Now my body is subject to government meddling

Each party has their own favorite private decision subject to meddling. For the Republicans, their meddling includes friends, especially intimate ones. Having let their party be hijacked by the right wingers who hate everybody and everything not associated with white christian men. They fill their airwaves with invectives against women who work; against immigrants who do jobs Americans won't do (when was the last time you met an American who was willing to work picking fruits), and people who would rather be intimate with others of the same sex.

Now, the Democrats decide that I am incapable of making a decision about what, when and how much medical care I actually need. Despite the fact that I am the subject of the right wingers invective (being a woman who works for a living), what the Democrats did upsets me more. Why? Simple. Being insulted by a bunch of folks who think Christianity is about suppressing economic freedom for 53% of the nation's population pales in comparison to a bunch of folks who think that I am incapable of making my own sick care decisions and think that I should have to not only be forced to pay for a cadillac plan for myself, but for others as well.

What the nation really wanted was insurance reform: outlawing certain practices that allows insurance companies to reduce their risk to almost nothing while reaping profits that make Wall St look like incompetent profiteers. In a true capitalist system, the higher the profit, the greater the risk. The insurance companies rigged the system so they can make huge profits while taking very little risk. Practices that the electorate wanted outlawed are dropping people from coverage when they actually file a claim for sickness, outlawing pre-existing conditions, charging women more than men because they can get pregnant (huh) and denying coverage to children with genetic conditions that left them debilitated. These conditions left a huge segment of the population unable to obtain coverage at any cost.

Americans do not want the government meddling with their health plan; Americans do not want cutbacks in Medicare. Instead of just being satisfied with insurance reform, the Democrats decided that they know what kind of medical care people should have. Moreover, they provided no way for healthier people to opt into less expensive plans simply because these people do not get sick often or if they do get sick, refrain from entering the system until they either suffer major trauma as in an auto accident or a hunting mishap, or acquire a debilitating condition that requires aggressive medical intervention, like cancer. While it is true that the US has one of the best medical systems in the world, it is also true that even for simple mundane things like an EKG, the costs are way out of proportion for the service rendered.

In our hodgepodge of insurance coverage, one option really stood out with the potential for really putting the brakes on overuse of medical procedures: the high deductible plan. Plans like these are designed for catastrophic care; and in my informed opinion, catastrophic, major medical is where the U.S shines. What high deducible plans do though is make the consumer conscious of the cost of "extra care" or a diagnostic test. If a consumer knows that a diagnostic test costs $1200, and all the test would do is confirm what the doctor already found through a good physical exam, the consumer may just opt to take the doctor's word for it and not sign up for the test. Putting the brakes on extra tests really will slash the amount of money we spend on health care.

Although health plans may not cover things like lasik surgery, chiropractors or naturopaths, there is no IRS regulation prohibiting the use of Medical savings accounts or Health savings accounts to cover those costs. People who have high deductible plans with a health savings account not only can cut down on overutilization, but also, use the savings account to pay for CAM, when their health plan won't. While there may not be expensive case controlled studies validating CAM, there is quite a bit of evidence that such care keeps people out of the hospital by working with the body's natural defenses or modulating the inflammatory responses which is implicated in a lot of modern conditions.

There are two interesting quirks in the health care legislation which will lead to a massive redistribution of health care resources. One is the mandate that all people get coverage or face a fine of upto 1% of their income. First, the mandate may be unconstitutional because the fine is called a "fine" rather than a "tax". A tax may be the only legal levy that Congress is allowed to enact on such a widespread scale. Of course calling it a tax is politically unpalateable. Regardless of the constitutionality of the mandate, the mandate itself will have an interesting effect: healthy people of all income levels will pay the fine, and the older you get, the better off financially you are to pay the fine. The Senate bill has no provisions for halting the rise of premiums on older people and in fact specifically allows insurance companies to raise rates on older people. If the fine (or tax) is a maximum of 1%, why not pay the fine? Even for seniors who do not qualify for subsidies, they are much better off paying the fine. When they get sick enough to require medical care, the non-discrimination clause in the bill will prevent an insurance company from denying coverage. When that happens, the premiums will be a bargain considering how much medical care costs.

The interesting thing is that younger people will be better off paying the fine also. Undoubtedly some of them will qualify for subsidies as they just don't need health care as much as older people do. Even unhealthy young people need less care, heal faster and can tolerate unhealthy dietary choices without suffering the consequences of such a decision. Moreover, when they do get the modern chronic conditions, no insurance company can deny them coverage and they too will benefit by using the money they saved by not paying premiums and putting these funds to work making more money.

Of course, that leaves the insurance companies with the sickest people. More seniors will be forced on to Medicare because they can no longer afford the premiums; programs like Medicare Advantage allowed Seniors who had the means to pay a very low premium (something like $80 / month for a couple). Medicare Advantage had higher reimbursement rates, so they were able to find willing providers. Without Medicare Advantage, many of these people will be forced to Medicare; with the low reimbursement rates of Medicare, many seniors will not be able to find any doctor accepting new patients. If the intent was to deny seniors medical care without saying it, the new health care bill does exactly that.

