The US healthcare system is, to put it bluntly, a “hot mess.” I suppose it’s all right for those who have qualified for Medicare, are covered by a group plan that is relatively all encompassing and inexpensive, such as, NYS teachers’ Empire Plan, or have qualified for free healthcare based on low income. For the millions of others, however, it has become a nightmare of rising premiums, deductibles, and co-pays, restricted coverages, disappearing providers, and cash-only doctors. Negotiating the exchanges to find a suitable healthcare provider has become an exercise in frustration and futility. More on this later.
Healthcare is an extremely complex matter, and, simply put, the ACA, aka Obamacare, has not worked out as promised. It has proven to be rife with unintended (or, perhaps, intended) consequences. I can’t believe I am actually saying that Nancy Pelosi, former Speaker of the House, was correct about anything, but I have to say she was downright prescient when she famously, or infamously, said with respect to the ACA bill “you have to pass it to know what’s in it.” Remember when President Obama promised the American people: If you like your doctor, you can keep him? WRONG. If you like your healthcare plan, you can keep it? WRONG. Premiums will not go up. WRONG again. WRONG, WRONG AND WRONG.
According to the Kaiser Family Foundation, a non-profit organization that focuses on healthcare issues, approximately 32 million persons under the age of 65 were uninsured in 2014. These were predominantly people in working families. Moreover, most of them had been without insurance for over a year. For most, this was not by choice. Over one-half of them cited the cost of coverage as the reason. When they get sick, they often forgo treatment, unless it is so serious they have no choice. Often, they do not fill prescriptions due to expense. They pay for mandatory treatment out of their own pocket. Approximately, one-half of them were eligible for ACA and had to forgo it. The tax penalty that was designed to entice people to sign up is a sham, as it is cheaper to pay the fine than any ACA premium, especially if one is young and healthy.
Many states have expanded their Medicare coverage. Approximately 70 million persons are now covered by Medicare. Generally, it is a good plan, but expensive. On the other hand, many of the people living in the states that have not expanded their Medicare coverage remain uninsured. They have not been able to qualify for the much-ballyhooed subsidies, thus rendering the ACA “UNaffordable” for them.
One of the key underpinnings of ACA was the state exchanges. In most states, they have been a colossal failure. According to Sally Pipes, President, CEO, and fellow of Healthcare Policy at the Pacific Research Institute, the exchanges needed 40% of the so-called “young invincibles” (aged 18-34) to sign up in order to remain viable. For various reasons, only some 30% have done so. Furthermore, many exchanges have either raised rates considerably, as much as 20% per year (Blue Shield, CA) or dropped out citing unaffordable (pardon the pun) costs. For example, just a few weeks ago, Northwell Health, Long Island’s largest health insurer, which currently covers 126,000 policyholders, announced it will drop out in 2018. Michael Dowling, President and CEO, stated the reasons succinctly, which I believe is a microcosm of the problem with ACA: (1) huge losses, e.g. payments into the state’s “risk-adjustment pool” in excess of $100 million for last year and this, and (2) uncertainty and instability in the marketplace.
Luckily for New Yorkers, 14 insurers remain in the individual market to choose from and 19 in the small group market. People in other states are not so fortunate. According to Newsday, in many states the choices are in the “low single digits,” one third of the nation’s 3,000 counties only have one insurer offering insurance on their exchange, and 40 have none. It doesn’t take an advanced degree in economics to discern that the fewer the number of providers, the higher the cost.
Take Arizona, for instance – John McCain’s home state. According to the AZ Department of Insurance website, premiums for the popular silver plan are projected to rise 116% in 2017, by far the largest increase of any state. By comparison, the nation-wide average is projected to be 22%. Furthermore, there will not be any PPO options available in any of the exchanges in AZ. This is part of a continuing trend, and is cited as a means to hold down costs. As most of you know, with PPO you can choose any doctor and do not need a referral to see a specialist. HMO plans require you to see a doctor from an approved list
Louise Norris, a healthcare.org contributor, wrote that many ACA critics have characterized AZ a prime example of a state whose healthcare system is in a “death spiral.” And yet, Senator John McCain came off a sickbed to cast the deciding vote to kill a bill that would have authorized the Senate to continue discussion of the healthcare issue and possibly pass a bill, which could be “conferenced” with a like bill that the House had passed. Just a discussion to keep debate alive! Inexplicable. As the late Desi Arnaz would have said: “He has some ‘splaining’ to do.”
To analyze all essential aspects of the problems and possible solutions would take a book, not a blog. I have tried to limit myself just to the essentials, as I see them.
Suffice to say, I know very few people who are pleased with the US healthcare system as it is presently constituted. It seems everyone has had a nightmare experience. Whenever I discuss it with my friends it becomes a game of “can you top this.”
I don’t pretend to have the answers. But, then again, it is not my job to have them. I am not a duly elected member of Congress. I don’t have access to the latest data and experts in the field. What I do know is that nationalized healthcare is offered in many countries, and although results in some have been better than others it has not worked well in any of them. There is plenty of empirical evidence around to support that. For example, I have heard first-hand accounts of people waiting months for a simple CAT scan or MRI. I know of many Canadians who simply travel to the US for emergency treatment. Free or subsidized healthcare for everyone sounds really good, but coverage tends to be inconsistent, delayed and very expensive for the government to sustain.
That said, I am continually frustrated by our government’s failure to resolve this problem. Once again, members of Congress prefer to squabble and score political points rather than find a solution. Former President Harry S Trumann won re-election in 1952, in part, by labelling Congress a “do nothing Congress.” That group was probably more productive than the current one. Politifact has cited an average of several polls conducted by CBS, NBC, ABC and CNN, which found that the Congress has a 14% approval rating and a 95% re-election rate. I don’t know what they says about us voters, but it tells me that Congressmen are good at two things and two things only – getting elected and getting re-elected.
In my mind, the leadership needs to do more. Leaders are supposed to lead, and if not, they should be replaced by someone who will. Dems have been operating in homogeneous negativity, uniformly opposing anything the GOP has proposed in the belief that that would be bad for President Trump, whom they despise. Perhaps, but more importantly, it is bad for the country. Many in the GOP seem to have forgotten that they were elected, in part, to repeal and replace Obamacare. They have failed to do so. How will these people be able to explain their inaction to the voters in their respective states or districts?
Since they’re acting like children, let’s play a children’s game. Instead of calling it “repeal and replace,” let’s characterize it as “refining and fine-tuning Obamacare.” It’s essentially the same thing, but maybe that semantical change will provide both sides with sufficient “political cover.” In any event, the nation has the means to resolve this severe problem satisfactorily, but does it have the will?