Effect Measure

We’re only just learning some of the crap that’s in this health care deform compromise/giveaway to the insurance industry, but some of it has come out (via the Manager’s Amendment .pdf [and I admit I don't exactly know what this is except it contains legislative language allegedly in the bill]). For starters, rest easy. Your fucking guns are safe. If you are a woman, no similar concessions to your uterus (h/t McJoan at DailyKos).

One of the things we are told by apologists for this monstrosity is that it has all sorts of great provisions for prevention and wellness promotion. I’m in public health. Prevention is what it’s all about for me. One aspect of prevention is helping people deal with alterable risk factors to decrease the chance they will become sick or die. Injury is the largest single cause of death through age 44 and in the top 10 at all ages. One major category of injury death is suicide and homicide. Wouldn’t we like to decrease the risk from these causes, when they are preventable? Isn’t that what Wellness and Prevention means?

In most states one of the largest single cause of suicide deaths is firearms. One of the reasons is that it is the most effective. If you try to kill yourself with drugs, you may or may not succeed (and you may or may not be glad you didn’t). But if you try with a gun, you will succeed. So if you have a gun in the house it is germane to the risk of suicide, not to mention the tragic accidental access by children to guns that are loaded and without trigger locks. Without any attempt to control guns, there are still major interventions that can be used to decrease gun deaths.

But this stinker of a bill has specific language in its Wellness and Prevention Programs section that forbids interventions regarding firearms under the rubric, “Protection of Second Amendment Gun Rights” (from The Manager’s Amendment):

(c) PROTECTION OF SECOND AMENDMENT GUN RIGHTS.?

(1) WELLNESS AND PREVENTION PROGRAMS.?A wellness and health promotion activity implemented under subsection (a)(1)(D) may not require the disclosure or collection of any information relating to?

(A) the presence or storage of a lawfully-possessed firearm or ammunition in the residence or on the property of an individual; or
(B) the lawful use, possession, or storage of a firearm or ammunition by an individual.

(2) LIMITATION ON DATA COLLECTION.?None of the authorities provided to the Secretary under [the bill] shall be construed to authorize or may be used for the collection of any information relating to?

(A) the lawful ownership or possession of a firearm or ammunition;
(B) the lawful use of a firearm or ammunition; or
(C) the lawful storage of a firearm or ammunition.

(3) LIMITATION ON DATABASES OR DATA BANKS.?None of the authorities provided to [the bill] shall be construed to authorize or may be used to maintain records of individual ownership or possession of a firearm or ammunition.

(4) LIMITATION ON DETERMINATION OF PREMIUM RATES OR ELIGIBILITY FOR HEALTH INSURANCE.?A premium rate may not be increased, health insurance coverage may not be denied, and a discount, rebate, or reward offered for participation in a wellness program may not be reduced or withheld under any health benefit plan issued pursuant to or in accordance with [the bill] or an amendment made by that
Act on the basis of, or on reliance upon?

(A) the lawful ownership or possession of a firearm or ammunition; or
(B) the lawful use or storage of a firearm or ammunition.

(5) LIMITATION ON DATA COLLECTION REQUIREMENTS FOR INDIVIDUALS.?No individual shall be required to disclose any information under
any data collection activity authorized under [the bill] or an amendment made by that Act relating to?

(A) the lawful ownership or possession of a firearm or ammunition; or
(B) the lawful use, possession, or storage of a firearm or ammunition.

We won’t know what this means in practical terms (although the intention is clear) until there is specific legislative language that is translated into regulations, here’s what some of it seems to say.

(1) seems to say an insurance company can’t require you to answer a question that affects your risk. They can require you to answer if you engage in hang gliding or skydiving or other risky sports, but not if you have a firearm in your house. It’s possible they can still ask, but no one has to answer. But if you do answer, (2) says the bill doesn’t authorize its collection or use. I’m not sure what not authorizing collection means, if a company asks it as a non-required (optional) question, since then the data are collected, but even if it means it could be copied down, it doesn’t seem any use would be “authorized.” At any rate, (3) says you can’t compile it. It qualifies it by saying “individual ownership or possession” but what’s the contrast? Collective ownership? You can’t strip identifiers if you don’t have individual ownership information first. (4) says the presence of a risk factor can’t be used in determining premium rates. In general that’s a good principle if you want to spread risk. The problem is insurance companies are not prevented from doing this for any other risk factors and the bill, as reported in the press, will allow them to do this for all sorts of pre-existing conditions, sometimes in ways that will make their mandatory insurance unaffordable. (5) just says no one that comes under the bill will be required to disclose gun ownership. Don’t ask, don’t tell.

