MarEx Mailbag:
This week’s Mailbag is heavy. All letters reference last week’s lead editorial which raised the possibility of offshore “International Medical Islands” as one potential consequence of the socialized health care reforms now being considered by U.S. lawmakers. The piece elicited considerable response from MarEx readers. We knew that it would.
Last week, our lead piece was entitled, “The Maritime component of Healthcare Reform.” You can read that editorial by clicking HERE. In that piece, we floated the possibility of a new maritime health care application that involves marine platforms operating in close proximity to – but outside the jurisdiction of – U.S. territorial waters. A U.S.-based international investor characterizes these (proposed) vessels as International Medical Islands. We also said that the concept might just blossom if any of the proposed health care solutions being bandied about on the Hill comes to fruition. And, while the focus of the article was clearly on a nascent maritime idea, some readers chose to focus their remarks on health care. Here’s what they had to say:
Dear Mr. Keefe,
I would like to start my letter off with a “sea story”. Recently the ATB I work on was alongside a Canadian ship preparing to lighter them. In the time between the connection of the hose and the beginning of their discharge the cadet, AB/Tankerman, and myself entered into a conversation with four of the Canadian seamen. I had recently disparaged a “Conservatives for Patient Rights” ( http://cprights.org/ ) ad that used Canada as an example on TV in the galley. I asked the Canadian seamen what their opinion of their system was. To a man, each expressed how much they liked their system and couldn't understand how we could put up with our system. This did not surprise me because I to have Canadian friends AND relatives living in England that say the same thing. For those readers who might like to bend their minds around the other side of the coin please go to the Physicians for National Health Care ( http://www.pnhp.org/ )
The pharmaceutical companies don't want national health care. Their total lobbying expenditure since 1998 of $1.6 billion proves that. ( http://www.opensecrets.org/news/2009/06/drug-makers-cash-in-on-lobbyin.html ) The insurance companies don't want it for obvious reasons even though they are responsible for the situation at hand. Our Senators and Congressmen know there is a problem of some sort but it doesn't effect them. They are already on their own version of national health care. We pay for it.
Several years ago the World Health Organization did a survey of health care through out it's 191 member nations. It was based on infant mortality and longevity. The USA came in at 37th over all. Almost every nation ahead of us has national health care.
Every system will have it's flaws but the one that is existent in this country is bankrupting the country, corporations and, individuals. It is stifling the natural entrepreneurial spirit in this country. That spirit is one of the things that has made this country successful.
Sincerely,
John R. O'Reilly
MarEx Editor’s Remarks: Believe it or not, I’m really not interested in debating health care issues. The concept of offshore medical services, convenient to, but not located within U.S. jurisdiction was an interesting one and I described the idea as it was told to me. That’s all. But, I will say that I’m happy with my health care, glad that I didn’t wait 7-1/2 months for a serious procedure and that I think the project might have legs, depending on what form health care “reform” takes in this country. That’s all. Here’s another:
Mr. Keefe,
I think you spoke without facts on this matter; and bought into the big FEAR that the medical insurance companies are trying to push on this issue. It is the same thing they did the last time we tried to get Medical reform.
First there is a huge difference between nationalized insurance coverage and nationalized medical care. Canada has the latter. Nobody in this administration is even suggesting that we go there.
The current proposal includes not nationalized medical care or mandated nationalized insurance, but the option of nationalized insurance. You can maintain what you have or you can opt for a MediCare type of policy. The HMO's and other medical insurance companies are going bats about that because they do not want the competition. They know what you obviously do not. That they are so overpriced and under serviced that the government, by balancing the risk over the whole nation, avoiding huge lobbying costs, avoiding huge executive salaries, avoiding duplicative reporting and having the ability to negotiate with drug companies, they cannot compete with the government in health insurance.
Right now they cover all the low risk people and make huge profits, and the Government has to pick up all those who are not profitable. So, in fact, we are supporting the profits of the HMO's already. It is like what is going on in the Wall Street meltdown. The insurance companies and the mortgage companies just want the profits, and when it comes to losses, that is when government tax money has to pay.
