Thursday, June 26, 2008

Health Care Interview with Spicey G

Today we are joined by Spicey G, one of SEE Level's favorite commentators, to address the health insurance and public policy issues we talked about last time. She brings a unique perspective to this discussion for several reasons. First of all, she's been covered for the past 38 years under the federal government's health insurance program. This plan is currently only available to government employees, but it closely resembles the favored Democratic plan for health care reform. In addition, she is currently the financial director of a private business firm, making her responsible for the purchasing and maintenance of their employee-based health plan. But most importantly, she lived part of her adult life in Great Britain, the country we will use today as our model for socialized medicine. Thus, her background gives her firsthand experience with the pros and cons of single-payer systems and important knowledge of how different universal health care systems can realistically be financed.

This interview will be presented in audio, so please click on "Spicey G" following a question to hear the response.

1. How good of a job do you feel we’re doing with health insurance in this country? Spicey G

2. In consideration of surging health care costs coupled with the high expectations we have for treatment, have we lost touch with how much it all costs? Are we the ones to blame? Spicey G

3. Would socialized medicine be a quick and easy route to universal health care? Spicey G

4. Here, S.G. tells us about how the British came up with their socialized medical system, which centers around a national debate they had in 1945 over what the government should provide for its citizens.

So what came of this debate in Britain? Are the issues we’re wrestling with 60 years later any different? What have they done about them? Spicey G

4. Mr. Benton mentioned how the big disadvantage we see with government-run health insurance is rationing of care, which inevitably happens due to lack of funding. But are we not rationing now? What are the differences between how the British ration health care and how we do it? Spicey G

5. What do you think of his argument about people in this country trying to get free health care? If not exploiters or young invincibles, who do you think these people are who lean on emergency rooms for health care? Spicey G

6. John Kerry and many other Democrats attempted to have a health care national debate around the 2004 election and drew up a proposal for what they thought would be a feasible was to achieve universal health care without being stuck without all the downsides of socialized medicine. Can you summarize this proposal for us? Spicey G

7. How would this program be paid for? Spicey G

8. Why shouldn’t businesses pay for this new system? Spicey G

As a side note, the British pay for their health care system with the VAT, value added tax, which is added to anything sold in country. We in the United States do not have this tax added to our imports, so we do not receive that extra funding for health care.

9. Lastly, what else do you think needs to change about our health care system? What about the fraud Mr. Benton talked about? Spicey G







Thursday, June 12, 2008

Health Insurance Follow-up

For Part 3 of my health care series, as promised, I conducted an interview with Bruce Benton, an insurance broker out here who works with Anthem Blue Cross, Signa, all the major health insurance companies. He was President of the Los Angeles National Association of Health Underwriters and served as Vice-President of Public Affairs for their California state board. This was supposed to be a conversation in which I’d get some insider perspective on what’s wrong with the health insurance system. I indeed did get background information, quite a lot of it actually, but this interview turned out to be much more complex than I’d anticipated. Why? He turned out to be a conservative.

This really threw me off because in all my interactions with him, Mr. Benton has been remarkably cool. And I don’t usually associate conservatives with being “cool,” so this was a surprise—we’ll just call him my friendly neighborhood Republican. Despite this pulling me in an entirely different direction, it was quite illuminating to hear the other side’s point of view. I have serious problems with what he said, but I felt he shared his opinions in earnest and that deep down he’s not a bad guy. It still freaks me out though, mainly because of how out of touch, intentionally evasive and judgmental a lot of his comments seemed to be. In any case, this interview raised brand new questions for me about the health care problem and put me face to face with why there’s so much controversy in Washington. I think I finally have a clue about why the Capitol can’t seem to get anything done—Democrats and Republicans are in many ways living on different planets.

So here’s what we’re gonna do: I’m going to give you my analysis of what he had to say, along with some clips from the interview, and then I’ll present responses from one of my favorite See Level pundits. So without further ado:

Here’s What I Think

Part #1:

Question: Is the health insurance industry what the media purports it to be?

