Monday, July 16, 2007

What Vinehout's story really illustrates

Over the weekend, I noticed a piece on Sen. Kathleen Vinehout's health insurance woes, offered as an illustration of what is wrong with our health care system. Perhaps it is, but my first reaction to the piece was to wonder why no one asked the Senator the simplest of questions.

Why were you unable to pay for health insurance when you were able to contribute almost $9000.00 to your own Senate campaign?

Here's the story.

Apparently, Vinehout and her husband are a pair of professionals who, at some point in their late youth or early middle age, decided that farm living was the life for them. It seems that some unspecified event in 2005 caused them to lose their health insurance or to decide to stop paying for the insurance they had. Just what that was - perhaps a decision by Mrs. Vinehout to go into politics fulltime - is left unstated.

We are also not really told why they decided not to pay for insurance. It was to "pay farm expenses" but what does that mean? Was it a choice between health insurance or groceries? Insurance or losing the farm? Based on the article, we don't know.

What we do know is that, although they saved something in the neighborhood of $23,000 in premiums over the 23 months that they went uninsured, they didn't quite make it unscathed. Shortly before Sen. Vinehout won election to the senate and its Cadillac health care, their son required an emergency appendectomy which wound up costing them $10,000. They say they had to borrow to pay the bill.

On his show this morning, Charlie Sykes apparently spent some time emphasizing the fact that Sen. Vinehout and her husband made a choice and so they did. But what kind of choice?

These are not unimportant questions if Vinehout's "tragedy" is supposed to be instructive on our health care woes. This is because we don't have an "accessibility problem," although do have some accessibility problems. If you don't take the time to understand them and how they are distinct, preferring instead to detour off into babble about how health care is a right and should be '"free," you aren't going to get the diagnosis right. And you'll cobb up the cure.

While we hear about the uninsured, there are many reasons why people are uninsured. Some are effectively uninsurable due to pre-existing health problems. That presents one problem set. Apparently, this wasn't the case with Sen. Vinehout's family. It certainly wasn't for her son.

Other people can't afford insurance. While we are supposed to conclude this was the case here, that is not clear. In fact it seems like it almost certainly wasn't. Apparently the family had the capacity to borrow to cover the uninsured costs of their son's surgery. Couldn't they have borrowed to cover farm expenses until the crops came in?

Even more to the point, it appears that Kathleen Vinehout contributed almost $ 8000.00 to her own campaign. Her husband, Douglas Kane, threw in another $1000.00. That money would have covered much of the premiums that they chose not to pay (remember that, as self-employed farmers, they could pay them with pre-tax dollars, while political contributions are after tax) and it would have covered about all of young Nathan's surgery.

This brings us to where Senator Vinehout's family seems to belong. Another group of people have no insurance because they choose to gamble on their health. Most frequently, this is young people (for whom it may be an arguably rational choice) but it can also be older people who don't want to make a difficult choice to provide for their health as opposed to spending the premium money on some other (often worthy) thing or doing something else that will cause them to forfeit their insurance. I may think it is crazy for a 49 year old with a kid to decide to go naked, but it does happen.

It looks like that is, at least in part, what happened here. I am all for middle-aged people following the dream - be it politics or keeping the farm- before it's too late. Heck, I'm in the process of doing it myself in a less dramatic and more conservative way. But the idea that the rest of us should pay for it carries a bit less sympathy and may suggest different policies than the story of someone who just can't buy or afford insurance.

This is not to say that the Kane/Vinehouts' choice, even if it was a bad one (although it looks like they came out dollars ahead), is uninteresting from a policy perspective. There is a "free rider" problem here in that we aren't going to let people (or their children) die because they made imprudent decisions. (Little Nathan was going to get that appendectomy no matter what.)

Sure, I'm speculating on some of this, but the article leaves me with no choice. In that sense, the reporter becomes emblematic of our health care debate. If there is a heartrending story to tell (and this is not much of one - nothing bad happened and no one was ever in danger), we ignore all the tough questions.

