I own a consumer healthcare advocacy. I appreciate this thoughtful, succinct and accurate (given albeit the very little we know thus far from the GOP) analysis of the desperate healthcare landscape post reform.
One point I would like to clarify, however. Thanks to the loopholes in the ACA left woefully unrevised by Congress for 6 years, insurers and healthcare providers have had free reign to exploit patients. Capped out of pocket spending is a myth in 99.9% of the cases unless you are willing to fight back.
Patients regularly receive “mystery bills” (called “balance billing”) that they don’t owe. They were denied claims that should be paid. They were charged $3000 for a back MRI that cost $300 literally across the street at a different imaging center, and their insurer won’t reimburse the inflated cost. They were charged more out of pocket for their prescription drugs when using their health insurance cards than if they had no insurance at all. The $300 bandaid in the ER the insurance company will only pay $20 for? You are on the hook for the other $280, according to the hospital if you want to protect your credit. The hospital is in your network, but the doctor is not and you must pay him.
There should be a Secretary of Patient Protection in the Cabinet. Americans have no voice, and no way to protect themselves from the most powerful profit gouging industry in our country today.
All very fine questions for which I’d love to have answers. Just got diagnosed with cancer on 11/28/16. I’m self-employed and buy my insurance through the ACA marketplace. I’ll get treated in 2017, but after that who knows? I’m choosing the most drastic of the treatment options in spite of my doctor’s assurances that it may not be necessary. I can’t possibly justify anything less given that I may never have enough funds for another treatment unless I liquidate assets and try to get on Medicaid (have no idea how that even works…). This is a crazy, crazy health system.
Remember why Obama Care was instituted in the first place. There was NO coverage for the poor and part time employees. They used the Emergency Room (ER) as their doctor and then couldn’t pay the bill. This overwhelmed the ER’s leading to long wait times and poor service in the cities. The combination of no coverage and poor transportation led many to avoid treatment for problems when they were small, they waited until they were in crisis before calling the ambulance and going to the ER. Costs were out of control. High costs, poor service, poor out comes all of this is why Obama Care was instituted in the first place.
Obama Care is a first attempt. No its not right, but think of the alternatives. Fix the parts that don’t work, keep those that do.
Lastly, if congress cancels Obama Care, then require all congressmen to use the public health system for the next year, to see the results of their actions.
This is a great list of questions. Another important question is WHY the GOP wants to dismantle the ACA? After all, it is based on conservative economic and social principles. The principles behind it were originally formulated by the conservative American Enterprise Institute. It is not the liberal approach to health care reform, which would be single-payer.
The answer to this question is obvious. The GOP is so partisan that it is willing to both shoot itself in the foot and throw millions of people under the bus, just because they cannot stand the idea that Obama and the Democrats created a very successful federal program. The success of the ACA gives the lie to Republicans’ hatred of successful government.
The notion that many Trump supporters subscribe to is that a businessman is more practical with money than a politician. From a profit motive perspective, that may be true. The primary tools for improving profit are cutting cost and rating revenue, that’s what businessmen do.
Donald Trump has already said he wants to cut revenue – taxes – so “profit” will come from cutting cost. Since the largest cost factors, by far, in the federal budget are people, reducing the population or cost per capita are effective ways to make “profit”. The evil genius of cutting health care spending is that it does both – it reduces cost per capital and population.
It’s always a problem to determine which population should be reduced, but again the unrestrained businessman has an apparently palatable approach – let the market decide. If you don’t have assets or a skill others deem paycheck-worthy, you’re expendable. In an age of automation labor disruptions, there are lots of “expendables”.
America – let me know that works out.
I recall very clearly being told by Mr. Trump during the campaign that he would repeal and replace Obamacare on day one and make available to us the very best, greatest health plans to take its place. It appears that he has not shared his very great plans with Congress, who now realize what most of us knew all along–you simply can’t eliminate Obamacare overnight with crashing the private insurance markets and doing a lot more harm than that.
If Trump wants a true place in history, he should work toward Medicare for all. It is the only rational solution–returning to private insurance plans and being forced to pay whatever premium the market will bear–when there is a veritable monopoly of giants in the field now–isn’t going to work.
These seven questions are all very good ones. But no one in the GOP can even start to answer them until they have revealed all the details of their “replacement” plan – a plan which Mr. Trump repeatedly told us during his campaign would be “something really great”.
But we should not hold our collective breath. Mr. Trump and the GOP have no intention of putting a comprehensive “replacement” plan on the table for public scrutiny, because they fervently believe that the government has no role to play in American health care policy.
In short, the GOP’s “replacement” plan is simply this: Privatization. Period. Return all management of health care policy (insurance coverage, medical providers and Big Pharma) to the health care cartels. Let them then “charge what the market will bear.”
You see, the GOP believes that health care is just another business – like building automobiles, homes or computers. The more money a citizen has, the better health care he or she can buy.
If you can’t afford the totally unregulated insurance premiums (or a provider’s services) – that’s not the government’s problem. Health care is not a human right, it’s just a business. You can either afford their products – or not. That’s the hallowed “Free Market” at work.
Perhaps former Florida Rep. Alan Grayson said it best some years ago:
“Here’s the GOP health care plan. 1. Don’t get sick. 2. If you do get sick, die quickly.”
That’s Trump’s “something really great”. Your heard it here first.
Please don’t call it a “medical economy.” This isn’t just about profits, jobs, and insurance premiums. It’s about people’s lives and their ability to work and support their families, their pain, their sanity. It’s new mothers worrying about an infant’s constant crying, a father’s trouble urinating, a lump in a breast, an infected wound, a broken bone, blurred vision and dizziness. Viewing what doctors, hospitals and medicine do as an “industry” or a “sector” of the economy may be what is keeping us from fixing what’s wrong with our healthcare system so that everyone can get the care they need.
The most important statistic is to project how many lives will be lost and how much quality of life will be lost under new health care policy. While not perfect, the ACA not only increased health insurance coverage it saved lives and improved quality of life. Nixon started the war on cancer because of his wife’s breast cancer. Which relatives of Paul Ryan, Mitch McConnell and Donald Trump have been helped by the subsequent public expenditures? Which from the ACA? I am sure they are out there they need to be identified to personalize the issues for these isolated decision makers.
These questions, while important, miss the key issue facing the ACA or any replacement..which is how to get the majority of young and healthy individuals into the mix. An underlying premise if any insurance, whether it be auto, home, life, and health, requires a spread of risk among hi and low utilizers. The current significant increase in premiums under the ACA is primarily due to lower than projected enrollment of needed good risks. So how will the current plan, or it’s replacement, address this critical issue?