While the health care bill does not use the phrase "Death panel" (and I doubt it ever did), the effect is the same. What difference does it make to overtly deny medical care to seniors or make reimbursement rates so low that no doctor will see them? The effect is the same: denying medical care to the elderly.

So what we have is a major shift of health care resources away from the elderly with families consuming most of the health care dollars, subsidized or unsubsidized. In fact, families with children may be the only group of people who are not sick to purchase health insurance. Younger people and healthy older people will opt to pay the tax because it is to their financial benefit to do so. If alternative health care providers are locked out of the reimbursements due to a Western medicine bias in all areas of the government, then their patient pool will consist largely of the healthy and many of these doctors can change their practice paradigm from specific conditions like low back pain to wellness centers. Many of these patients will be more affluent and more educated, have access to better quality food.

While the health care legislation is bad medicine, certain segments of the population are now better off and there will be a demarcation between the healthy and not-so-healthy, where the healthy end up being cash customers to alternative medicine providers and the not-so-healthy customers use their new found coverage to enter the sick care system and perhaps get sicker. Meanwhile those who choose to opt-in will end up paying the bill.

It goes without saying that the way to prevent this is to create a single payer system, where large insurers like Aetna administer the plan for all enrollees (the entire nation). Everybody is enrolled and everybody gets coverage. There are certain advantages to this: providers have no incentive to refuse patients, because the reimbursement rates are uniform. Premiums can be more easily regulated because the payer is not the one who collects the money. A single payer system is not to be confused with the so-called public option. In a single payer system, the government merely collects the money. The government is not an insurance company. It is up to the money manager to negotiate rates and process claims. With the public option, the government is one of the insurance companies. Being administered by an insurance company, the actual implementation would work like it does with large self-insured employers, where companies like Aetna already administer their plans.

Going back to the days of my youth (in the sixties), I can opt out of the health care system, pay the tax, and pay my providers in cash, just like I do now. Doing it this way allows me to use the exorbitant premiums for other more productive uses. Paying for more medicine than I need is an unproductive use of my funds.

John Dennis - 2010

Political pundits are probably wondering why John Dennis is even bothering to challenge Nancy Pelosi in San Francisco's 8th District; let alone even admitting that he is a Republican. Wonder no more. He actually has a chance, and a pretty good one to actually capture the seat. San Francisco is a politically dynamic place, where people on either end of the political spectrum toss their hats into a discussion regardless of the actual political views of the person to whom they are talking, and both sides feel just as strongly about the correctness of their views. The one thing, though, that everybody agrees upon is that this is a free country and San Franciscans love their freedom.

They love their freedom to express themselves and act or dress in ways that would be socially unacceptable elsewhere. They love the freedom to spontaneously block a city street in a densely populated part of town to protest something or express satisfaction of something. And, above all, they love their freedom to live their lives as they see fit, whether its with a spouse of the same gender or under a freeway overpass. With this love of personal freedoms, it is no wonder that many are embracing the campaign of someone who is challenging the status quo of an incumbent percieved to be trampling upon other people's freedom.

What outsiders see is something entirely different. Outsiders see a city full of people who are to the left of even organizations like MoveOn.org. A lot of this perception is media driven. The reality is, though, that San Francisco's demographics has changed quite a bit in the last decade or so, certainly since the mid-1980s. Politicos of larger cities do not change that quickly and San Francisco is no exception. What outsiders do not see are the incremental changes, who is moving out and who is migrating in. San Francisco was a major beneficiary of the in-migration of younger, entrepreneurs who fueled the dotcom boom. Many of these people have a somewhat libertarian bent to their political biases and for a variety of reasons settled in the city itself.

The media also sees libertarians as "Republicans", even though many are socially liberal. It is true that many do run under the Republican banner. But many can easily run under a moderate Democrat banner as well, as Democrats tend more to respect people's differences, even if they want to tell people how to live their lives. The ideal Republican who can win is one who runs on a platform of respect for liberty, respect for people's love of freedom. The unsuccessful one is a Republican who insists on using socially divisive issues like abortions or gay marriage as a way to differentiate themselves from their opponent. Such arguments do not fly in San Francisco as people there generally respect eachother's differences and many thrive on it.

John Dennis is running a smart campaign. His goal is not to convert San Francisco into a bastion of conservatism. The campaigns' goal is really to tell people how the Democrats are stomping upon their freedoms and doing so with legislative games that stymie healthy debate. As long as he sticks to the freedom message and stays away from socially hot button issues, his chances of actually winning improve substantially. It is too early to predict whether the freedom message will resonate with some of the entrenched interests, but it probably will resonate with the newer residents who grew up elsewhere.