “Exchange” concept would basically take these bad state policies and make it Federal law. In essence, you advocate the creation of a national Health Insurance Monopoly in your support of the so-called “Exchange” idea – only the biggest and wealthiest firms can afford to compete. This will have the effect of reducing competition and choice and push costs ever upwards. And to make matters worse, you give these large and wealth Health Insurance firms millions of unearned customers thru your support of the Individual Mandate! Again, the experiments with Mandatory Insurance in MA, ME, VT, TN, and HI have shown that health insurance costs will soar under this kind of scheme.
From your public statements, one would have guessed you were no friend of large Health Insurance firms but your actions indicate that you are actually one of their biggest supporters! If you truly wanted to squeeze the “Evil” Health Insurance industry and bring insurance costs down you would force them to compete via a national market for our business not deliver it to them on a silver platter!
Finally, a large driver of costs in Health Insurance and medical treatment is simply due to an aging population. There are a huge number of baby boomers who make up a large portion of the health insurance customer base (80 of 135 million), so naturally their increasing costs of medical care must be passed on other policy holders. Again, your so-called “solutions” do nothing to address meeting the demand for cutting edge 21st century medical care/drugs which are the true underlying cost drivers! Unless you are prepared to outlaw aging, we should be looking at ways to increase the supply of Medical services and empowering patients via transparent pricing to act as cost conscious consumers not simply forcing more people to dump more money in the pot. Your support of the Individual Mandate forces the young and healthy to buy more Health Insurance then they may need or want to cover the costs for the uninsured, old and sick. Again, this is a very disingenuous and coercive way to simply paper over the problem and simply props up the worst features of the present system.
“Skyrocketing health care costs make our businesses less competitive in the global marketplace and cost us good-paying jobs”
This is simply false. All reputable economists, the CBO, and even the President’s economic advisor Christina Romer agree on this: the rising costs of health benefits does not increase employers labor costs because these benefits are simply part of an overall compensation package and are not paid out of employer profits. Unless you are suggesting that American workers be paid less, this is a schlocky argument to make.
“We are already paying for the uninsured through overuse of the emergency room-the most inefficient and expensive way of providing care.”
This is true, but is very misleading and significantly overstates the true magnitude of the problem and is simply an appeal to envy/resentment against our fellow citizens.
First, you assume that everyone without insurance does not pay for their care. This is false – a majority can and do pay all, most, or at least some of their billed costs. Please have more faith in your fellow American Citizen!
Second, the problem you cite is a very, very small cost and not at all out of line with the “cost shifting” that occurs in every other industry and service in America. According to the Kaiser Foundation’s 2008 study on Uncompensated care, the cost passed on to the privately insured individual is 8 Billion dollars or less than $200 annually per privately insured household which is peanuts compared to the Trillions you are proposing to hit them with in new taxes, fees, premium hikes so that you can turn around and spend it to provide subsidies for the citizens your are forcing to buy private health coverage.
(http://www.kff.org/uninsured/upload/7810.pdf).
Here is the key quote from Kaiser Study (a non-partisan group):
“The remainder of uncompensated care left to be covered by private dollars is relatively small compared to the $830 billion that will be spent by the privately insured this year (< 2%)" So for less than 2% of costs per year you propose to tax and spend Trillions and take flexibility and choice away from 300 million citizens? And make no mistake about it, what you are propose to turn over control of our health care system to the Federal Government for this, in the grand scheme of health care spending, what is a trivial sum! And let’s be honest on this point too - the key components you endorse amount to a defacto Federal Government takeover of Health Care in this country. With the Federal Government setting all the rules, forcing everyone in the Nation to participate on threat of force, and sending billions of dollars of subsides out to support the plan, how am I not to conclude this is anything but Nationalization? Just because you propose to administer this Federal Government control and central planning in part thru quasi-private health insurance firms (essentially government agencies in all but name) is small comfort to me since these companies will be just about as independent as GM or Citibank once you establish Federal regulatory oversight and monetary control via subsidies. Personally, I speak for many when I say that I will gladly pay my 1-2% extra a year (its about the same as what I pay for in other industries/services) and consider it a small cost to live in a free and decent country that has the best medical care outcomes for all races, classes, and gender/age groups in the world! "I am committed to working with both my Democratic and Republican colleagues on the Senate Finance Committee to find solutions to America's health care crisis." Again, this is a nice talking point and I am sure it has poll tested extremely well too. But, given the fact that neither you nor the President has made any truly meaningful attempt to meet with Republican leaders in the past five months, your actions contradict your words. If you were truly interested in common sense, bi-partisan