Louisiana politics has fascinated me ever since I was old enough to vote. The parade of colorful and controversial characters through Louisiana's political history could never be called boring: Huey "Kingfish" Long, Earl Long, Edwin Edwards, David Duke. Now the new generation makes it mark: Livingson, Jefferson & Vitter.
Of course, the fact of scandal is never surprising. What's interesting to me, however, is how the different politicians responded to the scandals. Let's peruse some examples.
Governor Earl Long was committed to a mental hospital for "eccentric" behavior. While institutionalized, he kept running government (by phone), fired the head of the state hospital system, and then appointed someone who would release him. Now where are problem-solvers like that today?
Governor Edwin Edwards was a master of the one-liner, and a consumate entertainer. I will never forget one of his finest moments in scandal-response. Stay with me while I set the stage. Edwards faced the proposition of a run-off election against ex-KKK Grand Wizard David Duke. Edwards was at the same time plauged by allegations of extra-marital affairs. One reporter asked him if he was worried about the opposition from Duke. Without a pause, Edwards quipped that he had no worries about Duke, because HE was the real wizard underneath the sheets. Somehow, once he made you laugh, the alleged scandals were forgotten. Unfortunately, Edwards later violated a cardinal rule... thou shalt not thumb thy nose at the Federal Prosecutor. They eventually got him and he is doing time.
These new politicians lack the master's touch. Former U.S. Rep. Livingston merely resigned at the approach of alleged sexual scandal, although I suppose he deserves some moral points for that. U.S. Rep. William "Cold Cash" Jefferson understandably made like a clam after last month's 16 count indictment involving $90,000 in highly questionable cash found in his freezer. However, he had the gumption (if you want to call it that) to keep his seat while he fights the charges. You have to give him some credit for winning re-election after his alleged scandal broke. Ex-D.C. Mayor Marion Barry would be proud.
U.S. Senator David "Family Values" Vitter recently took an interesting Jimmy Swaggart-style "I have sinned" approach to his alleged sexual scandal, combined with a Cheney-esque attack the accusers twist. The best defense is a good offense? He plans to keep his congressional seat and ride out the storm.
The scandal response playbook now seems to have several options. It will be interesting to see how Jefferson and Vitter fare. Cold Cash Willie is actually in the hotter water, as he faces multiple serious federal indictments. Vitter lucks out in that his alleged hanky-panky with women of negotiable virtue may not subject him to criminal prosecution, because statutes of limitations may have run out on the alleged crimes. Will his Swaggart/Cheney gambit work on the public? It will be interesting to see.
Monday, July 16, 2007
Friday, July 6, 2007
Sicko And My Thoughts On Health Care In America
I have not yet seen Michael Moore's movie Sicko, but I note that it has evoked strong passion amongst my peers and friends. I deal frequently with the poor, people with disabilities, and the un/under insured and have witnessed some tragic results of the system. I have also seen the other side. Here are some of the dynamics as I appreciate them.
First, there is always going to be tension between for-profit health care providers/insurers and the public policy interest in receiving the best quality health care at the lowest possible cost. Why? Any for-profit company has a duty to its shareholders to maximize profit and return on investment. Thus, if they think they can sell you a service for $200 instead of $100, they actually have a legal duty to try. Even not-for-profits want to see enough income to continue their existence, or to improve their ability to accomplish their stated goals.
Is that evil? Few would deny that investors legitimately want to see a return on their investment. Indeed, that is capitalism, the engine of the American economy. We should be proud that the health insurance industry reaps such large profits, as shown in the Fortune 500 Health/Managed Care list.
That is where I run into trouble with the idea. There is a point where my gag reflex is triggered when it comes to what we as a society are willing to tolerate in the name of corporate profits. Not that I am against profits - just that certain methods of obtaining profits are, in my opinion, morally reprehensible. In my opinion, there is no question that the health care/insurance industries have passed that point in several categories. A few examples:
-Denial of high value legitimate claims as a means for boosting corporate profits. Trust me. It happens. Even if it only works a modest percentage of the time, it can save insurers millions.
-Widespread use of "stonewall" tactics, making it so difficult to continue pursuing even legitimate claims that many people give up (fewer paid claims = more corporate profits).
-Making the insurance claims and appeals process sufficiently complicated and burdensome that even legitimate claims are often lost on complex procedural grounds, or from lack of resources to continue an appeal.
-The "dry cleaner" effect: Have you ever noticed that dry cleaners virtually never conveniently list their prices for their customers? As a general rule, neither do health care providers. That makes it hard to shop around for a good price for a medical service if you are not insured. Result: they can more easily charge higher fee-for-service prices.
