As reported in the Des Moines Register, a jury recently found the State of Iowa guilty of illegal discrimination against a transgender man. He had not been allowed to use the men’s bathroom or locker room, and he had been denied health insurance coverage for gender re-assignment surgery. (See link below to Register article.)
It is morally correct and good public policy that our government not discriminate against a people based on their gender identity. But refusal by government or private employers to cover gender reassignment surgery under their health insurance plans should not be considered wrongful discrimination, unless the plans cover other types of cosmetic procedures for people who feel similar dysphoria. People may feel mental distress over their teeth being crooked, or their nose being too big, or many other aspects of their body, but that does not mean health insurance plans should be required to cover procedures to make people feel better about their appearance. We have already seen that requiring health insurance plans to cover almost everything makes the premiums unaffordable for many people. There is nothing inherently wrong with expecting people to pay their own way for cosmetic procedures.
The Des Moines Register recently reported that Wellmark Blue Cross Blue Shield has been accused of violating federal HIPAA privacy regulations in the case of a patient with severe hemophilia. (See link to Register article below.) As reported, a representative of Wellmark was discussing the high cost of health insurance at a Rotary Club meeting last March. She gave an example of an extreme case that was costing $1 million per month. (ACA – Obamacare – prohibits insurance companies from placing any limit on the amount it will pay for patients.) She did not identify the patient by name, but described him as a 17 year old male with hemophilia. Maybe she should not have mentioned the age or sex of the patient, but that information alone did not identify who the specific patient was, and should not be considered a violation of federal privacy regulations.
Wellmark and other insurance companies must be able to cite specific high cost cases that are causing health insurance premiums to rise to unaffordable amounts. How can we openly debate ways to contain health care costs if we don’t know what is causing the high costs? Can we really afford to require insurance companies to pay out unlimited amounts for any patient? I recently heard that the last remaining company to offer individual health insurance policies in Iowa may charge more than $30,000 per year next year for a couple who are 55 years old. Health care wants are unlimited. Our ability to pay is not. We need to debate whether or not government should prohibit health insurance policies from having limits on how much they pay out for individual patients.
In The Des Moines Regiser’s report about Wellmark getting out of the health insurance market for individual policies under the Affordable Care Act (ACA), they reported, “Forsythe (CEO of Wellmark) cited a single Wellmark customer who has a rare genetic disease that is costing more than $1 million per month to treat.” One person – A million dollars a month. (See link to article below.)
One of the fatal provision of the ACA is the requirement that there be no limit in health insurance policies on how much can be paid for any individual’s care. No limit. Should we really expect others (society) to pay a million dollars a month for the care of ourselves or our family members? If you help to pay that much for someone else, then won’t you expect the same to be paid for you if you have the need? How can that be sustainable? Who gets to makes decisions regarding who we pay for and who we don’t? Unfortunate as it may be, it is a reality of life that we cannot afford, even as a society, to pay for everything we want. To the extent that those decisions, including limits on health insurance policies, can be made privately and voluntarily, we will have a more just, civil, and sustainable society.
I will respect the ruling of the Supreme Court in upholding the subsidies under Obamacare, but the decision was wrong.
Those who drafted, supported, and voted for Obama care clearly intended to withhold money from those states that did not set up their own state health insurance exchange – just like many other laws that require states to meet certain requirements in order to get federal money. In this case, they intentionally wrote the law to provide subsidies only to people in states who purchased their health insurance through an “exchange established by the state.” It was intended as a carrot or a stick to get the states to comply. Many did not comply, so the strategy backfired.
The job of the Supreme Court is to resolve disputes based on the law, the facts, and the Constitution. It is not the job of the Court to fix mistakes in political strategy. That is what they did, and it was wrong.
The Register recently criticized our fee-for-service health care payment system for causing over-utilization and for driving up health care costs. (2/12/2015 – “Florida, home of medical scans — and scams” – see link below) They gave examples of doctors ordering unnecessary test because they get paid more for every additional service that they provide. They advocated paying physicians a salary like Mayo Clinic does, so that doctors, “…have no personal, financial incentive to provide unneeded care.” They urged the Obama administration to, “…continue to work toward reimbursing providers based on quality instead of quantity while fairly reimbursing them.” I agree with the Register that, “Ultimately, reducing the overuse and misuse of health care falls to patients.” They urge patients to not rush to the doctor for every ache, ask questions when doctors order tests, resist clinic staff who want to schedule tests and procedures.