solutions or truly improving Medical Care outcomes or lowering Health Insurance or other Medical costs, you would advocate proceeding in a sane and rational manner. We are dealing with 1/6 of the American Economy and the lives of millions – this is not something we can make errors on and “fix” later. Would it not be more rational to proceed in a slower and more incremental manner? Why can't the American people have public hearings on the issue where experts in all Health Care areas can be seen and heard from? Why can't we explore how state level efforts with government run health care and health insurance reform are proceeding? What about learning from other nations who have a government based systems? Why can’t we apply Federalism here and simply encourage state level solutions? Why can't each different issue involved in Heath Care reform be dealt with in its own separate bill - why do we need a 1000 page monster bill? Heck, why can’t we even be allowed to READ the bills being proposed? The simple fact that you voted against transparency by not allowing the American public to view the Baucus bill this weekend simply raises the suspicion in my and the many other’s mind that you back this reform simply as a matter of political expediency and to support the growth of government. As it appears to me and a majority of the American public (both left and right), the current so-called “Health Care Reform” proposals simply amount to a corrupt bargain that perpetuates the worst elements of the current status quo for the benefit of Washington Politicians, Big Government advocates, Big Union interests, and Big Corporations at the expense of the young, uninsured, elderly and the taxpayer. Surely with a more open and incremental process you would agree that we can do much better then this! And here is the bottom-line for me: Having said all this in response to your form letter talking points, I am still prepared to give you the benefit of the doubt and give you my support on Health Care Reform if you will withdraw your support for one measure contained in the Baucus and all other Democratic proposals: the Individual Mandate. As a matter of costs, I don’t see the necessity of having Individual Mandate unless you are simply committed to supporting the White House's deal with the Health Insurance lobby regardless of facts or likely outcomes. My personal opinion on Health Insurance costs is this - if you truly believe that your government based plan will reduce costs, then why do you have to force people to participate? If the price of insurance will be truly as affordable for the vast majority of us as you claim, why don’t you trust people to make then rational choice that is in their own best interests? President Obama said as much when he opposed the Individual Mandate when he was a candidate for the presidency. From the mouth of then Candidate Obama: “If you look at auto insurance, in California there’s mandatory auto insurance,” Obama explained. “Twenty-five percent of the folks don’t have it. The reason is because they can’t afford it. So John and I, we’re not that different in this sense; that I’m committed to starting the process. Everybody who wants it can buy it and it’s affordable. If we have some gaps remaining, we will work on that. You take it from the opposite direction, but you’re still going to have some folks who aren’t insured under your plan, John, because some of them will simply not be able to afford to buy the coverage they’re offered.” As a Candidate, the President quite rightly and sensibly opposed the Individual Mandate. A large majority of the Public supported him in his opposition. What has now changed besides the need to keep the health insurance lobby on board? Isn’t the real truth here? It is that all of the proposed bills do not address the underlying costs of medical care and health insurance. Rather they are designed to drag more money from more people for a short term prop up of a failing system all while at the same time making private medical care and Health Insurance so unaffordable as to collapse the system and pave the way for a full “single payer” system (again, see the effects of Individual Mandates and “community rating”/”guaranteed issue” regulation in MA, ME, VT, etc). Finally, I need to ask some pointed questions of you so I can better understand your political philosophy and views on government as my United States Senator: Why do you have so little faith in the American citizen to make rational choices in their own life and want to resort to forcing citizens to buy Health Insurance (and yes, for some Health Insurance purchase makes no sense if they are young and healthy with savings to pay for emergencies or are wealthy/self-payers)? Shouldn’t they be free to make this choice and suffer or benefit as an individuals from their decision? Why do propose and support substituting yours/the government’s judgment for your fellow citizens? Why the mistrust and assumption of the worst about your fellow human beings? I assume you deem yourself competent and responsible enough to take care of yourself in Health Insurance and medical care matters - why do you assume most Americans are not and need to be forced by the heavy hand of government to accept what YOU deem to be the right choice for them? What is your view of the Bill of Rights and Individual Liberty? Are there "exceptions" you allow where the government can infringe on these rights if you feel something needs to be done for "their own good"? As a matter of Personal Freedom and Individual Liberty, this is the most onerous and Unconstitutional law ever considered by the U.S. Congress! I know that "freedom" and "liberty" don’t appear as huge political topics for politicians on either side of the aisle and are not viewed as political “winning issues” by either, but it is a paramount issue to me and a lot of other citizens! This would be the first time EVER that the Federal government has FORCED private citizens to buy a private good or service (and please, don’t reply with analogies