We do it on policy too. Universal health care is not free. Universal is not unlimited. People and businesses will react to the incentives and costs that reform creates and this, too, will have an impact on real people and their health. Compassion is an necessary part of the health care debate, but it is not sufficient to end the debate. It resolves little of interest.

16 comments:

Anonymous said...

I worked for a large corporation that gradually diminished our health insurance program. Most of us didn't notice it because we didn't use it, but when we needed to what a surprise.

To make a long story short, in less than ten years of taking care of my wifes who had cancer, our out of pocket medical expense was over $150,000. In addition, the medical community is ruthless in there collection procedure to the point that when your insurance hasn't paid something that you don't even know about, you are suddenly served a notice to appear in court because they want to take your house (or a good part of it).

Its my experience that the health care industry is out of control and doing whatever they feel like doing. If socialized medicine comes, it will be because they took for granted the freedom to be fair and just.

Lew Wasserman said...

This story represents the failure to separate the issue of who pays for health care from the issue of who gets health care. A father and son from out of town go to the Minnesota hospital because the son is suffering lower abdominal pain (and perhaps other related symptoms). The father tells the admission clerk his family doesn't have health insurance but they will pay the cost of the care. Result: the boy is promptly and competently treated. The greatful family thanks the hospital and staff. The family gets a reasonable bill and they pay without complaining, because that's what they said they would do. (Imagine they tell the admission clerk they don't have health insurance and furthermore they will contest any bill no matter how reasonable). You get the picture...

Anonymous said...

lew - the question is who can pay and not who will pay. You may think $300 for a 2 minute office visit is fair but most people cannot afford that.

If the medical industry doesn't start treating all the population fairly, socialized medicine or laws regulating what percentage of people income can be charged for medical services will be imposed.

The train is coming...

Dad29 said...

Seems to me that if your Doc is charging $300.00 for ONLY a "2-minute office visit," (and there is nothing else involved whatsoever,) then you should fire your Doc.

That's called "making the trains run on time."

Anonymous said...

Dad29 - I'm guessing from your response that you've had little exposure to the medical monopoly or you don't read your bills because your insurance pays for it.

My point is that the medical monopoly will be regulated because our goverment has an interest in making sure that this rape on society gets under control. It's bringing it on itself.

MommaBlogger said...

My point is that the medical monopoly will be regulated because our goverment has an interest in making sure that this rape on society gets under control. It's bringing it on itself.

Are you daft? The government rapes us on a daily basis with taxes, and can't even control their own spending. And you think they're going to fix the health care system? They'll only make it worse, and it will become harder for people to get the treatment they need. It's bad enough now, but it will only get worse.

Anonymous said...

Mblogger - that is why I think it will end up to be some type of regulation that requires the medical industry to provide care to everyone with limits or caps on what they can charge people according to there income levels.

It would be like our progressive tax system but for medical care. A person that makes 10,000 a year w/o health insurance maybe can only be charged up to 10% of there income where a person making the same with health insurance can not have any further out of pocket expense. The more we make the more we can afford to pay.

Anonymous said...

Let's see, she and her husband can't afford healthcare, yet she can afford to stick $9000 in a campaign, then gives an interview that says she had to sell cows to pay for the campaign, and she had to negotiate the fee to St. Elizabeth's Hospital down to $10,000, paying for it by doing a re-fi on the farm, and then fails to attend events in her district by telling them that she and her husband are "on vacation". And let's not even start the whole "hot dogs for votes" thing at UWEC before the election, or the four page press release in the form of a poem.

Interesting choices indeed.

Anonymous said...

If I read one more comment on how government is going to screw up the health care system, I'm going to puke. GOVERNMENT ALREADY PAYS for half of health costs (directly through Medicare/Medicaid/VA or indirectly through tax subsidy) in this country. And our system couldn't be more screwed up. We PAY ALMOST DOUBLE per capita for health care than any other developed country and we still DIE SOONER. Americans are LESS HAPPY with their health care systems in polling than citizens of other countries. We get nothing for our extra spending except extra filing cabinets at insurance companies. If our health care system were a real business subject to normal market forces, it would have been bankrupt long ago.