From an industry prospective, the three reasons that the US Merchant Marine has a difficult time competing with other first world countries for manpower, they are:
1. The high cost of having to provide medical insurance for their employees when all other first world countries provide this.
2. The high cost of having to provide pension programs when other first world countries have national pensions. and
3. The fact that US Mariners have to pay income taxes on their offshore salaries, where other first world countries exempt them.
Having a decent national medical insurance would go a long way to make the playing field equal.
Best,
Jerry Hasselbach
MarEx Editor’s Remarks: Captain Hasselbach writes from a wealth of maritime and industry experience. But, on the other hand, I too come from a maritime business background (as a partner) where we had to negotiate benefit packages for our very small employee complement (<17 consultants). I’m happy to report that even with at least one dependent in the group with a serious medical condition, we managed to provide very good benefits and for a time in the early 1990’s, we did it without charging our employees one penny for it. Now, later on, of course, we had to ask them to ante up a couple hundred dollars a month for that coverage (medical / dental / workmen’s compensation, etc.) and you have thought we had tried to steal their first borne child. During that time frame, my wife worked for a top ten bank in this country and our little consulting company’s benefits were better and more reasonably priced than hers. Go figure. With regard to the foreign seamen proposed for the project, I merely reported what was described to me. Would I like to see U.S. mariners on every platform? You betcha. But, I can’t blame the guy who has proposed this idea for deciding to avoid all aspects of U.S. regulatory issues, in as much as is possible. Finally, and just this week, I read where the President is proposing that health care benefits be taxed as a way to pay for the new “reforms.” I wonder how that will go over? Here’s yet another letter:
Hi Joe,
Actually, the offshore medical business already exists, but without the ships.
I live in Costa Rica, a 3 hour and 15 minute flight from Houston.
Medical care here is first rate and costs a fraction of what it does in the USA.
There are doctors, dentists, clinics, and hospitals which cater to US "medical tourists". Folks who come down here for dental implants, surgery, cosmetic procedures, etc., all for a fraction of what they cost in the USA. Many of the doctors actually got their degrees in the USA. They prefer to practice here because this is home and they don't have a pack of rapacious lawyers nipping at their heels or malpractice insurance to pay. Across the board medical practice overhead costs are lower.
Costa Rica also has a Canadian style national health care system which my wife and I participate in, just in case of a major medical emergency. But for all other non-emergency medical procedures we pay out of pocket because the cost is much lower than paying US type insurance premiums.
I had an earache on a weekend a few months ago. I decided to go to the emergency room of the most exclusive expensive private hospital in Costa Rica because it was close by.
Not only did they see within 20 minutes, the total charge was $60.
I would never trade the health care system I enjoy here in Costa Rica for that in the USA.
But I don't think this system would work in the USA.
The US has too many malpractice lawyers and too many big "health care for profit" companies.
Cheers!
Capt. David C. Martin
Master Unlimited ~ DPO ~ Merchant Marine
MarEx Editor’s Remarks: I liked that letter. The conceptual idea of floating offshore hospitals, however, might be more convenient than going all the way to Costa Rica. Thanks for writing! Read on:
FYI:
I am a former executive at a HMO in the US. I think I have a basic understanding of Health Care in the US. I always amazed at the misinformation that people are willing to spread in order to push their own agenda. We have socialized medicine in the US. Its called Medicare. No one who knows Medicare can reasonably state that it has caused waiting lines for medical care. Those people who currently have an HMO option(non-Medicare) probably have more waiting and approval time for a hernia operation than they would under a new governmental option styled after either Medicare or the Federal Employee Health Insurance system. What the US does have is a medical system that makes it both uncompetitive and the most expensive in the world with poor results. With Medical costs approaching 20% of GNP we have an unsustainable medical system and the problem that legacy companies (such as GM and the legacy airlines) are non competitive in the world with the costs they must pay for the medical insurance of their current employees and their retirees. And we don't get world class medical by any of the normal measures...that is life expectancy and infant mortality. The US is not in the top ten of either such measures.
