Healthcare In America – Where Do I Begin?
Copyright 2017 Marc D’Agosta
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About the only advantage of being broke is that you actually get to see how the healthcare system works. Most people, including the politicians and media, really don’t seem to give us a complete understanding of how the Affordable Healthcare Act really works. Where do I begin? How about with what the Affordable Healthcare Act actually does?
Besides preventing healthcare providers from denying someone coverage because of a pre-existing condition, and requiring these insurance companies to provide a comprehensive package for care, all the Affordable Healthcare Act really does is help you make the payment on the premium. That’s it. A person chooses from the same private health insurance policies that are provided if that person were to go directly through the private health insurance company on their own, rather than the government. The only difference is, if you go through the private health insurance company directly, you pay the entire premium on your own; if you go through the government, the government helps you make the payment with subsidies--tax payer money that actually goes to the taxpayers, rather than primarily into the pockets of the wealthy with reckless tax breaks--reckless to the economy, reckless to the debt, reckless to our good health, and that really only buy the rich a greater luxury. But if footing the payment on a trillion dollar loan for a billionaire is what you really want to do, that is the right you have as an American. However, consider this, since President Obama and the Democrats repealed the Bush tax cuts for the wealthy in 2013, and even with the Affordable Health Care Act being on the books as law since 2010, the debt has been reduced--a true indicator, it’s not healthcare that wrecks the country economically--it’s the tax breaks for the wealthy that wreck the country. And incidentally, even though congressional legislators and their staff purchase their healthcare through the Affordable Health Care Act, and other federal workers buy their healthcare through the Federal Employees Health Benefits Program, the formula is the same--the government pays up to the lesser of 72% or 75% in subsidies towards their premium with regard to the type of plan and who is on the plan they choose; and if the Republican congressional leaders repeal the Affordable Health Care Act, they and their staff will most likely again be able to choose from the Federal Employees Health Benefits Program for their healthcare, while those they cut off will be left with nothing.
Now, the politicians and media often bring forth these complaints with our current healthcare system. You can’t choose your own doctor. The rates are too high. Co-payments and deductibles are too high. Nobody likes the mandate to buy into healthcare, or if you don’t—pay a fine later when you do your taxes. There are not enough young people signing up and buying into the pools, so healthcare providers want to pull out because they can’t make money or cover costs without the young folks. Also, a government public option would put private health insurance companies out of business and cost people jobs. And forget about even considering a single payer system. Well, let’s look at these points, and how health insurance companies really make their money.
As far as choosing your own doctor—what determines whether or not you can choose your own doctor has nothing to do with the Affordable Healthcare Act. What determines whether or not you can choose your own doctor is the type of health insurance policy you choose. If you choose an HMO plan, most likely you will not be able to choose your own doctor. Why? Because your own doctor no longer takes HMO plans. Doctors like everyone else want to get paid. HMO plans don’t pay. If you choose a PPO plan, which is more expensive than an HMO…yeah, you’ll probably be able to choose your own doctor. Why? Because your own doctor takes PPO plans. PPO plans pay. It’s that simple. So not being able to choose your own doctor is on your own doctor, not the Affordable Healthcare Act; and unfortunately, again, comes down to the rates you are willing to pay, or can afford. Therefore, let’s take a look at rates.
