Michigan Demolishes Notre Dame 47-21

The two top teams in the history of college football met today in South Bend. Michigan leads both in all time total victories and all time winning percentage, with Notre Dame just behind. The battle is so close that a win today would have moved Notre Dame back ahead of Michigan in winning percentage. Playing at home, where Michigan hasn’t beaten them since 1994, and ranked number two in the nation this season, Notre Dame appeared to have an excellent chance of sneaking ahead of Michigan as the team with the higest winning percentage. They had an excellent chance, until the first play, in which Notre Dame was intercepted for a Michigan touch down. Notre Dame intercepted one of their own soon afterwards and tied the score, but from there it was all Michigan. Now, if Michigan can only avoid an upset between now and November, this might set up the Michigan vs. Ohio State game as a key game for the national championship.

A Return to Normalcy

Dana Milbank does not appear very impressed with the Democrats for their brochure on A New Direction for America. From a political point of view he appears more impressed with the Republicans’ campaign slogan:

By contrast, Republicans have settled on a single, unofficial slogan, which essentially says: Vote Democrat and Die. And in politics, scary and scurrilous usually trumps elaborate and earnest — something Pelosi has experienced firsthand in recent days.

The Republicans generally do a better job of getting out a message to voters than Democrats. Republicans made a much better opposition party than the Democrats have. Unfortunately for the country, while they are great at getting out propaganda messages, they are totally inept at governing. In terms of governing party versus opposition, the Democrats and Republicans both do better in the other’s position.

The real change we are seeking is simply a return to normalcy. With a return to normalcy should Democrats control at least one House of Congress, legislators will hopefully return to finding areas of bipartisan consensus to pass bills rather than passing legislation by a single vote from the far right. While all lobbyist corruption won’t disappear, the abuses of the K Street Project will be ended. The checks and balances wisely devised by the founding fathers can be restored. Hopefully we can then have a foreign policy based upon protecting the country’s interests, as opposed to using fear to obtain more votes while strengthening al Qaeda and Iran. Similarly we will hopefully see the end of Congress concentrating on wedge issues to bring in the votes of the far right.

These don’t make for exciting campaign slogans, but it is these basic changes which are needed to start getting the country back on track. While the Democrats might not have an exciting manifesto, the public does sense we need a change.

The Failure of Private Health Insurance

I receive reports from the Commonwealth Fund virtually every week which demonstrate the poor state of health care delivery in this country. This week’s report, Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families has received coverage in the mainstream media and blogoshere (here, here, and here). The study looks at purchasing private medical insurance and finds, “most adults who seek to purchase insurance coverage through the individual market never end up buying a plan, finding it either very difficult or impossible to find one that met their needs or is affordable.” Of course you can read the report for yourself. It would be more valuable for me to note the problems I see people having on a regular basis, which are consistent with this report:

Many people are unable to afford private insurance. Of those who do purchase, a large number are under-insured for one reason or another. Many have high deductible policies, which are increasingly common as part of health savings accounts. The problem here is that most patients do not want to spend money out of their own pocket, and see money in their HSA as their money which they are reluctant to spend. This leads to patients avoiding preventative care and routine care of chronic problems. This expense ultimately gets passed on to the taxpayers as the problems become expensive to treat years down the road when the patient is often older than 65 and on Medicare.

Many plans exclude coverage of pre-existing conditions. This makes sense from the point of view of the insurance companies who do not want someone to purchase their insurance two weeks before having that elective surgery they have been putting off for years. It is a major burden on those with chronic medical conditions which require treatment on a regular basis and cannot go without care for months.

Many plans do not include prescription coverage. Patients may make it into the office and receive prescriptions to treat them, but it doesn’t help them if they cannot afford the medications. I’ve also seen patients who have prescription coverage on paper, but their co-pay is so high that they are paying the bulk of the cost out of pocket.

Many private plans do not cover routine office calls. For many relatively healthy adults this isn’t a serious problem, but for those with the chronic medical problems I typically treat, lack of coverage of office calls is a major burden. For example, landmark studies in the United Kingdom have shown a considerable decrease in diabetic complications among diabetic patients who received intensive treatment, including frequent office visits, as compared to those receiving conventional care. The typical under-insured patient in the United States doesn’t even receive treatment at the levels of those in the “conventional care” group in the UK studies. As with those with high deductible policies, the consequences of this are seen years down the road, often when the patient is on Medicare, unnecessarily increasing costs at that point. It is far more expensive to treat a patient who requires bypass surgery, dialysis, amputation of a limb, or rehabilitation following a stroke than it is to prevent the complications with routine care.

While these problems are commonly seen with those who must purchase their own insurance, I am increasingly seeing patients with policies obtained through their employer which have the same limitations. To a growing degree, this is a problem which is affecting a large percentage of the population, and with the trends I am seeing even those who currently have good insurance coverage should not be over-confident that this will continue.