I know, I know. Been away for a while. My life suddenly became incredibly busy, and blogging disappeared from the priorities of my life. Things have settled down a little bit, though, and I thought I'd post something about our current nonsense. If nothing else, this gives me a chance to vent.
The whole point of the PPACA was not "healthcare reform". Rather, it was "insurance regulation", a related but different creature. The main problem with our healthcare delivery system has been the high bar for access due to high cost. Insurance ceased to be something people had from employment, a benefit employers gave to workers, and by extension their families, as an inducement to work for them. Even companies that offer "health insurance coverage" do not offer it as a benefit they cover; they offer it as a private market, putting up plans from which employees can choose, but for which employees, rather than the employer, have to pay. Insurers cover fewer and fewer things. They refuse payment for treatments. They drop individuals either because of some suddenly-discovered pre-existing condition or because there was a cap on payments that had been reached. Plans change in midyear, sometimes with little notice from those who are on the plans, leaving them stuck. Add to that the 48 million Americans who simply had no insurance and the crisis becomes acute.
The PPACA addressed these issues in a pretty straightforward manner. They eliminated annual or lifetime caps on insurance payments. They eliminated the restrictions on coverage for individuals with preexisting conditions. And it created a marketplace for insurers to compete for individuals and corporate business for their products. It also provided the opportunity for individuals to receive assistance in paying for coverage with subsidies they could receive to help cover the cost of purchasing health insurance on the individual market. Finally, they offered states the opportunity to raise the Medicaid eligibility income level, bringing millions more in to that pool.
Most states have not created their own healthcare exchanges. Most states have not raised the Medicaid eligibility income level. These two things, combined with simple ignorance about what the PPACA actually does has brought us to the point where everyone is screeching and hollering about a lying President and a failed law. The "lie" was that people could keep their insurance if they wanted to; the truth is, they could keep it if the insurance company brought it up to meet the minimum standards of the law. The insurance companies refused to do that, then turned around and canceled millions of policies that were, by and large, little more than catastrophic plans with high deductibles, low caps, and tiny to non-existent co-pays. The attraction of these plans was their low premiums. The premiums were low because they didn't cover very much, or pay very much for the things they actually covered.
The President didn't lie. The insurance companies simply refused to make the plans satisfy the requirements of the law. For some reason, rather than being angry at the insurance companies for screwing them, the people receiving cancellation notices are angry at the President for telling them something that was true enough - they could keep their plans if they liked them - because he underestimated both how bad these plans really were and the recalcitrance of the insurers in updating the plans in question. You want to be angry about your cancellation notice? Be angry at the insurance companies.
Everything that's been in the news concerning the PPACA over the past few weeks has been frustrating as hell to read for one simple reason: most of the reporting, and almost all the mainstream commentary, has been abysmal. No one seems to understand what insurance is or how it works. No one seems to have looked at the law, or if they did they failed to understand how it works. For example, I saw a young woman complaining that her insurance plan covers OB/GYN services even though she is not planning to have any more children. Why should she have to pay for that coverage? For the same reason she has to pay for prostate exams, colonoscopies even though she's under forty, hospitalization even though she will probably not spend a night in the hospital, and hundreds of other things. Insurance is about pooling risk. When she was pregnant and had her babies, her insurance company paid its share of those costs not through the money she paid in, but in part through money paid in by thousands of others on the same plan, most of whom would not be taking advantage of the OB/GYN services. The larger the risk pool, the lower the cost for individuals and the companies. PPACA works by increasing the insurance risk pool, creating incentives through public subsidies for people to purchase plans they might not be able to afford on their own, thus reducing costs both for them and for the insurance companies.
It's really that simple.
