healthcare reform

Healthcare for all who want it

At least two months ago, someone asked me if I could explain the healthcare debate that is happening within the Democratic primary.  I’m a little bit late, but here’s my high level take on the debate.

Why does this matter?  

The United States is the only developed country that does not officially provide universal healthcare coverage.  And there are two massive problems with that.

First, we actually DO provide universal care, because regardless of someone’s ability to pay for treatment, we agree that allowing someone to die in the street is immoral.  Our public hospitals and emergency rooms care for patients all the time who have no insurance coverage. Those patients can’t afford preventative care, and often by the time they seek treatment, the care they need is urgent and costly.  Either those bills go unpaid or the patients go bankrupt attempting to pay. Either way, those costs are passed along to everyone else in the form of increased cost of care.

Second, our health care is a for profit, bureaucratic mess.  Insurance companies are in the profit business, and while there may be competition to offer lower priced insurance plans, those plans are designed to cover as little as possible.  The insurance provider is incentivized to keep the paperwork complicated and the consumer confused. Front line healthcare providers may try to do the right thing by patients, but even then corporate interests of the provider is often put above the interests of patients.  The result is that insurance companies cover as little as possible, and providers bill as much as possible. Americans are avoiding necessary preventative care, and then going bankrupt paying for emergency care.

The candidates in the Democratic primary field largely agree that something has to change.

There are basically two approaches: Single Payer and Public Option.

Single Payer – often referred to as “Medicare for All” – proposes that all Americans are covered by a government run health insurance program.  All Americans have standard health care costs covered under the same plan.

Public Option – sometimes referred to as “Medicare for All Who Want It” – proposes that all Americans have an option to buy into a government run health insurance plan, essentially expanding a Medicare option for all Americans regardless of age.

Where do the candidates stand on the issue?

(Yes, I left some candidates off this image.  There are just still too many.)

There will be a follow-up post going into more detail on “single payer” versus “public option”. (There might be an additional follow-up on candidate nuances in their approaches.)

Did I get anything here incorrect? Would you have stated something differently? Feel free to weigh in with thoughts, questions, or respectful disagreement!

I’m voting for President Obama, and here’s why

Over a year ago, I made a commitment to take responsibility for my part in shaping the future of our country and our world.  Since then, primarily as a result of the upcoming presidential election, I’ve become increasingly frustrated by the lack of honest conversation and debate.  The most important issues that face our world have boiled down to marketing campaigns determined to win at any cost. Compromise and common ground isn’t on the table, because it’s inconvenient when an election is at stake.

I want to argue about the big issues.  I want to talk about climate change, clean energy, religious freedom and perceptions of religious persecution.  I want to debate the benefit of social programs, the necessity of government regulation and the efficacy of our tax code.  I want you to try to change my mind with your facts – REAL facts – and your passionate opinions.  I want to learn and grow and better understand the world that I live in.

To do that, I need to be clear on my own point of view.  I have decided that I’m not going to be keeping my political opinions to myself, even though it’s easier or more polite to do so.  It might be polite, but it’s too dangerous to stay silent.  I want you to understand ME – and I’m willing to be wrong.

I’m a Democrat.

I am a Democrat.  I have known from a very young age that I was a Democrat. Like most individuals, my original values were instilled in me by my parents, but my parents rarely talked about politics.  They talked about equality, understanding and the importance of giving back.  As a teenager, I started to form my own beliefs – far stronger and more passionate than theirs – about my political environment.

As an adult, I’m learning to recognize that the idealist in my heart is much further to the left than the pragmatist in my head.  The pragmatist understands that our world is complicated; that people are complicated.  My opinions are changing. My arguments are evolving.  But my core values continue to align most closely with the Democratic party.

In the coming election, I am voting for President Barack Obama.  And here’s why.

We are not a Christian Country

We are not a Christian country.  We were not founded as a Christian country.  We are a country founded on the principles of religious freedom – freedom to worship as you wish, or freedom to NOT worship.  All religious worship should be treated equally and permitted with equal protection, with limitations only in so far as the actions of the worshippers present a real threat to others.  (Any violent action in the name of religion is violence, not faith.  Hate speech is more complicated of an issue – and I would be happy to engage in debate about the where freedom of speech ends and terroristic threats begin.)

Any argument about federally granted rights or freedoms based on a foundation of “Christian values” should be taken off the table, as the premise is false.  No religious beliefs should dictate our civil codes.

Equality

More than any issue on any platform, I am passionate about equality.  Our Nation must be a nation of equality.  We must not tolerate discrimination in any form based on race, religious affiliation (or lack of religious affiliation), sexual orientation, or gender identity.

Specifically, we must fight for marriage equality.  Same-sex couples deserve the same status and protections and heterosexual couples when it comes to marriage and family.  If same-sex couples cannot be married legally, then marriage should not be a government institution.

