The Unspoken Catastrophe of Obamacare

The Obama-era is nearly over. President Barack Obama was the first president I voted for with great enthusiasm and confidence. Eight years ago I’d argue that he came at the perfect time for me to vote for him, my political consciousness was developed and I had a candidate I can vote for which matched my political consciousness. In November of 2008, Obama was elected, the country was elated. It was a historic election, the first black president. He was going to bring great change to our country. In the euphoria of post election – some even forgot that we are in the deepest recession the country has ever seen since the Great Depression in the 1930s. The economy was something Obama can wave a magic wand and fix too.

His signature piece of legislation was of course Obamacare passed in 2010. It was to be his signature achievement in domestic policy. It was what he wanted to be remembered for. He passed this bill while Republicans in both houses were kicking and screaming. There were other serious problems in the country at the time, namely the recession, high unemployment rate, but he kept his laser focus on healthcare reform. It had been on his agenda since he was a presidential candidate. He wanted to overhaul and reform the broken, cost prohibitive healthcare system in America, where you’ve either got to be very poor, very rich or past the age of 65 to get decent healthcare. He wanted to do what the Clintons couldn’t do. The most obvious fix is the single-payer system or convert the current medicare system to cover everyone, not just people over 65.

He started out the reform proposing a single-payer system, but when the insurance companies lobbies came calling, harassing and threatening Democratic legislators, one by one they caved. What we ended up with was a hybrid between a single-payer system with the market system. State medicaid was expanded to cover those earning in the bottom 25th percentiles, but that was subject to the discretion of the states. So governors in Red states one by one, decided to cut their noses to spite their faces, many rejected the expanded Medicaid. Yet as each one rejected the expansion, they had no alternative plans to keep the most vulnerable (usually women or PoC) covered, in fact some even cut aid to state Medicaid – such as the state of Texas under governor Rick Perry. The states that needed the expansion of Medicaid the most, rejected it, and those are states with high population of people living in poverty.

For the rest of the people that fell in the middle, we were stuck with an impossibly difficult, time consuming, byzantine process while trying to apply for health coverage for the family. Where if you ticked the wrong box by mistake can screw up your whole family’s application. Every year, come renewal time,  you’ve got to check and make sure all of the doctors your family sees are still in the network you are on – if they are, then you can continue with your coverage, if not,  you have to find a new insurance plan to include them. More than half the time, the doctors of your choice are no longer in ‘your network’ because they found another ‘network’ which offers higher reimbursements.

While it’s nice the federal government provide generous subsidies upfront, even up to families of 4 making $125,000 per year and the demand side of the equation is solved, the supply side of the equation (the insurance companies and health service providers) presents new problems. While it’s illegal to do, many doctors, because of the hassle involved simply refuse to accept anyone who purchased health insurance from state or federal exchanges. Meaning to say, if two patients had the exact same health insurance, but one patient purchased it privately (off exchange or through employer) and the other patient purchased the coverage on the exchange (with federal subsidy), the doctor will take the patient who purchased it privately. The doctor will attempt to work out a cheaper ‘cash’ deal with the patient who purchased their coverage on exchange just to avoid the extra hassle and paperwork they must do for patients who purchased their insurance on the exchange with federal subsidies. The insurance plans with federal subsidies reimburse slower so no doctor or healthcare provider likes them and one can’t blame them. It creates extra work for their office staff which would then raise cost of wages. I was told this practice was illegal, but many doctors are doing it on the sly.

A lot of doctors, in the face of Obamacare decided to ‘go private’. Our children’s pediatrician did this. He didn’t want to bother with insurance companies at all. So what he did instead was he charged a flat fee per child per month and that flat fee would include wellness visits, immunization shots and sick visits too. Amazingly, he was able to keep over 50% of his patients and through word of mouth recommendation, was able to get new patients. So, if we wanted to keep our pediatrician, whom we love because he has an alternative and flexible immunization schedule and give my children lots of stickers at each visit, we have to pay his monthly fees and health insurance on top of that. Then you have the in-network and out-of-network issue, in non-emergencies, it’s fairly easy to arrange to see all in-network providers. But what if there was an emergency and an ambulance was called and you are unconscious or bleeding profusely, are you meant to tell your ambulance driver to make sure to take you to Hospital A instead of Hospital B or else you’ll be stuck with a $10,000 deductible – which would really render your insurance useless?

