Wednesday, March 8, 2017

The simplistics and complexities of health insurance

The only criticism that GOPers seem to be able to voice about the Affordable Care Act (Obamacare) is that some people have experienced premium increases. The real problem, of course is that it was President Obama's program and they want to write the African-American out of history.

Some of those premium increases are real. Some of them are the result of people who had coverage limited to a medical catastrophe and the ACA required them to obtain real health insurance. It is worth noting that catastrophic insurance is a terrible value and for good reasons. The carriers know that policyholders will not acquire basic preventative care and are more susceptible to grave conditions. People without comprehensive coverage often use the emergency room as their primary care. The ER is the most expensive care available and the bills are often unpaid, a cost to hospitals that is passed along to all of us.

The premium variables — It's not rocket science to reduce their cost:

Dilute the pool: Keeping young people on their parents' plan was actually designed to put younger, healthier people into the pool of insured. You may recall that, at one time, Republicans tried to persuade younger Americans not to purchase health insurance in order to sabotage Obamacare.

Decrease coverage: Usually this means higher co-payments for drugs and services and removing some drugs from the approved formulary. One of the problems, however, is that when people have to pay more they buy less. They receive less preventative care which eventually puts sicker people in the pool which ultimately raises premiums.

Reduce payments to doctors: Plans that reduce physician compensation will simply cause the better providers to opt out of the plan making quality care less accessible.

Regulation: There is some price gouging but I tend to agree with Republicans in a free market to solve that problem. Unfortunately, however, 26 states opted out of the ACA exchanges in order to sabotage Obamacare. The deregulation crowd is all for the regulations which prohibit re-importation of pharmaceuticals which would allow market forces to considerably reduce their cost. It is selective conservatism to benefit their donor base.

Irrelevancies: Health savings accounts and tax credits do absolutely nothing to reduce premiums. They are simply tax shelters and tax reductions for wealthier Americans which are paid for, according to the latest GOP proposal, by reductions to Medicaid. In other words, this is yet another gift to the haves from the have-nots. GOPers seem wed to the belief that being poor is an optional character flaw (kinda like being gay in their minds). They seem intent on punishing poor people for their lack of … something other than just money.


The only way that we are ever going to fix this mess is with single-payer — “Medicare for All” with premiums based upon individual income and variable rates for employers based (possibly) on number of employees. Existing insurers can participate exactly as they do now, giving consumers the option to enroll in Medicare Advantage plans. Medicare pays these companies a flat rate to provide this coverage. It is obviously very profitable because they are aggressively promoted by these companies.

Of course we have a Tea Party House Speaker who seems to think that Ayn Rand has all the solutions. Such a plan would be “government run healthcare” or, their favorite standby — “socialized medicine.”
In a truly civil society, everyone, has access to affordable, quality health care. One of our parties is supported, in part, by people who profit off of just the opposite. It's all very depressing.

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