Benton:

No. The health insurance industry isn’t primarily concerned with stockholder profits and equity, it’s just an easy target. Non-profits act the exact same way in how they assess risk, collect premiums, etc. These companies are really the good guys-- they’re in a difficult position and doing the best they can with the resources available.

So what about all the money they’re raking in? No no, corporate executives are just easy targets too. Consumer perception is the real problem; in seeing the industry’s high salaries and 10-15% rate increases each year, lots of people start thinking senior management should take a pay cut. The impact of their salaries on what you pay every month is extremely insignificant and besides, it’s not our business to dictate how much someone in private enterprise should pay themselves. We shouldn’t go after the health insurance industry’s means and ends because profits are the sign of a vibrant marketplace. In reality, health insurance people are just trying to make a buck like the rest of us.

Benton 1; Benton 2 (click to listen)

Rebuttal: While I agree that the insuring millions of people, keeping costs down for everyone and making profits must be really tough, let’s be honest--the health insurance industry isn’t hurting for money. The practices they use, including on young, healthy people trying to do the right thing, are without a doubt earning them a very pretty penny. That’s a lot more than “just doing the best you can.” To minimize how much these companies are motivated by personal financial gain would just be na├»ve. And that fact that oil and prescription drug companies were brought up as similar industries just doesn’t lend a lot of credibility to stating that health insurance companies are benevolent.

Now, while I agree that our monthly premiums don’t mainly consist of senior management payroll, I do believe that corporations have to be accountable to their customers. If the cost of health care is rising and our premiums are rising along with them, why should the boss still get his 15 million dollar bonus? Since we’re the ones cutting the check, don’t we have a right to ask these questions and deserve honest answers?

On another note, about the statement that published information in the media isn’t true-- there’s a reason health insurance companies like Blue Cross constantly make the news. Part of being a reputable journalist is that you don’t publish writing without facts, so if a health insurance company shows up in the New York Times for doing something wrong, it’s not because the paper made it up. This whole notion that highly regarded press organizations publish things they randomly made up is ridiculous. It’s the sort of crap Ann Coulter writes about… and the kind of thing that makes me wish I could raise just one eyebrow. Actually, when it comes to Republican ideology, I often think about how much I wish I could do that.

Part #2:

Question: Okay, so what about Blue Cross? They’ve been in the news quite a lot recently and they’re the largest individual health insurer in California. Are they just good guys too?

Benton:

You know all those cases Anthem Blue Cross has been sued for, well the truth is that all of those individuals who won their cases were actually at fault. Those previously insured members lied on their applications to get insurance. If they hadn’t deliberately concealed smoking, heart conditions, etc. Blue Cross would never have insured them in the first place. Innocent company investigations exposed their lies, so Blue Cross dropped their policies—something they had every right to do. Those members got exactly what they deserved. About the legal mess? Blue Cross got unfairly convicted for exercising their rights as a company.

Benton 3 (click to listen)

Rebuttal:

This argument makes no sense. First, here’s the back story. Anthem Blue Cross, the same health insurance company I wrote about in Health Care Part 1, has consistently been in the news for illegally rescinding members’ health care coverage when they’ve become very ill and run up high medical bills. Despite all the aggressive lobbying I’m sure went on, numerous impartial courts have convicted them and assigned millions of dollars in fines for these illegal practices. So considering all this, it would make sense that the prosecution had quite a bit of evidence that Anthem BC was indeed doing something very wrong. Now I wouldn’t begin to say that I have more inside knowledge of these cases than the people who tried them in court and won. If Blue Cross was ruled against in all those individual cases, I’m inclined to agree they had some culpability. Regardless, we're supposed to respect and uphold the decisions made by our courts of law and generalizing that Blue Cross was somehow right and all those people were wrong certainly does not do that. In Mr. Benton's statement, I also sensed a tinge of that Republican “you made it up” claim that I talked about before. So now, not only is the New York Times a bunch of biased haters, but apparently so is the California Supreme Court. Good to know.

