He's not even close to a blue dog. And yet, I think it is worth the time to at least poke these guys. Perhaps they are not willing to give up their jobs, just to please the Party Leaders. Anyway, here's what I wrote. Maybe you could do it too. Railing doesn't seem to work. So, maybe showing them a different kind of stick may.....

Senator Brown,

I work in Dayton as a Fire Lieutenant. A couple years ago, we had our own little Health Care Reform. Perhaps you already know about it. It passed our union vote easily, because we can see that things are really out of hand what with budgets and health insurance and the like.

Basically, it does what has been available for a number of years through the Tax Code. I believe the city is saving millions of dollars, just in our one smallish city. But, I'm sure you can find the actual figures better than I could. And the result is that those of us who are basically healthy, are able to save part of our health care costs for later years, when that may not be the case any longer. I know that most of the retirees are not only concerned, but actually hurting from the rising costs of that today.

I won't have much worry over that, thanks to our plan. And the young guys, will have zero worries, as well as a tidy nest egg by the time they retire in twenty five years or so. It has seemed to me, and I've often wondered aloud to people who are worried about health care costs, why our plan that is an already formulated, just about perfect plan for anyone, isn't already the norm. There is nothing special about being a firefighter or government employee. A private company could set this up just as easily.

Here's how it works. We each have a Health Savings Account, which is set up with a bank...almost any bank will do. And we have high deductible insurance, which doesn't kick in until two thousand dollars have been spent out of our accounts. That is provided for by the Tax Code, and has been for some years. It's just that almost no one seems to know about it. Or confuses it with the Cafe Plans that were "use it or lose it" propositions. With an HSA, anything not used, rolls over into the next year, even earning some interest.

The city saves giant piles of money, because High Deductible/Catastrophic Health Plans are far cheaper than Full Coverage. Here's what makes it work for us though. The city then also funds our HSAs with $1500 or $3000 dollars (single or family coverage). We can then add to that if we like, by having money taken directly out of our paychecks. I take out enough personally to cover the difference, which is about fifty bucks a pay.

In the second year, I already have a few thousand dollars in my account which has rolled over. By the time I retire, I will have enough to not only cover out of pocket expenses, but also the premiums for the insurance I will have to buy for myself then. The people in our plan, who already had expensive conditions are going through their HSA money, it's true. OTOH, they were already spending that much and more in deductibles, out of pocket before, when we had "Full Coverage". So they are a couple thousand ahead of where they were.

We have bargaining power with our out-of-pocket expenses now too, as our insurer has brokered prices, which we actually see in our statements. It's amazing how much effect that has on people's decisions as to whether the sniffles merits a full doctor's visit, or perhaps might be amenable to 15 bucks of over the counter medicine....which is also paid for with pre-tax dollars, though not part of the allowable deductible. Carrots are far more effective than sticks, it seems.

Since we as a nation, have seemingly decided that health care for everyone is the compassionate thing to do.... and I agree with that....the smart thing then, would be minimize the costs of providing it. As it currently stands, pretty much our Emergency Rooms function as clinics, because poor people know they can get seen, and they also know that they won't be paying for it. This leaves less capacity for actual emergencies. In my job as a First Responder/EMT-A, I would guesstimate that about a third or less or our runs, actually merit Emergency Room status. The other far larger fraction, is people with minor complaints who would be better served at a clinic or Urgent Care. Unfortunately, medic units do not deliver patients to anywhere but Emergency Rooms. And at $750 a run or so, that's a fairly expensive cab ride for someone with the sniffles, that we the taxpayers end up footing the bill for.

With an HSA set up for everybody, this problem would largely disappear. I know that many people think that the poor are too dumb to figure it out. But, they don't seem to have any difficulty figuring out their food stamp card. When it is a limited resource that they can see and have some control over, they seem to do just fine in that department. Having an HSA card would be no different....except maybe provide a little more dignity for folks.

At any rate, you seem like a thoughtful politician to me. I can't help but wonder, given the huge public reaction to this stuff over months and months, if you are sure you want to stay on this train-wreck of a bill, when something so elegant and proven effective is already available, and could be fairly seamlessly implemented. My union brothers and sisters are watching this carefully. I don't know how it is in other locals. But, in ours, we tend to vote a bit differently than it might seem, if you were believing the AFL-CIO big-wigs. And we do all go out and vote. As a firefighter, I know how important it is to stick to your guns when it counts. But, I also know that when the building is coming down around you, it's time to get out. I'm hoping you will make it out.

with respect,

Thomas Drewing