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2009
    October
         Thu Oct 8 22:43:41 2009
Open Letter
         Mon Oct 5 23:08:30 2009
My Charitable Giving
    September
         Thu Sep 10 23:24:51 2009
The Healthcare Debate
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Thu Oct 8 22:43:41 2009
 
Open Letter
 An open letter to my congressional representatives.


I can't remember the last time I wrote a letter with a pen...
Image courtesy of Hatework (the band)
 
I finally took the time to write up a letter to my congressional representatives about the healthcare debate. I had done enough research that I feel like I understood the core issues (see The Healthcare Debate), so I figured it was my duty to tell them what I'd learned.  
 
After all, I wrote an open letter to them a year ago about the bailout, and it didn't work (I asked them not to fund TARP). So why not try another letter?  
 
So this is what I sent to my representative (Jim McDermott), Senators (Maria Cantwell and Patty Murray) and President Obama as well:
 
Dear Representative McDermott, Senator Cantwell, Senator Murray, and President Obama-  
 
First, thank you for taking the time and energy to tackle healthcare! The current healthcare system (public and private) is going to run out of money soon, and that could have disastrous consequences. I know the issues are difficult and emotions are high, making the job harder still.  
 
I had three requests.  
 
1) Please fix the core issues. Expanding coverage is good, and I'm even willing to pay a bit more myself if that improves overall coverage, but coverage isn't the main problem. Getting sidetracked with coverage won't help the country in the long run.  
 
2) Please publish a short list of the principles you will use to fix the system. The current healthcare bills are unreadable. We (voters and taxpayers) probably won't read them anyway. But we do care how the problems are solved. Will you commit to transparency in healthcare pricing? Will you commit to solvency of Medicare and Medicaid? Will you commit to hard limits on federal healthcare expenditure?  
 
3) Please move away from medical insurance as the main form of healthcare funding. We don't pay for car maintenance with car insurance: instead, we plan ahead and pay for those expenses out of our savings. We don't pay for home maintenance with home insurance: instead, we plan ahead and pay for those expenses out of our savings, or perhaps borrow to cover them. Paying for everything with insurance doesn't work for cars and houses, and it doesn't work for people either. Insurance should be there for catastrophes only. All other expenditures should be covered by our savings and borrowing if necessary.  
 
I know moving away from health insurance scares people. But as our representatives, and the stewards of our economy, hopefully you are aware that all healthcare costs have to be paid for somehow. We pay today out of insurance and special fees paid by employers, which is a convoluted and obscure process. Asking people to pay directly out of their pockets will force hospitals to make bills understandable, costs transparent, and introduce positive market economics that rewards hospitals for improved healthcare at lower prices, which is the reverse of what happens today.  
 
You can still improve coverage by having the government help low-income families with healthcare costs. Doing that would cost no more than an insurance-based program today (since after all, it is medical costs you'd be paying anyway), but it would be through a much more transparent system.  
 
But whatever you do, please fix healthcare (and not just expand coverage of a broken system), and make clear what principles are guiding your decisions.  
 
Sincerely-  
 
(me)  

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Mon Oct 5 23:08:30 2009
 
My Charitable Giving
 How I give...


Next year, I'm just giving pies.
Image courtesy of Sherurcij (wiki)
 
I was catching up on finances last night, and realized I was behind schedule on my charitable giving (I promised myself to give every month). Furthermore, I had lost track of who I was giving to so I had to go back over the past year of donations and see what charity I was supposed to give to next.  
 
I'd been meaning to reorganize my charitable giving for a while, so now I went ahead and did it.  
 
Why reorganize? Because, with these economic times, I've seen more people out on the streets asking for money. You should never give money to pahhandlers, because many are scams, and even for those that aren't, if you give them money you are encouraging them to panhandle instead of working with local charities themselves to get themselves off the street. If you really think someone needs help, give them food instead (I tried that once and was rejected--the panhandler just wanted money!).  
 
But not giving money to panhandlers is only acceptable (to me) if I'm sure I am giving money to charities that will help people that really need it. But I realized that all of the charities I was giving to were political, so I wasn't actually giving a dime to charities that were helping people in need.  
 
So, as I said, it was time to reorganize. I went through and made sure I was giving to the organizations that I thought deserved or needed the most, and tried to make sure I had a good balance between political causes important to me and just generally helping people in need. When I was done I still felt like I was short-changing one charity, so I decided to give double in December.  
 
So here is my new allocation. There are 10 charities that I give to, three of them twice a year. It breaks down as: I didn't drop any charities in the reorganization, but a number are now getting less money a year so I can give more to the United Way, and environmental causes.  
 
How much do I give? Many years ago I started giving just $40 a month (I think that was it), and then every New Year one of my resolutions was to increase how much I was giving. Now I give enough that I watch who I'm giving to pretty carefully. But for a long time I didn't give anything, because I didn't think I could afford to. Now that I can, I feel like I should.  
 
