Obamacare redux

Let’s talk about insurance.  (And forgive me if I dumb this down a bit–sometimes it helps to start with basics).  Sometimes really bad things happen, things which cost a lot of money to fix.  Most non-millionaire people don’t have that kind of money.  But we don’t know when the really terrible thing will happen, or to whom.  So lots of people put money in a pot, and then, if the really bad thing happens to one of them, they get to dip in the pot, to fix the really bad thing that happened. That money, in that pot, is what we call insurance.

Fires.  Car wrecks.  Floods.  Serious illnesses. Death. These the kinds of bad things that might happen, and that we insure ourselves against. If you’re the breadwinner of a family, working and bringing home a paycheck, and you die, your family will suffer.  So you buy life insurance, which means insurance against death.  If you’re driving in your car, and you hit someone, and you’re responsible, well, paying for their injuries could bankrupt you.  So we all are required to purchase liability insurance.  That’s a legal requirement.  If you are caught by the cops without having insurance, that’s a crime and they can put you in jail for it.

They have to do that, because let’s face it, for most of us, insurance premiums involve money we spend that we’ll probably never get back.  We’re paying for peace of mind, basically.  But looking at it selfishly, what would make the most sense would be for us to purchase insurance only when the really bad thing has already happened.  If would make sense to not buy flood insurance, for example, until the waters were lapping at our ankles.  But that would defeat the purpose of insurance.  So the government (and remember, the government is us–people we’ve elected to protect our collective interests), forces us to buy lots of kinds of insurance.  Can’t drive a car without it.  Can’t buy a house without fire insurance and home-owners insurance. And we pay the premiums, mostly, without thinking about them, and if our house catches fire, we’re darned glad we did.

How much do we need to pay?  Well, as it happens, insurance companies hire people, statisticians basically, who spend their days figuring that stuff out.  They figure out the likelihood of terrible things happening, and therefore how much they should charge in premiums, plus, obviously, a bit more so they can make a profit, which they then invest.  But they take into account lots of factors.  If you live in a flood plain, flood insurance is going to cost more.  .

When it comes to health insurance, though, well, nobody really thought it through very carefully.  Remember that it’s only been in the last hundred years or so that going to the doctor even made sense.  Previously, going to the doctor was really a crap shoot, because doctors, mostly, didn’t have a clue.  For a lot of us today, having access to medical care can be the difference between life and death.  This hasn’t always been true.  And so, here in the US, we have a health insurance system that nobody ever planned for.  It’s jury-rigged, improvised, with a bewildering array of legislative efforts intended to fix this or that problem, without anyone ever integrating any single solution into the entire system.  This isn’t true of, say, auto liability insurance, or fire insurance.  But it’s true of health insurance.

So old sick people get Medicare.  Some poor people are eligible for Medicaid, but eligibility requirements and access differ from state to state.  Some companies offered ‘health insurance’ as an employment benefit back in the day, and in time, companies that didn’t offer it were seen as cheap, and the government (again: us) began to require companies to offer it, but under certain conditions.  And in other countries, where health insurance was seen as a national priority, where governments themselves insured everyone, companies didn’t have to offer insurance.  Putting US companies at a competitive disadvantage internationally.  Private insurance companies sprang up, some of them for profit, others non-profit. And they were regulated, state by state, and allowed some procedures and didn’t allow others and got themselves really seriously hated. Let’s not forget that–folks really hate their health insurance companies.  Unless they’re old, and get Medicare.

So in the US, we had great doctors and great hospitals and great medical research and great pharmaceutical research.  But not everyone had access to it.  So sick poor people started showing up in emergency rooms, where they got health care at a very high cost, which they couldn’t afford.  Hospitals were forced to hire really nasty bill collectors to harass deadbeats. Hospitals also got super creative in billing.  Check out your hospital bill sometime.  You’ll see all sorts of weird charges.  Even the costs of really basic medical procedures differs widely from area to area.  It’s a messy, ugly system. In fact, it’s a messy, ugly mess; it hardly counts as a system.

So, for example, most health insurance companies wouldn’t insure you if you had a pre-existing condition.  This requirement is one of the main things they’re hated for.  It feels so cold-blooded; to tell someone the only way his cancer is going to be treated is if he pays for it himself.  But surely you can see why the pre-existing condition requirement is absolutely essential.  Again, what makes selfish sense is to not buy insurance until the bad thing happens.  So if you’re a young healthy person, it makes sense not to buy insurance–why pay out money for something you’ll probably never use?  Or, perhaps, to shop around for a policy that just covers catastrophes.  As you can imagine, insurance companies would happily sell really basic policies that only cover serious emergencies for a fraction of what they might charge older people with iffy medical histories.