-The same effect applies for health insurance policies. Have you ever tried to read one? They are far too complicated for a vast majority of insurance consumers to understand without legal advice. They often contain vast coverage exclusions and limitations that consumers do not comprehend when they purchase the policy. Thus, just comparing premium prices and deductibles is not enough to know if you are getting a good deal or not. That's great for insurance sales and pulling wool over customer eyes, but terrible for the consumer when they unexpectedly find they are not reasonably covered for a critically needed service.
I don't have a good answer to all of these problems. However, it would be nice to create financial disincentives to the above types of behavior. Hire some public interest bean-counters and figure out how big the penalties would have to be to make the insurance company and health care corporate bean-counters advise their clients that it's not worth it to engage in such reprehensible practices. Then, the market really could correct some of the worst problems.
Not that I expect much change. The amount of money these interests spend on lobbying to prevent such changes is mind-boggling. Check out The Center For Public Integrity's "Top 100" reported lobbying organizations, where you will find the health care and health insurance lobbies spend hundreds of millions of dollars to keep things the way they want it. That kind of money can buy a lot of politicians.
The motif of my Citizen Franklin blog made me think back to colonial times and the Boston Tea Party. Is Michael Moore the new Samuel Adams, whipping up outrage amongst the populace regarding a great perceived injustice? Should we throw all of our insurance policies and hospital bills into Boston Harbor? Are we being taxed with unreasonable premiums and medical bills without representation, because health care/insurance company lobby money has bought off all of our representatives?
Let me know what you think.
I have not yet seen Michael Moore's movie Sicko, but I note that it has evoked strong passion amongst my peers and friends. I deal frequently with the poor, people with disabilities, and the un/under insured and have witnessed some tragic results of the system. I have also seen the other side. Here are some of the dynamics as I appreciate them.
First, there is always going to be tension between for-profit health care providers/insurers and the public policy interest in receiving the best quality health care at the lowest possible cost. Why? Any for-profit company has a duty to its shareholders to maximize profit and return on investment. Thus, if they think they can sell you a service for $200 instead of $100, they actually have a legal duty to try. Even not-for-profits want to see enough income to continue their existence, or to improve their ability to accomplish their stated goals.
Is that evil? Few would deny that investors legitimately want to see a return on their investment. Indeed, that is capitalism, the engine of the American economy. We should be proud that the health insurance industry reaps such large profits, as shown in the Fortune 500 Health/Managed Care list.
That is where I run into trouble with the idea. There is a point where my gag reflex is triggered when it comes to what we as a society are willing to tolerate in the name of corporate profits. Not that I am against profits - just that certain methods of obtaining profits are, in my opinion, morally reprehensible. In my opinion, there is no question that the health care/insurance industries have passed that point in several categories. A few examples:
-Denial of high value legitimate claims as a means for boosting corporate profits. Trust me. It happens. Even if it only works a modest percentage of the time, it can save insurers millions.
-Widespread use of "stonewall" tactics, making it so difficult to continue pursuing even legitimate claims that many people give up (fewer paid claims = more corporate profits).
-Making the insurance claims and appeals process sufficiently complicated and burdensome that even legitimate claims are often lost on complex procedural grounds, or from lack of resources to continue an appeal.
-The "dry cleaner" effect: Have you ever noticed that dry cleaners virtually never conveniently list their prices for their customers? As a general rule, neither do health care providers. That makes it hard to shop around for a good price for a medical service if you are not insured. Result: they can more easily charge higher fee-for-service prices.
-The same effect applies for health insurance policies. Have you ever tried to read one? They are far too complicated for a vast majority of insurance consumers to understand without legal advice. They often contain vast coverage exclusions and limitations that consumers do not comprehend when they purchase the policy. Thus, just comparing premium prices and deductibles is not enough to know if you are getting a good deal or not. That's great for insurance sales and pulling wool over customer eyes, but terrible for the consumer when they unexpectedly find they are not reasonably covered for a critically needed service.
I don't have a good answer to all of these problems. However, it would be nice to create financial disincentives to the above types of behavior. Hire some public interest bean-counters and figure out how big the penalties would have to be to make the insurance company and health care corporate bean-counters advise their clients that it's not worth it to engage in such reprehensible practices. Then, the market really could correct some of the worst problems.
Not that I expect much change. The amount of money these interests spend on lobbying to prevent such changes is mind-boggling. Check out The Center For Public Integrity's "Top 100" reported lobbying organizations, where you will find the health care and health insurance lobbies spend hundreds of millions of dollars to keep things the way they want it. That kind of money can buy a lot of politicians.
The motif of my Citizen Franklin blog made me think back to colonial times and the Boston Tea Party. Is Michael Moore the new Samuel Adams, whipping up outrage amongst the populace regarding a great perceived injustice? Should we throw all of our insurance policies and hospital bills into Boston Harbor? Are we being taxed with unreasonable premiums and medical bills without representation, because health care/insurance company lobby money has bought off all of our representatives?
Let me know what you think.
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