I’ve quote all the second amendment language here, while only the first section (1) was up on McJoan’s DailyKos post. But that post is noteworthy for an update by another dKos frontpager, SusanG, who notes this comment by dKos reader Mother Mags:

Mother Mags looks on the bright side, in comments:

Well, at least they didn’t mandate that everyone has to own a gun, and then limit our choice to one manufacturer that doubles its price every 5 years.

Not yet. That will probably be the next compromise agreement.

Comments

#1 Eadwacer
December 20, 2009

I am surprised that the free-market Republicans let this slip through. Obviously, if we are safer with guns in the house, an insurance company that lowers premiums based on this fact will gain more customers, pay fewer claims, and profit more than their competition. I’d recommend striking those provisions as an unconscionable government restriction on the operation of American business.
#2 Anonymous
December 20, 2009

Perhaps gun ownership is a preexisting illness that can’t be considered in granting insurance
#3 Dan
December 20, 2009

“one of the largest single cause of suicide deaths is firearms” doesn’t make sense. Your implication is that if there were no guns, then suicide might be prevented. Trust me, as someone who seriously considered suicide a few years ago, I identified two methods of choice, neither of which was a firearm, although I had ready access. One of my colleagues, who was an avid shooter, killed himself by injecting an overdose of insulin. If someone really wants to commit suicide, the absence of a firearm will be only a minor impediment.
#4 Adrian Griffis
December 20, 2009

While I do often find myself in agreement with my fellow liberals on quite a few issues, I am troubled by the level of anti-gun bigotry I often see in liberal circles. You’re right that we’re passing up substantial chances to do good with this health care bill. Congress simply seems unprepared to grapple with the important issues related to health care, and the Republicans, as a group, have been worse than useless in this process. I will go as far as saying that the conduct of many on the right in this process has been blatantly dishonorable.

I share your outrage at the religious right’s attempt to single out women’s reproductive rights as a target to attack in this bill. But surely these favors to the gun rights movement are simply a non-issue, at worst. Doesn’t it make more sense to attack the scum sucking bastards who are trying to impose their demented, medieval religious values on women with unwanted pregnancies rather than attacking gun rights activists with a somewhat overblown sense of the dangers healthcare might pose to their rights?

Adrian
#5 revere
December 20, 2009

Dan: No. The issue is lethality of method. I checked this with an epidemiologist whose speciality is intentional injury. She said that many suicide attempts are impulsive. It is one of the reasons that males have a higher suicide rate because while they try less often than women, women choose less lethal means (e.g., sleeping pills) and don’t succeed a good proportion fo the time. If you attempt suicide with a gun you are likely to succeed. You don’t get a chance to say, “I don’t think I need to do that again.” Whether it makes sense to you or not, it is a fact.
#6 revere
December 20, 2009

Adrian; It’s not a zero sum game. We can attack Joe Lieberman, Ben Nelson and the whole putrid pile that is called the Republican Party and have time and energy left to be anti-gun bigots. I’m certainly anti-gun. Bigot is your word.
#7 Roadtripper
December 20, 2009

There are no guns in our home because my room-mate occasionally has had suicidal thoughts. But that’s for us to decide, not some politician or bureaucrat.

Rt
#8 revere
December 20, 2009

Roadtripper: In this case, maybe his/her doctor might have some thoughts. But not under this bill. The politicians are the ones who have decided this. Don’t ask.
#9 Nancy
December 20, 2009

I seem to remember from my Suicide Prevention days (years and years ago) that in assessing risk for suicidal persons, potential means were evaluated for availability, lethality and speediness of effect. Guns, if I remember correctly, were considered by far the most dangerous, and I cannot imagine how that could have changed.

The right wing knows how to work things, both in terms of influencing ordinary people, and getting politicians to do their bidding. We Progressives, not so much. And it’s starting to feel real lonely. Revere, have you listened to Liam Clancy sing Peter Pan And Me yet? Has anybody else?
#10 daedalus2u
December 20, 2009

What this legislation lets health insurance companies do is ask “is there any illegal ownership, possession, storage or use of guns or ammunition in your household?”