Okay.  Obamacare tries to bring at least some order to chaos.  What Obamacare did not do is revamp our entire health care system. The government could do that–just say that from now on, paying for health care is the responsibility of us, of the government; everyone gets health care, and everyone pays higher taxes to cover the costs. We could have just expanded Medicare to cover everyone.  Like Germany, France, England, the Netherlands, Belgium, Norway, Sweden, Denmark, Finland, Canada, Australia. . . basically every country on earth where you might want to take a vacation.  But we decided not to do that; just wasn’t politically feasible.  So the ACA, the Affordable Care Act, (or if you prefer, the PPACA–Patient Protection and Affordable Care Act), took a messy, incoherent mess of a system and tried to bring some order to it.  The goal, first, was to make sure that everyone in the country got access to good health care.  And second, to contain costs.  The result is complicated legislation, a messy bill.  But it’s better than what we had.  And it’s probably going to work pretty well.

There’s been a tremendous amount of disinformation about the bill.  If your Facebook page is anything like mine, hardly a day goes by without someone going off on it.  Here’s a link to a blogger who explains things pretty succinctly.  One thing you’ll hear is that people are being forced to buy health insurance they don’t want to buy.  That’s true, they are, because that’s how insurance works.  Get rid of something people don’t like–coverage denial over pre-existing conditions–and the cost is something people also don’t like–making everyone buy insurance.  And you’ll also hear people say ‘young people now have to pay lots more for insurance.’  Also true, because really basic catastrophic-care-only policies sold to healthy young people WERE really cheap.  The larger point is, with a much larger pool of insured people, the overall cost of health insurance will go way, way down. And folks who can’t afford health insurance will be subsidized–given money to pay for it.  And you’ll be able to shop for it, on-line, in a health care exchange, where companies will be competing for your business.

Now, for someone like me, already insured with a pretty good HMO, nothing changes at all.  But for really rich folks, their taxes are going up a little.  For people without health insurance, they’ll now get to/have to buy some, with help if they need it.  Health insurance companies are going to have to offer some really basic services.  Kids get to stay on their parents’ insurance longer–a big deal for me, with kids in college.

Here’s what absolutely doesn’t matter, though.  It doesn’t matter that the bill was however many pages long.  It’s a complicated piece of legislation.  It doesn’t matter that  ‘not all Congress people read it.’  Ignore any projection that says it’s going to ‘increase the deficit by so many trillions of dollars.’  It won’t; it’s been carefully vetted by the CBO. Ignore any comments about ‘death panels.’ They don’t exist.  It doesn’t matter that ‘Obama shoved this down our throats.’  He campaigned on it, and passed it–if the process got ugly at times, welcome to the world of politics. Most anti-Obamacare arguments are frankly misinformation–not true.

But let’s admit this: it’s not a great bill.  It’s not the bill I would have preferred.  But it’s going to work, and it’s going to be fine.  I predict, right now, that Obamacare will NOT be an issue in the 2016 Presidential race.  It will have been implemented by then, and people will have seen the benefits.  And they will be substantial.

 

3 thoughts on “Obamacare redux

  1. Alex Kazan

    Well said and explained. Like you I wish the bill was more complete and provided us with the health care that all those European countries provide their citizens with, unfortunately our politicians are not about what’s good for the people, but what my party line tells me to do. I’m proud that Obama made an effort despite all the lies and misinformation, at least he got something done, but I don’t think it should stop there. Once people have experienced the Obamacare, and seen it’s benefits, I think another future president should take it upon themselves to push further until we too can have a health system comparable by countries such as our European allies.

    I live in the 25th District of California where we are represented in the US congress by Rep. Buck McKeaon ( a fellow Mormon) and he has done nothing but lie lie and lie about Obamacare to the extend that people are scared stiff of the bill. On multiple occasions I have written to him and asked him questions such as showing me where in Obamacare it talks about death squads and similar questions. I have never received a reply, though his website promises replies.

    The problem is not just healthcare, but everything that our government works on is being directed by the big business, and that’s what needs changing.

