Good Food Store promotes McDonalds

Our local, values-based natural food store is putting on a McDonalds Holiday Benefit. I knew times were tough for multinational corporations, what with the ever-escalating fight for who can pay the highest salary, but this seems a bit much.

Well, OK, that’s a bit deceptive. But, then so is the Ronald McDonald House that is the beneficiary of this event. Yes, it is a charity. And, yes, providing a hotel for families to stay in while other members of the family are undergoing medical treatment is noble, indeed. But, another big winner is McDonalds.

There is simply no way to separate the Ronald McDonald House Charity (RMHC) from the fast food chain. The trademarked symbol of every house features Ronald McDonald, a cartoon character invented to sell hamburgers. Every family that comes through the door is subjected to constant reminders of the connection to McDonalds, Ronald McDonald, and the Golden Arches. McDonalds is the single largest donor, and every house is funded and promoted by the local McDonalds. The sales of USA Today inside the store are all donated to RMHC. There is even a RMHC-themed McDonalds restaurant. And the website for the local RMHC is © 2005 – 2009 McDonald’s Corporation.

Don’t get me wrong. RMHC is a good charity, doing good service in many communities around the world. But, if McDonalds felt this was so important that it didn’t need to use it as a marketing tool, then they could have called them Missoula Hospital Family Stay. Oh, but wait, there is one: St. Patrick House, right near St. Patrick Hospital. (The Ronald McDonald House is on the campus of the Community Medical Center, and charges the same per night as the St. Patrick House.)

So, my question is why the Good Food Store wants to promote the charity arm of McDonalds? The Good Food Store is a “non-profit corporation dedicated to supporting a healthy community“. I’m not sure I understand how promoting McDonalds is supporting a healthy community. With a bit more forethought, they could have been doing a St. Patrick House Benefit or one for the St. Pat’s Women’s Care Center or the Rehabilitation Institute of Montana at Community Medical Center or the Watson Children’s Shelter.

What’s wrong with rationing?

As I’ve previously pointed out, we already have rationing of health care by bureaucrats – by unaccountable, faceless bureaucrats whose job  is to deny treatment suggested by doctors and other health care professionals.

But, why do conservatives think that rationing is evil? Surely they would be happy to let the market allocate scare resources to those willing to pay, all the while ignoring those who can’t or won’t pay.

And, why do liberals think that rationing is evil? Surely they would be happy to have all basic health care covered and let those procedures considered frivolous or unnecessarily expensive be paid by someone else than the government?

Sadly, just as the Obama administration has taken to re-labeling the current initatives health insurance reform, I now believe it must be health care reform. We simply must do something to rein in health care costs, along with health insurance costs. And that means we have to do something about Medicare and Medicaid, as scary as that might seem. (After all, why tinker with programs that are clearly successful and still quite popular?)

As Martin Feldstein of the Wall Street Journal points out, the Federal Government pays nearly half of all health care costs in the United States. Therefore, any attempt to lower per capita costs will have to involve government one way or the other.

The place to start is, of course, the big ticket / low value health care procedures. They’re the ones taking up a disproportionate amount of our tax dollars but with the lowest contribution to a return to happy, productive life. In this category I would put experimental treatments, where there is little track record of clear benefit from administered care; cosmetic procedures, which may be sought by patients but have little medical justification; low probability treatments, which just don’t have much hope of success but take up scare dollars anyway; and many of the unnecessary tests which are sometimes used as a second or third opinion on an already diagnosed illness or injury. In each case I don’t so much question the right of patient to seek these sorts of health care, rather the expectation that government should automatically pay for each and every treatment or procedure.

I believe that every health insurance plan, including Medicare and Medicaid, already make choices as to which treatments or procedures are appropriate and which are not. Controversial examples would include acupuncture, homeopathics, and even some forms of contraception.

In countries that provide basic health care for everyone, you can still purchase privately provided health care. It is also still possible (and frequently prudent) to purchase private health insurance.   It covers privately provided health care, your choice of doctor, greater privacy in hospitals, etc.   By some estimates, in Canada around 30 per cent of health care costs (around $39 billion) are financed by non-public sources. It all comes down to who pays for what.

Perhaps we should call it health costs rationing?

Whose faceless bureaucracy is that?

Denny Rehberg continues to get my goat up. His latest schtick seems to be the “faceless bureaucracy in Washington, D.C.” Like some high school snitch, our proud representative now wants us to turn in public servant who is wasting our stimulus funds.

All well and good, I suppose. Accountability, transparency and all that.

Problem is that Denny seems to think that the faceless bureaucracy is the problem of all our ills. It was the reason why he supported the Montana Fire Arms Act. It is part of how he supports the Hardin jail being used for Guantanamo Bay prisoners. He calls the NCAA as bureaucratic as any federal government department for insisting that there not be gambling on the outcomes of college football playoffs. And, yes, it was part of why he opposes the Northern Rockies Ecosystem Protection Act.