Rates. What drives up rates? Not what, but who? Health insurance companies! That’s who drive up rates, because that’s who still determine the rates you pay. It’s not the government. It’s not the Affordable Healthcare Act. It’s healthcare providers. That’s why the mandate to buy into healthcare doesn’t work. It’s healthcare companies who dictate the rates. What healthcare providers do under the Affordable Healthcare Act is give you a group of private comprehensive health packages you can choose from based on age and income, and then all that is mathematically worked out to determine what you will pay, and what the government will pay in subsidies. For example, if you are in no man’s land, like I am, meaning between the ages of 50 and 65—too young for Medicare, too old to get a decent rate to be properly covered—the healthcare provider I went through gave me three packages—a gold, silver, and bronze—and it’s a bit like the Olympics—gold is really great; silver is still pretty good; bronze—well, at least you medaled. The gold package provided comprehensive care, a low co-payment, a low deductible, but the premium was through the roof. So, chances are, if you are going through the Affordable Healthcare Act, even with the government kicking in subsidies, you will still be too poor to afford this package, as I was. The silver package provided the same comprehensive care, a little higher co-payment, a little higher deductible—but still both reasonable. However, the premium, though not reaching the height of the gold package, still went through the roof, and was still out of realistic reach for anyone going through the Affordable Healthcare Act. Finally, the bronze package…well, not bad, not great. A premium just barely within reach. However, a ridiculous co-payment of nearly a hundred bucks per visit to your primary care physician, along with a six thousand dollar deductible. Yet, it did provide comprehensive care, though as President Trump described while campaigning—really only good for if you get hit by a truck. But the way I figured it, if I got hit by a truck, at least I would be covered. So improvement does have to be made to the Affordable Healthcare Act. But you don’t kill it. And solution comes with understanding what the business of healthcare really is all about.
The Affordable Healthcare Act is not the biggest problem with healthcare. The biggest problem with healthcare is that it is an industry, when it should be a civil right. Healthcare companies are not in business to provide a person healthcare. Healthcare companies are in business, like any other business, to make money. A friend of mine once told me, health insurance is like a bet—you’re betting you’ll get sick, while healthcare companies are betting you’ll stay well. And that’s exactly how healthcare providers make their money, and why these companies are so very eager to kill the Affordable Healthcare Act. Like the Republicans are proposing and passed in the House with their healthcare bill, or really lack of healthcare bill, to replace the Affordable Healthcare Act, health insurance companies like to sell consumers cheap plans with cheap coverage. They want people to buy health insurance with a low premium, so that they (private health insurance companies) will only have a minimum to pay out. They want a person to pay this low premium month after month after month after month and so on—hopefully for years without ever having to use it. However, you don’t accumulate any points with the many times you pay the premium. You just get what you bought into—a minimum amount of coverage. And if you do use it, healthcare providers usually increase your rates. That’s how health insurance companies make their money, like any other business—taking in, more than they put out. And being required to provide comprehensive care by law isn’t something they can really afford, or make money off of. At least with the current way of their thinking. This is why it seems like health insurance companies manipulate a catch-22 like scenario—keeping rates high for young people, then turning around and complaining young people are not buying into the healthcare pools—what appears to be an ingenious method to kill the Affordable Healthcare Act. And an example of why healthcare providers are so eager to kill the Affordable Healthcare Act and sell cheap insurance with cheap coverage is that if a person or a loved one (even a young person) becomes afflicted with a serious injury or disease, the amount of coverage the health insurance company will be on the hook to pay out will be capped. They can just walk away, leaving you, the person who bought into cheap coverage, to have to pay the rest out of pocket. Treatments, medications, operations won’t be covered. The minimal amount put into the government vouchers that the Republicans promise will also be zapped dry. A father or mother will have to go into their savings, the kids’ college funds, or even to the great extreme of selling their home, because the bills will mount into the hundreds of thousands; and that six thousand dollar deductible under the Affordable Healthcare Act will start looking pretty good. And this is one of the things President Obama designed the Affordable Healthcare Act with comprehensive coverage to do—to prevent people from possibly losing everything they have because someone suffers from a serious injury or disease. Oh, and by the way, if you buy into cheap insurance that only buys you cheap coverage, forget about choosing your own doctor. So, how do we improve the Affordable Healthcare Act? Well, improvement comes with what is truly moral.
