I find myself unable to write my usual end-of-year post. You know, the take good care, be good to yourself, and be active post. I can’t write that at the close of this year because all I can think of is healthcare.
We’re at a delicate point in this country’s history. Anger and uncertainty are high on all sides. But the one thing we know, the one thing that has been made abundantly clear – if you’ve paid any attention to the things elected officials have said – is that the new government will dismantle the Affordable Care Act, or Obamacare. And they won’t stop there. They will also begin disassembling Medicare, Medicaid, and Social Security. How do I know that? Because they’ve said that, again, and again, and again.
Who will this affect? Everyone. Initially and most obviously, it will affect those of us who get our health insurance through ACA – like me. It means that the 10s of millions of people, many of them children, who got insurance for the first time will go back to being uninsured. Those children will go back to being largely shut out of medical care, or at least effective medical care. It will mean that the rest of us will go back to the completely unaffordable individual market of the insurance companies (see my last post for more on that). It means that very many of those caught in the opioid epidemic will lose any access to treatment. They may feel like there’s not enough help now, but when they have no insurance and what insurance is available has little or no substance abuse or mental health coverage, they’ll find a whole new level of hopelessness. And most importantly, we’ll go back to insurance companies excluding people who have been sick.
I’ll probably be OK. I live in New York, which has long had a law that insurers could not deny coverage based on pre-existing conditions if you had coverage with another insurer within 6 months. So I’ll be OK – might not be able to afford the coverage, but I can get it. But those of you in other states, sorry, you’re probably screwed if you’ve ever been ill.
But it won’t be just us who feel the change. All of you with your group employer-paid plans will feel the changes, too. Insurance companies will be free, once again, to raise rates to cover things other than your healthcare charges – things like their bad business losses, their bad investments, and their MASSIVE executive pay hikes (like 200% increase in a year). One aspect of ACA was that insurers had to spend 80% of premiums on healthcare, not executive pay or overhead, ensuring that your premiums went to pay for your healthcare, not the CEO’s yacht.
Other changes that will affect you group plan folks: insurers will no longer have to cover annual wellness visits for you or your kids, no longer cover the cost of regular screening like mammograms or colonoscopy (which means a whole lot of people won’t get them), they will go back to charging women more for insurance than men, they will go back to not covering mental healthcare.
And here’s the big change coming for all: lifetime caps. ACA abolished the lifetime caps; they’ll be coming back quick. Most plans pre-ACA had lifetime caps of $1 million. Some had caps far less than that – I was offered plans which could hardly even be called insurance that had maximums of far less than $1M. Now a million seems like a lot of money; it’s easy to think that’s not important. However, anyone who’s had a serious illness or injury knows how quickly healthcare dollars add up. A year or two of care can easily get up to $5-6-700,000. I never figured out what my total with Aetna was, but I was definitely getting close to their million cap. And then you’re kicked out, with a pre-existing condition, and no one else will take you.
But we’re told ACA will be replaced with something much better, something great. And no one will tell us what that will look like, how exactly it will operate. We’re told it will be a great market system.
Well, if we’re going back to a purely unregulated market system, I think we all should be in it. The definition, the whole economic point of insurance is spreading the risk of large emergencies over a large pool – each person pays in, the money is spread throughout the whole pool, and that pool of money is used to pay claims. By definition, some of us will pay in and not use the insurance, not have the need of payment; and some of us will pay in and end up using far more than we put in. But the risk is shared by all. It’s the same concept as homeowner insurance and natural disaster, or auto insurance. If it’s truly a market system, all people must be in the same pool, otherwise this talk of market is just bullshit. That means all the group plans must be invalidated. Everyone must be in the same pool. All those employer group plans – gone. Employer-based health insurance began in the Depression and took off in WWII. During the war, Congress had put limits on wage hikes in place, along with rationing supplies. Employers needed more workers, so they offered insurance in place of higher wages. Plus, insurance payments were not taxable. There’s a nice little history here, in a piece from NPR. So, if we want a market system, dump all those plans. Companies should simply pay their employees a fair wage, employees will get higher taxable wages with which to pay for their own insurance.
And all of those government jobs with insurance? Insurance has to go – back into the market system. That means all those federal workers will need to be paid a higher wage, which will be taxable, and they can buy their own insurance. That includes military. I get that in combat they should have medical care covered. But when they’re back home – market. And that certainly applies to Congress. They have very generous packages. If we’re going to go to a market system, we all have to be in the market or it’s not a true free market. Congress, get your own damn insurance. Now don’t worry, they’ll be fine. The men insisting on this change are all rich guys, they’ll be able to afford their own insurance. They won’t have to worry about “shopping for the best value.” They won’t worry about which hospital they can go to when they’re having a heart attack, or when their child has stopped breathing. They have plenty of money for their own health insurance – much of that money coming from drug manufacturers and insurance companies. In fact, Tom Price (trump’s pick for Health and Human Services Secretary) has made piles of money buying and selling healthcare stocks while working on healthcare in Congress (reported in Wall Street Journal, Fox News, and here’s a link to Politico, along with some other healthcare info). (I’m pretty sure this is the sort of thing that in the banking sector would be called “insider trading” and would land you in jail, but I digress.)
My point is that, if we are to be in a “free market” system for healthcare, if we are to have any semblance of fairness, then we ALL have to be in the system. If only some of us are in, it is not a “free” market, it is not fair. It’s only a sucker’s market for those of us who don’t have the right job. That may be what they’re going for…my brother-in-law has said in the past that I didn’t deserve affordable health insurance because I chose to be a musician instead of joining the Army – note: it wasn’t that I didn’t deserve “free” healthcare, but that I didn’t deserve “affordable” care, because I had the wrong job (even though I pay taxes and contribute to society). So maybe that is the point these leaders are trying to make – that some of us simply don’t deserve healthcare, that only certain people, only the “right” people deserve healthcare.
And this is just ACA. Medicare, Medicaid and Social Security are next on the block. Why do I think that? Because they’ve said so, flat out. So all the programs you might have been able to turn to if you made bad investments, spent your money on Christmas presents or new cars instead of saving it, had a child with a disability, or just had a string of bad luck, will be gone. Sure, the plans may be flawed, but they helped. You’ll be on your own now. Don’t screw up!
Well, maybe I will turn this into the usual New Year’s post….If trump, Tom Price, Mitch McConnell, and Paul Ryan have their way (and why wouldn’t they since they have complete unfettered control?), the safeguards many of us have expected would be there in an emergency will be gone. We’ll be on our own while they continue to collect money from corporations and wealthy donors. So take care. Be good to yourself. Be healthy. Do everything you can to lower your chances of getting sick. OK, you can’t do much about genetic issues, but you can lower your risk of many diseases through lifestyle choices.
So, get more exercise. Move more, be more active. Eat healthier. Don’t smoke; if you do smoke, quit. None of those things guarantee you won’t get sick, but they will help reduce your risk. Good luck.
I truly wish you, wish all of us, all the best in 2017. Good night, and good luck.