Repair-It

The whole thing is just borrowing money we don’t have to prop up the insurance industry since fewer and fewer people can afford to pay for it themselves each year. Also worth noting is the ACA added 30 million people to the insurance roles and not a single doctor. In fact the number of doctors graduating medical school each year hasn’t increased since the 80s (thank the American Medical Association for that).

It doesn’t do very much (it does a little admittedly) to control costs which is what is needed. But honestly as long as there’s 25 middle men - employer, employer benefits department, insurance, insurance benefits manager (insurance companies are mostly just people who manager money they’re making from premiums while the benefits managers are the ones who actually handle day to claims approvals and denials), billing departments whose job is to figure out how much to charge you and how much to charge the insurance as there’s a million insurances and plans within those insurances and the plans change year to year and within those years theres deductibles and copays and coinsurance etc. and even within Medicare there is Part A, B, C (Medicare Advantage plans), D and there is contracting and negotiating to be done etc. and then now there’s the government subsidizing that goes into that depending on income and age and where you worked and how many years you worked there. On top of all this there’s lawyers that need to be involved to make sure there is compliance. Can you imagine the legions of people you’d need working in a hospital billing department to handle all of that paper work? Now remember that most people don’t fit into neatly categorized situations where they just have an insurance company pay for part and they swipe their credit card for the rest. A lot of people don’t have insurance or it’s terrible insurance or they can’t pay because their deductible is too high or whatever and now the hospital needs to figure installment plans and send people to collections or deal with people’s medical bankruptcies.

I could go on and on but I think I made my point that our system is very costs a lot of money just to run it and a lot of the ACA was just putting a bandaid on things. It doesn’t solve anything really.

Insurances find it more profitable to set up plans and deals with large groups of people because it’s easier to assess their risk and expense from year to year and the administration costs are cheaper because of the economy of scale. The ACA brought individual plans to be available on exchanges. However it’s not efficient to do risk evaluation and administration an individual basis so the government is on the hook for subsidizing them. The insurance companies still aren’t making enough money even with the individual’s premiums and the government subsidies put together to make it worth their while in many states. As health care and premium costs just keep going up, the government subsidies must keep going up. It’s getting pretty ridiculous now especially with a republican congress that wasn’t excited about the idea in the first place. Even before the republicans took control though, there were insurances exiting the individual market and the more insurances that exit the exchanges the more costly it becomes to be in the remaining short list of insurance companies taking on ever more inefficient individual plans as these people are literally coerced to buy insurance by the government charging them just for being a citizen if they don’t have health insurance for more than 3 months per year.

So what needs to happen is the government needs to spend more subsidizing these insurance companies to keep them interested in the ACA exchanges. The problem with that is that the insurances are not only NOT the solution, they are the entire problem.

Also there’s aspects of it where the federal government is subsidizing medicaid heavily to help get more people on medicaid roles. This works pretty well except that it’s costs unholy amounts of money and the plan is for that federal subsidy for medicaid to eventually taper off and the states are going to be left holding the bag with all of the millions of people they incentivized to get free health insurance in the meantime. The states can’t just print money like the federal government can and that situation might appear to be working fine for now but its really just mortgaging our future. Some states with conservative governments that remember there’s no such thing as a free lunch saw through this situation and just refused to go along with medicaid expansion. Other states like California jumped in line to get a hand out, even if only temporary and there’s now about 13.5 million people in California getting “free” healthcare paid for by the state. For instance probably darn near half the people that walk into my pharmacy, get thousands of dollars worth of “free” medicine and many don’t even take it but they keep picking it up. Probably assuming it’s like $14/bottle instead of $2500. California is raking in ungodly amounts of tax income and is still broke.

The pharmaceutical companies see the opportunity to fleece the American healthcare system and do it 6 ways from Sunday.

Once you get people on “free” government provided services like that, you can’t really get them off because then it’s the guy that kicked them off’s fault not the guy who put them on it unsustainably’s fault. So now not even the republicans can really stomach kicking that many people off the government gravy train because they know the backlash that would ensue.

So now what’s to be done? No one really seems to have a clue.

The insurance provisions of the ACA fail because they simply “rearrange the deck chairs on the Titanic.” The solution is not single-payer, which also does not address the fundamental drivers of higher healthcare usage and costs. The answer is to have the government not only invest in health, but eliminate subsidies for unhealthy environmental influences on health.

We have an overweight population which puts a strain on our healthcare system, especially when chronic diseases become very serious. Yet our government subsidies corn starch and wheat, as well as sugar.

We all know that walking is preferable to driving to get places, but governments build highways and subsidize their upkeep.

We do not adequately penalize those who take unnecessary risks that lead to injuries for themselves or others.

We do not signal the difference between intelligent use of the healthcare system and overuse or misuse. In fact, if a patient is readmitted to a hospital because he or she disregarded the treatment plan provided by the doctor, the doctor and hospitalized are penalized, not the patient.

We reward the volume of care, not the value of care.

The ACA only marginally touched these issues. As for whether the healthcare system should have for-profit entities, I think that some level of profitability is an incentive for innovation. However, the uncontrolled advertising by hospitals and drug companies, which often manufactures “needs” people did not know they had, or drives people to more expensive and unnecessary uses of the healthcare system is a practice that should be curtailed. My wife and I are astounded by the number of ads for drugs on stations like WE, TNT and the Hallmark Channel. We medicalize everything.

They are forcing people to buy gambling rights for their basic human needs such as healthcare. These right are bought from people who profit by denying you care for their own benefit. They are allowing pharmaceutical companies to charge different prices for different people based on arbitrary standards for profiteering. What gives them the right to decide who lives or dies, or who can pursue wealth and happiness as defined in the Declaration of Independence? “…endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

In my case, I am self employed. I was promised a plan costing a fourth of what I was paying before, originally it was $450/month with a $2000 deductible and my choice of doctor. They did not give me the plan from the healthcare web site which cost over $5 Billion to develop and was still not working. They said my net income (not Gross) was below their arbitrary limit and they would give me Medi-Cal instead (that is California's Medicare) without my consent. A short time later they said I had to choose between this HMO or that HMO and if I did not choose one would be chosen for me. At that point I lost access to my Doctors and Medications. It would take upwards of three months to get an appointment with their appointed doctors. Their doctors would not consider my medical history and would not prescribe my old meds without a specialist. Their specialist would take as much as one year to get an appointment. Then they would say, even this HMO does not cover you, go try the county services. The HMO’s which I tried switching several times were worthless, and were being paid for by Medi-Cal. To add insult to injury they sent me a letter form the California Asset Recovery program stating that, if I am over 55, not married, and without children at home, they would be laying claim to my home when I die, to pay for what they decided to give me without my consent!

The simple solution is to provide all that money going to these racketeers and profiteers to actual healthcare providers, students entering the field, and practitioners to increase the supply of providers and resources to reduce costs. The AMA, insurance and pharmaceutical companies are in the way of that, and currently as much as 80% of the costs are going to administrators instead of those in the healthcare field.

kevm14 wrote: The very last thing anyone will care about if the gov't is paying, is the real cost of the care itself.