Friday, March 27, 2015

The Health Insurance Debacle

When our kids were little, I used to joke that I would only like to play football if everybody would play by my rules.

"What are your rules?" David would ask.

"Everybody has to throw me the ball, and nobody can knock me down.  I like it that way.  It's very exciting!  I get to make a lot of touchdowns."

"That's not fair!"  David would exclaim.

"Oh," I'd add, "Everybody also has to get out of my way when I'm running."

This always made me smile, the thought of catching a ball and running, unimpeded, across the goal line time and again.  It made me happy, but it made David very angry to think of.  I guess he was not imagining that he would be on my team.

Well, may I submit that most of us are not on the health insurance company team?

As the wife of a man who has worked for very small companies most of his adult life, making a decent wage (though certainly not exorbitant) but not having access to big company health insurance policies, we have noticed something about health insurance.

The premiums go up astronomically, year after year, while the coverage declines shockingly.  For instance, a few years ago, premiums cost $300-$400 per month for a high deductible family plan.  We were responsible for all our costs, out of pocket, up to our deductible, which was $2000 per person, and $4000 for the entire family.  After we met our deductible, costs were covered at 100%.  Last year, we paid $1000 per month for a high deductible family plan.  We paid out of pocket until we met our deducible, which was $6000 per person and $12,500 for the family, except that if a person reached $6000 before the family had reached $12,500, his costs were still out of pocket, which I do not understand, but there you have it.  They make the rules.

Yes.  They make the rules.  Like me on my fantasy football team, except in real life.

And, get this, then the president made a law that said every American has to buy a health insurance policy or be penalized with a big fine, payable to the government of the United States of America.

So, by law, we all have to buy health insurance.  This is the case even though the only health insurance most people can afford is the high deductible, where they pay out-of-pocket for all their costs, and the healthy-ish ones would certainly be money ahead just to pay their costs and save the $1000 per month ($12,000 per year) in premiums.

But yes, there's this law: "You have to buy health insurance."  And then what does the government do?  The government goes to the health insurance companies and says, "How do you want to work this?  How would you like to structure it?"

And if you are in health insurance, I guess you sing, "Jackpot!"  Because by law everybody has to buy your product, and you get to design the whole system that they have to buy out of.  Like me playing football: you have to throw the ball to me, and you can't knock me down, and you have to get out of my way.

So they raise the rates again.  And I expect that next year, they will again.  While denying coverage for everything they can possibly draw a loophole around.

Who gets hurt?  The small business owners and the people who work for them.  Basically, average middle class people.  Crazy rich people are in decent shape because they always are.  They can buy their way into a tolerable health insurance situation because they have money, and money equals leverage.  Poor people are okay, because the government always has safety nets for them.  People with government jobs are mostly ahead of the game because the government takes care of itself.  But poor old Joe-American is strapped.  For now.  Before too long, all his life savings will be bled away to pay for required preventative procedures, and then he can fall into the group at the bottom that lives in the welfare safety net.  This is not what he worked and saved all his life to achieve, but whatever.  Right?  Oh, except by that time the whole country might be bankrupt and there won't be any healthcare for anyone anyway, except on the black market.

If they thought we needed healthcare reform before, well, we really, really need it now.  They took a broken system, and then they took the health insurance companies (the health insurance companies!  I cannot get over this), the people who had the most to gain by exploiting a system of requiring citizens to purchase health insurance, and they said, "Hey guys!  How do you want to set the game?"  Dealing with the system this way is sort of like taking a broken chair and throwing it down in the middle of your driveway and backing your car over it a few times.  And then pouring lighter fluid on it and throwing out a lit match.

So.  Now that the Affordable Care Act has made healthcare (which was always expensive) completely unaffordable for most hardworking people, can we please agree that the system is terminal?  The Healthcare system in the USA is beyond resuscitation.  People would rather die quietly in their homes than go to the doctor and then try to navigate the plethora of befuddling and traumatizing bills that will result.  Can we please agree that this is not the solution we were hoping for?

I wrote once before that you cannot successfully combine socialized medicine with wildly profitable private health insurance companies.  It is true that this cannot be done in the way it is currently being done.  It might be possible to do, if we killed this system (well, since it's already dead, all we have to do it bury it, really), and started over.

What they need to do, what Obama needs to do, is gather a group of very thoughtful, very intelligent people from universities, medical schools and hospitals.  There should be people who understand poverty, and people who understand healthcare, people who understand how medicine works, people who understand how billing works, economists, and even some psychologist/sociologist/social worker types who understand how people work.  There should definitely be doctors and ethicists, probably representatives from various religious organizations.  This group needs to study and work together to figure out a sort of minimum healthcare foundation: what should the US government provide to its citizens as a reasonable and compassionate level of healthcare for every person?  This might include things like vaccines and immunizations, health education, simple antibiotics for common infections, emergency treatment for injuries, reproductive care, and palliative care.

Like public education, public health could provide a basic level of healthcare for all citizens, with assurance of compassionate palliative care for those whose conditions are too complex and expensive to be promised cures.  There could be public clinics, like public schools, where anyone could go at any time to receive these types of healthcare, free of charge.  It would be covered by our taxes.  Perhaps these clinics could be staffed largely by medical students, overseen by attending physicians. This would be so great.  It would circumvent the whole problem of uninsured babies going to the ER for amoxicillin when they have an earache.

Anything over and above this basic level of healthcare would be the patient's responsibility, and here is where private health insurance companies would come in.  Private health insurance companies, private hospitals, private clinics offering concierge services would all exist and compete for customers.  The private clinics and hospitals would be where research would center, and they could offer all the best, cutting edge technologies.  They could also do pro-bono work.

People would likely fuss about a system like this, complaining that why should this child over here die of cancer while that one over there gets treated because her parents can afford it?  This is a difficult issue.  I do not have all the answers off the top of my head.  This is why I think we need a highly qualified, highly intelligent, highly sensitive committee of doctors, economists and ethicists working out what is reasonable for the government to provide for its citizens.  I do not believe that anyone should die of strep throat, or a similar common illness for which we have easy cures.  But what about asthma?  Diabetes?  Lupus?  Cancer?

People do die when they come down with serious conditions.  People die.  In fact, every person who is born is someday going to die.  We are not an immortal species, and we should not approach healthcare as though we were.  The government simply cannot be held responsible to spend millions of dollars to keep alive every single citizen who comes down with a deadly condition.  That's what private health insurance should be for, if you can afford it, and if you can't afford it, the government should not make a law forcing you to buy it.  The government should let you figure it out for yourself.  You might get knocked down while you're carrying the ball, but hey, that's only fair.

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