Monday, August 26, 2013

The future of health care

So, then there were two.

I drove my daughter to college over the weekend which has now resulted in our version of the empty nest.  Of course, I miss her, just as I miss seeing my son, but I am also happy that our children are progressing towards independent lives without "parental" oversight.  As I have said to my wife, while we might miss the kids, we (and especially my wife) did a great job raising them and it is time to let them fly on their own with the knowledge that they can return if they need to.  Let's just hope they don't!!

As for writing, I must say I have been uninspired.  My interest in politics is wavering, my interest in debating issues is flailing, my interest in time in front of my computer is slight.  Still...

As the Affordable Care Act begins to kick in, and despite the obsession that the Republican Party has exhibited to repeal and/or defund it rather than addressing its weaknesses and proposing alternatives, I am hopeful that the American people will realize its benefits outweigh its negatives.

Ultimately, it seems apparent to me that we need to sever the link between employment and health care insurance.  Everyone needs to become more involved in the cost of their health care, and as long as we allow our employers to act as intermediaries, and allow the health care industry to dictate coverage, benefits, and choices through the filter of their profit, rising premiums and costs will remain the norm.

From what I am hearing, the exchanges that are being set up in some of the states that are ahead of the curve on this issue, are providing much more attractive premiums than have been traditionally available to individuals and small businesses in the past.  If we are not ready for a single payer option (due to the wrongheaded notion that this smacks of socialism) then we need to make sure that every state in America embraces the goal of providing the means for each of its citizens to have access to affordable health care insurance. 

I often ask my friends and family what contribution their employer pays toward their health care premiums and many don't know.  They certainly know what is deducted from their pay, but they don't know the extent of the subsidy that they are receiving from their employer.  Perhaps if that subsidy was paid to the employee, and each employee was required to purchase their own health insurance, we would be more cognizant of its cost and shop for the policy that bests suits our needs.  My experience has been that most employers offer a single rate and a family rate, and perhaps a married with no kids rate.  But families with one kid might find a more suitable (and less costly) policy assuming that the family rate is based on an insurance company configuration that most likely assumes 2 or 2.5 kids per family.  And, perhaps a single, healthy person might find a single rate on their own with a high deductible that would better suit their situation.

During my years of employment in the private sector, and in discussions with small business owners today, health insurance costs is a big part of their overhead, a pain to have to negotiate every year, a distraction from their actual business, and an impediment to hiring new employees. 

Of course, all that assumes that the health insurance industry is forced to offer group rates to all Americans, regardless of the size of their employer or group affiliation.  Yes, forced.  And, it assumes that all people must participate; yes I am in favor of the "Romney" care individual mandate.  Or, as Hilary Clinton might say, the 1990's Republican alternative to her universal healthcare proposals.  And, it assumes that employers will increase the pay of their employees in lieu of the their current health care insurance subsidy. 

You see, I believe in the market place to establish supply and demand for most products and services.  But, as there are exceptions to every rule, health care insurance is the exception to this rule.  If you want to buy a car, you purchase the car that you can afford. But if you are really sick, you need the health care services that will make you well, despite your ability to pay.  Everyone deserves an insurance plan that provides basic health care services with a catastrophic option that prevents bankruptcy, or worse, the necessity of choosing between health and death.  But personal involvement in the coverage, benefits and costs of our own health care and health care insurance may be the only way to break the vicious cycle of escalating health care costs.


Sunday, August 4, 2013

Past and Present

Our family has a tradition of taking a group vacation every year in the Poconos.   While this year was different in that my dad was not there for the first time in 45 years, my four brothers, one sister, mother, aunt, two sister-in-laws, three nephews, one nephew’s girlfriend,  one brother’s girlfriend, my wife, both my children and their respective girl/boy friend, one cousin and her husband, four nieces, and a sister-in-laws’ two sisters and one brother, were all in attendance, scattered in four cabins on the property.    Add to that the various friends who we see every year in three of the other cabins, and it all adds up to a vacation of family, friends, and fun.  As I write this, it is the last day of the 2013 version of this tradition.

In addition to spending time with all these people, I look forward to reading by the pool, falling asleep in the sun, jumping in the cool water, and starting that cycle over again. 
Apropos to the reading/sleeping/pool cycle, I read the August edition of the National Geographic.  Two articles particularly interested me.