to Car Insurance which is a state level issue – plus, I don’t have to own a car, I do have to have a body)! You propose to turn one of most basic life choices into a collective/political matter instead of an individual/family matter. And it leaves us open to the impersonal and often arbitrary decisions of a technocratic and leviathan state. Acceptance of this principle will surely lead to a very slippery slope where just about any action can be forced on the American public by force of law. There are a whole range of health related issues to be regulated/ micromanaged by an ever present nanny state once this precedent is established. If buying health insurance is good and within the scope of Federal Government powers, then, for example, what is to stop the Congress from enacting a Law that say Mandates all Americans run 2 miles a day, etc? After all, a majority may agree that this is "good" and therefore now within the scope of the Federal Government’s powers to mandate/force upon individuals based on this precedent you would like to set when you force people to buy Health Insurance. This is exactly the type of overbearing government and tyranny of the majority that our Constitution was designed specifically to prevent. The basic idea of the U.S. Constitution and the Bill of Rights is to protect the Individuals and unpopular minorities from such heavy handed government coercion and intrusion into their private lives. This so-called Individual Mandate is clearly Unconstitutional and cannot be allowed to stand if we are to remain a free and independent people! If you truly take your oath to defend and uphold the U.S. Constitution seriously, then you MUST change your position and be against the Individual Mandate! I am no fool and fully understand from your actions and statements that such quaint, and from your point of view, antiquated notions such as Individual Rights, Liberty, Personal Freedom, and the proper role of the Federal government very seldom enter your thought processes in your never ending quest to bring us Utopia on earth thru the use of government force and power. However, in this case, I beg you pause for at least a few minutes and open your mind and think about what you are doing here – you are asking us to pay a huge cost in dollars and liberty to completely overturn a health care system that may be imperfect but has saved so many millions. You demand perfection from the Free Market and Individuals yet you do not hold Government, which has a much worse track record, accountable to the same standard. You envision that further state intervention will bring about vast improvements and equality of outcomes when the facts and current practice in other states and nations do that hold that to be true – and the resulting unforeseen consequences and may be far worse than the Health Care Utopia you are hoping to create! Please also consider this thought since you fashion yourself a “Progressive” thinker and politician. The oldest and most “Regressive” idea about government on the planet is authoritarian control over the many by a few elites who think they know what is best for every individual. This is often couched in language and ideology that claims that this tyranny this is being done “For the good of the people” but in practice usually ends up benefiting a small and politically connected ruling clique. I would submit to you that the true “Progressive” idea is Freedom and a government that respects individual rights and Liberties. It has achieved better, more equitable and more human outcomes for the large majority of citizens. Is it too much to ask of you before you cast a vote as my and a good many other citizen’s Senator that you consider who these various Health Care reform proposals really empowers – the Government or the Individual? If there is any doubt in your mind, then is it not best to slow down and proceed with caution? I have no issue with helping my fellow citizen provided that is my free choice (not compelled through threat of government force) nor do I have any problem with finding real common sense solutions to the various issues that plague our current Health Care system. But can find none of this sentiment in the proposals you support and fear that they will a negative has impacts that go well beyond simply more expensive and less accessible medical care. I have young children and I truly don’t want them living in a Nation where the most intimate and personal decisions in life are subjected to governmental intrusion and are a matter of collective politics rather than individual choice. And that is where I fear we are headed if your supported proposals on this issue are allowed to become Federal Law. I would very much appreciate a non-form letter response from you or a member of your staff (or any live human) on the facts concerns I have outlined. If possible, I would like to speak with you or a member of your staff on this issue as soon as practicable. I would like to work with you and support you on achieving true Health Care reform on behalf of the American public. However, if you persist in your support of Mandatory Health Insurance purchase provisions, I will be forced to continue to oppose your efforts and will do the utmost in my power to alert my family members, friends, and the general public in the state of your support of Unconstitutional, expensive, and dangerous Federal Government Health Care takeover plan. Thank You This response was emailed to the Senator and corresponding staff. Remaining ever the optimist, I am hopeful that I will get a positive response, a meeting with the Senator or a member of the staff, or at least a personal acknowledgement of my correspondence/concerns from a real human being. Many of you may see this as wishful thinking based on your personal experiences with your Congressional officials or your observation of their responses on TV or other media outlets. But again, I am an optimist and remain open to the very unlikely event that something approaching representative governance will occur. "