The Truth about Obamacare

Don Rogers, Jack Rabbit Ranch blog

DonRogersWell, I can see it’s going to be a bad six weeks. I just heard a paid TV advertisement for people to call their Congressman and urge him to oppose funding Obamacare, because the President is exempt. I expect to see a lot more of these misleading ads, and if past is any indication there won’t be much response from Democrats. They are not nearly as loud and insistent as Republicans and I’ve never understood why.

Is the President exempt? I guess so, depending on how you define exempt. Anybody who already has medical insurance is exempt. I’m with Aetna, so I’m exempt. If you are over 65 and are on Medicare, you are exempt. If you are in the military, you are exempt. If you are a veteran with VA coverage, you’re exempt. If you are a member of a Native American tribe, you are exempt.

However, some changes will affect everybody. For example, if your medical insurance had a lifetime limit, it’s gone. If your plan had an exclusion for pre-existing conditions, that’s gone. If you have a child under 26 they can stay on your plan.  If you’re a woman, gone are the days when you could be charged higher premiums merely because of your gender.  Plus, all plans now must include preventive screenings, such as mammograms, and routine medical checkups at least once a year.  But most of all, your insurance company can use no more than 20% of what it collects from the pool you participate in for its administrative expenses and profit.  If they collect more than 20% from folks in your pool, they must return the overage they charged those pool participants.

Obamacare, or the Affordable Care Act, is for people who don’t have or cannot afford medical insurance. Up until now, when an uninsured person got sick, their only option in most areas of the country was to go to the emergency room, where the hospital was required to treat them. That is a very expensive way to provide medical care. Many hospitals and doctors, to keep from going under, then raise the costs for their services to the rest of us who do pay for insurance.  If folks had the opportunity to purchase affordable insurance, those critical conditions they ended up being treated in the ER could have been treated much earlier much cheaper.  But instead of being treated early, hospitals see them much later in the disease process when treatment becomes much more intensive and expensive … and even with help from the taxpayers, many hospitals have found it next to impossible make ends meet without passing on costs to those who can pay.

Healthcare costs in the USA were double the costs in every other country, and some method had to be found to cut the cost of heath care, as well as provide coverage to those who had no insurance coverage. The cost of medical insurance was skyrocketing, and we were reaching the point where almost nobody would have been able to afford coverage.  In essence, those purchasing insurance are paying for insurance for themselves and indirectly subsidizing those who choose to not purchase, or who don’t make enough money to purchase their own insurance.

So the object of a national health care plan was threefold:

  1. To cut the cost of health care by providing more competition between insurance providers.
  2. To cut the cost of health care by encouraging more preventive care, and enabling visits to the doctor rather than the hospital.
  3.  To increase the number of people covered by insurance to include as many as possible, especially young families and children.

Several different options were available to achieve these goals. The first would have been Socialized Medicine. This was never even considered by the administration. Under socialized health care, the government would take over all hospitals and clinics. All doctors and nurses would get a salary from the government. There would be no charge for the patients. No one would be allowed to make a profit from anybody’s pain or injury. I had this coverage in the US Army. All the military and VA hospital coverage was socialized when I was on active duty in the US Army in 1965. As I understand it now any service member on Tri-Care Prime and getting health care at a Military Treatment Facility is still receiving socialized medicine. Anyone who contends that Obamacare is socialism is displaying his ignorance or his duplicity.

Another option would have been a Single Payer plan. The hospitals remain private, for profit  institutions and the doctors are independent, for profit providers. But all insurance would be handled by the government on a non profit basis. Medicare is such a plan. Premium payments come out of payroll taxes, and the patient chooses among doctors and hospitals who accept the insurance coverage. President Obama never even brought it to the table, probably because he saw the insurance company lobbyists loading for bear. Some Liberals and Progressives felt betrayed, because Barack Obama spoke of this as he campaigned for the presidency.

A third plan was called the Public Option. This would involve for profit hospitals, doctors, and insurance companies, but would include a federal government run non profit insurance option competing with the insurance companies to force their premiums lower. Bill Clinton proposed a similar plan in 1993, but due to a concerted effort by insurance companies and conservative organizations, he and Hillary could not get it through Congress.This idea didn’t last very long during the negotiations for the Affordable Care Act, either.

So the Affordable Care Act became a collage of compromises to get all the health care actors on board so they would call off their lobbyists. Insurance companies don’t have to compete with a federal insurance plan, because Obamacare agreed to just subsidize the states to increase their state run Medicaid programs with expanded coverage for poor people.