As for the foofraw over the website, all I can say is if you really think this is some horrible thing demonstrating either the incompetence of the Administration or the inefficiency of government in general, all I can say is: Really? You can't pick up a phone and call a toll-free number? You can't sit down and figure out if you're eligible for a subsidy that will cover some or even most of the cost of a plan that offers far more comprehensive coverage than the plan you currently have? If you think the numbers of people signed up or signing up are too low, consider the deadline for signing up is the end of March (extended beyond the normal December 15 cut-off date because this was the beginning of the law's operation). People have time. Husbands and wives are doing the math, comparing plans and rates, thinking about that nagging back ache or persistent cough or pain that might signal something that needs more than a quick fix. The numbers might be lower than if the website were functioning properly, but hardly demonstrating some catastrophic failure in the law.
I'm no fan of the law. Personally, I would have preferred a system like they have in most of the rest of the world, where healthcare is just something the state takes care of because it's something people need. You can go to your doctor for a check-up, or the emergency room in a crisis, and not worry about finding your insurance card. That being said, the law is what we have and it's functioning precisely the way it was designed to function. Considering all the complaints, I have to smile thinking of all the complaints people had about insurance companies screwing them over, refusing to cover treatments, changing plans with little notice, dropping coverage all together, or jacking up rates and reducing coverage and co-pays without any recourse at all.
Being as the word "church" is in this blog's title, I got to thinking of the children of Israel, stuck on the shores of the Red Sea, the Pharaoh's army pressing down on them, bitching about Moses leading them to freedom when they were so much better off in slavery. To all those folks who want the law repealed, I say: Fine. Let's repeal the law. Let's kick millions of people off insurance plans, thus functionally denying them access to medical care because they have a chronic condition. Let's put back those annual or lifetime caps on payouts so people in need of long-term care suddenly find themselves facing personal financial ruin because the insurance company refuses to pay any more yet on-going treatment is needed. And let's not forget the 48 million Americans who won't have insurance coverage, yet whose treatment we pay for in higher fees and costs from medical providers. Let's go back to the way it was before 2010, when we all bitched and moaned because the system was clearly working only to line the pockets of the insurance companies, instead of providing access to healthcare of individuals and families. Let's repeal PPACA and then hear the howls because the insurance companies, no longer required to do all sorts of things, stop doing them.
In other words - grow up, America, and deal with it.
Lordy, but I feel better!
The whole point of the PPACA was not "healthcare reform". Rather, it was "insurance regulation", a related but different creature. The main problem with our healthcare delivery system has been the high bar for access due to high cost. Insurance ceased to be something people had from employment, a benefit employers gave to workers, and by extension their families, as an inducement to work for them. Even companies that offer "health insurance coverage" do not offer it as a benefit they cover; they offer it as a private market, putting up plans from which employees can choose, but for which employees, rather than the employer, have to pay. Insurers cover fewer and fewer things. They refuse payment for treatments. They drop individuals either because of some suddenly-discovered pre-existing condition or because there was a cap on payments that had been reached. Plans change in midyear, sometimes with little notice from those who are on the plans, leaving them stuck. Add to that the 48 million Americans who simply had no insurance and the crisis becomes acute.
The PPACA addressed these issues in a pretty straightforward manner. They eliminated annual or lifetime caps on insurance payments. They eliminated the restrictions on coverage for individuals with preexisting conditions. And it created a marketplace for insurers to compete for individuals and corporate business for their products. It also provided the opportunity for individuals to receive assistance in paying for coverage with subsidies they could receive to help cover the cost of purchasing health insurance on the individual market. Finally, they offered states the opportunity to raise the Medicaid eligibility income level, bringing millions more in to that pool.
Most states have not created their own healthcare exchanges. Most states have not raised the Medicaid eligibility income level. These two things, combined with simple ignorance about what the PPACA actually does has brought us to the point where everyone is screeching and hollering about a lying President and a failed law. The "lie" was that people could keep their insurance if they wanted to; the truth is, they could keep it if the insurance company brought it up to meet the minimum standards of the law. The insurance companies refused to do that, then turned around and canceled millions of policies that were, by and large, little more than catastrophic plans with high deductibles, low caps, and tiny to non-existent co-pays. The attraction of these plans was their low premiums. The premiums were low because they didn't cover very much, or pay very much for the things they actually covered.