Part #3:

Question: What are some of the biggest problems with the health insurance industry?

Benton: All those people trying to get free health care. Americans want health care when they need it, but lots of them don’t want to pay for it. Too many choose not to be responsible or accountable by buying health insurance and our lack of mandate to purchase it affords them that option. But those people get sick just like everyone else, so their bills get paid by the responsible people who actually buy health insurance. We live in a country that says “we cannot deny you critical emergency care at a hospital when you need it.” People think that means they can go without insurance because if they have an emergency, they’ll be stabilized at an ER. Without assets, they’ll just file bankruptcy and think "Bang, I’ve had free health care.”

Benton 4 (click to listen)

Rebuttal:

Yes. I’ll bet that’s exactly what millions of Americans are scheming. Let me first point out that he decided to point fingers at us first and not talk about any wrongdoing by the health insurance companies. This is ridiculous. Considering the sheer amount of reform legislation Congress tries to pass every year and how often insurance companies make the news, it’s not like they’ve got it all together. Is it really true that most of the 6 million uninsured people in California are that way because they’re trying to cheat the system? So the uninsured and the people who won their lawsuits against Blue Cross are all just irresponsible cheaters and liars?

Also, in this talk about how insurance is expensive because we the insured are the recipients of cost-shifting, I’m not hearing much about the health insurance companies absorbing costs. I hear about hospitals going bankrupt because they treat too many uninsured patients, I see my bill every month, what about the corporate execs? How are they doing their part-- is this “just the best they can?” Their paychecks suggest otherwise.

I also kind of got the feeling that Mr. Benton seemed to kind of disapprove of our national policy that ERs have to admit people who’re having a medical emergency. It was almost as if he wanted to say “Unfortunately, we cannot deny you critical emergency care, but we would if we could. It would be much cheaper that way.” Good to know how the other side sees it.

Do you hear that too?

Part #4

I asked if universal health care might be a viable option to alleviating our health care woes, to which Mr. Benton gave me some valuable information about how instituting this system would change the health care landscape. Using other countries as examples, he told me how there becomes a severe need for rationing of care based on the country’s inability to fund health care for everyone, especially at the levels Americans are expecting. In addition to significantly higher taxes, universal health care is also known to bring long wait times for essential treatment (3-6 months), and it’s common to see patients pass away while waiting for medical care. While I’m not convinced we should give up on the idea altogether, this information made sense to me and seemed very objective.

Mr. Benton then included this statement about the American consumer mentality: Benton 5

So, is this what the conservatives really think of us? Not only do some of us try to steal health care, but we want the best of everything and never want to pay for it. We’re selfish-- we want the latest technology when we're ill, we want to “keep our family members around forever,” all without footing the bill. And like a bratty kid, we bite the hand that feeds us—we blame health insurers and how much they earn when we don't like our monthly premium. So I guess that’s what they think of us, we’re just a bunch of spoiled brats.

Are we? Now I understand and agree that Americans are notorious for wanting something for nothing. I see it all the time, especially here in L.A., but I have real trouble accepting that our health care problems are all our fault. I’m not so sure the American people are deep down just a bunch of users who take what they want and totally disregard how it affects other people. Do most people not buy health insurance because they’re irresponsible and don’t care if someone else has to pay when they get sick? Are we that base? I don’t know, I think people don’t buy health insurance mainly because they can’t afford it. My premium is $316/month right now and while the national average in 2004 was only $189, that’s still a lot of money for a great number of people. I also understand that we too often look to health care to make our pains go away and sometimes to save our lives and the lives of our loved ones, but can you blame us? Modern technology has taught us that when a person contracts a terminal illness it doesn’t automatically mean their life is over. There’s a chance that they’ll survive because of medicine and powerful new treatment options, and when that person is our mother, father, sister, why is it so unforgivable that in those times we'd want everything to ourselves? Doesn’t love and desperation make everyone a little selfish?