And for those who are on Medicaid, you can forget about seeing the doctor ‘of your choice’. Most doctors with established practices stay away from Medicaid, reimbursement is low and slow and involves a ton of paperwork, a trifecta no well reputable doctor wants to touch. So, doctors who tend to accept medicaid are doctors in not-so-good parts of town, in dingy buildings where the waiting room is full of coughing, puking, screaming children and their exhausted mothers. This is not a slight on those doctors or nurses, those are great doctors who care deeply about their patients, but they are overwhelmed, with too many patients and not enough reimbursement, forced to practice in bad parts of town, in old buildings and most of those patients are women and children of color or undocumented immigrants. Many community doctors in California treat undocumented immigrants for free or for very cheaply. These are great doctors who perform their Hippocratic oath with very little reward in end.

That Obamacare allowed 90% of Americans to be covered by health insurance is an often touted statistic to prove the success of the program. Yes, 10% fell through the gaps and it’s the most vulnerable 10% of the population, but that’s becaues their states refused to expand medicaid and then you have the few lazy people who just can’t be bothered with applying for insurance. However, being ‘covered’ doesn’t mean anything if that coverage is restricting, cost prohibitive in the deductible and co-pay side. That’s no different than having just the basic coverage, just in case of a major medical catastrophe or accident happens – you will be covered, but for those with chronic conditions that require frequent doctor’s visits, or those with children who catch colds and viruses from other children. The cost of healthcare is still prohibitive.

I don’t want to go on a rant about Obamacare and not point out the great benefits that came with the law. Pre-existing condition is no longer a reason why anyone can be denied coverage, it was nice for once while applying for insurance, your insurance agent doesn’t even ask you about any pre-existing conditions you have. Children get to stay on their parents insurance until age 26. There are no more lifetime maximums for coverage, so those with serious chronic conditions who need a lot of medical care don’t ever have to worry about their insurance limit running out while they are still alive. Children’s policies immediately include a dental policy, so parents don’t have to purchase additional dental policies for their children. Children born with serious conditions are immediately covered on their parents health insurance plan without new ‘underwriting’ to determine eligibility or to raise their parent’s insurance premiums more. All of these are great improvements – but it doesn’t address the cost side. Those with a known pre-existing condition while can’t be denied coverage, can be charged higher premiums. Women of childbearing age are charged higher premiums – even if those said women have taken permanent measures to not have any more children. People over the age of 60 but not yet eligible for Medicare are charged sky-high premiums. This was the trade off or deal Obama made with insurance companies. This is where they ‘got’ us. Right now, some insurance companies such as Humana and Unitedhealthcare have chosen to exit the federal and state exchange business as they are losing money and they can’t do what they want with their plans and how they spend their money. If exchanges keeps losing insurance providers, then the ‘competition’ side of the exchange will weaken, with less competition, premiums will begin to rise anyway.

Which brings me back to the single-payer system, a beautifully simple, wonderful solution to the mess of choosing the right insurance and making sure the network includes your favorite doctors. There will only be one network, in which all licensed practicing doctors and health practitioners and providers belong. Very much like Medicare, it’s a single-payer plan for people over the age of 65. Incidentally, most of the people I know who work in the medical field love Medicare. Reimbursement is prompt, without much paperwork fuss and the amount is adequate. The patient is happy and the doctor is happy to treat the patient and provide them with great care. Most seniors also love their Medicare. The doctor’s practice is a business, their income has to exceed expenses for it remain a going concern. Perhaps a single-payer system can introduce method of reimbursement that not only reimburses doctors on a per patient basis, but subsidize the doctor on his overhead expenses as well. Since it is a single payer system – market based competition won’t apply, the government needs to make sure that each doctor’s practice, practicing in the single network of the healthcare system is well looked after and maintained. The area of healthcare, on principle and just on human decency should not be one that is based on ‘profit’. An insurance company making a ‘profit’ off of the illness of other people is grotesque. Their business model of hopefully having enough ‘healthy’ people who rarely visit the doctor but dutifully pays their monthly premiums to compensate for those who aren’t healthy is Orwellian and dystopian.

