February 5, 2017
J: The land mine in there is the repeal of the provision limiting the amount carriers can charge older people. The AARP will be all over that. The repeal of the individual and employer mandates is important too; it drive healthy people out of the market.
T: They are carefully extracting themselves from the preexisting conditions exemption.
J: I can understand the logic behind that; they want to discourage people from running out and getting insurance only when they get sick. If they’ve been covered all along the repeal of the exemption wouldn’t apply to them. But carriers could charge whatever the market would bear for older people.
T: I don’t dispute your first point – you shouldn’t be able to buy insurance after the fact, any more than you should be allowed to buy flight insurance after a plane crash – but according to this plan a temporary lapse in coverage – one late payment – and you are screwed. Done.
The GOP wants to get back to the “we only cover healthy people” model. Anyone with auto insurance knows the drill. If you are on the safe list- the never filed a claim list – they take your money happily, knowing there is virtually no risk that you will file a claim. But if you file a claim, they remove you from the safe list and dump you like you are radioactive.
You pointed out the land mine already: young, healthy people won’t be required to sign up, so they won’t. Later, when they are older or come down with serious conditions, they won’t be able to get the care your average prison inmate gets, because they will have a record of interrupted coverage. One day of lapsed coverage and they are ejected forever.
Anyone over the age of 2 needs to get coverage and keep it, and if you are under 2 you better pray the Shriners don’t have you on speed dial.
J: I understand that health insurance is expensive, and that’s only gonna get worse if the ACA is repealed.
We need single-payer in this country. All European countries have single-payer systems, and their per patient costs are from one third to one half less than the same services here in the US. That’s because there are no private insurers; the government controls everything, and it negotiates prices with drug companies and salaries with doctors.
T: Remember my Cake Principle?
Terry’s Cake Principle: If you leave a cake on the counter unprotected, it will eventually disappear. Like anaerobic respiration – a process where organisms eat anything that doesn’t move until it’s gone – the cake will be eaten, finger by stray forkful, until even the crumbs are gone, even if they have to be licked off the counter.
A medical billing system that does not regulate the insurance side of the equation might as well be a cake on the counter.
J: Insurance companies are in business to make money, and there’s nothing inherently wrong with that; it’s capitalism. However, we’ve reached a point in the system where the only way to continue to increase profitability (and make no mistake, insurers are profitable; they just want to be more profitable) is to restrict access to care.
They’ll start with the younger people who are less likely to miss it, then gradually creep up the age and sickness scale, licking more and more frosting off the cake.
T: Far too many people in this country who think medical care is free, and that is as big a problem as the inherent sneaky greed of the insurance bureaucracy.
J: It’s not free. Research and development of new drugs isn’t free, doctors don’t work for free, and those big hospitals don’t just appear magically overnight.
T: There is a reason why insurance is always so complicated and conflicted. Two sides, both unreasonably greedy because the system is so opaque and convoluted, struggle to find a happy medium between gouging and stealing.
J: As much as I’m opposed to socialism in general, there’s one aspect of life in America where it does make sense, and that’s health care. Making money on the backs of the sick, injured and elderly just sticks in my craw.
T: As often happens in our system, the middle class is expected to pay for everything. The poor get better medical care if they don’t work than if they do, and the morass between “too poor to pay taxes” and “rich enough to self-insure” is in danger of being broken – retirement plans, savings accounts and even homes lost to catastrophic medical bills – at any time.
J: I deal with the screwing of the middle class every day at work; it’s my job to get the insurance carriers to pay the benefits they’re contractually obligated to pay. You’re right about the working poor; if you’re not poor enough to get Medicaid, you’re going to get forced into a plan with a $6,000 deductible – you can’t afford to get sick – and don’t even get me started about the current VA mess.
T: The last couple of times I went to the VA Hospital the hallways looked like the zombie apocalypse, except all the zombies were wearing Vietnam Veteran ball caps.
J: Single-payer is inevitable in the US; it won’t happen until the Democrats have control of all three branches, maybe 2022, but it will happen sooner or later.
T: Will it happen in time for us? We’ll both turn 60 during the next administration.
J: I certainly hope so. I suppose the good news, if you want to call it that, is that we’ll hit Medicare eligibility not too long after that, so it won’t be our problem.
T: I’m VA eligible; I get to be a zombie.
J: By that time all the zombies will be wearing Desert Storm ball caps.