The problem with the current system is it provides "care" at the most expensive sites and very little incentive for the providers of care to provide preventative care. This will not change under the current system. Something needs to be done to change the incentives. Canada has an escape value which has always been the US. I wouldn't worry about the wealthy they can always figure out how to get care...anywhere in the world. It’s the great middle class that needs to worry. Is what is being proposed perfect? Of course not, so get in there and help fix it but dire warnings that we will have long waits for emergent care are frankly just nonsense brought about by people who want to prevent any true reform.
Thank you,
Sidney L Meyer
former Chair NJ Health Care reform Commission.
MarEx Editor’s Remarks: I don’t think that bringing up the true story of a 7-1/2 month wait for a hernia operation is “nonsense.” I would agree that it might come under the general category of a “dire warning.” Perhaps it should be considered as such. Bringing up GM as an example in your argument isn’t going to win you any points – with labor or the management who negotiated such stupidity (where as much as $2,000 of every vehicle produced in this country today pays for legacy costs.) And, that’s got little to do with health providers. Read on for another point of view:
Hi Joe,
Read your comment about Doctors leaving the industry if Medical care radically changes. This brings up a not so related case; but similar in results.
I have heard that the IRS is getting involved in Seaman Union's retirement plans. Have You? The gist is that due to the downturn of plan's investments, the IRS will require changes. Well and Good; but it sounds like the IRS, with it's head in the sand, wants to make a seagoing retirement like any 5 day a week, going home to the family shore person's plan. You know, full retirement at 65. They do not seem to realize that a seaman away for long periods is in a different situation. If the IRS succeeds with eliminating BOTH the full buy-out provision and the 20 year and out option, I am certain that there will be many Senior Officers leaving the industry early; ala, your Doctor scenario. After all, there will no longer be the incentive to stay another 10 years if a spouse desires you home more often. A seaman's life is getting more onerous by decree without taking away incentive to remain for at least the 20 years. I throw this out as something you might like to research the validity of for a future article. Rumor or No??
Enjoy your articles,
Capt. VAN (H. Vanderploeg)
MarEx Editor’s Remarks: Thanks for writing and your kind remarks. We’ll check it out. Here’s another letter:
Aloha Joe.
I read with interest your article, and as a Chief Engineer myself I always worry when people try these things that are not maritime operators or engineers. They look at a vessel and think gee that is pretty and should work. They do not think beyond a ship is a ship, a generator is a generator and an engine is an engine, best deal is low bid and so on. What they end up with is a vessel that they can’t afford to run and the equipment that they get is worn out, was low bid to begin with and is not suited to do what the task is.
Simple things such as the correct pump or correct sewage system, incinerator system and so on were not done in a lot of the older or early ships and so they would be unsuited or very expensive to convert. Even the US Navy and others have found this to be true. The US Navy and USCG have terrible obstacles to overcome with even simple things like upgrading and engine or system. Do not make the mistake of jumping to the conclusion that all is needed is to copy a present ship. It takes a team to do it right and just hiring a Naval Architect to do it is wrong as well. To many time they do what they have always done right or wrong for the equipment used. They are tasked to allow it to be done cheap, make sea trials and let the shipyard worry about it later. After that is done the crew must try to keep it running. Check out some of the new current ships that are in the shipyard more than they are underway. I for one do not allow that and keeping the lights on and the ship underway is the most important thing. Take it from someone who knows and has been there and done that.
Good article and I hope the concept builds.
Clark Dodge, President
CED Consulting LLC
MarEx Editor’s remarks: I liked this letter because it addressed the maritime operational aspects of such an endeavor. Perhaps Clark and Mr. Vassilopoulos should get together for a talk. Thanks for writing.