What most offends me about these conservative opinions is the lack of humanity. I re-read and re-listen to them and I just don’t hear empathy, I don’t hear “we’re on your side, we’re all in this together.” In fact, I hear the opposite, “look and what you did,” "you did this to yourself," not “what can we do to contribute?” There’s no benefit of the doubt, just this ugly assumption that underneath it all, you’re nothing but an user.

This all makes sense—look at the Bush administration and how it’s flagrantly disregarded civilian rights and common human decency. All along I’ve sort of known this is what the Republicans think, but to have it in my face makes me even more scared for this country. This is what we’re up against; no wonder people voted for Obama. He still seems like one of us, like he’s on our side, and that is giving people hope that government might not have to be a game rigged against them. This speaks to the core of who we are as people, how we want to be treated by those who represent us and what role government can play in making our lives better.

Wednesday, June 4, 2008

Ghetto, noun:

A section of a city, often rundown or overcrowded, inhabited chiefly by a minority group that is effectively barred from living from other communities, as because of racial prejudice or for economic or social reasons (Merriam-Webster Dictionary, 2006).

Los Angeles is filled with ghettos, real ones. How do I know this? My work has more recently taken me into the city’s rougher sides and it is quite clear that there are large portions of Los Angeles that are, for all intensive purposes, Mexican ghettos. If you don’t live here, you don’t know that probably one third of L.A. looks and feels like Mexico. This is another reason why I don’t use the term “Little Mexico”--there’s just too much to call it that. Beyond L.A.’s well-traveled roads and freeways, you enter the city’s third world, a place populated by poor, non-English speaking immigrants who have banded together, effectively creating insular communities for people like them. This is not new behavior, it’s why we have Chinatowns and Slavic Villages, but L.A. is different because of how large the immigrant population has become.

I’m coming at this from a unique place. Cleveland, my hometown, is far from being an all white city. In 2006, the U.S. Census declared it 64% White, 29% Black, 2% Asian and 4% Hispanic, with only 11% of the population not speaking English at home. To a native, the reality is that while there is a dominant minority, that minority speaks English and has been in America for quite some time. Also keep in mind that this minority, however dominant, still doesn’t even come close to exceeding the majority in size. Thus, race and immigration hasn’t been such a big deal**. In the absence of a significant immigration problem, there’s not only less racial and cultural tension but far less fighting over “who deserves to be here.” Before I moved to L.A., I honestly hadn’t given immigration or the need for reform hardly any thought.

However, it is a much more pressing issue in L.A. county. First of all, there’s almost 10 million people stuffed in here, not including commuters from Riverside and San Bernardino counties. Everyone’s competing for very limited resources--something that never makes people very friendly. In any case, here are the stats : 29% White, 10% Black, 13% Asian, 47% Hispanic.

So how has this been different for me? I feel uncomfortable saying this, but just the sheer amount of Latino influence is overwhelming. This realization is odd for me, because I specialize in Latin American social dancing like Salsa, Merengue, etc. so I’ve spent tons of time in the Salsa community. Here’s the difference: Salsa is mainly popular in Puerto Rico, Cuba, the Dominican Republic, Columbia, and some other Latin American countries—not Mexico. Mexicans do their own thing, they like cumbia and ranchera music, they prefer tacos and burritos to yucca and plantains, and then there’s this odd thing with Southwest ranching culture, like with these radio show ads from 97.9 La Raza which, somewhat appropriate to this discussion, translates as "the race.".