One thing the Register failed to mention is the importance of patients being required to pay out-of-pocket for some portion of their health care costs. To the extent that patients are not required to pay for some portion of their costs, they will not question the recommendations of doctors and other providers and they will tend to over-utilize health care. Requiring patients to make some out-of-pocket payment will also help reduce fraud, since patients won’t want to pay part of any fraudulent charges that billed to their insurance. Many insurance policies under Obamacare do seem to have significant deductibles and co-payments. That will go a long way to help keep down health care costs.
Link to Register article: http://www.desmoinesregister.com/story/opinion/2015/02/12/florida-home-medical-scans-scams/23278965/
Regarding The Register editorial today (11/17/2014) entitled “Obamacare foes are hoping for activist judges” Exactly the opposite is true. It is the Obamacare supporters who are hoping for activist judges to interpret the law differently than it was written. The letter of the law is clear. It states that only people who sign up for Obamacare through state run exchanges are eligible to get subsidies. Obama and his team created this threatening provision intentionally to pressure states to create their own exchanges. But more than 30 states, including Iowa, did not knuckle under to the pressure. The Supreme Court should uphold the law as written, not as Obamacare supporters wish or hope it was written. This is what happens when, as Nancy Pelosi famously said, “we need to pass this bill to see what is in it.”
A Supreme Court ruling today (6/30/2014) upheld our fundamental right to use our own private property in accordance with our own moral beliefs. The ruling gives priority to natural religious and private property rights over the politically created guarantee that private business owners will provide employees with a health insurance benefit that covers certain birth control pills.
The owners of Hobby Lobby objected to the Obama Care legal requirement that they provide their employees with an insurance benefit that covered morning after “abortion” pills. The law was in direct conflict with their sincerely held, honest and peaceful religious beliefs. Hobby Lobby has never used force or fraud to get people to either work for or patronize their business.
Governments are the only organizations that can legally use force against peaceful people. We created our government to use force, if necessary, to protect our fundamental right to life, liberty, property, and the pursuit of happiness. Government force should not be used to make peaceful people act against their own religious beliefs – no matter how good the cause or the intentions.
By the way, I am a peaceful, honest, pro-choice, atheist, libertarian.
Republicans are right to not increase the debt ceiling without some action to reduce our Country’s spending deficit. They are not right to pick out Obamacare as the only possible target. President Obama and the Democrats are wrong to insist that the Republican in the House of Representatives pass a “clean” debt limit expansion bill. The compromise should be to agree on spending cuts that are not specifically related to Obamacare. The four big drivers of the Federal budget deficit are Medicare, Medicaid, Social Security and Military spending. Any other spending cuts, although helpful, do not really solve our long-term problem. Republicans should propose some type of binding agreement on entitlement and military spending cuts in return for passing a debt increase bill. The real problem to be solved is that we must stop spending beyond our means.
Contrary to the letter to the Register on 5/28/2013 by Michelle Anderson, “Iowans should have access to naturopathic docs”, we already have open access to naturopathic doctors and medicines. What we don’t have and don’t need is for our government to license practitioners and then require that their services be covered by insurance. Individuals are not calling for licensure in the interest of public safety. Practitioners are calling for licensure in order to have their products and services be a required service under Obamacare. Unfortunately, as long as our government continues to use its power to force insurance companies to cover politically favored medical products and services, there will be many special interests, such as naturopathic doctors and pharmacists, who will try to get on the government gravy train.
Beginning on 1/1/2013, individuals with income over $200,000 and married couples with incomes over $250,000 will pay a new 3.8% Medicare tax on interest, dividends and capital gains. This increase will happen whether or not the Bush Tax Cuts are allowed to expire. Currently, the Medicare tax is 2.9% of all earned income, without limit. So, the wealthy pay the Medicare payroll tax on everything they earn. Beginning in 2013, they will contribute even more based on unearned income. This tax was included he Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare. The tax had nothing to do with protecting patients or making care more affordable. It was simply a tax increase on the rich to help reduce the tremendous Medicare funding deficit. So, Obama has already increased taxes on the rich.