Furthermore, we must fight for equality in the workplace to end discrimination based on race, gender, gender identity or sexual orientation. LGBT individuals should be assured that they cannot be fired simply on the basis of their sexual orientation or gender identity.  Women deserve equal pay for equal work.

This section is the shortest because I find it to be the least complicated – and on this topic I am firm.  We must have equality.

Healthcare Reform and Universal Healthcare

I believe that we cannot thrive as a nation when greater than 16% of our citizens are without basic health insurance, including almost 10% of children.  (Source:CNN June 27, 2012)  We can’t expect to thrive in the global economy if our citizens can’t meet basic needs.  The United States ranks 29th in infant mortality rate among developed countries.  (Source: CDC NCHS Data Brief – 2008.  More recent articles point to lower ranking, but I couldn’t easily validate the sources.)

I also believe that our current healthcare system – both the health care providers and the insurers – is riddled with fraud and inefficiencies.  (I am not speaking of the quality of care – I don’t feel educated enough to speak to that – but rather of the billing and administrative side of health care providers.)  Patients get bills they don’t understand, insurance statements they can’t decipher, and rarely question the detail.  In a recent personal example, I discovered that my insurance company paid for anesthesia services that I had already paid in full.  I called and had my payment refunded, but only because I questioned it.

We need smart regulation holding the health care and insurance industries accountable for their actions.  While more regulation and government audits are the typical – and costly – solutions, we should consider requiring simplified, itemized billing that can be quickly and easily cross-referenced to insurance and personal payments.  Require transparency so that patients can take the power back in auditing their own health care costs.

I also believe that we do need universal health care.  We need health insurance that is available for all Americans – with no lifetime limits and no coverage refusal for pre-existing conditions.  The only way to accomplish that is with a health insurance mandate, that all citizens must have some level of health insurance coverage.  (If coverage is not mandatory but pre-existing conditions cannot be refused, no intelligent individual would get insurance until they needed it.  It would be like allowing you to wait and get car insurance after you’ve already been in an accident.)

I am not going to pretend that the Affordable Care Act is perfect.  I can’t even pretend that we’ll get it right the first time.  It is a program that requires the very best minds, a great deal of compromise and a willingness to evolve, re-evaluate and adjust.  But it’s worth it.

I also believe that education and prevention must be a part of our national priority.  Prevention of childhood obesity, education on smart nutritional decisions, and incentives for healthy decisions should all be considered to lower overall health care costs and increase the health of our nation.  (This is said as someone who recognizes her own decisions are often not healthy ones.)

Pro-Choice and Pro-Life

I very rarely talk about my views on abortion because they are complicated, very personal and evolving.  Even as an idealistic, hardcore Liberal teenager, I considered myself anti-abortion and pro-life.  I had a hard time reconciling that with my otherwise very liberal views, but there it was.

Two things happened that made me reconsider my position.  First, I had an unexpectedly candid conversation with someone in my life whose opinions I hold in high regard.   My assumption had always been that she, too, was pro-life – and I discovered that I was very wrong about that.  She felt strongly about a woman’s right to choose, and felt as strongly about the beauty and joy of bringing life into the world.

The second thing that happened was an even more personal conversation with a very dear friend.  We were, in fact, discussing our political opinions – and with her, I felt comfortable enough to disclose that I was conflicted on the topic of abortion.  She shared with me that when she was fifteen, she was raped and discovered she was pregnant.  Suddenly that decision was very real, and I couldn’t imagine having made a different decision than she did in her situation.

I also have complex feelings about a woman’s right to choose versus a parent’s right to choose.  (Do fathers have rights to decide the fate of an unborn child?)  I absolutely understand the argument that decisions about a woman’s body should be hers, and hers alone, to make.  But I feel like there’s another side to the story.

In the end, I have come down on the side of being pro-choice, albeit with a very strong advocacy for personal pro-life decisions.

Personal Responsibility and Social Programs

The conversation about “personal responsibility” always seems to be shaped as an argument between those that believe in personal responsibility and those that believe in social protections like welfare.  I believe strongly in both.

I believe that I am responsible for my own actions and decisions.  I accept the consequences and I earn the rewards.  I am the master of my own destiny.

I also acknowledge that I did not achieve anything on my own.

I was born into a middle class family in a safe neighborhood.  I had two well-educated, intelligent, healthy parents.  I had all of the privileges that come with that.  And even still, our family relied on unemployment assistance when my father lost his job, and federal and state student loans and grants to pay for college.  I took opportunities presented to me and I made the most of them – but the important thing is that I had the opportunities in the first place.

