This post will not be of interest to my foreign readers, it’s all about American healthcare. And this is a subject that no one from around the world can understand. They can’t figure out how it’s such a problem in a developed country. They can’t figure out how by many measures, our healthcare system has been no better than third-world countries. They just don’t get it. So, sorry, this one is not for you.
Post-election 2016, I think it’s time to revive my “Health of Our Care” series. The second place finisher, the man who will be president, has vowed repeatedly to repeal the Affordable Care Act – Obamacare as President Obama’s critics dubbed it. And the people in control of the House and Senate have as well – they’ve made it their goal since before it was even written.
In the days since the election, the incoming leader has walked back from his plans to completely repeal it. He now says he’ll just “fix” it – whatever that means. So we don’t know what the future holds for us.
The many millions of us who have insurance through the ACA have been on pins and needles, or just in a flat out depression, since the election. Especially cancer survivors or anyone with a long-term health issue. Because one of the most important parts of the ACA is no pre-existing conditions – insurers could not deny us coverage because we were sick.
Now we’re hearing that perhaps that will be left in place. And maybe some other elements. But it will somehow – all completely vague – move back to more of a “market” system. Of course, we have no idea what that will look like, we just have to wait and see what the “great healthcare” will be.
So, I thought I’d take a moment to look back at what health insurance through the free market looked like for those of us who didn’t have access to group plans through employers. Just in case you’ve forgotten.
I had an HMO with Aetna for many years. It was expensive, but I was pretty happy with it. Once I was diagnosed with breast cancer, they began raising my premiums. And they started to routinely deny coverage of things I knew were covered. Once I called and complained, they would cover the charge, but it became a regular occurrence. And then my premiums would be raised again. And again. 20, 27, 30, 34% increases every year. And I paid. Because I had no choice. I was in the middle of cancer treatments. Between premiums, co-pays, and out-of-pocket expenses, I was paying somewhere around $18,000 – 22,000 a year. For one person.
And I felt grateful. Because I lived with someone who could cover more of our housing costs – I wasn’t able to work as much as I’d have liked to when I was sick. And because when would call around to other companies, I’d be told they wouldn’t cover me.
Lots of other people were not so lucky. I personally know people who lost their homes because of healthcare costs, not having someone who could make up the difference for them. I personally know people who had to choose between food for their kids or drugs to fight their cancer. I personally know people who had to tell their kids they couldn’t go to college, not because they had spent their money buying the latest iPhone for their kids instead of saving for college, but because they had to spend the college money on health insurance and hospital payments. I personally know people whose insurance policies were canceled for no reason, leaving them unable to get other insurance because of pre-existing conditions. And I personally know people – lovely women and men, hard-working, mothers, fathers, children – who died, unable to get the care they needed.
Please remember also the housing crisis. Remember? Caused by the big, bad banks? Except that, it turns out, it wasn’t completely caused by the big, bad banks. A study by researchers at Harvard (Himmelstein & Woolhandler) found that 62% of home foreclosures in 2007 were directly attributable to healthcare costs. And a study by Robertson, Engelhoff, and Hoke in 2008, found that 49% of all home foreclosures in the housing crisis were the result of medical problems.
That was the world of American health insurance in the free market. At least for those of us in the individual market.
With my insurance going up 20-25% every year, I decided to investigate why (my post about all the details I found is here). The common reason given by big insurers was rising medical costs and losses in the individual plans. And that we were all simply using too much medical care. If we would just help them control costs by not going to the doctor, it would all be fine. What I found when I downloaded the company’s SEC financial filings was interesting. Their medical costs had indeed gone up, but only around 15%. Their big losses were not in their individual plans, but in their group plans. They were increasing my premiums to offset losses from their group plans – because they could. They also needed to raise my premiums to cover executive pay increases, which ranged from 40-50% up to almost 200%. Every year. They also spent many, many millions of dollars on lobbying members of congress – the same people who now want to return our healthcare system to the “market”, like before, when insurance execs got 200% increases in compensation. (One of the important aspects of the ACA is that insurers must spend 80% of premiums on actual healthcare, not overhead.)
When I could no longer afford my Aetna (evil empire) plan, I had no choice but to sign up for an HSA – because no other insurer would accept me. With this plan, I had a high deductible, $10,000. I had an account that I could save money for medical costs. I earned interest in the account, and paid my medical bills from that. There were limits on how much I could add to the account in a year. And on top of that I paid a lower insurance premium. For me, it started out around $450 per month, but quickly rose to $700, $800, nearly $1000 per month, all while paying all of my bills myself. With the account, they charged me a fee for opening it, charged me another fee for maintaining it, another fee if my balance fell too low, and when I finally wanted to close it because I had a great policy through the new ACA, they charged me $200 to close the account. The HSA was a really great plan for the bank!
That’s what free market insurance looked like for those of us in the individual market. Forty-six million people were uninsured. Anyone with pre-existing conditions couldn’t get insurance. And we were all going broke. Because of this, the cancer community (and lots of others) have been freaking out since the election. The ACA was far from perfect, but for millions of us it was literally a life-saver. We owe our lives to Obamacare. Now we’re scared. We’re angry.
We still don’t know what their plan is because they don’t have one. We just have to wait.
One of the common ideas back then was that we – the users of healthcare – were profligate. We were wasteful. We were told again and again that we had no “skin in the game.” Well, we do have skin in the game. Those of us who have been through the system before, those of us who are sick, those of us who suffer, those of us who went broke, lost homes, gave up food, gave up medicine, whose children suffered, we have skin in the game. We have far more skin in this game than any of you politicians telling us how great this market system is going to be.
We have skin in this game. And bones. And lungs. And blood.
And if you – Speaker Ryan, Senator McConnell, Mr. trump – send us back to that completely unworkable system, we will start dying. Our blood will be on your hands, our dead bodies on your heads. And you will choke on the stench of our rotting flesh.
To the rest of us: good night and good luck.
(you can read all the Health of Our Care posts here.)