And the state of the debate is that the dad gum gummint gonna take away my health care. We deserve the piss poor outcome we have right now.

Want a solution? Adopt France's system: excellent cost containment, universal coverage, full patient choice of doctors, better health outcomes, and a strong role for private insurance. The French have a more "American" system than we do...unless you consider wasteful stpending and premature death to be American values.

Jim Jones said...

Aren't you people paying attention to the dates?

Of that $9000, $7000 went in on 11/1/2006, in the shadow of the election. By that time I suspect they knew they were ready to close the deal.

Who knows where the money came from? But by Nov 1st all the ads had been bought and the fundraising was long concluded. Spending $7000 when you are looking at polls conducted a week before the election, to cover expenses already incurred is nothing at all like dumping in $7000 a year earlier as seed money.

Jim Jones said...

And let's not even start the whole "hot dogs for votes" thing at UWEC before the election, or the four page press release in the form of a poem.

Lon, baby, is that you?

You're on the right track there. While Vinehout is taking action on an issue that is absolutely slaughtering agriculture and rural society (something ring suburb conservatives seem to be absolutely tone deaf to), you guys keep talking about hot dogs. I'm sure your guy will win next time.

Rick Esenberg said...

This is also the time that the medical bill that makes her face redden came due. As for whether she knew she would win or not, I don't see how it matters. The point is: they had access to money. It appears that she did not want to use the money (however they got it) to pay for her family's health care and is angry that the taxpayers wouldn't cover her while she ran for office - as opposed to, you know, getting a job that would provide health insurance.

There could be other explanatory factors. Maybe she inherited money on October 31. My point was that no one bothered to ask the simplest of questions about a story that begged for clarification.

Maybe the taxpayers should pay for the health insurance of middle-aged people who want to reinvent themselves (I do think that tying health insurance to employment is economically inefficient and can deter otherwise productive choices), but that is a different issue than the one that is supposedly illustrated by the half story that we are hearing.

Lon Noel said...

jones baby:

the previous post that you tried to pin on me, sorry, not me. The whole hot dog thing wasn't up to the scruteny of the elections board or the eau claire county da, so no harm, no foul.

As for the healthcare deal, we both know that the current plan is dead, but I certainly think that a compromise can be reached. It will take every person that has an investment in quality healthcare to call their elected official day and night and insist that some kind of workable deal can happen, and soon.

Marcus Aurelius said...

You may think $300 for a 2 minute office visit is fair but most people cannot afford that.

&

Dad29 - I'm guessing from your response that you've had little exposure to the medical monopoly or you don't read your bills because your insurance pays for it. [emphasis added]

Isn't that what we are trying to say, that will be what happens? You see, I usually go straight to the line that tells me what our responsibility is and could care little for what the insurance company is responsible for. Perhaps I am some sort of freak, but I think that is common. After all, who goes around wondering what the total bill for sending their child to public school is?

Or who wonders what the total bill for the company Christmas party will be and cut back on their consumption to save the company money?

Two areas of where government has its fingers deeply into are education and medical care (or at least rely heavily on third parties paying). Those two areas of endeavor experience a much greater inflation in the rise of prices than other areas of economic activity. Of course, who cares when someone else is paying for it?

Oh, there are two medical areas that are experiencing a decline in price. Yeah, they are optional, but no third party pays (govt, insurance, or otherwise) for them. Vision correction surgery and cosmetic surgery. I bet if a third party started to take over paying for those areas prices would do a reverse and start rising.

One last thing. Have any of you lived under a socialized medical system? I spent six years in such a system. Ms. Vinehout's son may not have survived his appendicitis in such a system. I know one little girl who will forever be six years old (appendicitis too) because the socialized med system failed her terribly.

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