What I find so compelling is watching the Republicans bow their heads so earnestly in prayer to Jesus, then after the prayer, proceed to cut over twenty million people out of healthcare. Doesn’t seem to be a whole lot of earnest belief in Jesus, or morality there. Poor Jesus must stand in front of God just shaking his head—where did I go wrong? And with all the debate, the way to really improve healthcare does seem to be with a single payer system to take all the ridiculous complications out of it, including the mandates, and put the good health of we the people first and foremost—something I think both God and Jesus would put first and foremost—something I think even the forefathers and foremothers of the country would put first and foremost—after all, it is right there in the preamble of the constitution…”to promote the general welfare…”—meaning to promote the good health and well-being of we the people—even though the words welfare and healthcare have been stigmatized as something ill to the country—a brilliant propaganda campaign executed by the rich, spurred on by ignorance and bigotry. However, as I like to think, whenever the Trump administration compares itself to the Obama administration—better to be in the black, than in the red. This should provide the Democrats with the slogan they should have in the upcoming midterm elections…”Let’s get the country out of the red!” However, if we can’t have the single payer system, at least let’s keep moving in that direction with what President Obama proposed right from the very beginning to set the standard of competition with the government public option—a means to create quality healthcare at an affordable rate. And if quality healthcare at an affordable rate is in place, the incentive to comply with the mandate to buy into healthcare will progress to being voluntary, which might call for some different thinking, but would also be healthy for healthcare companies. However, the Republicans argue the government public option would put healthcare companies out of business; that they couldn’t compete with the government. Well, isn’t that admitting, right there, that health insurance companies are unable to provide quality care at an affordable rate, and that this is really not the business they are in, and that they really need to rethink their policy towards our healthcare policies? All the government would be doing with a government public option is setting the standard of competition. And a standard does need to be set. Republicans tell us competition alone will bring about quality care at an affordable rate. But this isn’t true, because if health insurance companies really wanted to compete, they could compete right now. There is nothing stopping them, except themselves—because health insurance companies are not about competition. With health insurance companies, it’s you get what you pay for. Even if you buy out of state. That’s why a government public option is so important—it sets the standard to force healthcare insurance companies to actually compete, and bring good health not only to the country, but also to the healthcare industry. Yet, the Republicans also try to make the point—the government public option would cost jobs. However, do you, or I, work so that healthcare companies can make money, and people who work for healthcare companies can have jobs, and healthcare—and we can’t, because we can’t afford it, or afford the quality of care we need, because we are more compelled to have healthcare companies make money, and people who work for healthcare companies have jobs, and healthcare? No…! I know I don’t. And if there is a demand for the government public option, don’t you think there will also be a demand for jobs to absorb the increased demand on the government to provide care. There may be a raise in taxes, but nowhere near the amount the average person currently puts out to pay the soaring premiums of private health insurance companies. And don’t you also think there will be a demand for jobs within the healthcare industry when they are actually forced to compete with the standard of competition set by the government public option and the business that will generate from it? What all of this really comes down to is a choice.
With their health bill, the Republicans promise the people choices. But what they really promise is just the choice of cheap insurance that gives you cheap coverage. Nothing really different than the way things were before the Affordable Healthcare Act. Minimal care compared to that of comprehensive care. Back to the old standard of pay me now, or pay me later. Only now, everything is even more expensive, so we all will be paying a lot more out of pocket, later. And I guess the choice that we the people will have to live with from the results of the last election is making the profits of private healthcare companies more plentiful than our own health and economic stability. It seems though, that the promise to really keep both the private healthcare companies and we the people, who really are much more important, in good health and economically stable, would come with the action of improving the Affordable Healthcare Act with the government public option. Otherwise, the good health and stability of both will eventually perish with no chance of ever being plentiful. However, this current administration and congressional lawmakers in the majority appear to be much more interested in serving the wealthy, rather than the constitutional well-being of we the people. The mammoth triumph of improving upon our healthcare system and our good health seems to have slipped from the grasp of we the people and so haphazardly away with the ironically ill choices we made in the last election.
I will conclude with this—greatness does not come with bluster, greatness comes with action that is true to the spirit of humanity. And if a soldier can be asked to risk life or limb to pay the price for freedom and the well-being of the country, then there is no reason not to expect the wealthy to pay their fair share of taxes, and contribute to that price. The policy to strip away subsidies that go towards healthcare along with a discount for veterans, and redistribute this money and more towards tax breaks for the rich is class warfare. And for all the talk Republicans and the people who vote republican do about freedom and democracy, it seems they still want to be a nation ruled by great white kings and great white lords. And that sadly, does come at the price of our good health and the good health of our good country—America.