So the result of this is that I just don’t get Mexican culture. Anything Latin American I pretty much get, but not this. And because Cleveland was 29% black, I get the Mexican community’s sworn rival too. I could probably deal with this situation better if L.A. wasn’t almost half Mexican, but it is—which makes things a little strained. I’m surrounded by a culture I don’t understand and trying to live cooperatively with people who very often don’t speak my language. This sort of things usually happens when you’re in a different country, but Los Angeles isn’t some hybrid Baja-like country--this is America. Very often it’s like I’m standing in the middle of crowd asking “why are you guys all wearing cowboy hats?” There are two cultures here trying to live separately in the same place; Americans live here like its America and lots of Mexicans live here like its Mexico. We’re both turning our backs to each other and trying to do our own thing, but the inevitability of this is that have to coexist and we’re going to clash.

Many of the immigrants residing in L.A.’s Mexican ghettos came to this country for the opportunities it provides. They are avoiding assimilation partially because doing so is more convenient and it is not required. This sounds harsh, so to be clear I’m not saying this because of some beef I have with the entire Mexican community. There are enough large pockets of unassimilated immigrants existing in L.A. that you can rent an apartment, earn a living and build a life here, all without ever having to speak English. There are all the comforts of home plus the benefits and opportunities of being in the United States. I feel awfully Republican feeling this way, but is how that not selfishly using our country?

Eastern European immigrants who came over to the United States in the early 20th century didn’t have some federal program helping them assimilate or learn English. But they did because they wanted to assimilate into American culture and speaking English was the fastest way to upward mobility. The other big difference is that while there was a huge influx of immigrants at that time, you didn’t have cities that were 50% foreign born. That’s our problem today—the sheer volume of immigrants living in Los Angeles has created the possibility for ghettos so developed that you can move to the United States but never become an American. This is not to say that many Hispanic immigrants don’t try to fully integrate themselves into our society or attempt to learn English to get a better job. But unfortunately, you don’t always see those individuals when you look around L.A.

Living here, language is the largest barrier you run into with the working immigrant population. At many restaurants and cafes, you cannot ask for something they don’t expect, like half-caff coffee or no ice in a drink. If you try, it just doesn’t happen. At one restaurant, I was ready to order my dinner but hadn’t yet decided what I wanted to drink. When a server came over, I wanted to place my dinner order and this completely threw him off; he had to leave and get another server. I figured out that they’ve instituted a system where one server, always the less fluent employee, gets drinks and another takes food orders. Now, I understand the practicality of doing this since drinks are usually simpler to understand and dinner orders often come with more specifications. But this takes me back to a point I raised earlier: we’re not in a foreign country, this is America-- why in the spirit of accommodation and political correctness do we have to accept this?

These restaurant incidents happened well before my work started taking me into L.A.’s Latino ghettos. One day, I took the Metro from Long Beach (in the South) through to Downtown. I went through some crappy parts of town near Compton, places that looked more like Puerto Rico than California. The houses were old and rundown, there was an enormous amount of graffiti, the only thing missing were all those chickens running around. I’m serious, there is a substantial on-the-move chicken population in P.R. In any case, I started looking around on the train and realized that I was the only white person on the entire car. Apparently this is how things usually are because the all of the on-board ads were in Spanish. By now, I’m used to hearing Spanish more often than English in public places in L.A., but being the only non-Hispanic person on that Metro really made me feel like I was in a different country. But I wasn’t, I was in the United States.

Around this same time I was working a promotional marketing gig at a bank near the LA/Orange County border. About half of the people coming into the bank were Latino immigrants, something made instantly clear when many of them said outright “I don’t speak English” or smiled uncomfortably when I approached them. You get used to this shy response out here, when a person just doesn’t understand you. These were people who were customers of the bank, who had accounts and jobs that earned them money to deposit in them. I asked myself, how do these people go through life in America without speaking English?

One of the women I met at the bank reminded me of this same question. She didn’t speak enough English to recognize that I said Jamba Juice, which for Southern California is sort of like not knowing the word McDonalds. I ran into another woman at a street corner and asked her which way was west (I think a simple enough question) and she too replied “no English.” I feel Republican for this, but the first thing that came to my mind was “well, why don’t ya learn some?” Second, I tried to remember if oeste meant west or east and asked myself if I could form this sentence in Spanish.

