This is the last serious thing I will say publicly about the healthcare debate for months.

August 7, 2009

Dear Rep. Speier,

I am very happy to see that you have come out strong for a public option in healthcare.  Thank you for doing the right thing.  If you don't read the rest of this letter (it is long) please know that you have my support in pushing for universal healthcare, of which a public option is a key component.
There are a couple of myths floating around the healthcare debate that I want to address, not because I think you buy into them, but because I want you to know your constituents don't buy into them.

Myth: A public plan would put a bureaucrat in charge of your healthcare.  

Opponents of healthcare reform pretend this is a bad thing.  All insurance is by definition, part of a bureaucracy.  There is more paperwork in healthcare than we have trees.  Today we have health insurance bureaucracies run by for profit organizations who are not answerable to anyone except shareholders, whose interests are diametrically set apart from patients.   When they want to change the rules of your insurance coverage, they simply change the rules because they contractually reserved that right when you signed up.  And because they are a near monopoly in the market, you don't have any choice.

Government-run healthcare are systems that can be expected to follow reasonable and consistent rules, such as "You may not rescind coverage the day before you need to go in for chemotherapy treatment."  When they don't follow these rules, there are appeals to the courts and to elected officials.  The purpose of the enterprise, to keep you healthy and heal you when you're sick, is never lost.

Bureaucracy is inevitable with health insurance, whether run by the government or by the private sector.   I'd rather my chances of survival be chosen by me and my fellow constituents than by a board of directors.  I would prefer a bureaucracy run by someone responsive to me than by someone whose motivation is to pay out as little in healthcare services as possible.  Like public safety, healthcare should be a service not subject to market forces.

Myth: 2 out of 3 workers will lose coverage according to independent analysis by The Lewin Group
The Lewin Group is not an independent entity, it is an entirely owned subsidiary of health insurance company UnitedHealth.  Secondly, the rising cost of healthcare is driving people to lose their coverage because costs of employer funded healthcare are rising faster than we can keep up.  When I co-founded my web agency in 1997, we offered healthcare and paid the entire cost.  Today that isn't possible anymore and employees share part of the cost, and many business don't even offer coverage, or offer "sham" coverage.

The reality is that the current approach to health insurance has resulted in a loss of coverage for millions of people.  From 1998 to 2008, the percentage of large employers who offered retiree health coverage shrank from 66% to 31%, and the trend continues downward today .  [Kaiser Family Foundation, slide #12]

Rising costs will mean that many employees who are offered coverage won't be able to afford to accept it.  In addition, the KFF study shows that premiums have been rising quickly for the last ten years.  What isn't shown in that study is that out of pocket costs have been rising along with non-covered events.  We're paying more for plans that are covering less.  And that assumes that we can get insurance, or that we don't lose it through rescission.

Myth: There are millions of Americans who go uninsured (also known as "naked") in this country.  They should be motivated to work harder in order to afford health insurance.  We shouldn't just give them this benefit or they won't see an incentive to work hard.

For millions of uninsured Americans, maybe the best job they have been able to find is not enough to afford a $400 per month or more health insurance premium, or the copays that go with it.    In a capitalist labor market, some people just won't make enough money to afford health insurance as it costs today.  

Being poor in America, where we prize our standard of living, is itself a sufficient motivator to get people to work harder.  If the promise of a flat screen TV, a new car, or an exotic vacation isn't enough to motivate you to make more money, the promise of a life with health insurance isn't going to motivate you more.

Withholding health insurance means that these people will be poor and sick, which will do nothing to make it possible to work harder, and will likely only result in more expensive chronic conditions that our hospitals (and we) will end up absorbing the cost of.

Having a public health insurance option that refuses nobody means that when they do get sick, they can be automatically enrolled in the program and therefore reduce the risk pool and healthcare costs for everyone.  And of course, if they then decide that they want to buy a plan, they would be free to go on the open market and do business with the health insurance industry.

Thank you for fighting to hard for a public health insurance option.  As we have recognized our responsibility to protect the health of our elderly and our children, the public option will ensure that we cover our nation's working poor and middle class not covered by the healthcare market.

Sincerely,

Shabbir Imber Safdar

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