The first was called Sugar Love (A not so sweet story).  It traced the history of sugar, its modest beginning as a spice, rare, and only known to a small group of people in the islands of the Pacific off the Asian mainland.  From there it spread across Asia via the march of the Arab armies in the first millennia AD, and then was introduced to the Europeans during the Crusades.  As the taste for sugar gained traction in Europe and since trade between Europe and Asia did not prosper, new sources for sugar were required, and with the discovery of the New World, specifically the islands of the Caribbean, a source was found.   Here is a link to that article.
Of course, like most people, I was aware of the connection between the expansion of the slave trade and the need for cheap labor.  However, this article provided some details that I did not know about.  According to the article, over the course of a few centuries, over 11 million Africans were shipped to the New World, more than half ending up on sugar plantations.  Perhaps it sounds a bit dramatic to say, but there is a graphic illustration of the bloody and inhumane connection between sugar production and satisfying the sugar cravings of Europe.   A slave of the time, who is missing an arm and a leg, states “When we work in the sugar mills and we catch our finger in the millstone, they cut off our hand; when we try to run away, they cut off a leg; both things happened to me.  It is at this price that you eat sugar in Europe.”  
Well, at least we don’t do that anymore, one might say.  And yes, perhaps we have evolved, as I continually hope, in a manner in which we value human life a bit more highly.  Yet it is still true that workers in gold mines in Africa receive a miniscule amount of compensation for efforts that yield mine operators millions of dollars.  And it is still true that the rulers of various third world nations make deals resulting in lucrative contracts for them and their western business partners, but paltry salaries for the labor force.   And, while some may debate this trend, it even seems true that here in America, the value of labor has been kept artificially low in the past thirty years while those with wealth take a bigger percentage of the pie.

To me, It would be better if, instead of (or perhaps in addition to) learning the lessons of economics which includes the desire for cheap labor to provide new tastes, or precious metals, or inexpensive consumer goods, or lower cost energy, we were to focus more on the cost to indigenous populations, local environments, or the imported labor that is exploited to provide that new taste or cheaper energy.  It is all too easy to dismiss the days of forced labor and the toll that unregulated mining and non-existent air pollution controls had on our air and water and land, now that those days seem to be in the past, unless it was your ancestor who was forced into slavery, your land that was mined and left dead, your water and air that was fouled.   So, when we debate the issues surrounding the Keystone Pipeline, fracking, repealing some of the teeth behind the Clean Air and Water Acts, or even the minimum wage, it might be wise for us to consider the immediate cost to the people who risk limb and health for our newest western technology, might be of benefit to include the long terms costs of shooting chemicals into the ground or digging holes in the ocean, perhaps even include requirements to consider the cost of cleanup when that pipeline bursts or that oil rig explodes, as opposed to weighing everything by the short term benefit of some temporary jobs or a few additional percentage points of profit. 
It is said, by some, that man's progress has been marked by upheaval, violence, the suffering of the few for the benefit of the many.  Perhaps that is how it will always be.  For the good of the whole, the few will pay the price.  Whether it be through wars, low wage labor, lack of  environmental safeguards or just plain greed and non-caring, there may always be situations and events that require some people to suffer while others prosper.  It would just be nice, the Christian thing, if those humans on the advantage side were to recognize the pain of those on the sacrifice side as opposed to actively abusing them, and/or consciously developing ways to profit from that sacrifice.
The second article was about the Mayan civilization, specifically about their ability to mark time.  I imagine that all civilizations, all people who reflect on their moment in time, think that they are alive at man’s most evolved moment.  Those advanced Greeks who first discussed democracy over 2000 years ago probably thought they were living during the greatest time in history just as the great thinkers and artists of the 17th century Renaissance regarded themselves in a similar manner as did the great inventors and entrepreneurs of the recent century who gave us flight, computers, and instant, global  communication.  But sometimes I think in our mutual rush to glorify our particular time and contributions, we forget that greatness, uniqueness, times of incredible bursts of progress, all build upon what has come before.  Sometimes I sense that we believe that our 21st century condition exists in a vacuum, forgetting that the basics for so many of our advanced technologies were imagined and developed in past times.  Here is that link.

The Mayan article detailed their ability to identify the exact moment each year when the sun was directly overhead.  This twice yearly event enabled them to adjust their calendars which helped them plan for planting and harvesting.  Their advanced understanding of the cycles of the sun and the seasons produced a civilization that lasted a few thousand years despite soil with little moisture retention.  When we focus on their poly-theistic religions, their belief in the need for sacrifice to appease the gods, be it food, animal or human, their agrarian society without industry, we gloss over the simple facts that their understanding of the cycles of nature was perhaps more advanced than our own.  Well, maybe not more advanced, as a hurricane in their time would have most likely been devastating as well as a surprise event, but more advanced in the practical use of the knowledge they gleaned from nature.  They knew the signs of a coming good or bad harvest and took the appropriate measures to feast or conserve.  With all our high-end technology, we seem to act or not act based on economic or political reasons (see the continued debate on climate change) as opposed to what is required for base survival. 
History indicates that the peak of the Mayan civilization was about 650 years, from AD 250-900.  It is also conjectured that the Mayan people existed from as far back as 1800 BC.  By simple arithmetic, we can conclude that these people were present in the area of the Yucatan Peninsula for more than 2500 years.  
As I said before, in an age when one can type an essay from a desk in Perkasie, PA, post it and have it become available to anyone, practically everywhere in the world in an instant, when telescopes have been developed that enable us to "see" practically to the beginning of the universe, when bombs have been created that can be released hundreds of miles away yet hit an individual target the size of a man, it is normal to assume that we believe that we represent the apex of human existence to date.  But perhaps before we rush to judgment we need to survive the test of time, to be around in the year 4000 before we come to that conclusion.   And to more fully understand that we are only us, now, because of the past.