The President didn't lie. The insurance companies simply refused to make the plans satisfy the requirements of the law. For some reason, rather than being angry at the insurance companies for screwing them, the people receiving cancellation notices are angry at the President for telling them something that was true enough - they could keep their plans if they liked them - because he underestimated both how bad these plans really were and the recalcitrance of the insurers in updating the plans in question. You want to be angry about your cancellation notice? Be angry at the insurance companies.
Everything that's been in the news concerning the PPACA over the past few weeks has been frustrating as hell to read for one simple reason: most of the reporting, and almost all the mainstream commentary, has been abysmal. No one seems to understand what insurance is or how it works. No one seems to have looked at the law, or if they did they failed to understand how it works. For example, I saw a young woman complaining that her insurance plan covers OB/GYN services even though she is not planning to have any more children. Why should she have to pay for that coverage? For the same reason she has to pay for prostate exams, colonoscopies even though she's under forty, hospitalization even though she will probably not spend a night in the hospital, and hundreds of other things. Insurance is about pooling risk. When she was pregnant and had her babies, her insurance company paid its share of those costs not through the money she paid in, but in part through money paid in by thousands of others on the same plan, most of whom would not be taking advantage of the OB/GYN services. The larger the risk pool, the lower the cost for individuals and the companies. PPACA works by increasing the insurance risk pool, creating incentives through public subsidies for people to purchase plans they might not be able to afford on their own, thus reducing costs both for them and for the insurance companies.
It's really that simple.
As for the foofraw over the website, all I can say is if you really think this is some horrible thing demonstrating either the incompetence of the Administration or the inefficiency of government in general, all I can say is: Really? You can't pick up a phone and call a toll-free number? You can't sit down and figure out if you're eligible for a subsidy that will cover some or even most of the cost of a plan that offers far more comprehensive coverage than the plan you currently have? If you think the numbers of people signed up or signing up are too low, consider the deadline for signing up is the end of March (extended beyond the normal December 15 cut-off date because this was the beginning of the law's operation). People have time. Husbands and wives are doing the math, comparing plans and rates, thinking about that nagging back ache or persistent cough or pain that might signal something that needs more than a quick fix. The numbers might be lower than if the website were functioning properly, but hardly demonstrating some catastrophic failure in the law.
I'm no fan of the law. Personally, I would have preferred a system like they have in most of the rest of the world, where healthcare is just something the state takes care of because it's something people need. You can go to your doctor for a check-up, or the emergency room in a crisis, and not worry about finding your insurance card. That being said, the law is what we have and it's functioning precisely the way it was designed to function. Considering all the complaints, I have to smile thinking of all the complaints people had about insurance companies screwing them over, refusing to cover treatments, changing plans with little notice, dropping coverage all together, or jacking up rates and reducing coverage and co-pays without any recourse at all.
Being as the word "church" is in this blog's title, I got to thinking of the children of Israel, stuck on the shores of the Red Sea, the Pharaoh's army pressing down on them, bitching about Moses leading them to freedom when they were so much better off in slavery. To all those folks who want the law repealed, I say: Fine. Let's repeal the law. Let's kick millions of people off insurance plans, thus functionally denying them access to medical care because they have a chronic condition. Let's put back those annual or lifetime caps on payouts so people in need of long-term care suddenly find themselves facing personal financial ruin because the insurance company refuses to pay any more yet on-going treatment is needed. And let's not forget the 48 million Americans who won't have insurance coverage, yet whose treatment we pay for in higher fees and costs from medical providers. Let's go back to the way it was before 2010, when we all bitched and moaned because the system was clearly working only to line the pockets of the insurance companies, instead of providing access to healthcare of individuals and families. Let's repeal PPACA and then hear the howls because the insurance companies, no longer required to do all sorts of things, stop doing them.
In other words - grow up, America, and deal with it.
Lordy, but I feel better!