Insurance companies agreed to provide coverage nationwide instead of statewide as long as the law made coverage mandatory, so they get more customers. Most states will get more companies competing for their business, so prices should come down.

Big Pharmaceutical companies agreed to go along if the law prohibited the government from negotiating for lower drug prices. So we still have to go to Canada or Mexico if we want drugs for 1/10th the cost. But the gap in Medicare Part D coverage for drugs (The Donut Hole) will be reduced each year until it disappears in 2020.

Doctors got changes to their billing practices, including being paid by the patient rather than the procedure. That’s supposed to reduce the number of unnecessary and redundant procedures and save costs. Eventually they are supposed to go to standardized medical records on computer, for easier access, reduction of errors and lower costs.

Since Obamacare is expected to greatly increase the number of people receiving health care, hospitals immediately got money to expand and renovate. If your local hospital has a new wing or even a new hospital in the last two years, it’s probably funded by Obamacare.

By co-opting every group who had opposed universal health care in the past, Democrats were barely able to get the bill passed by one vote. By not having all the changes happen in the first year, they gave themselves time to get it implemented. And as snags have come up they have made revisions and postponed some of the deadlines.

This is a big and complicated bill, to deal with a large and complicated problem. The writers knew it would not be perfect, and so there is flexibility written into it to allow for fixing problems as they arise.

Already some people are noticing the elimination of their lifetime limits and their pre-existing condition clauses going away. Some have been able to keep their kids on the policy longer, which is a lot cheaper than having to buy a second policy. Some people have gotten rebate checks back. because insurance companies are now required to give money back if 80% of the premiums are not spent on health care, but on overhead or salaries.

As more and more people start to experience the benefits of having affordable health care, they may begin to understand and appreciate what they have received. For the first time they do not have to live in fear and dread of a medical condition devastating their lifetime savings.

Republicans know this and some have said as much. They are desperate to find some way–any way–to stop the Affordable Care Act from being fully funded and implemented. They fear that voters will remember who helped them when they needed help, much as people remembered for two generations which party got them Social Security, and which party fought it tooth and nail.

Some states with Republican governors and legislatures have decided to refuse the federal funds intended to set up the insurance exchanges and expand their Medicaid coverage, hoping to somehow stymie Obamacare. It will be interesting to see when they figure out that they are handing control over to the federal government to set up the exchanges and provide low cost federal insurance instead of locally controlled Medicaid programs. They are enabling the public option some of us preferred in the first place.

After decades of people losing their savings and their homes, being forced into bankruptcy when struck by cancer or some other medical disaster, finally we are catching up to the rest of the civilized world!

And today I just heard a TV ad for Obamacare with a number to call for information and application forms! Maybe they are going to start selling this thing after all!


Our Health Care System is Still Sick

The health industry is about making money, not healing.

— by William A. Collins

William A. Collins

Not much system
To our care;
Can’t find treatment

It’s great living here in our rich country, as long as you’re rich yourself. Take our health care system. Unlike other wealthy countries, our nation’s medical apparatus allows those at the top to receive top-notch care, while the working class has to scrounge to survive.

If you’re lucky enough to obtain coverage in the first place, you’re then confronted with a tangle of red tape. Doctors, clinics, hospitals, nursing homes and drug companies vie for our business with inadequate oversight. But what if your coverage expires or the cost of your care exceeds policy limits? Tough luck.

Meanwhile, the lucky among us continue to live longer and add to the national health tab, increasing Medicare costs.

But in this era of corporate obsession with efficiency, the health care system is a paragon of waste. Instead of a streamlined system, every insurance company operates according to its own prerogative. Doctors’ offices are now filled with more clerks than white coats. In 2011, American doctors spent $27 billion more on bureaucratic paperwork than our Canadian neighbors operating under a single-payer system. Canadians, like most everyone else in rich countries, appreciate their universal care and scratch their heads in disbelief at our nation’s medical free-for-all.

Another of our mind-boggling ineptitudes is that we pay medical providers according to how often they see us and the procedures they perform. They should earn more for keeping us healthy than simply treating our ever-rising number of ailments and administering increasingly pricey tests. With no incentive to get the job done right the first time around, savvy docs set up their own clinics to refer us to, while hospitals load up on snazzy equipment to test us excessively.

Money-in-Health-CareMany of the CEOs of our nation’s top hospitals rake in salaries well over the million-dollar mark. The health industry is about making money, not healing. And it’s a big business.