This brings me back to my question again: how do you get through life in this country without learning enough English? When I couldn’t communicate (albeit, due to their not assimilating), I immediately thought to be accommodating and try some Spanish. This might be another large contributing factor into how so many get by not knowing English. Not only are the Mexican ghettos a safe haven, but the public transportation system, banks, etc. are doing everything in English and Spanish, even though the U.S. is not a bilingual country like Canada.

When I was working at that bank, people came up and started talking to me in Spanish. This sends a pretty clear message of how prevalent our accommodation is of the Spanish-speaking Latino community. Even as a white woman, these people just assumed that I spoke Spanish because, well, who doesn’t out here? This seems relatively harmless, but I think it illustrates that the Latino community has grown so used to us accommodating them and making their cultural needs a priority that now it’s something they’ve come to expect. This isn’t right. Maybe being practical and just making everything Latino-friendly isn’t making everything easier in the long run. Maybe it’s just putting off the problem and, in all likelihood, making it worse. Plus, half of Los Angeles is female, so there are countless non-English speaking women raising children, who of course won’t speak English either. And so the cycle continues.

I consider myself to be a very patient and tolerant person, but hitting these linguistic and cultural roadblocks all the time makes it very difficult to not start thinking about illegal immigration in this country. I’m all for welcoming and accepting other cultures, but the number of unassimilated Latino immigrants is Los Angeles is way out of hand for this being an American city. Yes, I feel Republican saying that but L.A. has gotten to that point where you have to begin addressing those questions. No wonder so many people have such an angry, “they’re taking over” mentality. If we just talk numbers, California has huge problems including our deficit, traffic, the water shortage, overburdened hospitals, pollution, quality of schools--the state is effectively sinking. According to Californians for Population Stabilization, much of this can be traced back to overpopulation and the rapid influx of Latino immigrants. I’m not surprised; not everyone can crash the party and still get a beer.

So how do the presidential candidates propose to address this issue? John McCain’s Straight Talk Express certainly didn’t extend to this issue with his website simply stating that we need to secure our border …as if we didn’t know. He also suggests that keeping a political alliance with Mexico will discourage its citizens from fleeing to the U.S. (um..right), that not cramping American businesses with taxes, regulations, etc. will make it so they don’t have to hire cheap labor, and also that we must recognize the importance of assimilation (we have, John, we have). Lastly, he added this self-congratulatory message about remembering that America’s a “shining city upon a hill”— that’s why everyone wants to come here! Aren’t we great!

Obama highlighted surging undocumented population growth, the process of acquiring citizenship and unsuccessful raiding as the prominent contributing factors to our immigration problem. He mentioned securing the border too, but also promoting economic development in Mexico and removing employment incentives for people entering the U.S. illegally. As for citizenship, he talked about creating a system where illegal immigrants in good standing can more easily go through a citizenship process that involves learning English and not receiving priority status in processing.

Obama seemed to have it more together; he was far more specific than McCain, which is funny because people have gotten on him for not talking specifics. I’m impressed. Because if we really look at this issue, you can’t simply tell everyone here that doesn’t speak English or who came here illegally to just get out. Besides how impractical this is and how immigrants are a viable part of America’s economy, telling all these people to hit the road and leave their families behind is neither a graceful nor humane way to deal with this problem. Despite how this “we’re already here” philosophy reminds me of Iraq, it cannot be denied that this problem is urgent and we must make it a priority. I truly hope our new president can do something, because if this post accomplishes anything, I hope it drives home the point that this is a serious roadblock for California and we can’t keep banging our heads up against it forever. Something’s got to give.

*Don’t get me wrong, I understand that there are significant racial tensions in Cleveland. However, the scope and magnitude of the problem in LA dwarfs that of Cleveland, especially when you consider factors such as population and the persistent Latino-Black gang violence.