I don't think how much is given matters that much--and donating time is usually better than donating money anyway! The important thing is to give.  

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Thu Sep 10 23:24:51 2009
 
The Healthcare Debate
 The new proposals don't fix anything.


Please fix this patient!
Image courtesy of John Asselin, U.S. Air Force
 
Of course, the Great Healthcare Debate is all over the news now. Obama gave a speech to Congress yesterday--check that out, it includes the heckling!--and there have been various healthcare proposals flying around.  
 
[Random aside: did you read his Back to School speech? I thought it was excellent.]  
 
I wasn't sure what to make of the healthcare debate! I had to spend some time educating myself on the debate, and healthcare. I've had various small health care issues (bad ankle sprain last year, for instance) where I had to visit an Emergency Room and deal with complicated medical bills, but nothing like a prolonged stay in a hospital. I get healthcare insurance covered through my employer and rarely think about it.  
 
However, this is clearly a large debate with many things at stake:  
I'm not a Democrat, but I'm not a Republican either. I'm an Independent who cares about healthcare (and no, I'm not going to any town hall meetings). I just wanted to understand the issues and see what I thought should be done.  
 
I had many questions myself. Why exactly is our healthcare system broken? Many people claim it is broken, and they all have their own solutions to sell, but what exactly is broken about it?  
 
Also, What is the Democratic solution? How is it going to fix the problems?  
 
And finally, Why is the solution so complicated? I remember everyone complaining that No one had actually read the healthcare bill, why didn't they?  
 
What I discovered was:
  • The current proposals don't talk about what is broken, they talk about coverage (which can be related, but isn't the same thing).
  • The Democratic solution is about increasing coverage, not fixing anything.
  • The proposal is complicated because they are adding more tweaks to an existing complicated system, rather than fixing the root problems.
 
To put it succinctly, I was disappointed! I was hoping someone might fix something. I don't think improving healthcare access is bad, but this isn't really a fix.  
 
My guess (and prediction) is that a version of this healthcare bill will pass. We'll spend a bit more to increase coverage, and try to find ways to pay for it. I doubt we'll be entirely successful at that, but increasing coverage may be worth spending more money.  
 
However, I do wish someone would actually fix the system. This isn't tweaking, or addressing fraud, but really going back to basics and rebuilding the system right.  
 
First of all, the fix shouldn't start with a complicated 1000 page document. Instead, there should be a simple statement of principles that fits on one page. Then we could look at the principles and decide if they were right or not. If they were, we could tell Congress: "go and implement a healthcare solution that follows these principles."  
 
So what would those principles be?  
 
Lately, I read a great article about the healthcare system by David Goldhill in The Atlantic Monthly. The author gave a good overview of what was wrong, and his points on how to fix it. You may disagree! But I thought he had a great starting point for principles to really fix the system.  
 
Here are Goldhill's principles:
  1. Move away from comprehensive health insurance, and avoid any single form of financing. Instead, consumers would pay for healthcare in a variety of ways: out of our pockets for major, predictable expenses, with only massive, unpredictable expenses covered by insurance.
  2. Have a catastrophic insurance program that all Americans would pay into. It would pay out only for real catastophes (medical incidents and bills over $50K only, for instance). Most of us would never be benificiaries. This fund is just there to cover the true, rare catastrophes.
  3. We'd pay for healthcare out of our income and savings. Large events that cost more (appendectomy, birth) would be covered by credit.
  4. For low-income Americans, the government could fund some of this.
  5. The government could fund preventive medicine as a way to bring overall costs down.
 
The number one complaint to the Goldhill approach (having us pay for almost all expenses ourselves) is that it would be too expensive. However, we are paying those costs today! It's just hidden. If you are lucky enough to be employed, a huge chunk of money is being paid for your healthcare by your employer. (If you aren't lucky enough to be employed, your government healthcare payments are coming from the paychecks of those that are working--the government doesn't create wealth, after all, it just moves it around). You don't see it, but it's money that is being paid and can only be used for healthcare. Under the Goldhill plan, you would get that money and be able to save it yourself. And you could spend it on other things besides healthcare if you wanted to!  
 
Goldhill's article gives a good argument for why this might work. I like how his plan gets medical costs and bills to be very transparent, lets consumers decide what to do, and naturally forces hospitals and healthcare providers to lower costs while improving care.  
 
And the general idea, that comprehensive health insurance is a poor way to cover most healthcare expenses, is key.  
 
I don't know enough to say if Goldhill's plan is the best or not. But I like how it fixes (or attempts to address) the core economics of the issue, rather than trying to patch or extend something that is already broken.  
 
If nothing else, ask your Congressional representatives to provide you with a clear, short list of the principles they will use to reform health care!

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