And the big kicker is on health care, where Denny’s main point seems to be the evils of putting Washington in charge. This is where we find him out. As Mike Dennison reports:

Rehberg … attended a May 6 briefing in Washington, D.C., by political consultant Frank Luntz, who wrote a 28-page memo instructing Republicans how to defeat Democratic health reform proposals.

The memo, among other things, advised Republicans to characterize Democratic plans as a “Washington takeover” of health care that would put “politicians” or “bureaucrats” in charge of deciding care.

I know this is great soundbite politics. But, stop and think about health care in this country for a moment. Today you face an endless avalanche of paperwork should you ever need help. On top of billing from your doctor, you will receive Statements of Benefits from your health insurer (should be lucky enough to have one), summary of charges from the hospital, letters of limitation from your Health Management Organization (should you be so unlucky as to have one), bills from the x-ray technician, bills from the radiologist (often based in India where he reads your x-rays), bills from the phlebotomist, bills from the pharmacy, and so on.

Tell me again why single-payer systems are such a bad idea? Somehow I think I prefer bulk-billing whereby all those folks charge the government and leave me out of it. I can’t understand all the codes, the hidden levies and surcharges, the co-insurer this and the insurance co-pay that. I’d rather have the federal bureaucrat keeping check of all those charges than leaving it to me (as I am recuperating hopefully) to tackle all the intricacies.

As anyone who has had a long stay in hospital will tell you, we already have bureaucrats “rationing” the health care you receive. They’re called HMO’s and they tell your doctor what treatments are acceptable and what are not. They have a listing of drugs that are covered and what are not. They tell the hospital when you are allowed to stay and recuperate fully, and when you are not. Try getting your doctor to explain their reasoning to you and you will hear a exasperated litany of abuse for “faceless bureaucrats” making medical decisions in some office, far far away.

Still, it sounds like Denny is sticking to his marching orders pretty well. From a political consultant in Washington DC, no less! I guess some bureaucracies are OK, while others are not.

Will we ever learn?

The recent spread of swine flu may be a good thing. Stubborn as Americans are, sometimes it takes an epidemic for us to realize how important good habits are. Like washing your hands properly. Like covering your mouth when you cough. These things used to be polite and a marker of someone fit for going out in high society.

Maybe also it will help us remember why we have sick days. Yes, they make taking care of yourself a whole lot easier. You don’t have to be sick AND worry about how you are going to make the next rent check. And, yes, they are the right thing for a beneficent and caring boss to do. Show a little compassion for the poor wretch who normally puts up with being your employee, when they most need it.

But, it was also good social policy. If sick people didn’t feel pressured into coming to work (because they need the money, because they fear losing their job, or because the organization is so light on staff that your job responsibility it just that, your responsibility), then they might stay home when they are sick and get better sooner. And if sick people stay home when they are sick, fewer of the rest of us get sick.

Get it? Sick leave isn’t just a personal benefit, it is a social good. We all benefit when we structure the workplace to take care of one another, when we treat one another like human beings.

We all should get sick leave, regardless of how long we have worked at a particular location, regardless of how many vacation days we are allowed and have used, and regardless of whether we work for an hourly wage or annual salary.

Perhaps those bosses who make it nigh on impossible to take a day off when sick could be held responsible for their actions? Would it be possible to hold them liable for any employees who pass on their illness to other employees or customers? After all, some employer groups seem to think they control the workplace and everything that is allowed (or not allowed, in the case of union organizaing) on their property.

Market Failure II

Do rural communities deserve a lower standard of health care? According to the Missoulian (1/25/2009), they do. In an article written by David Brown of the Washington Post, the backbone of rural medicine is disappearing. Young surgeons are in great demand and rural hospitals and health clinics can’t afford to pay for them. Its simple economics – the result is that rural communities don’t have access to general surgeons. And that means family practitioners in those communities “can’t deliver babies, emergency rooms can’t take trauma cases, and most internists won’t do complicated procedures such as colonoscopies.”

You can’t blame the surgeons. After they have labored through years of medical school and more years as a resident, they have chalked up hundreds of thousands of dollars of debt. They simply can’t afford to work in a rural community.

You can’t blame the rural hospitals. They don’t have the population to be able to pay the same salary that the big city, billion dollar, non-profit hospitals are able to offer.

You can’t blame the current general surgeons. With the advent of HMO’s we have seen them spending less and less time with more and more patients in order to achieve the ‘efficiencies’ that the insurance companies insist on. There is no reason why they would encourage young medical students to follow in their footsteps and practice the craft of general practice. The non-surgical specialities such as radiology or cardiology pay about the same without the intense workload and scheduling.