    Alex

    Reply
  2. An unlike mind

    “It doesn’t matter that ‘not all Congress people read it.”

    this statement as currently worded is false. It goes like this “not a single congress person read all of it” which means no one who voted on it knew the complete contents. That matters.

    “Ignore any projection that says it’s going to ‘increase the deficit by so many trillions of dollars.”

    Because not being able to pay our current bills won’t matter… we’ll magically be able to pay this despite our already being in the red?

    “Former CBO Director Douglas Holtz-Eakin released his own analysis, finding that the law will cost $1.072 trillion in subsidies during the first ten years and another $2.85 trillion in the decade after that. That’s a total of nearly $4 trillion in spending over the next 20 years.”

    “Ignore any comments about ‘death panels.’ They don’t exist.”

    Read this: “health care costs will have to be controlled, which will surely require having Medicare and Medicaid decide what they’re willing to pay for — not really death panels, of course, but consideration of medical effectiveness and, at some point, how much we’re willing to spend for extreme care” – Paul Krugman

    So, “Consideration of medical effectiveness”; he tries to rephrase it to change its meaning. He’s talking about budget restraints, and that’s what the “panel” looks for. The “death panel”, as discussed by opponents of reformed healthcare, is a mechanism whereby the govt. decides, as Krugman puts it, “what they’re willing to pay for” i.e. some get care to stay alive, other’s don’t, based on govt. decision. They will weigh whatever criteria, and have the power to deny a tax-paying citizen their request for healthcare. Is that preferable to our current system where, because you paid for it, you get it? This is what is meant by “death panel”. Not some backlit faceless individual at a tall desk handing down death certificates necessarily… instead just your friendly neighborhood bureaucrat in charge of budgeting, mailing out letters saying “with regards to your surgery request, we regret to inform you…”

    The name “death panel” is thus coined under the conclusion that denying some people healthcare will ultimately lead to a shortened or otherwise terminated life due to lack of care. This is of course a reasonable conclusion and an absolutely guaranteed eventuality. Especially in the case of a choice between an elderly citizen with a short life expectancy, regardless of the care administered, or a younger person with better chances for healthy and productive life after care.

    Also… Steven Rattner agrees with Krugman. And then there was this:

    http://www.nytimes.com/2012/09/17/opinion/health-care-reform-beyond-obamacare.html

    and how’s this for “misinformation”

    http://www.forbes.com/sites/theapothecary/2013/07/01/wsj-health-insurance-rates-could-double-or-even-triple-for-healthy-consumers-in-obamacares-exchanges/

    Also, do not neglect to consider the effects of the opt-out fines that the young and healthy will take. It costs less to pay that than pay the premium. Thus a lot of the money people are expecting from those who aren’t using it, to pay for those who are using it, won’t exist. Employers also have a cheaper option to either pay fines or move their employees to part time. I don’t think the “no care” option or reduced hours at work is going to help the 30 million that reformed healthcare was supposed to insure.

    It also seems foolish to be excited about a law that all of those who passed it, and their labor union constituents, are trying to avoid and be exempted from. If it were any kind of improvement upon the current system, there would be no reason to run from it, yet they are running.

    http://www.reuters.com/article/2013/08/07/us-usa-health-congress-idUSBRE9760YL20130807

    They are receiving massive subsidies to cover their premiums because they claimed they could not afford them. However, the earnings range for the people on capitol hill is between 70k and 174k. So how does being the top 67% – 92% of wage earners entitle them to such subsidies? If reformed healthcare frightens the wealthy to this extent, how excited should the less wealthy be? If someone making over 100k says they can’t afford the cost of healthcare reform, how are the people who couldn’t afford care in the first place going to afford these reforms?

    Congress doesn’t want it.
    The working class unions don’t want it.
    The reforms are an imposition… not a benefit

    Reply
    1. admin Post author

      Yes, we will be able to pay for it. The bill is fully funded, and best current projections are that it will cost less than initially projected. And the deficit is going down, or hadn’t you noticed?
      Those aren’t ‘death panels.’ They’re far less draconian than current health insurance practice. I do agree with both Krugman’s analysis, as with Rattner’s. There isn’t any kind of health insurance that can offer unlimited coverage to everyone. ‘Death panels’ suggest a room full of uncaring bureaucrats going ‘Mrs. Gladys Johnson of Fresno? Useless woman; let her die.’
      Neither Congress nor unions are ‘running away from Obamacare.’ Nor am I running away from it, because I already have adequate insurance.

      Reply

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