A person’s health is their wealth. It’s not a old cliche but a simple fact of life. That without your health, nothing else in the world matters. Billionaires will gladly give over their whole fortunes if someone can cure them of an incurable illness. I am willing to bet all I have that Steve Jobs would give over significant amounts of his fortune if someone could cure his incurable cancer that ultimately claimed his life prematurely. It took me having my mother who became critically ill, but thankfully was in a country that had universal health care that provided her with lifesaving surgery and brought her back to full health and not costing her a dime for me to appreciate this old ‘cliche’. I shudder to think what would have happened to her if she was in the United States when her health crisis happened and she was inadequately covered.

15 thoughts on “The Unspoken Catastrophe of Obamacare

  1. Reblogged this on Writers Without Money and commented:
    This was extremely informative. Not having children, and being in good health, I don’t make much use of the healthcare system, so some of these issues (the effective two tiered system within Obamacare) had never even occurred to me.

    Liked by 2 people

  2. Nothing could be more disastrous than a single payor system run by the government. The problems with a single payor system are numerous. Principally, though, the government runs and dictates everything. This means innovation comes slow or not at all. Doctors and other providers who actually see patients will not be listened to when they make suggestions on how to improve the system. Worse, politically connected people motivated to be known as the “savior of healthcare” will enjoy free reign to make and institute all sorts of impractical suggestions. Plus they will employ their unqualified friends and cousins as directors of various healthcare concerns. Medical records will become monstrously non-versatile, inefficient and lengthy. Lengthy medical records cluttered up with useless information will result in greater morbidity and mortality. The end result will be VA medicine for all. In time, a black market for healthcare will arise.

    No, what is needed in the healthcare system is competition, not greater federal control. You can read about some practical suggestions on my site: http://www.fixthebus.com.

    I am principally a Medicaid provider.

    Archer Crosley, MD

    Liked by 2 people

    1. I believe there are 2 schools of thought about healthcare – whether it should be market driven/based or not-for-profit. Where you fall in those beliefs will inform your ideas on how it should be dealt with. The second thing, which relates to the first, is how you feel about access to quality healthcare – is it a ‘right’ or a ‘privilege’, if you believe like I do that access to quality healthcare isn’t a privilege where only if you can afford to live in nice areas with well funded hospitals and medical providers, and good health insurance because you have generous employers – is when you deserve to get good healthcare, when you need it, wherever you need it. I believe it’s a right that everyone should have access to a GP or Pediatrician when illness strikes and it should not be cost prohibitive or difficult to access.
      I am aware that a single-payer plan can’t solve all the problems and there are issues with countries that have single health payer systems, but it can solve the (or go a lot towards) solving the basic problem is the overall affordability of healthcare of if you do have affordable health care (ie Medicaid), you have to travel far and wait a long time to see your doctor, which is the case here in some areas of California. Since government can’t ‘force’ doctors and providers to join Medicaid network, and unless Medicaid provides enough incentive to join them, the same problem will persist – what’s the use of having ‘free’ health insurance, when there’s not enough doctors or hospitals to service you?
      I read your site, it’s very informative and I always like to see a doctor’s point of view and I do not agree that doctors have to bear all of the responsibility should something goes wrong, especially in a system as broken as ours. There is no perfect system where everyone’s healthcare needs will be met. No matter what system we devise, someone somewhere will fall through the cracks. But to cover most people at the preventative level, some form of Universal Health Plan (Single network/payer system) is needed.