If the person says no, and is untruthful, then any and all health insurance claims can be denied retroactively. Shooting oneself is not a legal use of a gun, so if you shoot yourself and are not dead, the insurance company will not pay for treatment.
#11 Paula
December 20, 2009

Reveres, the deform bill twisted by the Senate is so horrific this gun stuff is just peanuts. After a year of urging and shouting to news and Obama people and local and national legislators to back some form of single-payer and not to let “reform” turn evisceration of Medicare benefits and/or indulgence for the insurance industry, not to let the public option become either minuscule or debased, not to let “healthcare reform” become another “welfare reform,” one still now must keep eyes on the prize, keep trying, rev up to try again. And your suggestion yesterday of only limited proposals–for now–rather than this disastrous bill is so good. How do we push that, and swiftly, would you suggest–?
#12 revere
December 20, 2009

Paula: I’m afraid health care politics of this kind is not our expertise. Our tactic here is similar to what we do in other areas: write things that are subtly or not so subtly subversive. The guns issue is our way of pointing out where the priorities are and aren’t: cave to the NRA but stick it to women in general and NARAL and NOW in particular. We agree the guns is small potatoes. But in this debate, so are we Reveres. We just do our small part in our corner of the blogosphere. We are used to being just pairs of hands in a big project. At times we are able to take the lead because of our expertise, but this isn’t one of them. The best we can manage is to speak for what we think is right.

Having said that, it seems to us that the voices that make sense are Howard Dean and on a more sophisticated level people like David Himmelstein and Steffie Woolhandler. Both are docs (full disclosure: both are friends) and both write very astute things for NEJM and other medical and MSM publications. You should be able to find their stuff on the internet without trouble if you don’t know them already. So defend Dean from attacks as someone with unrealistic and ideological goals (neither are true), speak against fatal compromises wherever and whenever you can and hope that some Senator like Bernie Sanders will put a stick in the spokes of this wagon to political disaster. Delivering our health care system into the full and open and greedy arms of the insurance industry while giving away reproductive rights and who knows what else cannot be a net gain, even if there are some decent things in the bill.
#13 Paula
December 20, 2009

revere: I know. I joined PNHP, know Himmelstein’s and Woolhandler’s work on this issue. Looks as if the whole garbage bag’s going to go through in the Senate in the next several hours. Meanwhile, should we consider another public health joy, like wind turbines? Just learned this little county is planning some on a hilltop a mile from here–after all, so few voters out in the countryside and it’ll bring in revenue, looks green, and is so much the fad–never mind the infrasound effects on people’s health, sleep, sanity, lives. Some European countries have halted such projects, but the U.S. seems never to learn when it’s health versus monies.
#14 Don S
December 21, 2009

And you thought the sausage making of meta-analyses was bad! Policy making is far uglier.

The series of events was that Reid introduced a bit to allow wide implementation of Wellness Programs as some insurers already try to do. Mostly they try to screen for modifiable risk factors and hook people up with programs to modify them. Screen for cholesterol, stress, adequate sleep, untreated depression, obesity, lack of exercise, diabetes. Participate in the screening program and you get a discount. Presumably the bean counters figure that modifying those risk factors saves them ore than it costs. It was not intended to be a gun control back door but gun nuts are a paranoid crowd and were afraid that the anti-gun crowd would use it as one. So this was put in to make it clear and not lose votes.

No insurance Wellness Plans don’t screen for gun ownership. Nor would they in the future with or without this amendment. Gun owners are not going to join a plan to help them get rid of their gun ownership habit or be receptive to literature educating them about their higher suicide risk they place themselves under compared to the minimal defensive gun use benefit effect (if it even exists at all). And besides, the bean counters don’t save money by preventing someone from killing themselves with a gun – it is effective enough of a method that they cost no medical care.
#15 llewelly
December 21, 2009

Real Americans don’t rely on police to protect us. We rely on our 2nd Amendment rights.
Real Americans don’t rely on ObamaCare to secure health care we can’t otherwise afford. We rely on our 2nd Amendment rights.
#16 Adrian Griffis
December 21, 2009

llewelly: You’re just not helping, here. You say, “Real americans don’t rely on ObamaCare to secure health care we can’t otherwise afford. We rely on our 2nd Amendment rights.” You make it sound like we might use guns to gain access to health care.

I am a pro-gun rights liberal, but I must say that some of my fellow gun rights advocates are their own worst enemies, and I think you are in that category. Nothing you’ve said would be the least bit convincing to anyone who isn’t already on our side in this matter. We are much more likely to persuade good people on the other side of this issue if we try to be respectful in our persuasion. When we make arguments that could only sound good to those already on our side, and when we make those arguments to those whom we already know are not on our side, how can this be anything other than an insult. Granted, some anti-civil rights advocates deserve the insults, but even then, what about our audience? What good can possibly be accomplished with the argument you offered?