And let’s not forget the drugmakers. Their wares are keeping us alive longer too, if we can afford them. But keep in mind that their industry spends more on marketing than it does on research. One study found that for every $19 Big Pharma spends on advertising and marketing, only $1 goes to funding basic research. And our rigid patent system favors these medical moneymakers by granting drug developers patents for 20 years. This allows companies to jack up drug prices and prevents low-income patients from accessing cheaper alternatives to drugs they depend on. The FDA also makes it illegal for individuals to purchase prescription drugs abroad at much lower prices.

But one thing the medical mob can’t yet keep you from doing is seeking treatment and procedures in other countries. Asia and South America have become hotbeds of American medical tourism. And if we are allowed to travel to close-by Cuba and use its state-run health care system in the future, you can bet we’ll flood that country too.

As always, those at the bottom of the economic ladder are hit the hardest by the health industry’s incompetency. If you’re poor, maybe you qualify for Medicaid, or maybe you don’t. Maybe there’s a neighborhood clinic near you, or maybe not. Maybe you’re fortunate enough to be healthy, or maybe you inherited a gene that triggered a costly chronic illness.

President Barack Obama’s Affordable Care Act is already helping people obtain or maintain health insurance and by January 1, 2015 it’s supposed to be fully implemented. But don’t get too excited — an estimated 26 million Americans will remain uninsured by 2020, according to the Congressional Budget Office’s calculations.

OtherWords columnist William A. Collins is a former state representative and a former mayor of Norwalk, Connecticut.

Corporations Score another Supreme Court Victory

The Affordable Care Act ruling won’t heal our ailing health system.

By Margaret Flowers

Margaret Flowers

As a physician, I find it very odd that the debate over the Affordable Care Act has focused on the effect the law will have on the presidential election rather than the impact it will have on patients, health professionals, and health outcomes.

The Supreme Court case reinvigorated the debate over the Obama administration’s 2010 health care reform law. But we’re still getting partisan talking points instead of an honest review of the changes that are in store. This will likely worsen as we get closer to Election Day.

The new law is based on concepts developed by the Heritage Foundation, a conservative think tank. Republican presidential candidate Mitt Romney passed a very similar law for his state when he was the governor of Massachusetts. So while most Democrats are celebrating the Supreme Court decision to uphold the Affordable Care Act and Romney is saying he’d repeal it, consider this: Had a Republican passed this federal law, we would have the opposite situation.

imageLet’s put politics aside and look at the law from a policy standpoint. The big winners of the Supreme Court decision are the corporations who are profiting from the current health system — private health insurers, pharmaceutical companies, and corporate-owned hospitals and medical practices.

The Court has deemed it constitutional for the government to require people to spend up to 9 percent of their income to purchase private insurance despite it being a defective product. People with insurance continue to face financial barriers to care. They delay and avoid necessary care because of the cost of co-pays and deductibles.

When patients have a serious medical condition, they risk financial ruin. Illness and soaring medical costs are the greatest causes of bankruptcy in the United States, even though four out of five people experiencing medical bankruptcy have health insurance. Purchasing private insurance is going to be subsidized with taxpayer dollars. It will cost Uncle Sam an estimated half a trillion dollars between 2014 and 2019 to pay that tab, according to the Congressional Budget Office. The insurance mandate and these subsidies will create corporate welfare on steroids.

What will the insurance companies do with all that money? They’ll hold onto as much as they can by denying and restricting payment for care. And they’ll use those dollars to weaken regulations meant to protect patients.

When national health care reform is fully implemented in 2019, 26 million people will still lack coverage. And health costs will continue to rise because the law lacks proven cost controls.

While the law does include a few positive provisions, it won’t stop the deterioration of our health care system. We’ll continue to see unnecessary suffering and preventable death. This is unacceptable when we are already spending nearly twice as much per person on care each year as other industrialized nations with universal health systems and much better health outcomes.

The truth is that we can solve our health care crisis. The fastest way to accomplish this is to drop just two words from the Medicare Act — "over 65" — and immediately expand Medicare to every person. That would create a system that’s about health care, not corporate profits. A universal Medicare system would control costs and improve the quality of patient care.

Let’s demand Medicare for all now. The longer we wait, the more people will suffer and die needlessly.

Margaret Flowers, MD is a pediatrician from Baltimore and co-director of ItsOurEconomy.US.  Distributed via OtherWords (