      Liked by 1 person

      1. We can cover all people in United States overnight by allowing people to receive tax credits when they purchase healthcare insurance for themselves and for the indigent. This removes government from participating in the financing of healthcare. When government collects money for any service to be provided sticky hands reach for the money. Politically connected hucksters reach for the money. Plus, because the government can never go broke it is unwise when spending money. The financing of healthcare is best left to private concerns who have motivation to spend that money wisely. Of course this does not mean that the government cannot regulate. Government should do what it does best – regulation. Business should do what it does best – handling money.

        Of course, power should be dispersed so as to spread risk. If the financial collapse of 2007 has taught us anything it is that big business and big government can be too big.

        Is healthcare a right or a privilege? It is an entitlement that must be managed as if it were a privilege. If we manage it as an entitlement poor care for all will ensue but even poorer care will ensue for the poor.

        Ronald Reagan stated in 1980 that a rising tide lifts all boats. Socialists scolded him for that because a zero-sum society is essential to their philosophy. They think that if we take from the rich and give to the poor there will be an evening off in income. This has been proven false by Barack Obama. What Barack Obama has done is to unwittingly confirm Reagan’s ideology although in a reversed manner. Under Barack Obama we have seen that a lowering tide lowers all boats. We have also seen that the bottom is bottomless. No one has suffered more than the people in the black community, and yet according to socialist dogma their lot in life should have improved.

        My point is that a competitive, pluralistic environment improves the quality of life for all. A noncompetitive, non-pluralistic environment decreases the quality of life for all.

        Not all capitalism is bad. Small business capitalism where power is dispersed can add much value to society. Who has given a bad name to capitalism are these big business pseudo-capitalists through their cronyism and bribing of big government officials.

        One should not confuse a large defense contractor with a mom-and-pop ice cream shop.

        Liked by 1 person

  3. With lawyers, insurance and pharmaceutical companies practicing medicine, you get what you’re willing to pay for. None of these special-interest groups has to take personal responsibility for the outcome. Doctors are the only ones personally accountable, and they are blamed for every adverse event. Insurance and government regulation raise the cost of health care to its currently unaffordable levels. They bleed every level of the system, create unnecessary risks, time delays, and fragmentation. The idea of a single-payer system is illusion, unless you have charity hospitals and clinics directly supported by the government and free to all.

    Liked by 2 people

    1. Health care costs right now are inflated and arbitrary. It doesn’t cost $15 for an aspirin in the hospital, an aspirin cost 25 cents (if that). An IV bag is not $200, it doesn’t really cost $30-40K for a routine surgery. Every single thing you pay for for each item/care you access is going towards paying something else. We in America have this sense of ‘health care is so expensive’ as being just the way it is and the political elites tells us its so expensive because ‘it’s one of the best in the world’ – our healthcare system is not one of the best in the world, compared to rich industrial nations, the US lags behind all of them.
      Re: The idea of a single-payer system is illusion, unless you have charity hospitals and clinics directly supported by the government and free to all.

      Charity hospitals/clinics should be included in this, and the troubling thing is, even in hospitals which are ‘non-profit’; meaning they can only charge the amount to break even, it’s still terribly expensive.

      Liked by 1 person

      1. *this* is exactly where i think a huge part of the problem is. the greed and pathology of the institutions finds ways to multitax the individual who feels so tiny and vulnerable against the System. annual fees AND deductibles AND a 10k% mark up on the menu items???
        this succinct statement gets to the heart of it: We in America have this sense of ‘health care is so expensive’ as being just the way it is and the political elites tells us its so expensive because ‘it’s one of the best in the world’
        how is this different than bailing out Wall St.? its just a slow motion behemoth of exactly the same design. and the tragic joke of it all is that they just need to clean house; no real bail out would be needed if criminal elements were removed.

        Liked by 1 person

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