Programs like unemployment assistance, Welfare, Medicaid, Head Start programs, and Pell grants are not entitlements.  They are opportunities and they are protections for citizens at their most vulnerable.  It is arrogant of any one of us to think that we are above needing such protection.  Catastrophe could happen tomorrow that would put me in a position to rely on welfare.  And I will be grateful that it is there.  In the meantime, I am willing to pay my taxes to fund it.

It is not socialism to believe that my taxes should go to programs that protect our most vulnerable citizens.  It’s reality.  Without social programs, we continue to build a greater divide between those that have and those that do not have, destroying opportunities for future generations.   That divide will destroy us.

With that said, these programs aren’t perfect.  People will take advantage of the system.  Others will fall through the cracks.  The system should be more efficient and the outcomes could be better measured.  Programs that are not succeeding in meeting their objectives need to be discontinued, in favor of those that are making an impact.  These are programs that need thoughtful innovation and improvement – not thoughtless discredit and destruction.

Fair and Balanced Tax Code

Reducing taxes for the wealthiest Americans, providing enormous tax breaks for corporations, providing loopholes that allow corporations and individuals to avoid taxes by moving money off shore and eliminating things like capital gains taxes does not improve the economy.  Increasing taxes on the wealthiest Americans by 2% will not cause those individuals to stop building businesses and making more money.  Instead, it will allow the federal government to spend more on developing infrastructure to support their business or providing educational opportunities to the citizens that will work in their businesses.

(For the record, Atlas Shrugged remains one of my top ten favorite books of all time.  I love the celebration of individualism – and yet I can recognize idealized fiction versus reality.)

I am happy to pay my share of taxes, just as I’m happy to take advantage of the roads and bridges, I’m grateful for the protection offered by our military, and I was proud to accept federal funding for my college education.

Investment in Clean Energy and Green Technology

To say that investing in clean energy and green technology is waste of money – because there’s plenty of coal and gas that we can continue to mine and drill for – illustrates a disregard for the long-term future of our planet and our species. We cannot continue to use the natural resources like coal, petroleum and natural gas as though there is no end to the supply or no repercussions to the health of our planet.  I care what happens 100, 200, or 1000 years from now.

I believe that the only way to break our bad habits, however, is to subsidize the development of better ones.  We need investment in clean energy and green technology.  We may need subsidies, as well, because coal and natural gas will continue to be cheaper than alternatives until those alternatives reach mass acceptance.

Given the current state of our federal budget, can we afford to spend the necessary money on research, development and subsidies?  I honestly don’t know, but I don’t know that we can afford not to, either.

As a coal miner’s daughter, I also very personally understand the argument that further regulation on coal will cost coal miners their jobs.  It will.  And that hurts.  I won’t lie and say that it won’t impact lives.  Every decision made impacts lives. So let’s put measures in place to re-educate coal workers to work for green technology.

Regulation of Financial Systems

I wanted to provide a reference to start this off that succinctly explained the stock market crash of 2008 in a non-partisan manner, but it is surprisingly (or sadly, not surprisingly) hard to find.  Here’s a timeline, but it’s thin on context.

The bottom line is this: Lenders started to realize that they could loan money to people who couldn’t afford to pay it back, but play with the numbers to make the risk look less…risky.  And it all came crashing down.  (Wow, that’s oversimplified.

Since 2008, it seems that we hear something new every day that is happening in our financial systems that sounds like fraud, but isn’t technically illegal.  Our financial security is in the hands of well-educated individuals who are incentivized to play a numbers game – not to ensure that our futures are secure.

I want that to stop.

I want intelligent regulation on our financial systems to dictate the level of risk that they are allowed to take when it comes to global financial stability.  I want loopholes to be closed and fraud to be prosecuted as fraud.  I want individuals held accountable for their decisions, rather than being allowed to walk away from a decimated corporation with their own wealth in tact.  And I realize that this is all extremely complicated – and I want the most intelligent, Wall Street-independent and morally upstanding economists tasked with figuring it out.

I also believe we need to reform our financial system at the lowest levels.  We need to help citizens to live within their means.  We are a nation in debt, and we are a nation of citizens in debt.  Credit card reform that limits the amount of credit card debt an individual can accumulate, as well as limits on the amount of interest that can be charged are critical. Education that focuses on money management and the reality of debt should be encouraged – both for young people and for any adults who find themselves looking for help with bankruptcy proceedings.

obama2I am voting for President Barack Obama.  That’s why.

There are more issues on the table – and more issues that I would love to discuss and even argue about.  Intelligently.  Respectfully.  And with the goal of finding compromise.  If I haven’t talked about it here, it may be that I’m not not passionate, it may be that I’m not as educated as I’d like to be about it, or it may be that I simply forgot to mention it after the eight pages I’ve already written.

I ENCOURAGE comments of the respectful variety.