Regarding health care, I encourage you to think about this: Our federal government grants a monopoly to companies that develop drugs and medical equipment (among other products). That government forbids us to do some of what we might choose to do to help ourselves, and there are companies that rake money in as a result of these government protected monopolies. If we sit and do nothing, we do not really have a free market where we have the right to help ourselves. Something needs to be changed. I’m not sure the health care bills we’re looking at in Congress are what we need. But a glib statement that we don’t rely on Obama care to secure health care isn’t really what we need, either.

Adrian
#17 revere
December 21, 2009

Adrian: I should let llewelly speak for him/herself, but I strongly suspect the comment was snark, not to be taken literally. I’ll grant you that some comments here that are meant literally might be mistaken for The Onion, but in this case I think it’s the other way around.

I don’t mind guns for sporting or recreational use. For those uses they should be regulated. Anything else I consider a public health hazard from a defective consumer product.
#18 llewelly
December 21, 2009

I am a pro-gun rights liberal, but I must say that some of my fellow gun rights advocates are their own worst enemies …

I apologize to you, and to anyone else who mistook my comment as an argument in favor of 2nd amendment rights. It was not intended as such. On the contrary, it was a sarcastic (and, in retrospect, ill-considered) response to the fact that 2nd amendment rights are treated with unude holiness (as seen for thousandth time in the bill discussed above), while rights from the 1st, 4th, 8th, 9th, and 14th amendments are casually ignored. (Among other things, it shows that while a trained operator might be able to use a firearm to protect themselves from a criminal, firearms are of no value for protecting one’s rights from callous legislators.)

As for the possibility that someone might “rely on their 2nd Amendment rights” to secure otherwise unobtainable health care – that’s quite rare (and I believe it will remain so), but a handfull of cases can be turned up by any dedicated searcher. (It’s not something I could do myself; I don’t own guns, and I know from experience I can’t hold a rifle steady under the best of circumstances, much less under dangerous circumstances.) I brought it up because I am very, very tired of the common (and easily disproved) claims that if other forms of freedom or security are not protected by legal means, tney can be protected by “second amendment” means.
#19 Oh the Irony
December 21, 2009

So it’s OK to terminate the life of an unborn child, but not one’s own life ?

Rights, are those things you don’t have to use force to take from other people. You have a right to access healthcare, and any other service you might like. You don’t have the right to coerce me to provide healthcare for you.
#20 Paula
December 21, 2009

Speaking of rights, can anyone here tell me what rights we may have to protect our health, sanity, and quality of life (including right to sleep at night) against the emplacement of wind turbines near our homes? I’m suddenly threatened by this out here in the Oregon countryside, as a result of ill-considered local hot-shots’ decision to raise county funds by selling “green energy” at the expense of “only a few” residents in my immediate rural area. Any and all help, citations (esp to peer-reviewed materials), etc. re the effects of these things on public health etc. will be much appreciated. Okay to contact me offline on this, friedman[at]gorge.net (I hope we may put our e-addresses here?).
#21 revere
December 21, 2009

Oh the Irony: Whether a fetus is a person is one question, but a person of sound mind is entitled to take his or her own life. Indeed I think it’s a rational act for many people. But it’s not a rational act if you are a teen turned down for the prom or any other reasons of momentary reactive depression. I think doctors should be allowed to assist, too (do you?). But that’s not what we are talking about here, which, if you weren’t so fixated on controlling a woman’s uterus, you would possibly have realized. Irony comes in all flavors. Including anti-abortion pro-death penalty folks.
#22 llewelly
December 21, 2009

But it’s not a rational act if you are a teen turned down for the prom or any other reasons of momentary reactive depression.

Aside: I am very skeptical of the widespread notion that teen suicides are disproportionately due to being “turned down for the prom” or other reasons of momentary reasons depression. For starters – I’ve yet to see any evidence. Additionally, it’s often used as excuse to ignore real problems, such as domestic violence. Not that you’re doing that.
#23 Jubal
December 23, 2009

Congratulations! You have distilled a 600+ page bill down to it’s essence. That’s right, the most important items in Health Care reform were the 2nd Amendment & reproductive rights. Every time a politician needs to obscure the agenda they will throw out a red herring to get the dogs of their trail. These two nuggets work even better, because they rally the faithful to the pols side while at the same time derailing any coherent discussion. I for one always look forward to a respectful discussion that is started with “…rest easy. Your fucking…” What’s next? Taste Great…Less Filling? At least this subject might address obesity and alcoholism.