Of course, there are some sensible solutions. We could make medical school free. Students would still have to cover their living expenses and pay for books, but tuition and fees could be paid for by the public. Or, we could pay all general surgeons the same amount, regardless of the location of their practice. Or, we could make every hospital that wishes to be considered a non-profit (and therefore doesn’t pay tax on their profits) to provide equal coverage to urban, suburban, and rural areas in a surrounding region. Surgeons could take a rotation across the different campuses of the same hospital.

All of those solutions are perceived to be anti-free enterprise. We would lose the brilliance of the marketplace, in deciding who can afford to go to medical school, where the best surgeons should work, how much they should get paid, and how to more efficiently provide the highest standard of health care to those willing to pay for it.

But, that free market fails the rural community. They don’t deserve equal treatment. Or if they did then they would have to move to the city. Living on the backroads of Montana comes at a cost. Is it your health?

Here’s to your health!

I posted a comment over at NewWest about why business owners should pay for the health insurance costs of their employees. But I don’t think the owner, Jonathan Weber, quite understood my point. Bottom line is that it is best for the business.

Many employees of small businesses can’t afford to get sick. An extended illness or recurring injuring can be financially crippling. Once your sick leave runs out, most of us don’t have any way to pay the mounting hospital bills. Without health insurance the only option seems to be bankruptcy. Given the choice, most of us would take another way out, any other way out. But, that’s the sad truth of the cost of medical treatment – there is no other way out. The bills are just too big. Other than our homes, most of us don’t own sufficient assets to pay hundreds of thousands of dollars of medical bills.

So, while it is the right thing for the small business owner to protect their employees from bankruptcy, it is also in the best interests of the company to do so. Rather than being faced with financial ruin there is a good chance the employee can come back to work. All the time and effort that went into recruiting and training that person isn’t lost. All the accumulated wisdom isn’t lost. And with a bit of luck the business doesn’t suffer too much of a hiccup as they get back up to speed.

Of course, there’s also sound health reasons for providing health insurance. No one wants sick people coming to work, bringing their illness or disease into the work place. Just like lots of places offer free flu shots (in the hope that a flu epidemic won’t break out in the workplace), there is a real cost savings when fewer of your employees get sick. Hence, smart employers remove all possible barriers to folks staying home and getting the care they need. That’s why we have sick leave, that’s why we encourage preventative health care, and that’s why we make it cheap for people to get looked at before the illness or injury gets too bad. Much can be treated easily and cheaply if a prognosis is made early. Folks get better quicker, too. Which means they can come back to work sooner.

Moreover, employees with health insurance we have one less thing to worry about and that allows us to focus more on our work. A similar logic is used in Europe and many US corporations that provide child care for their employees. Simply knowing that you are taken care of means a much greater level of productivity and much less lost time.

It all sounds a bit patronizing and nanny-ish, but it does create ‘stickiness’. Employees are less mobile, less likely to flit from job to job, if the conditions at the workplace are good. And, if the work is good and the pay is good, then most of us are content to stay put and continue to grow the business as a mutual project. It gives us something to believe in, something to contribute to, something to be a part of. A sense of we’re all in this together.

Fact is that employing someone is a competitive project. Most businesses want to pay as much as they can afford. And most businesses have to pay as much as they can afford. Otherwise, they are likely not to get a fully qualified person or someone who fully meets the expectations of the job. To get the best you have to offer the best. And that includes offering health insurance. Because of the way the health system is set up today, it is much easier and cheaper for the business to buy into health insurance than it is for an individual to do so (particularly if they are middle-aged or have pre-existing conditions).

Jonathan was right, in a way, when he asked, “A healthy population with access to good medical care is a universal good that benefits everyone, not just employers, so why should employers alone be responsible?” Ideally, we would have universal health care and employers wouldn’t be responsible. But, that’s not the case in this country. And it might never be.

Until that day, it would seem that we have two options. Either the employer pays or the employee does. I would argue that the employee already does. Not only are they the person who is in hospital, but with the extensive co-pay or deductibles we are already looking at quite high bills. (A recent dose of pneumonia cost me over $10,000 and I have pretty good insurance).

I can accept the logic of co-pay to a certain extent in that it makes the consumer a bit more responsible with their selection of healthcare. But, in most cases it is not an ideal market – as patients we have no idea what we are purchasing, nor do we have the information or skills to know how to choose the right product for the right price. Literally, we are at the mercy of the health provider.

Its all an interesting argument, but I am struck with the question of why business owners want to ditch health insurance for their workers. Is it simply a cost-savings mechanism? That is, shift the cost for someone else to pay and forget about the full cost of labor. Socialize the externalities, right?

I admire small business owners. It takes a lot of guts, a whole chunk of money, and a huge stack of time and effort to make a go of it. They’re putting it all on the line and hoping that now is the right time for their great product or service. And in these tough times it must be even harder.

But, for a small business to survive and thrive they are going to need great employees. In sickness and in health!